Quick recap from last post. Up all night due to antibiotic, got up and around without nurse assistance as I felt great due to the heavy dosage of drugs I was on for the second procedure. After the extreme pain I had coming out of the first procedure the pain management doctor upped my dosage of ketamine from, in her own words "The highest of a low dosage, to the lowest of a high dosage". They had switched me from morphine to dilaudid in my button controlled pain pump, and they had begun to give me 3, 5mg roxicodones, along with tylenol. In other words I was in la la land all night watching television shows and movies. My night nurse left with my next dosage time on the board of 8:00am.
I will say before hand, this next description is pretty rough on the nurses, but in the end, I love the nurse I had throughout this day, she followed her orders. She was very busy and I'm sure there were others in more dire situation than my own that she was attending to. When I needed it the most she went to bat for me with the doctor and got me the pain control I needed in order to be back on track by the end of the day for release the following day. She didn't show any frustration, if she held a grudge against me or my wife for going to her superior she didn't show it, she was professional and courteous throughout. In the moment tho things got a little rough.
I hadn't seen my day nurse come in yet and it was about a half an hour past my pain medicine dosage time of 8:00am. I pressed my little nurse button and asked for my dosage, and my nurse quickly appeared. She was rambling on that I had my last dosage at 5am according to what the previous night nurse had recorded in the computer system and that my dosage time should have been 9am and that the night nurse must have written it on the board wrong. I disagreed but couldn't be sure because I was the one on drugs, at this point tho I don't know why it was even brought up because by then it was already 9am anyway and time for my dosage, now I was a little stressed from arguing for my medicine for no reason while I was in pain. She gave me my 3x5mg Roxi dosage, then it was time for my ketamine drip to be discontinued for my 24 hours had expired.
My nurse is beginning to remove the designated ketamine IV tube from my IV while leaving the needle in my arm. She also informs me that at that time they have requested that my pain pump with the dilaudid be removed as well. I begin to question that as my roxi's have not kicked in yet and I was beginning to hurt more. She received what sounded like an urgent message so I told her to just go take care of that and we would finish up with me afterward. She decided to remove the dilaudid anyway then left me there with two IV needles in my hand but nothing attached to them. The nurse that gave me the IV's before my first procedure had told me that they could not stay in for more than 72 hours, so I thought that they were going to come in and remove them so I would just talk to them then about maybe weaning me off the dilaudid rather than stopping it at the same time as my ketamine. But, they didn't come to remove it.
I just laid there while the pain steadily increased to the point where I had to be absolutely still and stiff as I never even felt the effects of the roxi's they had given me before removing my IV pain medications. My breakfast had arrived but I couldn't move to eat it, my patient care specialist came in and asked if I was going to eat, I informed her of my pain situation and she left to go find my nurse. She did not return. I cannot tell you exactly how long it was I laid there waiting but it was not less than an hour. My wife called me to see how things were going and I was practically in tears telling her I was in a lot of pain and couldn't find my nurse whom I assumed was taking care of somebody else maybe in worse shape than me. She said she was on the way. Before she arrived I called my case manager, the one who I was pretty sure asked me to take part in the ketamine drip in the first place, I got her voicemail and left a detailed message of my situation, but being Saturday I wasn't sure if she was even working. A couple of physicians assistants had come in from the hospital doctors office and another doctor from my vascular surgeon's office to check on my progress. They were amazed one that my nurse had put me onto an unrestricted diet so fast post surgery as they usually give 24 hours for liquids but I was eating meat loaf around 10 hours after the procedure, and two that they had removed the strong hospital medications so abruptly while I was in considerable pain.
As I was talking with them my wife came to my rescue before she even came into my room she had made contact with the head nurse and my nurse and had them both on the way. As the doctors I was talking with exited my nurse entered with her boss and I gave them the rundown of my situation. They got me a dilaudid injection into my IV and got a couple other prescription pain relievers into my rotation. I asked about my IV needles needing replaced and they responded with "yes after 3 days" she did return later and removed one of the IV needles, but the other wasn't removed until just before I was released on Sunday, which made it 5 days or 120 hours.
My nurse returned after another half hour and gave me another injection of dilaudid that the doctor had approved a higher dosage than they had originally given me, she also had added non-narcotic tramadol and muscle relaxer Robaxin. She told me that all of my medications were "scheduled" into their computer system so that I would get them automatically without asking for them, except for the dilaudid as that was the drug they wanted to wean me off of. They were trying to get me to where I could get my pain control through prescription pain medicines available through the pharmacy and dilaudid was not. After a couple of the injections of the dilaudid I had adjusted my pain tolerance and I didn't ask for any more injections, I just wanted to be down to prescriptions so I could go home.
Even with the dilaudid injections and the new prescriptions I had a new level of pain and had to adjust to a different type of pain once the ketamine treatment was gone. I would say that the Ketamine was a good choice, but the transition should have been handled a little better rather than going from elevated dosages of ketamine and dilaudid to nothing but prescription strength medications, they should have removed the ketamine and lowered the dilaudid dosage a bit and it would have been a much less painful process. I would also say that the doctor's and nurses should prepare the patient a little better for the mental effect of coming off of the ketamine. Like I said before I had built up in my head that I was so much further down the road in my recovery than I really was, mainly because I just didn't know how much of pain was being blocked by the ketamine as I didn't have any real side effects from the drug.
I finished out that day, Saturday, slept the best I had slept since I had been in the hospital only waking up to take my medications when the night nurse came in. I got up around 5 and walked the furthest I had yet covering all the halls I had available, then returned for another catnap and finally woke up to one of the doctors from my orthopedic surgeon's practice who asked me if I was ready to go home, you can guess my answer! I met with all the doctor's or their staff and got releases from all of them. All were very impressed with my recovery to that point. I was released Sunday at about 11:00am after being there since Wednesday 7:30am.
I will continue with weekly updates as to my recovery progress. I will also fill in some of my back story such as symptoms and also my recommendations for anyone that is going to have this procedure done. Thank you for your interest and I hope this helps somebody out there.
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