Post Op Shop II

Since my last post, things have progressed quite a bit. I remained in the hospital room until yesterday (24 October) noon. This was one day longer than I expected, but mostly due to tiredness.

Crutchety Old Man
On 23 October, the PT person got me out of bed and on crutches for the first time. Crutch use isn't as difficult as you might think, but it takes lots of arm strength - more than I expected. Crutch use mimics the walker - move both crutches forward, then bad leg, and good leg. Though tough at first, I was able to go all the way down the hall to the PT room (~20 meters). Once there, I rested a bit and was then tempted with a short set of stairs (5 steps). I decided to give it a go and was able to go up and down with effort. Up with the good leg, down with the bad leg - that's the mantra for doing stairs. You use only one crutch, and one rail - lots of arm strength again. After stairs, I crutched back down the hall to my room.

Holy Crap
I was able to repeat the crutch feat later in the afternoon - around 2:40pm. But before that I had an ordeal the likes I had never expected when I had to have my first bowel movement. Often after surgery, you are dehydrated and the cocktail of drugs they give you leaves you constipated. When mother nature paid a visit to me, I had to wait 15 minutes before a nurse could help me to the commode. Then when I got there, the urge to go was great - but so was the pain. I had to make a lot of effort, then was scolded by the floor nurse in the middle of it. They were worried I would pass out. Well, after assuring them I would just 'let it happen', I was able to finish. The pain was excruciating, and I was exhausted. And it was embarrassing to have a nurse tech clean me up after. Aaagh! Perhaps this was worse than catheter removal.

Night to Forget
I had hoped to be discharged on the evening of the 23rd, but the constipation episode wore me out. I felt I could use the extra rest and attention. Unfortunately, the nursing staff was not particularly cooperative or quiet that night. I couldn't get pain pills when I wanted, and they bothered me when I was trying to sleep or nap on several locations. Perhaps this was a sign that they wanted me gone. :-) But more likely that they had a very busy night shift.

Discharge
There was no doubt in my mind I needed to leave when I woke up on the 24th. I was tired of asking nurses to do everything (and impatient), and weary of my surroundings (except the great river view). My mother had already checked into the Belaire (hospital's hotel) and it sounded nice. Perhaps the thing that propelled me most was what I saw in the mirror when I got to the bathroom. After 5 days I desperately needed a shave, and my skin was very red around my beard where my eczema (dermatitis) often flares up.

The PT people came around again to confirm my first outpatient appointment, and even arranged for a sales person to come by with a 'reacher' - a device that helps you grab or pick up objects beyond your range of movement. I had one more PT session at 11am to practice crutches and stairs, then signed the paperwork for discharge. I had to agree to only take the prescribed medications (vicodan and enteric aspirin), and a number of other physician mandated restrictions. Then at noon, I said goodbye to my urine bottle and room, while a nice, tall blonde Russian girl wheeled me to the Belaire.

Reality Bites
Once in our 6 floor 1 bedroom apartment, it became clear that home life was not going to be a piece of cake. This realization came crashing down on me soon after I had entered the room. Although this hotel is run by HSS for families of patients needing extended care, it seems to lack things required by disabled or recovering patients like myself. No elevated toilet seat or chairs, low sofas, and a too soft bed. I can't really complain, as this will get paid for by someone else eventually. But you would think they'd pay more attention to needs of the disabled.

I also found that things are quite different when you aren't flat on your back in a hospital bed. You have to walk to the bathroom, stand while washing, move several meters to bed, chair, couch, etc. on crutches. If you change clothes (or pull up your pants), you have to use the reacher (or get some help). Fortunately, my mother helped me with many things, including going out to get meals, cleaning clothes, pushing chairs, picking up dropped items, reaching hard to reach places, lifting my operated leg, etc. Hell, I can't even get to the phones from the couch or bed in a few seconds.

Wow. If I was alone somewhere, I'd never make it after release from the hospital. Now I understand why hospitals in Japan keep you in a rehab facility for nearly a month for full hip replacement.

Post Op Shop

On the Other Side
My surgery was at about 10:30 AM on Friday (19 Oct), and I woke up after about 1pm. It was a little weird getting my sensations back bit by bit, and I didn't relish the lack of control. However, in a few hours I had all my major senses and not much feeling below the waist.

They kept me in the post op recovery room for 27 hours, because of lack of bed space in the hospital. Everybody wants their recovery on the weekends, maybe. But the nurses in the recovery room were very nice and helpful - pulling me through some confusing times. I was fortunate, in that I had little or no post operative pain. When the PT got me up for walking, I had some pain but was able to take a couple steps with a walker.

Wired
I was struck by how many tubes and wires were attached to my body, to either monitor body functions or deliver some important substance to my body. I had a saline IV in my hand, an antibiotic IV (wrist?), a PCA epidural in my back, sedative drip in my jugular vein (neck), 3 EKG electrodes on my left lower rib cage, a catheter up my schlong, oxygen tubes up my nose (photo), a bag to collect fluids from my surgical incision, and two pressure cuffs on my lower legs to encourage circulation (minimize chance of clots). Maybe I've forgotten something? The only thing left now is the cuffs, which pleasantly squeeze at intermittent times with a 'puff' sound. These cuffs actually brought the first sensations to my lower legs - making my toes tingle, then feet, then ankles, calves etc. Removing most of these things was often painful - as they were taped to my fairly hairy body. Rip!!

Stoned
The cocktail of chemicals and pharmaceuticals in my body was also impressive. I had/have blood thinners, clot busters, pain killers, anti-inflammatories, antibiotics, stool softeners, vitamins... I've probably omitted something. The PCA epidural is a machine that delivers pain blockers to space between vertebra in my lumbar region. So, sensation from pain receptors at or below the level of the epidural were minimized. PCA refers to 'patient controlled anaesthesia'; I had a device with a button that I could press to deliver a pulse of meds to the epidural. While in post op, the machine delivered meds at a slow rate, so any pressing I did just upped the dosage temporarily. When I moved to my room, the auto drip was off, so I had to pump to get the drip. At that time, however, they also started giving me Vicodan and eventually weaned me from the pump altogether. I now take Vicodan every 4-6 hours (when I ask) and think I've cut it to one pill instead of 2. However, PT may push my dosage up again.

Room with a View
They moved me to a room at 4pm yesterday. I shared it for one night with an amazing 66 y.o. guy that had two THR (one a revision of a BHR), and was in such great shape he was ambulatory after 3 days. The room is on a remodeled floor (8th), and very spacious. I count eight window panes over looking the East River. Both beds face the river; I have a great view of the lights at night and the sunrise in the morning (below). Some aspects of the layout and equipment are not optimal, but these things could be worked out with little effort. Every morning with breakfast, they bring you a flower that you can stick in a little vase - gives you a sense of how many days you've been in the clink. Rooms are provided with free wireless internet of dubious quality, and you have to pay $8 a day to use the TV. After my roomie left this morning, I've had the room to myself - so I could really enjoy TV at normal volume levels.

I was switched from liquid to solid foods Saturday evening. Speaking of food - the quality is OK (and quantity), but the service is erratic. I remember writing down preferences before surgery (low lactose) - but apparently these have been forgotten. We are given menus with choices to circle. Unfortunately, some mental midgets on the serving staff are unable to remember to give me what I asked for, despite having highlighted my selections and attached it to the meal tray.

Physically Challenged
Today was day three - and my first full day in the hospital room. In the morning PT session, I had some light-headedness, so I didn't walk any. I felt embarrassed and frustrated - and also worried. I think my Vicodan wore off, as the pain was prominent. Or it may have been related to the fact that I didn't sleep well after they removed the catheter on Saturday evening. The sensation was annoying, and I couldn't figure out if things were moving or staying. The threat of replacing the catheter if I couldn't void put a lot of pressure on me to go before midnight. It was like learning how to pee again, but with lots of irritation. And my best friend is a plastic bottle between my legs that I fill up religiously. Maybe this has been the toughest thing to deal with so far, but I'm happy to report that my plumbing is nearly normal at present time. :-)

After an hour's nap and lunch (with more omissions), I felt stronger. When the afternoon PT person came, I rather easily sat up on the bed, stood with the walker, and made it halfway across the room and back. I think the timing of my pain pill around lunch also helped. Later on, after my wife and mother arrived - I sat up on my own, and with some help got to sit up on an elevated chair so that I could watch some TV from that position. Well, that was my hope. But with both gals yakking and fussing, I didn't see much. That's an easy price to pay when someone that is willing to bring you a decent cappuccino and donuts.

They also have taken my bandage off, and I've seen my incision with the help of my digital camera. It's pretty ugly, and seems to be covered with some sort of papery material. I don't quite see stitches or staples, so I'm not sure what keeps it close.

The care here at HSS has been excellent for the most part. I'm a little disappointed with myself that I can't make more physical progress. It will come, but I wish I didn't have to push myself so much to get over the pain or be so reliant on pain meds. My MD told me to try sitting to motivate me to get up more. I think it helps. I really want to be up and about on my own. And with bowel issues coming in the next day or so - I have added motivation. If I have the time or energy, I'll give an update in the next few days.

Well, the lame ALCS game is nearly over, and like the Indians, I'm out of gas.