Wednesday, April 19, 2017

So, How Was YOUR Easter?

I had plans, I promise you. There was laundry, and typing up 2 meetings worth of minutes, and hunting all the... um... chocolate Easter eggs in the back yard and scooping them up.

Instead, I woke up feeling a bit off. I took my morning pills and decided to postpone breakfast.That turned into a wise idea. I was thirsty a bit later so drank some water, then hit the bed because "off" was turning into something worse. When Steve woke up, half an hour later, I called him to come talk to me. I let him know I was sick, and by the time I'd spoken five sentences, I needed to make a mad dash to the throne. It was my first set of dry heaves for the morning. I admit I was a bit surprised this soon the stomach was already empty. But it certainly got our attention.

Meanwhile, the pain had been traveling as well as increasing. I first thought bladder infection, then bowel, then appendix despite not having one of those for 56 years! Then the pain climbed up my back to sit waist high, just right of the spine. Almost like is was in the kidney. I decided Steve was going to drive me to the ER, that being the only available medical care available on the holiday. While he was tending to the dogs so they could stay home for a while, just in case, I was digging around for the least dirty clothes I could find. Laundry was due, after all, and would soon become overdue.

At the ER I asked if I could lie down anywhere, since I certainly didn't feel like sitting up by then. I got their routine response that was only a mite more civil and helpful than "Take a number and wait", but that's what it meant. They also answered my request for a pan, since the nausea was returning, and when it hits, it doesn't wait on a trip to a possibly already occupied restroom. As soon as I sat down, it became useful. My fellow waiting room inmates were treated to a spectacular series of dry heaves. I figured they must think I was hung over. By the time my name was called, the count was up to 4 sets, with two more to follow before they shot me up with an appropriate medicine. It kept Steve running to resupply me with tissues for after, since each bout left my eyes and nose streaming as well as the mouth.

The only good thing was I wasn't producing any bile, so no horrible taste or smell. On the other hand, it didn't do a thing to ease the pain, and left me even now with sore muscles across my back from over-use.

I asked Steve to hit the front window again with my request to lie - somewhere, anywhere - down while I was waiting. A couple minutes later they took us and my pan back... to a room with chairs!

I do believe there are times when it's appropriate to let someone know, even to the point of raising your voice, that they are not listening! A room with a bed miraculously opened up right then, and it almost felt better to lie back. I say almost because that still did nothing for my pain. But I was done with having to sit up. We even figured out how to hold the pan while I was horizontal so everything went into the pan and not on me, the bed, or the floor. By the time I finished the last bout, what was collected in the pan totaled about two tablespoons, all saliva I figured.

Things improved. The anti-nausea meds via IV worked. I can't tell you what they used, even though they told me twice. The brain was on hold for certain higher functions. I did recognize the term fentanyl , which started easing the pain, but it took the addition of toradol to really bring it down. In fact, it was good enough that I could raise my arms up for the CAT scan, a real challenge after rotator cuff injuries. And that CAT scan gave them their diagnosis, confirming a kidney stone.

I was getting admitted.

I learned a lot the next few days. The CAT scan only showed the one kidney stone. I would need to be concerned and adjust my diet if, like most who show up with one, already had a bunch of others sitting up in the kidneys just waiting their turn. Being lucky doesn't always feel like lucky.

There were several different options for treatment, depending on a variety of factors. Did this one also show on an X-ray? Size is a factor, graded by under or over 5 millimeters. Mine is exactly 5. How they go in, as in down from the top or up from the bottom, depends on how far down the tube it is. Following a pattern here, mine was exactly halfway. Options include a couple different ways of smashing up the stone, but neither is possible if there is a UTI, or urinary tract infection, which I tested positive for. Turned out to be e coli, the most typical culprit. It can be hard to clear the infection, since with a stone still imbedded, there is lots of habitat, if you will, for the little buggers to hide in. "Stone" brings to mind something smooth and round, so think more like sand burr. Surgeons can reach the stone with a lighted gripper thingy and pull it out, and not need a stent to keep urine from continuing to back up in the kidney. However, if the tool accidentally punctures the ureter the stent will still be needed so urine bypasses that spot to let it heal. But if it's more than a tiny hole, they have to open you up immediately and practice their knot tying, and you still get the stent.

But hey! maybe none of those options would be necessary if the stone flushed itself out, so they pump IV fluids through me at a high rate to keep me peeing, and catch that in a little insert under the toilet seat, then strain the contents before anything gets flushed and see if any little 5mm something shows up.

None of the information influencing options was available yet, so I made it onto the surgery schedule for the next morning. Something was needing to get done, unless I could produce a stone in the strainer. By then we know I had a UTI, limiting some options, that no stone had passed, so the first procedure was to be -hopefully - a simple stent. 20 minutes under. Nothing to eat or drink before surgery, of course.

With my kidney in the shape it was in, I wasn't feeling hungry anyway. Painkillers didn't change that. Good thing, since the hospital food absolutely sucked, except for the red grapes or the banana I got later. Not only was the meat over-cooked, dry, and tasteless, the baked potato like a rock that didn't even smell inviting, the whole wheat dinner rolls were old and cold and again, yuk in the flavor department, but every tray had about 12 carb units where I'm allowed 3, so I had to make choices of what is the least worst. Then again, even now I barely have an appetite, so much of that food would have been tossed anyway. At least the grapes and banana could be saved for a late night snack.

Most of the nurses were great. However, both my roommate and I had special attention needs, primarily for being unplugged from multiple outlets, and quickly enough that we could make it to the bathroom without either creating a mess or enduring an unnecessary level of pain. Sunday night was the worst. A couple of the nurses made sure we knew how much inconvenience we were causing them.  What made it worse was them sounding like there was a party out there.

If we hadn't shift-changed to new sets of teams, we both would have gotten very good at becoming even more of an inconvenience. I had pain pills I needed on schedule, especially since my pills were only 2.5 mg of percoset and wore off well before I was allowed the next. You better believe even at my most out-of-it, I was a clock watcher. And yes, I was a bit out of it that night with a low grade fever.

One issue I solved for myself by figuring out how to take stuff apart so I didn't need help every 2 hours or sooner. The pink plug came out and went back into the wall behind my bed, and the IV rack it was attached to had a display showing battery life, usually 4 to 5 hours. No way I was going to need it unplugged that long. The leg cuffs that squeeze alternate legs in order to prevent blood clots took a bit longer to figure out, since they had an alarm that sounded if they were disconnected for a certain length of time. I finally just decided to just unplug my cuffs and wear them into the bathroom, and it the alarm brought somebody, well, all to the better. Ann and I had different staff assigned to us, and that first night they were very territorial, in a not-my-problem kind of way. Again, that improved, and we had gotten very good at saying, "while you're here could you just....?" Ann had extra complications keeping her from unplugging herself, including being hooked up to O2, and a bed alarm.

After both of us were feeling better we started chatting occasionally. You never knew when the other was sleeping, with the curtain kept pulled. She has led a very interesting life, traveling to many different countries for work, on all 6 of the major continents. At present she was battling COPD on top of Valley Fever, had been here 5 days already, and had only one sleeping pill in her history that worked for her, which the hospital pharmacy didn't stock. After 5 sleepless nights, the staff finally threw up their hands at a problem they couldn't solve, and consented to let her have somebody bring her own labeled bottle of sleeping pills. They were talking about discharging her soon, but she'd been through the repeated routine of going home and needing to return two weeks later, stay a while, go home, come back. She wanted not only more care, but better.

Back to me: Monday morning I was awakened with the news that surgery was at 11:20, and the CNA needed to assist me with two antibacterial "baths". Think towel, washcloth, and thin pink soap. I informed her no way until I got my already overdue pain pill. Maybe it takes messing with their schedule to get your needs met, because the pill arrived shortly. In between the two baths, I was informed surgery was now moved to 12:30. That worked for me because my pain pill would just be wearing off then and the OR staff could deal with it however was needed. I should be under, and then on whatever was needed for after surgery. One way or another, my kidney would be unblocked and stop trying to kill itself. Even if the stone remained, it was the kidney causing all the pain, not the stone traveling the length of the tube, as most people think.

So my morning was devoted to getting 2 scrubbings, blood drawn, vitals checked, and trips to the toilet, straining my own urine because the staff had somehow lost orders for that in the transfer, so the "not my job" resurfaced, and it was really simple. Whether that stone had passed was vital information for the surgeon. Plus for hygeine there was a nice sink with soap and paper towels, the strainer rested in another container, and the toilet insert sat next to it all in the shower, out of the way. Get over it: after changing thousands of dirty diapers, this was not obnoxious.

Once down in surgery, we knew the stone hadn't passed,  I had a fever, a UTI was presumed, so a stent to relieve the pressure was the only task of the day. Taking out the stone under these circumstances risked a blood infection. Antibiotics before and after surgery, and a follow through with my urologist to make sure the bug was gone, and we'd schedule lithotripsy and stent removal. Oh yeah, and now the schedule was changed again, so surgery something like 2:20. Or whatever. I wasn't going anywhere. I just laid there quietly, not even up to reading. (Nor for most of my stay.)

I didn't particularly appreciate the lead-in to surgery. I got wheeled in on the gurney to a spot reasonably close to the operating table, and asked to transfer myself over. Uhh, sure, you bet. Of course it means sliding from one slippery surface to another even slicker one, nothing to grip or that would stay put for leverage, and it took them a while to decide they probably shouldn't leave me half over the edge of the second because I might fall. Well duh! I was a long way from worrying about falling yet, with the two gurneys touching. My issue was the hard inch-wide, inch-high rim on #2, not - so - cozily nestled right under my spine.

Hey guys, a little assist?

Then the anesthesiologist shoved this plastic mask down over my nose and mouth. I couldn't breathe, so started wiggling my face around to create an air gap, and gasping. As far as he was concerned it wasn't possible that I was having trouble breathing, and he just told me to slow it down. Hey, my body is slipping into full panic mode right now! He removed the mask for a few seconds, then clamped it back on me again. Same result. He removed it once more. The third time he told me he was putting something in it to help me sleep. Well, about effing time! So down came the mask, and... I wasn't going under for what seemed an age. "Breathe deep."  Hey, what the hell do you think I'm doing here, trying somewhere to find some air or sleep or something! My eyes are rolling, searching the room for help, but nobody's looking. I started counting breaths. I remember 10. Way-y-y-y too long, guys! And why should it be so difficult in the first place? Hose kinked? Nobody turned the O2 on?

If it takes surgery to remove the stent, I want a different assisting staff!

In the recovery room, I was mentally out of it long after being physically awake. I knew who I was, I'd just had surgery, and why. But it was still too hard to connect the verbal part of my brain to answer the basic questions they shoot at you. Finally I was able to answer. "Do you know your name?" "Yes." Hey, everybody asks you that, every time you see them. Birth date too. So far the best I could do was answer the question they asked. It went rapidly uphill from there, giving full name, date, and volunteering,"I have to pee!" They heard me. Within a couple minutes, they had me sitting up, making sure I had balance, and brought over a commode chair next to the bed. Ahhhhhhh....

The fever stuck around most of that evening, not too unusual after this surgery I'm told. My blood pressure was also well  up there past the healthy zone. I was loaded with pills, the IV with antibiotics, potassium to make up for the IV flushing practically everything out of my system, and settled in to
 trying to get out of bed in time. The fever shot down hope of leaving Monday night, but maybe Tuesday, if....

I improved overnight and through suppertime Tuesday, but so far only the urologist had signed off on my going home. Steve was trying to arrange his schedule for picking me up, a challenge when nobody will commit to anything. A pair of good friends stopped in for a visit, after finding out I was still going to be there in the hospital to see them.

It turned out the doctor who was needed to sign off on my leaving had no idea my urologist had already given the OK. Once she heard, things got rolling. Fast! I was out the door and in the car in half an hour. That was still time to get to my pharmacy for my 3 new prescriptions, then home to a comfy chair, even better a comfy bed. Steve and I watched a half hour of TV, and by the time I got back to the living room after that next potty break, I was ready to crash. No more TV. No more pills as I'd just taken what was needed. Just sleep.

The good news is the kidney pain was gone by the time I woke up from surgery. However, I'm one of those who find the stent very uncomfortable. I've got pills for that. Next Tuesday I see the urologist for a post-op evaluation. If all goes well, we can schedule Lithotripsy for about a week later, but there are "ifs". Later that same day I see my primary for a post-hospital evaluation. Of course the calendar is already spotted with the last post-op check with the eye surgeon, the 1 year check on my knees with my orthopedic surgeon, and the 6-month cardiologist visit, all before we head north. Hmmm, funny, I don't feel like I'm falling apart.

I do feel... good that the laundry finally got done today. And maybe ambitious enough tomorrow to go harvest those chocolate Easter eggs. I'd like to head back into lapidary, but if it comes to a choice between taking the good meds and spending more time working on rocks, you can guess my priority.

Anyway, that was my Easter. How was yours?

Better food, I bet!

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