|Shelby’s Frist BHR January 2012
Six days post op with the first of two BHR’s and I’m sad to report I’m not going to join the ranks of those who trekked in Nepal during their first week with the new hardware. Today my goals are more modest – three sets of low level PT exercises, a few laps around the homestead with my crutches, figuring out how to put my socks on, knocking out my taxes… Ok, joking about the last part and I’ll actually be pleased if I can do the rest. Anyway, here’s a couple highlights and lessons learned from my hospital stay. Writing these down for my own benefit and to provide another case study for those who follow. Apologize in advance for what will probably be a long post. Short attention types like me are advised to skip to the end.Quick recap to set the stage. I’m a 49 yr old male, getting two BHR’s by Dr. Brooks at Euclid Hospital, in Cleveland, OH, the first one in January 2012 and the second set for four months later. Alright, onward with the first lesson learned – I failed to take heed of the recommendations regarding fiber and all that. Next time around I’m going to skip the steak and pale ale for dinner the night before surgery and go with something a bit more healthy, like a bowl of alfalfa sprouts and a glass of carrot juice or a high fiber smoothie from down at the local Jamba Juice. Won’t be as much fun but it would no doubt make things a little easier down the line. Have to remember to scout out some other tips on the board on how to avoid the dreaded post op constipation, too. Surgery day went smoothly. On deck at 8 AM, checked in, scrubbed, gowned and watching cartoons by 9. On the scrub step, it was easier than the session the night before which left me with a burning/itching feeling all over my body, despite having waited an hour after my shower. The morning session was not at all irritating, but foreshadowed what would come in regard to privacy, dignity, etc. Nothing like standing behind a curtain, stripping down to your birthday suit and scrubbing all over with antiseptic giant baby wipes. Oh yah, then I donned my first “gown”. Kind of like the painter’s smocks I wore back in grade school art class but less stylish. Just when I was getting in to the adventures of Dora and her band of renegade jungle critters I met my anesthesiologist. He gave me a quick brief on the knock out options – a starter cocktail shot into the IV to loosen me up followed by my choice of either a gas/general anesthesia or a spinal. Sounded like both would work about the same, but the spinal would probably clear my system a little easier than the gas, which he said has a track record of causing nausea after surgery. Not a big fan of that so I opted for the spinal. About 9:45. I gave my DW a quick kiss and they wheeled me upstairs and into the shop. Though it wasn’t rigged out with chop saws and routers, there was enough hardware and gear in there that I had the feeling they’d soon be giving me the full Steve Austin treatment. No worries though – my doc’s PA met me along with another surgical PA. They hoisted me onto the workbench and while we BS’d about work and sports, they dropped the first round of pain relief/relaxation chems into my system. A few minutes later, Dr. Feelgood (no disrespect, Dr. L. You’re the best!) delivered the spinal. About all I remember is the surgical PA holding my shoulders, the doc telling me to expect a sharp pinprick followed by a little pinch (about as painful as a flu shot or when they draw blood). Very next thing I was magically in the pre/post op area with a nurse asking me to wiggle my toes, which, happily I was able to do. Seems the surgery took about an hour and apparently went according to plan. Since it was now about 1 PM, I surmised that I’d lost about an hour and a half (cue creepy sci-fi music, enter Agents Mulder and Scully. “Sir, have you ever heard of alien abduction?”) Other than that, I felt pretty good – heck, I felt great! And as I attempted to launch my career as a stand up comic/lounge singer, they gave me the boot and rolled me on to the medical/surgical floor and into my unoccupied semi-private room. I was first to arrive so I got the window seat allowing me to enjoy decent view of Lake Erie, some trees and a couple of houses off to the east of the hospital. Bonus! As I regarded my new surroundings and chatted with my new best buddies (the trash can, a balloon tied to the bed, anybody in earshot), my dear wife arrived and gave me a rundown of what had gone on. The surgeon told her that things went “perfect” and that I came through it all very well. “Cool! When’s lunch? Oh look, a chicken!” Maybe my world view was still a little under the influence of modern medicine. About this point my parade of visitors began – RN’s, Nurse Practitioners, PA’s, STNA’s, blood techs, housekeeping, dietitians, the floor’s attending doc, my case manager (the head nurse?), the Asst. Nursing Mgr., one of the guys from engineering/facilities, the dudes from patient advocacy (coffee, newspapers, jokes, etc.), the Pink Panther and the Great Black Beast of Arghhh, though these last two seemed to stop visiting as soon as I backed down on the pain relievers. By the second day I could almost tell the time by who was walking through the door. Blood draw? Must be 7 AM. While my wife was still there, Dr. Brooks and his PA, Phil stopped by for a visit. Vaguely recall trying to high five Dr. B after he showed me an x-ray film of my new gear, maybe telling a lame joke or two about my new role as Iron Man, the 6M$ Man and/or Sponge Bob. After my wife left I passed the rest of the day without incident. Oh, I was able to begin cycling on what the staff perhaps somewhat euphemistically referred to as the urinal. More like a small graduated plastic milk jug with a big opening and a replacable cap. Key feature, that. Anyway, this little feat apparently spared me from the dreaded catheter treatment or at least a second one. First may have occurred during surgery (or alien abduction – why the heck are my dangly bits bruised?). Even so, it did make for an awkward moment when I had to call and ask someone to come in and empty the urinal. This would turn into my primary motivation to get on the walker and out of bed. Didn’t stay up too much after that and around 8 PM, I tossed back a couple of pain meds and drifted off. After a refreshing couple of hours I was back up, or at least awake, feeling nauseous and light headed (low BP, apparently due in part to dehydration). A quick shot of fluids via IV got me back in the pink, though. My new roommate was also wide awake and saw it all go down. Great guy, in for a shoulder surgery and like me, or probably because of me, seemed to be a light sleeper. Pretty much how the rest of the night went – an hour or so of sleep, waking up for a BP check/blood draw, fill the bottle, compare notes with my roomy, maybe call for another pain pill, then back to sleep. Rest of the night passed this way, mostly without incident and with little pain (2 out of 10 or less), probably because of my acceptance of pain meds and ice packs when they were offered. Rolled in to day two with a welcome sight – breakfast! Really, I woke up hungry and was pretty happy when chow arrived. Ate it all, right down to the fruit cup and the coffee, and was grateful. Followed this by a brief nap which took me right up to my first physical therapy session. The two therapists put me through my paces on knee flexions, ankle pumps, quad flexes and butt clenches – probably not the correct names for these exercises. Then they showed me how to get to the edge of the bed, stand and walk with a walker. Surprised since I had expected to use crutches and not a walker, but I pressed on and made a go of the three or four feet that separated me from my objective, a little chair next to the bed. Made it maybe a step or two when the light headedness started and by the time I got to the chair I was seeing stars. Low BP again, apparently. This time no extra IV, PT’s just got me back in bed, got my feet up and restored my sense of well being. Not an uncommon occurrence, they told me, but it put an end to my dream of being the first one in my class (three or four others had the same thing done by Dr. B on the same day as me) to circle the floor under my own power. Fortunately, my nurse saw to it that I got back on the rig and drove the walker down the hall and back. For whatever reason, her relief took the walker away, perhaps due to my record of low BP. Whatever the reason, they took the darned thing out of my room. Drat! No solo bathroom trips for me! Rest of the day passed without incident, that is if you overlook the nausea, restriction to bed and hence the need to pee in a bottle. Felt pretty good on day three, after getting a couple of three/four hour blocks of sleep. After breakfast, my nomination for nurse of the year made sure I had a chance to change into a pair of shorts and a T-shirt. Great for my moral. (Note to self: try to move this ahead in the timeline next go round, and especially remember to pack boxer shorts). Once again PT was on the agenda for the day, though the morning session was to be down the hall at the “gym”. There I got fitted for my own set of crutches (aka “freedom sticks”) then had a chance to take a few laps around the room, plus a short session in the stair well. Easy day, really, and it was back to the room for chow and a nap. After a relaxing 5 minute snooze I was greeted by an enthusiastic STNA who cheerfully told me it was time for an ultrasound, which I’d been told was to spot blood clots. “Yippee, let’s go” I said and jumped into the wheel chair. Ok, it was more like I held on to the aide while he pushed the wheelchair under me, but I did so with great vigor. Pretty sure it would be a piece of cake and continued to feel that way even after I arrived. The tech helped me onto the table, applied some kind of lubricating gel, which was warm, gently took hold of my leg and commenced to drill to China with the ultrasound probe. Holy potatoes! Well, at least got my money’s worth. Got back to my room after that, had a seat in the chair (less time in bed, good) and waited for the next evolution, my second PT session for the day. By the time the 2nd session kicked off my DW had arrived and was able to watch me go through my paces. I think this really helped her gauge my progress as well as have her questions answered about how I’m supposed to do things and how to help me do them. Good chance for me to show off, too. Hey, when it comes to ankle pumps, I am the man. Rest of the day passed without incident and by this point I was up to around 6 hrs. between pain meds. Pretty good day, all in all. Day four dawned cold and snowy, perfect for going home. Not that I was excited by the prospect of freedom, but I found myself completely awake and in good spirits as soon as they woke me to take the 5 AM vitals. Had one more PT session set for after morning chow, so I powered through the eggs and toast and readied myself for another session with the black robbed ninjas of physical therapy. Again, as before they loaded me into a wheelchair and whisked me off, but this time to another floor and another cadre of the men & women in black. As I waited the rest of my BHR cohort arrived for their own session. Turns out we were all set for one more session and would do so simultaneously. Made it really hard not to engage in that mortal sin of resurfacing – comparing your progress with others. Soon enough I was back in the room, getting my gear together and waiting for the discharge paperwork. One final visit from the floor doc, the head nurse then my wife & son arrived. That keyed the paperwork and then the ride to the front door. Sat in front on the short 45 minute run home and the next thing I knew I was safely ensconced in my favorite chair, feet up, butt iced and legs blanketed. All I needed was a pint and the picture would have been complete. And that, dear reader, brings us to the end of my tale. Hope there’s a few items of value here for those who will follow, even if it serves as an example of how not to go through the process. So here I am, six days after surgery. Made a trek today down the drive and over to the neighbor’s yard and back, all without tripping, falling or having a wardrobe failure – an amazing feat considering I’m still sporting inflatable knee high’s and what seems like several yards of pneumatic tubing. Pain’s still low (1 or 2), swelling seems to have peaked, and flexibility is improving. All in all there’s progress in enough areas to be encouraged. That said, I’ll drop another post at the next milestone, more likely at the follow up x-ray session and not from the foothills of the Himalayas, but who knows – thanks to the hard work of a lot of great people, I’ve now got good reason to believe that, one day before too long, anything will be possible. Cheers! Shelby
Shelby’s Second BHR May 2012
Since I did my best to share all the fun I had on the first surgery, seemed I had a responsibility to do so with the second. Second time around, should have known what I was in for, or so I thought. I was also under the impression that I should have an idea on how things should go based, an idea based solidly on personal experience. Put me up there with other notables who suffered from a tad too much hubris – Midas, Liberace, Joe Dirt. Anyway, given my outstanding level of fitness/vitality (I’ve been told I can easily pass for a man in his late 40‘s) and my recent familiarity with the process, this recovery should be a piece of cake. Despite what I’d been told I was just certain I had it all figured out, like how on day number X, my level of stiffness/pain/swelling would be at level Y. Looking back on that pre-admission visit and my chat with the PA I’m reminded of that scene from MP & The Holy Grail with Tim the Enchanter: “I warrrned yewh but no…” With that, here’s a summary of my latest excellent adventure, organized around some of what I considered to be more important points. Again, I apologize in advance for the erratic use of tense, lack of subject/verb agreement, wholesale lifting of Shakespearian plot lines and the occasional exaggeration. Here goes…Food and Irregularity. 1st time out I had what I consider major league constipation, most likely due to the anesthesia and pain meds following surgery. This time around I thought that I’d be able to get a handle on it, so to speak, by modifying my diet a few days beforehand – increasing my fiber intake, cutting down on the meat, cheese and ale, thinking happy thoughts about the healthy bacteria in my gizzard, etc. Certainly that would be enough to do the trick, right? Not hardly! It was almost a week before I could… er, make any movement in that dept. Even now, 8 days post op, I’m still not regular but I remain hopeful that this will improve as I decrease the use of the pain relievers to zero over the next few days. Until then I’ll rely on whatever laxative my DW has added to our “little” home pharmacy (looks like I’ve opened my own Walgreens annex in our kitchen cupboard) to do the trick. That and more fiber. Which reminds me, its time for me to have another piece of wood… Pain Meds. Admittedly, I’m not a fan of pain. You could even say that, despite having played hockey for most of my life, served in the military for 24+ years, and having lived with chronic osteoarthritis pain for over eight years, I have a low threshold for it. Seems I should have taken better notes last go round on this topic, too. Anyway, I recall that 10 days after the first surgery I was totally off pain relievers and that’s about all I had loaded in my memory banks going in to round two. As a result, this time I failed to ramp down and off as smoothly. In fact, today, day 12, I’m still in need of one 5mg dose of oxycodone every 4 – 5 hours, especially at night. I’d tried increasing the duration between dosages to 6 – 8 hours 3 days after surgery. Ended up on a pain roller coaster, going from pain free to aching then cycling through it all over again. What worked before was decreasing the dosage (2 pills, 1 pill, half a pill) while holding the duration between from 4 to 6 then 8 and then ten hours. Now all I can do is implement the dosage reduction and hope the tapering coincides with the depletion of the prescription and diminishment of pain below the mild discomfort level. [Note: Night time discomfort still pretty high, enough to wake me up 2 – 3 times a night, though it’s muscle pain/stiffness down around the knee not pain in the joint]. Fortunately this affords me the opportunity to keep up on the latest infomercials]. Which brings me to… Beer. Fellow Alemeisters will understand why this topic is included. Others may elect to skip to the more conventional topics below. First surgery I celebrated my release from the TED’s and declaration of no clots with a trip to a local burger pub to indulge in suds and cholesterol laden delicacies (back on the probiotic/whole food/zero fun regime shortly after though). This was at the two week mark and coincided with the end of my use of pain killers and muscle relaxers a day before. This time around, TED’s came off, no clots found but pain meds were still a part of my nighttime routine. Hence, and to my chagrin, hoisting the elixir of the gods was forbidden. Oh the humanity! Took me almost three weeks to discontinue the use of the pain killers and though my interest in doing so was more out of a fear of their prolonged use, I must admit that I was at least in part motivated by thirst. Others more learned than I would no doubt agree (see Wikipedia entries for Ben Franklin, Ralph Kramden, Jeff Spicoli, Doug and Bob Mckenzie, et. al.). Physical Therapy. For whatever reason, perhaps my robust physique (see above), medical plan and/or my doc’s professional opinion, I’m once again doing a self directed course of physical therapy, consisting of going for short walks (1 block to 1.5 miles) on my crutches and range of motion exercises for the operated leg three times a day. I know there are others out there who receive daily visits from nurses or physical therapists who put them through their paces while others go off to a local med/PT center to get their fair share of abuse. Despite being on my own here I’m making what I believe to be decent progress. Why just yesterday I was able to do multiple sets of power cleans with the couch… Seriously though, I am quite proud of how good my quad and glute flexes have gotten and my heel slides/ankle rotations are, in my DW’s opinion, quite compelling. Bottom line, can’t honestly say if I’m doing better, worse or the same as last time on this metric, and this may be one of the advantages of having professional assistance with the post op exercises – built in measurement/record keeping. Might also help to have someone hit you with a cattle prod if you fail to hit the mark (“Get that knee higher, mister!”). Not sure if insurance covers such a motivational program but for those who follow it may bear looking into. Swelling and Bruising. This is one area that I can say there’s a difference on the second surgery. First time my leg was extremely swollen from hip to ankle. This was accompanied by severe and extensive bruising. Basically the back of my leg was purple from butt to calf. Even had some strange bruising in my nether region which even now strikes me as odd. Second time the bruising and swelling have been confined to my upper leg, both much less severe than the first. Elevating the leg and regular use of ice packs may have made the difference on this point. There was some slight amount of unexplained bruising again in the dangly bits that I’d like to attribute to the procedure but as a former fan of Agents Mulder and Skully, I know the truth is far more sinister (cue creepy sci-fi music). Mobility. Another area of improvement, second time around. As the first surgery was three months ago I still have all the move around skills I developed – one foot side shuffle, moon walk, double crutch hand stand, single crutch vault to double salchow, etc. In truth I’m also painfully aware of the need to carefully go up and down the stairs. No need to repeat the two or three little tumbles I had the first time and the weeks of angst/worry that followed as I contemplated whether or not I would wind up with a THR revision. Thankfully that did not come to pass.
Sense of Humor. No joke, this is a key area for good health and recovery. Even the hardcore science type skeptics out there would agree with me on that point. First surgery I was the life of the surgical ward, or at least I thought I was. In fact I swear I saw “Johnny Vegas” written on top of the chart hung outside my door. No doubt this was in part due to the bags of clear fluid that were routinely added to my IV, perhaps in an attempt to shut me up. Quell mystery! Seems to have backfired though as my DW recalls my first words to her following surgery were something to the effect of “I feel GREAT!”. The second time, well, not so much. Instead I felt like that toddler in the E-trade commercial (“Nobody knows…”). Didn’t really get my rapier whit/sense of bonhomie back until just a few days ago (3+ weeks after the fact), which coincided with the diminishment of pain/discontinuance of pain meds/resumption of Operation Oktoberfest (might be a grad school project out there on this for someone – let me know if you need a test subject). In any case, like the sage once said: “A flute without holes, is not a flute. A donut without a hole, is a Danish”. So gentle reader, if you’re still reading this and take nothing else away, seriously, do whatever you can to keep your sense of humor. Your nurses will thank you, your kids will be embarrassed and, most of all, your recovery will benefit. So there you go. Oh, and World Peace! With that…Good hunting! Shelby