Interventional Radiology UK NHS – What Happens?

Imaging of the right kidney using Digital Subtraction Angiography (researchgate.net) or DSA, a technique used for imaging in interventional radiology

I wrote a blog post in April about the LLETZ procedure and my experiences with HPV, colposcopy, smear tests, and eventual excision of the transformation zone – this post was popular and one or two people wrote to me and said they were having the LLETZ and the post helped them understand what would happen.

So, I wondered how many people out there have been booked in for interventional radiology and have no idea what to expect? I figured I could help them out here – I’ve had two procedures under interventional radiology ordered by my hospital treating my endocrine/renal/blood pressure issues, St Bart’s Hospital in London, although the procedures themselves were carried out at the Royal London Hospital, which is part of the St Bart’s network.

Please note that although I am briefly giving accounts of my experiences, I am not giving medical advice or offering any form of education – I’m a patient, a lay person, and anything you need to know must be discussed with your doctor. What I can give you is an honest overview of what you can expect if you’re having this procedure yourself. With that said, I hope you find this useful and I hope it brings you calm to read about somebody else’s experience.

What is interventional radiology?

Interventional radiology is a medical subspecialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography, magnetic resonance imaging, or ultrasound.

https://en.wikipedia.org/wiki/Interventional_radiology

What procedures did I have, and why?

I was recommended for a right-kidney embolisation using interventional radiology because my doctors suspected that a small blood supply to my very damaged kidney (see my 8lb tumour story here) was causing my extremely high blood pressure, which I’ve suffered with since the age of 26. I’m now 30 and still taking three medications a day to control my blood pressure. I’m at risk of stroke and eyesight problems (which I’ve already had a brush with when my high blood pressure was first discovered) and pregnancy for me is considered high-risk, with extra monitoring required and a change of medications. I had a successful embolisation procedure, which sadly did not reduce my blood pressure problems as hoped, and I had a second procedure to investigate other areas which could need embolising, resulting in no need for further treatment as there were no vessels feeding into the kidney.

What happened?

This procedure was treated as a day-stay procedure, but largely went ahead in much the same manner as any other operation on both occasions. I was asked to present myself at Royal London at 7am and await my turn, where I was gowned up and the procedure explained to me. I met with the anaesthetist and consultant who would be carrying out the operation, and I was fitted with a canula in the preparation room. I was then led to the operating theatre where I could hop-up on the bed myself and get comfy. The anaesthetist then fed a line into my cannula and spoke to me while the team busied themselves around the room, all gowned up in scrubs and masks of course. As my second procedure happened during the covid-19 lockdown, I had to wear my mask before and after the procedure.

The anaesthetist then began feeding the (beautiful, beautiful) drugs into my system, watching me and speaking to me to test how sleepy I was getting. The drugs flood through you in a magnificent wave of pure happiness, I assure you – it’s a beautiful fuzzy feeling, so don’t be afraid of it and just enjoy the ride. Everything is very carefully calculated, monitored and controlled by the anaesthetist. My particular procedure required access through a vein in my groin, where a thin wire was fed up through my aorta, through my heart (I believe!) and back down towards the right kidney, going with the blood flow. To the best of my memory that’s how it was done both times, but if you’re a medic, please correct me if I’ve gotten anything wrong there. These can be a little painful and you need to be incredibly still, so naturally it’s best to go under anaesthetic. The anaesthetist put an oxygen mask over my mouth and nose, as levels tend to drop when going under any kind of sedation or anaesthesia. There is no intubation required for this type of sedation and it is all fed in via cannula, allowing the anaesthetist to control your sleep and wake you up if need be. Not long after enjoying the psychedelic wooziness of the drugs in my system, my eyelids started to feel heavy. Eventually I dropped off to sleep as if I was taking a nap on the sofa.

During my first procedure, I was brought awake once or twice in order to breathe in and hold it – this was to allow them to take an accurate X-ray. Once they’d achieved the image, I drifted back to sleep. I do remember bits and pieces of this surgery – I remember feeling as if I’d been abducted by aliens. I woke up several times and saw the doctors gathered together around monitors at one point, and feeding the line into my groin in the next moment, and so on – it happened in snapshots. I often looked at the anaesthetist and he spoke to me and asked if I’m okay, if I was enjoying my intermittent napping. During the second procedure however, I was totally out for the count for the entire procedure. I woke up and asked how long it had been, and was shocked to find I’d been asleep for 1hr 30 minutes!

After both procedures, there was a lot of pressure applied to the site on my groin, as the artery will naturally spout out a lot of blood and needs pressure to help it clot and heal. After both procedures, I was left with a lot of bruising in this area – this is fine and should be expected, especially if you bruise like a peach as I do. As they wheeled me off to the recovery room after my second procedure, unfortunately my leg decided it wasn’t done bleeding and it was pooling out of me – however, I told the nurse and we stopped in the middle of the corridor to apply more pressure and more dressings.

I stayed for a short time in a recovery room (one or two hours) where I was given an electric blanket (on both occasions!), which was a god-send, because after both surgeries, I felt absolutely freezing cold, shivering even. Then, it was 4 hours of bed-rest and dozing off in a general ward/ recovery area. I think I was allowed water and eventually food, but I had to stay laying down because the wound was delicate and needs opportunity to heal properly. Unfortunately on both occasions I needed to pee like you wouldn’t believe, to the point where I just couldn’t hold it. The nurse brought me a bed-pan both times and I had to pee with the curtain pulled around me. I’d never peed so much in my life! Top-tip – if you’re worried about anyone hearing you, ask the nurse to put toilet paper in the bottom of the pan so your pee doesn’t echo against the metal bowl. You will thank me!

After my first procedure I had a morphine drip, which was a delight, and I clicked away until I was enjoying a heady trip. Morphine is a happiness drug for me and I can say for sure that I understand why people get addicted to opiates, though I of course do not condone drug use (or theft or misuse of morphine for that matter!) However, after my second procedure I didn’t need pain relief and so I just basked in post-anaesthesia doziness. Eventually I was allowed to go home, so I washed briefly in the washroom/loo and dressed very groggily in my going-home clothes. During the first procedure I was staying with family, but after the second I elected to recover for a few days at my then-boyfriend’s house (now my fiancΓ©!) and keep away from family in case I’d contracted covid.

Aftercare

Given mine was a day procedure, my aftercare was pyjamas, love, movies, pizza, and a day or two off work spent napping. However, yours may be different and it really depends what you’re having done. My advice is you listen to what the team tells you and don’t deviate from their advice, or do so at your own risk. Remember to relax, rest and recuperate -your body has been through a lot. Anaesthetic can make you feel dozy and groggy for a good few days and I for one napped for England. Eventually I was able to take off the dressing (again, the nurse will advise you about aftercare of your wound – don’t deviate from this or you risk infection) and I had a fair amount of bruising, but I felt no other after-effects.

All in all, I was very happy with my treatment both times and I was once again amazed by the level of care available to us on the NHS. No matter how worried or scared you get, just remember the first-class health service you are receiving and how envied we are the world over. I for one feel nothing but gratitude for the healthcare I’ve received.

I hope if you’re having interventional radiology that you find this blog helpful. Just remember that, as with most things, it’s all in the mind. Stay calm, trust your professionals, and ask questions – lots of questions – if you need to. Consider all your options and work with them. Remember, they want to help you and they wouldn’t offer these procedures unless they absolutely felt it was in your best interests.

Thank you for reading, and I hope your procedures go as smoothly as mine did!

Best wishes,
Ashleigh

How to Get Through Major Surgery

Welcome to my blog! I put out new posts every Wednesday on topics ranging from careers to crafts, and poetry to health.

The following is supposed to be genuinely helpful for people about to go through major surgery to the abdomen like I did in 2017.

It’s also an opportunity to show off my massive tumour and pat myself on the back for being a big, brave girl. πŸ˜‰

Regardless, I do genuinely believe that sharing our experiences can help one another (providing we aren’t scare-mongering or sharing untruthful information) because it’s only through sharing that we feel less alone.

Backstory

In Spring of 2017, I had a funny feeling in my right-side when I laid down, so I went to the doctor and told him I thought something was up with my kidney. Being a good lad, he booked me for an ultrasound scan. I got a phone call at work to say they’d found a “shadow”, which scared the shit out of me, and they wanted to do an MRI.
I could tell by the looks on their faces after they’d scanned me that they’d seen something, but I had an agonising weeks-long wait before I was called in to discuss it. I caved and phoned in, to be told that there was “nothing to worry about”, but that the doctor would still like to see me.
(This appointment and what followed changed my life forever, but I guess worrying wouldn’t have helped much)

My MRI abdomen showing my 20cm Phaeochromocytoma
(And yes, I am showing off!)



I went to my appointment and was shown a strange image of a giant mushroom.
Eventually I realised that this was in fact my MRI scan, and that “mushroom” was in me. They said it was a 20cm long mass, and they (mistakenly) thought it was a Hepatic Adenoma, which is a tumor arising from being on “the pill”. They would soon find out they were wrong, but it wasn’t an unreasonable diagnosis based on the scan.
They were very certain, just by looking, that it wasn’t cancer. Happy days. But it was absolutely huge and it was going to cause me problems for the rest of my life, so I was referred for surgery at the Royal London Hospital.

It was only when they opened me up that they realised this was not a hepatic adenoma. In fact, they had no idea what it was. I was put out via an epidural and the surgery took about 8 hours. The tumor bled profusely and I lost a scary amount of blood, so I had several tansfusions when I was moved to the ICU, where I began my slow, arduous, sticky, sweaty recovery, with tubes seemingly coming out of every available vein.

Three weeks post-surgery, I received a call to say they’d tested the tumour and found it to be a Pheochromocytoma, caused by a mutation of the SDH-B gene, which is a tumor suppressant.
The surgery killed off my kidney, but left a small blood supply (they think) which has since caused me to have ridiculously high blood pressure. I’m on several pills to calm this down, and unfortunately a further surgery (awake, I might add, on beautiful drugs) for interventional radiology did not fix my kidney problem.

So alas, I am still suffering in a way, and my gene mutation means I’ll be monitored for life (as will my family), which has its good and bad points. I’m here though, and I survived the giant tumor, so there is that.

I’m not going to talk about SDH-B or the pheo, because I wanted to make a practical post for people about to face major surgery. You could say I learned a thing or two.

So if you’re facing major surgery, I hope this is helpful advice for your recovery. If you have any questions or just want to talk things out, get in touch with me.

Disclaimer: I am not a medical professional. I’m an experienced medical patient but I have no medical knowledge at all. All of the below is based on my experiences only and is not to be taken as medical advice.
If you need medical advice, ask a healthcare professional such as a GP, nurse, or surgeon.

Don’t do it alone

First and foremost: when you know you’re going in for major surgery, surround yourself with those who love and care about you. You need them to look after you. You’ll be struggling to walk upright for a while after abdominal surgery and you’ll need help just to get out of your seat. Not just in hospital, but at home too. This is going to last a while. Don’t despair; you are loved and you will spend this time feeling beyond grateful for the existence of these people in your life.

If you live alone and have contact with your family (and hopefully a good relationship), I strongly advise that you organise someone to stay with you, or for you to stay with them.

If you are estranged from family and don’t have friends who can help, then you need to arrange for carers to help you in the home. Your hospital will arrange for your aftercare if you do not have support at home. They will establish this prior to surgery in their questioning, so be honest.

Let people look after you. You’re going to be irritable, angry and in pain, even in spite of the pain relief. This is a tough time. Try to be patient with people and let them care for you. You’ll be grateful when you’re ‘you’ again.

Pain relief medicine is your best friend

Do yourself a favour and don’t attempt to go through hell just so you can be the hero. You will lose this fight, so you might as well trust your doctors and take the prescribed pain relief.
If you find that the pain relief isn’t working well enough, this may well be for your own safety; you’re going to be given heavy drugs and they might be restrictive with the doses.
What’s more is that the drugs can become addictive (and no, taking your prescription will not make you an addict overnight) and so they might be going softly-softly at first before upping the dose when required.

Some medicines affect people differently than others. Tramadol, for example, made me sweaty, twitchy, and I came down with nightmares. I communicated my issues and they changed me to something more agreeable.
I was on a constant stream of both morphine and Tramadol while in hospital. The morphine was administered first through my epidural (I believe), and later, once this was removed, I took Oramorph (morphine which you administer yourself via a syringe to the mouth). I couldn’t even turn my body to see the clock on the wall, and one nurse joked that she wasn’t going to tell me because I’d be watching the clock for my next dose.

As time goes by, your pain will ease up. My stitches (see above) pulled relentlessly for a long time, but I found pain relief and bio oil helped. You’re on a journey here. Do yourself a favour and use the tools you are given to recover as comfortably as you can

Nursing & physio

In my experience – and as far as I’m concerned – the staff at the Royal London Hospital (and at St Bart’s for that matter) were angels sent to earth. I’ve never felt so well looked after before and I’ve felt so very, very grateful for the care I received.
When I was in the high dependency unit, I would often find myself waking up during the night to find my own nurse waiting right there for me. They’d smile, whisper and ask if I’m okay, and tend to my every need. Whenever I woke up, there they were.
I know you hear some bad stories out there, but please don’t be afraid. My experience of NHS staff has been amazing and I honestly shed tears when I think of them. You are in excellent hands.

Of course, if you are worried about your care or the way you’ve been treated, then communicate this to other members of staff or escalate the issue to the appropriate body. Whilst my experience could not be faulted, I accept that not everybody has had such good fortune.

Physiotherapy begins the very next day after your surgery. When my physio team arrived, I looked at them as if to say “Are you f-ing serious? You think I can get up?!”
There is a very good reason for why they insist on attempting to get you out of bed so soon, and it’s because the body starts healing itself much faster the sooner you get started.
When I first tried to walk, I had a catheter, a drip stand, a tube in my neck, and a tube draining fluid out my right side. I was held upright by two people who helped me walk from one end of the corridor to the other. I was hunched over like an old lady (you will find it hard to stand upright after abdominal surgery) and I was sweating, dizzy, and faint.

However, with their help, I did it. I even went up and down a small flight of stairs at the end.

Sure, I conked out the second I got back into bed and went off into fairyland, but your body is fragile at this point. Your achievements will be little but often, and that’s just fine.

Keep in contact with the ward

When you go home, it’s a good idea to be monitoring your blood pressure and your temperature daily, especially within the first couple of weeks. Sepsis is not likely to occur if you’ve gone home, because they will have been monitoring you for this in hospital, but it’s worth knowing the signs.

However, secondary infections can occur, especially if you’re particularly vulnerable, and in my experience these present themselves via your body temperature. Paracetamol and other medications can mask this by bringing your temperature down, so just try your best to be observant.

If you have any issues at all, your ward will want to know. Do not be afraid to call them for advice. You’ll be on a recovery pathway and it’s their duty to continue with your care even after you go home, so do not go thinking you’re making a fuss or wasting their time. You are what they’re working for.

Recovering at home

I was signed off for 3 months to recover from surgery, and I ended up taking 2 weeks more.

I was one of those dear, sweet fools who thought they’d come bouncing back after just a couple of weeks. Nah. It did not happen like that.

Get things straight with your workplace and make sure they understand that this is absolutely crucial and non-negotiable. No reputable employer would question this recovery period – not if they don’t want to be liable for your health and any injuries incurred if you come back too early.

Recovering at home is actually the hardest part. You are at home, you are grumpy, and you are in pain. You might even be surrounded by well-meaning people who are getting on your nerves.

Try to use this time to rest. I myself got into some pretty interesting hobbies during my time off! I built a snail terrarium in a big green bottle, I bought a big fish tank and bought myself a lovely goldfish, and I practised watercolour painting, amongst many other fads and creative pursuits. This is your time to recover and it’s up to you how you use it.

I found that going on slow walks in nature helped me to get used to my new body while it healed.
I also found that my appetite changed for quite some time and I dropped a lot of weight. Don’t be alarmed; you will be back to your old self in no time and, sadly, you’ll put that weight back on once your appetite returns!

To conclude

I hope this post might be useful for someone who has a phaeochromocytoma or anybody who is facing surgery to the abdomen. I did a lot of internet searching before I had surgery and it helped me to read about other people’s experiences.

Remember that recovery is a physical process, but how you deal with it emotionally is all in the mind.

Be kind to yourself, pace yourself, and give your body the time it needs to heal. Your body puts up with a lot throughout its lifetime and it’s done you proud, so cut the poor thing a break. You, in the meantime, should take up a hobby.

All the best until next time,
Ashleigh