30 November 2006

Bummer

I went to the doctor. She took out all my staples and pronounced me doing beautifully after she lifted and swung my leg around. She was pretty surprised that I was off my pills, and told me most people were still on them after nine days. She told me that I could put all my weight on my leg as tolerated, and take off the TED sock on my unoperated leg.

Then came the bad news. No, I could not go to the movies or out to dinner or, indeed, hardly anywhere because I would lose the home health benefits, including the valuable blood tests she needed to figure the Coumadin dosage. She grounded me until Dec.11.

I cried. I said, "it's about having a social life and going out to dinner."
Dr. Whirlow looked at Chelsea and said, "you are going to have to entertain her."

Even while I was crying and saying this, I felt like a jerk. At my stage in the surgery, most people are still fighting the pain. It's very hard to complain when you are doing as well as I am: you don't get any sympathy. But the better you do, the more you want to do, and the more frustrated you get when obstacles appear.

Dr. Whirlow continued helpfully,"have a dinner party." Chelsea and I looked at her as if she had suggested we give birth to an aardvark. Neither of us cooks, and I lived in my house for almost a year with a gas stove that didn't work --without knowing it. Chelsea is juggling the three retrievers, her business, being away from home, her SO, my TED socks and my personal concierge tasks. Dinner party????????

As a last effort to be helpful, she said, "you can drink a glass of wine while you take Coumadin."

I admire her. She was really trying. I think she was telling me to get blitzed at home until Dec. 11. I am a lucky person to have her...and Chelsea...and the constant parade of people who come to see me and call me all day long.

29 November 2006

Tuesday

Another physical therapist showed up today and told me that, as a recipient of home health services, I had the right to go to my doctor's appointments, my place of worship, my hairdresser (that's quite an interesting one) and that is all -- or I quit receiving services.


She also told me that  if I pushed it too hard, blood would pool in the wound and I might get a DVT. This is a direct contradiction to what the nurse said the day before: that more active people had LESS risk of DVT.And another therapist had told me that a lot of the doctors thought there was very, very little risk of DVT unless you had a famly history.

I do know two people who have had them, and I don't want one. But I'm not sure what to do, so I spent most of Tuesday doing what most patients would do: shuffling around the house a little, and mostly laying in bed.

By the end of the day, I was in a big depression, and had to send out to Houston's for dinner. Then, because I didn't do anything all day, I couldn't sleep last night.  Fortunately, today is my doctor's appointment and I will get some decent advice about what to do next.


28 November 2006

Resting

The big concession I made to my wild weekend was not to go to Starbucks on Monday. , Chelsea brought it back for me. We've got those TED socks and the plastic bag thing knocked, so I got dressed and hung out for a while with Mark Salustro, who I asked to walk me. I was practicing walking on the walker without a limp.

But by Monday afternoon, after Rob Dunaway came by with seven excruciatingly tasty bars of chocolate, and Paul Bendheim brought me a software program to test, and I wrote a BizAZ column, I once again felt like going out to dinner. The visiting nurse had come, and changed my dressing, showing me my incision. Lo, I am healed (almost). Seriously, I feel pretty good about how the scar looks. It still has the staples, however.

This time I chose the Chinese restaurant in the neighborhood, the dinner went off without incident, and I celebrated with my friend Fred and a glass of Chardonnay. Reminder: couldn't have had a pain pill if I needed one, because I drank, so I made sure I didn't need one.

Still have high blood levels of Coumadin, and took only 2.5mg today. I doubt I will have DVT, because I'm up and around a lot.

One week out

What a bunch of days. You would think that after the EMT Party I would rest. But I woke up on Sunday and went to Starbucks again with Chelsea. After that, the physical terrorist came to the house for the first time to show me my exercises and check out my walking. Of course she said I was getting along fine, threading my way among the retrievers. She gave me a series of quad, hamstring, and glute exercises. The only things she gave that I can't do with ease are the abductor exercises, because I had an abductor contracture from years of using the wrong muscles to walk. Because my hip hurt, I didn't use my abductors and they got tight and weak. I guess she had to move or cut them and disturb a lot of tissue to release them so my legs would be the same.

I did not have a resurfacing or a non-invasive procedure for two reasons: first,I have scoliosis, spondololithesis, and spinal stenosis, and I wanted to make sure the new hip didn't aggravate any of those, which I now control through exercise; and I love yoga and wished to go back to it. So Dr. Whirlow opened me up wide enough to see the joint and position it correctly. I am thankful for this. I doubt you will ever be looking at my thigh to see my scar, but you may be seeing me in tree pose in a few months.

After the pysical therapy, Ed came over and we had a party in my room. At about 6 PM I decided I couldn't eat another night of turkey or another meal in the house, so we all went to Chelsea's Kitchen. Unfortunately (for us, not them) it was crowded, and we ate at a small uncomfortable table outside in the bar. Lots of atmosphere, but low on ergonomics.

By the end of the meal I was in enough pain towant to pass up dessert, but didn't.

In the middle of the night, I had to punish myself for my bad girlness by taking a Vicodin to relieve the most intolerable pain I had experienced since the surgery.

26 November 2006

Sunday

We had a bit of a hiccup in the stellar recovery process last night. Belle rented some movies and we watched 'Jesus is Magic" (Sarah Silverstein) and "Wordplay." I didn't think Sarah was as funny as she's supposed to be. I really enjoyed "Wordplay," though, because I grew up doing the NY Times Crossword Puzzle.

Somewhere at the end of the second movie I drifted off to sleep. Remember the Coumadin that I have to take to thin my blood? Well, I guess it has been doing too good a job, because in the middle of the night I woke up spitting blood. I had watched a video in the hospital about Coumadin and understood that one of its side effects was bleeding, so I called 911 and my doctor. The doctor answered her own phone on Saturday night after midnight, and told me the blood was probably from my nasal passages from the intubation. It was a big-ass nosebleed and not terribly dangerous, although she stopped the Coumadin for a while.

When the EMTs came, they checked out the color of the blood and concurred. They were terrific: a bunch of young firemen accompanied by a female medical student. I was a little embarrassed, but not as much as I would have been if I had not called and had bled to death :-)

On the positive side, I ambulated with the walker into Starbucks yesterday and had coffee with Greg. Then my friend Mary called, and met me there to take me back home. While she was visiting, Gillian showed up, and Dan came over with Bluey. When we opened the door to let in the fourth dog, all of them got out and started running down the street. Apparently my next door neighbor had the gate open into his backyard, and they all went in to visit his dog. When Kodie saw that the man had a pool, he apparently belly-flopped right in! (I didn't see it because I was home entertaining mere humans).

Finally I got tired and repaired back to the bed, where the nurses kept me company all afternoon.

25 November 2006

Saturday morning=5 days post op

There is a magical quality to recovering in the presence of animals. At least two members of the golden nursing team are with me all the time on the bed.Once again, this experience has given me the opportunity to learn about how incredibly sensitive dogs can be. No one has even stepped into my path or brushed up against me since I have the walker. Everyone is extremely helpful, laying in positions that don't make me uncomfortable. Last night Chelsea and Temple went out for a drink, and for three hours all three dogs stayed with me. Nobody even moved! They were working away, guarding me and making me feel safe.

I have cut out the Vicodin, although I'm still on the oxycontin. I don't have a lot of pain, but my leg is still swollen around the surgery and thus everything feels tight when I walk.

The home health nurse came today and drew blood for my INR levels (how much clotting propensity is in my blood). Thank goodness my level was 1.9, a number only significant because it means I don't have to give myself shots of Lovanox(another anti-clotting drug) in
the stomach all weekend.

I've gotten pretty good at picking things up off the floor with the grabbing tool: socks, phones, pieces of paper. The only thing I can't pick up is the tool itself, which falls over constantly if I stand it next to the bed.

I have also gotten good at dressing myself. If you lay on the bed, throw your panties up in the air with your good leg and raise the bad one slowly and carefully to meet them in the air (only lift about 30 degrees), you can dress unassisted. Here the grabbing tool is also useful.

Also got a good piece of advice about wrestling with the TED socks (another anti-embolism precaution) that I have to put on every morning. The socks have a hole in the front by the toes. What you do is put a 1-qt freezer bag over your foot, start the sock by sliding it over the bag beyond the foot and pulling the bag off your foot through the hole.

It is amazing how much we do by bending over more than ninety degrees or raising our legs more than ninety.






24 November 2006

Golden Retriever Nursing Team

 
 

Upperleft is the patient. Then clockwise, Blu, Bear (aka Kodie), Boda, and Chauncey Posted by Picasa

23 November 2006

shower!

I am going home for sure, and I get to shower first. In fact, I was supposed to have been bathed every day and was usually only given a cloth to wipe my face. I really didn't get cleaned at all after the first day, When Dr. Whirlow, my elfin surgeon looked at me she was surprised and ordered the shower. I think the care at this hospital goes from very good to incompetent depending on the moment.
.

photos

I have uploaded some pictures of my hip replacement recovery at Flickr . Probably TMI unless you are having one yourself.

small details

I have been getting in and out bed on the week leg side. What a jerk I have been! It is so much easier from the other side.
I am on vicodin now, and it seems better than Percoset, although they both make me know I am on drugs.I feel like I have spider webs in my brain.a nice nurse finally came in last night and assured me things would get better because the floor had been overwhelmed when one male patient went bad.

thanksgiving

The nursing is really bad tonight. John never gets here. Neither does the chubby male aide who doesn't know anything anyway.these guys are more cavalier, especially since the Monday surgeries are off morphine and catheters:that means we have poorer pain management and it is in their hands.for the first time, I am scared of the care.I have no control.. Ed and Chelsea are gone. A moment ago, I sat at the side of my bed waiting an eternity for one of the boys to take me to the toidy.I rang and rang and no one came. Then this nice kid came and I asked him for tylenol because I thought percoset on an empty tummer was not good. Haven't seen him since.
Now feeling bummed out, vulnerable and depressed. Time to meditate.

22 November 2006

disconnected

I'm going to go home tomorrow! I can get out of bed and go to the bathroom with only minimal oversight and all my catheters and tubes are gone.
Nothing has changed with me and pain pills; as always, I hate the way they make me feel--foggy and wiggy, as though one more would send me over some edge.
Today I could see the hospital get ready for the holiday: none of the usual nurses will be on tomorrow and I don't feel as safe.Tons more people came in today, though, timing their surgeries over Thanksgiving.
I had my hair washed today, because I realize I won't be able to shower until the incision heals.
I also try to get an appointment for a manicure in the hospital spa, but they are booked.

This hospital is like the cruise ship, but with bigger rooms. It even has room service. After all, it is Scottsdale! It act a lot like a resort.
I walked twice around the floor today and each time got easier, but remembering not to bend forward and not to raise my leg when I get home will be a study for a while.I see why they say it is a long recovery. No matter what shape you are in, the tissues take just as long to revive. But I feel blessed.
I am strong.

Wednesday

Yesterday I went flapping down the hall trailing catheters and IVs behind
me, for 100 feet.learning to walk again-walker'nad leg,good leg,walker,bad leg,good leg.I loved it.today I lose the catheter and the IV and the morphine pump. And more walking so I can go home tomorrow.
Let's see how this goes.
Yesterday'too, was party central in my room as ed, Marc, Mark, Marilyn,chelsea'temple and fref came by.the funniest was when Marc and Jlein appeared almost simultaneously with frappacinos.
So the worst thing is the catheter and the embolism socks. The best is the morphine. And I had Houston's take out for dinner.
The nursing staff here is head and shoulders above others I have seen. The indicator is that I felt okay sending Chelsea and ed home and staying here over night.

21 November 2006

i walked!

When the physical therapist came today, I walked and it was not painful at all. It was, however, complex because of all the rules:don't bend forward, don't put all the weight on the new leg..a lot to learn.
As bad as the preop process was, the nursing care is admirable. And everybody has read my blog, so I get awesome care.
They have also
Asked to use my blog for training.
Blogging turns out to have been very useful.

day 2

This is really cool, blogging from the hospital on the BlackBerry.
Had a great night with no pain. If I don't move I have no pain.
Will you believe this? My blood type is B positive!
Is that perfect for me?
Today I get solid food and get up more and get Starbucks!

20 November 2006

up and at em

Sort of. Surgery went well. On big drugs! Stood up already and living on
chocolate pudding. It is uncomfortable with catheter, etc but I did it!

The Day!

4:45 A.M. Up early to go to the hospital. Two hours of pre-op procedures, including positioning me correctly on the table and conferring with the anaesthesiologist. Now I'm excited, because I know that by noon I will be in another place, in a new beginning. I know I've made a good decision, and I'm going down the right path.

I know I will be frustrated after today by the lack of wireless in the hospital. I'm bringing my Blackberry, but I know I don't have the patience to write long pieces with my thumbs.

Slept beautifully, given the pain in my hip, with my dog on the bed. Got up to meditate and do some pranayama breathing to inflate the lungs and slow the heart rate. Might as well give the anaesthesiologist something to work with.

19 November 2006

Party the night before

It's the night before the surgery, and I've been to dinner at Wildfish and had scallops and red wine. I've already taken off all my jewelry, shaved the leg that will be operated on up to the waist, and raced out to buy a bathrobe for the hospital because I didn't own one. I also tried to buy a night gown, but when I went to Target I found out that night gowns must be out of fashion: they didn't have any. Only pajamas! Who knew...

I've been hyper-hydrating (forcing fluids) all weekend, and I've also been drinking cranberry juice because the surgeon told me to do it. She called me this afternoon to ask if there were any "surprises," (am I sick or something) or do I need anything. I found that touching. It's also good marketing.

I've been beautifully supported today by the arrival of my daughter and her SO with their 2 golden retrievers. My friend Dan also brought his golden over, and then he began to throw balls to them in my (big) backyard. When he threw out the opening pitch, four goldens took off after it, falling over themselves and looking as silly as goldens can. It was a LOL moment.

Now I go to bed, stop drinking at midnight, and only take essential meds with a sip of water in the morning. I have to be at the hospital at 6 AM for the pre-op; the actual surgery is at 8. Because I won't remember anything of tomorrow (according to the surgeon), I probably won't try to write anything. If I did, it would be like dialing drunk...

18 November 2006

I've Claimed this Blog for Technorati

Technorati Profile

That means anyone who wants to read about hip replacements can search Technorati and find mine.

Scottsdale Healthcare North

It's not easy to be the patient these days. This week, it has taken every IQ point, every yogic mantra, and every ounce of emotional intelligence I have to get through the preop procedures and actually make it to the surgery without strangling someone.

Gone are the days, of course, when you checked into the hospital the night before surgery and had all the tests necessary to determine whether you were "good to go." Now those are all done in different places by different people whose systems don't communicate, and as a patient you feel like a rat on a grid by the time you get finished preparing.

Months ago, I chose the surgeon and the date, and began an exercise program geared especially toward hastening my recovery: Pilates, water aerobics, glute-strenthening exercises, and meditation on the positive outcome.

I chose the surgeon because she was willing to show me my X-rays, explain the procedure, and answer my questions. Before her, I went to see one who pooh-poohed my fears that what was done to my hip might influence my spine and make my back problems worse. He told me he had done 30,000 hip replacements, and I shouldn't worry. He said he didn't know much about backs. He said minimally invasive surgery was the way to go. Then he left the room and his staff began telling me the realities behind his hard sell. That was Dr. Maltrey. I'm sure he's a fine surgeon, but he scared the hell out of me. I like to think of my body parts as connected.

I left unconvinced. When I found Dr. Janet Whirlow, I cried in her office because she actually began to answer my questions. Later I came to find out she also answers her own phone and calls her patients personally to explain things.

So I scheduled the surgery, and planned a trip to China for the week before. I figured jet lag would be a good accompaniment for surgery. When I told Dr. Whirlow this, she laughed. It turns out I would have to give blood, in case I needed it, and have all the pre-op testing in the week I had planned to be in Guangzhou.

So I revised my plans. In the past two weeks, I have driven the 40 miles to and from Scottsdale Healthcare North a dozen times, mostly to act as my own courier, bringing my X-rays, tests, etc. from one place to another. Three times to receive "blood doping" shots I should have been able to get much closer to home.

My family doctor was on vacation, so I saw his nurse practitioner for my pre-op exam. She didn't have a rcent stress test in my chart, and told me I had to take one. I told her I had had one less than six months ago, and where to get it. She then told me there was no record of it at the hospital I told her to call. I had to go to Banner Samaritan, to the bowels of the basement, and pick up my own records, hand carrying them back to her office. Like a breathless retriever, I arrived in her office with the envelope in my teeth. She smiled: "you're good to go."

Then she never faxed my medical clearance to the surgeon. Last Friday, five minutes before I was to go on the air as a guest on a radio talk show, I got a panic call from the surgeon's office saying she was still missing the clearance. I made an emergency call to the doctor's office and made them promise to fax it within the hour.

When I got off the air, the surgeon's office called again. Yes, they had the clearance, but the lab had lost my UA. Would I mind going out to the hospital lab and peeing in a cup? Can I do it at the lab around the corner? No, because the surgeon can't get into their records.

I hop into the car (if you have ever needed a hip replacement, you know that hopping into the car is a metaphor) and drive out to Scottsdale. I present myself at the same outpatient lab that drew my blood the day before. I ask for the cup. They say I have to be admitted before they can take my sample. I proudly flash the hospital bracelet they had given me the day before at PreAdmission and Testing, and say I was already admitted. Hand over the cup, please.

The lady behind the desk said that was a hospital admission bracelet, not an outpatient bracelet, and I had to be admitted to the outpatient department. But the admitting lady was not working there on Friday afternoon, so I would have to walk around the entire hospital to the main admitting area.

I am walking with a cane, the hospital is under construction, the hallways are long, and I am pissed. I know I am already in their system, and that I have filled out the same forms about ten times in the past two weeks. I walk around to admitting.

The admitting lady laughs, and prints out another piece of paper for me to carry back to the lab. Can't you just email this to the lab? Or can't they see it on a screen, I ask? Nope. You have to bring the piece of paper. I ask why.

HIPAA, she answers. For the past two weeks, as I fetched and carried all the films and pieces of paper from place to place, I amused myself by asking "why is this process still done with paper?" The answer is always "HIPAA." I've begun to believe that everyone relies on HIPAA as the universal excuse -- it's code for "we're too lazy to figure out how to change our work flow."

No one working on the business side of the health care system cares a fig for the patient. They care only for the process. They do not care that patients may work, and be trying to get some things accomplished before checking out for surgery. They do not care that orthopedic patients may be uncomfortable walking and driving. And they certainly do not care that the inept processes they follow must cost billions of dollars a year.