Pre-op: packing list

Since many of us come to a hyst as our first surgery, we're not even prepared for the experience of being a hospital patient and may have little idea of what we'll need to take with us when we're admitted. Your "closet" will have only room for a single outfit (to go home in) and your belongings must fit on the surface of a small table plus, perhaps, a small drawer, so anything more than that is going to be a clumsy bother. Most of your time will be spent sleeping, drowsing, or walking, so you simply won't need much with you.

Some things you might bring to the hospital with you

1. Pre-op instructions/permits/papers, any pre-registration forms you filled out, copy of your health insurance card
2. Glasses, hearing aides, dental appliances you can't do without. Be sure to bring cases or containers for all, and any necessary cleaning materials. If you don't have to have it, though, don't bring it. You most likely will not be allowed to keep them with you until you reach your room after surgery, so if it's irreplaceable, leave it in the keeping of your partner while you're in the OR.
3. Toiletries: you'll get a toothbrush and soap and lotion as part of the obligatory personal care kit. You will probably get to shower before you go home, but you aren't going to feel like indulging in a lot of frivolity. Pampering yourself sounds more attractive now than it will be when just water flowing over your body will be a delicious treat and simply standing up the height of your physical ambitions. Just bring the bare necessities (we're only talking a couple days, here): conditioning shampoo, deodorant, moisturizer, hairbrush. Two things that you may find especially helpful, though, are lip balm and a moisture (scented water) spray.
4. Hair: if you have very long hair, consider arranging for it to be braided or French-braided before surgery and again the day after surgery: you’ll enjoy not having to wrestle with it. You’re going to need to pamper your hair very seriously for several months post-op if you have general anesthesia (it is very hard on hair), so if you must have a perm, get it a week or so beforehand so you can go awhile after without having to repeat it. Most hairdressers won’t use any chemical processing on the hair of someone who has had surgery for several months. Take a very gentle hairbrush with you, so you can keep the “bedhead” rats gently detangled.
5. Your own sleepwear: not really needed. You’ll want to wear the hospital gowns for at least a little while rather than risk staining your own, and it’s much simpler to put on a second gown backwards than to wrestle your IV into the arms of a bathrobe. Forget struggling with jammie bottoms: bending over is not going to be high on your list, and they are kind of strangling when sliding around in a hospital bed. If you must, make it loose, simple, and no more than knee length. You'll also most likely be wearing heavy elastic stockings or pneumatic leggings and have a catheter for the first day, so jammie bottoms are only going to be in the way.
6. Slippers: slip on, with non-slippery soles (as in: rubber). No matter how cute, anything else is a liability and aggravation. Washable is good, so you can de-hospitalize them when you get home.
7. Books, magazines, tapes or CDs or mp3s and player (extra batteries): you’ll probably want some entertainment, but make it really undemanding. Anesthesia dulls the mind, as do the medications you’ll be taking post-op. This is the time to read frothy stuff and listen to gently soothing music. Anything more will be Too Much Work.
8. Mini-office in a large envelope: notebook for jotting down doctors’ instructions, names to write thank-you notes, keep track of post-op appointments; pens, address book with the phone numbers of anyone you might want to chat with (don’t rely on memory—it’ll be addled by anesthesia); small calendar; consider a mini-recorder to tape your doctor’s visit because you will not remember what he said.
9. A small huggable stuffed animal or small pillow with washable cover. Hugging something to your tummy supports it while you do the coughing and deep breathing necessary to keep your anesthesia-surpressed lungs from getting pneumonia. Also, you will want a small cushion between you and the seatbelt when you go home. Don’t have one? A large bathtowel or small throw works equally well if tightly folded.
10. Clothing: send what you wore to the hospital home with whomever you came with as soon as you undress into your gown in pre-op. There isn’t room in your room for much stuff or a suitcase. Bring something loose and comfortable to wear home. Large panties (a size or two larger than normal, that come up to the waist) are helpful. Make sure you can get into your bra without gymnastics. Slip-on non-slippery-sole shoes. Sweats or a long, loose dress (my personal fave) are best—you won’t be zipping up those levis over that tummy for a few weeks. Remember: this only enough to get you from the hospital to your home without being arrested for indecent exposure; you’re not going on a Royal Progression. Don’t bring: panty hose, garments with back closures, anything snug about the middle. Also, remember that you will need to get back out of this clothing at home, when you are tired from the trip: tight pull-over-the-head things are so difficult to remove that you may end up spending days in them before you can extract yourself. It's perfectly fine to go home in a gown and bathrobe or loose coverup, too.
11. Self-adhesive mini-pads: most of us have a little drainage and these beat the daylights out of the industrial-strength elastic belt and mega-pads the hospital stocks for the maternity ward. Enjoy the thought, when you buy them, that they represent the last time you’ll do business on that aisle of the store!
12. Comfort stuff: eyeshade and earplugs so that you can sleep when you want to, not when your roommate wants. Big bandaids or cut-off sock tops for your elbows (they will be your primary mode of transport in your bed, and those sheets quickly begin to feel lie sandpaper). Backscratcher (if you are prone to itchies)—it also makes a nice extension hand.

Some things you shouldn’t take to the hospital

1. Jewelry of any kind. You may want a watch afterwards, but get someone to bring it in for you after the surgery. Don’t bring any personal adornments—they just get in the way and you won’t want to bother. Check at your pre-op appointment with anesthesia as to whether they will allow you to keep a wedding ring on: some will, taped; others won’t. It’s best to leave your ring in the keeping of your spouse than risk it being lost by someone whose job it really isn’t to keep track of stuff like that. Most anesthesiologists will also require that you remove nail polish and any nail adornments on both toes and fingers—check with yours at your pre-op appointment if this is important to you. Although it’s not something you can leave at home, don’t come in with fresh tattoos or piercings: your doctor may postpone your surgery out of concerns for infection. If your plans include these, discuss them with your doc pre-op (there may also be a time guideline for how long he would like you to wait after surgery, as well). Speak with anesthesia at your pre-op about the possible need for removal of nose, tongue or nipple ornaments; if you are having an abdominal incision, speak with your surgeon about any navel, labial or other operative-area jewelry pieces.
2. Checkbook, credit cards, driver’s license—anything you won’t be using. In fact, leave the whole wallet home: there is no security for your belongings. Bring a small amount of cash for vending machines, pay phone or snacks from the hospital coffee wagon. If you plan to make a large number of long distance calls, you may wish to bring a pre-paid phone card to cover them if you don't have a cell phone.
3. Demanding handwork projects, that challenging book you’ve been meaning to find time to read, anything that takes concentration and involves multiple pieces. They are too hard to keep track of and you won’t have the concentration. Save those for when you are home.
4. Hair dryer, styling stuff: too much effort to hold your arms up that long. Figure out a no-effort hairstyle or braid your hair. Really, no one expects you to look great: go for clean and tidy and the world will consider you radiant.
5. Makeup: ditto.
6. Your own prescription or over-the-counter medications or vitamins/supplements. You should have discussed these in detail with both your physician and your anesthesiologist at pre-op appointments. Do not bring anything in with you unless you and your doctor have previously agreed that you do so. The doctor will also need to write “patient may take own [med]” as an order in your chart in order to protect the hospital staff from liability for any mistake you may make with your own meds.
7. Contact lenses. Use your glasses instead. You will be dropping off to sleep at odd intervals and it’s too hard to get to a schedule of taking them in and out. The care for them is too involved and bothersome as well, and the hospital is full of Bad Germs. It’s only a few days and there’s nothing much you need to see anyway.
8. Abdominal binder, surgical stockings—unless your doctor has specified you should do so. If he wants you to have these, he’ll arrange for them in hospital. Ask him at pre-op: different doctors have different procedures, and reasons for them.

Things to do

1. Listen, take notes (or use a mini-recorder), say thank you. Ask for a copy for your records.
2. State your needs clearly. If they are not met in a reasonable amount of time, ask for the charge nurse. The management tree from there is head nurse, then nursing director.
3. You have the right to question and refuse anything. Ask what that medication is for. If a medication doesn’t look the same as the last dose did or you don’t think you’ve been taking it, ask to see the order for it. If you really think it’s wrong or you really don’t want it, simply state “I refuse this medication. You may note this in my chart and I will discuss it with my doctor on his next visit.” Do not be intimidated at “causing extra work” by asking a nurse to double-check your medication: that is their job and legal obligation.
4. Similarly, if you are in pain and you have had all the ordered medication (or have other medication needs), politely insist that your doctor be notified that it is not providing adequate relief and request another medication order. The fact that it is the middle of the night and the nurse would have to wake the doctor is not an excuse for delaying this. You are paying the doctor and the hospital very well, and not suffering excessively is part of what you are paying them for. If your nurse is resistant, work up the management tree. If necessary, call your doctor's answering service yourself (have that number in your phone notebook) and ask that the on-call doctor covering for your surgeon get back to you asap.
5. Never let your IV run dry. Remind the nurses when it's getting low and really get noisy if it gets to the bottom of the bag. You're the one who gets another stick if it clots off.
6. Move around in bed, with special attention to stretching and flexing your legs, often. In this application, "often" means hourly.
7. Walk. Then walk some more.
8. Deep breathe and cough; use the blow toy as you are shown—these are making you well, so don't skimp. Hourly is good.
9. Drink until your pee is nearly colorless.
10. If your temperature goes up, drink, breathe and walk more. The walking and drinking are also the remedy for gas and constipation.
11. Stand up straight when you walk. Contrary to the way you may feel, your guts are not going to fall out onto the floor.
12. Don’t let yourself be overwhelmed with visitors. Before surgery, suggest that your friends call you to see if you want company rather than just popping in. Visitors are exhausting, especially in the first day or two, so tell them that it will most likely be a few days before you’ll have the energy to enjoy their visit. Also, if there are obnoxious family members or “friends” you don’t want to see, or you want a graceful way to keep the entire 86 members of your family from camping out in your room for four days, ask the nurses to post your room as “no visitors” with your spouse (or single other designated Acceptable Visitor) okayed by you as the exception. If folks are determined to send flowers, suggest that they wait to do so until you go home, where you can enjoy them properly. Hospital rooms are just too small to hold very many things, and that’s not when you will be most appreciative. If they want to do something while you’re in the hospital to show their concern, suggest they have a double-latte milkshake delivered to your room instead ;)

Healing

While I haven't begun to exhaust pre-op topics, I'm going to flip over to the other side and talk about healing and postop stuff for a bit, since it's important even to those just at the planning stages to understand something about what is involved in the healing. Although it's easy, when you're looking at this surgery, to focus on the operation itself as an endpoint, in fact that is simply the beginning of the real work: healing. And it's how well you undertake the active work of healing that determines the ultimate results—and your satisfaction with them—of your hyst.

The main tasks of postop healing from a hysterectomy (of any type)

The earliest weeks of healing have three basic objectives:

1. Watching for/protecting from infection: nothing in the vagina for 6 weeks, minimum; get specific permission for bathing/swimming (doctors vary--I got permission for both once my staples were out; others wait at least 6 weeks); report any smelly or pus-like discharge, incisional heat/redness/swelling, or elevated temperature; and keep your incision clean and dry.
2. Protecting internal healing by not lifting anything heavier than a coffee mug (well, 5ish lbs) or doing anything that is so joggly that your abdominal contents whip around and stress all the gazillions of internal sutures. This includes doing laundry, running a vacuum, riding a bike, doing exercises other than walking until you have specific clearance (again, usually at 6 weeks or so). This also includes driving a car—don't do it until you are released, both for the protection of your healing and for the protection of the rest of the world who would be imperiled by your inability to react/brake/move as quickly as you should.
3. Enhancing good tissue healing by getting plenty of fluids, eating a diet with adequate protein, fiber, iron and other nutrients, gradually increasing your physical endurance by walking more each day, every day (my own rule of thumb was to exercise only as far as I could recover in a nap that day—no carrying over fatigue). Naps are good: nap at least daily up till 6 weeks and whenever you need to after that.

Sex

One of the big questions everyone has is sex. The "nothing inside" rule is firm, firm, firm. The risks of damage to dissolving sutures, not to mention infection, are too high. At that early stage of healing, the scar tissues are too stiff and inelastic to stretch without tearing—and if you open your cervical cuff (the place where they have closed off the top of your vagina, creating a pseudo-cervix that supports and closes the end) at all, you've opened the whole contents of your abdomen to communication with the outside world (Big Yuck). Also, some women have suture ends in the vagina whose sharp ends men have run into, causing catastrophic loss of...interest. This does not mean that you cannot satisfy your partner using other means, and does not mean that you cannot test out your response on your own or with your partner using non- penetrating/non-contaminating methods. Usually it's good to ask your doctor when it is safe to experience an orgasm (which stresses all those internal sutures and healing points) and wait a bare minimum of at least a couple weeks before trying this, just to allow internal healing to get a good start.

Healing sensations and time

You will experience a lot of twinges and zots as healing takes place. Nerves and other tissues heal at different rates, so these sensations spread out over a couple months.

Healing is not a smooth curve, but rather a series of steps in which one type of scar tissue forms, then is dissolved and replaced by another. Healing starts with a scab, and then gradually moves toward the end result of smooth, strong, elastic scar. In the interim stages, that new tissue is vulnerable to damage.

One of those periods comes at about 12 days, when the earliest scarring resolves into a stronger one and sutures are dissolving and letting go. It is very common to experience a little spotting or extra twinging as your body readjusts things in this first major healing stage.

Skin numbness and burning are also common in a nerve healing stage. I've heard that nerves regenerate around your incision at the rate of about an inch a month, but not all abdominal numbness or edgy sensations from cut nerves go away, even with time. This is typical of any surgical incision, and isn't special to a hyst.

You can expect to go through these tissue healing stages for at least two months, and it takes six months to a year to reach maximal healing. That's right: that long.

OMG, it takes how long?

My doctor said I'd be all healed and ready to go back to work in 6-8 weeks. Now you're saying a year. What's with this?

This is a classic "apples and oranges" situation. From your surgeon's perspective, by 6 weeks you've healed through the immediate postop period in which you are likely to have complications from the actual surgery itself. He can't do much more for you, now—it's up to your own body to finish the process up—so he considers you "done" as a patient.

But that only means that you've gotten the early, most fragile work finished. From this point, healing is slow but steady, without a lot of drama. But for the first six months postop, you're still doing heavy healing as all those scars turn to good strong tissue and your nerves grow back. The drain on your body will express itself as much more fatigue that you'll expect, and you'll continue to have some belly swelling late in the day or when you overstress the healing area. You will reach about 80% of your total healing by roughly six months and it takes the rest of your first postop year to reach 100% of the healing you will ultimately achieve.

If this amount of time seems astonishing to you, you have a lot of company. Overwhelmingly, women who have had a hyst say that the single thing they were least prepared for is the duration and extent of postop fatigue. That fatigue, I'll point out again, is due to the complexity of the surgery and the great extent of physical healing involved; it's nothing specific to the actual nature of the organs removed.

My postop body

What happens to the space where my organs were? Is there a big hole now?

The healthy uterus is really quite small—barely a small woman's fist in size. So it's not as though there's a huge space when it's gone. Now, those of us with the fruitbasket of fibroids (have you noticed? everyone's is "big as a grapefruit" or "a cantaloupe" or whatever) have gotten used to everything being shoved out of place and cramped in by our oversized uteruses. Frankly, when a big uterus full of fibroids goes away, the sensation is a big "aaahhhhhhhh." You regain your bladder capacity, your bowels don't snarl themselves up trying to empty, and everything just feels like a better fit again. Your guts may actually feel a bit "slithery" for the first few days, but that's okay--they are on panels of slippery tendon, and meant to do this. That sensation goes away once everything has moved back into its rightful place again. And because that newly-vacated space is so small and your innards are meant to move around, things just ease back into position and "fill" that space right up.

Do the abdominal muscles bridge the gap created by the incision in surgery? Do these muscles ever grow together again?

Yes, they are firmly sutured back together, bringing the cut edges back into alignment. They will heal (scar) back together and be essentially a strong as they ever were.

If they do not heal fully or the scar is weak and rips back open (in the muscle layer—not through the skin!), then you have a condition called a "hernia." This can be repaired later, either by a surgery with an incision or by a laparoscopic procedure. Women who fail to take adequate care of their healing belly tend to be more prone to later hernias along that incision line.

The scar

How can I minimize my scar? What will help it heal?

I've heard of women using Mederma, but does it really make a big difference? That Mederma is pretty pricey stuff.

What about vitamin E? My hairdresser says that really makes a scar disappear.

I've seen women report being very satisfied with Mederma, but also women express the same results in roughly the same time frame who were using vitamin E or nothing special, so it's hard to make a call on this. To some extent, your scarring will reflect every other scar you've ever had: if you tend to heal nicely over time, you most likely will have a minimal scar (assuming a tidy surgeon); if you are prone to large, lumpy scars, this one may follow suit. Women with a history of keloid scarring may need to make their surgeons aware of the problem and ask to have special measures taken to try to minimize the keloid tissue formation.

I personally used the oily contents of a regular vitamin E capsule massaged (gently) into mine a couple times a day, and I'm quite happy with how mine healed. To be honest, though, I have no idea whether the vitamin E had any particular effect or whether it was simply the massage...or just my personal healing style. Doctors are divided in their opinions on the efficacy of vitamin E for healing. For some months my scar was red and hard and lumpy, but now it's just a white to pink line. Just remember that you don't want to put anything on it till the staples are out and it's scabbed over well. And whatever you put on should be pretty simple stuff—I accidentally got some body moisturizer on mine when it was still fresh and that stuff really burned until I rinsed it back off, even though it's fine on the rest of my skin and I use it all the time.

Recovery period: household chores

One thought for your husband/family needing direction with household stuff: don't forget that just because you can't, physically, do the chores doesn't mean that you can't verbally direct someone else in their performance. The way I look at it is that the recovery period promotes you to management: you point; they jump.

On the other hand, several women I know have successfully convinced their husbands that having a hyst means that you can never vacuum again. I leave you with this thought in hopes that happy creative contemplation of it will help pass the time until your surgery.

Healing and exercise

But do you really know, medically, about the harmful aspects of stretching? If I just stretch to the point of not feeling a real pull, wouldn't that be all right?

What I know is the basic physiology of healing and the basic post-op care of wounds. There are multiple healing phases between the initial cut, scab, and eventual scar tissue, and even that scar can, years later, change due to things like nutritional status (as an aside/example, fr'instance, severe scurvy causes old scars to reopen). It's not a case of cut once/heal once. Every 12 days or so your body goes through a stage in which the past stage of healing is dissolved/absorbed and replaced with a new, stronger stage. At those points, when this is going on, the ultimate strength of the scar tissue is vulnerable to stresses put on the scar area as that dissolution/replacement is going on. And, since the cells along an incision/scar (remember: we're talking all the internal repairs as well as the surface incisions on your belly and in your vagina) aren't all on exactly the same schedule, there's a fairly good-sized window for damage to occur.

Now, don't let this feed too much paranoia, ladies. I'm talking about severe events, not just routine living. But stretches and exercising, especially impact loading with acceleration/deceleration, are the extreme sort of stress that can indeed damage the scar. And you might be fine even so. Or, in another 30 years, you could find yourself with a little hernia. It's about setting up the odds of getting the best possible results.

Who can know how far along I am in healing? How can I tell when it's safe? Would a physical therapist feel or take x-rays?

No. They can look at your stage of exterior healing and utilize their training and experience in predicting broad norms for when you are ready to do something (and that is valuable, don't get me wrong), but they cannot make firm and absolute determinations of exactly when it is or is not safe for you, nor can they quantify in any specific way exactly how much you can stress a given area. Even a PT, if they were working with you as a trainer, would be wanting feedback from you on how hard you are working that surgical area. They would tell you more or less what I have: you need to listen to your own body and you are the best judge of how much you are stressing it with any particular activity.

Am I being conservative here? Yes. I do this from the firm belief that we only get one chance to do this right, and the investment in patience pays off years later. When it's only a matter of a month, the line between cautious and go-for-it, I do firmly believe that staying on the gentle side of the line is correct. At the same time, I don't believe in being inert--you need to push yourself up to that line to hold your own while the healing is going on. Personally, I believe that line lies where you can feel a little stretch but not a pull. In the early healing months, gentle exercises limited in effort and building endurance seem to serve our needs best.

Are there websites or books that will tell me specifically what exercises "bind" the abdomen horizontally across the vertical incision?

No. There are no single broad bands of muscle that run laterally across your belly, and belly tone is provided by layers of muscles running in different directions from different attachment points. What you need to do is exercise and strengthen all the muscles together. Over-training one set and not the others will affect your posture and can lead to back pain. You need to work them all.

The good news is that those muscles will gradually begin to regain tone just from the normal activities of daily life. At first, this includes things like rolling over in bed and getting up to the bathroom. If we are careful to stand upright, fully straight, instead of hunching over, we are already exercising those muscles in the right way. As we can do more, like walking further and going up and down stairs, we gradually work the muscles harder in a very gentle way and they can resume more and more of their usual load. It's important to hold to the fine line between challenging them and over-stressing them, which is why early stomach-flattening exercises are a bad idea and can actually cause more damage than help.

After all that giant uterus I had taken out, I thought I'd for sure have a nice flat belly after surgery. Instead, I look six months pregnant. Help! How can I get this to go away?

There are two things going on in belly healing. One is the muscles re-attaching at the cut and forming a good scar, as well as regaining their former tone. The other has to do with swelling as the day goes on, which includes some fluid collection in the tissues due to circulation disruption during surgery. This is really the same mechanism as the swelling that recurs in a sprained ankle when you use it too heavily again, even months after it has seemingly healed.

You will get—especially—afternoon belly swelling long after you have regained enough muscle strength to sit up without pushing up using your hands, perhaps for 6 months or so. It's easy to blame that limp afternoon belly on muscles, when it really isn't entirely that and it will (yes, really) resolve with time. I know that even with my horizontal incision, I spent several months wearing loose dresses rather than pants that turned into tourniquets as the day went on. This is normal.

So, much as firm answers sound as attractive as a firm belly, neither one is exactly within reach. Sorry.

I've seen women ask about wearing a "belly binder" postop, or a girdle. Should I do this to help support my belly?

No, not unless your doctor specifically recommends it. This is a sort of old-fashioned thing that is now understood to be counterproductive. By supporting your belly and taking the workload away from your muscles, it actually delays the process of their regaining their own strength and can result in weakened abdominal muscles. There's also the risk that too tight a binder or girdle will cause circulatory trapping that can lead to blood clots.

It's healthier for your muscles to be gradually and gently challenged by everyday activities. It's also important to stand up very straight, even right after surgery, so the muscles don't shorten to your hunched-over posture. Your doctor has stitched you up very firmly: you are not going to have your belly break open, so stand tall.

Once you're more active, the discomfort of jouncing your belly around serves as a good reminder of when you're over-doing and stressing healing tissues. Once you are standing/walking more, you may find that wearing a light pair of control top pantyhose or elasticized panties will support your belly while shopping or other gradually lengthening activities, but don't use it as an excuse to over-extend yourself and do be wary of the tourniquet effect.

Remember: your goal is is to retrain your belly muscles to resume their normal work, not to substitute elastic garments for them.

A rough schedule of post-op recovery

It's all very well to talk about finding our own level of healing, but it's also scary not knowing what to expect or not knowing whether we're healing as we should be. Things like our pre-op state of health, our specific operative pathology, and the exact procedures we had done are really the driving influences. But for those who would like a general set of guidelines, this is roughly what a broad average looks like.

Week 1: comfort, exercise and rest

Focus is on balancing comfort with the need for exercise to get your system moving again (prolonged bed rest is especially hard on lungs, guts and the circulatory system [= clot risk]). Pain meds are good, but narcotics cause constipation and so should be used judiciously. Many of us feel only moderate "be careful" discomfort rather than "knock me out, please" pain, so don't plan on being in agony. Drinking a lot along with exercise (walking increasing distances at increased intervals, with rest in between) are your best strategies. Watch for signs of postop infection.

Week 2: pacing your recovery

Focus is on increasing your endurance and stamina. You'll feel substantial improvements daily, but will need to moderate growing impatience to be up and about with the need to continue devoting your energies to healing. Lift nothing heavier than a mug, continue heavy fluids and eat plenty of fiber to keep your guts going in this ongoing lowered activity. You'll have your staples/sutures out and be healing on the surface if you had an abdominal incision, but all surgeries still have a long way to go to heal internally. Don't rush. Oral anti-inflammatories or mild pain relievers, longer walks outdoors, and a daily nap characterize this week. Also, bathing may be permitted if it hasn't been by now. Your belly will still be poofy and flaccid, but you'll see improvement over week 1.

Week 3: not a setback

Your increasing stamina will cause you to do more than you should, thus leading to increased fatigue and a feeling that you are losing ground. This is a major turning point in internal healing, but to you it will feel like hitting a wall: more fatigue just when you are bored; more abdominal discomfort just when you thought you were really getting on top of things. It's not a disaster, but it's very frustrating. Plus, you're bored with walking and all the housebound stuff. You can't drive for at least another week (many insurance companies won't cover you yet), but you're ready for more car trips with someone else. Most of us go out and overachieve in a giant box store and come home discouraged this week. Will you ever be better? Yes. But you can't zip your levis yet.

Week 4-6: more visible progress

Progress picks up again. You're still aware, every day, of having had the surgery but you will be able to sleep on your stomach again and move around more freely, without always thinking of your belly. You continue to need a daily nap, and shouldn't stint on it as you need the energy to devote to healing. Clothing is a totally boring agony: returning nerve function along belly incisions can cause great (albeit short-lasting) irritation; best choices are sweats/tights/long loose dresses. You are doing more around the house again, but still need to limit what you lift; you can drive again. You may get the okay to resume sexual relations (with vaginal penetration). This is scary the first time. Talk with your partner about your concerns and try to arrange a position in which you can control the depth of penetration. This is not the occasion for circus sex.

Week 7-8: nearly there?

You feel nearly back to being able to do stuff, and you are getting ready to return to work. You should still nap any time you feel tired. Your clothes still may not fit. You may have a second checkup now, and get clearance for work. If you have a job that is physically demanding, ask your doctor for a written direction as to lifting and other performance limits to take to work. You may get your doc's okay to return to your fitness program so long as it doesn't stress your belly (fitness swimming is good; step aerobics is not).

Month 3: why am I not all better yet?

You return to work and are floored at how totally wiped out you are for the first week. Plan on nothing more than work and sleep. It will get better. Don't feel bad about napping, although it won't happen on a daily basis any more. You are still only about 75% healed. More of your clothes fit, but you are motivated to develop a fitness/weight reduction plan. If sexual relations are still uncomfortable, check with your doctor to see if a little vaginal estrogen might enhance healing and elasticity.

Month 4-6: reaching 80%

By the end of this period, you have whole days that go by in which you do not think about having had surgery. Your incision is fading. Your vaginal scarring (the cervical cuff or other incisions) is resolving and becoming more elastic, and sex is less nervous-making. You are 80% of the way to your ultimate extent of healing, and have resumed most of your preop activities (or perhaps more, if you were seriously impaired by your preop condition).

The rest of the first year: leaving your hyst behind you

By your hysterversary you are 100% as healed as you are going to get. Abdominal incisions may still be sensitive to pressure. The surgery begins to fade as part of your identity. Any hormonal changes wrought by surgery and subsequent HRT should be settled down. You are moving on.

Questions for your pre-op appointment

This is a list of basic questions to ask your doctor at pre-op appointments. It may not cover absolutely everything that might be pertinent to your surgery, but it should help you cover the important points. A good way to use this list would be to copy the page, paste it into a word-editing document, add extra lines between the questions, and print it out. Then you can take it to your appointment and write the answers down (or take a mini-recorder and tape them) so you can review them at home, when you have time to think things over. Be sure to jot down any other questions you may think of while reading this, so you remember to ask them, too.

1. What is the full name of my surgery? (Write this down!) What exactly will you remove: uterus? ovary/ies? cervix?
2. Will you be combining this with any other procedures? Appendix removal? Bladder repair? Rectocele? Tummy tuck?
3. How will you remove the organs and where will the incision be? Abdominal (horizontal "bikini"? vertical?)? vaginal? using a laparoscope?
4. Which things you remove will be going to the lab for pathology tests and when will I get the results? If my surgery is for suspected cancer, how soon will I begin treatments and what will they be?
5. Should I donate blood before my surgery? If so, when? If not, what if I need a transfusion? If I don’t need a transfusion, is there something else I should do afterwards to build my blood back up?
6. Right now I am taking (list all of your vitamins, herbs, special dietary practices as well as prescription medications, birth control pills, hrt; if in doubt, list it!). Should I stop them before surgery? If so, when? And when can I go back to taking them after my surgery?
7. Will I have any special surgical preparation: enema? laxative? douche? Will I be shaved? If so, where and by whom? May I do it myself instead?
8. What if I have my period when I’m supposed to have my surgery?
9. I am planning to have my [whatever] pierced or get a tattoo. If I have it done before, how long must it have to heal before the surgery is scheduled? How soon may I have it done afterwards?
10. May I leave my finger- or toenail-polish and/or artificial nails on when I go to the OR? May I leave my wedding ring on?
11. What kind of anesthesia will I have? What if I prefer a different kind? Will I meet with my anesthetist before surgery?
12. How long will my surgery take? Will you report to my family afterwards, while I am still in the Recovery Room? How long will I be in Recovery before I am taken to my room?
13. How will my pain be managed and what will you be giving me? Will I receive it in the Recovery Room? Do I have to ask before I can have it, or will it be given to me? How often may I repeat it? What if that doesn’t work—will I have another option? How will I get that second option?
14. What if I become nauseated after surgery? May I have something for this? May I have it before I vomit? in the Recovery Room?
15. How long will I be on bed rest? When will I get up? How often should I get up?
16. Will I have a catheter into my bladder? Will I be awake when it is put in? When will it be taken out?
17. When can I take a shower? When will I be able to bathe? Use my hot tub?
18. Will I have vaginal bleeding after my surgery? How much and how long?
19. Will I have on special stockings or pneumatic leggings to prevent clots in my legs after surgery? How long will I have to wear them? Will I be receiving any medication for this purpose? Which one, and how long?
20. Will I be hooked up with/using any other equipment or special things after surgery? Tummy binder? Breathing exercise devices?
21. How long will I have an IV after surgery?
22. What will I be taking for post-op gas and constipation? How long will I need this? If I'm not prescribed something and develop these problems, what do you recommend I take?
23. If I am having my ovaries removed, when will I start taking hormones and which ones will I take? What is this choice based on? How can I expect them to make me feel? What if I don’t like the way I feel on the first prescription or think I am having a bad reaction?
24. If I am not having my ovaries removed, how can I tell if they are or are not working post-op? Will I have hot flashes anyway? If my ovaries don’t work right away, what will I experience? How long will I have to experience menopausal symptoms before I can take something to relieve them?
25. What things have to happen before I will be discharged from the hospital? How long should I expect to be in for?
26. When will I see you after I leave the hospital? What if something happens or I have questions about how I'm doing before then?
27. What pain medication and other medications will I go home with? If I run out of pain medication, how do I get more?
28. What kind of problems should I be watching for at home?
29. Do I need to have someone stay with me at home after I am released from the hospital? for how long? Should I arrange for another caregiver or board out my kids and/or pets?
30. What activity restrictions will I have at home? Stairs? Bathing? Driving? Housework including laundry and vacuuming? Lifting how much when? What about my kids or pets—when can I pick them up?
31. What if I do something and it makes my incision/belly really hurt? Can I hurt myself by doing too much too soon? How will I know?
32. Will I need to wear a tummy binder or light girdle at home for belly support? If so, for how long?
33. I am planning to do something special (go to my son’s wedding 2 weeks after surgery—move to a new state a month postop—return to grad school classes of 3 hours a day at about 3 weeks after surgery—take a tropical vacation 2 months after surgery—start paragliding lessons—whatever) in the first 6 months after surgery: is this going to be okay? Should I reschedule it or my surgery to accommodate this plan?
34. When can I return to my job? (Note: be sure that your doctor knows the exact nature of your work! A work-at-home web designer does not have the same physical demands as a warehouse worker toting hundred-pound sacks of cement mix working a twelve-hour shift.) If I return to work and find it too strenuous, will you authorize an extended leave or a limited return to work?
35. When may I have sexual intercourse (penetration)? May I engage in other forms of sexual activity (including orgasm) before that time? If so, when?
36. When may I resume exercising? I normally do for exercise (walk, run, swim, step aerobics, ride horseback, lift weights, bike)—is there any part of that activity I should avoid at first? When and how can I work on regaining tone in my belly? Will you refer me to physical therapy after surgery so that I can work with them on preventing internal scarring and regaining physical conditioning safely (check to be sure your insurance will cover this, but many will if your doctor orders it)? When can I do Kegels again, and should I?
37. If I have more questions after this appointment, how can I get them answered: email? fax?