Staying Alive....PO Day 86

I wish I had read all of Consumer Report's advice before my shoulder replacement surgery. I was not a good, proactive patient. Don't get me wrong, I was, and still am, very satisfied with my doctors and my hospital. They are not clairvoyant. If I didn't speak up how could they possibly know?

It is not in my nature to complain. I'm sure anyone reading this blog finds that hard to believe! In real life I have this compulsive need to be the "low maintenance" wife, mother, patient, whatever. But if there is ever a time in your life when you should be "high maintenance," it's when you are sick or wounded or have "gone under the knife."

Every time someone checked my oxygen levels in the hospital the first go-round they would tell me to breathe more deeply to get the numbers up to acceptable. I was only there a day and a half after surgery and there was very little demand on my lungs, a short trip to the bathroom a few times only made me very slightly breathless. I ignored the signs that something was amiss. I did not discuss it with anyone.

As soon as I came home and began to walk around I realized I was very short of breath. I thought it was due to the pain medication and requested a prescription change. To her credit, my surgeon's nurse to whom I spoke told me to go to the emergency room if my breathing did not improve. But I, ever the optimist, convinced myself that I was getting better. At least I was toughing it out. Not the right approach!

It wasn't until a week later when I went in for my first post op visit and had an X-ray of my shoulder that the radiologist was surprised to see I had a large area of collapsed lung, (pneumothorax), a serious complication of the interscalene nerve block frequently used in shoulder surgery.

4. Interscalene Block

"The interscalene block is the gold standard for shoulder anesthesia and the most commonly used block for shoulder procedures. This approach blocks the brachial plexus at the nerve root or trunk ... The block is especially useful for procedures involving the shoulder, including the lateral two-thirds of the clavicle, proximal humerus, and shoulder joint [1]. "

"Common complications of the interscalene nerve block include phrenic nerve blockade (hemidiaphragmatic paresis), Horner’s syndrome, recurrent laryngeal nerve blockade, and vasculature puncture (hematoma). Rarer, but potentially devastating, complications include carotid artery puncture and intervertebral artery injection, pneumothorax, subdural injection, intervertebral foramina injection resulting in spinal or epidural anesthesia, and nerve injury.


Who knew? I bet these risks were mentioned deep in that sheaf of papers I hurriedly signed lying on the gurney before being wheeled into surgery. Do you think I could have asked them to wait while I did a little internet research on my iPad?

The point is it's all about Staying Alive to fight another day. Consumer Reports encourages us to be informed, be our own advocate, research and question everything. It's not necessarily easy to do. We all need this stuck in our brain as we bravely roll into the operating room...

http://youtu.be/I_izvAbhExY

Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September...

Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September....

http://youtu.be/I_izvAbhExY

CR: During Your Stay and after...PODay 85

Excerpted from the same Consumer reports article:

1. Monitor your medications. The Institute of Medicine estimates that, on average, there is one medication error per every admitted patient. Ask what the medicine is and why you are being given it.

2. Guard against infection. There is little you can do to protect against contamination during surgery where most infections start. Poor hand washing protocol  and improper instrument sterilization are the main causes of surgical infections. But you can be diligent before or after the fact: insist on clean hands, including those of visitors; encourage the removal of catheters, ventilators and other tubes as soon as possible; ask if you should have a single antibiotic dose immediately prior to surgery; ask if shaving your surgical site is really necessary, cuts or nicks can provide an opening for bacteria; and question why you are prescribed a drug for heartburn, if you are. Many of the commonly prescribed ones can increase the chance of intestinal infections and pneumonia.

3. Reject unnecessary tests. Know why a certain test is being scheduled.

4. Expect enough, but not too much, pain relief. Ask your doctor to write a standing order for pain medication. Also something for sleep and for constipation.  Discuss anesthesia with the surgeon or anesthesiologist before your operation. Report if you have a high tolerance for pain or a low tolerance. Your analysis can mean you are more likely to get your pain meds timely or keep you from being over medicated and feeling groggy.

Speak up if you are in pain. And don't be afraid of narcotic painkillers. Short term use in a hospital setting  poses little risk, if any, of addiction.

 Ask if a nerve block is indicated. This is particularly useful with joint replacement surgery.

5. Get up out of bed as soon as advisable but be sure you have help. If you have to a stay in bed ask for special pads to prevent bedsores and pneumatic stockings to prevent blood clots.

6. Stay warm. Ask if you will be covered with a special surgical blanket to keep your temperature from dropping during the operation.

7. Your surgeon should initial the body part on which he will be working. Everyone prepping you for surgery should call you by name and confirm you are who they think you are. Be prepared to state your date of birth over and over. It's a good thing.

8. Stay alert...if you are awake. Trust your instincts and question something that seems not quite right.

Finally, when it is time to go home, discuss exit plans in advance of leaving. Talk about arrangements the day before you expect to be discharged. ~ Be part of the decision that you are ready to leave the hospital. If it seems that your doctor cannot extend your hospital visit and you feel you are not able to be discharged, appeal to the discharge planner or hospital patient advocate. ~ Get a discharge summary. This is a clearly written statement of what you should do when you get home, such as, how to care for surgical wounds, how active you may be, when you can shower, drive a car, return to work, and resume a normal diet. ~ Have a written list of medicines you will be expected to take at home. Know their purpose and side effects. Ask about possible after effects of anesthesia. ~ Be sure lab tests done in the short time before you leave the hospital will be copied to your doctor. Ask for copies for yourself. ~ Know when you are to follow up with your doctor and if an appointment has been scheduled or if you need to arrange it.





Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September....

Advice from ME and CR: PO Day 84

The  big day - When you check in:

According to ME:

Hopefully you have pre-registered and don't have to discuss insurance and financial responsibilities on the day of your surgery. But do bring a photo ID and your insurance cards, just in case. Hand them over to your "hospital helper" before you are taken back to the pre op holding area.

 Don't count on cell service within the surgical wing, leave tech equipment with your "hospital helper" so it does not get misplaced. Have a small bag for your glasses, hearing aids, and/ or dentures, things you might need soon after surgery, even in post op, with your name on the bag. Do not wear ANY jewelry- NO earrings, watches, ankle bracelets, toe rings, nose rings, eyebrow studs, belly button piercings, not even your wedding ring that you have not removed in 36 years of wedded bliss.

Follow the instructions regarding food and liquids. NPO means Nil Per Os or Nothing Per Orem. Either way it means No Food Or Liquid by Mouth. A "little orange juice" or a "bite of toast" is NOT okay. At best consuming something can result in your surgery being cancelled, at worst you could vomit during surgery and precipitate an emergency.

Don't wear make up, finger nail polish, nor lotions on your skin. The anesthesiologist needs to be able to see your "color," are you pale, ashen, flushed? It's hard to do with concealer, blusher and foundation making you look fabulous. The "pulse oximeter," that gadget that clips on your finger tip, needs to be able to "see" through your fingernail, a cool lacquer manicure obstructs the 'view.'
Lotions and creams are not sterile and prevent surgical tapes and EKG clips from sticking to your skin.

Things move fast in pre-op. Stay calm, listen to your nurse and trust you have made good choices and are in good hands.

Consumer Reports, CR, stresses the following:

Bring two copies of your drug list, one for the surgery staff and one for the floor nurse.

Introduce your "hospital helper" and be sure everyone knows she is there to act for you, if needed.

Ask for the name of the hospital " Liaison," a staff member whose job it is to solve problems.

Ask who will be in charge of your case if your surgeon is not available. Will you have a hospitalist?

Check your wristband. Look for misspellings and missing information such as drug allergies. Hospital staff should check your bracelet every time they administer a drug, take a blood sample, or perform a test.  Be sure the info on it is correct.




Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September....

Here's that link...

http:/medicare.gov/hospitalcompare

More CR Advice....PO Day 83

Excerpted from the same Consumer Reports "Survival Guide:"

Before you are admitted:

Check out the hospital's ratings. Ask about infection rates. Try to find a survey of patients and what they thought. Even if you cannot choose to go elsewhere, you will know what problems to watch out for. Go to Medicare.gov/hospitalcompare and enter your zip code to see how your hospital compares to the national averages.

Schedule an appointment with your doctor where you can discuss his plans. Be sure he knows what drugs you take, including over the counter supplements. Make a list for him and for the hospital. What pre-admission tests will be required? What procedures will be done as you are admitted? Do you need to make any pre- op changes in your diet? How long will you be in the hospital? Make notes and have a "check off" list.

Time your surgery well. Mondays can be hectic when weekend emergency room patients have to be worked into the schedule. If your surgery is on a Friday you may find fewer staff around over the weekend. Tuesday, Wednesday or Thursday is best.

Discuss your heart attack risk with the surgeon. Will you have a pre-op EKG?

Designate a hospital helper, a friend or relative who can be your advocate if you are too ill or distracted to speak up. Be sure it is someone who can check on you daily and be with you at check in and check out.

Prepare a living will and choose a health care proxy. Be sure the health care proxy has a copy of your living will. This is something  we all should have done well in advance of any surgery. But if you didn't, now is the time!

Bank your blood if your procedure could require a transfusion. This has to be done well in advance of  surgery so plan ahead.

Quit smoking! You won't be allowed to smoke in the hospital nor on the grounds. Better to start the withdrawal process before you are operated.

Consider being screened for MRSA. (My hospital did this as a routine pre-op test.)

There is more good advice from Consumer Reports to follow. Next: When You Check In...





Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September....

Year of Living Dangerously...PO Day 82

It's not the romantically thrilling struggle by Mel Gibson and Sigourney Weaver in the 1982 movie. It's not the moral challenge  faced weekly on the environmental showtime TV series of 2014. It is making the  right choices, doing the prudent thing, asking the probing questions which increase your chances of surviving your hospital surgical experience that can extend months before and months after your operation. It's fairly common for the surgical patient to be told "full recovery" is about one year. What can you do to increase your chances of surviving?

It starts with choosing the right hospital which is usually based on proximity. It doesn't occur to many of us to look outside our own community for a better facility. We've built a relationship with a physician whose surgical privileges are limited to one or two nearby hospitals. Commuting to a larger city, even one not too distant, would add tremendously to the burden of family and care giver. But what do we really know about our hospital of choice?Consumer Reports in a September 2013 article ranked American surgical hospitals like they do TVs and refrigerators. The basic score was determined by the percentage of the hospital's Medicare patients who died in the hospital or who stayed longer than expected following surgery. The scores were adjusted for age, general health and other extenuating factors. A score of 5 was the highest, 1 was the lowest.

I was surprised to learn teaching hospitals scored higher on procedures like angioplasty and carotid artery operations but they were no better than other hospitals for hip, knee, and back operations. Just because a hospital (St. Francis Hospital, Roslyn, NY, for example) scored well in one category, '5' in angioplasty, it did not alter the fact they scored poorly in another, carotid artery surgery got a '1".

There can be quite a difference between hospitals only a few miles apart. The Greater Baltimore  Medical Center scored high, but nearby Johns Hopkins Bayview Medical Center scored low. Both urban and rural facilities can surprise you. Urban hospitals often did well in spite of a patient population that is typically poorer and sicker. And rural hospitals did better, on average, than other hospitals. Sadly, big name hospitals often did not live up to their reputations.

Hospitals that are part of the same healthcare system can have quite disparate total scores. Florida Hospital  DeLand was rated 4, Florida Hospital Flagler scored a 3, while Florida Hospital St Augustine and Florida Hospital Orlando received the lowest rating, 1.

Of approximately 140 hospitals in Florida, only eight received the highest score, "5". Ten rated "4".
The majority, seventy-six were judged as a "3". Twenty-two were judged next to the worst at "2" and twenty-three scored at the bottom, "1".

If you are a subscriber to Consumer Reports you can learn more about your community hospital on line. Knowing more about your hospital might just take some of the danger out of your surgical experience and make you a survivor.





Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September....

Thoughts from the dark side...PO Day 81

                                 From the dark side we can see a glow of something bright 

                                                There's much more than we see here 

                                                        Don't burn the day away 

                                                                                                            The Dave Mathews Band

It's 2:45 AM and I am wide awake. I think this is a pattern that I have fallen into. I will toss and turn for fifteen minutes, then do the one thing all sleep counselors advise against - I turn on the TV. The distinctive silver glow illuminates the room, crawls down the stairs and peaks around the window shades, announcing to insomniac neighbors that someone else is not able to sleep.

I fluff three pillows and shore up the mountain of cushions designed to fool my shoulder into thinking I am sleeping on the sofa which has been its  bed of choice since breaking my arm. My arm loves the sofa but my back and neck prefer the bed. I mute the sound and begin to scroll up the channels. Familiar faces fill the screen and smile at me like I am an old friend come to visit.

Cindy Crawford will show me the secrets to ageless beauty. It certainly has worked for her. 'No Name' spokesmodels who look seventeen advise me on how to look  30 years younger and air brush techniques will make my wrinkles disappear. If I hate my turkey neck (who doesn't) there are creams for the conservative and LifeLift for the brave. Zumba and the Body Beast will tone my tummy and the 21 Day Fix and Healthy Meals in Minutes will melt pounds away. I can stop hair loss, grow new hair, or manage my lush, thick hair. I can win the fight against cancer or deal with pain and depression.  My water can be filtered, the Shark will steam clean the floors. I can vacuum the couches or vacuum pack our food. If I am tired of paying for TV there is someone to show me how to dump my cable provider and I can learn to "flip" a house and make a huge profit.

There's a spray can that turns a screen door into a boat floor. Little cups will hard boil eggs that come out shelled. ( I actually was tempted by that one! ) Body suits make Zumba and the Body Beast superfluous. Skillets let fried eggs slide right off onto the plate and conduction burners boil water in 30 seconds. I can make a chicken dinner in a slow cooker that takes all day or in a pressure fryer in just 20 minutes. It's a miracle.

Or not. Even my sleepy brain recognizes that shipping and handling often costs more than the
item itself. I know nothing can make me look 30 years younger. I am pretty sure that boat is going to sink when they put it in the water. And flipping houses is fraught with risk. I wonder who buys these things. I do know who's awake watching the ads. They should  feature a cure for Insomnia! Fact is I already know what to do.  Give up and go sleep on the couch!





Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September....