First Post Surgical Appointment

Tuesday February 18, 2014

Gearing up for my first post surgical appointment the night before (February 17) I was so excited at the opportunity to finally leave the house that I made sure to actually go through the motions of using hair products and picking out a very special yoga pants outfit. I was even going make sure to wear make up, something I hadn't done since January 31 (surgery day). The forecast overnight was not looking good, there was to be a wintry mix with a possible 3-5 inches of snow. We stayed up a little later than normal and watched a movie and even caught the first few moments of Jimmy Fallon's first monologue as host of The Tonight Show. Even at midnight no precipitation had begun-maybe they would be wrong? It was still cold, only time would tell.

David took the day off in order to take me to my appointment. That being said, we woke up a little later than our usual 4:50 am. The outside didn't look too bad, the cars were barely covered, but the temperature was very cold. However, it quickly went from bad to worse and the snow came down with a vengeance and schools that had at first had a delay were now cancelling classes for the day. Our street became covered in a thick blanket of snow. While I was getting ready,and I DID put on some make up and especially my favorite item-mascara, David went outside to start the car and clear off the snow. On the news there were multiple reports of accidents and increasing numbers of cancellations and worsening road conditions.

7:45 and I was suited up and ready to make it down the stairs of the porch and into the car. The snow was still coming down. The roads were TERRIBLE-Travelling in our area was at best a crawl. Since our winter season had started so early, and just like much of the country we were under the veil of the Polar Vortex and record snows and cold communities were either out of salt or on very limited supplies. As we began our journey I could tell it was going to take a while, I called ahead and let the office staff know that we were on our way. The last thing I wanted was to be counted as a no show. All in all we got to the Medical Building only 15 minutes past my actual appointment time. Not great-but much better than what we thought when we first headed out.

David dropped me off at the door and I used my walker and slowly  got to the second floor and checked in. Since the weather was so bad, I think everyone was operating on a delay. The waiting area didn't look too overrun with patients at this point, so I breathed a bit of relief and found a spot and waited. 

The wait was quite tolerable and probably the least amount of time since I have been going to this group. Berniece, my surgeon's nurse came out to greet me and we walked first to X-ray.

 It must have been the technician's first day because both she and I had to tell him that I would need assistance to get onto the table and to position my legs. He also asked what happened and what I had done to my hips. When I told him that I had CONGENITAL hip dysplasia corrected with a PAO surgery -he looked at me and said "Oh were you in an accident or something?" Oh geez-thank goodness he just runs x-ray equipment. "No" I said politely. "I was born this way and had it corrected."  Well, in cases like these I just think just get through it and move on...he doesn't know and don't waste your time. But, I will say that my surgeon's nurse just gave the technician a look and said "She has had MAJOR SURGERY-ON HER LEFT HIP-please make sure you get clear films. " I am guessing this guy is just not a morning person. He seemed nice enough, so we all have off days. 

After the x-rays were taken, they are digitally captured and I was led to an exam room. 

The doctor came in and said that things were looking good. He wanted me to stay non-weight bearing for at least another two weeks and come back. he would like to see some "bony bridging" before I would be allowed to put pressure or stress on my hip joint. If you look closely you can see how he recreated a new hip socket and that the screws are still doing the work. The right side is still dysplastic, but one thing at a time, one side at a time.

All in all he was very pleased with my numbers, overall health and progress. everything seemed to be on track!

The last order of business for the doctor's visit was to check the incision. The dressing was removed and Bernice removed the dressing tape. The surgeon actually used a "glue" to close up the incision! Everything looked really good, not swollen, healing nicely (well as pretty as a 10 inch glued incision can be)

The incision: Not conventionally "pretty" but in the wound world it is a SUPERMODEL

So, for the next two weeks it will be more of the CPM machine twice a day. More resting, more eating right, and more positive thinking. The other great thing is that my weight and appetite are maintained at its normal level. In fact, I feel like I have actually lost a little bit of weight. Nothing of significance, but before surgery one of my concerns was that I would gain weight by being so sedentary during my recovery. Dr. Sauber was right, there is a lot of energy being used in this healing process. 

~DRIVE SLOW~

The First Fortnight Home- Adjustments and Adaptations

My first night home was February 4, 2014-
 It was a very long day and I was exhausted. Shortly after our arrival home I had to call the home health care equipment company and request that my "special toilet" be delivered. I was certainly able to make it to the bathroom, but the "bedside commode" ( the word commode makes me cringe) was adaptable to go over our home facilities to achieve a higher seat" and offer hand rails for safety and bracing.

Bedside Commode

Adapted on Residential Toilet

In addition to this little number was the shower transfer bench, which I think I mentioned in another post. We had ordered one while I was in the hospital from Amazon. Taking advantage of my Prime membership it was to be delivered on the next day. SO-Here is a little "fun fact" that I found out through our adventures getting the house ready. A shower bench/chair is NOT COVERED by MOST INSURANCE PLANS BECAUSE IT IS CONSIDERED TO BE A LUXURY ITEM. Being Clean is considered to be a luxury??? How about prevention of infection? Maintaining a healthy living environment, wound care, general health and hygiene?What about safety? People having had all types of illnesses and surgeries that leave them either too weak or just unable to stand to bathe? Talk about totally absurd! So, Readers, I implore you to write to your local lawmakers and please tell them that if items such as a toilet, walkers, crutches, walkers, wheelchairs, and braces are covered by most plans, THEN so should items to aid in the daily health and hygiene of patients. The solution that we were told that so often happens was to use a LAWN CHAIR in the tub or shower. A lawn chair is neither safe, nor sturdy, and so easily tip over in a wet tub or shower stall.

Proper Shower Transfer Bench

Often suggested Alternative-UNSAFE

As far as our home is concerned, it worked out pretty well that our master bedroom, bathroom kitchen and living room are all on the first floor. David and I did decide to switch sides of our bed so that I would be closer to the door and have less obstacles, a clear path, less steps to the bathroom if needed during the night. The first few nights I was still very immobile and needed assistance in and out of the bed. We also noticed how dark the hallways were and having hardwood floors also worked well for me. We found that having the light on the range hood on all night cast a nice soft light to illuminate the hallway and into the bedroom for me without being so bright to keep us awake.

My first fortnight was also met with meeting several home health care workers. Visiting Nurses ,an  Occupational Therapist,and a Physical Therapist. These Nurses came every other day and checked my wound sites, changed dressings, took vitals, and instructed me that this was an extension of my hospital stay and that it was very important to monitor my health, wound sites, and to be mindful that I was still quite susceptible for infection and especially pneumonia. I am taking ALL of this very seriously and incorporating this in to my own plan.

David has been the designated shower helper. The first time was a bit of a learning curve and we had a bit of a mishap. But it wasn't horrible. The trick for the first few times was to get onto the bench clothes and then remove them. Getting out of the shower would require making sure that all body parts were completely dry and a towel is placed on the side of the tub so that my "bad" leg could not slip or slide. The transfer bench is definitely the way to go if PAO is the surgery you are having. It allows for more of a "scooting" motion and then your helper can gently life your legs and you pivot into the tub. Our shower already had a removable sprayer head so that I could wash my hair/body. In addition we purchased a bath pouf on a long handle. This helps tremendously when unable to bend over and you need to clean your legs, feet, arms, and back.

We brought home the CPM machine as well. It is the Continuous Passive Motion machine that I was given to use twice per day for two (2) hours at a time to gently move my left leg back and forth. This was going to help keep my knee from getting too stiff, start to work my quad (slowly), promote circulation, and serve as the first step after a major surgical procedure.

Kinetic CPM Machine

The most substantial addition to our household during my recovery has been my mother, Anna. She has been staying with us during the week to assist during the day while David goes to work since I am in no position to really do anything other than going to the bathroom by myself. Anna is a tireless and selfless veteran of taking care of me. She has been doing so at various times throughout my lifetime for various reasons, several health issues, and for varying lengths of time. My mom, of course was my first caregiver and was around for my very first hip operation when I was only a few months old. This was WAY BACK in 1975 at Children's Hospital of Pittsburgh. It was not as invasive of a surgery as this one, but surgery is surgery. And surgery on an infant is very traumatic. My mother was a MacGuyver BEFORE there was ever a writer born that could fathom that show! She used to cut diapers into pieces and re-piece them for me. My first Halloween costume was a lamb, so that it would camouflage/match the body cast that I had been sporting. 

The first few days, even a week or so, she was quite jumpy and every time I moved or breathed heavy she was ready to get me something or assist. I believe this would be some sort of reflex coming back to life, an instinct of sorts. But even though we sometimes disagree, I do appreciate the efforts and concern. The intentions are true and as I am getting stronger she is seeing the progress. We do share a lot of interests and have been enjoying some mystery programs and true crime shows. She is a great cook and that is also a huge plus. Having someone around to make sure that I am eating, and eating full healthy meals is important to a successful recovery. 

I have my first Post-Surgery Appointment Tomorrow-So Stay Tuned and DRIVE SLOW

Five Days of Hospital (-ity)

February 1, 2014

First Day at the hospital was spent in surgery and then the rest of the time was spent in recovery receiving fluids and antibiotics via IV, and also oxygen. I was also being monitored every two hours for my vital signs-this is normal. All was going very well and other than a bit of a higher than normal heart rate in the beginning, which seemed to settle itself.

Pain management: Every two hours I was able to receive some type of pain management medication. I was either receiving an IV Morphine, or a Percocet tablet. I was also asked at each administration of medication what my pain level was based on the Wong-Baker Pain Scale (illustrated below)

During my first days I was also still feeling numbness in my left hand .

The doctors were monitoring the sensation/lack of sensation that I was feeling and swelling. They suspected that it was due to the positioning that my body was in for the extended period of time and that possibly some nerves were "squished' or "asleep" and it was taking them a bit longer to "wake up". This while I knew was probably the case, I was a bit concerned. During this time I was unable to use my left hand to hold, grip, or feel anything. On more than one occasion i had fallen asleep holding a cup of ginger ale and because I had no sensation in my left hand was awakened only when the cup spilled onto my front.

Post Surgery-w/Oxygen

Since my surgery was on a Friday, the next thing I experienced was the phenomenon of  WEEKEND HOSPITAL NURSING STAFF . **Please note: this is my experience, my blog, and my opinion**

In my experience of being a patient several times in my life I have found that Nursing staff and nursing support staff on the weekends are not nearly as attentive as those during the night or as those on the weekdays. This was proven as I was having to call multiple times on the second day in the hospital for pain medication. This was only my first day post surgery and I was still in a HUGE amount of pain. I was also not sure what was going on as far as what to expect. I still had my Foley catheter and was unable to move very much at all. I didn't appreciate having been told by one set of staff that I was going to be able to have the Morphine as a "breakthrough" in between other doses of pain meds and then the weekend staff it was a chore of having to use the nurse's call button more than once and having to ask for medicine each time. When the nurse did come into the room, it was almost always as if I was taking up the woman's time or a nuisance. It was my understanding that I had been moved from a nicer and bigger room to this side of the orthopedic ward so that there would be adequate nursing staff to patient ratios. Maybe I was wrong.

The other experience I had that I found interesting was that I had to ask the nursing staff to assist me in daily bathing and grooming. I am very lucky and thankful to have a very good friend in the field that came to visit me a few times who showed me how to do bedside bathing and also how to assist me in other areas of self-care and grooming. I cannot thank Gail enough for all she has done for me, not only as a friend but only as a health care professional for knowing how to go to the nurses and get the things I need and letting staff know that I was going to want to be on a regular schedule. I know that you cannot shower or really get an incision area wet after a major operation. But, after even one full day in bed, you will want to brush your teeth and at least have a warm soapy wash cloth to wash your face and perhaps sponge bathe your back, chest and arms. It can really make a difference in how the rest of the day goes as far as your demeanor and outlook. 

I was seen very early every morning by the Orthopedic Team, usually right as I was just getting to sleep (usually seemed to work out that way-hospital stays are not known for getting all the rest you think you would or should get), and then the IV team came in to either check or change the IV in my arm. The medications and fluids took their toll on my tiny veins and had to be changed twice during my stay.

They also monitored my wound drain. The drain was placed a few centimeters from the main incision site and used as a means for drainage and prevention of hematomas and swelling. As a result I really have had little swelling and very little ugly bruising. While it sounds very gross, it was pretty painless, as I was very numbed up with local anesthesia . I had a lot of drainage the first two (2) days, but then went down significantly. By the time i was ready to be discharged it was managed with a regular wound dressing.

Wound drain reservoir

Second Room

Gail takes a well deserved snooze

Throughout the other days I was at the hospital the weather continued to be terrible.

Surprise Visit From Coworkers

View from my room Pittsburgh Cultural District

Despite the staffing issues, I was okay and managed to get the care and medications I needed. Over the years I think hospital food has gone through an overhaul and I was actually not that displeased with my meals. They weren't 5-star, but they were more than edible and I was given a choice of what to order (within reason).  I was always able to have snacks from the nurses if I wanted them. And thanks to friends and family I received a fruit basket, cookies, and candy as well.

Proudly Serves Starbucks @ AGH

Get Well Cake received from Coworkers who visited

Fruit basket from family