speed re-cap #63

Part 4 

Surgery-Day + recovery 1

I’ve really been struggling to figure out the best way to describe the experience of having a hernia operated on.

Since you’re kept awake during the 45-minute procedure, but highly doped-up - I would like to present you a bunch of memories from the day in point-form 

it’s going to be flashes of things, probably incoherant, and highly confusing - much like the real surgery-day

• Woken up by the nurses at 0545

• Early surgery-groups have already showered the previous night, and have their surgical-sites shaved by an aggressively bored nurse, starting at 0600.

• If you’re in the later groups (like me), then you’re the last to be shaved @ 0700-ish; and are able to shower afterwards. 

• This will be your last ‘real’ shower for at least a week, so enjoy standing under the water, as you’ll be sponge bathing ‘till the incision has had some time to heal.

• No breakfast (nil by mouth since midnight) - so if you’re in one of the later groups, like me, they’re expecting you to be very hungry by the time you’re able to have some dinner = nurses will give you a glass of apple juice around 0800.. 

• Being the second-last surgery for the week, I got the full effect of anticipation, hanging out in a surgical gown, in the lounge, while the doctors finished up their morning chopping, and then took a lunch break...

• Rules say that you’re not allowed to leave the floor, or go outside, on the day of your surgery (dinner will be provided to you in your room).

• At 1245-ish, when the orderlies collect you, they walk you to the elevator - which takes you to a subterranean surgical area.

• You’re asked to lay in what looks like a left-over set from the x-files (very creepy hospital ward), dim lighting, cold and clinical - almost military in feeling...

• The surgeries are run to a very tight schedule.  EVERYTHING is set up to run as smooth and efficient as possible for the surgeons.

• This means that the ‘next’ patient is prepped and waiting, ready-to-go while the surgeon is starting the ‘previous’ patient.

• You could conceivably be laying waiting in a cold military ward for 45 mins, get some sleep - it’s oddly relaxing.

• When it’s your turn, you’re guided into the surgical suite - those present are: your lead-surgeon, a junior-surgeon who’s assisting, an anaesthesiologist, a lead-nurse, and another floating assistant-nurse.  

• There’s music playing - I remember it taking at least 6 songs for the surgery to be completed. 

• Remark on the musical tastes of the team - shocked that my older-male surgeon was a Justin Timberlake fan, it was pop-y, fun, and kept everyone moving.  Well, except for me - i had to stay still :) 

• You are FULLY conscious and lucid throughout the entire procedure

• Different doctor to the check-in guy (the one who made the sharpie mark), though I did see that he was operating in a different suite...

• There are 4 surgeries happening simultaneously, I’m the 6th for this ‘team’ = ~26/day

• It was an ultra-efficient team (anesthesiologist was best needle insert I’ve ever had) - clearly having each team complete 6 surgeries a day makes them good at what they do

•  IV fluids (due to the longer wait-time) and some kind of pain blocker (checked later, it’s fentanyl)... along with oxygen via nose thingy. All in all it means that you are present and awake, able to continue conversations with the lead-nurse, but don’t feel any pain.

• LOTS of “dragging” and “pulling” feelings as they slice and sew. 

• You’re asked to let the team know ‘if/when’ you can feel a jolt of pain, so they can administer more local numbing fluid...

• Then, before you know it, they’ve sewn you up and you’re in a wheel-chair, on your way back to the ward 

• The whole surgery took about 45 mins (plus an hour or so in the creepy-ward)

• Try to get some rest... a later post will explain why that was exceedingly difficult...

• Lead surgeon checks-in on their way out for the week (in street clothes) 

• Then a nurse checks me

• A second nurse delivers some Tylenol (~1515)

• The other surgeon (junior) checks in (still in her lab-coat)

• Then the weekend ‘on-call’ surgeon checks in on me...

• Original nurse delivers a dinner just before 1700, sit-up, scarf it down, request a coffee. (sweet sweet cafeine!!! it’s been 20 hrs!)

• They allow me to try the “sit up and wait 20 mins” test - passed - I’m allowed to call the nurses back to try the “get up and move around” test

• Start to walk around, feel light headed like all blood is draining from my body, sweaty etc.  that’s a FAIL!

• Told to lay back down 

• This is not unusual - in fact the whole reason for the ‘test’ is that about half of all the patients will fail the first time 

• I try again after waiting for 20-ish mins...

• Sit up for 20 mins, call it a pass, and get up to pee... Naughty boy! (should have called the nurses!)

• Same lightheaded feeling while washing hands = Shuffle back to bed = FAIL #2

• At the 1hr mark from my first test, a nurse comes back to check on me.

• Naughty man! - you shouldn’t have tried to get up on your own... Since I failed my first ‘test’ - doctors orders are to stay in bed overnight = no getting up, even to pee = you have the bottle - use that! 

SLEEP OVERNIGHT (well, sort of... more details later)

• Woken at 0545, delivered a Tylenol and told to pee in the bottle 

• Here’s the thing - I’ve never actually pee’d in a bed-pan/bottle thing before, and have been holding it in, thinking I’d be allowed to get up if I passed the ‘test’

• Silly move, I should have been flushing away all my opioids  - this is probably the reason that I’ve failed the sit-up test twice - I still have too many drugs in my system.

• Pee in the bottle - it feels weird, but is quite a relief.

• Nurse comes in at 0600 to get me to sit up for 20 min

• Nurse leaves, and I last about 5-10mins before same symptoms (light headed, sweaty, hearing is all tinny and blocked) = FAIL #3

• Lay down and call nurse to let them know that I didn’t make it

• They make sure I lay back down, deliver some water and ginger ale.

• Failed test = Breakfast order taken just before there’s a call for all patients to head down to the dining hall for breakfast = I’ll be dining on my own...

• Breakfast is delivered, and I’m allowed to sit up - slight light headed and nausea feelings, but not as bad as I was... 

• Nurse comes in to remove the bandage covering my incision; so that weekend doc can remove every-other clip. 

• Since I’m one of the last patients to have my clips removed today - he’s feeling a little speedy and non-gentle... it’s more painful than the actual surgery ;)

• Told to lay back down for a half hour, then call the nurse to let me try sitting up again,

• Success!!!

• I’m allowed to walk around a bit, pee, hang around in the lounges etc

• Exercise-time at 1100, it’s like super slow yoga with a bunch of people who move like zombies... quite amusing to observe/take-part-in

• Lunch ~1145

• Post-surgery massage at around 1230

• Masseuse is running late...

• It’s basically a big ol’ tummy rub... no pressure, lymphatic stuff, questionable benefit for the additional cost...

• Bladder is so full that I have to call it quits, 20 min into the 30min massage.

• Pee - lots.

• Back to listening to podcasts and sitting in the chairs in the lounge 

• Transfer some photos to the iPad, post a blog update.

• Finally take my first bird-bath in shower room - not allowed to get the incision site wet for a week, so it’s sponge bathe only...

• Pain meds (alternating Tylenol/Advil)

• Another coffee at around 1620

• Finally 💩 at around 1645! Apparently opioids cause severe constipation, and it’s a great relief when you can finally let go, it’s actually a major point of conversation amongst the patients.

• Dinner at 1715

• Time to chill in the lounge till you’re tired enough to go to sleep...

You may have noticed that once I was able to get out of my room, I pretty much never went back...

There’s a reason for that, which I’ll get into in more detail later.

But now it’s time for some photos

View from the bed

Dinner

  

Breakfast 

View out the window

more tomorrow...

new photo #123

Kevin in the window - 26th March 2018 - Chester, NS

sony a6000+35-1.8, @f2.2, for 1/50th sec, ISO 100

speed re-cap #62

Part 3 

The Ward.

it’s a 1960’s college dormitory - a long carpeted corridor with about 5 rooms on each side, and a nurses station at the end. 

Each room has 2 beds, and appears slightly more hospital like... 

When reaching the nurses station you see a large lounge area, and then what seems like an identical corridor (with the same number of rooms) to the left. 

The nurse seems overworked, but nice enough, and gives me the penny-tour… “station here, shower there, lounge here, stairs there, here’s your room, did you get your lunch voucher?” - I did not. 

Since I’ll be nil by mouth at midnight, and may not be through surgery ‘till much later on in the day - I’m sent back to the front counter to collect my laminated card for a lunch.

Hospital-food from a very outdated small counter. refrigerated cold-cut sandwich and a bowl of scorching hot soup.

Back to my room to unpack and explore.

I’m in the bed closest to the window (#2), there’s a bag and jacket in the left-hand closet, so I put mine into the right one.

it’s only 2pm so I take the camera and go for a little tour to explore my surroundings.

It turns out i’m on the Ground floor, and there’s an identical room layout upstairs.

Each of the two lounges has a pool-table, several couches, and two large circular tables - there’s an alcove with a fairly large TV setup. Books and board-games are stored in some shelving to the side.

Downstairs is a commissary, along with a baby-grand piano, and a shuffle-board setup opposite the stairs.

The stairwell has cubicles for phone calls, and some pay-phones on each level (no phones in your room)

There’s a fairly large amount of green-space outside, and if the weather was warmer, I could see people heading outdoors to engage in some swift walking therapy post-surgery.

speaking of post surgery; those that have been operated on are now quietly recovering in their rooms, slowly wearing off the effects of the opioids they’ve been given, to allow the surgery to happen as a local anaesthesia.

Wandering around outside, I see yet another Ontario "Roid-squirrel!" 

…not as bulked up as the ones I remember from my time living in Toronto in 2001, but still way bigger than those we have out east.

Tour completed, I head back to my room, and while entering, I hear a large amount of painful groaning, and “sorry buddy I’m really not doing too good” from the bed closest to the door… “could you close the blinds, it’s really bright in here”

…This will become a recurring theme…

I close the curtains, swiftly collect my ipad and keyboard, and head out to the lounge area and edit some of the photos from Palm Springs.

Tomorrow; it's all about the surgery experience...

new photo #122

sparkly sunset - 26th March 2018 - Chester, NS

sony a6000+35-1.8, @f13, for 1/25th sec, ISO 100

speed re-cap #61

Part 2

The Shouldice Clinic 

Founded in the 1940’s as a way to get otherwise healthy men back into fighting shape for WWII - the ‘Shouldice-method’ of hernia repair involves a surgical procedure (under local anaesthetic); whereby they sew a multi-layered cover over the hole using your own muscle tissue, and a small amount of non-absorbable suture.  

Upon completion, you’re kept close for a couple of days observation and then thrust back into the world, confident in the knowledge that your ‘repair’ wont require weeks and weeks of bedrest and delicacy.

The hospital moved to a larger location in the 1960’s, and does almost SEVEN THOUSAND repairs a year (that’s over 130 surgeries a week, or 26-ish a day!).  People from all over North-America come to the clinic to be healed by doctors who ONLY do hernia repair.

Great - where do I sign up?

Firstly you need to ‘apply’ - they heavily screen patients, only choosing those that seem to have the least complications. This allows them to do what they do, effectively and efficiently.

They’re focused on ‘quantity’… and favourable long-term patient results.

Because it’s a multi-day ‘hospital’ stay, in another province - there’re a bunch of additional costs associated with the experience. Costs that won’t be covered by any Canadian health authority.

But fuck it - I don’t like the idea of having a lot of foreign material close to an extremely mobile joint (my hip). I also don’t like the idea of a procedure where i’ll need to wait 6 weeks for the muscle to grow ‘into’ the mesh before it’ll be strong enough for me to lift things again.  

Add in the number of people claiming long-term pain needing medication, and a “removal” of the mesh (which is now ‘fused’ into the muscle tissue) - I’m down for the expensive option that gives you a big-scar.

Before all that - you need to be screened.

Fill out the forms, email them off and wait for a response.

Bookings are about 3-4 weeks in advance, and since it’s in another province there’ll be some travel involved.

Lisa had a continuing education conference booked on the west coast, and I was already planning on tagging along.

What if I could somehow be lucky enough to simply ‘stop-over’ in Toronto for a couple of days during our return flight, and then catch another flight back home?

Turns out that’s exactly what we were able to organise. Someone cancelled, and there was an available spot - right around our return date. 

Booked a new return flight - Accepted a very generous offer from some extended family in Toronto, for an overnight stay - along with transport to and from the clinic.

The Experience.

I was dropped off in front of what looks like a plantation house from the deep south, with a large extended ‘wing’ - all of it under full-renovations.

There’s a mobile-office and temporary-washrooms in the driveway, and the sound of drop-saws in full swing.

Check-in will require a quick blood test, and doctors’ visit on-site to determine if I really am ‘shouldice material’ - Many people are told that they need to lose a substantial amount of weight before being admitted, to reduce potential complications - But given my age and general health, there’s no real reason to worry about being "rejected".

The hospital also runs as a ‘day clinic’, allowing local people to bypass the online registration.  For them it'll be a ‘hurry up and wait’ kinda deal, as the clinic will be filling any empty spots with locals.

Back to the check-in...

It feels like any other busy hospital triage, but with carpet on the floor.

People are streaming in and out, and the numerous staff are doing their best to keep things running smoothly.

I'm told to leave my bag in the (very public) hallway, and go out to the mobile-home for my blood test; have a chat to the financials department, and then come back in to see a doctor before being able to check in to my bed.

Onwards to an extremely small waiting area in what looks like every mobile office setup, on every construction project, around the world.

I’m bounced ahead of a few of the people waiting *(can only assume that they were day clinic), and chat to a nice efficient nurse, who collects a large vial of my blood.

Back to the teeny waiting area (with 8 chairs and 10 people) - strike up a few conversations. 

The demographic is older, white, and mostly affluent.

I am called to see another nurse - who takes my weight, some measurements, and checks over the forms I’ve filled out. 

She’s friendly, efficient, and blown-away by my “authentic”  Australian ‘blundstone boots’ as she’d just purchased a nice pair herself… there were photos and stories of her son having a pair too… *side note, Canadians LOVE their blundstones!!!

Back to the waiting area - more are coming in, and thankfully I’m told to wait in the corridor for the financial person to finish a call...

…Sit down - present my health care and VISA cards - discuss the financial aspects of what’s about to happen... 

They pre-authorise a $3145.00 charge on the visa - to be finalised on discharge, and talk me through what it’s all about.

*Because I’m a legal permanent resident, and have the same national health care as all Canadians, ‘part’ of the charges will be covered by my provincial health authority - about half the surgeons fees, or what they’d normally pay a ‘local’ surgeon to fix my hernia.

*Then there’s a charge to the health services of Ontario for my space on the ‘ward’. (This seems to be one of the sticking points with ‘anti-shouldice people’ = what they consider to be an ‘unnecessary’ amount of post-operative ward-time.)

*The additional ‘semi-private’ room charges aren’t covered by any government health authority - some extended health insurances may cover those.  My union health insurance does not.

All in, It looks like I’ll be on the hook for around $2000 of the $3200, once I’m reimbursed by my local health authority. (in another 10-ish weeks?)

Back to the plantation-building - corridor - waiting seats - over-filled...

There are two doctors checking over patients from both the day-clinic, and ‘pre-booked’.

My turn comes and the doctor is clearly not interested in any kind of bedside manner - He’s gruff and focussed on getting shit done. (my guess is that this is all a part of the surgeons ‘additional duties’, something to be rushed through - no molly-coddling here!  You know why you’re here, so let’s get ‘er done!) Turns out he's spent almost an entire 20 year career at the shouldice logging thousands upon thousands of successful surgeries

Sadly “henry” (my hernia) - which has been fairly well pronounced over the last week, including this morning - has decided to take a holiday and is completely unobservable!

Could it be my over-full bladder? from all the waiting around?

I’m allowed to go to the bathroom, instructed to walk around, and cough into a tissue - as coughing forces the hernia to present.

If it pops back out - DON’T sit down!

I do - it does - I don’t 

Back into the corridor to stand and wait.

Doc sees me and we try for take 2.

Henry's back! and verrrrry easy to see this time, so the doc draws a sharpie-mark on the affected side - and I’m off to check-in.

Thankfully no one has stolen my stuff, and after signing a few  more forms, I walk past the day-clinic waiting area, past the renovations, and into…

...tomorrow's blog.

speed re-cap #60

Part 1

The Bulge

At the end of last year, I noticed a small imbalance in the shape of my lower stomach/groin...

Just above my genitals - slightly inward from my right hip - there was a non-painful swelling? Almost like I’d put on a little weight - but only on the right side.

It went away, and I thought nothing of it.

In February, after a couple of days of work - which included ’wearing’ a heavy-wireless-speaker while ice-skating… the same thing happened. (it's a long story, but the speaker was hanging from my sound-harness, and the only way of safely and adequately achieving our shot, with the equipment to hand) 

This time around, the bulge looked a little more “severe” - and warranted a check-up at a walk-in clinic.

Again, it wasn’t painful; but with some travel approaching, and a potentially busy summer - it made sense to see what was going on

I had some suspicions (I do frequently swing heavy things around for a living), but it’s always best to get a trained professional to take a look.

It took the clinic doctor about two seconds to confirm - I had a hernia.

An inguinal-hernia to be more specific.

Basically there’s a weak spot in the muscle lining, and a small hole had appeared, through which, part of my insides were attempting to become outsides. 

The insides could easily be pushed back (reducing); but they would almost always be able to come back out through the same hole. It’d never heal on it’s own, and although not immediately dangerous, there’s the potential of complications if things are left too long.

A referral was made to the ‘Halifax hernia clinic’ and I was instructed to keep an eye on it, only seeking “immediate medical assistance” ...if there was ‘extreme pain’.

Like any modern patient, I hit up “doctor-google” to see what I could do, until contacted by the NS medical system for a repair.

There seemed to be a bunch of information, certainly nothing too alarming - and plenty of advice - turns out that this is a fairly common thing to happen; even to someone as ‘young’ as myself.

First thing was to order a couple of “support belts” as I had no idea how long it’d be before getting the hole fixed.

These are a waist belt with strapping to assist in placing a foam pad over the affected area.  You push your bulge in, apply the belt to hold it, and go about your life as if there’s nothing strange about needing to ‘plug a hole in your abdominal-wall’

Two belts ordered, and temporary strapping applied until they arrive.

The next day, I felt uncomfortable - not painful, but definitely not enjoying the sensation.  

So I headed down to the local pharmacy to see what they had in the way of supports - purchasing a belt to cover me until the online orders arrived.

Not too bad, it fit nicely and seemed to do the job. 

Mostly a psychological support - but at least you feel like you’re ‘doing’ something.

The Solution

The modern public-health-systems' solution is to laparoscopically insert a coated ‘mesh’ to “plug the hole” during a day-surgery. This then requires a substantial healing period before reaching a point where you can go back to lifting things. 

Quite a few of these meshes have been ‘recalled’ or taken off the market over the last decade, and there’s also a growing number of people complaining about long-term post-operative pain.

What might be ‘better’ for the health-system (quicker procedures, less capital outlay) doesn’t really seem to be better for the patient, as it takes a long time (~6 weeks) to get back to where they were pre-surgery; along with a high risk of long-term pain...

My mother-in-law (Ursula) had been researching various options for my father-in-law, as he has something similar going on.

Being quite a bit deeper into her research than either Lisa or myself, she found a clinic in Ontario that claimed an extremely high success rate - using an ‘older’, but well-proven surgical technique, with an overall quicker recovery-period, and less reports of long-term pain.

As with anything on the internet - you’ll easily find people either praising or demonising, and the ‘Shouldice clinic’ is no exception.

Accusations of ‘price gouging’ and ‘outdated practices’ were weighed against a multitude of success stories…

…I made my decision.

More tomorrow.

single word post #36 + #37

inguinal + hernia

speed recap #59

Sunday mornings - 25th March 2018 - Chester, NS

IPad mini 4, back-camera, auto settings

new photo #121

Post-hunt - 13th February 2018 - Chester, NS

Sony a6000+35-1.8, @f1.8, for 1/30th sec, ISO 1000

old photo #91

locks, locks, locks - 22nd April 2016 - Boston, MA

sony rx100 28mm (35 equiv.), f5.6, for 1/500th sec, ISO 125

here's a link #93

the-difference-between-a-snafu-a-shitshow-and-a-clusterfuck