Abdominal Cerclage, Round 2

 My first abdominal cerclage was an awful experience. The hospital wasn't great, I was in the 8s and 9s on the pain scale, my digestive system broke down on me, and I wasn't ready to return to work four weeks out, although I did.

I was scared stiff about how this one would go, given that I already felt like hot trash from the HG. It was a breeze. I would do it again, no hesitation, if only because whatever the anesthesiologist gave me afforded me three, gloriously nausea-free days! So, here's the recap. This was with Dr. Sumners, and Ascenion St. Vincent Hospital in Indianapolis.

Tuesday: Flew to Indy.

Wednesday: Pre-op appointment. I had a detailed scan, looking at baby and cervix. After that I met with Dr. Sumners, several of his nurses, and another doctor who was shadowing him. He told me at this point that he was planning to place both a single TAC band, and a TVC. He never said anything, but I could see when watching the ultrasound that the lower portion of my cervix was already dilating. We discussed my pain from last time, my allergies, and timing for disability leave. He was thoughtful about my concerns and had sound responses. He told me he wanted me on anti-contraction meds for 48 hours post surgery.

After he left, his nurse walked through things with me like the pharmacy I'd use to fill my prescriptions (pain meds and anti-contraction meds). I had sent Dr. Haney a 3 page summary of past surgeries and pregnancies. The nurse expressed her appreciation that I had that together and she didn't have to pull it from my hundreds of pages of charts! She was also really sensitive and didn't make me rehash all past pregnancies, but said she'd fill those in from the summary I gave her. That was a thread with nearly everyone I worked with: real sensitivity to my past losses. I appreciated that a lot, as I find I rarely experience that compassion. 

Thursday: Surgery day. I had to check in at 6:45 am for an 8:45 surgery time. The hospital was relatively empty, with just my mom and I and two pregnant ladies who were clearly checking in for c-sections. I was taken back alone for pre-op. Changed out of all of my clothes (but held onto the piece of Quinn's blanket that I had brought with me until the last moment). Was told I have great veins and had an IV placed. The nurse spent nearly an hour going through my full medical history. She was extremely thorough, which was nice. Everyone agreed to put 'Zofran' as an allergy on my chart, to ensure that I'd be given something else instead. We discussed the best tapes to use for that allergy. There was a TV in the pre-op room, so when she left I turned on something mindless.

Dr. Sumners and the Dr who had accompanied him the previous day came in. He assured me that he'd been practicing on the patient before me! I was asked to confirm what surgery I was there for. 

The anesthesiologist came in next. We discussed my issues with Zofran and preference for Reglan. I brought up some of the pain control options, and the fact that morphine makes me puke when I take it orally/IV post op. He listened to me, but kept trying to steer me back to what he wanted, which was standard spinal and post op PCA. In the end we agreed on a nerve blocking medication, decadron for nausea, a standard spinal with morphine, and Norco for post op pain medication. That was an awesome combination. The worst my pain ever got was a 5, and most of the time if I laid still, I didn't feel any pain at all. Best of all, the nausea went away. I can not convey how awesome that was. I could lay still and feel good and human again, even right after surgery. Such a difference from last time!

I was moved to antepartum a few hours post op, and they did a doppler check so I could hear baby's heartbeat All sounded good. They insisted on clear liquids only, to give my digestive system time to recover. I made sure to get a full dose of Miralax in, along with as much apple juice as they'd give me! 

During the day, I drowsed in and out, thanks to the meds. I didn't get much overnight sleep, because I was having my blood pressure measured every 10 minutes. It kept being very low (80s over 50s), so the alarm would go until I pressed the call button for the nurse to come in and silence it. A few ties the alarm went off because my heart rate was high - basically any time I rolled over I'd get THAT alarm, too. Frustrating. 

Friday: Around 5 am Friday morning, after not sleeping due to alarms, I realized I was having contractions. I also realized that I hadn't been given the anti-contraction medication since right before they wheeled me back for surgery, almost 24 hours ago. It's supposed to be taken every 6 hours. I asked the nurse and she said there weren't orders. I told her there should be and asked her to contact the Dr since I was contracting. She asked me to wait for rounds around 9 am and I told her I wasn't comfortable with that. It took about 2 hours, but she asked the resident, found out I was supposed to be taking it, and gave it to me.

Around 9 on Friday morning the nurse removed the catheter and I got up to pee. Side note: last time I had a TAC, peeing burned like the worst charley horse you could imagine. This time, almost no pain at all, despite the fact that they'd removed a lot of scar tissue from my bladder. So, so grateful.

When getting up, I made it to the toilet just fine, sat down just fine, even peed a bit, but realized I was going to pass out. I needed help to get back to bed. I tried to get up and walk an hour later and it was the same story - almost passed out. Since my blood pressure was still 80/55 this wasn't surprising. I asked them to let me have solid food, since being NPO, then clear liquids only for 36 hours was a lot. After I ate something around lunch time, I tried walking again and was able to toodle around my hospital room without issue. That, plus the fact that I'd passed gas and urinated, meant I had met discharge criteria. 

Normally, Dr. Sumners has you come to his office for an ultrasound post-discharge. Unfortunately the u/s room was in use, so after a few hours, a technician came and wheeled me to the ultrasound in antepartum. We checked that baby was still alive- yes, and that my cervix looked good. She said she was getting some swelling in the way, but it looked good. Overall the most pain I've felt the entire time was when I had to lay down on the ultrasound table, which didn't have any rails, and then get my legs into stirrups. The tech tried to help, but I wasn't clear what I needed and so it hurt. After that I confirmed meds quickly and my mom drove me back to our extended stay hotel. The hotel hadn't gotten the promised wheel chair, but I was able to walk in, up the elevator, and up to our room by myself. 

Saturday: I kept up with Norco and nausea medication every 6 hours. As mentioned, as long as I was still, I felt really good with minimal pain. Slept well, too, thanks to the meds. Got a shower and it was so much less traumatic than either my first TAC or my c-section. I was able to put my own socks on! I had to sit down on the toilet to do it, but I did! Even dried my hair a bit. Did laps up and down the hotel hallway every few hours. 

Sunday:  Got up, got a shower, had cereal for breakfast, then headed to the airport. My mom had arranged to have a wheel chair waiting for us at the rental car return, and I was grateful. I could have walked a decent amount, but not all the way to our gate. They got us there, with only a small snafu when my mom went in the pre-check line while I got the regular peon line despite still having her luggage. The screener pulled her bag, because it had cashews in it! Go figure. She had gotten us bulkhead seats, so I didn't have to shimmy into a tight window seat, which made the flight home easy. I have never been so appreciative of grab bars in airplane bathrooms!

There was a waiting wheelchair when we landed, and that took us to the curb where my husband was waiting. I took one last norco when we got home, and that was the last narcotic I needed. 

Monday - Thursday: I slept in our guest bed and kept up with tylenol and my nausea meds every 6 hours. Getting into and out of bed, and rolling over in bed were hard, but kept getting easier. By two weeks out, I have mostly normal use of my body, although my uterus still hurts. 

So, in TLDR terms; What went wrong: Already dilated, needed TAC and TVC, lots of scar tissue, nicked a vein, didn't get my anti-contraction meds, had super low blood pressure, was missing a wheel chair. 

What went right: TAC in place. TVC in place. Baby and mama both have heartbeats still. Much easier recovery than last time, despite being pregnant. 

I would absolutely recommend anyone with cervical issues/cervical insufficiency/incompetent cervix reach out to Dr. Sumners.