Thursday, April 14, 2016

3 days after surgery - pain, breathing, diet. Thursday April 14

Recovery from RP surgery has shown me some new things about breathing and diet important even to life before/beyond surgery. Breathing exercises and control of breath are a central part of yoga and of yoga-like exercises all over the world, so I was surprised to learn a little something of real value this week that I didn't know before. Diet likewise, though the week raises questions more than answers. I will go into detail below.
As for the surgery itself - I had high expectations for my surgeon, Dr. Chung of INOVA Fairfax, but outcomes exceeded even those expectations. One result: much less pain than expected. I still remember the awful pain I felt for a week back when I turned 14 and had my appendix taken out; this has been far less. Operation on Monday 8AM , out on Tuesday 2PM (though they offered longer stay if I chose). As I left, I asked when last I had Tylenol or percocet for pain. The nurse said "none at all today. You asked it be used only as needed, that you would tell us if you needed it."  From then to now, I still get pain easily if I make the wrong move. Some people just don't move if they risk pain, but we can move by choice and will. The pain signal allows me to move with less damage to the body than without it. Does pain also turn on reflexes bad for a person recovering from surgery? I am glad my pain has not been so serious that I have to worry about that.  Even on Monday, when I woke up on the same intravenous (IV) hookup they inserted at 730 that morning, dispensing some pain medication, Luda noted that I was clear and normal, not like others under heavy narcotics at that stage.
That's the good side. On the bad side, living with catheters turned out to be more restrictive and obnoxious than expected, and diet issues are tricky. I am glad it comes out in 6 days at 9AM! At the hospital, until I left, I was wired up in 4 ways - catheter, IV, and two "sequential compression" sleeves on my legs.  The sequential compression sleeves felt really great and really right for doing their job (massaging legs in the best way to prevent clots or Charley horse) - until I saw how they were hooked up, with plastic pipes, not consistent with medical orders to just walk around 5-10 minutes each hour (partly to avoid leg clots but not only). One reason I decided it would be better for my recovery to leave the hospital: the IV. Hard enough to move around with big catheter avoiding pain; IV was too much and unnecessary by then.
Another reason: diet. As I prepared last week, I found a recent paper explaining what is really known about digestive systems relevant to surgery and more.
 My ex wife, who recently went through more serious surgery, said she wished she had seen that paper in advance. Issues like strain, nausea and bloating can be problems after any kind of surgery, or even in normal life. But a broad spectrum of nutrients is also vital to the rate of healing, and to the "microbiome".
From day one, I knew I should drink lots of water, and I made a pest of myself asking for refill after refill of the water pitcher. But: I think this helped improve my score in one key metric of progress after RP: the color (blood content) of the liquid in the bag. As Dr. Chung looked at that, he said the catheter could indeed come out Wednesday or even Tuesday.
But the paper also stresses the need to use the natural digestive system more, while taking foods and medicines tailored to minimize problems. Maximum fiber, minimum fat (though many oils help), protein. Lots of pious stuff exists on the web about sacred beans and rice, and I remember still the crackers and tea for flu decades ago, but last week I simply checked numbers I hadn't paid much attention to. At DC Costco, ever so many cracker boxes proclaiming great fiber benefits and such.. but the real labels didn't fit the hype. At Costco, we did buy kashi, dried apricots, and a zero-fat bag of crackers/pretzels. But at home.. canned salmon is more stellar than I realized. 
And so, for these tricky initial days, I prepared juice and broth, Miso soup with canned salmon instead of my usual clams, and a bowl of plain yogurt with heated frozen berries and kashi. That fit the research a lot better than the choices at the hospital, and was one more reason to leave.
But today I still wonder. Even the best scientific knowledge about the body leaves very basic questions unasked, let alone unanswered. I suppose I shouldn't get too deep on that right now.. but I still don't know yet what the first solid output will be like or how feeding the microbiome factors into this. Those questions (and some loud "meows" from the abdomen) persuaded me to give in and say yes this morning when Luda offered me to share the delicious duck soup she made for breakfast this morning.
Breathing... Since my pain was low and my consciousness intact even as I woke up in the recovery room Monday, I was bemused and curious when they asked me to inhale through a plastic device called an "incentive spirometer." They wanted to be sure my lungs didn't suffer from surgery/anesthesia. I was happy and proud I could pull the blue disc almost all the way to the top, and happy to see surprise on the face of the nurse. But then she said: "OK, but now you must do your homework. Every hour, you must do this ten times. It strengthens the lungs, but more important, it prevents you from having too much coughing. Coughing could really hurt your sensitive internal organs trying to heal." A kind of treadmill for the lungs.
Later when they finally moved me up to the GI Ward on the 11th floor, I saw another one of those plastic spirometer in a plastic bag, sitting next to the one I had used already. It seems they give these out like soap in a package in hotels. I wish I had asked whether they planned to discard the one I had used, and, if so, just taken out home. It did not look big or expensive. Training for the lungs, to reduce coughing, pghlem and snoring, could be very handy. More seriously, the kind of deep breathing which this device trains plays a key role in all kinds of activities. The Wikipedia article on incentive spirometer notes that people who play wind instruments, who really have to get their breathing right, already use this training tool. Of course, one can do deep breathing without the artifice, but extra feedback can be very helpful. Many people may do breathing exercises and other exercises over and over.. getting it wrong always due to lack of feedback. Still, a trick would be to use the device in a way which does not distract from other dimensions of such exercises/experience.
Just last night, I realized I might be about to risk a painful cough... and remembered to do that kind of deep breathing, which did work.
So many other details which I should cut short. I wish instructions had been clear to bring small extra bag to hospital (toothpaste, Kindle, cell phone). Was impressed how the whole surgery depended on one older nurse, Irene (maybe Latin American) who could insert IV so much more than others. A supply problem with beds left me hear other conversations in the recovery room a long time, and in the DC area they were interesting. Less intensity upstairs on the ward, and less hand washing. Luda searched months ago for best urologist in DC area, and showed me just two choices, one reason my expectations were high. But now my GP warns what all this could do to kidneys... Oh well, man is still mortal.
No pictures. Would violate esthetic standards. I write this on my Galaxy Tab. Laptop too heavy; desktop violates rule against sitting with legs not elevated. I copy this standing in front of desktop. Heavy fluid intake rules out use of small leg bag – constraining but healthier and i need to be as healthy as possible about this.

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