A Divergence

This year we were lucky enough to have 3 bird houses full of babies in the backyard at Old House.  We had wrens.  We think they're all out now.  We had sparrows - not sure about them.  And we had bluebirds in our bluebird house.  This has been very exciting to watch.  There have been babies in the box for several weeks, and just last night, Hubs was able to catch them starting to come out:

Daddy and Mommy Bluebird are fierce defenders of their house and babies.  For many evenings over the last few weeks, we were able to sit out on the patio and watch Dad sit in the nearby tree ready to chase away any birds that got too close.  We saw him swoop down on Blue Jays at the feeder, and he really didn't like the Cow Birds.  It's very exciting to get to see the babies.  Since we haven't been over there much in the last week, we thought we might miss the coming-out.  

The other garden photo I have to share today is my new rose.  I ordered a rose from David Austin Roses in Texas.  They have a lot of English and "old world" varieties. I got one that is a yellow climber called Golden Celebration, and it came as a bare root stick.  We planted it according to the directions - several weeks ago - and we weren't seeing ANY sign of growth.  Until last week, while I was in the hospital, it decided to start to grow.  Here it is as of Sunday the 16th:

Who knows, maybe I'll actually have flowers to share yet this season!

More later.  

:)Amy

Day 6

It is interesting how we perceive the passing of time.  In some ways, it feels like time is dragging, but then I realize I'm already Day 6 post-op and it seems like it has flown by.  The night was fairly good.  I didn't get too achy and managed to sleep soundly for hours at a time.  I woke up around 5:30 and wanted to get up, but I decided I would wait until 6 to wake Hubs.  Then the next thing I knew it was 7 and he was coming in to wake me up.  I was soooo stiff - not just Bessie but my back too.  I think the restrictive sleeping position is the worst part of this process as of now.  I got up, went to the bathroom, walked around a bit and got dressed.  Then I got back in bed for my morning exercises, which I don't feel went as well as last night - I think because I was still very stiff.

One of the things that I came home with was a leg-massaging machine.  My instructions are to use it almost all the time for 2 weeks.  I am not supposed to have it off for more then 30 min at a time, and not more than 4 hours a day.  I'm pretty sure I've not exceeded the 4 hours off a day, but I've gone over the 30 min thing a few times.  Yesterday, I had it off for several hours while I took a shower and washed my compression stockings. It is tolerable, but does get annoying at times.

My unit can be seen here.

The wraps are segmented into 3 sections for easier fitting, and are affixed with Velcro.  (The strongest Velcro on the planet, I might add!)

I keep the top one on Bessie a little loose because it can sort of irritate my incision when it expands and contracts. I'm not sure how often it activates. I would guess every couple minutes.  It whirs and makes a series of popping sounds when it activates.  My control unit hangs on the handle of my walker, so I can walk with it on, but often times I just disconnect the leg cables when I'm moving so they don't get in my way.  Then I hook them back up when I'm sitting.

I tend to run hot anyway, and having these things on my legs all the time, along with the compression stockings, does tend to make me hotter.

Well, I am expecting my Physical Therapist, Brian in about 30 min.  I'll let y'all know how that goes later.

:)Amy

Day 3 - Home Health Care... and on to Day 5

The big excitement on Day 3 was the initial visit of the Home Health Care agency that is going to be doing my PT.  A nurse came to do a medical evaluation and get the paperwork done.  She had a "ride-along" with her - a man who is going to be working for the company.  They both said my knee looked really good. At that time, I really hadn't started bruising much.  They said that the fact that there wasn't much bruising was a testament to how gentle the doc and his team were with me.  Well, now I'm bruising, so I guess Bessie just took awhile to get up to speed on that.

The nurse indicated that my PT will start on Monday.  On Tuesday, another nurse will come to change my dressing.

The Case Manager at the hospital sent me home with a Rx for Percocet (which is what they had been giving me in the hosp) in spite of the fact that I'd told multiple people that I preferred Vicodin.  The home care nurse said I could switch if I wanted to, and she recommended Vicodin too because it has fewer negative effects, like constipation.  So, after she left, I put the Perc in the drawer.  On Day 3 and Day 4, I mostly took pain meds every 2-3 hours.

The pain has changed a lot since Day 1.  On Days 3 and 4 it would sort of come in waves.  Sometimes a dull achy feeling that was deep.  I felt like I wanted to wrap it in a warm moist blanket and massage it (or get into a hot tub!).  Sometimes the pain was just along my incision and was more sharp - sort of a tingling, stinging pain.  In all cases, a dose of Vicodin would knock it down quickly.

As of Day 5, I really haven't had much pain at all today.  I didn't take any pain meds during the night last night, and didn't take any until noon today.  So I went almost 12 hours with nothing.  What I feel today is more a stiffness.  I am feeling my best when I am walking around.  When I sit still for very long, I get stuff.  I try to walk the house every 45 min or so.  If I'm sitting in front of the TV for very long, sometimes I just stand up for a few minutes.

This is a new lifestyle.  I sit here at the computer and type.  I read a book.  I watch TV.  I do my exercises.  That's it.  I did take a shower today with Hub's help.  That was big.  It felt good to take my TED hose off.

Well, it's back to the TV for me....

:)Amy

Home - Day 2

I got home about 2:30 on Day 2.  I sat in a chair for a little while, but then I really felt like I needed to lie down.  I quickly learned that getting in (and out) of bed are my biggest challenges without a moving hospital bed.  My bed is sort of high anyway, since I'm vertically challenged.  Scooting myself far enough on to the bed is the first challenge, and then the second is getting my leg into bed with me.

Side note:  I've decided I need to name my operative knee/leg.  I've thought about various options that might be symbolic, but I think I've chosen Bessie.  She is sort of cow-like in some ways - kind of a big dumb weight that just sort of hangs there and doesn't do much.  When I talk to her to tell her to move a certain way, she doesn't always respond immediately, so Bessie really seems to fit.

So, back to the bed thing.  I quickly learned that if I cross Bessie over my good leg, I can lift and move her that way.  This helps with getting in and out of bed.  However, I still have to have someone actually do the heavy lifting to get her onto the bed.  Once I'm on the bed, I can wiggle my butt enough to move myself to where I need to be.

I have a set of 4 exercises that I have to do 3 times a day on the bed.  Hubs learned how to help me with these from the PT at the hospital.  The good news is he says he can tell I've made progress already.  I think I have too, but I still feel like he is doing 75% of the work when we do these.  After I've done these exercises, I lie with an ice pack on my incision for about 20-30 min.

I'm also reminded that I don't like to sleep on my back.  It wasn't quite so bad in the hospital when I could move my bed different ways, but I can't do that at home.  All I can do is adjust the pile of pillows to go up or down.  Sleeping in that position for a whole night is a bit of a problem.  I'm really hoping my PT will tell me that I can sleep on my side sometime.  Otherwise, my back is going to put up a huge fight.

I can't put anything under Bessie.  I have to keep her flat to the bed and straight, so she heals that way.  I can put a pillow under my other knee, and that helps.

I tried to eat some dinner on that first evening home. Jello - applesauce - toast.  However, I got very nauseous, so I gave up on that.  By Day 3 I was able to eat normal food with no problem.

For that first evening home, a lot of the time was just spent reorienting ourselves to how to live with Bessie.  I can walk with my walker unassisted. I can go to the bathroom unassisted.  The biggest assistance I need is with the bed and also with moving chairs in and out and carrying stuff like food and drinks to the table.  I made a little tote thing that hangs on the front of my walker.  That has phones and a book and my meds, and some other basics stuff, but I can't put everything in that.

It felt good to be home, and I ended up deciding the docs were right - I needed to come home on Day 2 !

:) Amy

Day 2 - Thursday

I don't know how to explain the change that magically occurred over night from Day 1 being horrible, to Day 2 being Very Good.  Part of it was about pain management.

People can tell you "it will hurt", but knowing that doesn't prepare you for the reality of the pain, especially when it is relentless.  Once the spinal wears off, and your body starts responding to foreign things having invaded, and the trauma of the assault, it takes awhile to find enough meds in the right combinations to actually make a difference.  The nurses work hard on pain management because that is one of the big goals that has to be reached before a patient can be allowed to go home.  During the night between Day 1 and Day 2, we found my pain management formula, and I started noticing a difference - that was a huge relief.

The other magic was the whole bladder issue getting resolved.  I know that many surgery patients have constipation issues after surgery, but I didn't know the bladder could actually go to sleep and not wake up.  I felt insulted by the bladder issues.  I was thinking, ok, here I am dealing with this leg-thing, and now they have to drain my bladder?  Really?  On a practical level, I get it - the spinal anesthesia puts everything to sleep from the waist down.  But, emotionally, it is one more thing to have to deal with.  Then, I'm thinking, oh yes, let's give me a pill to make me have to pee, and then make it very difficult to actually go to the bathroom to do it!  That's a winning plan!  Can you tell I have an attitude?

About 6 am on Day 2, my surgeon came in for the first time.  I hadn't even seen him in Pre-Op.  He came in with 2 assistants.  One of the assistants pulled my TED hose down so he could see my wound dressing.  He said, "it looks very good".  Then I took a chance and dared to ask him if there was any chance I could stay one more day.  He listened to my reasons, then told me they were weak reasons.  I said that I felt if I could get stronger before going home, it would be less of a strain on my home care-giver.  He said that if there were actual scientific reasons for staying that's one thing, but the reason I gave wasn't scientific enough for the insurance company nor the federal government.  He said that if I pass all my goals, which I was on target to do, I would be going home later in the day. He also went into a long tirade about all the reasons to NOT keep people in hospitals any longer than absolutely necessary.  He talked about sending his own family members home as quickly as possible.    Okey dokey.  I get it.

A little while later the hospital GP came in.  He went over my computer records, asked me questions, checked me out, we talked.  I expressed the same "stay one more day" wish to him, and basically got the same response only a little nicer.

I did the eggs and bacon breakfast thing again, but I kept falling asleep over it, and by the time I was about half way finished the eggs were cold.  I guess the pain meds were making me sleepy, and because the pain was reduced I was able to sleep.

My PT lady came in and took me for a walk.  It actually felt good to stand up.  I was able to walk all the way to the nurse's station and back - she was VERY impressed with my progress and so was I !

The Case Manager - I think I forgot to include this in Day 1.  It was actually something good that happened on Day 1.  A woman who identified herself as my case manager came in and indicated that she would be setting up my outpatient physical therapy.  She said that my insurance would cover total home PT at 100% if I was interested in that.  Ummm.... YES!  It would be one less thing to have to deal with if I could get all my PT at home, so she said she would set it up.  A different case manager came back on Day 2 to confirm that I'd been set up with a company called Home Health Plus (or something like that).

After PT, I was allowed to take a shower.  A couple of the techs helped me get dried and dressed in real clothes, and we started the process of getting me ready to come home.  My ride and Hubs were coming at 11:30, and he was to work with the PT to learn my exercises.  The process of getting ready to go home took a long time - hours.  There was a lot of waiting for people to do things and for the process to happen.  Finally, around 2 ish, everything came together and I was sent on my way.  I got home about 2:30.  WHEW!    At that point, I felt most comfortable in bed, so that's where I went.

And so, the home care process begins....

:)Amy

Day 1

I have decided to count my recovery days with "0" being the surgery day, and 1 being the first day post-op, etc..

We will start Wednesday, June 12 with the doctors' visits at 6 am.  First came the resident GP for the hospital.  He looked over my chart (on the computer) and asked me some questions.  He said things looked to be "on target" for me.  He told to not be shy about asking for what I needed.  Then came a partner of my surgeon's group.  He looked at my leg and my chart, and made a comment about range of motion.  Then left.  I wasn't too impressed with him.  At this point, I'm not even sure what the range of motion comment referred to.

The highlight of Day 1 was breakfast.  I wasn't particularly hungry, but I knew I should eat, so I ordered scrambled eggs, bacon and English muffin.  I didn't have high expectations for the eggs because I know scrambled eggs made in big batches are usually dry.  However, I was very pleasantly surprised - the eggs were actually excellent and so was the bacon!  I also had  part of an orange, but it wasn't cut up very small, so it was hard to eat.  I also had Cran Juice and had ordered chicken broth too in case the eggs were a wash-out.

Then came the student nurses.  Oh... my... goodness.... bless their little hearts... As a teacher who often has student teachers, I certainly "get" the importance of student nurses.  I had 2, and they were about as different as it was possible to be.  One was very professional, introduced herself and talked to me about her role with me that day.  The other seemed totally clueless.  She didn't introduce herself, and she didn't seem to know what she was supposed to be doing.  After she came in a second time talking about things others had already talked about, I suggested she go back to the nurse's station and get a clearer handle on what she was supposed to be doing for me.  The instructor was with the better one, and I wasn't sure she was even supervising the second one at all.  It seems there could have been a better way to deal with the students.  They needed clear tasks to do that weren't overstepping the regular nurses and techs.  It was almost like there was no coordination.

Little Miss Clueless brought me a tub of soapy water and some towels so that I could wash myself.  Then she left.  I don't know if she was supposed to offer to help me or not - I'm not sure she knew.  Later, someone else brought me water and towels, so I had to say, "The student already brought this to me..."  Based on the reaction I got,  I felt like this girl was more in the way than she should have been in a more coordinated situation.

Around 9 am, my PT came in and took me for a walk.  My room was about in the middle of the hallway, and I walked to the far end of the hall and back.  She was very impressed by what I could do.  Before I got back in bed, I went to the bathroom, but nothing happened.  In spite of all the water I'd had during the night - no pee.  Hmmm...  We reported this to the nurse who brought me a pill to relax my bladder.  This issue haunted me all day and leads me to say that Wednesday was NOT a good day.  By 2 pm, I still wasn't able to pee, so they did a bladder scan, found out I was full, and had to drain my bladder with a catheter.  Bleh!  Not what I was expecting.

The other negative for the day was my high pain level.  Every time I was asked, I reported a fairly high pain level, and nothing they gave me seemed to bring it down much.  When the PT came back at 4 for my 2nd walk of the day, I could only go about half as far because I was in so much pain.  The nurse tried putting Dilaudid in thru my IV, but it really didn't make much of a difference.  Finally, my night nurse Sarah added Vicodin to my pain meds, and THAT finally started to make a difference.  After the 2nd dose of Vicodin was working, I started to turn the corner.

I tried a bunless cheese burger and broccoli for dinner, but it wasn't as good as breakfast, and the chocolate pudding was virtually inedible. I don't know how it is possible to make bad chocolate pudding, but they found some!

My friends who visited on Wed both could tell I was not having a good day.  The pain seemed relentless, and I felt like I had a steady stream of people in and out of my room who really weren't doing anything for me.  By bedtime, I was starting to wonder if I'd made the wrong decision to have surgery.  During the night, the pain was relieved, and I started to feel better about things.

:) Amy

1st night

I don't think I really slept soundly at all that first night.  I dozed/rested my eyes, but I never really felt that I was sound asleep.  Partly it was because someone came in every hour to do something, and partly because there was a constant whir of noises from my machines.  The IV monitor was sort of ticking off to my left, and my leg pumps were pulsing rhythmically.

I can't say I was really in any pain... until about 1:30 am... then I started noticing that my incision was sore when I tried to do my quad sets.  I called the nurse's station and asked for a pain med.  She didn't come in with it until about 2:15, and then she gave me a 5 mg dose of Oxy.  It helped quickly.  Shortly after that, I started passing gas (I had a notion to text everyone, "I FARTED", but I controlled the urge.)

Around 3:20 my tech came in for a blood draw and changed the batteries in the power pack that all my chest-leads were hooked up to.  At 4:40 my IV monitor started beeping because my bag was empty.   When the nurse came in to hang a new bag she also changed my dressing.  I took pictures on my phone, but I can't figure out how to get them off my phone and on to my computer, so I can't share here.  If anyone wants to see my incision at that point, text me and I will text it to you.

My incision looked a lot better than I had expected.  From surgery my leg was wrapped from top to bottom in an ace bandage.  Once that was cut off, I saw a long dressing taped to my skin that was 3" wide and about 8 or 9" long.  It was filled with blood.  As the nurse pealed it back, I saw that the center of the dressing was an absorbent material (not gauze).  I could see a line of staples going down.  She wiped off along the edges of the incision and said it looked very good. There wasn't really any bruising, which is highly unusual because I usually bruise very easily. She then applied a new dressing which was the same as the old one.  The center 1.5" is an absorbent material and then the outer sticky part is like plastic.  Once she applied this, she then put on a new thigh-high stocking (TED hose), like the one I already had on my other leg.

I now know more about this dressing because I got one to bring home with me which I have to change on Day 7.  It is called "Optifoam AG Post-op Strip" - Silver Antimicrobial Wound Dressing made by Medline.

   One of the nice things about it is that I can get it wet in the shower.

After the dressing change, the nurse also removed my catheter.  In general, I had a good night.  I was sort of itchy all night - the nurse said that was from the spinal, but I think it was from the Oxy (Percocet has made me itch in the past). And so the end of the first night...

:) Amy

In Recovery and 1st Evening

I woke up in Recovery fairly quickly.  I don't remember feeling groggy, I was just suddenly awake.  I could hear someone talking about me on the phone - telling someone on my floor that they were about ready to bring me up.  I heard him say, she is 54 but doesn't look it.  I said, "Thank you" and he laughed.  I said, "I'm a teacher.  I hear everything."  He laughed again.  They wheeled me up to my room (206) at about 3:30.  The next little while was spent with my RN and my Tech getting up to speed on me.  They had to go over my meds and get me all situated in the bed.  I had leg pumps on my calves, but more about those later.  They hooked me up to an IV with basic hydrating fluid and antibiotic.  They hooked me up to a monitor with 5 or 6 contact points on my chest, and a pulse/ox meter taped permanently on my finger.  Then they took my blood pressure for what would end up being the first of about a million BP checks.

My friend was there waiting for me.  Once the nurses were done with their initial "stuff", I called Hubs and assured him that I was indeed still alive and still had both legs.

About 6:00 pm, Gabe from Physical Therapy came in and announced that I was going to walk.  I laughed.  He said, "no, really!"  And... I DID!  With his help of course, and with a walker, I got up and walked from my bed to the door and back again.  I was amazed !!

Gabe also instructed me in 3 leg exercises that I was told to do 10 times each hour:  1 - ankle flexes, 2 - quad sets (tightening the muscles in my thigh just above my knee and bringing the back of my knee down to the bed), 3 - butt squeezes.  I learned that my leg would be kept flat against the bed so it would heal straight rather than having it bent over a pillow where it would heal bent and be harder to straighten out later.  This is a change from when my mother had her knees done. Her legs were propped on pillows when she was in bed.

From a Respiratory Therapist, I was also given an Incentive Spirometer These are very common in hospitals.  Patients are instructed to inhale through the mouth piece and make the little ball at the right float and the big yellow thing slide up the scale to the indicated point.  I was told to do this 10 times an hour.  This helps keep the lungs clear and reduces the chances of pneumonia.

Also around 6:00 my nurse gave me my first pain med - Oxycodone, a 12-hour slow-release variety (it was explained that my spinal was still providing pain relief), and aspirin for blood thinning.

About 7:30 I met my night-shift nurse and tech - my vitals were all good. I still felt "drugged" but not sleepy.  I ordered my dinner from room service (I was only allowed clear liquids until my intestines woke up, which would be signaled by passing gas) :  chicken broth, orange and red jello, cranberry juice and Sprite (which I mixed together).  I ate very slowly and didn't feel nauseous at all.

At 8:00 my sugar check was 156.  At 9 my vitals were good again and I was given my cholesterol med, iron and a stool softener.  It was then a very quiet several hours.

:) Amy

The Big Day

My friend picked me up about 10 am, and we headed to the hospital.  I was at a facility called the Mount Carmel New Albany Surgical Hospital.  It is just for orthopedic surgeries, so there aren't "sick" people there.  I believe that greatly reduces the chance of infection.  This is really a lovely facility - it looks more like a luxury hotel than a hospital.  Everyone I worked with there was great!

I checked in at the front desk and was sent to registration.  I had already pre-registered, but I still had to show my driver's license, insurance card, and my Living Will and Health Care POA.  Next we were taken to the surgical waiting room where I check in.  In just a couple of minutes a nurse came to get me, and I was told to bring my CPAP machine with me.  I was taken to a large area that sort of looked like an emergency room, with bed/areas that were curtained off.  I was put in a little cubicle and told to take my clothes off, put them in a bag, and then put on a gown and little booties.  Then I was to make myself comfy on the bed.  A nurse came in and asked me lots of medical history questions, which I had already answered several times.  She also drew blood.  Then they let my friend come sit with me.

A little while later, I spoke with the head anesthesiologist and then later with a student on his team.  They both explained that I would be getting a spinal as well as another anesthesia.  They explained the benefits of both - that I would wake up faster, be less groggy and get more help with pain for a longer time.  They had me sign a consent form for that plan.

Around noonish, my friend was asked to go back to the waiting room, and I was given my spinal, and then wheeled into the operating room.  I could feel the spinal immediately.  My hands could feel my body, but my body couldn't feel my hands.  Then a mask was put on my face and I was gone.  The next thing I knew I was waking up in recovery.

More to come - stay tuned!

:)Amy

About Ready to Go

I slept fairly well - went to bed at 2 and first woke up around 6, but I managed to go back to sleep until my music came on at 8.  I had very weird school dreams.  In the weirdest one, all the freshmen boys had to drive mini race cars onto the gym floor.  They parked them all in the middle, then they got out and chased each other around and over the cars.  What's up with that?  I'm sure there is some deep psychological significance, but I'm having trouble finding it right now.

I showered... again... used more antiseptic.  I'm sorry - I TRIED to use the whole bottle, but I just couldn't!  Even after washing my whole body twice and my leg about 4 times, I still have some left.  So, if I end up with an infection, let the record show it is my fault because I didn't use the whole bottle!  Ok - that's on me!

I now need to distract myself for another hour so I don't eat anything.

Let me digress for just a minute to say that I got to see the Broadway Touring Company's performance of WICKED at the Ohio Theatre on Sunday night.  O M G !!!  The show was totally amazing!  I've seen it at least twice in NY, but this cast was every bit as good (and better in some ways).  There were several highlights: John Davidson was a real treat as the Wizard.  I didn't know he was in the show when I ordered my tickets, so that was an exciting surprise.  He is just as hot at 71 as he was "back in the day".  Those dimples are winners no matter how old he gets, and he is one of those men who has turned into a "silver fox" with the full head of white hair.  mmmmm  mmmmm mmmm !!!  The next highlight was Kim Zimmer as Madame Morrible.  I wasn't familiar with her from The Guiding Light, but I was very impressed with her - she was very well cast in this part.  Glinda was played by Jenn Gambatese.  I loved the humor she added to the role.  It is hard to imagine anyone topping Kristin Chenowith, but Jenn gave her a run for her money.  By far the biggest highlight was Alison Luff as Elphaba.  Her voice was simply amazing, and "Defying Gravity" blew me away!  I'm pretty sure there were a few script changes along the way, but then I don't really trust my memory 100%, and it has been a few years.  I got things out of this viewing that I didn't remember from before.  This is one of those experiences that I didn't want to end, and I will remember for a long time.

Ok, time to dry my hair and finish getting ready to go.

Talk to you again soon!

:)Amy

P.S.  Please don't forget to feed the fish while I'm gone!