Pic of the day – Got Hammered (M’Histoire)

Pict1101

First things first. The surgery was a complete success, the bony lump
is gone, I have way more space in my mouth than I used to, and the
attending (who is an absolute wizard at all this) pronounced the
results, “Perfect.” To which I replied, “I expected nothing else.”
Smiles all around. Speaking from a few hours out, I am quite pleased
with the results. Now, on to the story!

The joke was on me! They DID use a hammer! That is, in addition to the
“saw” (actually a high speed burr), there was a hammer and chisel,
with other tools of course.. Let me tell you, they might numb the one
spot they plan to hit, but when you get hit with a hammer the pain
reverberates in other places as well. When they pulled out the hammer,
the first thing I thought was, “Bang, bang, Maxwell’s silver hammer
Came down upon her head.”

There was a little trouble with the local anesthetic. They had to use
double what they planned, and even then I was feeling things at the
edge that probably shouldn’t have been felt. The anesthetic was
wearing off while I was still in the chair, and was decidedly
uncomfortable before I made it out the office door, so we went
DIRECTLY to the in-hospital pharmacy to get the scripts filled
immediately. That took a half hour or so, by which point I was
struggling with tears and debating whether this meant the pain was and
8 or a 10 or higher, since the docs usually tell me to use childbirth
as the reference point of ten for the “how bad is your pain on a scale
of 1-to-10?” question, and childbirth made me yell, but didn’t make me
cry.

Question. With this happening in a hospital, and a pharmacy on the
premises, and knowing that the patient will definitely need pain meds
immediately or shortly after the procedure, WHY not at least have a
couple pills waiting to take while the local anesthetic is still
working? Heck, why not have the whole script waiting, and make paying
that charge part of the process of paying for the visit and all that
other paperwork? I know they’ve done that when I’ve been admitted, and
it would be a real gift to those who are having ambulatory procedures
to include them in the benefit as well.

When the meds came from the pharmacy (we were sitting right there
glued to their desk so I wouldn’t have to wait a second), it turned
out the doc had told me one thing about the mouthrinse and wrote down
something different, so they had to page him to verify. I begged to
get the pain meds without waiting, and they were really sweet about
working that out. I ran off and took two right away, which were
starting to help by the time the other med question was straightened
out and we were ready to head home.

There was also just a little bit more blood than expected, and the
bleeding went on longer and stronger than expected. Not bad, but the
doc was quizzing me on what meds I’ve been taking lately. He started
out listing specific meds he was concerned might have caused the
bleeding, I know enough about this to figure out what he’s after (and
have had surgery before and been told what not to take), so I filled
in a few blanks.

Dr: “Have you been taking aspirin at home?”
Pt: “Unh-unh.” (This with my mouth open and full of gauze.)
Dr: What about ginko?”
Pt: “Unh-unh.”
Dr: What about St. John’s Wort?”*
Pt: “Unh-unh.”
Dr: “What’s the one I’m forgetting?”
Pt: “E”
Dr: “What?
Pt: (Plucking gauze from mouth) “Forgot E”
Dr: “Oh, right. Have you been taking vitamin E?”
Pt: “Stopped a month ago because I knew it was an anticoagulant.”
Dr: “Oh, saw palmetto, that’s what I forgot. Have you been taking saw
palmetto?”*
Pt: “Unh-unh.”
Dr: “What was the one you stopped taking a month ago?”
Pt: “E”
Dr: “Hmmmm.”

The problem with a teaching hospital is that conversations like this
that ought to happen BEFORE the surgery might get missed, as they did
in my case. Lucky for me, I’ve had surgery before and already knew
what to avoid, but I am wishing they had a checklist of things that
all patients should know before any procedure. In my situation, every
pre-op visit I had was with different people, and I ended up signing
two different consent forms with different folk. There was a lot of
information I wished I had gotten before the surgery that I did not
get. I should have been told about stopping or avoiding certain types
of meds. I should have been told about post-op care BEFORE the
procedure. (Hello? I am a single mom of a special needs kid with no
car, and after the procedure is too late to find out what I need to
have in the house.) There are assumptions that most people have a car,
or most people have family to take care of them, or other similar
issues that can impact on the outcome and recovery. It is hard to know
what assumptions you have until you hit up against one. Checklists are
great for this sort of thing, because you can harvest the experience
of a wide community of docs about questions that didn’t get asked and
should have that impacted on outcomes for their patients.

The pain meds are much appreciated. A Good Thing. It is funny, they
make me groggy & dizzy. I look like I am asleep, but I hear everything
going on around me, but still have pretty (strange) images that flash
behind my eyes.
– hummus capped with a frosting of soap bubbles
– snow drifts in a parking lot dotted with colorful blooms of paper origami
– a summery Lily-of-the-Nile
blossom in silhouette
– a large snowflake with a burning phoenix at its center

I cut back on the pain meds after the first dose. I am staggering
doses. Rather than take two at the same time, I took one when I
started to feel more pain, and then am watching this. I don’t want the
pain to get out of control again, but at the same time I am really
muddled when the pain is well controlled. There is this midground
where I am feeling shadows of pain and can tell more is headed my way,
but where I can still think. I have been using that time to write this
post, so I am going to call it quits now and go take that next pill.

*NOTE: Saw palmetto is not one of the herbs that cause bleeding, and
various sources disagree about St. John’s Wort. Here are a few places
to learn more about this.

Brigham & Women’s Hospital: Herbs & Surgery Don’t Mix:
http://healthlibrary.brighamandwomens.org/RelatedItems/1,2332

Memorial Sloan Kettering Cancer Center > Cancer Information >
Integrative Medicine > About Herbs, Botanicals & Other Products > FAQ
> 3. I am taking anticoagulant medication. Which supplements might
cause dangerous interactions or increase bleeding?:
http://www.mskcc.org/mskcc/html/11917.cfm#36455

University of Wisconsin Health: Health Information: Medications and
Herbs Which Affect Bleeding:
http://www.uwhealth.org/healthfacts/B_EXTRANET_HEALTH_INFORMATION-FlexMember-…

Advertisements