Tag: surgery

Get RID of post op restrictions? I think not.

As most of you may or may not know, I have to renew my board certification for obgyn on a yearly basis, often with a multitude of articles and modules that require completion and a series of tests to take. I think they think that it is a good reminder to stay invested and keep up to date. I personally feel that I am capable of that on my own without paying exorbitant fees, but oh well.

Anyway, I regret to say that it is rare that one of these required articles contains information that is either brand new to me or significantly useful. Most of the time I am looking at them and having to read them for credit and just go with that approach. Some of the articles I feel are downright potentially harmful. I need to tell you about one of them.

Most recently, I read an article in a very reputable journal suggesting that we abandon all post op restrictions. Post op restrictions are the what I feel is very necessary guidelines to maximally assure a good recovery after surgery. They include things like holding off from sexual activity for six weeks. No lifting, pushing, pulling anything over a full gallon of milk for six weeks and no driving for a car for at least one week. Yes, I know, it potentially sets a patient up for ultimate boredom and frustration. You are watching your house get dirty. You are watching your kids run amuck. You are missing out on your normally awesome cooking, etc.

However, having said that, I have found that, in my almost thirty years of experience, that these recommendations, while not popular, are the way to go. It is my way of helping to ensure a good recovery for my patients. So, I read this article, claiming that all these recommendations are anecdotal/heresay at best and have no scientific evidence or backing. This article also says that there is the same change in intrabdominal pressure with getting out of a chair as lifting something heavy. I am sorry, but that cannot possibly be true.

So, I started doubting myself. I thought maybe I am being too strict. Maybe these “experts”( that probably haven’t treated an actual patient in years) were right. So, I gave it a try. I gave up the post op recommendations for one set of surgeries for one day. You know what happened? Two of my patients ended up bleeding after wrestling with a dog or picking up their kids since they couldn’t stop….and one ended up back in surgery after tearing their vagina open. That was a definite turn off for me. I guess my anecdotal self realizes after thirty years that not all incisions are created equal. I can see that with a visible abdomen incision you might get a heads up if you are about to make a big mistake and tear your incision open. With a vaginal incision, there is nothing you can monitor visually and no good prior warning signals you have to to tip you off before it’s too late.

The bottom line is, I tried to follow this nonsensical potentially dangerous advice and it backfired almost immediately. So, we are officially BACK to the post op restrictions!

Dr. Katz

I got my triple lumen out today!

Today was a big day toward my journey toward normal life. First, I had my follow up check up at the stem cell clinic. I found out that my wbcs were normal, my platelets were normal, my electrolytes were all normal and my hemoglobin had increased to the nines range. All big wins. I actually graduated to the next level of stem cell clinic because I was doing so good. On top of all of that, only should have been home the day before but I had already been home for 10 days. Awesome. I am so grateful.

On top of that, I got to get my triple lumen central line catheter out. So that big old three port things has been inserted into my main veins and sticking out of my chest for the last two months. It is the remaining visual cue that I am sick, besides the baldness of course..lol. Anyway, so that got to be removed today. It was actually the first thing scheduled by me that I got to home after it was completed. It was really huge. We actually had fun with it. They played AC DC for me. They did it all with local anesthesia. It was one of the easiest things I had to do so far. Then, I actually got to go home with less appliances attached to me for once. Win! Have a great day everybody.

Dr. Katz

Man! It’s hard to feel sexy when you have cancer.

Picture the scene: Your partner gives you the let’s get frisky look. They start petting you in the way you are normally into. The sexy dance has started. The lights are dimmed aaaaaaand……nothing. You are laying there all bald and post chemo( well it has been a few days but you get the idea), fresh off your latest chemo hot flash, tired, bloated and not the least bit sexy….in your mind. You just aren’t up for it. It’s not you. It definitely isn’t your partner. It’s the freakin absence of sexiness that sometimes comes with cancer and chemo. I tell ya, the changes in appearance alone are a real confidence killer at times. My husband is the most amazing partner and best friend on the planet and regular me can’t get enough of him. But, cancer me is another story.

Cancer and cancer treatment can have a very significant impact on a woman’s sexuality in many ways. Disfiguring surgery may be required that can significantly affect your self esteem and confidence. Treatments can sometimes put you into premature menopause with hot flashes, vaginal dryness, pain with intercourse and decreased libido. Certain pelvic cancers require such extensive surgery, radiation, etc that a woman is left without proper function of her sexual organs permanently.

I get it, this sounds all doom and gloomy. The good news is that not all women are left with permanent sexual dysfunction after cancer. Sometimes the effects are temporary and things go back to normal when treatment is over. I am seriously hoping that I fall into this category.

Fortunately the data shows that if a woman was able to have satisfactory sexual experiences before cancer, she will be able to again. The American Cancer Society has a whole section of helpful tips and information for women who are having sexual issues resulting from cancer treatment. Some of these are in fact very helpful. The bottom line of all of them is that sometimes you have to get creative and you have to reinvest in your own self-love and confidence. Sometimes the same techniques for sexual satisfaction that you used before will not be successful anymore. You might not even have the same parts anymore. You may have to use more lubricant when you didn’t have to before. You may have to explore different things that excite you. You may require a vibrator for extra stimulation. You may need to try different positions. You may need to employ more fantasies into your sexual relationships. You may need dilator therapy to re-stretch the vaginal canal. These are just a couple of examples.

There is an interesting set of exercises recommended by the American Cancer Society for patients feeling anxious about sex and the way that their appearance has changed and adjusting to those changes. They suggest looking in the mirror, dressed at first, and noting the changes in your appearance: your surgical scars, ostomies, missing parts, etc. Then notice what you try to avoid looking at. Then while dressed, try to find three things that you like about your appearance. Once you are comfortable looking at yourself as a stranger might see you, then change the exercise and repeat it with you being dressed “sexy” for your partner. Finally, repeat the exercise nude with the same steps until you are able to look at yourself and adjust to the changes and feel comfortable. Don’t stop until you can give yourself 3 compliments like you did in phase one of the exercises.

The last thing to address regarding the impact of cancer on sexuality is the anxiety that goes along with it. It takes time to realize even when treatment is over that you are actually better and that life can go on, including sex. Clear communication is the absolutely paramount here. Talk openly with your partner about your fears and issues. Don’t leave them in the dark and just reject them. They can’t possibly understand what is going on in your head unless you tell them. Get therapy if you need to. Talk openly with your doctors. You be the one to bring it up. I can tell you right now that most physicians are not comfortable enough to make sure to address sexual issues at any time, much less with their cancer patients. This will be something that you really need to take charge of and advocate for if you want things to change and improve. As much as we try to deny it at time, our sexuality and sexual health are key components to our relationships and overall health. Sex is just as important for cancer patients as it is for every day folks. So, do what you can to preserve it. It’s for your health!

Dr. Katz

I’m Here to Cancel My Monthly Subscription

I heard this this morning from one of my hysterectomy patients in pre op. She came in wearing a sweatshirt with this quippy saying ironed on the front of it. She wanted to make sure that I could see it. It literally made my day and we both laughed out loud. I truly treasure these moments when a patient and I are able to laugh and joke right before major surgery. I applaud her for her sense of humor. On top of that, this particular patient has been going through some major life stuff lately. In my mind, the fact that she stayed on track with taking care of herself and following through with surgery makes her even more bad ass. I completely respect that. Also, her facility for humor tells me that I have been able to achieve a level of comfort for this patient that actually allows her to make jokes before saying goodbye to one of her main organs. She is able to balance her nervousness with the necessity of her decision. That can only be achieved with extensive counselling, back and forth discussion, establishment of comfortable rapport, and making it a priority to allow the patient to take an active role in the decision-making process regarding her own body. There is nothing that engenders feelings of hopeless and loss of control like someone telling you that you need to be put to sleep and have things done to you that will change you forever. That is huge in my book. Think about the trust that you need to have in your doctor to relinquish that ultimate level of control! It’s hard to fathom really. I think we as physicians need to embrace that humbling fact at the beginning of each and every case that we do. It’s a way to appreciate the patient’s trust, keep yourself in check and remind yourself of your responsibility as a physician and a surgeon. Have a fantastic day everyone!

Dr. Katz