R.I.C.E? Not the *best* idea!

I have meant to do this several times and forgot -- there is still an Ian over at ImpactEDNurse and he seems energized, having left his job in the Emergency Department and moved on to be a stellar member of his hospital's Medical Emergency Team.

Still didactic, but in a caring/sharing way, I was really surprised by the latest research he showcased on caring for sprained ankles:

Its funny how something we consider best practice will often be replaced by
something we previously considered worst practice.

In a new study of 600 patients published in the Lancet, a below knee cast has been found to be more effective than a compression bandage in the management of sprained ankle.

In fact, a tubular compression bandage, combined with ice, elevation and advice to mobilize as soon as possible (which is pretty much current practice), was consistently found to be the worst treatment of all those examined.

Yes, I know I said I was done blogging until after surgery. Well, kiss my grits! I am overwhelmed at the moment with getting my life in order -- before I go to the hospital, the ducks, they are in a row! The house clean. The important papers easily found but not glaringly obvious. Bills paid. Small bag packed.

I never know whether to bring my computer or not. It physically hurts to use it and it is undoubtedly stupid, as it could easily "walk" away. So... decision! It stays home.

I need to luxuriate in Hibiclens... Wash and condition the crowning glory hair... Figure out what would be fairly healthy and yet extremely comforting to eat before going NPO at midnight... Help the Fredster with whatever organizational issues remain... and I need to sleep. I usually don't, so why I think tonight will be any different, I've no clue.

And so ends a post about how happy I am that Ian is back, and without ever really going away.

Doing It Twice

The next surgery is scheduled for Monday, February 16, at an as yet undetermined time. I know that they prefer to do "dirty" cases last, so I anticipate a late afternoon start time. Due to Fred's hectic schedule this week, the only day we can get the pre-op testing and all the admission details done is Friday. Cutting it close, but the nurse said it would be okay.

She hugged me again.

Everyone is hugging me. It makes me nervous.

The PA was sweet -- a tough adjective for such a big, tall guy to pull off, but he does. The two of them sort of crashed in my exam room -- I am like a comfortable piece of furniture over there -- and I was surprised to hear them violating HIPAA all over the doggone place, much as they did last week. Not that I remember, or even care to remember, any of the patient names they tossed around. They were not badmouthing anyone (except for the occasional raised eyebrow and shift in tone of voice) and they were clearly exhausted. Dr. ShoulderMan is running them ragged. Red-rimmed eyes, the both of them.

This was my informed consent: "You know the drill, right?" Actually, I am fine with that, though I did have a moment of feeling pissy about how blasé we all are now about slicing me open. This will be the fourth major operation since the end of August, the third on my right shoulder. They anticipate removing the spacer that's in there and either giving me another (if still infected) or if everything is pristine, giving me another prosthesis.

NOTHING showed on the x-rays of the left shoulder -- which absolutely blows my mind, because I cannot even use the damned arm, and the slightest jostling causes intense pain. The PA will show ShoulderMan the films today or tomorrow, to see if the Master has a different interpretation.

And so they "consented" me for bilateral shoulders on Monday, but with no real intention to do both -- the two of them said it was definite for the right side. In the interim, I am to try taking more muscle relaxants, and doing "whatever works." God, I wish ShoulderMan had been there. Not that I don't trust the PA and the nurse -- they are excellent -- but he is supposed to be the freaking orthopedic genius. And as nothing is working, I am kind of clueless how to help myself. Maybe I will slap the stupid TENS unit back on and groove to the funky beat...

Okay, so maybe he was busy, off somewhere saving limbs and lives. Or attending a conference full of ultra-important information that he really needs to know. Possibly, he is delivering a paper of earth-shattering significance, being the Bone Sage.

This morning, I tried using the arm, with no improvement and excessive pain. So I switched back to one-arming it with the infected-as-all-get-out right arm. [We all know it is still infected, or re-infected, if one wishes to engage in semantics. My fevers, white count, C-RP, etc. all are screaming to be acknowledged.]

And then I blithely, unconcernedly, stupidly, picked up the full carton of milk. No, that wasn't so stupid. What was stoopid was doing it twice. (Back on 22 May 2002, after falling and fracturing my leg and other skeletal parts, the Evil Deaf Asshole Nurse made me stand on it -- slamming the door to the hall shut and hissing "It's not broken, stand up, standupstandupstandup!" And so I tried, falling back to the floor with another loud c-r-u-n-c-h sound. With such a great initial result, of course I tried it again -- at her effing urging. By then, my entire foot had rotated to an inhuman angle, the leg was purple and swollen, and, unbeknownst to Evil Deaf Asshole Nurse, unbeknownst to me, CRPS had begun...)

Ummm: Flashback.

{Who is that screaming? And is it now or is it then?}

I am prone to flashing back with doing-it-twice pain -- stoopid pain that could easily be avoided -- also when I am fearful.

Erin was my physical therapist -- home visits -- back in 2002. My left arm was messed up (nothing like falling on a freshly operated body part) and immobilized in a sling. My right foot and leg were in a cast, non-weight-bearing. My right arm was kind of bad off -- it had initially been scheduled before the left for replacement and I don't recall why the switch was made. So when the time came for me to try standing up, with Erin and Fred right there, I could not do it.

It felt physical. I simply could not do it. I was weak, the one leg would not hold, it was impossible.

There surely was no relationship between my hyperventilation and shaking, and the impossibility of standing beside the hospital bed that completely took over the bedroom. So when Erin began asking what I was afraid of, I had no clue. I kept trying to stand, then sinking back onto the bed, more and more approaching real exhaustion.

Once Erin elicited the underlying truth -- that I was not just afraid of falling, but that I knew with complete certainty that I was going to fall -- she and Fred got so close to me, so obviously had control over anything that might happen, that I conquered my fear just long enough to quickly stand, then sit back down.

Erin cheered. It wasn't easier after that, but I began to make some steady progress. Now and then, I would still get "stuck" by memories. Don't ever forget that fear is powerfully paralyzing. Fight fear at all costs, Dear Readers.

All of which to say that I could learn to appreciate black coffee.

Still, I am a coffee fanatic; I like it the way I like it; The rest of the day is instant doodoo if I cannot get properly prepared bean juice.

Good thing I am not nervous about Monday. Good thing I got over that stoopid fear of falling. And of doing it twice.

Nerves are setting in

I couldn't sleep last night. I have the Hospital Terrors and was so hoping to avoid them. There are mountains of things that need to be done and my tendency to make lists has kicked into high gear.

Now it would be spiffy if I could just check a few things off.

I will be the last surgical case of the day. Apparently, orthopedic surgeons have this hangup about operating on infected joints when there is the most remote chance that a microbe will escape into the rarefied air of the surgical suite... and then jump into the open wound of another patient. My bacteria are very social.

The pain is kind of out of sight but I am not medicating for it. I am doing a modified Drug Holiday (yes, on my own; no, Shoulderman hasn't a clue). It will help me post-op. But the pain is starting to suck, so I may have to end the vacation.

Fred has gone off to... church. Here at Marlinspike Hall, deep, deep in the Tête de Hergé, his worshiping options are plentiful. He attends the First Existential Congregation of TdH, an interesting group of very strange people. I stopped attending over a dispute about the ordination of Transgendered Alien Republicans [TAR]. Nothing gets to me like the pointed exclusion of a group of people, even if they are TARs.

It occurs to me that these infections may be my end. Maybe their concern over the MRSA is not so puerile after all. Shoulderman has intoned that we may end up chasing these nasty bugs from joint to joint. I haven''t had the courage to tell him my left hip is hurting.

How much hardware do (well, at this point, *did*) I have?

1999-left hip fractured and pinned
2001-right hip replaced after collapse
2002-left shoulder replaced after collapse
2002-right ankle reconstructed after fall in ICU (the beginning of a Sentinel Event that ushered in the era of CRPS)
2005-right shoulder replaced after collapse
2007-right elbow reconstructed after a fall
2008-right shoulder prosthesis removed, replaced with cement spacer
2008-Monday, December 15... left shoulder prosthesis [probably, but pray not] removed, replaced with cement spacer impregnated with killer antibiotics...

We're going to chase infection in all of these possible incubation hot spots? In that same space of time, there have been four ressuscitations, three Addisonian crises, two pneumonias, many lupus inflammations of heart and kidneys, and *way* too much time spent hanging around on ventilators. My terrific luck cannot continue to hold.

Way to talk myself into a funk!

Solution? Scrub the golden toilets of the Manor! Change the bedding of the various Sleep Chambers! Clean the Moat! Mow the Wimbledon Miniature Courts! Dust the Rubens! Refinish the Velasquez! Go to town and snag more Gold Leaf for the 16th century dinette!

Ar! Temp? 101.2. Ar! Would that those First Existentialist Congregants prayed...

I have great faith in ShoulderMan. He is easily one of the top ten OS in the country, very humble, and tenacious as heck. He is also an unusually talented *doctor* -- and by that, I mean that he doesn't shrug, mutter, and disappear when my medical crapola surfaces after his surgeries. He listens, absorbs, and doesn't coddle -- the perfect combination for me and my increasingly woe-is-me attitude. He will do his part and I must do mine. What is my part, though? I have been living with pain that stays on the very high end of that stupid 10-point scale, running fevers daily, sweating, able to do less and less, not sleeping for all the pain, and... chest pain is becoming way too frequent an occurence. It is hard not to worry about that freaking "dilation" of the aortic arch.

When did I become so fearful, so tentative?

Where is La Belle et Bonne Bianca Castafiore? On those rare days where I need that Diva-Witch, she is nowhere to be found!

He beat her senseless

My apologies for not making mention before now -- but La Belle Bianca Castafiore will be de retours from a luxurious vacation early next week. We have missed her around the homestead -- her dulcet tones, her low key and comforting presence.

Yesterday and today have been marked mostly by pain and depression. I am doing the best I can to address each but these bastard symptoms are adroit at feeding off of each other.

Fred ferried me to the Infectious Disease doctor and Infusion Center, then off to see my VIPMD. I have not been keeping track -- but it hit me yesterday how much we are paying for the privilege of parking. It's outrageous.

Riding in the car brings me to tears, and that stresses the Fredster out, particularly as he is doing his best to avoid potholes, uneven streets, and rabid commuters. Having me sob doesn't do much to keep him calm -- and he is the one having to face some of the worst traffic known to motoring-kind.

I abhor others' logic in response to my illogical emotional outbursts. My MDVIP, for example, felt it necessary to point out that I am in much better overall health now that the infection has been "removed." Never mind that I am left with only one useful limb -- in his shortsighted view, I should be happy to be alive.

Harrumph. What a PollyAnna-Man. I might as well be gorked out, put in diapers, and parked in a corner somewhere. It took me five hours of hard work to accomplish the very basic of tasks this morning -- all before the gentry of the manor rose from their slumber, as I don't wish to be pitied, or aided. Just as Fred got up for the day, I was ready to take my first nap, and was, of course, in tears. He must think I do nothing other than weep.

I cannot make you understand.

There was a sweet elderly couple in the waiting room at the doctor's office yesterday. They carried a folded walker, so I am not sure who actually needed it. It seemed to function like a sleek fashion accessory -- the shades pushed up into the hairline, the pink crocodile cowboy boots.

She said, in that quiet, sweet voice that some confused -- but secure -- people adopt: "This is a nice room. I wonder what they use it for." Her husband told her that it was a waiting room and that patients sat there until seeing the doctor. She was clueless about being at the doctor's office but covered well -- laughing, tossing out "of course" after "of course."

A few minutes later, she wondered why she was there, and he told her that she had some sores on her arm that would not heal, and together they looked at those reddened spots of skin. She managed more laughter and the obligatory "of course."

She had beautiful poofy white-white hair, no grey, and swimming blue eyes.

I dreamt that he beat her senseless in the elevator on the way down to the very expensive parking garage.

Home

On 25 August, I had surgery to see if my right shoulder prosthesis (one of three -- prostheses, not shoulders) was infected and needed removal. After finding 4 pockets of pus and having the prosthesis fall out of its own accord, I wasn't doing well. So they decided to keep me on the ventilator, hide me in the ICU, and not close the wound. On 29 August, the second surgery was performed with the goal of "washing out" the wound, putting in several drains, and inserting a sorry looking cement spacer impregnated with antibiotics.

My cultures were inadvertently left in the OR overnight, so what organisms were growing became a topic of consternation between my surgeon and his staff and the infectious disease guru and his minions.

I did, however, clearly grow MRSA, and so spent my 10-day stay in isolation. Yellow is a most unbecoming color and Fred found those blue gloves hot and cruel.

My supremely talented orthopedic surgeons are adroit at deflecting my pleas for promises of a new prosthesis in a few months -- they just won't commit. My main orthopod does a bad imitation of a spastic retard when I ask him what my arm movements would be like without a shoulder.

He fails to understand that this would leave me with one functional extremity. He fails to understand, indeed, everyone seems to fail to understand, that I cannot lose any more.

Did you hear me?

I cannot lose any more.

I am on i.v. antibiotics at home -- vancomycin and *bleep* (I cannot remember and don't feel up to rolling into the kitchen). So that is 4 infusions a day for 6 weeks. It is not a big deal -- except insofar as it reminds me of circumstances I'd rather ignore for a bit.

The pain is horrible but I believe the management of it is at the optimum.

(Don't touch that sentence... It was difficult enought to formulate once -- I won't do it again.)

The Friday before surgery, I had an echocardiogram to rule out endocarditis, as I have a bicuspid aortic valve. Thankfully, I came out "clean." Oh, except for the aortic arch aneurysm that is currently measuring at about 4.7 cm. The cardiologist who called and reamed me out for missing a few years of testing was not hesitant to scare me to death.

So there is much on my mind and much that is hurting the body -- the CRPS/RSD, for example, is unbelievably inflamed (my legs have never ever looked/felt this terrible).

Despite getting two units of blood to boost my hemoglobin of 6 -- I am tired and wonder what my H & H is now. My surgeon's admonition of how to go about life until seeing him at the 6 week mark? "Rest and think healing thoughts." What a lovely man, not to mention a talented physician. I don't know if it is technically true, but my heart says that he saved my life.

Well, off I go to try and catch up on some reading in the ether of the blogosphere... Thank you for any stray good thoughts you can label and let loose on my behalf in the coming weeks.

Bianca's Big Mouth or Wetback Entitlements

Mes chers lecteurs, mes lectrices hors comparaison,

Je vous écris à propos d'un petit rien.

Voir: http://prpnurse.blogspot.com/2008/08/entitlement.html

Dégueulasse! Jonathan Swift, a-t-il dû se soumettre à de telles bêtises?

"Ah! Je ris de me voir si belle dans ce miroir..."

Quelle saloperie! Je viens de perdre ma tête, de m'énerver, de me mettre en colère! De quoi s'agit-il? Il s'agit d'une blogueuse impérieuse, pseudo-pseudo, qui voudrait être toutes choses pour tout le monde (eh oui, tout le temps!).

Je me demande... serais-je aussi bouleversée si demain n'était pas demain?

When will they understand that to laugh in the mirror comes only with the well-developed, umm... capacité... la habitude... of seeing oneself? I am fearing the ones without the laugh en face de, in the face of -- the looking glass.

@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
Retired Educator, here. I need La Belle Bianca's grande bouche getting me in trouble today, of all days, like I need a prosthetic shoulder joint or aortic aneurysm fix!

a cup of trouble, anyone?

dear all,

would anyone like to borrow some trouble?

i had my echo at 8:30 this morning. i asked the tech how it looked and she gave me a thumbs up and a "looks good to me." so we go home and i plan to pay some bills, declutter my piles of paper, etc.

ring ring ring.

it is one of the cardiologists. he is talking fast, and i cannot understand the words.

so... my heart is pumping well. i still have my usual aortic regurgitation from my bum aortic valve. and then there was that other thing. oh what was it?

oh yeah! where the aorta attaches to the heart ("the aortic root"), well... it is kind of dilated. like in an aneurism. i become a regular chatty cathy -- i ask if this precludes me having the surgery on monday and he says, no, that will be fine. then he starts to yell at me about how i need to have echos regularly -- that they found this dilation back in 2003. i don't *remember* that! (after i hang up and am talking to a weeping fred, he reminds me -- my cardiologist told us that it wasn't as bad as it looked on the echo -- and that i did NOT need to foillow up with him anymore! fred remembers that vividly.)

anyway, it measures 4.65 centimeters. i ask what needs to be done about it -- and the guy fairly hoots! (he actually was very nice) "major open heart surgery," says he.

well, what kind of symptoms should i be looking out for? and i am getting a chill just typing his response.

"you won't have any symptoms."

as in, it blows, i die. (hence, the weeping fred.)

there must be something extremely wrong with my mental health, this all seems like a great big joke to me! whahaha! what's gonna happen next?

i told fred that this is definitely an incentive to live in the moment.

so -- i guess it is a good thing i don't have hypertension.

whahahahahahahahaha!

love,
prof

Hiatus

Retired Educator here,

I am having surgery Monday to remove an infected shoulder prosthesis. No one was able to tell me whether or not I will have internet access if I bring my computer. The closest intel was "Well, I know that we are a wired hospital because we have these things everywhere!"

Huh. I anticipate major 'puter withdrawal. The distraction would have been nice and I also was looking forward to blogging the patient-side of a hospitalization -- now that I am more familiar with the major gripes let off by medical types, I think it could be an interesting exercise.

Yes, thank you very much, I know that there is nothing preventing me from taking notes, even sketching the pieces out long-hand. I can still do it. Still -- stop trying to solve my problems, you people, you! I need to fuel useless angst -- it serves to crowd out the more dire reality! You're just messing with my Trojan Horse of Denial.

I'll be in the hospital between 5 days and several weeks, according to the surgeon. According to his nurse, I'll be there 3 days. I'm thinking she probably knows best. They will put in a cement spacer that is laced with antibiotic -- after a "few months" that can be replaced with a new prosthesis. I'll also get i.v. antibiotics through a PICC line. My orthopedic surgeon, however, seems intent on depressing me further by saying, and saying again, that I could end up "without a shoulder joint." There is nothing someone who is already a geeky gimp stuck in a wheelchair wants to hear more! Excuse me while I panic.

I couldn't even get him to give me odds. That's low, when someone won't even give you odds.