Swiss cheese brain update 28/10/08
Well, all in all I’m not feeling too bad. In fact, considering everything I’d even go so far as to say that for this stage in the game, I’m feeling pretty damned good.
I spent most of Sunday after I got home dozing on and off, and a fair amount of yesterday either dozing or watching daytime TV, so I’m not particularly doing very much. I guess because it’s the third VP shunt/revision I’ve had I knew what to expect afterwards. Apart from being generally sore I’ve got a bit of a headache, but it’s only on one side, so I think it’s the after effects of the op rather than high or low pressure. I’m still on the high dose of my normal painkillers, but I’ll probably cut that down a bit over the next few days and see what happens. Usually the only thing I miss about hospital when I get home is the beds (they have those fantastic electronic ones that you can adjust to any position), but I slept surprisingly well last night once I was dosed up with painkillers and managed to pile cushions and pillows all over the bed to get reasonably comfortable.
The district nurse has been this morning to take some blood for my INR check, and the plan was that I’d test it myself using my machine at round about the same time to check whether we’re getting the same result from the machine as from the lab tests, but that didn’t quite work out, as though I managed to get a decent blood sample eventually and get it onto the test-strip and get a result, it was way past the 15 second limit for lancing the finger and getting the sample on the test strip, so the result wouldn’t be valid, as the coagulation process would be already under way. It’ll be interesting tomorrow though when the result comes back what the lab result shows.
Residents of my forum are amazed that I’m not still totally out of it, floating around in a haze of painkillers, but I’ve always come round from anaesthetics pretty quick and got over the initial post-op period pretty quickly. The first time I had a general anaesthetic when I was in my teens I was sitting up in the recovery room and asking the staff if it was always that quiet (I’d been the first on the list, and there was only me and a couple of others in the recovery room at that stage) and they were trying to get me to lie down and relax When I had my LP shunt revision a couple of years ago, I was fairly late in the afternoon going down to theatre, but when the anaesthetist came round to check on me when they’d finished the afternoon list, she got to the ward to find me sitting up in bed eating my tea, and said she thought I was probably okay! This time when Mr M came round to see me early evening I was sitting up a chatting with my mum and dad, and I’d already persuaded the staff to let me out of bed to use the commode (me and bedpans don’t get on, and they know me well enough from my previous stays to know that it’s a lot easier for us all to use the commode option rather than bedpans) and swap the oxygen mask for nasal cannula.
I was thinking about it earlier though, and this is my fifth op in four years, but to say it’s still only three days since the op, this is probably the earliest I’ve felt this well (probably not a good idea to say that though – I’ll probably feel crap tomorrow now!). Part of it I suppose is because I’m on pretty heavy-duty painkillers anyway, so my body’s used to functioning with quite high levels of drugs. I’m always better when I’m actually doing something that takes my mind off whatever bit of me’s currently hurting – not that I’m really doing anything at the moment. I was up around 8am this morning – though that was mainly because I needed some more painkillers – but then just got myself comfy on my reclining chair and watched the breakfast news and daytime TV and then had a shower and got dressed around 11am. Since then I’ve just been watching TV and every so often reading a few more emails and checking out a few messages on the various online fora I frequent – nothing too taxing.
Apart from the “live for the day” philosophy I’ve adopted, the other big part of my way of coping with it all is planning. I work in strategy where we make plans for the future, and to a certain extent I do that in my life as well. Sometimes it’s little things and sometimes it’s big things, but I have a kind of plan in my head (or more often these days on the computer as otherwise I forget what the plan is!) of what I want to get done and when I want to get it done by. Often it might be little things, and if things don’t go according to plan and I don’t get them done, it’s not the end of the world, and a total disaster if I don’t meet my “targets”, but it gives me something to aim for.
While I was in hospital I’d got a plan in my head of how it was going to go though, and fortunately everything went according to plan and there were no complications, and the staff were okay with my plan. I knew I was third on the morning list on Friday, so I’d probably be going down to theatre late morning/lunch time, and having had a VP shunt revision before I knew roughly how long it should take, and figured I should, if the theatre recovery room staff were happy with my progress, be back on the ward for around 4pm. I’d guessed right, and it was bang on 4pm when they wheeled me back up to the ward. That meant I’d be sorted out and ready for tea and visiting time at 6pm. As I said, I’ve always come round from anaesthetics pretty quickly, and fortunately they don’t tend to make me feel sick or anything.
Once I was back on the ward I established that the anaesthetist had said to keep me on oxygen for 6 hours, which was fine with me as I’d been off it by 10pm in time for bed, and fortunately I’d only been written up for one IV of fluid (which was a relief as I know from experience it’s when they leave me on an IV all night that we start having problems with bedpans etc.). I knew that they’d be waking me every hour during the night to do the neuro obs, and I knew as long as everything was okay I’d be allowed out of bed on Saturday. That meant as soon as I was allowed up I could get down to the bathroom and have a wash and get dressed (very important part of the plan, as if you’re up and dressed and not looking like a poorly person, you’ve more chance of being allowed out sooner), and then after breakfast and a couple of wanders down the ward to test my legs and make sure I wasn’t going to go too dizzy when I started walking, I could head off downstairs to the shop to get a newspaper…and more importantly nip outside to join the other escapees on the bench outside the main doors for a ciggie and to phone my mum and friend Pinkie.
Mr M had said when he came to see me on Friday evening that they’d want to monitor me for 24 hours, but then if I felt okay I could go home, but that there was no rush, and if I didn’t feel up to it I could stay as long as I needed to. According to the ‘plan’ in my head I was thinking probably Sunday or Monday for going home, but of course the big question was whether haematology would get theit hands on me. Fortunately, of course, they didn’t, and even though I doubt I’m anywhere near my therapeutic range for my INR yet, the ward doc said I was okay to go but to have my INR checked tomorrow. After my LP shunt revision a couple of years ago I really did feel rough after the op and had really bad low pressure, and I was in for 5 days after the op that time – the longest I’ve ever been in after a shunt op, but this time, things seem to be going okay, and the ward doc on Sunday said I was fine to go home on Sunday.
Friday and Saturday they had me on a double dose of Clexane (Enoxaparin) (one of the injected anticoagulants) as they didn’t want to re-start the warfarin too quickly and thin my blood too quickly because of the risk of post-operative bleeding. How all the different clotting factors in the blood works is very complicated, but although Clexane is an anticoagulant, a type of heparin (low molecular weight heparin), how it works is different to how warfarin works. Since Sunday when I re-started the warfarin I’ve been on a high dose which they usually give when starting or re-starting warfarin, and then depending on what my INR is tomorrow I may have to adjust the dosage, depending on what’s happening with my INR. It was 1.2 on Saturday morning when I checked it with my machine, but I’ve not checked it since then, hence wanting to check it around the same time as the district nurse comes to take some blood, to see if we get the same result from the lab test. From what I’ve read though, results can even vary slightly between different labs using different reagents, so if it’s not exactly the same as the lab result it’s not a major problem. The ward staff were certainly very impressed with my little machine.
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