The Cutting Edge or Adventures After Surgery

Wednesday, July 10th - Day of Surgery - I had a general and no nerve block. My anesthesiologist told me she would introduce me to everyone in the OR, and she did. I had a glance in front of me while she was accomplishing this where I saw a vast array of shiny steel hardware and was able to think, "OMG, some of that is going in me!" That was my last conscious thought til recovery. The surgery took almost exactly two hours. I woke quickly and was amazed it was over. Not too long afterward, and I really have no idea how long, I was moved to my room which was private (surprise!) and huge. I had a PCA morphine pump, and the pain was minimal. I usually was able to adjust my hip or leg slightly to change the amount of pain. I also had fluids and antibiotic through the IV. I did not have a Foley during or after surgery. I had TED hose on my non-surgery leg which I had put on pre-surgery, plus a wrap around pump like contraption on top of the hose which would inflate and deflate randomly. The Iceman Cold Therapy machine was kept running constantly. Wednesday night was long, and I seemed to wake every hour needing to empty my bladder. The bedpan and I were not friends. So hard to release in bed, yet I had such a full bladder. Hard to have to ask people to help you go to the bathroom particularly when it was so often. My mouth was exceedingly dry, so I was using ice chips at first, and then water in copious amounts which did not help the bedpan relationship.
Thursday, one day post-op - still feeling pretty good. Still dealing with dry mouth. Wasn't hungry at all for breakfast, but ordered some toast. Could barely get some down. Dry toast and dry mouth are incompatible. Starting to have acid reflux pain. I take omneprazole (prilosec) daily (thank you years of NSAIDS,) but missed it on the day of surgery. They gave me one this a.m., but it takes a while to get back into your body. I kept asking someone for a Tums or Rolaid. Nothing. When my surgeon came in, I asked him about something for the reflux, and told him that if I had my purse, I would have taken some already. He told me to have my husband go get my purse since he didn't think they were in the formulary.
They constantly ask you what your pain level is on a scale of 1-10. I find that very hard to quantify. I think most of the time I was telling them it was in the 2-3 range, but it wasn't painful all the time, twinges or cramps would ramp it up.
I was finally able to go to a real toilet!!!! They moved me to the bathroom in a wheelchair where I had to transfer to the toilet. It felt so strange to stand and wasn't as painful as I had imagined. Emptying bladder is still hard though better than before. I have to really concentrate and push almost like a BM (which also hasn't happened yet.)
I had an 8 a.m. PT appointment where I taken by wheelchair. The PT told me to take things very easy (that was good to hear,) and not to bend past 90 degrees on anything. I first had to walk the parallel bars backwards several times, then actually went up and down a small riser height set of stairs and did some relevés (lifting up to toes) I felt shaky, weak, and especially the pull at the back of my leg. After a couple of rounds on the stairs, the therapist got me on the table for heat on my thigh to drain my lymph, ice on the knee and elevation. She told me to trace the alphabet with my ankles while I was doing the ice/heat thing, but I kept falling asleep between letters.
Back to my room, dry mouth is still a problem. Hard to talk. Acid Reflux is worse. I have no appetite. Ordered a tuna sandwich which tasted like sawdust and I could only eat a small amount.  Husband brings me much needed Tums - relief is just a swallow away.
After lunch I had second therapy.  Walked a few more rounds on the parallel bars, and did 10 minutes on the NuStep without the arms.  I was given my walker, so now it will be easier to motabulate to the bathroom without having to get the nurses out each time.  The PT also has me lifting my foot to the back while using the walker, and putting as much weight as possible on right knee.
When my OS came by today, he asked me if I could lift my leg.  I looked at it, and said, "Lift!"  A slight shaking was about all that happened.  Guess that will happen when it happens.
I'm still hooked up to IV, so I have to drag that around, so I do still have to get nurse help.  Which, BTW, my nursing staff is excellent!  Couldn't ask for better.  Starting to notice that pain upon bladder evacuation has not gone away even though I don't get my bladder as full.  Also I am very sensitive to temperature - sometimes have the shakes as if I am running a fever.  This has the earmarks of bladder infection – Yuck!
Still no appetite.  I ordered the fruit plate for dinner and was able to eat a little, but not much.  I’m trying to eat enough to stay healthy, but really, is losing some appetite such a bad thing?
Thursday evening was somewhat better, only got up every two hours to go to bathroom, plus actually being able to go to the bathroom (as opposed to being in bed) helped.  Still having pain and low grade fever.  The thot plickens.
Friday a.m. I discover today that I have to give myself a shot in the stomach area for the blood thinner required.  The nurse does the first one, but after that, it will be me.  It’s given much the same as an insulin shot which I am familiar with, although since my husband has an insulin pump, he hasn’t had to do that in years.  They’ll send me home with prefilled syringes to use for about the first two weeks.
I feel really rotten.  I tell my nurse that I think I have a bladder infection and also report to my surgeon.  He says he’ll order a sample done and see me in therapy where his P.A. is going to remove my big bandage, so I’ll get to see the Bride of Frankenstein’s leg for the first time.  It doesn’t look too bad for 8-10 inches of staples down the front of your leg.  They put some gauze and plastic wrap over it, and I’m cleared for showers which I hope will be today at home.  Jury is still out on my leaving today with possible bladder infection, and the fact that the in home therapy has not been scheduled.  The P.A. is working on it.
The TED stocking for the right leg is gingerly put on.  If they’re going to make me wear these thigh high stockings, they should at least have some sexy garters.  I do some parallel bar walking, but the PT can tell that I am wasted.  She ices me and sends me back to my room.
Back in my room and the PCA is removed and I am now officially on Norco every four hours.  What a pleasure to crank up the walker and go to the bathroom unaided.  I may take a while, and I may be out of breath when I finish, but by golly, I’m doing it.  I’m using an extra TED stocking to loop around my foot to get it off the bed.  I can raise my leg slightly now, but it takes a lot out of me.
Urine sample is taken, but comes back negative for bacteria.  I’m still having burning, so (due to my vast medical knowledge,) I decide it must be from trying too vigorously to pee after surgery.  I try to relax more when evacuating.
Dry mouth has eased, appetite is still gone.  Somehow I got put on a cardiac diet, so the food has little seasoning.  Combined with my lack of appetite, not many calories going in.
Getting in and out of bed is slow, but not too painful, as long as I take it slow.  Walking is getting more confident.  There is still a strong pull on the back of my leg that needs to be worked through.  No therapy this afternoon, so I practice ankle pumps and quad stretches as much as possible.
P.A. tells me I have to stay through the weekend since the snag with in home therapy has intensified.  My insurance wouldn’t approve it.  Don’t know why yet.  They’re looking for outpatient PT close to my home.  I’d give a lot for a computer and internet right now to do some research on this, but I’ll have to wait. Hubby goes home as he and the puppy have been staying in a hotel on base hoping that I would get to come home today.
During my numerous trips to the bathroom, someone has been coming into my room and replacing the filling in my mattress with doorknobs.  Every day it becomes harder to find a soft spot around the doorknobs.  And I have to be here three more nights!  AARRRGGHHH!
Saturday, July 13 The food service has been pretty decent until now.  They have a Room Service menu, you call Room Service, and they bring you what you’ve ordered.  Except for the fact that I’m on a cardiac diet and have no flavor, the food is OK.  Today, that changed.  I called and called the number for room service and no answer.  Evidently something is wrong with the phone system.  About two hours after I had taken my pain med, I still had no breakfast and started to feel a little nauseous.  The nurse gave me some juice and crackers, and I felt much better.  I had been going to wait till after breakfast, but Room Service called me for my order, and it was going to be 45 minutes so, I finally took a shower!  Zing, what a feeling!  By the time I had finished, dressed, and gotten back into bed, my breakfast and therapist showed up.  I was so exhausted by the physicality of getting clean, that I asked the therapist if she could come back later, and tackled breakfast. I’m not a huge cereal fan, but had ordered Cheerios with a banana, and they left the banana off.  I just couldn’t eat naked Cheerios; so I just had toast and yogurt.
I am giving myself my belly shot with aplomb now.  The urinary burning is definitely subsiding, but other areas have yet to make an appearance, so still taking Miralax and stool softener
The therapist came back and we did some simple walking around the room and holding my leg up etc. The stretch at the back (hamstring?) is still tough.  My OS came in for his check and asked me about pain now that I’ve been on the Norco about 24 hours.  I told him the Norco was certainly not as comprehensive as the morphine, but I still only had twinges of pain that would travel over the 3-4 range.  That was then.
The problems began with my inability to get in a comfortable spot.  Before, I could always adjust something, and the pain would go away, but not today.  I am beginning to think that a shower and therapy was just too much.  I get a little depressed thinking that maybe this surgery was not such a good idea.  My afternoon is not made better by the fact that Room Service is totally shot.  They finally bring me a lunch similar to the old hospital types of lunches. – “You vill eat this and you vill ENJOY it!” It has fat free milk which I cannot stomach -  One per cent fine – fat free – NO!  I’m able to get some of the sandwich and the fruit down.  Same thing at dinner – salad with fat free Italian dressing, broccoli with Mrs. Dash, sliced turkey and mashed potatoes with gravy – “Can I have a side of flavor, please?”
OK, I know I’m just in a crummy mood, but sometime after dinner, everything changed.  Suddenly, I was able to get in a comfortable position, the depression hammer was lifted, and I felt pretty good.  It was almost like turning a corner from a gloomy, shadowed side street to a bright, cheerful flowered boulevard with.  Glad that’s over with.
Sunday, July 14 
Today I feel like singing the Act I closer to Les Misérables – One More Day!  I have truly enjoyed this as much as I can stand and despite the really good nursing, I am ready to break out.  After all, how can they miss me if I don’t go away?
All body systems are now go (no more Miralax,) but Room Service is broken.  Today they brought me oatmeal for breakfast.  I have a love/hate relationship with oatmeal.  I would love to like it, but I hate it.  Can’t stand the texture mostly, and I blame my younger brother for this.  He loves oatmeal and used to make a big pot of it.  This is WAY before those little microwave packets.  He would eat most of it, and would put the pan into the sink to soak when he was through.    As the female (remember this is the 50’s and early 60’s,) I was expected to wash the dishes.  The sliminess of a cooked oatmeal pan is beyond belief.  So I managed to eat half of a bagel, and some fruit.
It’s amazing how much better I feel today.  The dark cloud has lifted, and I’m ready to get on with my life.  There’s no therapy today, but the nurse and I walk down the halls with my walker.  This is when I find out that all the other rooms are regular hospital type rooms; I’m the only one who lucked out with a suite because it’s usually used for pediatrics.
The word is out that the Room Service system will be fixed by dinner.  Callooh! Callay!  I ordered a grilled pork chop with mashed potatoes, gravy and corn.  I can’t eat it all, but even without salt, it tastes so much better than the stuff they’ve been choosing on their own.
I’m really happy, and settle in for what I hope is a good sleep in spite of the doorknobs
Monday, July 15 Well, a good night’s sleep was not in the cards.  I slept for a little bit, then was wide awake.  I was taking my pain meds which usually made me sleepy, but for whatever reason, I could not fall asleep.  I finally turned on the TV and watched lots of mindless television hoping to bore myself to sleep.  I’d drift off for a moment, and then be back awake.  Maybe it’s because I’m so ready to get out of here.  Maybe it’s because my bed seems to be made entirely of doorknobs.  At any rate, not a good night.
Therapy scheduled for 8 a.m., so I wanted to take my pain pill about 7ish; however, breakfast had not shown up, so I took the pain pill at 7:15.  Breakfast finally shows up about 7:40.  I can eat about a third of it, when my appetite just shuts down, so I decide to get ready for morning PT.
I get up on my own using the walker, deal with the toilet area, and I remember just feeling so tired that I rested my head on the walker arms.  I moved over to the sink for teeth brushing etc., and it hit me like a wall.  I felt dizzy, nauseous, cold sweat, trembly – you name it, it was not a pretty sight.  I managed to make it to the chair in my room and called the nurse.  After describing my symptoms, she put a call in for the doctor, and the technician gave me a cold compress and some ice chips which helped.  We decided that it might be taking the pain meds before breakfast since I had had a problem with that when my breakfast was delayed on Saturday.  I did ask her if it could be a low blood sugar since I had not been eating well, and I’m pretty familiar with hypoglycemia as my husband has been a Type I diabetic for almost 42 years.  The nurse didn’t seem to think so since I had eaten some breakfast.
The longer I sat, the better I felt, although my hands still trembled.  I continued to sit in the chair, elevating and icing. I felt that if I returned to the Throne of DoorKnobs, I would not be responsible for my actions.
After about an hour, I felt in control enough to finish my morning ablutions.  Just that simple act, wore me out however, and I returned to my chair (which also happened to be a recliner.)   My husband was supposed to head out today to bring me home, so I called him and filled him in on the latest wrinkle. I told him I wanted him to go ahead and come out, proceeding as if I was still being discharged.  I was so depressed by the turn of events that I couldn’t help crying as I rung off.
The Social Worker appears as I’m in the throes of the crying jag and is appropriately sympathetic.  She’s still working on the home therapy, and I ask her why it was denied since practically every other insurance company approves this.  They told her it was because I wasn’t “Home bound.”  Well, the depression left immediately and anger took its place.  “Excuse me,” I said.  “Not home bound?   I can’t drive.  My husband is 100% disabled and can only drive short distances.  Let me at ‘em.”  She was unaware of my husband’s situation, so she said she’d take it on from there.
My surgeon comes in and is apprised of the new wrinkle in my health.  He seems disappointed that I was unable to make it to therapy, as they wanted me to have two more therapy sessions before discharging.  His disappointment does not equal mine.
The day moves on with positive breakthroughs in the insurance covered therapy. Evidently the person who denied the coverage on Friday should not have even been answering the phone, much less denying coverage.  Coverage is on, now they just need to find a therapy company who accepts my insurance.  I have something called ChampVA which comes from my husband’s 100% service connected VA disability.  It’s not as well-known as Medicare or Tri-Care, so a little harder to find facilities with a contract.
I’m feeling much better, making sure that I eat before pain meds.  I still feel somewhat wiped out by getting up and moving around, but no dizziness, cold sweat etc.  My PA comes in and wants me to stay another night.  NOOOOOOOO! I tell him I must go home today.  Finally I convince him that if I have a good therapy session, he’ll let me go.
Therapy comes and I work on the Nu-Step, do some stretches, walk with a cane instead of my walker, and my therapist says I’m great.  I’ve got 90 degree ROM (range of movement.) My PA comes down, but still is not convinced to let me go without my therapy being sewn up.  I beg and plead, was close to bribery, and he relents.  He goes off to fax paperwork and order meds, and I go up to my room to wait.
The discharge nurse appears and begins having me sign papers.  All looks wonderful until a doctor whom I have not seen before, but is identified as the Chief of Medicine comes in.  He is most upset that he had not heard about my little incident this morning.  He is convinced it could have come from a cardiac problem and wants to run all sorts of test etc.  If I could have gotten down on my knees, I would have.  I try to tell him that I truly do not believe it is cardiac.  At length, he tells me that if it happens again, I’m not to think twice, but immediately got to an Emergency Room.  I promise faithfully.  Everyone leaves, the discharge nurse comes back and says the pharmacy is really backed up, could be another hour before we can leave, so I better order dinner.  I’m so excited (insert sarcastic font here) to have another cardiac diet meal before I leave.
Hundreds of years pass, the discharge nurse takes me down to the pharmacy; my husband goes to get the car.  Moments later, I am wheeled to the blessed car, and we head toward home.  Of course by now, the Chicago evening traffic is in full swing, so lots of stop and go.  I made the mistake of getting in the front seat because I knew I could extend my leg; however, I had not counted on the hours of sitting with my leg down previous to the actual escape.  The swelling is palpable.  I ask my husband to exit the Tri-State Tollway at the first oasis, so I can remove to the back seat and have my leg up.
It is close to 7 p.m. before we pull up to our house – even the lumps in the driveway look good.  Our five month old Cocker Spaniel puppy is in her “playpen,” and greets me with abandon.  In no time at all, I’m on our recliner sofa, leg elevated with pillows, Iceman strapped around my knee and totally happy. There is no place like home.