Brain-Fried Noodle

Redwood Park

It’s post-op day 8, woo hoooo!  To all my patients who have had surgery, now I know what it’s like—a little bit.  What a fascinating experience, and I’m so grateful now that I can relate!

Some of you may know that I tore my ACL in November playing volleyball.  It only took me a few weeks to decide I wanted to have it repaired (reconstructed, actually), because I don’t ever want to wonder whether my knee is stable enough to do the things I want to do.  I have now officially embarked upon that journey of rehab, and so far so good. This post is my story so far.  Just wanted to share.

Pre-Op Eval

The 10 days prior to surgery were some of the busiest in recent memory, starting with a whirlwind weekend with the kids in San Francisco ending with us on a redeye back to Chicago and cabbing it straight the office where I borrowed my colleague’s clothes for the day.  Then back to back meetings, clinic days full of patients, a team-building seminar, a Grand Rounds presentation, Chinese New Year, a teaching session with my awesome medical students, a movie playdate, a confirmation retreat, and laundry.  I barely got enough sleep, and the eating was not great.  But at least I wasn’t sick/infected.

I got all kinds of useful advice from friends and colleagues:

Use the meds!  Opioids are great for post-op pain. Expect maximum pain and swelling at 48-72 hours.  Well the block lasted at least 48 hours so no pain then.  And since then it’s actually not that bad—like a giant toothache at the knee, with radiating soreness up the thigh and down the leg.  Tylenol alternating with Advil pretty much takes care of it.

ICE ICE ICE!! Oh, how I love my electric ice machine.  It’s a pad that wraps around my knee and circulates ice water drawn through tubing from a cooler.  Brilliant!

Take time off, at least 2 weeks!  Like a silly person, I’m going back to work tomorrow.  I was even sillier initially to think I could have surgery on a Thursday and go back to work Monday!  Lesson learned, but hopefully I will never need to apply this learning?

The Jitters

The night before surgery, I wrote in my journal an “In case I die” entry.  I told my sister where I left the book, so she would know where to look for the message to my kids in case something bad happened.  It’s a little embarrassing to admit, but I imagine I’m not the only mom who has ever felt this way.  It was pretty irrational, but hey, it was my first major surgery—anything could happen!  Sitting in the cart in pre-op, I got tearful (and still do now), thinking of how much I’d miss the kids, what they would have to go through, how everything would change, if I died.  But when the anesthesiologist asked, all I could articulate was, “I keep thinking about all the things I should have done for them this morning—packed their lunches…”  He had the perfect words: “It’s never enough.”  And with that I felt strangely reassured and absolved.

The MEDS!!

So here’s the most dissociating part of the experience.  In pre-op I was handed a little cup with five pills: two 500mg acetaminophen, one 75mg diclofenac, and two 300mg gabapentin.  That’s standard pre-emptive pain management, apparently.  Then for the femoral and sciatic nerve blocks, the anesthesiologists used bupivicaine and triamcinalone.  Once in the OR, they started clindamycin to prevent infection, and then midazolam, fentanyl, and propofol for the sleeping cocktail.  Of these nine medications, I had taken exactly three of them ever before.  It was a little alarming, even though I knew the indication and rationale for each drug.  I found my inner voices exclaiming at once, “Wow, this is totally routine, we have really got it all figured out,” and “HOLY SHIT ARE YOU KIDDING ME NINE MEDICATIONS SIX OF WHICH I HAVE NEVER HAD BEFORE AND YOU’RE JUST GIVING THEM ALL TO ME LIKE IT’S NO BIG DEAL I COULD TOTALLY DIE FROM THIS WHY ISN’T ANYBODY THE LEAST BIT BOTHERED!?!?”  And I did just fine, like everybody expected.  Fascinating.

new tongue out emoji

Source: http://www.iemoji.com/view/emoji/2488/smileys-people/crazy-face

And whoa, the meds…  Apparently it’s a known side effect of propofol to shiver when waking up from it.  That was uncomfortable, but even more so was the inability to pee for about 40 minutes, despite having a bladder that felt like it could burst at any minute (I know that could not happen, but literally, you could have bounced a coin off of my lower abdomen it was so full).  Thank God for the experienced nurse who offered me hot tea—what a relief!  And finally the nerve blocks—amazing.  I could flex my hip normally, so I lifted my braced left leg into the car while standing on the right; but lower than that I had neither sensation nor motor control for a full 24 hours.  It.  Was.  Dead.  The foot/ankle came back first, with that creepy, stinging, tingly sensation.  Then slowly, begrudgingly, the thigh returned.  The muscle twitches throughout came mostly at night, as if waking from anesthesia is, of course, a nocturnal activity.

I felt pretty clear-headed after about an hour in recovery, fully coherent and articulate.  But man, I could not really focus or hold attention for long at all.  I had all kinds of articles saved to read those first two days lying in the recliner, but it was just not happening.  My mood was great and I had long periods of alertness.  And then I just wanted to sleep–deeply.  My body was not only unresponsive in the left lower extremity; it felt limp and weak kind of everywhere, my mind included.  Hence the title: Brain-Fried Noodle.

The Pain

Those first two days were fantastic in terms of pain—none whatsoever (thank you, bupivicaine)!  And I was on the ice machine 24/7.  Since then two pain patterns have emerged.  First, the deep ache from having the joint capsule invaded and a tunnel drilled through bone.  That’s the giant toothache, almost like a deep itch that wants to get scratched from the inside.  The second is a hypersensitivity of the skin where all the bruising is.  It’s swollen, tender, and oh-so colorful!  And it zings every time I pull on my compression sock, from the ankle to halfway up the thigh.  That’s what makes me stop and breathe deeply for several seconds.  I figured out today that I’m probably not drinking enough water, which likely contributes to my pain.  It’s so ironic, as my primary advice to patients for almost any ailment is to hydrate first.  Well, this is me trying to walk the talk.  I’m so happy not to have needed opioids (so far), and everything should continue to improve as the tissues heal.  HYDRATE!

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The Rehab

I swear, I think I have lost 50% of my quad on the left.  My physical therapist thinks I’m progressing well, and I’m happy with where I am.  This will be a long road and I must monitor my expectations.  First, prevent further atrophy while tissues recover initially.  Then weight bearing, stability.  Then strength, coordination, and eventually back to sport.  Patience, diligence, persistence.  I’m told PT should make me cry, it’s so painful.  Well, it’s definitely making me sweat!

The LOVE

*sigh*  We really can’t do anything well alone in life, huh?  All the advice, all the well wishes, all the texts and messages right before and right after surgery—every single one held me up a little higher.  And my mom, who insisted on coming despite my denying the need—now I get it.   And thank God for her.  Thank you, Ma!  Last week would have been quite hellish for us all if not for you!  The hubs and kids have been pretty great, too, accommodating my crutches, ice machine, and constant occupation of the chaise side of the sofa.  Every day they come home and ask how I am and how they can help.  I’ve tried to do what I can—sort laundry, rinse/cut vegetables, instruct our amazing sitter on recipes, pay bills, make sure our DVD machine doesn’t die from under-use…  But there is no substitute for a wide and strong support network, and mine is as dense as they get.  Thank you, all my friends and family, for all of it.

* * *

Huh…  I thought I could accomplish so much more in 8 days off!  I fantasized about all kinds of blog posts, reading, correspondence, de-cluttering.  Hey, I said fantasy, didn’t I?  Oh well, time flies like an arrow, fruit flies like a banana.  Things don’t usually turn out the way you plan.  Maybe it will be good to slow down for a while, reorganize, reprioritize, focus… For now I gotta get that second set of exercises in tonight and get to bed on time—and hydrate—work tomorrow!

Onward, friends, hope you are all well!

On the Second Arrow

wound-man

NaBloPoMo 2016, Letters to Patients, Day 11

To Patients Who Suffer:

Which arrow causes you more pain, the first or the second?

Fellow blogger Michelle at The Green Study recently posted a piece in which she distinguished between pain and suffering.  It reminded me of a Buddhist teaching that inspires and humbles me.  Blogger and curator extraordinaire Maria Popova quotes it in this article she wrote last year, on a book by Tara Brach:

The Buddha once asked a student, “If a person is struck by an arrow, is it painful?” The student replied, “It is.” The Buddha then asked, “If the person is struck by a second arrow, is that even more painful?” The student replied again, “It is.” The Buddha then explained, “In life, we cannot always control the first arrow. However, the second arrow is our reaction to the first. And with this second arrow comes the possibility of choice.”

The first step to suffering less is cultivating awareness of the second arrow.  This takes practice, and we must resist the self-judgment that comes the moment we realize we have not only shot ourselves again, but have been twisting that second arrow deeper and deeper.  This shame and self-revulsion is, after all, another drop of poison on the second arrow’s tip.  Instead, I like to apply Ben Zander’s acclamation when he finds himself or his students doing something ‘wrong’: “How fascinating!”  Look what I did!  No judgment, just lighthearted observation.

The second step to suffering less is, of course, to avoid the second arrow.  Once we notice, learn how to remove it and tend the wound.  Breathe deeply.  Identify the sources of anger, fear, resentment, blame, contempt, shame, despair, anxiety, bitterness, envy.  Breathe again.  Loosen our desperate grip on these feelings.  Hold them more loosely, ever more loosely.  Breathe.  Breathe.  Hold also the Space, emotional, cognitive, and temporal, for them the move through and exit us.

Eventually, breathing, we can let go the negativity, pull the arrow out.  Breathe.  When assailed by another first arrow, see the second arrow coming and sidestep.  Breathe.  Keep breathing.  Practice self-compassion and forgiveness.

Life will continue hurling arrows at us.  Some will miss, others will land in our most vulnerable spots.  Mindfulness practice, centered in attention to the breath, helps us evade the wounds and anguish from our own second arrows.  The data, accumulated over the past four decades, is all but irrefutable for the benefits of mindfulness for depression, anxiety, chronic pain, burnout, and overall well-being.  Prolonged practice even changes the physical structure of the brain, and it’s never too late to learn.

If you’d like to learn more, I have included a few more links below.  You may find it worthwhile to invest in the practice.  Be patient with yourself.  And let me know how it goes!

http://www.wildmind.org/texts/the-arrow

http://www.huffingtonpost.com/susan-bernstein/dont-shoot-the-second-arr_b_5102701.html

http://www.nscblog.com/miscellaneous/avoiding-the-second-arrow/