At the suggestion of the members of Sans-Uteri, here are some recommendations for women who are preparing for hysterectomy and/or oophorectomy surgery:

• Research your proposed surgery thoroughly.  Some excellent books that may help are:

   

  1. Your Guide to Hysterectomy, Ovary Removal, & Hormone Replacement: What ALL Women Need to Know
     by Elizabeth Plourde, Ph.D., C.L.S.

  2. Misinformed Consent by Lise Cloutier-Steele

  3. Screaming to be Heard by Elizabeth Vliet, M.D.

  4. The Woman's Guide to Hysterectomy by Adelaide Haas and Susan Puretz

  5. I'm Too Young to Get Old by Judith Reichman, M.D.

   

• Have several consultations to verify that surgery is necessary. Select the best and most qualified surgeon that you can find. Seek consultations with surgeons who are not affiliated with each other (note: physicians who do not agree with your primary care surgeon who is suggesting the surgery may never get another referral from your doctor if the 2nd opinion does not confirm their diagnosis and suggested treatment).

• Schedule your own appointments and personally bring your records to the appointment.
• Request pre-operative baseline hormone levels of estrogen, progesterone and testosterone as well as bone density testing. Both will be invaluable guides to achieving "normalcy" after surgery.
• Fibroids are easily diagnosed by ultrasound, transvaginal ultrasound and MRI. Endometriosis may only show up during laparoscopic surgery. Insist on lesser invasive procedures to obtain a definitive diagnosis.
• Check with the licensing board of your state to verify the surgeon is Board Certified. Ascertain the competence of the surgeon through courthouse records which will show legal suits against him. Ask other medical professionals of their opinion of your surgeon's technical ability and bedside manner. Talk to friends and relatives regarding their experience with a particular surgeon.
• Select the hospital carefully. Once the surgery is completed, you are at the mercy of the nursing staff. If a particular hospital has a reputation for being short-staffed or has lots of negative publicity - try to go elsewhere.
• Ask questions. Talk to doctors, nurses other women who have had the same surgery. Listen carefully to what is being said. When you meet with the surgeon have a list of questions and keep asking the question over and over until you are satisfied with the answer. If possible, have your significant other or a close friend or family member attend the consultation with you.
• Do not allow yourself to be rushed into a decision to have surgery. Do not allow yourself to be scared into having otherwise healthy organs removed because it makes the surgeon's work easier.
• Remember that YOU, and ONLY YOU, will be the one that is truly affected by the surgery. Better to err on the side of caution than to regret your decision for a lifetime.
• Read up on hormone replacement therapies and what to expect if your ovaries are removed or shut down after the surgery.
• Arrange to meet the anesthesiologist prior to surgery (not in the Holding Area). Discuss the anesthesia to be given, advise her of the medications you are currently taking or have taken in the past month and your reaction to various medications and/or anesthesia. Be sure to advise your surgeon of any drug sensitivities and discuss her medication plan for you after surgery.
• Start your list of questions for your doctor now. When you think of something you'd like to know, jot it down. You can ask how your pelvic floor will be supported with the absence of your uterus, how the Dr. is going to ensure your ureters are protected during surgery, what will the suture line look like and where exactly will it be, will the Dr. (not a learning resident assisting him/her) be doing the surgery and suture closing. Doctors respect you for coming in with a list of questions.
• Donate your own blood in case you require a transfusion during the operation. It's called an autologous donation. You need to donate it at least 10 days prior to your operation. Some research a Sans-Uteri participant found seems to be indicating that donating blood prior to surgery can increase your need for a transfusion, so discuss this, and ALL medical concerns with your physician.
• During your pre-operative visit with your Dr., ask that s/he prescribe your pain medicine for your at home recovery then. This will allow you to pick it up and have it at home long before you come home from the hospital.
• When you meet your anesthesiologist you can discuss extra anti-nausea medication and a pain killer before you wake up post-surgery.
• Know what routine procedures will be done before, during, and after surgery. Such as a catheter into your urethra.
• Before going in for surgery request to see the consent form for both the surgery AND hospitalization. Read them very CAREFULLY. Cross-out and initial any portion that you are uncomfortable with. Make sure the consent form clearly states the procedure to be performed. Do not allow and skip over any vague terms.
• Consider purchasing a panty girdle - lightweight lycra - to wear after surgery. It provides light support to the incision site and protects the skin from the unpleasant sensation of clothing and bedding rubbing against sensitive skin. Thigh-high hose are a good substitute for panty hose.
• Purchase a full body pillow for sleeping more comfortably after surgery. Small pillows can also be used to cushion the abdomen. These are especially helpful for the ride home from the hospital in keeping the abdomen cushioned from the seat belt.
• Purchase panty liners for post-op vaginal drainage (no tampons are allowed).
• Have loose fitting clothes on hand that either have a loose elastic waistband or no waistband at all (dresses, jumpers, housecoats).
• Go grocery shopping prior to surgery and stock up on food that can be easily prepared or cooked and frozen for post-operative meals ahead of time.
• Purchase cranberry juice (good home remedy for urinary tract discomfort), yogurt (good remedy to help avoid yeast infections after antibiotic medication and to soothe upset bowels) and salad fixings (good for roughage and easier bowel movements).
• A hand-held spray attachment for the showerhead is useful.
• Bring an over the counter drug called "Phazyme" (generic name: symethicone) with you in your overnight bag for gas pains. You might have horrible gas pains afterwards and they don't always have this "miracle" pill at the hospital. They can rid you of gas super quick!
• Buy thank you notes and stamps to use when you feel up to writing.
• If you take vitamins - continue taking them until the morning of surgery.
• Be aware that some or all of your pubic hair may be shaved for surgery. An abdominal incision may only require the shaving of the mons. A vaginal hysterectomy may be only the labia or could be the entire area. If you prefer to shave in the privacy of your own home, ask you surgeon if that is permissible and what areas to shave.
• Make arrangements to have at home assistance available for after surgery. A spouse can be a helper, but only you will know whether additional assistance is needed for younger children or carpooling, grocery shopping. Better to have them lined up and not need the help than to need it and not have it available. If possible, hire a maid for a few weeks.
• Arrange for your softest linens to be on the bed when you get home from the hospital. Have the telephone, reading materials, and anything else you may need within easy reach of your bed.
• Schedule an appointment with your hairdresser prior to surgery.
• If possible, have your prescriptions filled before you leave the hospital.

Suggestions for Your Hospital Stay

• Comfortable nightgown and robe.  Keep in mind that you will be walking the hallway with an IV so take button down AND over-the-head nightwear. A wrap-around robe may be all that you use over the hospital gown.
• Bedroom slippers, heel-less are easier to use.
• Pillows
• Fresh smelling, light cologne
• Loose fitting pants and top for the trip home.
• Lightweight socks (toes get mighty cold in hospital rooms)
• Chap stick
• Toothpaste/toothbrush/mouthwash
• Hair brush/comb
• Breath mints, hard candies, and gum
• If you are a smoker bring nicotine patches and/or nicotine gum to get you through the hospitalization.
• Air-line pillow/baby pillow as discussed above
• Underwear - larger in size than normal for when catheter is removed so that you can secure sanitary napkins to them.

Suggestions for After Surgery Care

Your surgeon and the hospital staff will give you post-operative instructions. These suggestions have been contributed by the members of Sans-Uteri as they have been personally helpful to us.

• Take it easy. Your body has just been through a major trauma and needs rest and pampering. Your incision may be healing well on the outside - however - inside there are layers and layers of tissue that need to heal. Making the bed, doing laundry, even sitting at the computer may be too much. Several naps a day are suggested. The more rest and good nutrition you get the easier your recuperation will be. Do not push, pull, reach or lift for two weeks to allow internal sutures to heal.
• Drink plenty of water. This is necessary for a returning of normal bladder and bowel function. If you begin to develop changes in urination, pain, burning or frequency, report this to your doctor immediately.
• As soon as you can, ask the nurses if it is safe to have them take out your urinary catheter. Sometimes they might leave it in overnight in which case, have them remove it first thing in the morning as it can cause horrible bladder infections and a lot of discomfort. If you have a history of cystitis discuss this thoroughly with your surgeon. Sometimes they will avoid using a catheter, if possible, but you need to ask.
• Do not strain to have a bowel movement. Gas is normal and the use of Gas-Ex, Phazyme (generic name: symethicone) or similar over-the-counter therapies will help. If constipation is a problem consider adding more fiber to your diet, Metamucil or a MILD stool softener. Remember that pain medications slow down intestinal mobility and can cause constipation. Walk slowly, as normally as possible and as much as you comfortably can & drink water.
• Attempt to stand up as straight as possible. With an abdominal incision there is the tendency to slouch over because it hurts - to continue to do so will allow the muscles to contract and erect posture will be difficult at a later date.
• Get out of the hospital as quickly as you can . . . it's the worst place to be to heal. Try to stay only two days and then get home for your real recovery. Take walks as soon as you're able. Make sure you have someone at home who will let you rest, rest, and more rest.
• Should you find yourself constipated, and if you're a regular coffee drinker, have a cup of coffee!
• Try to maintain your pre-surgical food consumption. Sometimes estrogen therapy may increase your weight. The urge to snack while at home recuperating can cause additional weight gain. (Another point of view on eating after surgery is that it maybe better to eat more to provide extra nutrition for healing and to offset the exhaustion women feel after surgery, rather than dieting during this time.)
• Your most comfortable pre-op position in bed may not be comfortable post-operatively, at first. Experiment with recreating the positions that were comfortable in a hospital bed with pillows under your knees and supporting your back.
• Do not bathe or shower until your doctor gives permission to do so. When it is allowed, make sure someone is nearby in case you need them―at least the first few times you bathe.
• Do not drive a car until the doctor allows you. The need to brake suddenly may be painful early on and that is a dangerous position to be in.
• Keep stress levels down. Let others help you when and where needed. This is not the time to be superwoman.
• Restrict lifting children, pets, and heavy things. Although you may not feel it―abdominal muscles are used in these activities and these muscles need time to heal after being cut.
• If you will be home alone during the day have an ice chest next to your bed or chair for fruits, drinks, and sandwiches.
• Attempt to wean your usage of narcotic pain medication opting for analgesics as soon as possible. (Another point of view on this is that it is important to be proactive in the use of pain meds, especially at first. If you know you're going to be up for a while, or doing something more active, having pain meds on board will help prevent the "backlash" that we sometimes get. Women should not suffer through the pain because it can do nasty things like raise blood pressure. Taper down, by all means, but don't push it.
)
• Update your telephone answering machine daily to avoid having to give individual status reports to well-wishers checking in on you.
• Some people believe that massaging the incision area speeds up healing. However, do not use any creams, lotions, or Vitamin E oil until the incision is completely closed.
• This is important! This is not for *infected* or open incisions, but to *keep* the incision from getting goopy, infected, opening if you have belly overhang. Do this only after discussing it with your surgeon. It is used for continual wound drainage. Ask your nurse for a "peri bottle" before leaving the hospital & when you get home rinse the incision site after your shower with hydrogen peroxide from the peri bottle. Then, very gently, pat the area dry and further dry it with a hair dryer on a COOL setting. Place long strips of cotton about 2" wide (from old T-shirts or underwear) long enough to cover the incision with room for the cotton to stick out the sides of your belly over the incision. The cotton acts as a wick to draw moisture away from the incision. This is particularly helpful when there is overhang of abdominal tissue over the incision site.

Below are suggestions from women who have successfully used homeopathic remedies

(please note: you must work with a skilled homeopath to decide what remedies will work for you).

1. Arnica 10M:  3 single doses one day pre-op and 3 single doses immediately post-op to minimize bruising.  Do not use for more than 7 days in total.

2. Causticum 30: if having trouble urinating.

3. Cantharis 30:  if only producing small amounts of urine and burning sensation.

4. Nus Vomica 6 or 30: post-operative nausea, constipation and irritability.

5. HYPERICUM 6 or BELLIS PERENNIS 6 - for bruised, deep sore feeling.

Summary

This is just an overview. Ideally your surgeon and/or the hospital staff have given you guidelines. If in doubt of whether your should participate in an activity―lean towards the conservative. Remedies for one person can be poison for another. While operations may have the same end result, often times the procedures were performed differently, & there may have been special considerations or consequences for you. We are all different, so when in doubt ask your health care provider. Sans-Uteri is here to be a support for you―offering our advice and empathy and solutions that have worked for us.

This project was the joint effort of the members of Sans-Uteri. Our attempt was to incorporate, in a general sense, information that would be helpful to the largest population. Ideally, your surgeon will give recommendations that have been successful in their practice. If a bowel prep is required, your surgeon will go over those details with you. That issue will not be discussed here because not all surgeries nor surgeons require this.

Many thanks to the participants of Sans-Uteri and Ellen Blumin for the pre and post hysterectomy suggestions. If you would like to add to this list please contact the List Managers.