If you have had a big operation, you might wake up in an intensive care or a high dependency unit, instead of the ward you were on before the surgery. You usually move back to the ward within a day or so.
In intensive care you have one to one nursing care. In the high dependency unit you have very close nursing care. Your surgeon and anaesthetist also keep a close eye on your progress.
These units are busy and often noisy places that some people find strange and disorienting. You'll feel drowsy because of the anaesthetic and painkillers.
Tubes, drains and drips
When you wake up, you might have several tubes in you, depending on the type of operation you had. This can be frightening, so it helps to know what they’re for.
You might have:
Drips (intravenous infusions)
You might have one or more drips. They give you fluids until you are eating and drinking again, and blood if you need it.
There might be a couple of electronic pumps attached to one or more of your drips. These give you a constant, measured dose of painkillers or other drugs you might need to have through your drip.
A tube into your bladder (catheter)
You might have a tube into your bladder, called a catheter. This is so your nurse can collect and measure your urine. This helps them make sure you don’t get dehydrated or have too much fluid in your body.
A tube into your stomach
Eating and swallowing are difficult until you recover and any swelling goes down. So you might be fed liquid food through a fine tube into your stomach.
After surgery to remove the tumour from your nasopharynx, you are most likely to have a gastrostomy (PEG) tube. This goes directly through the skin into your stomach.
You might have one or more wound drains. These come out of your neck or near your wound. They collect blood and fluid, to stop them from collecting around the operation site. This helps to stop you getting an infection and helps you heal.
The wound drains connect to suction bottles, which help to gently draw out the fluid. When the fluid stops coming out, your nurse takes the drains out. It usually takes a few days for the wound to stop draining.
A clip on your finger (pulse oximeter)
When you first wake up, you have a little clip on your finger called a pulse oximeter. This is to measure your pulse and blood oxygen levels. Your nurse also measures your temperature and blood pressure often during the first few hours.
You might have an oxygen mask on for a while.
It’s normal to have pain for the first week or so. Your doctor and nurses give you painkillers.
Tell your doctor or nurse as soon as you feel any pain. They need your help to find the right type and dose of painkiller for you. Painkillers work best when you take them regularly.
Immediately after surgery you might have painkillers through a drip into the bloodstream that you control. This is called patient controlled analgesia (PCA).
You get painkillers to take home. Follow the instructions your nurse gives you about how often and when to take them. Contact your doctor if you still have pain or if it gets worse.
After surgery to remove lymph nodes in your neck (a neck dissection) your surgeon might cover the wound with a dressing. The dressing might be left in place for a couple of days. Or they might spray a clear protective film over your wound. This helps the doctors and nurses to see your wound clearly.
If you have stitches or clips, they stay in for around 10 days. You will probably have them taken out before you go home. But your doctor might let you go home with your stitches still in if your wound is not completely healed but you are well. You can go back to the hospital to have them taken out. Or a district nurse can visit you at home to remove them.
If you have wounds inside your mouth or throat, your surgeon will have used stitches that dissolve and don’t need to be taken out.
Eating and drinking
Whether or not you can eat and drink after your operation depends on the operation you had.
After surgery to remove a tumour in your nasopharynx, you are most likely to be fed through a gastrostomy (PEG) tube into your stomach.
After a neck dissection, you are usually allowed to eat and drink on the same day or the day after your operation. This depends on how sore your neck is and whether you feel like eating or not.
Surgical and nursing teams generally recommend eating and drinking the same day to help with recovery.
Once you have fully recovered from your operation, there are usually no restrictions on what you can eat and drink.
Getting up might seem impossible at first. Moving about helps you to get better, but you do need to start gradually.
Your nurses and physiotherapists help you to move around as soon as possible, usually from the day after your operation. They check you’re doing your breathing and leg exercises regularly.
Over the next couple of days, your nurse takes out most of the tubes and drains. So it gets much easier to move around.
Your physiotherapists will give you neck and shoulder exercises to do several times a day. You gradually increase the time you hold each posture as it becomes more comfortable. You usually carry on doing these for a few months after surgery.
After a few days you can be up and about more. Gradually, you start to feel better.
At first, eating is easier if you have lots of very small meals rather than 3 large meals a day. The hospital dietitian will give you help and advice with managing your diet.
Often people have lost quite a bit of weight by the time they are diagnosed with a cancer of the head or neck.
If you have lost quite a lot of weight, your doctor or dietitian will probably recommend that you try and boost your calorie intake with some high calorie liquid feeds. These usually come as small carton drinks.
These drinks have all the vitamins, protein and carbohydrate that you need for a balanced diet. If you’re trying to put weight on, you can sip these through the day as well as eating meals. They come in many flavours, both savoury and sweet. Available brands include Ensure, Fresubin, Fortisip, Complan and Build Up.
You can also get powdered protein or carbohydrate supplements to sprinkle on foods and drinks. A dietitian will be able to help you plan a suitable diet and advise on supplements.
You are likely to have times when you feel very down. Try to be patient with yourself while you fully recover from your operation.
You have had your cancer diagnosis to come to terms with and you have been through a big operation. You may need a lot of support from your doctors and nurses, family and friends.
After you have had surgery, you have regular appointments to check your recovery and sort out any problems. This is called follow up. Your appointments are a good opportunity to raise any concerns you have about your progress.
The first appointment is usually within two weeks. Your doctor gives you the results of your surgery and checks for any issues following your operation. Your appointments gradually get further apart as you recover.