Tuesday, November 30, 2010

Monday-Tuesday Recovery Report

Yesterday (Monday) was a big day, almost as big as surgery day. Larry was transferred from Cleveland Clinic proper to one of Cleveland Clinic’s associate hospitals with a Rehab Unit for those not ready to go home. It is one of two recommended by his surgeon.

A new phrase added to our family sayings is “Poking the bear”. His surgeon used the reference from childrens literature. You poke the bear once, no problem, you poke him twice, three, with little response. By the fourth time he will come after you. He was using this to tell Larry not to push himself to fast to get back on his feet or he would pay a penalty.

Scot and Laura came Sunday afternoon to be here Monday when Larry was transferred. It was a tremendous help to me to calm my nerves for the transition. I have a good hotel to stay at and daily shuttle to the hospital. So we are back to a routine.

Tomorrow (Wednesday) Larry begins 2/day PT and 1/day OT. He is ready to prove how quickly he can improve. Up until a couple of days ago, he did not have the strength to stand and support himself on his walker. Now the effects of 6 hours of surgery and the more complicated surgery than expected are behind him and it’s on to the challenge of recovery. And you all know Larry; he will put his all into the effort.

He’s hoping for a return home in 5-6 days but we will see how fast he can improve enough to get the physical therapy department to release him. I am helping every day with the exercises and learning all the moves. Haven’t even gotten to reading anything I brought “to fill my time.” Larry does that. Recovery is hard work!

Thanks for all your encouragement.


Monday, November 29, 2010

Sunday Report

There have not been many changes lately. Larry is getting stronger and his internal blood loss has been replaced with all his transfusions. Damn coumadin complicates everything. He’s down to Tylenol for pain. Physical therapist work with him yesterday (Sunday) went well. He made it out the door again, rested in a chair in the hall for a few minutes and made it back to bed again. Sat in the bedside chair a few times also. You just can’t build strength and energy lying in bed.

Today the case manager is working on getting everything in order for transfer to a Cleveland Rehab hospital. The discussion has been about a 5-10 day stay for intensive 3 hr/day rehab sessions all the while with doctors and therapists whose job it is to deal with those who are motivated to get home but have the expertise to deal with the medical issues also.

Scot and Laura arrived yesterday evening to check on their dad, help with the transfer to Rehab and give me some moral support. It helps at this point to know I am not the one totally responsible for watching over him. Got too many years invested in this guy to turn decisions totally over to someone else, even if it is a nurse or doctor. I know him and can read him better than anyone else.

So all the nitty gritty about what goes in and what comes out seem to be going well. His resident and surgeon will both be in for a final discussion this morning. They both have said that they know he is a “motivated” patient.

More later. Thank you all for your interest and concern. Email if you want; we are reading them every day.


Saturday, November 27, 2010

Saturday Day 5

Things change so quickly from day to day, always keeping us on our toes. Today started at 3 a.m. with two more units of blood because of low hemoglobin. I couldn’t sleep so went back over to Larry’s room at 4 a.m. I slept in a chair until the hospital came alive.

The dressing was changed today, somehow it was overlooked yesterday with all the ins and outs of nurses on a holiday. There was a lot of bruising at the top area above the incision. As usual, I took a picture of the wound. Later when the resident came in, he wanted to see it but hesitated to remove the fresh bandage. When he heard I had a picture and showed it to him, he said that gave a new meaning to the term “Kodak moment”.

In the end he decided to cut back on Larry’s coumadin and Lovanox and use a pressure Ace wrap in that area. This is quite a guy. He had been on 24 hour duty that night, came in to see Larry as he had promised at about 30 hours. After that he was to be found working at the computer after showering and shedding his doctor’s coat. He went out of his way to contact Larry’s surgeon and work up a plan.

Therapy was good for the first time today. Larry had more energy so was able to get up from the bed, sit up for a half hour, stand up and walk 15 yards on a 4 posted walker without putting any weight on the surgery leg. His therapist today was great – an athletic young woman with just the right amount of modifying exercise so that Larry was successful.

He sat up on the side of the bed a second time later in the afternoon. And the every important BM took place. Some hospitals make a big deal out of BMs before going home but Cleveland Clinic does not seem to be that concerned. Nevertheless, just one more checkmark for the day. (Larry thought this was important information but I think it just might be TMI. :o)

Patient load census this weekend was only 11 on the orthopedic floor tonight. The nurses all seem to want upbeat optimistic Larry for their patient.

To quote a line from the movie “Overboard” with Goldie Hawn……. “It’s a great day at sea, sir”……our version is “It’s a great day at Cleveland Clinic.”

To be continued…………..


Friday, November 26, 2010

Day 4 at Cleveland Clinic

Hospital life is a list of unending changes depending on the latest doctor or therapist’s visit. Both the surgeon and resident agreed that Larry could go home today as far as surgery and vitals were concerned.

HOWEVER, the physical therapist said that Larry is not ready and he would not recommend that he leave the hospital. The difficulty of the surgery and effects of past recent surgeries have left him weak in the upper bodystrength area. So it has not been possible for him to use enough muscle strength to stand and walk with the walker, while not putting any weight on his surgery leg. He has 3 months ahead of him doing just that, not putting any pressure on the surgery hip area while the new bone forms and heals.

So since insurance companies frown on staying in the hospital “only” for therapy reasons, they have been trying to arrange a transfer to one of the Clinic’s Rehab centers for a 5-10 day stay. There are 2 here that are used by Larry’s surgeon, but this being a holiday week there are difficulties contacting insurance people and lack of staff at the rehab centers until Monday.

To all our friends in our computer clubs, you shouldn’t be expecting to see Larry as soon as he planned. Although this time the drugs do not seem to have affected his mind as much as other surgeries, so you will hear less complaints about forgotten passwords.

Family and friends who want to communicate with us can email me (you know my email address) as I read my email daily. The cell phone reception is iffy in some parts of this enormous place, so that really is not an option.

Finally, I cannot say enough about the excellent care Larry has received here. His surgeon is a genius, his main physical therapist is a young Nigerian man who is also remarkable. The nurses are all excellent and caring, and of course Larry has charmed them with his banter.

5:00 p.m. Update…..they could not find an opening at the Rehab Center, so unless Rehab calls over the weekend that they suddenly have an opening and doctors on staff for admittance of a new patient, we will be here at Cleveland Clinic at least until Monday. What an exciting and nerve wracking week this has been so far!


Thursday, November 25, 2010

Thanksgiving at Cleveland Clinic

Thanksgiving Day at Cleveland Clinic was pretty quiet, fewer patients and visitors. The parking lot at the Guest House was only about half full. There was a skeleton crew on duty when I left at 10 this evening.

Last night, Wednesday night, Larry’s second night after surgery was a tough one. We heard today from the nurses and doctors this is not unusual as the body begins to wake up and react to all the insults over the last 24 hours. He was not able to stay on top of the pain, so I went back over to the hospital about 4 a.m. The Clinic Guesthouse is just across the street from the main entrance.

To top it off, his roommate had many issues which brought quite a number of personnel to the room during the night. Eventually this led to the roommate being transferred to a different floor this morning. The nurse aide came in this morning and jokingly said “hear you had a perfect night last night.” Everyone at Cleveland Clinic seem to go out of their way to be pleasant and listen to what you have to say. Nice! So for the time being, Larry has a “private” room.

The orthopedic resident told Larry it is expected that he would be weak after 6 hours of surgery. The resident was happy with how Larry's surgery looked. Physical therapy this morning -- Larry was still very weak and struggled to stand with a walker. Work with the Occupational Therapist this afternoon went better, able to get up from the edge of the bed and stand with some help from the therapist. Succeeded again later with Judy’s help. Each effort makes it a bit easier.

Just as a measure of how he is feeling, he wasn't even curious about the Black Friday ads in the enormous Cleveland paper.

We both sneaked in several naps during the day. We are not pushing the docs to let Larry rush home, trusting their judgment. Just making the 5 hour drive home will be a challenge, followed by a lot of hard work.


Wednesday, November 24, 2010

Hip Re-do Day 2

A picture is worth a thousand words.

This morning when I arrived at the hospital the nurse had begun a blood transfusion.  Larry’s blood pressure had dropped very low.  Eventually he received another unit later in the afternoon, which raised his blood pressure and his oxygen levels.  His endorphins were still high from yesterday’s big day, as were mine…..relief that the surgery part was behind him.  So he was feeling good.

The surgeon and his PA arrived at 11:45 and gave details of the surgery.,. most of which I reported in yesterday’s information.  He reported that he did use 300cc from the bone bank for the graft.  Since the hip and surrounding pelvis were rebuilt, the recovery time is going to be almost as extensive as his back surgery.  Larry will be on a walker for a minimum of 3 months, not putting any weight on the surgery leg, in order for the bone to grow together and strong.  From there on, his recovery protocol will just depend on his progress.

Physical therapy today with a very bright young man from Nigeria.  He said he was in the operating room during Larry’s surgery and commented on the surgeon's precision and meticulous work on forming, fitting and refitting the “cage” to make sure it fit perfectly.  This therapist was just as attentive to detail, helping Larry to sit on edge of bed and stand with walker the first time.  It took a tremendous amount of energy and strength for Larry to do this and he was somewhat discouraged that he didn’t move well.  They reminded him that it was only 24 hours since his surgery.

So I left at 7:00 this evening to come back to the room.  He was sleeping and would probably be sleeping most of the evening.  I think tomorrow might be another tough day as his body awakens more and he begins to feel the effects of 6 hours under anesthetic, plus a lot of “poke holes”. 

At this point, it looks like we will be coming home Saturday but there is a lot to be accomplished before then.  And lots more recovery work to be done when we get home.

Larry is one tough guy.  Where does all that inner strength come from?  In case it isn't obvious, I'm quite in love with this guy.


Surgery Day

After an early call to report to the Clinic at 9:30, Larry was taken to Pre-Op.  At 10:30 I spent an hour with him until the “limo” aka Cedric arrived to take him to the Operating Room.

At Cleveland Clinic there is a large electronic board listing all the patients there that day for surgery and their progress.  It reported that Larry went to the Main OR at 11:57.  However surgery did not begin until 1:15.  Our discussions with the surgeon indicated that the surgery was a 2 ½ - 3 hour surgery but eventually it was 7:15 before he was released to the Post-Operative Recovery.  It was finally 9:45 until I was able to see him; he was transferred to his room shortly thereafter and midnight before I got back to the hotel.  Hence, the reason this is being posted this morning.

The surgery was more than just a simple replacement of the cup the ball joint rides in.  The bone was lodged around the cup and the bone was paper thin.  The regular jumbo size replacement cup did not fit so the doctor did a 300 cc bone graft in the area, put in a larger “cage” with 9 screws.  This will take longer to heal.  The femur bone had pulled away but was not loose, so he cleaned out around it and decided it was not necessary to do more. 

The surgeon was very happy with the results and said it was just a normal re-do surgery.  This extra will require 3 months on a walker.  There was talk of going to a rehab center but we already have the “rehab” set up at our house.

We will probably be going home Saturday.  We will get more info today when we see the doctor.

Off to begin another day at Cleveland Clinic.  High praises for their expertise and care of patients.


Saturday, November 20, 2010

2 1/2 days and Counting

Family Thanksgiving today at Laura's.  Tying up loose ends tomorrow.  38 hours til we head out to Cleveland.  22 hours til surgery on Tuesday.  We'll know the time for sure when we do the usual "evening before" call to the hospital.  We're ready!!!


Friday, November 19, 2010

Pills: To Take or Not To Take

Besides all the Pre-Op tests (blood work, X-rays, heart, anesthesia and financial checks), one of the major requirements is to stop certain medications at certain times prior to surgery.

For Larry, the major concern of all surgeons is blood thinner (Coumadin). The standard answer is to stop Coumadin 5 days before surgery -- which he will do. This gives his blood a chance to return to a normal coagulation state. The risk of a stroke for heart patients NOT on Coumadin is 1/1000, so missing 5-6 days is a negligible risk increase.

But surgeons worry about other drugs which can affect blood clotting. So here is a more complete list of DO NOT TAKE items:
NSAIDs (like Motrin, Aleve and Naprosyn) should be stopped 7 days before surgery.
Aspirin should be stopped 7 days before surgery.
Vitamin E, multivitamins and fish oil (all oil soluble) should be stopped 10-14 days before surgery.
All herbal preparations should be stopped 7 days before surgery.

On the other side of the coin, iron has been added into Larry's medications. This is a form of blood-doping; it worked very well on Larry's back surgery two years ago.

So I am elevating everything in the house so Larry can get up and down when he returns from the hospital. This includes the bed, the toilet seat, a chair and the davenport.

Our B.S. lists (that's Before Surgery) are shrinking in size. One more social commitment of the 'blended' family Thanksgiving dinner at Laura's in Chesaning this Saturday and we will be ready to head for Cleveland.

No pictures for this post.


Wednesday, November 17, 2010

6 Days and Counting

It is Nov 17, and I have set up a blog for you to track Larry's hip surgery at Cleveland Clinic.

We have made two preliminary trips to Cleveland to take care of all Pre-Op details, so we are good-to-go.

On Nov 2 we made a fast, 13 hour round trip to Cleveland Clinic to get cleared by a Cardiologist. Surgeons get up tight about ones heart condition, especially if you have had previous surgery like a triple by-pass and a pacemaker installed. We saw Dr. Michael Faulx (pronounce that one!), and he passed Larry with flying colors (that was after getting the usual high BP of 150/90 when in any doctor's office). After running the manditory EKG and listening to his heart, he gave Larry a 9 on a scale of 1-10. (This rating was somewhat tempered by a subsequent comment that, since Cleveland sees the very worse cases, anyone with a half-way normal heart beat would be rated high!)

On Nov 15 we had our second visit to Cleveland Clinic. We saw 8 different departments over an 8 hour period. Again, they could find nothing to rule out Larry's surgery. I may write more details in a subsequent blog, but for now I want to make sure this baby is working.

So on Nov 23 Larry will go into surgery. Surgery time is estimated at 2.5 hours, recovery time about 2.0 hours and hospital stay is 3 nights. So we will be eating turkey in the hospital and return home on Black Friday.

The above picture is the entrance to the hospital, one of about 20 buildings.

Much more details to follow.