How Do I Feel?

How DO I feel?  Since tomorrow is the one month anniversary of my surgery I realized that I haven’t given the simplest of updates… how I’m feeling as I progress in my recovery.

I wouldn’t go so far as to say that I am fully recovered.  As I understand it, it can take up to roughly six month, on average, to be fully 100% (or better) yourself.  I understand that, and can live with that.  All things considered, though, I feel really good.  I feel like my recovery is going quite well.  Judging by comparing to others around me in rehab, and from what nurses tell me, I believe I am recovering faster and better than most people in the same situation.  My breathing exercises have been lacking, and I still have a small issue with lung congestion, which I am working on.  Even with that, I get the feeling that I was in better shape than most people going into a bypass surgery, which seems odd to me, but ok. I mean, I wasn’t exactly a pillar of physical strength and virility prior, if you know what I mean.  I’m certainly younger than pretty much all of them, which isn’t something to brag about, either.

I have virtually no pain whatsoever from the surgery itself, meaning the inside stuff.  I’m still short of breath and tire easier than pre-surgery, but that’s normal, and that and my stamina are steadily increasing with each day.  The day after I got home I got wore out and had to take a long nap after just unloading the dishwasher… which Missy chastised me for doing too much too soon.  Fast forward to today and I can do that and more, to the point that I feel like I’m actually accomplishing things.

My skin is… interesting.  The two incisions on my left leg are pretty much fully healed.  The two small incisions on my stomach from the drainage tubes are almost fully healed.  I am amazed at how well the 7″ chest incision is doing.  The scab portion is almost gone, only about an inch left.  The 9″ incision the length of the inside of my left forearm is taking longer.  It’s making progress, so I’m not worried, per se, but it is still about 80% scabbed with inflammation and redness.  Just in the last week has it started healing enough in places for the scab to disappear.  My skin on my forearm is forming some ‘pockets’ where the skin is pulling together unevenly.

Part of my left forearm and a portion of my left palm, in just the last 10 days or so, have developed some numbness and sensitivity.  I was warned up front that this would be perfectly normal and not to worry about it.  I have also since been told to ‘exercise’ it by stretching and working my hand and wrist from time to time.

My feet already had some very minor neuropathy from my diabetes prior to surgery, but now my feet and my upper chest, along with my left forearm, are all hyper-sensitive.  Something as simple as wearing a shirt can be painful.  My shirt will lightly brush against the incision areas and cause irritation, which turns to actual pain if it goes on for a few hours.

Part of my upper left chest will always be numb because they took out an artery that had some nerves attached for the bypass.  And… this surprised me… I will never again have a legitimate pulse in my left wrist.  The artery is gone from there, too, so there’s nothing to measure.  Makes sense now that I think about it.

Mentally and emotionally I feel fine.  I’ve been very open about this from Day One of being diagnosed.  That’s been very therapeutic.  I’ve been very stoic about it.  It just is what it is, let’s deal with it.  I feel like this blog has also been very helpful, keeping me in a good frame of mind.  As I have mentioned before my sleep schedule has been upended, but I’m getting enough sleep and it has been good sleep.  My appetite has been fine, though I’m consciously trying to eat smaller portions.  I’ve pretty much cut out table salt, and have tried to make some better choices, though I haven’t gone total health nut whack job, and doubt that I will.

So that’s it.  My health checklist, you might say.  I’ll revisit this a couple more times before I’m done.

Pain & pain meds

Pain

‘Does it hurt?’  ‘How long until the pain goes away?’

Those are common questions that I often hear, and that I had myself.  I can say that results have not met expectations… in a good way.  Right out of surgery you would think it would hurt like hell.  You would think the pain would be constant.  It really didn’t.  I was sore, very sore, but not really in pain, per se.  Of course there were some really good pain meds being pumped into me via the IV, so I’m sure that had something to do with it.

It did hurt when I would try to sit up, or twist my upper body.  Getting in and out of bed was a chore, and in the first few days I really needed help doing it.  This was tough for me.  I’m someone who always prided them self on being independent.  I’m a big boy, I could get up and go to the bathroom on my own, right?  Well, no, I couldn’t.  I needed help.  At first from nurses, two in ICU, one in the regular room, but later as I improved Missy was able to help me alone.  Then, once back in bed I wouldn’t be up high enough so two nurses would have to ‘adjust’ me.  One on each side, they’d grab the sides of a pad that I was laying on, 1… 2… 3… *heave!*, and that would work.  My bed could be adjusted up now and I could go back to sleep.

It hurt when I coughed, which I was warned about from everyone, but not as bad as I had been warned.  A local charity gave me a heart pillow that would become my ‘security pillow’ for the foreseeable future.  Coughing is a big deal.  You hold this tightly to your chest when you cough, it helps manage the immediate pain somewhat, and you’re encouraged to cough often to clear your lungs of stuff so you don’t get pneumonia.    Breathing clearly is one of everybody’s foremost concerns in your recovery for this reason.

What does hurt, and what no one had really warned me about, is sneezing.  One person did warn me, after I mentioned it to them, to “let it fly” and not hold it in, and now I know why.  When you hold it in it creates a great pressure and strain on your lungs and chest, and they don’t need that right now.

By the time I came home, there was virtually no pain at all, except for coughing and sneezing.  The soreness lasts quite awhile, and you move slowly everywhere and for everything.  Two days after I got home I unloaded the dishwasher, and that single effort wiped me out and left me in some pain and soreness, so I took a nap.

As I sit here writing this almost three weeks later my chest is still sore, but much of that is the skin around the incision tightening as it heals, which it is doing quickly.  Last couple days I have had a few instances where it felt like my heart ‘jumped’, and would sometimes cause a reflex in my arm and/or leg.  This is new.  Some internet research indicated that it might be AFib (Atrial Fibrillation), which is fairly common after heart by-pass surgery.  I am on meds to prevent blood clots, and AFib usually goes away fairly quickly in this case.  I have a doctor appointment with my surgeon for a check-up later today and will ask about it.

The two very small incisions in my left leg have been fine.  The long incision on my inner left arm has been the most problematic.  It’s appeared more inflamed, but my cardiologist said it was fine.  It gets sore as well, partially for the same stretching reasons, but also partly because it keeps rubbing against things, primarily my stubbly chest and stomach hair as it grows back in.

Both my chest and arm incisions are hypersensitive, though.  I do not enjoy not wearing a shirt, but have had to go shirtless a lot here at home because a shirt brushing up against an incision is quite irritating, and if it goes on for too long they do begin to hurt.

Pain Medications

Prior to surgery I was given some kind of medication to take on a daily basis that I call “mini nitroglycerine”.  If I remember correctly this was to expand my arteries, or something like that.  It gave me severe headaches, which I had been warned was a possibility, so I stopped taking it after about 3 days.

I do not remember what pain med they gave me through the IV after surgery.  I was taking Oxycodone and Tylenol in pill form after surgery.  The Oxycodone was interesting.  I had some strange dreams on that stuff.  One while in the hospital had me dreaming of scrolling Facebook on my phone, and I somehow knew my hand was up near my face actually making scrolling motions.  I told myself to stop doing that, but I kept doing it.  I would have thought nothing of it, but Missy told me about it the next morning, and confirmed that not only did she see my hand making the scrolling motion, but my legs were moving, too, kind of like how a dog runs in its sleep.

The second day after I got home I started getting sick.  Discharge instructions said to call the nurse’s station if any issues so I did.  They said call my family doctor, so I did.  They said call my surgeon’s office, so I did.  They initially didn’t want to deal with it, but when I explained more she went and consulted with my surgeon and he said to discontinue my two anti-biotics and the Oxycodone, as either were known to potentially cause this.  I did so, and I stopped getting sick.  Before we ended the call, though, I was instructed that any other questions should go to my family doctor.  😐  Thanks.

Post-Surgery… ICU

Roughly four and a half hours later I came to in the Intensive Care Unit (ICU)… which is standard procedure after this type of surgery… in a dark room and with a bunch of tubes and hoses in me.  Very sore, very groggy, but I slowly woke up.  I was allowed limited visitors, and I made it very clear to my family beforehand that while I was in ICU I only wanted visits from three people: my wife Missy, my son Matt, and my sister Vicki.  I was willing to see anyone once I get into my regular room after ICU, but not in ICU.

My memories of visits initially are vague.  I do remember Missy coming in, vaguely, I think she was first, and I’m not sure if I reacted or not.  I think I did.  I remember Matt coming in, not sure for how long, but I do remember grasping his hand right before he left.  I was aware enough for that, and I sensed that it was something that both he and I needed.  I also know that Vicki visited, but she was unlucky enough that I was usually sleeping when she did.  At first, visits were limited to one person at  a time.

In me were a breathing tube, a catheter, a large drain tube from my stomach, a small drain tube from my stomach, a heart monitor (which would stay on to the very end), an IV in a large vein in my neck, and either two or three IVs in my right arm.  Throughout this entire blog this is the only thing that I am going to rail about:  the breathing tube.  I had been told by everybody… doctors, nurses, people who had had this surgery before, experiences I’d read online… that you generally don’t even know it’s there.  It’s removed prior to you waking up, as soon as you’re able to breath on your own without outside assistance.

That didn’t happen with me.  In my ICU room was a clock on the wall right in front of me, and I was aware and coherent enough that I was able to count the time.  I was awake and aware of the breathing tube for three hours.  THREE  HOURS!!!  Because it disrupts your vocal chords you can’t speak or even make grunting noises.  Because my hands were secured to the bed… so people don’t remove the breathing tube themselves, which people apparently do when given the chance, and now I know why… I couldn’t even signal anybody to ‘ask’ that it be removed.  Three hours I laid there staring at the clock watching the time slowly tick by.  I was livid.

I have been since told that I wasn’t breathing well enough on my own for the anesthesiologist’s satisfaction.  I didn’t care.  They should have put me back out, or something.  Once they finally told me they were going to remove it, I started planning in my mind all the invectives I was going to let loose with.  “It’s about fucking time!  What the fuck is wrong with you people?!?”  Once it did come out, however, all I did say was a solid, “It’s about time!”.  I even said it twice to make sure they heard it.

Moving on, I was recovering very fast, they said.  I stood by the side of my bed later that afternoon, which I was told is unusually fantastic.  The next morning, roughly 18 hours after surgery, I took my first walk around the nurses station.  Everyone was impressed with how soon and how well I was doing.  Because of my plethora of tubes and such still in me I had three nurses accompanying me, both to carry the tubes and stuff, and to make sure I was steady and didn’t fall down.  They said I walked them, I did so well and so fast.

My web server had a major implosion and was down for five days, hence the delay in this post, so I forget a couple of the details, but my memory tells me that no tubes other than the breathing tube came out the first day.  The next morning some of the tubes started coming out… not necessarily in order, both stomach drain tubes, the catheter, the neck IV (which required the nurse holding pressure for roughly 15 minutes so I wouldn’t bleed to death), and one or two arm IVs.  By the time I was transferred out of ICU and to my “regular” room around mid-day I only had one arm IV and the heart monitor.  I am told that my recovery was going much faster than average and very well.  Impressively well.

Surprisingly, as major as this surgery is supposed to be, I didn’t feel all that bad.  Sore, sure, but not any real pain.  Of course I did have some good pain medicine coming into me via an IV, but even after that stopped I never did have real outright pain.  The vast majority of pain medication in my regular room was simple acetaminophen (Tylenol).

Before I headed off to my regular room I distinctly recall a nurse practitioner rip my two nurses a new one because one of them cancelled a particular medication that she had ordered.  Kind of reminded me of Army basic training the way she spoke to them.  She was tough!  I did kind of chuckle because, before she started chastising them, she pulled the curtain to my room closed as if that might preclude me from hearing.

One aspect that intrigues me is that the nurses on the recovery floor were absolutely awesome, but the ICU nurses… while certainly capable and good… were a little sketchy by comparison.  The whole ICU seemed to be a tad less coordinated than the recovery floor, which is where we’re heading next.

Uh oh!

…I woke up on a Wednesday morning, August 22nd, and didn’t feel right.  Discomfort in my chest, shortness of breath, and the slightest exertion such as tying my shoes wore me out.  People always ask me about chest *pain*, and maybe one’s personal definition of pain applies here, but I’ve never felt chest pain, only discomfort.  Which I normally blow off as acid reflux, which I have too, and which mimics the same symptoms.

Anyway, I get ready for work, and am sitting on the side of the bed contemplating what to do.  I finally decide that I’m going to call in and go back to bed.  I can sleep it off, I tell myself.  So, I do that, and also text Missy to let her know.

Missy is suddenly worried.  The doctors said after the angioplasty that if I experience ANY signs of pain or discomfort to get myself to the ER, either by ride or 911.  She tries to call.  No answer.  Keeps trying.  No answers at all.  (I was sleeping.)  Fearing the worst, the worry gets to be too much so she leaves work and heads home.

I wake up about 9:30am as she’s crawling into bed with me.  I eventually wake up fully, and she asks me whats going on.  I figure there’s no way I can my usual uncommunicative self, so I fill her in.  She’s now riding that fine line between feeling relief that I’m “ok”, and feeling upset because I worried her so much.  She also insists that I go the the ER… so we get dress and I go to the ER.

We get to the ER… she drove… and I walk up to the window and am greeted by three ladies.  One asks what I’m there for.  I say that I’m having chest discomfort and am going to have by-pass surgery in 2 to 4 weeks.  They immediately burst into action.  The one takes my info, another one offers me a wheelchair, and a third speaks into a microphone on her chest, something that was all code but obviously about me to get people in the back into action.  And action it was.  I didn’t even have a chance to sit down even if I wanted to.  I am escorted to a room where they begin to undress me from the waist up, and start poking and prodding and asking questions, about four people total, if I recall correctly, and even more enter and do their thing and leave at various times afterward.  I bet I was worked on and talked to by over a dozen people just in the ER.  It was actually kind of impressive in its efficiency.

I get my chest x-rayed.  There are various tests, many involving the drawing of blood, I take my first ever nitro glycerine pill, more questions, and I swear every person who wondered within a 100′ radius felt the need to break out their stethoscope and listen to my lungs and heart.

I going to have to apologize because I don’t always remember all the technical terms and names of the tests, but they did one checking for some anti-body or something in my blood, and it checked out fine, but they had to wait I think three or four hours to do again, which checked out fine.  Meanwhile, my cardiologists partner was on duty that day, and I met her and she was helping to try and figure out what might be wrong, and whether or not I might have to stay.

At the end of it all, she says that she’s not comfortable with my lack of diagnosis, she can’t rule out anything, so she’d like to keep me overnight for observation.  Ok, I suppose.  (I always wonder what they’d do if someone refused.  I’m sure it happens.)  They get some paperwork done, and wheel me, in my bed, upstairs to my room for the night.  For this trip, and my x-ray trip, they always seem to have the most petite young women wheeling my and my huge NASCAR-looking bed around the place, yet they seem to be used to it and aren’t struggling too much.

Anyway, I get the most awesome room.  For a hospital and in Cedar Rapids, anyway.  It’s a corner room, with a clear view of the s-curve of the adjoining freeway, and lots of light and a very airy feeling.  I ask if I can request the same room for after my surgery… they laugh.  My new assigned main nurse asks me to tell something about myself so she can put something on my white board to help people connect.  I say that I’m very sarcastic, and it works, because that little tidbit does help spur conversation during my stay.

Missy and I settle in for the night.  Missy goes home to take care of a couple things.  My son and my sister visit, and we have the most wonderful conversation for about an hour, just catching up.  It almost feels like a night out at a hotel, except for the constant checking on my breathing… I’m tellin’ ya, every person that walks by.

Headaches… and migraines

It’s amazing how busy a person can get even when something like impending heart surgery is looming on the horizon. It has been twelve days since my last post, and I have more stuff to say. But today we’re going to take a detour from my path to this point and talk about headaches… or more specifically, migraines (with aura).

I am not one to get migraines. Never have been. I’ve tried to understand what people who do suffer from migraines go through, but I’ll be honest and say that I don’t fully understand it. It’s not literally required that a person has to have “been there, done that” to fully know, but it often helps.

This past Friday, after lunch, I felt a headache coming on. Within about 30 minutes it had progressed so far so fast that it was almost unbearable. Intense pain, most only on one side, the right side, if I recall correctly, primarily behind and above my eye and radiating back into my head.  (I do get sinus headaches, so I needed to make sure it wasn’t that.)  Inability to focus mentally and really think, though if I absolutely had to I felt that I probably could. Aura, or visual disruptions, inability to focus visually, distorted vision, black spots. Oh, and did I mention the excruciating pain?

It wasn’t fun. But did I leave and go to the doctor? No. One, I don’t think I would have been able to drive safely. Two, I had just gotten back to work after two days in the hospital for what turned out to be something of a false alarm… but we’ll get back to that in a future post.

Anyway, it was incredibly difficult to work, and after a little over an hour it subsided. Not completely, but bearably miserable. Quitting time came and I was out of there and on my way home. Still had a non-migraine regular headache that hindered my concentration into the evening. Took a long nap that evening, and woke up with headache. Yay me. It didn’t finally go away until I woke up the next morning.

That day, Saturday, went well. No headache, no issues.

But Sunday. Woke up fine. Ok, woke at 1pm, but to be fair I didn’t go to bed until after 4am. Anyway, was fine in the beginning, then around 3pm it came back. It’s 9pm as I write this  Not migraine level, but bad enough. So I have to wonder, what causes migraines and/or headaches in general? Each of these incidents was preceded by a stressful event, so there may be that. I was also started on a new medication, some what I call a min-nitro glycerine pill that I cannot remember the name, and was told that it can cause headaches in some, so it could be that. At this point I really don’t know, but I don’t like it.