Wednesday, June 28, 2017

It's been a year (tomorrow)!

A close friend emailed me early this week wondering whether the anniversary date is getting close and I realized that yes, it is either June 30th (this coming Saturday) or tomorrow (the last Thursday in June), . . . right around the corner in either case. 

Thursday morning feels like the more appropriate marker as it aligns with last year’s weekly routine, so I’ll drop by Vertical World tomorrow first thing for a moment of silent reflection and thanks giving.  If you haven't yet, you should visit Vertical World's website sometime to get a sense of their amazing climbing walls.

I have experienced further improvement in walking gate smoothness and speed in the last week or so after starting a very modest course of aspirin in the AM and PM.  I happened to be reading something that indicated aspirin is excellent for reducing inflammation and joint pain, and after restarting with it (and bumping up dosage slightly to AM &PM) I noticed immediate improvement.  My left ankle hasn’t looked this svelte in months, and I can step right through the ankle bend with nary a twinge.  Pretty cool.

Last week I had the last visit with the spine surgery team (one year hence), and they were all "your healed, get out of here!" They still warn that because fewer vertebra are carrying the bending/twisting load there's a likelihood that they will need to fuse the next one down in 10 years or so.  I asked, and they indicated that strong core muscles will slow the degradation, . . . 10-minute abs here I come!

Friday, June 9, 2017

Pain, drugs, and backing off the meds at Anderson House

Before Harbor View could discharge me to a skilled nursing center and free up a bed in their trauma center, I had to be off of intravenous pain meds and stable on oral meds.  This all seemed to be happening pretty quickly and it gave me concern as pain meds were definitely still required to maintain an even strain, but in the last couple days at Harborview I gained confidence meds could be administered effectively orally and leaving Harborview wouldn't result in a major set back.

Looking back on the transition from Harbor View to Anderson House, I can understand how cautious I felt about "change for the worse," but there's no question that Anderson House was a much better place to begin convalescence.  Harbor View is a place to get put back together, . . . not a place to mend over a longer period of time, . . . It's hectic, fast paced and staff are stressed, . . . it's like a war-time mash unit!  Regardless, I still ended up wanting to hang onto "the devil I knew" versus being cast off into the unknown.

In a much earlier post I indicated what a good living environment Anderson House provided for early convalescence.  Peace & quiet, helpful & friendly staff, a large private room, good food, encouraging & resourceful physical & occupational therapists, access to an shaded outdoor patio, . . . overall Anderson House put together an excellent program.  No skilled nursing center can fully meet expectations every minute of every day, but Anderson House came pretty close.

Naturally, there were times (usually around the meal hours) when assistant staff were heavily engaged getting people up and out of bed for meals, and so I needed to adjust expectations to account for these busy times.  On rare occasions, my needs would become unforeseen & urgent (think, I need a bed pan!) and there just wasn't anyone immediately available.  Oh well, . . . suppose there are worse things than dealing with these relatively minor consequences / inconveniences.

Anderson House nurse staff were almost always timely with meds and were uniformly friendly, helpful, compassionate, and looking out for my best interests.  Right off the bat it was apparent they were not as maniacal as Harbor View staff about reducing med levels, as they were not under the gun to discharge folks and free up beds.  We still did the "what's your level of pain" dance, but they were much easier to work with in making adjustments.  They instilled confidence that if we tried reducing meds and it wasn't working we could always readjust.  I was anxious to demonstrate zero dependence on pain meds and so we established plans to reduce first one prescription, then the next, and then the next.  Then we worked through each plan and celebrated being weaned off of each med. 

In retrospect, there were several comical / farcical episodes associated with coming off various drugs (Oxycontin, Dilaudid, and Gabapentin).  I weened from Dilaudid first and without memorable complication.  Although Oxycontin is a great pain med, it can be addictive and it definitely causes constipation.  So on the one hand, I had a choice of maintaining Oxy dosage at the risk of becoming dependent but also at the cost of frequent suppositories, and on the other hand, I could work down the Oxy and transition from suppositories to prunes.  Seems like a no brainer right?!  Yah, but you gotta' be careful about backing off of Oxy or you'll find yourself in a very uncomfortable state.  Looking back, it's comical to reflect on the fact that I initially leaned in favor of continuing suppositories!   There were definitely celebrations by all involved when I zeroed out the Oxy and was able to keep things moving with prunes and coffee!

The last med I was on was Gabapentin, and when I talked to the doctor about it she indicated it "just soothed nerve endings."  So later that day in a moment of hubris, I told the nurse to go ahead and zero out the dosage rather than go through a more gradual reduction regime.  Mistake!  Around bed-time it became apparent what Gabby was doing for me, . . . and what it felt like to go without. Going cold turkey off of Gabby resulted in turning up the thermostat in every square inch of skin to top-bench sauna temps. 

Holy fish cakes & mother of pearl, what an uncomfortable night!  Not "pain" per se, but incredible debilitating/maddening discomfort.  The next morning I had a "conversation" with nurses & doctors about the benefits of more gradually backing off of Gabby, and I didn't take the last pill of it until several weeks later, well after I was discharged from Anderson House and living at The Ballard Landmark assisted living center, the retirement home that housed me while I was still non-weight bearing and refined to either bed-rest or a wheel chair 24/7.

Since leaving the pain meds behind I have been on a daily regime of one aspirin, four Tums, and a drop of vitamin B, . . . the aspirin to keep blood a little thinner than usual to reduce the negligible odds of a blood clot breaking off of ongoing internal repair work going on in my shins/ankles/feet, Tums for calcium bone-building material, and vitamin B as a catalyst to absorb the calcium. 

Seems to be working, . . . the last time I visited the foot orthopedic team they were impressed with the amount of bone generation that has occurred since surgery.  They said I can do just about anything I want other than play basketball and sky dive!