I HAVE COMPLETED THE JOURNEY

TA DA!! Here I am! We did it! And, so far, it’s great!

Okay, I guess I’d best go back to Square One and start from the beginning. I was going to try to tape record my daily happenings and feelings…even bought a small tape recorder for that purpose…but Bob kept such meticulous notes, I can use them. I mean, he even noted whenever I said “Ouch!”

Monday, 3/31/08
Arrived at hospital as scheduled at 9:30 a.m. for 11:00 a.m. procedure. Did all the sign-in stuff then sat in patient waiting room with Bob for awhile. They gave Bob a beeper so they could keep him updated on my progress. Around 10:15 off I went to be prepped. IV’s in both hands, epidural in back, funny hat that kept falling down over my eyes (they finally had to tape it in place). I was quite anxious about the epidural because the thought of someone sticking a needle in my spine just didn’t ‘float-my-boat’ so to speak but they were so good, I barely felt it. So there we are…all prepped and primed….and no where to go. Evidently there was a TX scheduled for the OR right before me and it either didn’t go well at all or it took quite a bit longer than anticipated.

I need to put something in here while I’m thinking of it. For some reason, not once, from the time they set the operation date to today, was I anxious, nervous or scared about it. I think some of the reason is because I have been working out at the gym with TX applicants since January 14th and I have seen about 8 of them get their lungs and come back to rehab looking great! I realize LVRS is a more serious procedure than TX because you still end up with your crappy lungs…just less of them….whereas a TX gets you new, stronger lungs. I think the main reason I didn’t feel anxious or scared is because He got me here (sold the house in 3 days, found a nice RV park to stay in down here, etc.) so He was going to take care of me. That, plus when you’ve got hundreds of people all over the country praying for you, you know you’re in good hands.

----------------------------------
There are two methods of doing LVRS
In the one, called open sternum, they cut right down the center of your breast bone. It leaves a very fine scar that, in most people, disappears over time. Some doctors prefer this method because it gives them an open view of the whole chest area. I’ve heard that there isn’t as much pain with this method because they aren’t cutting through a lot of muscle.

The other method is Video Assisted Thoracic Surgery (VATS) in which they make 3 small, about 1" incisions on each side. They insert a camera and teeny tiny tools (I don't know; maybe some use laser. I should have asked) and perform the surgery that way. In either method, they surgically remove the predetermined amount of lung (1/3 of each in my case) and then stitch the remaining gap. They used to use bovine pericardium to reinforce along the stitch line but my doc used some sort of dissolving gortex!

I don't know if either method is better than the other; it's just however your surgeon chooses to operate. The recovery time for the open sternum method is just a little longer than the VATS method and you do have a few more restrictions post-surgery than VATS such as no driving for about 10 weeks, I think Tony said. Muffin will be able to clarify that. In either surgery, you are limited in the amount of lifting you can do until the sutures heal.
----------------------------------

Back to the story
I don’t know just when the operation started but I was out of there by about 3:00 (per Bob’s notes). He said he met with the doctor who told him everything went just fine and that he could see me in about an hour. I’m sure Bob felt a great surge of relief at that point ‘cause I truly think he was more anxious about the whole thing than I was.

I don’t remember a whole lot of the recovery room except that I hurt!!! I do remember I kept trying to say “I want to go home” but for some reason, I couldn’t say the word “home”. Looking back, I think I may have still been intubated (but I’m not sure) and just couldn’t form that word around the tube. Intubation is a normal part of the operation and they insert it after you’re under the anesthesia and remove it before you’re completely conscious. The doc had warned me that I would have a sore throat from it but surprisingly, I didn’t at all. I think I was in the recovery room a bit longer than anticipated because they didn’t transfer me to my room ‘til 7:30 or 8:00. I do tend to have trouble coming out of a general anesthesia.

Poor Bob. When they finally transferred me to my room, it was during shift change so he sort of got lost in the shuffle. He didn’t get to see me until 8:30 (it was a very long day for him!) and I know I wasn’t very pleasant ‘cause of the pain and I just wanted to sleep so he left around 8:45.

This pain I speak of….during surgery, 4 flexible rubber tubes about a foot long are inserted in the incisions along your sides, 2 on each side. This is to facilitate the draining of blood and fluid from the surgery. The tubes were similar to a "Y" with a common tube continuing to a box on the floor where the chest fluids collected. The fluids in the boxes are measured frequently. That’s what hurts…the tubes. You have to lie on your back since you can’t lie on either side in the beginning and since my back aches if I lie on it too long, I just could not get comfortable. And, of course, your whole chest hurts because they have been inside there...cutting and sewing and pushing and pulling. Then to add to that, I was feeling quite nauseous and certainly didn’t feel much like eating so, to be honest, the first day or two, I was not a happy camper. Plus, each day they give you 2 shots of heparin, a blood thinner to prevent clots from forming. These shots are given in the stomach and the nurses are pretty good 'cause you barely feel it. However, the one nurse either wasn't as experienced as the others or she had a sadistic streak in her 'cause every shot she gave really hurt!

By Wednesday, I finally figured out that it was the strong pain med they were giving me via the epidural that caused the nausea and asked that we switch over to an oral med, oxycodone. Once that was done, the nausea left and I felt much better. Still couldn’t sleep particularly well and still hurt but I was alive and I could breathe!

Tuesday, 4/1/08
April Fool’s Day!! But I certainly wasn’t feeling up to pulling any April Fool’s tricks on anyone this year. Up and out of bed and grab that walker and walk those halls! They don’t let you lie around in bed here, that’s for sure. It’s really a bit of a production, getting ready for your daily walk. You’ve got a catheter bag; you’ve got 2 drainage ‘boxes’, you’ve got your O2 tank and you’ve got the walker….try to handle all that while walking down a narrow hallway without running into anyone, LOL. I did get better at it after about the 3rd time around, though, and it really did feel good to be walking. When you’re not walking, you’re supposed to be sitting up in the chair. Well, I was still feeling so tired that I just wanted to lie in bed and sleep. The nurses were not happy with me.

Wednesday, 4/2/08
Feeling better each day. When the docs came in on rounds, I told the one to please apologize to the people in the recovery room for me. I am sure I was not very nice there. He laughed and told me I was really rather funny…and besides, “You remind me of my grandmother!” Well, let me tell you…that young man is darn lucky I was still “confined” to my bed with the tubes and O2 or I would have had his hide! LOL!! His grandmother…indeed!!

Walked about a mile today (19 laps around the nurses’ stations equals 1 mile).

Today was remove Tube #1 day. I have heard this is the worst part of the tubes…the pulling them out. The doc that did mine was very good, though. First of all, they unsnip the stitches holding them in place and then, when he’s ready to pull, he told me to hummmmmmm. That supposedly keeps me concentrating on something other than what he’s doing and creates some sort of ‘out’ vacuum so no air enters the hole. Whatever. I hummmmm’d, it did hurt , and then it was done. Tied the holes up (that part hurt the most) and then down to x-ray to check for air leaks and/or bleeding and all was good.

Thursday, 4/3/08
Feeling better with each passing day. Tube #2 came out; down for x-rays. One would think one would begin to glow after getting so many x-rays but so far none of the nurses has noticed an eerie light coming from my room at night.

I have 2 very loose bottom teeth that get in the way when I try to chew anything so I’ve just had liquids for the past 4 days. I was hoping those teeth would “accidentally” get knocked out when they inserted the tube for the surgery but no such luck. They are still there and they are still bothering me. They get in the way when eating so I’m sticking to a basic liquid diet…soup and juice.

Other than the pain from the surgery, there was a very interesting feeling that I wondered about. It felt like I had a VERY TIGHT bra on…you know, it was very tight around the ribs. I wasn’t wearing a bra so this feeling was confusing. Finally asked one of the nurses and she said it was because of the internal stitches across that area. This confused me a bit since it was part of my upper lungs that was removed (1/3 of each!) and that area is up by your collarbones. Never did find out why I had that feeling but it has slowly disappeared since I’ve been home. Another interesting pain…if pain can be interesting…is that my skin hurt! It hurt with just a light touch to it. Don’t know why. Still have a bit of that pain with me 3 weeks later. Must be another “referred pain” deal. Referred pain is when you have an injury or trauma to one part of your body but another part hurts.

Friday, 4/4/08
Nurses are concerned that I haven’t had a bowel movement yet. I told them I haven’t eaten anything since Sunday so there’s nothing to make a bowel movement out of. So here they come with the Milk of Magnesia (in addition to the stool softener they are already giving me). People, be very careful with this combination!!! It works….when you least want it to!! And try to get to the bathroom dragging your drainage boxes and O2 without getting totally tangled up in it…..whew! Didn’t like that AT ALL!! But the nurses were happy at least.

While I was in the room and not out walking, I was continuously hooked to a heart monitor. Not much of a problem except the mechanics of it are in a little box about 3” x 6” that is carried in a “pouch” in the front of your hospital gown. It’s heavy enough that it drags the front of the gown down and feels rather heavy on your chest. And if you unhook it to relieve the weight there, the nurses get a little upset.

Tube #3 out. Down for x-rays. Walked.

Saturday, 4/5/08
Last tube out today! Boy, is it neat to be able to walk about and not have to drag anything behind you! X-rays are good; no leaks; no bleeds. Blood tests are good – no infections. Feeling pretty good. The oxycodone is keeping the pain at a reasonable level. Still keeping O2 on but reduced it to 1 lpm. I think this is going to be the hardest thing to do -- wean myself from the O2. For 5 years, you’re so used to having a nose hose and now all of a sudden, you supposedly don’t need it. Sats stay in the upper 90’s.

Nothing too new. I get to go home tomorrow. Nurse wants me to be in chair if I’m not walking; I want to be in bed ‘cause my back hurts and I’m tired. A battle of the wills. We compromise.

Sunday, 4/6/08
Here we go home!! Thank goodness we have the rental car (truck is getting some side panels put on) because I certainly can feel every little bump we go over!! Owie!

Wednesday, 4/9/08
I know this is going to sound silly to you but for me, it was a wonder! Bob took me to pulmo rehab today. There weren't any parking spaces (I didn't have my "handicapped" parking card with me) so he dropped me off at the entrance and then went to park the car in one of the lower lots. Well, I walked into the building (without O2), visited a bit (without O2), signed up for evaluation tomorrow (without O2) and then when Bob came in, turned around and left with him (without O2). I can't do anything at rehab until I get re-evaluated. It turns out he parked the car about 2 blocks away and he headed off to get it and pick me up but I just kept walking. I walked all the way to the car ...... AND I DIDN'T GET SHORT OF BREATH!!!! Oh, I felt normal again. Before the operation, I would get short of breath just walking out to the car, parked 1/2 the distance closer, and being on O2. This felt absolutely wonderful!!! I do hope it's not just a fluke but is something that will continue to improve. My sats did drop down to 88% but they came up above 90% within a minute or two. My only concern was that my HR was about 115 but the people at rehab said that, too, would come down as we go on.

So, that's my VERY EXCITING news for the day. I'm sitting here right now without O2 and my numbers are 93/83. I'm about ready to go lie down a bit, though, 'cause my back really aches a lot. But I can breathe without getting SOB!!!

Friday, 4/11/08
Guess who washed her truck today!! Granted, it was at one of those self-service power wash places but I did it!! Without supplemental O2!! And I didn't get sob!! This is something I haven't been able to do since June of 2007 (hence, a VERY dirty truck!) and Bob was along 'just in case'. In fact, we've been on the go for the past 5 hours and I did not get sob at all during that time.

Left here around 1:15; got the truck; over to drop off car; to car wash to get truck all nice and shiney; to Red Robin for lunch; to Walmart for fan, hair color, etc. and finally home by 6:15. A VERY LONG day and I’m a’hurtin’….but did it all without O2!!! How fantastic!! And did NOT get sob!!! And my sats stayed in the mid 90’s all by themselves! This is just so wonderful!!

Back to Rehab 4/14 – 4/18/08
Monday
Started rehab today. Back to square one there, too….no weights (therabands instead), no excessive stretching, only 20 minute walk and 15 minutes on the recumbent bike. Okay on the floor exercises but I couldn’t do the ones where I had to lie on my sides (side leg lifts) ‘cause that hurt. Felt good to be exercising again, though. And I didn't get sob! Can you tell that's the best part of all this!?

Tuesday
Upped the walking and bike time. This was “leg” day where we do lower body strengthening. Those weights were lowered a bit, too. For some reason, I am walking ‘funny’…sort of wobbly. Used a walker for my 20 minute walk.

Wednesday
Increased weights a bit and ‘graduated’ to a red theraband! Was able to lie on sides for the leg lifts but for some reason, lying on my left side hurts inside and I can’t do a good inhale. Gotta’ ask about that. I’ll tell you one thing….my out-of-shape muscles are aching so much, I don’t even feel the surgery pain anymore, Lol!! I’m trying to remember to take 2 pain pills about one hour before I leave for rehab and that seems to help.

I have Clinic on Thursday so won’t be at rehab.

Friday
The doc took the staples out yesterday and released me…with the caution to complete this post-op rehab and then continue exercising on my own. He said everything looked fine and that was that. I was a little disappointed, to tell you the truth. I sort of hoped he would advise me of what to look out for or whatever but he just said “Go”. Oh well. He did advise me to get a pulmo doc but I’m not sure how I’m going to do that since we’ll be traveling around the country. Maybe I’ll just keep my regular pulmo doc in PA and go back to see him once a year.
**********************

So, for now, I think this is the end of My Road to LVRS. Obviously, I’m hoping the results will last at least the projected 5 years but for now I’m just so glad to be able to do stuff like a normal person -- without getting sob.