Stitch by Stitch: Pain, Nausea, Recovery | 8

Today, we're talking about a topic many of us are all too familiar with: dealing with pain, post-surgery complications and nausea. The journey of recovery after major surgery is filled with challenges, both physical and emotional. Thrust into a world where managing pain becomes as routine as morning coffee. We take a look at the complexities of post-operative life, from wrestling with the simple yet excruciating task of changing a drainage pipe adhesive to wrestling with the unpredictable nature of her new digestive reality.

Slow-healing wounds meet the desperate need to continue chemotherapy, and delves into the delicate balance of pressing pause on treatment to promote healing. Her story brings to light the unspoken side of surgical recovery that many face in silence.

This is a story for all to learn from and to connect. Please join us.

Thanks for listening. For more information please visit hopelovecancer.com. You can also follow us on Instagram or Facebook.

Transcript

Welcome back to "tumour, tumour on the wall" presented by hope love cancer, as we continue our journey with your host, Charlie.
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Welcome back to Episode 8. Today, we're talking about a topic many of us are all too familiar with: dealing with pain, post-surgery complications and nausea. Rosemarie is recovering from her bypass surgery, and things are pretty hard. She is still staying with Tobie and Magda and Renée's now joined them in South Africa. Tobie insisted that they extend their stay with them to give Rosemarie all the support she needs and to help Renée to take care of her.

Rosemarie's going through a lot. She can't even get up by herself and she also still has a drainage pipe from her surgery that has to be dealt with. It's more than just the hurt from the surgery. She's got to manage her pain, look after the wound, keep up with her pills, make it to her doctor's appointments and the list goes on. It's about the relentless aches, the discomfort, and the difficulties it presents in her day-to-day life.  Some days, she feels like she can't take another step, but Renée is pushing her, telling her she has to keep fighting and not let this pain or the cancer win. Even more so, Renée believes that Rosemarie will beat this.

Let's see how Rosemarie gets through this.
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Rosemarie's journey to recovery is proving to be more complicated than anyone might have expected, especially when it comes to the simple task of managing the adhesive for her drainage pipe. Every time it needs to be changed, it's not just a standard procedure but a real pain – a pain in every sense of the word – a pain in the butt and a literal physical pain. The adhesive, crucial for keeping the drainage pipe secure, sticks to her skin with such a grip that removing it causes her considerable pain. This issue, seemingly small, actually shines a light on a larger problem within healthcare. Despite our technological progress, finding effective, pain-free solutions for these kinds of recovery challenges remains difficult. It is frustrating, really. You would think that with all our advancements, we would have figured out a better way to deal with something as basic as adhesives by now.

Magda and Renée are helping Rosemarie with the drainage pipe, cleaning the wound, and dealing with the leaks that require frequent changes and, unfortunately, more adhesive. The care extends to the very delicate task of managing the wound care around the staples that hold the surgical wound together. These staples, while important for healing, complicate the situation further, particularly as the wound is stubbornly slow to heal around its edges. This sluggish healing process is likely due to Rosemarie's cancer and the chemotherapy she underwent before the surgery. The decision to put a temporary stop to chemotherapy in order to allow her body to heal, feels like choosing the lesser of two evils. Yet, it's a decision that shows the complex balance between treating the cancer and managing the recovery process.

After Rosemarie's surgery, the way her body processes food underwent a major change, leading to a complex situation with her bathroom habits. Now, when the urge hits, it's immediate and pressing, creating a sense of urgency that can be quite stressful, especially when she's not at home. It's as if her body is constantly on alert, signaling an urgent need to go to the bathroom, only for her to find out it might be a false alarm due to constipation.

This puzzling scenario stems from the surgery's alteration of her digestive tract, specifically bypassing sections of her intestines that normally absorb water from digested food. This alteration was meant to help with her condition, but introduced new challenges. Although food now moves through her system quicker, suggesting a faster and more frequent need for bathroom visits, the reality is often the opposite. The lack of water absorption means that her stools become hard and dry, making it difficult to pass and leading to constipation, the primary issue she faces. 

However, on very rare occasions, the situation flips to the other extreme, resulting in diarrhea. This unpredictability adds another layer of anxiety to Rosemarie's daily life, as she navigates the uncertainty of her post-surgery digestive responses. Despite the predominant problem being constipation, the occasional bout of diarrhea means she has to be prepared for anything at any time.

Dealing with bathroom troubles after surgery can be really tricky, especially when your body starts acting all unpredictable. One minute you're rushing to find a bathroom with that "got to go right now" feeling, and the next, you're stuck because nothing's happening, thanks to constipation. And just when you think you've got it figured out, things switch up, and you're dealing with the complete opposite problem.

So, what can you do about it? Well, adjusting what you eat and making sure you drink enough fluids are super important. Eating foods that have a lot of soluble fiber can help make things easier to pass, helping with the constipation part. But here's the thing, not everyone loves drinking water all the time, right? If water isn't your go-to drink, finding other ways to stay hydrated is key. It's all about keeping things moving smoothly without going too far in either direction.

Finding the right balance for your body might take a bit of time and some experimenting with different foods and drinks. It's all about being patient with yourself and paying attention to how your body reacts to these changes. Remember, it's normal to need some time to adjust and find what works best for you after surgery. Your body's doing its best to get back on track, and with a little help from the right foods and enough fluids (even if water isn't your favorite), you'll be on your way to feeling more comfortable.

Rosemarie is scheduled for a post-op follow-up with the surgeon. She is still weak from the surgery, the effects of her cancer treatment, and the toll it has all taken on her body. Concerned that she would not be able to walk all the way to the surgeon's clinic, because of her pain and muscle weakness, Magda has arranged to get a wheelchair. 

During the visit, the surgeon examined Rosemarie’s wound. He told them that the drainage tube, or "the pipe," were not yet ready to be removed. The conversation then turned to managing Rosemarie's pain, a constant challenge. The surgeon suggested morphine as an option, as she was already on a low dose of oxycodone. 

However, the suggestion of morphine brought up concerns. Rosemarie's oncologist had previously advised against it due to its potential to worsen her constipation—a side effect of her digestive system's altered state post-surgery. This advice pointed out how tricky Rosemarie's condition is. Trying to take care of one problem, like pain, might end up making another issue, like constipation, even worse. It's all about finding the right balance to manage everything carefully. The surgeon's reaction to Rosemarie's overall condition, muttering something about cancer and shaking his head, reflected the gravity of her health challenges.

Looking back, they should have taken the morphine. Combining morphine with a laxative might have offered a more balanced approach to pain management, addressing both the need for pain relief and maintaining digestive health. This possibility points to the importance of holistic care that considers all aspects of a patient's health and well-being.

For everyone listening today, it is absolutely crucial to understand how to manage pain with medicines called narcotics or opioids. These medicines are used for pain relief, but come in different strengths and have various effects on people. It's not safe to start with the stronger options first, as this can lead to an overdose and potentially kill you. Instead, you should begin with milder medications, such as codeine, which is less potent and usually used for mild pain or coughs. This careful approach allows your body to adjust and helps prevent the risk of an overdose. As your body gets used to these medicines, your doctor may adjust your treatment, moving to stronger medications - only if necessary. This step-by-step increase in medication strength is essential for safely managing pain. Listening to your healthcare providers and pharmacists are extremely important throughout this process. 

Let's talk about these medicines. First, we have codeine, which is not too strong and is often used for coughs or mild pain. Then there are medicines like hydrocodone (you might have heard of Vicodin) and oxycodone (in OxyContin and Percocet), which are stronger and used for more serious pain. Going up the scale, there's morphine, which is pretty strong and used a lot in hospitals, and hydromorphone (or Dilaudid), which is even stronger. At the top of the list, we have fentanyl, which is super strong and used for very severe pain, often for people with cancer.

The most important aspect of pain is open communication. If you're dealing with cancer, you shouldn't have to endure pain in silence. It's critical to track your pain, talk about it with your healthcare team, and work together on managing it. This means updating them on your pain levels, any side effects, or how the medication affects your daily life. It is so important to find the right medication and dose. Why? To improve your quality of life without risking your safety. 

Throughout Rosemarie’s journey, managing her pain has been a significant challenge. The reluctance of her other health care physicians to prescribe anything stronger than oxycodone, highlights a careful balance. They are navigating the tight rope between providing relief and avoiding the risks associated with more potent opioids, such as dependency or adverse side effects. This caution shows the complexities of treating chronic pain, particularly within the context of cancer treatment. Maybe they should not have been so reluctant? 

As we explore more of Rosemarie's cancer treatment, we see that nausea has been a big challenge for her. This problem is pretty common because chemotherapy, the main treatment fighting her cancer, often makes her feel very sick. This happens because the chemo affects parts of the brain and stomach that can make you want to throw up.

To help with this, Rosemarie got prescribed a medicine called Ondansetron. This medicine is really important for people going through chemo, because it helps stop you from feeling so nauseous. It works by blocking the signals in your body that tell your brain you're going to be sick. The idea is to make the treatment a bit easier to handle and also making sure Rosemarie feels as good as possible while it's happening.

However, even though this nausea medication is strong, it doesn't always take away the nausea completely. There were times when Rosemarie still felt really sick, even with the medicine. 

Renée recalls one particular night when Rosemarie was feeling especially unwell. Rosemarie began vomiting, and within minutes, Magda and Renée found themselves juggling two pans to catch the vomit. It was a distressing scene, made even worse by the sight of what came out—it wasn't food, but a strange green and white substance with what looked like bubbles or blobs in between. It was also an awful smell that filled the room that night—a nauseating odour that made Renée’s stomach turn. Despite feeling like she might also vomit from the smell; Renée knew she had to keep it together and stay strong for her mother.

As Renée and Rosemarie locked eyes in that moment, Renée felt a wave of helplessness wash over her, unlike anything she had experienced before. She could see the plea for help in her mom's eyes, and yet she felt utterly powerless to make it better. It was a nightmarish moment of realisation—what can you do when even the strongest pills don't seem to work? It was a heartbreaking experience, highlighting the harsh realities of dealing with the side effects of cancer treatment.

Nausea is a significant concern for cancer patients undergoing treatment, impacting their daily lives and overall well-being. Open communication with healthcare providers is essential for effective treatment plans. By discussing symptoms, patients can receive appropriate medications, dietary advice, and supportive care. This proactive approach helps prevent complications and ensures patients receive optimal support throughout their cancer journey.

As we wrap up today’s conversation on managing pain and nausea, we want to say a big thank you to our subscribers and followers for being part of this journey. But our story isn't over yet. In our next episode, we'll peek into their world of emotions – the roller-coaster of emotions that come with living with cancer.

Let's end with a powerful reminder from Elizabeth Edwards, who bravely battled breast cancer: "She stood in the storm, and when the wind did not blow her way, she adjusted her sails." 

This is a lesson for all of us. Sometimes, life gets hard, but we can always find a way to keep moving forward, just like adjusting sails to catch the wind. Stay tuned for more of Rosemarie's story, and let's all learn to adjust our sails in our own lives. See you next time.