My Staycation in Anchorage, Part Six, May I Take Your Vitals?

May I Take Your Vitals?

 

    Sleeping propped up in a hospital bed post-surgery presented some challenges.   Yes, I’ve fallen asleep while sitting up before, but this was different.   I had to be propped up all night.   I artfully arranged some pillows and found a position I thought I could maintain all night.

    “All night.”   What a laugh that was.

2 A.M.:   A nurse wakes me and asks if she can take my vitals.

4 A.M.:  Another nurse wakes me and gives me two Tylenol.

5 A.M.:  A nurse wakes me for another check, including incisions.

6 A.M.:   A nurse wakes me and asks if she can take my vitals.

 

    And so it went all day and all night.  How does anyone get any rest in a hospital?    Vitals every four hours.

    One advantage was that I was in a private room post-op.   I don’t know how that happened.  It might just have been happenstance.

 

    I was restricted to a liquid diet for the first week. On the minimal hospital menu were listed Ensure, Muscle Mile protein drinks, beef or chicken broth, popsicles, and Jello.  I asked the nurse how to get something, she told me how, and then she kindly ordered what I wanted.   Chicken broth and Muscle Milk that turned out to be a protein drink like the kind you can buy at Costco.

 

    The broth was insipid, just like the bone broths I bought and had to drink before surgery.   Only a large dose of salt would bring out any flavor.

   

 I wasn’t hungry at all but knew I had to consume something.  I drank what was delivered over a period of a couple of hours, then failed to order anything else during the day.  Somehow, Ensure was delivered.

    The surgeon stopped by to check and we had a great conversation.

   Diane was there, so she, too, stayed informed.   The surgery, he said, lasted three hours.   In addition to saying the herniated hiatus opening was FOUR inches instead of the size of a quarter, he also went through the post-op dietary restrictions.   He said he wanted me to have at least 300 calories a day.   Two protein shakes would cover that.

    I was discharged the following day and, after stopping at the in-hospital pharmacy and leaving with a bag full of six new prescriptions, Diane and I returned to the hotel room

    I changed and got into bed—propped up as required.   Maybe now I could get some uninterrupted sleep.   I remembered that eight hours had passed since my last Tylenol.  I got out the sheaf of discharge papers and tried to decipher the nurse's  handwriting.  I couldn’t and neither could Diane at that time.

Salmon for you, little one, but not for me.

    So, I took one Tylenol and went to sleep.

    I woke late afternoon to a fresh new hell!   I tried to roll over to get out of bed and a searing, over-whelming pain enveloped the entire side of my right back—shoulder blades to waistline.  It was like a giant spasm or cramp and it took away my breath.

    All I could do was freeze and wait for it to diminish. Though it probably took several seconds, it felt like an eternity.  That continued off and on during the night.   By now, Diane has deciphered the nurse’s handwriting to mean two Tylenol every eight hours, so we stuck to it religiously.

I    n the morning, Diane was trying to help me get out of bed and the pain was the worst ever and lasted the longest  She jumped back with a horrified look on her face, her hands outspread, as I let loose with a LOUD “AHHHHHHHHHHHH!”   (Payback to the guests in the room upstairs who must have been moving furniture all night.)

"Laparoscopic browsing"

    I took care of my morning ablutions and went back to bed.   When I awakened near noon, that horrific pain was gone and never returned.   I found I could get out of bed with minimal assistance, but that depended on my starting position.  Sometimes I got stuck and needed a hand on my arm and one on my back.   Eventually, that lessened to just a hand.

    Diane went out to get some take-out for herself and brought back some soup broth from a Chinese restaurant for me.   She said she thought I was eating because I had to and not because I wanted to. 

    That was true, as I had no appetite.    The broth was DELICIOUS.   After that, I never again drank the tasteless broth from the boxes.

It was not piraña broth.   Or maybe it was.

 

Then came Wednesday night and the fright of not being able to breathe.

 

 

My Staycation in Anchorage, Part Five, All the Gory Details (NOT)

 

ALL THE GORY DETAILS (NOT)

The closer the date of my surgery came, the more stressed I was.   I knew it wasn’t doing me any good, but with my history of unusual reactions to procedures and certain medications, I thought I was right to worry. 

One day, I thought, I might not make it through another reaction.

An all-text post is boring so here's a nice photo that has nothing at all to do with the post subject:

This was the view from my loft windows at sunset.

Then, I came up with a semi-solution.   I lay in bed at night and imagined every step of the events right up to being wheeled into the surgical suite.   It worked, even though my imagined steps didn’t occur in real life, my repeated imagined scenarios calmed down my nerves.

The day before the big event, Diane and I went to Anchorage and checked into our hotel room.   The layout of the suite was perfect, affording me a place to rest quietly and Diane a separate area to work on her craft items or read.

I had a suitcase with cartons of bone broth, Gatorade, and protein shakes that I would consume on my restricted “clear liquids only” diet post-surgery.

All went well on the big day.  Check-in was amazing, the three pre-op tests the surgeon required were done easily and at my bedside, and I was wheeled into the surgical suite.   I’d had a chance to speak with the anesthesiologist beforehand so he was ready for me.

The nurse relieved me of my dentures and I said I wasn’t speaking or answering questions anymore.   That drew some chuckles.

A mask went over my face and I was soon in lala-land.  

The next thing I knew, it was the middle of the afternoon. A nurse awakened me in recovery and said she would keep me a little longer until my blood pressure stabilized.

The surgery lasted three hours.   Five small incisions were made so the surgeon could insert and manipulate the laparoscopic tools—three near my waist, one off to the right side, and the fifth in the center of my midriff.

Having watched an online video of a similar procedure, I knew the surgeon had a long job ahead of him as once the stomach herniated through the diaphragm, connective tissues grew on it and the esophagus to hold them in place.

When he freed them, he pulled the stomach into place below the diaphragm—the site of its initial installation at birth—and stitched the hiatus (the opening through the diaphragm) back to a smaller size.

I found out later that the hiatus, where food in the esophagus empties into the stomach, is normally the size of a U.S. quarter.  Mine was FOUR INCHES!!   That doesn’t mean the tissue was torn, but that the muscles had separated.   Still!!  No wonder I hurt.

Then came a procedure called a fundoplication.    I searched the internet for a video that described the procedure I had and came up with this one.   It isn’t exact, as my surgeon tightened the hiatal opening, and I think did only a quarter or half-wrap of the stomach.

Plus, this is an animated video so it’s not really gory.

 

The difference in the video to my situation was that my entire stomach had slipped through the diaphragm and was above it.

Why am I going into so much detail about my medical situation? Because of the estimated number of people in the U.S. suffer from hiatal hernias.

Here's the chart: 

 

The prevalence of hiatal hernias increases with age. It is estimated that: 

• 10-20% of adults have a hiatal hernia
• 50-60% of adults over 50 have a hiatal hernia
• 70-80% of adults over 70 have a hiatal hernia 

"Gastroesophageal reflux disease is a condition in which stomach acid repeatedly flows back up into the tube connecting the mouth and stomach, called the esophagus. It's often called GERD for short. This backwash is known as acid reflux, and it can irritate the lining of the esophagus.”

That acid irritation can lead to BIG problems, including cancer.

 

 

You’re welcome.

 

My Stay-cation in Anchorage, Part Four: Logistics and Frustration

 

Logistics and Frustration

 

I’m a planner.   I plan for every contingency, especially when I'm about to venture into the unknown.      I over-plan, make allowances for emergencies, and consider plans from all sides

With the familiar, however, I frequently follow the advice from  one of my Refrigerator Philosophy Magnets collection, that being a quote attributed to Marilyn Monroe: “Ever notice that ‘What the Hell’ is always the right decision?”

 

So, when  I first contemplated large hiatal hernia repair surgery a couple of years ago, I was stumped by the logistics.  I live a hundred miles from the doctors and hospitals.

 

You know how hospitals won’t let you leave in a taxi after procedures?   Yeah, that.  I fussed over that.  

 

Who could I burden with that chore?   Drive all the way to Anchorage, wait for my discharge from the hospital, and drive to a hotel.   I figured I’d have to hang around Anchorage for a couple of days after, just in case.

 

So, where would I stay that didn’t put me in the poor house?   And what would I be able to eat while staying in a hotel?   And who would want to stay in a hotel with me for however many days?

I found a convenient hotel in Midtown Anchorage and made reservations for five nights.   I also bought trip insurance.

 

And on and on it went, a veritable wealth of excuses for not proceeding with the surgery.  Me, chicken?   No, too many logistical hurdles.

 

Yes, chicken.

Phone photo taken post-surgery of our hotel room.  Obviously, I'm in bed.

 

After putting up with the pain in my back all of 2024, I had to admit I needed to do something to regain any quality of life.  

Plus, there was always the threat that my stomach or esophagus would be strangulated and that would be a medical emergency.   A pretty serious one requiring immediate surgery.

 

I called my stepdaughter Diane and asked her.   She said yes!   She had lived in my little town years ago and was always glad for a return.

Looking from my bed, past Diane's unmade bed, to the lounge, kitchen, and desk alcoves.

Hurdle one was solved and, as it turned out, my surgery date corresponded with when she was free of other obligations.

My first pre-surgery consultation with the surgeon went well.   I was impressed with the four framed “diplomas” on the wall, all attesting to his completion of specialized training.   Duke, Yale, Cornell, and another medical school?   Who wouldn’t be impressed?

Most importantly, I liked him.

We went through all my history and my concerns.   He carefully addressed my fears and laid them to rest, somewhat.

Before surgery, he said, I had to have three tests: a blood draw, an X-ray, and an ECG.

He didn’t specify, but I assumed that arranging for these was my responsibility after he submitted orders to the appropriate venues.

 

A scheduling clerk called and set my surgery date for March 24.   I asked about the three tests.   Could they be done on the 20^th when I picked up Diane from the airport?   Or, could they be done the day before surgery, which was a Sunday.   

 

She didn’t know if all the labs would be open on Sunday. 

And then began the most frustrating two weeks ever.

I waited a week or so and tried to make an appointment with one lab.   There was no order.   I waited some more.   No orders.

I tried contacting his office to find out when the orders would be transmitted.   No response, not even within the “3 day” noted on the recording..”  I called again.  No response.

I would be in Anchorage only one day before surgery and time was drawing nigh to get those tests done.   Still no orders.

I tried again and again and again.   No responses.

This photo is of the next room we had after extending our stay.

 

Finally, I dialed the hospital’s admitting nurse.   She reassured me that all three would be done on the morning of surgery.   I could relax.  Now, why didn’t someone tell me this before I drove myself into a dither?  

After thinking about this for a long time, I came to one conclusion.  Staff does this stuff every day and it’s rote to them.   Boilerplate.  They can’t see it from the patient’s side.   Plus, with my little bit of medical experiences, I was a neophyte.

So, on Sunday, Diane and I were off to the hotel in Anchorage, armed with a suitcase containing bone broth, protein shakes, fruit juice, and Gatorade for my post-surgery restricted diet.

Also with us was a bright red The Club.  

In addition to The Club, we had another device that locked the brake pedal to the steering wheel.  

The hotel was conveniently located for those staying for medical reasons.   It was also conveniently located for the homeless and the thieves who prowl the parking lots for vehicles to steal.   And, it was in a large cluster of such hotels.

I read Anchorage crime reports on Facebook and was well aware that these hotels, as well as the hospital parking lots and garage, are prime targets for the parasites around town.

 

The couch became my bed, post-surgery, as I had to sleep propped up and not lying flat.

The tray next to Diane was provided in all the rooms, and was excellent for holding the stuff I needed near.

The kitchenette and desk area were opposite the couch.  Large and roomy, with sink and fridge.   The only problem was there was no coffee pot for the coffee maker.  The pot had disappeared from our first room and the second room didn't have one to begin with.   Repeated requests failed to bring the arrival of a coffee pot.

My nest on the couch, and a king bed for Diane.

Beyond the TV and closet was the sink alcove and the bathroom itself was opposite that alcove.   Excellent layout for this room.   The TV is mounted on an interior wall and not on the wall for the next room.

My Stay-cation in Anchorage, Part 3, The Decision

 

Adventures, Challenges, and Quality of Life Decisions

 

As reliable as the tides, the new year of 2024 changed the page on the calendar, bringing with it some much-anticipated plans and some that were not-so-welcome.

 

My friend Leilani was to move to Florida in June so our bird photography outings were coming to a close.  She was always the "ears" for our outings as with her acute hearing could hear and identify birds while driving slowly down a remote road with the window open.

 

Still, when she called and suggested a trip to Homer in early March, I thought she might be a bit barmy.   Way too early, I thought.   We went and saw several birds that I had never seen before (and some wonderful scenery).   We call those birds “lifers,” as in first time in my life.

Evening grosbeak.   Blown off course and rarely seen in this part of Alaska.

Long-tailed duck, formerly called an Old Squaw.   One of the few drakes that is prettier in its non-breeding plumage.

Sea otter with starfish.

Sunrise in Homer

An old cabin in Ninilchik on the way to Homer.

Moose

I began my 18^th season of cleaning up litter along 44 miles of the Seward highway in early May, and made it through 17 miles before  I had to quit for the foreseeable future.   I was plagued with those continuing back pains when I absent-mindedly tightened my abdominal muscles so I took a lot of breaks to wait for them to go away.

 

I’ll tell you one thing: trying to unlearn Mom’s admonition to “hold your stomach in” is almost impossible.

 

Leilani and I, along with two friends from Canada,  had plans to fly to Nome in early June to photograph migrating birds that we never get to see in our part of the state.   Plus, there were muskox all over the place, right in town.

So away to Nome we went, a place  I had never been before.   It was a roaring success, with several “lifers”.

 

 

The extraordinary Bluethroat, the prime goal of the trip to Nome.

Rock ptarmigan.   I've seen lots of willow ptarmigan, but this was my first rock.

Long-tailed jaeger!!!

American golden plover.

A herd of muskox crossing the road.

 Then, with a short gap in between,  I was once again picking up folks at the airport.   My two cousins, Bud and Bob, came to replace three sets of exterior stairs that were rotting away after a couple decades.  Bud is younger than me by five months.   Bob, by five years. 

 

Mission accomplished and now it was my turn to embark on some home maintenance projects.    I had three walls of my log-sided home to refinish as the Behr Log Home finish had failed.   This was not the first time, but almost an annual necessity.

Hauling around ladders and planks to jerry-rig scaffolding, hanging onto a 4-1/2 inch angle grinder with coarse sanding disks was not easy and again I found myself taking frequent rest breaks to wait for pain relief.

The facia needed restraining.

 

Then, in August, a windfall!   A completely unplanned trip to photograph the huge Coastal brown bears and puffins!

 

Digging razor clams.

Horned puffins.

By the time autumn arrived, I had to face that quality-of-life decision.   That pain was interfering in everything, including holding up my camera with its heavy, long lens.  Can’t have that.

I contacted the gastroenterologist I had seen a couple years before and requested an appointment, promising that I would go through with the surgery this time.   Eventually, he referred me to surgeon, and I followed up on the appointment.

 

Of course, I moaned about how scared I was and the various reactions I’d had to meds and procedures and how I feared I might not pull through one of those reactions etc., etc.,etc.   All excuses.

By the time I left his office (awed by the certificates from Duke, Yale, Cornell, and one other medical school that were displayed on his wall). I consented to the surgery.  

 

But first two more tests were required.   I’d managed to talk him out of an endoscopy.   He said he would do it while I was under the anesthetic for surgery, thereby eliminating double anesthesia.

 

So, the worst was the barium contrast X-ray.   This test had caused problems for my mother and I was not looking forward to it.

 

But, I went, swallowed the barium, rolled around on the X-ray table, and never did see the barium again.

By now, it was 2025.   I spent the next couple months terrified of the upcoming surgery date of March 24.   I also made meticulous plans, arranging a ticket for my step-daughter to fly up from Arizona to be my nanny during the operation, making hotel reservations because I had to remain in Anchorage for five days after the surgery, and stocking up with clear liquids to consume pre-and-post.

Then, it was time.  I was off to do something I’d been postponing for a long, long time.