Tuesday, August 23, 2011

Pre Op

Testing, Testing, One Two Three

I drove to Philadelphia yesterday for all my pre operation testing.

From here Philly is about an hour and fifteen minute drive, if you don't hit traffic. Remarkably enough, I didn't hit traffic until I was near the first set of city exits off I-95 and while that lost me perhaps 15 minutes, once I cleared the inexplicable traffic jam, getting to the hospital itself was not too hard.  My GPS kept disagreeing with the written directions I had from the hospital, so I compromised between the two and pulled up to the valet parking garage with minutes to spare.

So, what does pre op admissions screening involve? Well, for one, lots of questions. Every nurse or doctor along the way asked me to identify myself with name, address and birthdate. This way, they are sure each time they are filling out paperwork for the right person. Then, an every stop, I had my blood pressure taken. Even with the stress of the moment it was fine each time--I am on medication for hypertension and it seems to work really well.

At the first stop, I had a lot of blood taken for something like eight different tests. I also had an EKG done to check my heart--good too--and someone listened to my lungs and heart. They made lists of the medications I was taking including any vitamins, and, eventually, the anesthesiologist came in to talk to me.

That was the low point of the day. Apparently, I will not be getting a general anesthesia as I've had before for surgery. My doctor is known for efficient knee replacements, so it usually takes him about three hours to do two knees. Despite his speed, this is considered to be a long surgery, so they prefer to go lighter on the anesthesia.  Ugh. I will be getting some kind of drug to make me relax and then I'll get an epidural--injection in my spine--to cut off all sensation below the waist. Apparently, I need to be somewhat awake when they administer this. Great.  Then, once I am both totally numb and unable to move, I will get some more "relaxing" stuff, and off we go.  I may be partially awake during the surgery itself, or I may drift off and go to sleep. I am hoping the latter.....

Once I'm in recovery, they will bring me out of my "twilight" state and I'll be there for perhaps another hour--the epidural is supposed to last about four hours--unable to move as the drug wears off. At that point, I will start to "feel the pain" of the surgical procedure and I'll have my "pump" to use to administer painkillers as I need them.

Oh, Goodie. What fun....not. I must admit, I am a little freaked out about this aspect of the surgery.

When I had my hysterectomy, I had the morphine pump and used it on the second day, when my shoulder began to hurt so badly. By the third day, I was sick to my stomach all day. I'm not keen about taking morphine because of that. I also am pretty sure I had a bad reaction to it when I broke my wrist. So I guess I need to tell them at the hospital before I have my surgery that this might be a problem.

Anyhow, after that disturbing bit of news, off I went to the cardiologist for another consultation. He checked me out and said everything looked great for double replacement surgery. Apparently, all patients are not good candidates for this. He said my doctor is particularly conservative in selecting patients for bilateral replacements, and usually, once he sends someone for testing, it's pretty sure that patient will qualify just fine, and he said I was no exception. He said my swimming was a great idea and that most teachers were highly motivated people so that both were an added plus for a good recovery.

Nice. I needed an "upper" about then.

I stopped at a nice little deli for lunch--recommended by the nurse at the cardiologist--and had a really good grilled chicken an avocado salad.  Since I was next going to donate blood for my surgery, I was supposed to be sure to eat.

That left nearly two hours before my blood donation. I'm not sure what sights or stores might have been in the area, but I decided to sit in the hospital lobby to read my book rather than wander about the city. My knees were bothering me anyhow, so if I'd gone too far, I might well have regretted it.  After about a half hour, I decided to find the blood donation room to see if there was any way they could take me earlier.

A little "wending my way" about the hospital and I found the spot. Sure enough, early was fine, so an hour before my scheduled appointment I was hooked up and surrendering a pint of blood.  The hospital was running an internal blood drive as well, offering tee shirts and meal ticket incentives to hospital employees, so I had plenty of company in the room.  We all chatted a bit in between our book reading.

I was done and on my way in about 45 minutes.

Parking, even with the courtesy discount was still $14 for the day and I tipped the valet another $2. With lunch, my insurance co-pay at the cardiologist, and my iced tea and doughnut on the way home, the day cost me about $40.  Not too bad since I managed to avoid any tolls on the road by the route I took.

My GPS had a mind of its own on the way home. Something must have gone a bit wrong when I first plugged in the command for "home."  I was driving through city streets going no where. At a stop light, I reprogrammed the "fastest route" option, then hit "home" again, and suddenly, it directed me off to the right--where I knew Route 95 was lurking, and with a bit of a "take a U-turn" and a little sensible interpretation on my part, I finally made my way to Route 95 north and headed home.

I made it back in time to attend the EVA (our local conservation group) meeting where we were discussing our involvement in the future of the farm we helped preserve.

Then I drove home to feed the Boys and collapse on the couch to watch TV for the evening. Enough done for one day, I think.

Now it's a matter of getting ready for the Big Day.

Mixed feelings here. On one hand I am really looking forward to the prospect of actually having good knees again. On the other, it's a little scary.


  1. Anonymous11:26 AM

    Sounds like everything went smoothly. Actually not having general anesthesia is a good thing - no need for intubation and less likelihood of after-surgery problems, and lower risk as well during surgery. I've had two c-sections with epidurals, and they work just fine - you don't feel a thing - and they have screens up so if you're awake you won't see anything - but likely you'll be dozing.

    Let us know when the date is so we can send best wishes and be thinking of you.

  2. I detest driving in Philly. The streets were just not built for automobile traffic at all!

    Both my c-sections were done with only a spinal block. It is a bit disconcerting to know someone is cutting you open and rearranging your innards, but they put a drape up so you can't see anything. And the drugs make you feel awesome!

  3. Vote number three for epidural over general anesthesia.

    I hope everything goes just as smoothly for your surgery as the pre-op did. Just think how great it will be to have comfortable knees :) We'll be thinking good thoughts for you.

  4. have to say i wouldn't fancy that either. but hadn't realised it was so close!

    more to the point, have you been affected by the earthquake i've read about? i have friends just outside DC (falls church) and happily they're ok....

  5. Each stage of your surgery and recovery will have its own challenges but take some comfort in the fact that these doctors know what they are doing. And also take comfort in the fact that you are a good candidate, deserving too I might add. I am pretty uninformed on epidurals vs going totally under but it's intuitive to me that the epidural is much less risky. Keep swimming! And keep yourself busy with making arrangements for your boys. You don't want to worry about them when you need to be recovering. Think of this like a jump, look at a point beyond the jump/surgery to help you get there.

  6. I'm glad your pre-op went well. I can understand that you would be a little uncomfortable about no anesthesia, I would be freaking out because I'm such a chicken. I'm sure it will be fine with the epidural and I'm sure they'll give you some good drugs and you won't even know what's going on. Try to keep thinking that it's only 3 hours and you'll have two brand new knees and no more pain (after they heal of course). Let us know when you're surgery date is so we can all wish you well.

  7. It's reassuring that so many questions are asked and tests are done pre-op. The partial anesthetic might as well be full as you won't remember a thing.
    I still prefer a good map book in my car, so that I can work out for myself where I want to go.

  8. What a well-thought preparation. It must make you feel more confident.
    I had an epidural too, it is fine. I prefer it rather than a general aneasthesia, that is an artifical coma.
    I hate it.

    Do not worry, they will pump so many relaxing drugs in you that you won't care about a thing.

    Regarding the morphine, there are many variants. I am sure they will find one for you ^-^

    I am going to pick your brain when you are recovering. I hope to send you mini-video of Teena and me, for analysis.
    I am gonna keep you busy ^-^

  9. Glad all the testing went so smoothly!
    I don't blame you for being a bit scared. Major surgery is a scary prospect. I am on the fence about general anesthesia vs the epidural and twilight. It may be better the way they have it planned for you. When I wake from general not only is it disorienting but I woke to full on pain, possibly with the twilight method you are more aware as the epidural wears off and have an easier transition.

    Plus you have none of the hunky lung after effects of the general!

    Think positive!! Be Brave!! Sending you all the best vibes!