Whenever the rainbow appears in the clouds, I will see it and remember the everlasting covenant between God and all living creatures of every kind on the earth." Genesis 9:13

Sunday, May 11, 2014


I'm scared.  It's still a month away and I am more scared than I was a day before my hysterectomy.  The simple reason is that I need information and I'm not getting it.  Also nothing is working out with scheduling.

I had asked to not have pre-op on June 4 as I have a dental appointment scheduled.  I was originally going to have the hole in my tooth fixed (laptop smacked me in the mouth as I caught it falling down the stairs) then but it hurts so much it is getting fixed Tuesday.  So I can re-arrange my cleaning again, I guess.  But anyway, they scheduled pre-op for the week before that so that it is when I'm on vacation.  I found this out on the online site and so I called and left a message asking to change that.  5 minutes later I called and asked them to change my first post-op appointments because I was supposed to be in the cast room at 8:30 AM, 5 days post-op.  Given the pain level at that point, the 2.5 hour drive to get there and my slowness is getting anywhere I was concerned we'd have to leave at 5:30 to ensure lots of time to let me out to get a wheelchair and then wait for my mom to park a long way off and then come back to get me.  So I called again and left a message asking if a later time was possible and if not we'd make it work.

But the thing is that I have no idea what the timeline is.  There isn't a lot on the internet about the 3 procedures I'm having but the standard generally is 2 weeks in a surgical splint, 4-6 (sometimes 8) weeks in a fiberglass cast, transition to cam walker and then about 6 weeks in that and then gradually re-learning to walk in a shoe.  The nurse (who changes her story often) told me the first day that I wouldn't be weight-bearing for about 6 weeks.  I assumed that would me the typical process.  But instead I'm going 5 days post-op to get a cast.  I don't know if they'll take the sutures out then; it seems pretty early.  Someone responded on a message board that she was casted on day 5 and then that was removed at 2.5 weeks and stitches were removed and she talked her doctor into a cam walker instead of the cast he usually used.  I'm the oppposite; I hated the boot when I wore it before I until I'm allowed to do ROM I want a cast.  Her surgery wasn't the same as mine and mine requires no movement to allow excess scarring to form so that it can later be broken down. I assume that this means I'll either stay casted from day 5 or be re-casted after sutures are removed at a later date.  I just don't know.

The nurse who is the contact person tends to tell me one thing and then change drastically a day later.  She also doesn't easily give out information.  The surgeon gave less information about what he was doing than my cat could give.  If I weren't a therapist I couldn't have followed what he said before having me sign consent.  So instead of going into this with a good understanding of exactly what is happening I know nothing. 

I have told the nurse in an email that I need information to help me feel in control and less anxious.  I sent her another email asking for the breakdown of the casting process.  I hope she answers it tomorrow and is clear and accurate instead of her usual answer that changes the next day.  I more or less know what the surgeon will do.  It's the afterward part that worries me.

The surgeon and his nurse also have the attitude that my MAOI is only anesthesia's problem.  It isn't.  They rely on nerve blocks.  Anesthesia has to decide if I can have one.  The ortho has to decide what pain med to send me home on.  There are a number I can't take and the rest the Emsam increases their effectiveness so they need to be sure I can tolerate it before they release me.  Anesthesia has to decide if they require admission; Dr. Brain doesn't know and I can't remember but think they do.  However I mostly remember the last surgery when I just wasn't going to be released until my pain was controlled because it was so bad the prior time when they refused to treat it since I couldn't take ibuproferon when the vicodin wore off.  Giving steroids would be bad since my body hates them.  There's all this stuff the ortho needs to know and which Dr Brain has now sent him.  Whether he pays attention is another story.

I truly am not that impressed by him.  I think he knows the ankle stuff and will do the surgery fine.  But as far as making his patients comfortable with what is happening he sucks.  And his nurse sucks.  I need to try hard to not answer the phone in my sleep if she calls in the morning.  I want her to answer in writing and I've expressed that; writing is easier for me than talking.

I just want to know what to expect.  I know already that this is fairly painful surgery.  Part of my dread of the day 5 visit is the 5 hours in the car unable to elevate the ankle well while sitting awkwardly.  I can handle the pain if I never have to feel things tearing in my ankle. The day 5 casting is going to hurt terribly. The cast puts your ankle in a pretty precise position and my ankle is not going to want to go to that position.  I'm not worried about pain though; as long as they figure out the pain meds before sending me home I'll be ok.  I just want to know what is happening, more than the total information the dr gave me which was "scope of ankle, modified Brostrom, peroneal tendon repair, about 4 inch incision plus scope holes, please sign here".  Glad I knew what he meant.....

I am really hoping his resident is the one who does the surgery.  I felt much more confident with him. 

I just want to have this done.  Or to be told what is happening.  That seems so minor and it has been so hard.....


Jean Grey said...

I have found that most surgeons are not good communicators. There are a couple of exceptions I have met, but most are not. I guess if you are good at cutting, you don't have to be good at talking. And the nurse usually doesn't know all of the answers. When I call about a patient- they always have to ask the doctor or get the doc on the phone for me.

If I were about to have surgery, I would do medical hypnosis. There is a website called "The Hypnosis Network" and they have a set of CD's for surgery. You can also download them I think. My step mother used them and after the third day of her knee replacement she never took more than tylenol.

Jean Grey said...

I don't know a lot about surgery in the lower extremity- but with the arm, the blocks usually have epinephrine mixed in. It decreases blood loss and keeps the anesthetic in the area so it lasts longer. But when I was on an MAOI, I was told epinephrine was a no-no. I don't know if that has changed. Maybe there is someone you can ask?

Just Me Jen said...

My problem with the nurse isn't that she doesn't know everything; I don't expect her to. But she pretends she knows things or will take care of things and then she does the opposite or does nothing at all and then is annoyed with me for asking again days later. Plus she does know some things (like his protocol with casting) and it took 3 attempts to get that out of her and it is pretty standard.

The hypnosis thing sounds interesting. I'll look that up tonight.

I have to wait until pre-op when I talk to anesthesia to find out if I can have a nerve block. I have the same concerns. I know my dentist uses blocks with epi but only a certain amount then he switches to something without it that isn't as effective. Today I think he didn't use epi at all and we had a hard time keeping numb (although I am very numb now...). My psychiatrist may find out when she emails anesthesia but it's likely I won't know until pre-op and even then it might change on surgery day when I see an MAOI protocol trained dr., which probably won't happen with my anesthesia visit. I'm just going to go prepared for anything; if the nerve block can't be done then I assume I'll be on a PCA pump for a while until they have the pain controlled. I have no problem with that. So I may go home the same day and I may be admitted for several, just depends on what anesthesia wants. Not knowing for sure is not my idea of fun, but I can't control that part. Just like we know morphine works and that it is potentiated by the MAOI (all pain meds are) enough to require a lower dose, but they aren't going to send me home on that so it would be reasonable to admit me to find what is safe to use without over-sedating me (I was given a bolus of morphine in the OR after my hysterectomy and started to go back under; I remember them telling me to breathe and bagging me but until my mom told me much later that I'd had a little morphine issue I thought I just remembered being put under.). These are the things that scare me; I wish he were saying right now "I'm not comfortable sending you straight home without adjusting your dose of whatever" but I'm not sure he'll do that. I think that anesthesia may suggest it strongly and if there isn't a nerve blcok I assume I'll be admitted but it would be nice for the surgeon to be slightly concerned about these things.

Dr. Brain is trying to get him interested. We'll see how that is going..