COIL REMOVAL SURGERY AND RECOVERY

SEE UPDATES BELOW;  LAST UPDATE 23 NOVEMBER (1 YEAR AFTER OPERATION).

THE OPERATION

I went into the clinic about noon on the 18th of November.  I was asked to fast 12 hours before going in.  No other preparation other than showering with Betadine.  After the usual bureaucratic paperwork, i was suited up, bedded down and wheeled off to surgery a couple hours later.  I had general anesthesia.  I didnt see much of the surgery room before going under because they made me take my glasses off and i have poor natural vision. 

The following is the video I currently have from the surgery.  sorry i know it’s not complete and that’s a bit frustrating but he hasn’t given me the rest.


The operation report is pretty minimal, unfortunately (what type of antibiotic created my rash?   Type of stitches used?  Etc.) :

Après avoir fait les orifices permettant l’abord péritonéal, on retrouve en transparence péritonéale les deux parties du ressort.   Il faut noter qu’il existe des adhérences coliques qui sont probablement à l’origine de ses douleurs.   On libère toutes ces adhérences.  On ouvre le péritoine.   On dissèque en haut et en bas la totalité de la veine spermatique embolisée.   Ligature de cette veine en retirant la totalité du ressort.   Fermeture des différents orifices.

My translation :

After having made the openings that allow for peritoneal access, we were able to find the two parts of the coil in the transparent peritoneal areas.  We noted that there was adhesion to the colon, which was probably at the origin of the patient’s pain.  We liberated these adhesions.  We opened the peritoneum.  We dissected above and below all of the embolized spermatic vein.  Ligation of the vein by removing the coil completely.  Closure of the different openings.

You could compare this to my rudimentary translation of the technical operating room report for the coil removal surgery of Fabian’s doctor in switzerland, which is much more complete.  The doctor does not want to post his name.  See original in French in Fabian’s post on the Preface page.  Sorry, no promises as to the accuracy of the translation, I did my best :

Patient in supine position under general (spinal) anesthesia.  Zinacef 1.5g via i.v. induction.  Arcuate incision in the left inguinal fold at the para-pubic starting point, where the spermatic cord (which has been closed off with a lasso (Lacs)) can be distinguished.  Local palpation demonstrates that there are some hard nodes where a coil is suspected to be located, to be cut out.  We first located the most laterally placed coil in the spermatic cord. Indeed, there was clearly a piece of metal here attached to a small nerve, to be coagulated and sectioned. Complete excision of the coil. We then returned to the left para-pubic area to find the same type of material in contact with the bone. Excision. Note: for the excision of the first coil we had to open the aponeurosis of the external abdominal oblique muscle in order to follow the cord to the deeper orifice.  Washing of the surgical site with saline solution. Closure of the fascia of the external abdominal oblique muscle with Vicryl 2.0.  Superficial closure with Vicryl 3.0 and a continuous intradermal stitch of Monocryl 4.0 with water.

POST-OPERATION

I woke up fours after going under in a different room.  The nurses told me that everything went fine.  I don’t know if it’s my imagination or real, but as soon as i was lucidly awake, i could feel that the coils were no longer there.   I had basically three bandaged points, hardly looked as if i had had surgery (click on images for enlargement) :

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That being said, the points were painful for the first day.  They used morphine in an intravenous drip immediately in post surgery but when i asked for more they told me i had reached my quote so i began going with intravenous Paracetamol (aka tylenol).  I could not lean on my left side without considerable pain and was bed stricken.  I had pain in the shoulder area.  I learned later that this pain comes from the CO² gas they put in during laparoscopic surgery…. it rises inside the chest cavity and is painful but once you know what it’s from it’s really not that bad all things considered.

I saw the surgeon a couple hours later.  I had mentioned to him before the surgery that i believed that the coils were attached onto the intestine and pulling on it.  After the surgery, he told me that he and his colleagues hadn’t believed me but it was in fact true—there was adhesion between the coils and the intestine to such an extent that it took ten minutes to detach the coil via scalpel. So he was not surprised that i had had digestive issues.  The doctor gave me the coils that were removed (i will have to clean them, they’re pretty unsightly…) : (sorry a bit graphic.  click on image for hi-def).  

I was in the clinic for the night.  I woke up at 3am with pain, they gave me more Tylenol via IV.  Went back to bed, woke again definitively at 5am (The anesthesia really screws with sleep patterns apparently.)  I just read for a while in bed.  Minimal pain but getting up to go to the bathroom was painful and annoying bc i still had the IV.    Again, the left side incisions were sensitive but the gas pains outside of the intestinal cavity, are probably the most painful thing after the first day.  Apparently, the best fix is to walk around as much as possible : https://healdove.com/health-care-industry/Getting-Gas-Pain-Relief-after-Surgery  . I did this and felt considerably better.  I took a taxi home at the end of the day after surgery. 

Laughing in the day or so following surgery was excruciating to the surgery wounds.  Avoid funny people at all costs.  And sneezing. 

The surgery incisions one day after surgery :

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WEEK 1 FOLLOWING SURGERY

The gas pains lingered for about a week or so, progressively getting less and less.  Two days after surgery i was walking around fine, i just had to avoid flexing my ab muscles.  Three days after surgery i even spent the day building shelves (yes, no joke… obviously this was not ideal, but i could not avoid it for a myriad of reasons i won’t go into). 

I went back to the surgeon to have my staples removed on Day 7.  The top and bottom incisions seemed to have healed super rapidly.  A photo of the points on Day 9 (wow this photo came out quite pasty…) :

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Redness around wounds is from the bandage adhesive (except for the staple marks and associated bruising).

I thought that the muscles beneath the middle incision were quite tight but this turned out to be a hematoma, undoubtedly because of laughing/sneezing/overdoing it in the week following surgery..  as you can see in the photos, the area is nice and swollen.  I have also noticed some smaller nodes in the tissue below the bottom incision point. hard to tell what is hematoma and what is scar tissue forming.

For those of you curious but timid, i already had sex on Day 5 or 6, all is well.

One very annoying thing about the surgery was a weird dermatological reaction that occurred on my right side (the opposite side from the incisions) and some on my back.  This reaction subtly started the day after the operation.  I just assumed it was a temporary thing and would go away but it got worse and worst until four days after the operation i took action and contacted the surgeon.  He prescribed the anti-inflammatory Prednisone (which, according to my general practitioner, was a bad idea, because it may have “hidden” the arising hematoma).  When I saw the surgeon on Day 7, he said it was a reaction to the sling but i am almost postive the antibiotics used may have played a role (my GP agrees with me).  It has cleared up considerably, but is still visible.   After Day 3 or 4, it didn’t really spread, just got more and more red and itchy.   This is a photo after 9 days after the operation :

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WEEK 2 and 3

At two and a half weeks, this is what my incision points look like:

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The hematoma has reduced notably, but is still slightly present, as you can see.  but it feels much better, and less inflamed overall. i have been massaging the hematoma to help it disperse.  The staples marks are disappearing and i will undoubtedly have scars from the incisions.  I still have a couple months before summer hits to make up some great scar stories. 

The antibiotic rash is pretty much gone… there is a slight hint of it still on my side

I did experience what seemed like interior inflammation, at the area where the coils were removed, in week 2.  probably bc i did yoga and went running at the end of week 2.  As of the end of week 3, i have not gone running again but i have been stretching.  I have not re-experienced the interior inflammation.  so clearly, the area where the coils were cut out is healing and needs a bit of time before i start getting too physical.  I have been using Arnica gel locally on my abs.

I have been doing the “cobra position” (lying on my stomach and pushing my shoulders up in the air) and thus stretching my abs.  i feel great doing this, as i haven’t felt in many years (as you may have read in my “long story”, it was this action that caused the first “sharp pain” post-embolization.  It’s as if I am giving blood and circulation and loosening up nerves that haven’t been awake for a long long time. 

I have been pretty active sexually, no problems on that front.  In fact, i feel great.  Don’t know if it’s psychological, but i feel notably better in terms of blood flow, maybe related to what i mentioned in the last paragraph. 

I had some tightness at my lower colon during week 2, probably related to the interior inflammation, but this has gotten better and my colon feels fine. 

so overall, i think recovery is going well.  As of Day 23 post surgery, i am very happy that i had the coils removed, i feel no daunting negative consequences of the removal, there is not even the remotest doubt that these coils were creating all kinds of horrible problems, whether from the metal, their adhesion to the colon, their touching nerves, who knows—or all of the above. 

WEEK 4

It has been exactly one month since my surgery. 
The hematoma is still present, doesnt seem to be going anywhere fast, and the rash has all but gone away. 

Visibly my ab looks pretty much like the last photo i posted. 
I have noticed that my left varicocele has slightly reappeared, and my left testicle is more sensitive than it has been in a long time.   This does not particularly bother me, in fact i feel pretty good about it (not sure if i should) because it means that blood is getting back into the testes and these may get back to the way things were “pre-embolization”. 

I still perceive some inner inflammation at the place where the coils were removed.  I have not been running since week 2, But i’ll probably give that a try in a week or so.  During sex, i have tried to be a little less violent on the ab area, which seems to have helped inflammation.  Like when i first had the embolization, the inflammation seems to be most notable when i am sitting.  but, unlike the emolizatiuon inflammation, this inflammation is really not too bad. 

I have been doing yoga without problems but i do feel very tight and achy painful in what seems like the ab psoas when i perform the Utthita Parsvakonasana ( http://www.yogajournal.com/pose/extended-side-angle-pose/ ), when my left arm is above my head.  clearly things are a bit tight in the abdominal area, either because of the hematoma or the coil removal, or probably both. 

I repeat that I absolutely do not regret the removal operation and there is no doubt that my body is much better without them.  and that the small pains associated with the removal are worth it. 

WEEK 6

Feeling much less tight in the ab area, i have been stretching daily. 
No recent inflammation pain in the operation area.  I feel fine overall. 
The varicocele that i mentioned coming back is really quite small and hasn’t appeared to grow (and isn’t painful).

I do still have a bump underneath the middle scar.  Dont know if it’s the remains of a hematoma, or the muscle healing in a funny way.  But it doesn’t hurt.  I’d rather it not be there but it’s not the end of the world either.  It has reduced in size since the last photos. 

TWO MONTHS

Same as 6 week status.  Yoga and running without pain.  All seems well. 

FOUR MONTHS

18 MARCH 2017

I am exercising (running and playing football ie soccer) as i haven’t been able to in years.  I was an avid runner and athlete before the embolization in 2008.  After the embolization, I began having abdomen pain and cramps while running, even after 5 minutes.  As previously described, it was a weird upper left abdomen cramping… similar to a “normal” ab cramp but in a weird upper location.   The pain and cramping got better with therapy (osteopathy and deep tissue massages) but never completely went away.  Until now.  I am happy to say that i have been able to get back running quite hard over the last month and haven’t experienced any cramping.

Playing football with no embolization related pain (i am a bit out of shape…;).

Above all, i have energy flow, i can feel a serious difference.  I can “get in the groove” of running.  If all is well in the body, exercise should give you energy not take it.  It has been a very long time since I’ve felt exercise giving me energy…. since i’ve been able to push myself, exhaust myself physically but keep going and feel physically good about it afterwards. 

So currently I am perfectly happy with the results of the procedure. Here is what my ab currently looks like :

There is still noticeable scar tissue underneath the middle incision point (the point to the right of my belly button in this photo) but i keep massaging it and it seems to slowly reduce in size.  No associated pain, even while doing ab exercises, but it is present.

1 YEAR

18 NOVEMBER 2017

It has now been one year since the coil removal.  I haven’t regretted the removal operation for one second during all of this time.  I would do it again without hesitation.  I feel much better without the coils. 

My varicocele, already resurfacing a little bit in the years following the embolization, has come back more since having the coil removal.  But, still, if I had to choose between the coils and the varicocele, I would choose the varicocele any day of the week.  

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