I expected pain after my open heart surgery. I knew the surgery would involve cutting a lot of tissue and bone. I wasn't too worried about it, just knew it was something I had in my future. Aren't I the brave one, huh?
Well, the future has not disappointed in that regard. There has been pain, a lot of it, constant. "Knowing" something intellectually like I did before the surgery is quite a bit different from 'knowing" it as a current experience.
All I can say, is "wow."
When one thinks about managing pain the first thought of course is medicines. Mine too. But I also knew that there were other strategies. One strategy is to re-frame the pain. Instead of viewing it as bad, for example, to view it as reflecting the fact that I am alive. So, the pain I have experienced in the past week is the trade-off for being able to stay alive longer. Which would I choose? To be dead now and feel no pain or to feel this (temporary) pain? Keeping that in mind helps.
Another strategy I knew would help was to have everything else, to the extent possible, be under control. Have my life organized. Don't leave a bunch of unfinished stressors. So, Vicky gave me a haircut two days before surgery. That may seem like a small thing, and ordinarily it is, but feeling like my personal hygiene was under control helped. Our Nuestra Casa home in Mesa had a leaky roof. We contracted with someone who completed the repair two days before the surgery. Now I don't have to worry about that. It's under control.
I didn't want to get sick before my surgery, so for the two weeks prior to it Vicky and I wore masks whenever we went out into public, and we limited out public trips by buying groceries, etc. before that. We wore latex gloves whenever we went outside, and used lots of Purel. Who knows whether I might have been OK without doing that, but I went into the surgery knowing, to the extent possible, that I had not been exposed to any viruses.
Us at the airport flying back here from Mesa:
"Keeping the rest of my life under control" means "Vicky going the extra mile for me." We work as a team on this. We try to use the old phrase about work, "only handle a piece of paper once," as our motto. Keep up with things, get things done right away, that kind of thing. For this current ordeal the principle has served us well.
Medications:
While in the hospital I used three pain relievers which, when I reflected on it, were a strange combination.
It's odd to think about the fact that one of my most important medicines is an over-the-counter one: Tylenol. In fact, it is the base pain reliever. It is actually a highly potent drug. One of the staff at the hospital said that if the FDA knew then what it knew now about Tylenol (in terms of strength and side effects) that it would not get clearance to be an over the counter medicine.
The second was Oxycontin. More on that later.
The third was shots of Dilaudid. Dilaudid is an opiod derivative. I was told it was many times stronger than morphine. I got a few, not many, of those shots while in the hospital. When the nurse came to administer it I violated one of my cardinal rules for being in the hospital----That rule was that I was NOT going to make captive nurses deal with old man humor.
But I couldn't help myself, I was in pain, under the control of drugs, just had open heart surgery, and am a special person. Anyway, my old man humor was to start singing the Cole Porter song: "It's delightful, it's delicious, it's Delaudid!!!!
I'm sure the staff was sorry to see me discharged.
So, now, at home, I am using Tylenol and Oxycontin, doing a lot of reading about both kinds of medications. One an over the counter drug that a child could walk into a gas station and purchase, and the other a controlled substance that is so dangerous that to get it you have to physically walk into a pharmacy carrying a paper prescription. Doctors can't just phone the prescription in for you as they can for all other kinds of medicines. These two medicines couldn't be more different.
Our strategy is to deal with the pain by taking close to the advised dose of Tylenol (but staying shy of the upper daily limit) and taking Oxycontin only at night so I will get a good night's sleep.
It seems to be working.
(If by "working" one means "making things barely tolerable until my body heals.")
I had, of course, like most others, been following the problems associated with Oxycontin, in particular the almost unbelievable numbers of people who are using it as a recreational drug. From what I have read, though, the problem is not Oxycontin or the maker (Perdue Pharmaceuticals) but, instead, the problem is that it is just this era's drug-to-abuse of choice. Before that it was Meth, before that it was crack cocaine. Before that it was Heroin, and goes on and on.
To abuse Oxycontin one has to take active steps to make it addictive, That is, it is a time-release pill. To get a high from it, one must pulverize it and then either snort it, or swallow it, or put it into a liquid form to inject it.
When taking it in an unauthorized manner makes it addictive, people take more and more of it, and experience withdrawal when they stop.
One thing I am pleased about regarding my care at Virginia Mason is that the physicians there are not going to make me pay for other peoples' abuse of this medicine. It is highly effective. I am allergic to codeine, so don't have that as an option. And I have no history of illegal drug use. I have taken Oxycontin in the past, after other operations, and had two reactions to it: (1) it worked, but I only needed it for a short time, and (2) I did not feel any type of "high" or "euphoria" from it. Same this time. It gives me about as much of high as do the laxative pills I need to take.
Pain is not a growth experience. I don't believe it should be thought of as something to just "tough out." My lungs are an example of this principle. During the operation my lungs were deflated. Then several hours later they were inflated. Imagine your lungs as a deflated balloon. When they are reinflated there are still tiny sacs that need more inflation. I have a breathing tool (Voldyne 2500) to help me reinflate those sacs.
The problem is that to use this breathing tool means drawing in a big, deep breath. When I was feeling the most pain I could only draw in a medium sized breath until the pain would become intolerable. When the pain is managed, I can inflate my lung sacs more. So, having my pain reduced leads to better healing of my lungs.
I also need to walk as much as I can tolerate. This is easier to do when my pain is somewhat managed. The medicines give me more space to move my body, which is important for healing.
Upon discharge from the hospital, my instructions were to walk as much as I could tolerate. For this, I am using another tool: My Fitbit! I am adding 400 steps/day and no more. I want to build up slowly. When the weather is nice I can walk around our driveway. When it is rainy (most days) I do laps inside the house.
Not only are there pain medicines, but there is a large collection of other types of medications that need to be taken in the morning and others in the evening.
Boy, do I ever depend upon Vicky for all of this. We have a process for the medicines, for example, that keeps everything on track. I am so grateful for her. I'll be saying that and saying that for many years. Taking these medicines is a time when it is good to engage the obsessive-compulsive side of you. Do everything precisely as prescribed.
Maybe not for other people, but for me the experience of being under anesthesia affects my short-term memory for quite awhile after the surgery. That is something I noticed with short, orthopedic surgeries on my foot. In addition, I am taking Oxycontin. And I am in pain. Add all of those factors up and I am not in a good position to be able to accurately monitor my medicines. I don't know how someone would do it if they lived alone. Or if you didn't have not only a capable care-giver but a willing one, like I do.
Vicky had a funny experience when she picked up the Oxycontin at the hospital pharmacy in preparation for my discharge.
When she got to the pharmacy she found that she needed to provide a street address.
Well, this was awkward with all of the focus on illegal use of Oxycontin as a "recreational" drug: The reason it was awkward is the street name where we live: Zig Zag Lane.
Now, something I didn't know until after I bought this home in 2006 was that Zig-Zag is a type of paper used to roll marijuana cigarettes. I wasn't even all that aware of what street the house was on because there was no street sign. Apparently people living on the lane just gave up erecting a street sign because it was always getting stolen. I wonder by who.
So, imagine the discomfort of picking up a prescription for Oxycontin and having to write down that you live on Zig-Zag lane. "Oh no.......we aren't getting the Oxy for recreational use. I know we live on Zig-Zag lane but it wasn't named for the paper but instead because it zigs and zags.......honest!" Nobody gave her any grief about this, of course---they were very professional---but we thought it was funny and could only happen in Washington State.
I will be so glad when I am beyond this experience of pain and discomfort. But I can tolerate it, with her help, while my body heals itself. Without her running interference for me and taking care of day-to-day details, I would need more pain medicine I am sure. She is what is keeping everything under control so I can use my resources to get better.
No comments:
Post a Comment