Under the Knife

February 23rd^h, 2011.   Kim drove me to the orthopedic surgeon first thing Monday morning, and we were both impressed with his knowledge and attitude.  He confirmed it was a nasty fracture, with two options: have the bones re-set (they weren’t all pointing in the right direction any more, it was really quite gross), wear a cast for six weeks and go forward with a potentially painful wrist for the rest of my life, or; go under the knife and have the fragments pinned together (along with straightening the major bones out and cleaning out the wound area).  The remarkable aspect of option #2 was that this could be accomplished as out-surgery and would only require a cast for ten days.  Of course it would be quite painful the first few days after surgery, but there was no difficulty in making a selection.

So we made arrangements to go into the hospital Tuesday at 5PM, which seemed a late start for an out-patient procedure?  Tuesday was a challenge because I needed to fast for eight hours beforehand (mainly to ensure my stomach would be empty), which meant adjusting my insulin routine.  I usually inject four times daily: there is a shot of Lantus, a basal rate insulin which works slowly throughout the day, and; three injections of Humalog, a quicker acting insulin which I take immediately before breakfast, lunch and dinner.

A bit clueless on how to keep me blood sugars normal throughout this trying day, I opted to omit all of the Humalog and reduced my Lantus 25%, hoping it would tend to the light breakfast I had around 6:30AM.  This scenario was a bit conservative and when they tested my blood during the operation preparation I was over 300.  Well, the last thing I needed was to go low on the operating table, so I wasn’t terribly concerned.

Of course this did merit attention from the team of folks constantly huddled over me during the hour before surgery began.  To insure my safety, a battery of tests were conducted and I was bombarded with questions.  I was appreciative that my input counted and they reduced the insulin injection to bring my blood sugar down after gaining my feedback.

Discussions with the anesthesiologist were perhaps the most fascinating part of the indoctrination.  I had never had surgery before and confess ignorance around the notion of a ‘local’ anesthetic.  My assumptions were that I would be awake during the procedure, but it would be quicker and less costly.  While I don’t consider myself squeamish, who knows how they will react to such a startling new experience?  I was committed to opting for the local despite harboring a fear of the unknown.

My anesthesiologist quickly provided an education around taking me under which was informative and comforting.  He first explained that I would be unconscious either way, alleviating concerns around my response to awareness that someone was knitting my bones back together…

More fascinating was learning how the local method worked by identifying four key nerves in my arm via ultrasound (I actually watched the screen he was using to pin the suckers down) and subsequently “blocking” these with a minimal drug dosage.  IV’s were also inserted and after an EKG and other tests performed, a cocktail was introduced into my drip that led to la-la land.

I recall scrambling out of the gurney onto the platform in surgery and chatting briefly with my doctor and the nurses --- and then nothing until it was all over and they wanted me to scoot back to the roller unit.  There was no pain whatsoever and soon I was in recovery for some crackers and sugar-free ginger ale (to ensure I could keep food down).  Only discomfort was hearing one of my neighbors howling about her pain, which left me feeling somewhat blessed.

Soon I was plunked into a wheel chair (stood up with no problems) and rolled out the front door to where Kim had pulled our car up.  Think this was around 9:30PM and just amazing that everything could be wrapped up so efficiently.  Of course it was straight to bed and then the post-op learning curve began…

Not a fun event having your completely numb arm propped upon your chest.  It was discomforting feeling this blob weighing me down while possessing the sensation my arm was really laying alongside my body.  But I am thankful part of the post-op advice included getting pain killers into my system before the ‘block’ wore off.  Apparently  it takes a bit for the medication to ramp up and I was advised to be prepared for when the shock waves began.  They started about 2:30AM and hurt like the dickens.

Kim had set her alarm for 4AM to give me the next pain killer…but she sure didn’t need to wake me up as the pain was intensifying and the drugs winding down.  I thankfully returned to slumber about twenty minutes after the second round of pain medication, but despite the pain I still had zero sensation in my arm, which was a bit unsettling.

When the morning finally arrived I did have quite a bit of sensation in my arm, all of it painful.  Be careful what you wish for!  Wednesday would be the first sick day I had taken off from work in over ten years, and I assure you there wasn’t a single enjoyed moment during this long, long day.  But the road to recovery has begun...