Friday, January 16, 2009

Hickman surgery successful, still sedated and recovering

I probably won't remember parts of what happened this afternoon, so I'll try to write as much as I can before the amnesiac effects of the sedation wipe it all away :)

The surgery went well. Last night and this morning I showered using a special antiseptic soap on my chest that they require patients to use before surgery. They'll actually postpone the surgery if you don't do this. The way the Hutch works, the pre-soap ritual was probably the result of someone's research that found that patients using a surgical soap in advance of this surgery decreased their risk of infection by some percentage. Anyway, I did the soap, wore freshly laundered clothes to the surgery room (also required), and it was on.

The procedure involves 2 incisions, one at the jugular vein in your neck, and the other in your chest above your nipple. Rather than having an unsightly catheter sticking out of your neck, they tunnel the tube under your skin between the 2 incision points. This way, the catheter enters the vein at your neck, but comes out of your body lower down on your chest. With your fingers, you can actually feel the catheter under the skin. This layout makes it much more convenient since the ends of the tube can rest in the natural chest cavity pocket there. I have a necklace with a clip on the end to keep it from dangling around too much.

The illustration shows a single-lumen Hickman. Mine is a double-lumen Hickman, which means it has 2 tubes coming out, and the tube itself is split into separate chambers all the way to the heart. This allows them to do things like an infusion on one line, while drawing blood from the other. With a single lumen they would need to interrupt the infusion.

Apparently Dr. Hickman, who invented the device, retired just a few months ago at the ripe old age of 83 and was the sole person doing these surgeries until the day he retired. I'm not sure if that's a good thing, or a bad thing :) The doctor who performed mine studied under Dr. Hickman for years, and was great. The surgery went perfectly.

The procedure itself wasn't too bad, though I'd read up on it so I knew pretty much what to expect. The doctor and nurse also did a great job of explaining, and did a show-and-tell on the ultrasound so that Johanna and I could see the actual jugular and where exactly in the jugular he would insert the catheter. It pulsed with my heartbeat, and you could see it squish and move around as he pushed down with the ultrasound tool.

Really, the most uncomfortable part of the whole procedure was the lidocaine injection into the neck for the incision, since it burned a bit, and when they used the tunneling tool to open a passage under the skin for the catheter. Everything else was relatively easy. The amazing part was that once they got everything sterilized and set up, the procedure itself took only 10 minutes. But it took a 45 minutes to properly prepare and sterilize the room. What I mean is, I was covered from head to toe with a sterile tarp and a piece of metal near my head to suspend it from my face. A window was cut out of the side so that I could breathe and talk to the nurse that was applying the IV sedatives and pain-killers. Around the surgery site, the tarp was taped down and the site of the surgery was sterilized with antiseptic soap. The doctors, technicians, and nurses were fully gowned and had face masks and hair nets. It was nice to see the amount of care taken to keep the place sterile, since infection is the leading source of problems with these central lines

A combination of ultrasound and x-rays were used to position the guide wire into the proper position in the superior vena cava above the heart, and to make the appropriately-sized hole in the jugular vein for the catheter. I was on a flat table beneath a large x-ray machine, and the table was tilted back with my feet above my head. So the experience was like being in a narrow tent, lying backwards downhill. I'm glad I wasn't claustrophobic! But like all my previous procedures, once the sedative started flowing, everything felt great :) I was relaxed and calm and just enjoying the fact that the procedure was happening and would soon be over.

Recovery was fairly quick, and after some string cheese, Oreo cookies, and apple juice (I wasn't allowed to eat all morning and was starved), we were done! We headed to Taco Time to satisfy my taco craving, and then stopped by my old office to see coworkers I won't see for a while. It's been a few hours since the surgery, and I'm hardly noticing the Hickman at all, except for some soreness in my neck, which is expected since there are a lot of small muscles up there which they had to cut through. I think it may prove to be less of a hassle than the PICC line.

Tomorrow we take a class on caring for the Hickman, such as changing the dressing and how to protect it when taking showers, and I'll have an hour-long IV infusion after that and again on Sunday. Then Monday I'm admitted into UW Hospital. It's sort of a relief to have this week over with, since there were a lot of unknowns, like what the results of the CT scan and data review would be, and how I would feel after getting the Hickman line. It all feels pretty good, so I'm excited about moving on to the next stage.

Ciao for now! Thanks for all the comments :) I love reading them all, they really make my day!


Cassie said...

Thanks for stopping by the office, Steve! It was nice for us to get to hang out with you for a bit. :-D

Liz said...

Happy Hickman day Steve!

I hear Glad Press N Seal is good for taking showers... (according to my patients at least)

Anonymous said...

Greetings from the McLeans in Michigan.
Steve, Jon and I have been following your blog and our thoughts are with you as you embark on the actual transplant experience.
Feb. 2nd will be Jon's 4 year anniversary of his transplant here at U of M. He's still leukemia free! Yeah!!!!
Jon's Hickman was a triple leumen and it's a wonderful convenience for several months....saving MANY "sticks".
Brian will return from Iraq at the end of the month and will be at the Pentagon for a while and then attend Marine Command and Staff at Quantico, convenient since that's where his wife, Jen, is stationed. (She's a Marine lawyer.)
Just wanted to let you know we're thinking of you and cheering you on from afar.
Kathy McLean

Anonymous said...

Here's a tidbit of information for your next PET scan. The formula for computing the fraction of the radio-isotope remaining in your body relative to an arbitrary base time (typically the time of injection) is 1/(2**n), where n is the number of half-life units which have passed. For example, if the half-life is 4 hours and injection was 24 hours ago, n = 6 (24/4). Thus, 1/(2**6) = 1/64. That's 1.56% of the baseline dose. This is useless information, but it generally impresses the bejeezus out of the nuclear medicine tech. You can work up some self-effacing, modest comment to go with this. It's fun, in a bizarre sort of way.

I have an interesting transplant-related issue which is very rare: I'm the first U of M patient to have it, so don't lose sleep about getting it. I have cutaneous T-cell lymphoma (CTCL) which is a generally not-very-threatening skin cancer. I got it from the donor's cells. To treat it, I get UV treatments 3x/week. It's drive 30 minutes, undress, stand in the booth a minute, dress, drive 30 minutes. . . Not too bad, really, and something you'll most likely never deal with. There are all sorts of things which will crop up post-transplant, but you and the docs can deal with them as they come. Your obvious good attitude will help see you through. And then there's scootering!
Hang in there,
Jon McLean

obscurity said...

I have to say, reading this reminds me of that mid-80's "Weekend Update" where Al Franken graphically describes the prostate surgery that Ronald Reagan was about to undergo (The link to which, I have, unfortunately, been unable to find)

BUT I'm totally stoked for you and how well this is starting off.... Can't wait to read the rest ... although next time I'll do it BEFORE breakfast.

OH OH OH. Are you totally stoked for Lost #5? Did you see last night's BSG?