Early morning visit
I rolled out of bed and straight to the hospital this morning. Pulled up to the front entrance, parked first out in the drop off lane, figured I was dropping off yall’s love so I’d be good. Then straight to the recovery area hallway till it was time to go back. Hospitals are so much easier and less stressful once you know your way around. She was awake and in good spirits when I arrived. The night was a little rough for her though. They gave her a bath and had to move her more than she liked. It was so painful they had to call the doctor to get her more pain meds ordered. After that her neighbor moaned it all night in pain. We should be in a private room tonight so that will help. Overall not bad for a first night out of surgery. They are having a hard time regulating her sugar. It was in the high hundreds last night when I was there. Her insulin was increased, then earlier this morning it dropped to low, so they gave her some juice. I was asking the nurse about her blood pressure also. She said it was dropping a little as she slept and and when she received pain meds but was getting better as the night came along. The epinephrine drip, blood pressure control, was stopped while I was there. That’s one step closer to getting out of recovery. Her blood pressure remained stable while I was there too.
I’m not sure the nurses like all my questions but hey when I can’t be with her, this nurse meaning myself, needs to be updated! The nurse this morning was very sweet though. They should be getting her out of bed and in a chair right now. I’m sure that will be painful. The majority of her pain isn’t even on her side at the surgical site but in the pacemaker pocket. As I mentioned before her pacemaker is buried deep below the muscle to prevent infection. I imagine there was much scar tissue. They also had to tunnel the pacemaker wires to the pocket. Tunneling of any kind just doesn’t sound like it could be pain free either. Everything is looking good to get out of recovery today. Next is to wait for the doctor to see her and give the go ahead. Expect another update around 11.
Up and sitting
When I arrived this time they had her sitting in a chair. She wasn’t to happy about this! It was pretty painful for her to be moved around. The doctor swapped her to oral pain meds, the same as she takes at home, which wasn’t cutting it. I’m sure this is the SOP but for someone in her situation, of being on the medicine at home, it just doesn’t work. This is the usual learning curve with the doctors and nurse. No matter if we tell them ahead of time or not, they always have to see it for themselves. She said she sat in the chair and cried for an hour because it hurt so bad. She was back on IV pain meds prior to my arrival and received another dose just as I was walking in, so she was sleepy for this visit. Prayers for pain relief again please. They were just about to put her back in the bed when I left. I know that will be painful
The doctor had already come by and said she was doing good enough to go to a private room later today. The Medtronic rep, pacemaker dude, came by while I was there. He was the same rep that had interrogated her device prior to the surgery. Which was good because the doctor had been asking about the previous settings and threshold levels yesterday. Amanda knew something was different in the pacing and she was right. The atrial lead, the one that was dislodged, was turned completely off and she was only paced by the ventricular lead. This make her feel funky. Normally she is paced 99.9% of the time by the atrial lead. Now it is the opposite. This is fine and all but quality of life isn’t so great. It was just straight pacing at 70 bpm. The rate response was turned off, this means that it will always beat the same no up or down with movement. It took a long time for them to fine tune the pacemaker to get to a comfortable setting for her. The rep did tell us that, in his opinion, the atrial lead has no conduction at all. The atrial lead is suppose to fire first, he dropped her rate down to 40 in the ventricle and the atrium lead never kicked in. So this means more than like another surgery to connect the epicardial lead to the pacemaker.
The doctor did mention that he would not connect the lead during this stay but in a couple of weeks. This is a simple procedure usually done under local, or conscious sedation. With Amanda’s low pain tolerance we had a doctor at the Cleveland Clinic tell us to never let that happen again. He said she moves to much and is to uncomfortable during the procedure. We’ll need to address this with the surgeon. I plan on contacting her electrophysiologist, pacemaker doctor, also to see if he could swing by and give his opinion on the electrical side of thing. I think it’s always better to have different eyes and perspectives on things. With surgeons is kind of like letting the cabinet maker do trim in your house. He can do it with ease but it’s not his normal job. The trim guy is going to know trim better. It’s better to let specialist do the job of their areas.
The neighbor is driving Amanda crazy still. Poor guy, she said he moaned for 2 hours straight. Hopefully we’ll be in a private room this afternoon. I can tell she wants me to stay. I was pushing the clock on my allotted visitation time by hiding behind the curtain! She didn’t want me to leave. I think there were 2 other patients ahead that we’re waiting for rooms then it was our turn. It will more than likely be late afternoon. They never do discharges on the cardiac floor before lunch, at least that’s been our experience.
Almost to a private room
Well I almost missed the last visit! Their schedule is so wonky. Sometimes it’s on the hour and sometimes on the half hour, with consistency. I thought it was at 1:30, I just happened to check the schedule about 10 till 1 and realized it was at 1. I was still in the hotel room and needed to check out, plus get my bags to the truck. This fat boy was in turbo mode! I got to the parking garage but it was full, so valet it was. Threw the keys and a tip to the attendant and off I went. I was there just a few minutes after the visitation started.
She was doing good but had been in a lot of pain while she was moved back in bed. The pain seemed to be under control but still there. They do have a room for us but the nurse had all kinds of paper work to do before they would transfer her. They had order some different pain medication after she was hurting from moving back to the bed. This is in addition to the IV pain meds. Hopefully they can get ahold of the pain management today. I just wish they wouldn’t let it get so bad first.
Once we’re in a room and I can be there I’ll be able to advocate for her better. It’s hard trying to talk with the nurses when I’m only there for 30 minutes at a time. Her blood pressure and sugar are both doing good now. She’s off all IV medication except fluids. They should take one of the central lines out if her neck before they move her. This is the line that has a blood pressure monitor and a IV manifold for the 6 different medications she was on after the surgery. Hopefully she’ll be able to move her neck around a little after it’s out. Once we are in the room and settled I’ll post another update. Some have asked for our room number I’ll post that also. Thank you all for caring enough to check in.
Out of recovery
Amanda is out of recovery and in a private room. It was a good bit longer than the recovery nurse’s ETA. It was enough time however for me to sneak in the room early and get in a nap! I was surprised she was brought up in a wheelchair not a bed. Once here she was able to stand up and walk to the bathroom and then to the bed. The anesthesiologist from yesterday stopped by while she was still in recovery to check on her. They took both of the central lines out of her neck. The Foley catheter was removed also. She’s only left with the chest tube and a couple of IVs now.
She hasn’t eaten since a small meal Monday night. This is common for her, she usually doesn’t eat much the night before surgery and eats nothing for a day or more after. I can just hear all of you mamas fussing right now! The nurse suggested only liquids for now, since she hadn’t eaten in a while. I really didn’t think she would eat anything but I order as requested apple juice, fruit ice, and jello. When delivered the order had pepper and Mrs. dash with it! That gave us a laugh. After she ate I played nurse and forced her to use the spirometer, a meter that measures the volume of air put out by lungs. It also helps rebuild lung function after being on a ventilator. Prior to arriving she hadn’t reached the goal of 500 but after eating and trying again she reached it a couple of times. She’s never been a fan of using them because of the pain in her chest, today her throat is sore after using it also. She wanted the tv on because the chest tube drain makes a gurgling noise that grosses her out. I put it on the channel the chaplain recommended yesterday, meditative music and nature scenes. She’s sleeping now and I feel another nap coming on! Her pain seems to be better. The surgeon ordered a new pain medicine. Toradol as the regular scheduled pain medication with Dilaudid, what she’s been on at home, for break through. I was a little worried with the Dilaudid dose being so much lower than what she takes at home, but she seems to be doing good with the combination though. Toradol is a NSAID, anti inflammatory, and works different than the Dilaudid an opioid. She can’t stay on the Toradol long because of the effect on the liver though. Hopefully after the surgery pain is eases down she won’t need any pain medication. That’s our goal and prayer at least. No more pain meds and no more 24/7 oxygen. We should have a new nurse coming on soon. Their shift change is at 7 and they are on 12 hours shifts. So we only have 2 nurses per day, which is better for us.I still have get the truck out of valet, grab my grip, and get a few things for Amanda. While I’m out I’m going to grab some non hospital food. I know there’s a Shipley’s close by I might hit that on the way so I’m prepared for breakfast in the morning!
Things are going good
Everything is going good. Just as I was posting the last update Dr. Nair, Amanda’s cardiologist came by to check on her. He’s been in close contact with Dr. Lameles after the surgery. They also met for a while just prior to us meeting Dr. Lameles. It’s good to have a team that works together.
Nurses changed shifts for the evening at seven. The new nurse is very sweet and easy to get along with. The assistant however, bless her heart, must be new. I believe my nursing skills are more advanced than hers. I had to help her with all the tubes and getting Amanda up for a bathroom run. I pretty much had to get her hooked back up, checked the chest tube, and get her o2 line myself.
The pain med schedule seems to be working well. I got Amanda to wait to take the IV Dilaudid just before she gets up to goes to the bathroom. This way it’s kicking in just in time for the worst of the pain while she up and moving. That’s working well now. Once she got her nightly meds and the IV Dilaudid, she was a chatter box. Talking to the nurse for a long time and then just talked to me till it really kicked in and she fell asleep.
She’s been sleeping a good bit, which is good. I left when the respiratory l nurse came to give her breathing treatments. I went out to grab a bite, Torchy’s so yes I’m happy! I had to defend my tacos from the assistant though. I was gone about 45 minutes and Amanda was out cold when I returned. She didn’t wake for another 45 minutes or so. The surgeon should be here early in the morning. My sleeping area is ready, I’ve got a good reclining chair too. I know which ones are good for sleeping, I’ve slept in all of them! There is an extendable loveseat but they don’t extend for my height! So it’s the chair with the loveseat to prop my feet on for my bed tonight. Good night all.