Living Donor Pre Assessment Clinic including final meeting with surgeon, anaesthetist, pharmacist and Transplant co-ordinator.
By law you have to have some medical checks done within 2 weeks prior to the operation. This is to ensure that you are fit and healthy just prior to the operation. Some of the evaluation tests were done a few months ago, so up to date ones would be required.
I arrived early in the morning at the hospital, knowing I would be there most of the day. Here is a list (as presented to me at the hospital) as to what the day would hold. I was at the hospital for around 5 hours and the following took place but not necessarily in this order:
Tests I had done:
1. Blood and urine samples (they took 20 tubes of blood! yes .. 20!)
2. MRSA swab (gave me a loooong q-tip I had to wipe the inside of my nose with)
3. Chest X-ray
I was seen by:
1. Consultant Surgeon
4. Transplant Co-ordinator
1. Consultant Surgeon:
My Consultant Surgeon explained that he would not be available to do the operation. There would be two other surgeons. He told me a bit about them. I was a little unsettled about this, as familiarity of people/faces goes towards a relaxing atmosphere and I felt I knew my current Surgeon and felt very relaxed in his company. But then I thought I am going to be out of it anyway under anaesthetic, so won’t really matter, so I was okay with that.
The surgeon went through the procedure from admission to after the operation. He drew a picture showing where the incisions would be and why. There would be a small incision just above the belly button, through this the camera would go. Two more would placed to the right of the camera incision – one just under the rib cage and the other same distance below the camera one. Through those two the surgical instruments would go. My surgeon comically called them “chopsticks”. Another small incision would go to the right of the one just under the rib cage. Through this incision an instrument would go that would move the liver out of the way which is very close to the right kidney. Those four small incisions would be around 1-2cms (the one above the belly button actually ended up around 4cms the others were very small though). The final incision is along the bikini line and would be around 6 inches. It is through that the kidney is extracted. He also explained that it would be hard to move around in my abdomen as not much room, so they inflate me like a large balloon with carbon dioxide. An after effect of this could be that some gas could escape up into the shoulder blade area and afterwards cause some discomfort for a few days (it did! lol).
He also explained that I could get quite a bit of pain, it varied from person to person. Take the pain killer tablets that I would be given when going home. I said I knew three people who had a kidney extracted and had no pain at all. He said he would rather explain that there could be quite a bit, then it would not be a surprise if there was, when I was expecting there not to be. Again he was right .. lol .. I did have quite a bit of pain.
The operation was anticipated to take between 3-4 hours. I only had a small kidney. Then a couple hours in recovery while they monitored me and then back on the ward.
Recovery varied from person to person. Certainly the first week to take it very easy. Not even lifting a shopping bag. Week 2 to gradually see what can easily be done but no heavy lifting etc. Driving depending on how I felt. He suggested once I thought I was ready to drive again (maybe 10 days onwards) to just sit in the car and see if I could do a pretend emergency stop with no pain or discomfort. Could I also turn around in my seat for reversing etc. As long as absolutely no pain or discomfort at all, then could be ready to drive again.
Directly after the operation I would have pain meds that I could self medicate – Patient Controlled Analgesia (PCA). Pressing a button would give me a safe dose and I could keep pressing as much as I wanted up to maximum dose. It would automatically shut off for 5 minutes when that happened. So no way could I overdose on it. I would also have panadol and tramadil tablets. The chances were I would also get constipated but laxatives would be given. (I refused the first offer, which was the first night as I was scared I would be caught short! No such luck ..and wish I had taken them. So take the laxatives when they are on offer, it will still be a day or two before you can “go” and you do feel quite uncomfortable until you do)
He wanted me to come in the morning of the operation. As for discharge, he said about a third of people go home the evening of the second day after operation – if the doctor agrees all is okay, otherwise the rest go home the third day after operation. But I would only leave if I felt well enough to. They would not release me until they and me were 100% happy about it. [I came home 2 days after operation]
He said the two days after the operation were basically days where I gained my confidence. I would get out of bed the morning after the operation and I needed to be able to get in and out of bed and get to the bathroom and use it etc etc. It would take a little while for me to know what I could and could not do and also the best way to do it. I also had to be able to urinate okay (once catheter removed) and to have a bowel movement.
I was reminded of the risks of the operation and also told that it would not be until they actually opened me up that they would know for sure which method would be the preferred method of operation i.e. keyhole, or open surgery. I was asked to sign a yellow consent form which consented to either or .. keyhole/open.
2. Consultant Anaesthetist:
I met with the Consultant Anaesthetist for the first time. Lovely man. He went through the procedure …. I would be given anaesthetic and then when under a breathing tube would be inserted – he asked if I had any lose teeth or dentures etc. He pointed out that sometimes the patient could end up with bruised lips etc – that was just one of the risks. As it was my right kidney being removed, I would be laying on my left side/arm for the duration, so there could be some numbness in my arm afterwards. I would have other drips etc in me. He also explained that the most frequent question people ask him, is they were nervous of being awake during the operation and feeling it. I must say that had crossed my mind. He said it was very rare about 1:1000 and that they did everything for this not to happen and I would be very very closely monitored. I asked if I could have an epidural, that I was led to believe I would be offered one (had one for childbirth … bliss!!!). He was not in favour of this for two reasons. One my blood clotting was excellent as it clotted very easily, so prior to the operation I would be given a heparin injection to thin the blood a bit. That did not mix with epidural. Also there are / can be side effects complications with epidurals which included paralysis and was far safer to have a general anaesthetic. I was more than happy to go with his good judgement. I have to admit when I had one 30 years ago there was a problem afterwards in that my bladder stayed closed for a long while after the epidural had worn off and catheter taking out. Talk about pain! So I am glad really he did not approve.
He said there was one problem though, he was not totally happy with my ECG. He said it gave a wiggle going down. He showed me and we compared it to the ECG I had at the beginning of my evaluation process. It was there originally but more pronounced now although it was still only a small wiggle. To try and describe it, ECG show large peaks along a line and in between the large peaks are little peaks. My ECG did that but just after one of the big peaks was a very small peak that dipped below the horizontal. Did that worry me? yes to begin with it did. My anaesthetist did say that if I was having an operation to make me better because of an illness then he would have no hesitation at all for the operation to go ahead. But because I was offering part of my body and there was nothing wrong with me, he had to make totally sure everything was right for the anaesthetic. He said he would speak with my consultant nephrologist and suggest a heart ultrasound.
Any medications I regularly took would be noted and if clashed with any meds I had to take during my stay she would discuss with me the options etc. I took levothyroxine for under active thyroid, but that would present no problem. She asked if I was allergic to anything. She also wanted to know about any regular vitamins or mineral tablets, headache tablets, literally any prescribed or non prescribed tablets/medication. She noted I used to be on HRT but came off that a while back in preparation for this operation. It takes several weeks for your body to get back to pre HRT levels.
She also advised me that because after the operation I will now only have one kidney not to take NSAID’s (ibuprofen, nurofen etc) as they might aggravate the kidney. They thin the blood and so the efficiency of the remaining kidney could be affected. A low risk but still a potential risk. This also included aspirin. Should I need any such medication from my normal doctor must make sure he is aware of this. She said some centres are not so concerned about this, but their recommendation is that I don’t take them. I have to say that in the past I have taken them, but will make a point now not to.
4. Transplant Co-ordinator:
My co-ordinator then saw me and asked if I had any questions. I didn’t have any as they had all been answered during the day by one person or another. She told me that she also would not be available on the day as would be on holiday, but one of her colleagues would take good care of me and visit me on the ward. She introduced me to her colleague and I felt very at ease with her. She then took me to see the Day surgery ward. I would report there on arrival for my operation.
She then showed me around the transplant ward. After the operation I would either be on the transplant ward, or if they were full, then the renal ward which was next door.
I did feel a bit sad though that two people who had featured so greatly in my evaluation process … the surgeon and the co-ordinator … would not be there at the end.
It was now 9 days away from the operation. Apart from the ECG, which I had to wait to hear about, everying was falling nicely into place. A couple of days later I was telephoned with an appointment for a heart ultrasound. The appointment was for 2 days before the operation. I had to laugh. Seems that I am to be kept on my toes right up until the last minute.
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