Friday, October 7, 2011

Preparing for Your First Surgery

Quick Update on the Leg

Before my accident in February 2010, I had a couple of surgeries under my belt. However, none of them required the insane pain management we've had to experience with the last four surgeries.

Throughout these surgeries, Brooke and I have developed a process that helped us recover from three painful external fixator installations.

But before all of that, I wanted to give a quick update on the ankle. In fact, I'm not the one that was motivated today to take the pictures and video. I got an email this morning from Dr. Jeng.
How's it going over there? Need an update.
Working on a three day weekend? Dang!

The proximal k-wire on the lateral side is still acting up. Depending on the level of activity, we'll see a lot of clear and bloody drainage from the site. As you can see from the picture above, it's red and angry.

No scabs have formed on the site, so the skin moves around as I flex the shin muscles to move my foot up.

This video demonstrates how questionable this pin site is. The skin slips across the pin site fairly easily now, unlike the other pin sites.

When you get an external fixator, the medial side of your other ankle is going to occasionally take some abuse. I took a nice hit last night as I got off of the couch.

The pin sites are still sore after a long day of walking, and edema seems to be a growing problem the longer my ankle is relatively immobilized in this thing.

I'm definitely looking forward to the November 3rd removal.

Preparing for Your First Ex-Fix Surgery

1. Write down your questions. Come prepared.

Take time to brainstorm what you don't understand or know about your procedure and write down your questions. Print them out and bring them with you to your surgeon. If you're not going to see him until the day of the procedure, that's fine. Your surgeon will appreciate the work and effort you put in to show up prepared.

I had several questions during my surgeries. Because I had severe nerve damage, I usually asked about what to expect about neuropathy. With ankle distraction, your nerves will be stretched and nerve pain is a possible issue.

While I didn't end up with nerve pain, I did lose all sensation in my heel.

I also want to rehearse our game plan for pain management, so I usually make sure that things have been ordered and I'll wake up with a PCA. You might need to work with your nurse anesthetist or anesthesiologist and your surgeon about this.

2. It will hurt.

I'm sorry to say this, but it's going to hurt. It's a combination of swelling, stabbing, and a high amount of tension if it's a distraction arthroplasty. I've had surgeons and nurses tell me that ankle surgeries are one of the most painful.

The good news is if you're only getting an external fixator, it won't be that bad. If you're getting plates, screws, and bones internally fixated -- you're in for a wild ride.

Before you show up to the hospital, work with your surgeon, physician's assistant, or nurse practitioner to get a plan in place. It's always good to get things ordered going into surgery, like a dilaudid bolus when you're taken off of the PCA, and the appropriate oral pain medication as you are weened off of the bolus.

And because you're going to be on all of these pain medications, start taking Miralax a few days before you show up for the big day. Trust me. This is a good idea.

You'll also want to start asking for Benadryl early. The massive amounts of pain medications coursing through your veins will make your skin itch like crazy.

We always made sure I had a patient controlled analgesia (PCA) device hooked up to my IV. Usually, your surgeon will administer a nerve block under your leg to help with pain. As that wears off, you'll start to feel your ankle. Before the nerve block wears off, it's a good idea to get several PCA doses in your system.

3. Hospital physical therapy

If you've never had to use crutches, it might not be a bad idea to take a few lessons from the hospital physical therapist. Because I've been crutching for almost two years, I usually decline the hospital physical therapy offers.

4. Always stay ahead of pain

This is the most important thing to know about your surgery. That's why I ask for a PCA, a IV bolus on order, and oral medications of every kind. Don't mess around with pain.

Be honest and polite but stubborn with your nurse. Do not wait for the pain to get a little bit worse before asking for help. Do not get behind. If you're on oral medication, and you get behind on your pain, it might set you back to IV bolus dosages to catch back up.

That's a big set back.

Sometimes, when I ask a nurse for a bolus or something to help with pain, it feels like I'm getting into an argument. I tell my nurse I'm in pain (it's a 5 or 6 going on to a 7 out of 10), and she counters with, "there's nothing I can do."

This isn't always the case. There's always something we can do.

This is why it's so important to have every option available on order so your nurse doesn't need to bother your surgeon. My wife happens to be a nurse, and I've found that having her at my side to act as my squeaky wheel has really helped.

Just remember that the longer you're in pain, the longer you'll be staying in the hospital.
The same rule applies when you're at home. Once you get behind your pain, it takes a long time to catch up.


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