Post Debridement Surgery and Drains

I woke up this morning to head down to Englewood to my PM specialist appointment. Unfortunately, I reported that while things have been generally going better on the increased regimen, only hours later I was about to be subjected to yet another surgery. After my appointment, I downed my pre-surgery Ensure... it was really gross.

At any rate, I checked in for surgery early and as a result got a bed so I was a bit more comfortable prior to the surgery. Around 1:30PM things started to kick into gear. I met with my anesthesiologist, agreed to be put under general for the procedure, but interestingly, given the abbreviated procedure (wasn't going to be 3-5 hours) they told me they didn't need to put in a breathing tube and instead something would be inserted into my mouth to just keep my airway open from my tongue. She then asked how I was doing on pain. I hadn't taken anything for the 12 hours prior, so she was kind enough prior to surgery to get some meds into my system. I ended up zoning out to The Adventures of Gumball, which I had never seen before, but my God that show is some drug-laden inspired show. Since each episode was 15 minutes and since Cartoon Network has only limited commercials, it helped to pass time from around 1PM to 2PM.

Finally, last minute my anesthetist was switched to someone on her team, but the plans remained in place. They were doing a much easier general anesthesia. I got carted into the OR a little after 2PM. When I got in, things sort of unfolded rapidly. Switching to the table, immediately bam... they gave something for me to relax. Next thing I know, a mask with only oxygen, they underlined. Not sure because during past procedures they have lied to me before about that. Then finally the medication they used to put me to sleep, I was actually surprised to remember the exact moment I couldn't fight it and it began to overtake me. There have been few surgeries where I usually remember this far, but I actually remember closing my eyes and the exact moment I began to lose consciousness. It is sort of neat to try, but generally never works when they give you an amnesic. I find anesthesiology to be a fascinating field... controlled unconsciousness and how it works. At one point it interested me enough that originally I had considered that half-way into the 6 years it took me to get my bachelor's to seriously consider this track, post-graduation.

Similar to my three preceding surgeries this year, I woke up in an immense amount of pain - body moaning and tensing up as I'm being brought out of the anesthetized state. Fortunately, unlike last surgery, I didn't feel like I woke up with "aquarium lung", or that I had fallen from obliviousness down into a deep dark hole of pain. But I did still hear myself moaning and breathing heavily, with high blood pressure with a constant 9/10 on the pain scale. I'm not the kind of person to scream or cry when I'm in pain, I sort of just hold it in. So it was one shot if this, one shot of that. I tried to explain to my nurse that the pain wasn't deep, but superficial and it took a lot of drugs to bring this from a 9 to a 7, then from a 7 down to a 6... then my final shot before I got discharged, fortunately brought things from that 6, down to a more manageable 4. I guess I was brought into recovery around 2:45PM... so it didn't take long for them to complete the surgery. It was mostly wound irrigation and debridement, although I did spend a good two hours in recovery trying to get ahead of the pain curve after being behind.

My specialist took an x-ray perioperatively and she said whatever issues I was having with popping, etc. doesn't seem to be an issue with anything coming loose. Respectfully, I don't understand how this is the case, but trust her and can confirm that I haven't experienced the 9/10 situational flareups from earlier today, and the night prior. So my best guess is as the wound began to close up the pressure in my leg is just really high, or potentially the issue was missed. Regardless, I only noticed by the time my Mom arrived two things: (1) the bed they transferred me to off the operating table didn't have a "flat" leg area and was bent, which could help explain some of the pain, (2) I noticed I have two types of drains in place: an internal one for fluid and another is a silver suction dressing. The first one is just a bulb you squeeze closed to create some very mild negative pressure within the wound and the other is this electronic pump I that is battery powered, but now currently plugged in. For some reason, I can't help, but be reminded of Death Stranding and the EX Grenade 0 (blood grenades) because that's exactly what the bulb looks like when it's filled with blood drainage.

I gotta say my leg doesn't feel so great at the current moment and I can't wait to pick up my meds tomorrow, since they were unable to get them filled today. It just so happens I'm on a two week cycle with the elevated regimen, with additional sparing amount of meds for breakthrough from this surgery.

I have to wait I think it's 3 days until one of the drains can be decommissioned, and the other will be removed during my follow-up in the office a week from now (although they do have me down for a tele-health visit - go figure). In addition to using staples, they have stitched the entirety of my wound. I love how the nurse was such a hard-ass about the amount of meds I needed post-surgically and said my wound was only "this big", offering less than an inch between his fingers. He has no fucking clue, I'm certain it is larger than that because they needed to open up larger portions to address the non-healing component and second, the tissue debridement and irrigation on a wound that has been irritated for a majority of this year - he's a novice when he says he RARELY has to administer these amounts of meds. Well whatever, I'm used to people not understanding my situation and even more so used to the hysteria that they wrap around people who have legitimate uses for them. After all, this is only my fourth surgery this year and anyone that knows me (especially at work) can attest that I have been walking with a progressively worse limp each and every day. This is not something you can simply make up, so props to them for trying to make me feel guilty for being insistent on getting pain under control.

Anyways, that's all I am going to write for now. Here's to hoping this next week goes well and I'll be on the mend into next year and setup to discontinue my antibiotic regimen 2-4 weeks from now. I know the plan is to keep the sutures in place for 3 weeks along with the staples. Once I graduate away from the negative pressure dressing, they want me to cover my wound with a silverlon dressing. Again, I asked the nurse if one was enough given the length of my incision and that was the time he felt it necessary to interject and be a heartless badass. I can only presume projection here that he's jealous he's got to administer the meds and has none for himself. Please refer to my initial post on this blog which outlines people like him and how in contrast, good providers that are educated have no qualms or issues with Rxing me these meds because of the medical necessity and are more well versed in their usage. If I had a drug problem, I would have woken up mid-surgery, etc.

Stop making up bullshit excuses to make me feel bad that I kept my leg post-cancer, you heartless asshole. I can't expect you to understand, but that doesn't mean you should take out your insecurities on me, or decide that you will take matters into your own hands and deprive me of these meds when my providers are fully willing to do what's necessary to make me comfortable. 

I won't launch into it now, but that is exactly what happened during my previous surgery... a hospitalist, a nurse and a charge-nurse all deciding I didn't need these meds. It wasn't until staying up all night in agony that I informed a different day hospitalist of what was going on that they finally decided that my request for IV meds was appropriate, warranted, and not up to their executive judgment to deprive me of them and instead titrate me as they would have no questions asked 16 years ago (rather than two hours post-surgery weaning me onto purely sub-optimal dose of oral meds). Our culture seems to hand out antidepressants like they are candy while vilifying patients dealing with legitimate pain. It was icing on the cake pre-surgery when I got some meds from the anesthesiologist prior to surgery (because she asked me and it has been 12 hours, due to the no food/drink policy) that I was in ear-shot of the nurse asking "are you sure? Yes, he is currently stably on a high dose of meds, give it to him." Once again nurses second guessing the doctors with the prescribing rights. [See my related writeup: basis of good providers vs. bad: https://aetheryl.blogspot.com/2021/12/note-please-excuse-mess-this-is-bit-of.html]