December 25, 2007

Part II of ACL Surgery: Forgotten Pain Meds and More Agony

Merry Christmas to all my readers who celebrate the holiday! I’ll be spending mine on the couch with an elevated, iced knee.

This is part II of my ACL surgery story. For the first post, go here.

Tuesday

My awesome night nurse left and I was worried. I had read in many online journals that day two was the absolute worst it would get. I couldn’t imagine it getting more awful, but it would.

In walked my day shift nurse. She came in, introduced herself, looked at my chart and said, "Oh honey, ACL’s are the worst! I know you’re just in agony right now." She was right. My day shift nurse told me that she had the exact same surgery seven years ago and that she completely understood how I was feeling. I told her that I was really concerned that I couldn’t pee. She confirmed that I wouldn’t be able to go home unless I could. She came up with a plan to wean me off of the morphine pump.

My breakfast was delivered and included scrambled eggs, a bagel with cream cheese, orange juice, rice krispies and coffee. Despite the hospital having very good food, it all made me sick. I felt like I couldn’t hold my head up and I also felt nauseous. I buzzed my nurse and she came in with an injection of zofran. Zofran and I are old friends. Zofran helped me when I had food poisoning two summers ago. The nurse told me she would be right back in with saltine crackers and some percoset. It had now been 40 minutes since I had hit the pain pump button. I was getting myself off the morphine pronto. I would just deal with the pain which was increasing each minute.

I kept dozing off, but it wasn’t a good sleep. I started to feel like when I fell asleep I was forgetting to breathe and I would wake up with a start, gasping. It was horrible. One of the surgeon’s from my doctor’s practice came in with two students. He took one look at me and all three of them looked like they felt really sorry for me. I must have been a sight. I don’t remember a whole lot of our conversation. I remember telling him I was in terrible pain and that I couldn’t pee. He said I couldn’t go home unless I could pee. He gave me some encouraging words and advice. He saw my backpack in the corner and asked me if I was on winter break and where I was a student. I laughed out loud, told him the backpack was my "diaper bag" when we went to Disney World and that I was 32 years old. When someone tells you on the day after ACL surgery that you look 10 years younger than you are, you smile despite the pain. He’ll be one of my favorite people for life.

An anesthesiologist came in a few minutes later and told me he was removing my nerve block. He pulled it out painlessly and I was sorry to see that thing go. Even if it wasn’t working perfectly, I can’t imagine how much worse it would have been without that block.

I was itching something terrible and found yet another lead stuck to my side that I hadn’t pulled off the night before. I was starting to get permanent rake marks on my good leg and stomach from scratching incessantly. I couldn’t have been more miserable as my pain continued to ramp up. My leg was just throbbing and burning something terrible.

About an hour later, there was still no sign of crackers or percoset. I was in pain and I was once again sitting on a very uncomfortable bed pain willing myself to just go already, when in walked my surgeon. Fabulous. I’m so happy I was at least covered up. He asked me how I was doing and I told him, "I’m sitting on a bed pan and I’m in pain." He smiled, unphased, and started telling me about the surgery. "Your knee looked great. Perfect, expect for the torn acl. We replaced it with the allograft. Everything went fine. Your knee was perfect except for the stability." He then loosened my knee brace and said "I’m taking your drain out now" and pulled that sucker out. It hurt, but only for a second and what’s more pain when you already feel like you’re dying. I had no pain meds at the time, but I was happy to see that bloody drain go.

I asked him why he thought I couldn’t pee and he told me it was probably the morphine, or perhaps the general anesthesia had put my bladder to sleep. I told him I hadn’t hit the button for hours now and that I was still waiting for oral pain meds. He seemed puzzled and concerned when I told him I was still waiting. He finished putting my immobilizer back on and talking to me. As he was leaving, I yelled "Hey!" and he stopped and turned towards me. "So, um, you know that part where you said it wasn’t going to hurt much?" He got a big grin on his face and said, "Yeah?". I said, "Well you are a big fat LIAR!" He gave me the biggest grin and made his exit. It’s hard to be mad at a man with a smile like that.

After going almost 2.5 hours without any pain meds, I had it. I was feeling a bit more "with it" and "with it" isn’t good when it makes you even more aware of the pain you’re in. I hit the call button and an assistant came in. I told her I was promised saltine’s and percoset hours ago. She acted like she had no clue what I was talking about. A few minutes later my nurse came in apologizing with the crackers and percoset. It was 10:30 a.m. My pain level was at least a 7 when she finally arrived.

The PT ladies showed up to take me to the "gym." I was disappointed that I had a brand new therapist in the hospital. A familiar face would have been really nice; and I was so scared about what they were going to do to me at the "gym." They helped me out of bed and I was finally able to go to the bathroom upright and on my own. I felt like breaking out a bottle of champagne until I saw my reflection in the mirror. My hair was crazy in the back and my eyes looked swollen and purple. I looked defeated; there’s simply no other way to describe it. No wonder the doctor had looked at me with such sympathy.

The PT and her assistant made me crutch it to their elevated wheel chair in the hallway. It was so painful and so hard to do. I had to go so slowly. It felt like it took me five minutes to make it from one side of my room to the other. The pain was making my whole body tense up and shake. I had to keep reminding myself to relax and slowly, mechanically go through each body part in my head and will it to relax.

I was wheeled down to the gym and they put a harness strap around my waist. I had to get up, crutch it over to the stairs and learn to go up backwards with my bad leg straight and without putting any pressure on it. She also showed me how to go down the stairs. Crutches, bad leg, good leg, was the order. The PT stood behind me on the stairs; her assistant stood in front of me, holding onto the harness. I had to back my crutches up until they were touching the back of the step, same with my right foot. Then I had to hop up and backwards with the good leg, dragging the crutches and bad leg up behind me.

On the first step, the assistant had to grab my harness. I wobbled and almost fell forward. I made it the rest of the way up and couldn’t even imagine how I was going to do this at home. To get in my house? One step up, six steps down, one step up. To get to my bedroom, seven steps up followed by another seven steps up. I made it back down o.k. and told them I needed to go back to bed. I was in agony.

I ate lunch, dealt with the pain by trying to distract myself with Fox News and HGTV and was told I wouldn’t be released until PT cleared me. Right now, I was not cleared. I had to do the steps again and better. In addition to all the other discomfort, my room was a furnace. My roommate and I were both roasting and getting annoyed that nurses kept coming in and covering us up with more blankets when we were clearly telling them not to! Finally, the PT assistant heeded our request and turned the thermostat down. Our room started pumping in cool air and my roommate and I got a little relief, at least in that area.

By the time 2 p.m. rolled around, my leg was hurting badly. I could feel myself tensing up again. I knew I had taken the percoset at 10:30 and that I would soon be due. When 2:30 rolled around I hit the call button and asked about my meds. My nurse was no where to be found. One of the LPN’s found my chart and said that I may have had the meds at 10:30 but it wasn’t written down until 10:50 so I had to wait another 20 minutes for another dose. Percoset takes 15-30 minutes to kick in and an hour to hit its peak. It was going to be a rough hour. My pain level was at least a solid seven now. For comparison’s sake, I never recorded a pain level over a 5 while going through over 15 hours of natural child birth. It was serious pain.

At 2:50, my roommate was having major problems. Her blood pressure dropped to 90 over 30 and she was in bad shape. There were tons of nurses trying to help her and she was moaning in pain. I was twitching at that point from my own pain (a solid 8 now), but didn’t want to call anyone when my roommate obviously needed them more than I did. At 3:00, my PT girls came in to get me. I told them I couldn’t possibly go right now. They knew right away that something was wrong. I had to pee terribly so there was that pain. Top that with my throbbing, on fire leg and I was a mess. The PT girls said they would come back for me in half an hour after I had my pain meds.

At around 3:10, one of the nurses at the main station buzzed my room and told Ana (one of nurse assistants) over the loud speaker in the room that a patient in the next room had too many blankets on and needed her to take one off. Ana was obviously annoyed. She yelled back, "I’m in the middle of an emergency here so do you think you could go do it yourself!?!" They were still trying to help my roommate get more comfortable and get her blood pressure back up. Trembling and sweating from the pain, I yelled out, "I will go take a blanket off of the patient if someone will please just get me my pain meds first." The nurses/LPN’s/assistants behind the curtain laughed and one of them said "You go girl." Ana remarked that she couldn’t believe I didn’t have my pain meds yet. As an assistant, she was not allowed to give them to me. She and I had previously bonded over the now lower room temperature, and she had spent part of her afternoon hanging out in a chair beside my bed doing her paperwork.

At 3:30, the PT girls came back into my room and asked me if I was ready to roll. One look at me told them otherwise. My forehead was dripping with sweat and I was trembling uncontrollably. "I didn’t get my pain meds" I blurted out and the tears started to flow. The PT assistant (who is an absolute angel and I am writing her a letter to tell her so) said, "What??? You didn’t get your pain meds yet? You should have had them an hour ago!" She stormed out of the room and there was much yelling in the hallway. The PT went with her and they were both going ballistic on the lazy nurses who were apparently just hanging out at the main desk. I was in too much pain to take what would have been usual enjoyment from someone sticking up for me in such a fashion.

Two minutes later, my original nurse who had disappeared in the morning came in with my percoset, a drink and apologies. She went on to tell me that she had been called to a meeting and that she had given explicit instructions to the next shift nurse to give me my meds. I didn’t care what her excuse was. I nodded at her and didn’t say a word. I had never experienced pain like that in my entire life and all I wanted to do was have it stop. The PT girls helped me get to the bathroom and now I only had one pain to deal with.

I told them I didn’t want to wait for the meds to kick in, that I wanted to go do the steps now and get the hell out of there. The PT and her assistant kept apologizing to me about what had happened, and I stopped them immediately. I told them they were the only reason I even got my pain meds and that I was so thankful for them. It wasn’t their fault at all.

By this time Mr. BBM and Big I had arrived at the hospital. I cried when I saw them coming down the hall. I was just so relieved my family was there. Despite my disheveled appearance, Big I only saw her Mommy and smiled at me and began telling me about her day. It was a fabulous distraction from the pain, and I now had advocates with legs that worked! They wheeled me down to PT and I did the steps twice in a row. The pain meds had not yet kicked in but I was determined to get them done and get out of there. They signed off on me and I was ready to go home.

Mr. BBM helped me get dressed and packed up all my belongings. The nurse gave me my discharge instructions and said she was going to call for transport to come and get me. Forty minutes later, no one had come for me. Mr. BBM, Big I and I shared my dinner tray and waited. Finally, Mr. BBM went to check on my transport and guess what? No transport had been called. Ten minutes later, when the man with the wheelchair (which looked more to me like a magic chariot to me) arrived, I was so happy. I said goodbye to my roommate, wished her well and said I’d pray that she got to go home soon.

Getting into the car was a challenge but the cool air outside, combined with knowing I was leaving made the pain seem minimal. It took me about 20 minutes to get in the house and up to my room once I got home. It was a real work out. Mr. BBM went to pick up my prescription and I thanked God I was home and had been spared another night at the hospital.

Later that night, I was breaking through with the pain meds just two hours after taking them and was miserable. Mr. BBM called the surgeon and spoke to the on call doctor. They promised me a stronger prescription in the morning when I went to PT and gave suggestions for managing my pain better through the night. They were shocked at how I was treated at the hospital and told me that unlike the two pillow max they gave me to prop up my leg there, I was really supposed to be using 4 or 5 pillows to elevate my leg. They said they would be "having a talk" with the nurses in the ortho surgical unit.

To distract me from my leg, Mr. BBM used a basin and washed and conditioned my hair while I lay in bed. The morphine had made me so itchy and it felt so good to have my hair washed.

Mr. BBM woke me up every two hours to give me either Vicodin or Ibuprofen through the night. He was amazing. . . exhausted and amazing. Besides the few seconds it took for me to swallow my meds, I slept almost the entire night. Finally some sleep and a little bit of relief.

Wednesday

I woke up, and was shocked to find that I had very minimal pain compared to the day before. Mr. BBM helped me get out of bed because my entire body ached. I felt like I had done 500 push ups and equally as many sit ups. My neck was also killing me, along with my arms, shoulders and back. Everything just hurt. My Mom said it could be from them moving me around while I was under general. I thought at least part of it was from being so tense during the previous two pain-filled days.

I brushed my teeth and went to the bathroom (a real pain in the butt for a woman who needs to sit when you have a brace so high up on your thigh). When I came out of the bathroom I was sweating and seeing spots. I had to sit down. Mr. BBM helped me get dressed and I realized I was going to have to take it a lot slower getting up and back down.

I arrived at PT and my PT gave me a big grin. I don’t know if he was happy to see me up and alive or he was more amused at my attire. I arrived wearing a pair of shorts with a pair of extra large aqua blue scrub pants over top (Mr. BBM’s from many years ago). I also wore a t-shirt that didn’t match a thing and a black zip up fleece sweat shirt. I had attempted to brush my hair, but left the make-up zipped in its bag. I was surely a sight.

He removed all the bandaging and what I saw wasn’t as bad as I expected. I have about 8-10 stitches total (I think): two small poke holes and two larger incisions (one below and one above my knee to the sides). My knee was swollen but not as badly as I expected, and there was only minimal bruising. That comes later I guess. Here it is, two days post-op, in all its glory:

The lowest incision with the steri-strips is the biggest and most annoying.

The view from the front. Pretty huh?

Some random nick on my thigh. What the heck is that anyway?

The scrubbed off remnants of the "yes" that told the surgeon he was on the correct knee.

My PT put ice and stims on my knee and it felt so good. He also refit my brace (They had messed it up a bit at the hospital). He showed me some exercises to do. I did some quad sets and both my PT and Mr. BBM laughed because I thought I was making a killer good muscle contraction but my leg was barely moving. He also had me bend my knee and checked my flexion. 55 degrees-not bad for two days post op. I was also able to lay my leg completely flat at 0 degrees extension.

My PT gave me a bunch of simple exercises to do and I headed back out. It went really well. Unlike so many horror stories I’ve read online about getting nauseous or dizzy at PT for the first time, I felt great. I made an appointment for a week later. My goals are to do my exercises at least three time a day, and ice it a lot. In one week, hopefully the swelling will have gone down, and I can start doing more.

The rest of the day went relatively well. With the new Percoset scrip, my pain was controlled pretty well. Mr. BBM continued to set the alarm and wake me up through the night to keep ahead of the pain and it seemed to be working.

After feeling like death would be easier on Monday and Tuesday, Wednesday was a refreshing and encouraging day.

This is part II of III. For part I, go back a post. Part III will appear tomorrow.