The Best Laid Plans


My surgeon set my surgery 13 days out so that she could get everything set up to go smoothly.  I had multiple calls from her staff who were coordinating with my pain management doctor.  And the stars were aligned…

And then a comet broke up the alignment and yesterday definitely did not go as planned.  I am blogging because I am in agony and can’t get comfortable enough to sleep.  Almost all positions hurt my body except one, and that one allows me to type on my computer, so I am.

The anesthesiologist walked in and told me my requests were going to be ignored.  I would be getting a normal surgical routine of propofol and nothing else.  A few minutes later, my surgeon enters and tells them to hold off on the IV.   She sits down and tells me the anesthesiologist she had set up to do my surgery had taken the day off due to a family emergency.  She had spoken to the anesthesiologist on duty and he didn’t believe in Complex Regional Pain Syndrome, so he wasn’t going to do anything special to prevent it and I had a couple of options…

She had been studying up and a therapeutic dose of Ketamine via IV was enough to prevent the spread of CRPS during surgery.  We could do the therapeutic dose of 6mgs via IV injection or we could reschedule.  And no nerve block because Anesthesiologist All Mighty was refusing.  Wow.  Well.  What now?  She did tell me if the CRPS spread as a result of my agreeing to the surgery, she would back me in a malpractice suit against the anesthesiologist at a later date since both her and I had informed him that I had CRPS and she had even brought literature to the surgery that said a Ketamine drip was the recommended way to proceed with surgery on a patient with CRPS.  As were nerve blocks.

I went ahead with the surgery simply because this month has been torture when it comes to my daily pain levels and my pain management doctor thinks this could be because of the gallbladder dysfunction.  And I was already pretty sure the nerve block wasn’t going to work anyway.  And she was willing to do the therapeutic Ketamine dose that has proven to be helpful in preventing the spread of CRPS.  She gave a touch more, since most therapeutic doses are 2-4mgs.

I awoke in agony.  My own moans and groans of pain penetrated by brain before it wrapped itself around the fact that I was in a ton of pain.  The nurse rushes over and asks me if I would prefer Fentanyl or Dilaudid.  Well that’s easy, I can’t take Fentanyl… I hate dilaudid too, but I don’t have the side effects to dilaudid as I do to Fentanyl.  I manage to tell her dilaudid and she asks if I am sure?  Yep.  I hold up an allergy bracelet to her, in it are the words Fentanyl and ALL METALS – the metals really was in all capitals.

I also feel sick.  Really sick.  She tells me that most people who receive therapeutic Ketamine wake up sick.  She pushes a does of nausea medication.  Then we have to do another dose of dilaudid, because my blood pressure is still rising after the first dose.

Then she tells me a secret that I didn’t know before, people with CRPS usually have trouble getting their surgical pain under control because our central nervous system is already overloaded from the disease, adding to it, doesn’t help.

As I prepare to leave, the nurses, two of them, remind me that I must stay on top of my pain, regardless of the fact that I feel sick and the dilaudid is already starting to give me a headache.  What happens if I don’t stay on top of my pain?  This…. Blogging at 1 am because I hurt too badly to fall asleep.

Here’s where I screwed up.  The Ketamine/Dilaudid mix made me heave my guts up when I got home from surgery.  I did make it home thankfully before it happened, but after tossing my cookies, I might as well have not received the dilaudid.  At that point, I should have started taking the pain pills they sent me home with.  Instead, I decided to go to bed and sleep some of the side effects off.  I took a partial dose and slept until 4ish pm.  After that, I got up ate a sandwich and took a full dose of medication.

Oh H!  Why?!  I’m in quite a bit of pain, completely my fault of course.   Why would you do something so stupid?!  …I have this terrible fear that I am going to accidentally kill myself with medications.  I have a lot of medication sensitivities and I don’t actually have much narcotic tolerance.  Adding hydrocodone or oxycodone to lots of Dilaudid worries me.  So I tried not to take them.  Eventually I had to give in and take the full recommended dose, but it worried me.

Which contributed to my inability to sleep.  And my writing of this blog post.

Despite the plan going awry, I feel my surgeon had my best interests at heart and wouldn’t have agreed to do it at all if she hadn’t found a way to limit the possibility of spreading the CRPS.  I think if she had not found research that a therapeutic dose works, she would have walked in and said “I am so sorry, we are going to have to reschedule your surgery because Dr. Asshole All Mighty refuses to listen to reason and I can’t take any precautions against this disease spreading as a result, so we need to do it when I can offer protections to you.”  

The surgeon was a general surgeon, meaning she does a variety of them.  If I ever have to have surgery again, I’m going to try setting it up with her.  She put me at ease, even when the plan went all to Hell.  More impressively, she was willing to let me walk out yesterday morning and reset up the surgery with her.  I don’t feel most surgeons would have offered that.

Recovery time wasn’t really given to me.  I was told it would be slow and it could take a week just to recover from the surgical incisions.  And my pain management doctor said he would be surprised if I was fully healed in 3 weeks.  I meet with the surgeon in a week to discuss the surgery and after effects and my daily pain levels at the sites.  I have four holes, three of them seem to be in weird spots.  I knew they were going in through my belly button with the camera, and they did, but there is a hole about four inches from my belly button on the right side, as well as two nearer to my gallbladder, and one that is slightly left of my stomach.

But since I didn’t get to talk to the surgeon afterwards and for some reason my mom is no longer listed as someone that can talk about my medical procedures (need to redo paperwork).  I don’t actually know what they found during surgery yet.  I suspect in the month leading up to surgery, I did develop a gall stone, but I don’t have confirmation of that…  I am looking forward to my meeting with her in a week.

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