One armed and dangerous

The operation got under way at two o'clock. My last memories were from shortly before.

My anaesthetist had given me a block whereby local anaesthetic is injected in and around the area where  the nerves that control the arm.are located. This ensures the arm is numb for at least twelve hours. If it works that means little or no pain in the immediate post op period.. Yahoo!

I woke in my room with a dead cold ham on my chest. Aargh! I had not felt I needed to stand out from the crowd by advising them I was pretty much vegetarian but was this some kind of sick joke?Could my family or workmates have planned such a prank?
Well the cold ham turned out to be my own "dead"arm.  Quite disconcerting in some ways but the lack of pain was great. I too felt great. The arm slowly melted after twelve hours but was still pretty dead at the eighteen hour stage. Wow!

I rearranged the bed slightly to get into the recommended half sitting beach chair position and arranged a pillow to support my injured arm at the elbow. Next of course I texted my wife to let her know all was well. I had "banned" her from hanging around for the operation and then being there afterwards, Dozy patients after surgery are hardly the life of the party and we live an hour out of town and have animals to care for. She would come the next morning to collect me.

There is no point recalling in a "My Diary" sort of way the events of the night or of the morning. However I will note a few points I think are of interest;

• A nurse came to see me regularly with pain relief even though my arm was good. This was to help my body get on top of the pain before the block had worn off.  They were important to have even though the need for additional pain relief at that time was not there. " Drink plenty of water. These medications can cause constipation". So I did refilling my drink bottle from the tap throughout the night. I had a reasonably fitful night but hey, who cares? I had time off to recouperate afterwards, I had my MP3 player loaded with music to listen to and good headphones, I had TV and the sport was on, I had a pen and paper and the desire to learn to write left handed legibly. What more could I want? I got up regularly for more water and to go for a walk around the ward. Exercise gets the blood flowing and helps reduce any chance of developing a clot. It also meant I could make myself a few cups of tea. Luxury!
• Unfortunately hospital food fills a hole but I would hardly say it is overly nutritious. Frozen vegetables boiled to death, they always seem to do that.. But we are in a hospital not a hotel. This is always to be remembered. If there is a next time, I would have packed some fruit and a few snacks. The importance of this will be revisited at a later time, and I was totally unprepared for the consequences!
• Always check  or ask what treatments you are being given. It keeps you involved, it is another check the medications are correct and seriously, you need to have some responsibility for your own care. The medications I was given this time were all correct and in line with exactly what I had been told to expect. However,when my last nurse of my total visit mentioned something in passing, it had never been noted on the notes for my admission that I had a coronary stent in place. She was gobsmacked and as I said, have some responsibility for yourself. It might really pay off.

• Pain

• Importance of Controlling Pain

  Inadequately managed pain can lead to adverse physical and psychological patient outcomes for individual patients and their families. Continuous, unrelieved pain activates the pituitary-adrenal axis, which can suppress the immune system and result in postsurgical infection and poor wound healing. Sympathetic activation can have negative effects on the cardiovascular, gastrointestinal, and renal systems, predisposing patients to adverse events such as cardiac ischemia and ileus. Of particular importance to nursing care, unrelieved pain reduces patient mobility, resulting in complications such as deep vein thrombosis, pulmonary embolus, and pneumonia. Post surgical complications related to inadequate pain management negatively affect the patient’s welfare and the hospital performance because of extended lengths of stay and readmissions, both of which increase the cost of care.
  Reference: Chapter 17Improving the Quality of Care Through Pain Assessment and Management
  by Nancy Wells; Chris Pasero; Margo McCaffery.from the book:Patient Safety and Quality: An Evidence-Based Handbook for Nurses
• Pain needs to be assessed. There is no pain-o-meter or something that can be placed under the tongue to determine the amount of pain someone is experiencing. Patients can assess their own pain as they are often asked to do." Given that unbelievable pain is 10 and no pain is 0, what number woudd you give your pain?" However people perceptions of pain vary widely as do the perception of the nurse taking the information. It is not hard to see when someone is in real and severe pain but after that it comes down to a personal analysis which gives rise to error. There have been a multitude of studies into pain relief. These studies and others suggested that when patients had moderate to severe pain, they had only about a 50 percent chance of obtaining adequate pain relief.
• So back to me. Remember this is all about me. I had been warned shoulder surgery is painful. My clinicians were aware of the fact and I had the block just prior to surgery to give me a good amount of post surgical pain relief. They started oral medication when I was yet to be sore to ensure they were on top of the pain before any chance of breakthrough pain raised its ugly painful head. I was provided with a script for some reasonably powerful pain medication to last me through my first days at home. To be honest, there was pain but it was manageable. I have had back surgery previously and compared to back pain this was a walk in the park! Don't worry your body lets you know pretty quickly when it doesn't like something but change what or how you are doing something, obey instructions, do as you are told with post op exercises and take your medication as advised and you will be fine.
• However, nothing could have prepared me for what happened next. I thought I was going to and I wished almost that I could, have died.