January 16, 2015 "Operation Day"Early day -- 6:00am at the venue where my surgery would be performed: Texas Orthopedics in northwest Austin. I don't really remember much about this day other than they knocked me out and when I came to, I had a big bandage on my right leg. I had opted for a "nerve block", so I could feel absolutely no pain at the incision. Somehow, Dana managed to get me piled back in the car, and we picked up the prescribed pain meds on the way home -- Hydrocodone for pain, and Diazepam for potential muscle spasms. I was pretty much out for the day.
January 17, 2015 "The Day After"I slept... the nerve block was still in effect so I didn't really need pain meds. However, I couldn't get up easily, though this is just something you learn as you go along. I actually had to have a PT person come out to show me such tricks as getting up out of a chair, going down and up a single stair (our house has TWO of these small steps.)
January 18, 2015 "Fun (or NOT) with Diazepam"The nerve block began expiring. Post op instructions said to try to stay "ahead of the pain". So... I tried. However, I soon learned that Hydrocodone and I do NOT agree on many things. I don't have the nausea that many people complain of, but did have the following: rash, itching, drowsiness, depression, and BIG time issues with NUMBER 2. Ouch...
When my leg began twitching, I added the diazepam to the mix. Turns out, I also experience many of the side effects of this drug, too -- particularly "impaired motor functions", "impaired coordination", "impaired balance", and, apparently a touch of the "anterograde amnesia", since I really can't remember much from the days I took diazepam.
Unfortunately, this kept me off my feet (on the walker) for a couple of days... who needs a setback at this point in recovery.
January 26, 2015 "Learning to Scoot"I had my first follow-up appointment with the Orthopedic Surgeon. They removed the staples and said the incision was healing well. My mobility at this point is still "light toe touch" on the walker.
Let me tell you... getting 20 feet on a walker with "light toe touch" is an athletic feat. My triceps will be good and strong after this, even if everything else is completely gone to pot.
The plan was to begin early PT around February 9. I was eager to continue down the road to rehab.
February 2, 2015 "Pain in the Ankle"I began having severe pain in my right calf. By Thursday, the pain was so intense that I had trouble making the 20 foot trip to the bathroom.
February 5 - Feb 10, 2015 "Six Days on the Road"The calf pain was worse... I called Texas Orthopedics. My surgeon's physician's assistant told me to go to ARA (Austin Radiological Association) for a ultrasound on my leg... N O W. So... we piled into the car.
I figured that they'd do a test... tell me everything was fine... go home and bite my lip. But... this is NOT what happened!
Instead, they told me that I had developed major blood clots in my femoral vein and multiple pulmonary clots. Serious stuff. They told me to go immediately to ER. We did, and I went from ER to ICU where stayed for the next three days.
I was first told that the pulmonary clots were the most dangerous and that they were planning to do a "procedure" to stick some sort of tube down my neck into my lungs, then pump a drug (something like this link) to break up the blood clots.
However, after the radiologist reviewed the CT Scan, the physician in charge decided the pulmonary clots were too small to be dangerous and that they should perform the "tPA" procedure on my leg... let the body take care of the pulmonary clots.
They did something to desensitize my leg, and gave me some mild sedative. First in was a "portal" about the size of a coffee stirrer into a vein in the back of my leg. Through this, they threaded three IVs (or a XII -- ha ha) into the vein. One tube carried the tBA (the clot busting substance"; a second was an Ultra Sonic carrier -- high frequency vibrations; and, the third was a saline cooling solution to keep the Ultra Sonic motion from overheating my body. All this was guided in real time via an X-Ray display. When the tubes were all inserted, I could still see two of the captured images on the displays -- one of my hip joint, and the area in the femoral vein where the largest part of the clot resided. The other image was just below the knee, the portal insertion joint.
The attending physician, Dr. Poley, told Dana that I'd slept through the whole thing. I'm glad that I fooled them... I was awake for the whole thing!
From Radiology, I was moved back to ICU. Seton has some good staff... attending nurses (Travis, Josh), clinical assistants, and attending physicians (Dr. Kalyanaswamy... pronounced exactly as it's spelled) were really good, friendly, responsive to questions, and informative. This is good -- I was to keep my leg immobile for at least 24 hours.
Sometime during the night after this procedure, the insertion point began oozing blood -- not just a little bit. I mean it was pooling on the floor. The nurse on duty, Josh, was, I'm sure, alarmed. However, he immediately called the company that provides the equipment for this procedure, and managed to reach Dr. Poley. It turns out, although it's not what they intend, it's not unusual. Keep in mind, the insertion portal was like a coffee stirrer or small soda straw. So... .they just cleaned, changed pads under the leg, until morning when the redressed the leg.
Late in the morning or early afternoon, the opted to inspect the progress. I was taken back to the same (or similar) radiology lab, where they examined the blood clot. Once again, I was sedated, but awake, and I heard a round of "look at that!" from all the staff. Turns out, this was the GOOD response... the clot was largely dissolved and full circulation was restored to my leg. They pulled the entire apparatus out. Before closing the portal, the sent a "stint" up the vein (similar to how they do the heart thing), to help clean the vein. Back to ICU... until Sunday when they moved me up to the orthopedics wing for recovery. Much better... much MUCH better.
I still had a couple of days to spend in IMC (intermediate care) while they fed me Heparin, a powerful anti-coagulant, and monitored my blood by withdrawing copious quantities from a dozen or so pin pricks in my left arm.
I'm glad they were doing all this, but what I can tolerate five, six, seven... maybe even eight times... becomes REALLY irritating the fifteenth or twentieth times! Yikes... what do they do with all that blood?
Finally, on Tuesday morning, Dr. K (what they call Dr. Kalyanaswamy) came by... I asked when I might be released. She said, "This morning... in about an hour." I have to admit, it brought tears of joy to my eyes... I immediately called Dana. She was caught off-guard, but was equally as happy as I.
My advice... Seton is a really good hospital, and the people are very nice and seemingly quite competent. However -- DON'T GET STUFF THAT MAKES YOU WIND UP IN THE HOSPITAL. "Out of the" is a much better relationship to the hospital than "in the".
I'll be taking a blood thinner for probably 3 to 6 months, and this is not without issues. But this is a relatively new drug call Xarelto and doesn't involve dietary restrictions or constant dose monitoring and dose alteration like the alternative, Coumadin. Unfortunately, being new to the market and sold only under the brand name, Xarelto is also expensive.
A really proactive and energetic social services person at Seton, Emily, found me a card that would cover the first 15 days of Xarelto, for which Walgreens was asking $565. THANK YOU EMILY!!!
Walgreens, by the way, was less than helpful about anything. As a result, we had the prescription transferred to Costco where, as in every other aspect of Costco's operation, the pharmacy staff was very helpful. Also, for the same prescription that Walgreens would charge me $565, Costco would have charged about $300. So... next time you start to go to Walgreens, think twice. Go to Costco -- if you don't have a membership, GET ONE!
So... out of the hospital... .home... back to learning to walk again!