Monday, November 5, 2012

Day 14 posted on Day 17, Oops

 [Sorry for the delay folks, this post got away from me, I've got to remember to post updates and not dissertations]

Two full weeks from OR, one full week since our return from Boston, and it is hard to say how things are going, at least it is not possible with any one simple sentence. Considering what Lis actually went through, her recovery is proceeding extremely well; however, that by no means, means she is well.
It is now 5 days since the end of the steroid taper, and the buoying effect they had on her activity level, and their analgesic effect, are now quite evident.

(Caregiver Alert;  items mentioned in the following 3 paragraphs are really easy to miss, the person you are caring for may not be a reliable source of information.)
Lisa's pain levels have been going up. I have had to discover that even though I know Lis is notorious for under reporting pain, that does not mean I will recognize when she is. We went to see her primary care provider today, and when she asked what Lisa's pain level was she said 7! This elicited an immediate, involuntary, rather loud exclamation from me of, "What? You didn't tell me that!" I have to learn how to pay closer attention, and to read more subtle signs. Or I suppose she could just buck up, and tell me. ;) I think I'll stick with looking more closely, I think it is a pretty engrained pattern of behavior.

We also discovered that I have  been under-medicating her.  This is partially my fault, and partially the fault of inadequate post-op instructions to the patient and caregiver (another topic). When Lis was in the hospital they had her on 60mg of codeine for pain but, every time they gave her that much, it would pretty much knock her out, decrease her rousability, and make her pretty loopy for a while. So when they released her we asked that they make the prescription for 30mg tablets. With all the other concerns at the time, do you think either of us remembered this for longer than it took to make the request? Also another point I completely failed to take into account was that, every one of those hospital doses was administered within 2 days of her having been anesthetized for over 12 hours. What it seems to me we were seeing was the codeine combined with the residual effects of the anesthesia. This seems to be supported by the fact that after the PCP appointment, the next time her pain spiked, she took 60mg. and it did significantly reduce her pain, while not having the effect it did in the hospital. I could slap myself for that one.

Another thing to watch out for is sleeping posture. Unless you have a hospital style bed at home, this can be tricky. Lisa was not at all comfortable with the big, foam wedge so, we put her on the couch, and probably the first time we did that, we were careful to be sure that the elevation of her head was accomplished gradually from the waist up. Be sure to continue to watch this, if the one you care for begins complaining of markedly worse pain upon waking up in the morning, check this, it could very well be contributing to the problem.

So, "How is Lisa doing", "How are we doing?" Like I said, no simple answer presents its self. This is not to say we aren't doing reasonably good, thus far I think we are; however, to continue doing so, I think, is going to be a significant challenge, one that must be faced consciously, and then confronted actively. I'll take this up later, this post has gotten away from me, and been delayed by too many days already, as what I was saying above led to considerations of what might be more successful strategies for maintaining optimum recovery. Sorry folks that's just the way I think, and sometimes it gets away from me.

Lisa is doing very well, I just want to be sure that we do everything we can, that she may be doing as well as possible.



  1. So glad to get the update. It sounds like you are a pretty good nurse Kevin.

    Stay warm.

  2. I'm so glad to hear she's doing well over all! Pain management is one of the worst parts of post-op care. Hang in there, you will find the right dose eventually, and the rest of us will be cheering you both on. :)