Wednesday, August 12, 2015

Gaining strength and endurance

Recovery is progressing, probably at the rate that doctors may expect but at a rate slower than I desire.  I left the hospital with all my muscles atrophied to an extent that I had not realized.  My first walks at home were just three houses down the street and back home which took almost all I had.  My arms have lost tremendous amounts of strength and that is saying something, given my lack of musculature that I had before the obstruction.  Upon coming home, I was able to do only about 20 arm curls with my left arm with a less than 1 pound weight.

I am now able to make 2 mile walks, even with a significant hill coming back home.  My arm curls have now progressed to 3 pound weights 30 times but it is a stretch getting to that 30th curl at this point.  I am still very weak but I do see the progress and know that it is just going to be a matter of time until I am closer to whole again.

Stephanie and I head out to see the surgeon in New Orleans on the 25th of August and hope to get his clearance to return to work at least part time. shortly there after.  I may delay it until after Labor day to ensure that I am able to tolerate both the time at work along with the drive and walk into work that I anticipate.  That will mark 13 weeks post surgery which is still ahead of the rule of thumb of 1 week for every hour of surgery (14 in my case) but I have the months of lack of eating to make up for as well.  That said, part time will be more tolerable than a full time schedule and is something that works well with the long term disability policy that Metron has provided.

I am also looking forward to playing hockey once again but that is dependent upon my regaining sufficient strength as well.  I still have to struggle back to my feet when I am on my knees and I worry about how well I will or won't be able to move my glove hand (right arm) with the additional weight and resistance of goalie gear.  The next session of hockey will likely start on August 31 but the next game is Labor day and I am hoping I may be able to return to the ice for that game.  First, I need to try skating and perhaps go to a sticks and pucks session or two to evaluate my readiness.

The other issue causing me concern is my colostomy.  Losing 25 or so pounds has changed my body shape quite a bit and it is causing issues with keeping things in place.  I am experimenting with new products and new techniques, hoping that they can solve some of these issues which must be resolved before a return to work or hockey can occur.

I am being somewhat successful in eating which is a good thing.  I am now up to about 146 pounds  and am gaining weight at about half a pound a week.  My stomach seems to be expanding again and I can eat more at a single setting than I could a month ago.  I do also continue to consume supplements such as Ensure or protein bars and I try my best to plan my meals and food around calories and how this will benefit my weight gains.

Finally, I am receiving physical therapy to address the numbness and tingling in my left arm.  The therapist always asks if things feel better and it is extremely hard to evaluate.  The same way that it is difficult to notice someone's weight gains or losses on a day to day basis, it is difficult to evaluate these changes for me.  Fortunately, on my first day of therapy, they performed some tests that have a definite ability to measure changes and we will re-evaluate the changes at a later point to give a measure of certainty.  For now, I just need to believe that they are doing things that will help make my disability better.

Overall, things are looking up.  I have come a long ways from the brutal surgery that I endured and the bizarre post-op period in the ICU.  I am on my way to full recovery and look forward to seeing everyone at work and play!

Monday, July 20, 2015

Prolonged recovery

Surgery was 6/11, 5 weeks ago and recovery is very slow.  After my surgeries in 2002, 2008, I was back to 100% 6 weeks after surgery and playing hockey.  The 2012 surgeries had 10 week recoveries and, after the second 2012 surgery, I went on a big ski trip, again running at 100% with no obvious problems.

This one is not like the others.  We are 6 weeks post surgery and I have successfully made a half mile walk but it was at my limit.  I still take (often twice) daily naps due to fatigue of recovery and think I have finally gotten through the water retention and associated swelling.

My weight currently is now about 143 which is 20 pounds less than I was 6 months ago.  I am eating as much as I can but my stomach has shrunk and volume is difficult so I am having to eat lots of small meals, kind of continual eating.  Regaining the weight and muscle mass is something I have to work at now.

How long will recovery be?  I have heard a rule of thumb that one should expect one week of recovery time for every hour of surgery.  This means I should be expecting about 14 weeks of recovery which puts me right at the start of September for a return to more normal behavior.  I think that that is probable but am thinking it may be a graduated return, starting at half time and working my way up to full time over a matter of weeks.

Today was a pretty good day and makes me think it is possible but I have bad days as well.  My arm is slowly strengthening but has a ways to go and the numbness and tingling is still there.  My walks are slowly lengthening and the speed is increasing.

First week of September is 12 weeks post surgery but I think it is doable.  This is indeed quite prolonged but, 6 weeks out, it looks possible.

Saturday, July 4, 2015

5 weeks gone, one week home

We went to NOLA this year in late May, expecting to be home around June 10th but those plans got destroyed when I got to the clinic on May 26th.  I am going to try to give a recap of the past 6 weeks but Stephanie has alot of more accurate info at her caring bridge journal.

Pre surgery:

5/25, arrive NOLA
5/26 Clinic.  Dr Boudreaux was about 2hrs late (probably due to surgeries the day before) but we did not think about it because I was getting his full attention the next day.  As we sat with him, he said no surgery tomorrow but possibly on 6/3.  We did not know what to do with this information, got a sandostatin LAR shot and went back to the Hope lodge before my hospital admission the next day.
5/27 Enter hospital on though ER onto the 5th floor.  Begin daily 5 sub-q shots as we try to rebuild my strength, reduce anemia and provide some growth hormone for the future surgery.
6/1 surgery again delayed due to my weakness but is now planned for 6/8.  Stephanie is going out of her mind coming to and from the hospital
~6/1 NG tube inserted and will be my 'friend' for the next couple of weeks.

Surgery.  Finally.

6/8 finally arrives and I go down for surgery about 8:00.  Surgery starts at about 9am and runs for 13.5 straight hours with 67 tumors removed and my intestines back to a healthy pink color.  My ureters are not touched nor my colostomy but 14 hrs of surgery is pretty extreme.
6/9 I 'wake up' in ICU intubated and start my path into insanity.  I don't know how many days I was intubated but had various visions of small girls playing under my bed, my arrival in SE Asia, my room changing with straps behind me and a door in front of me and all sorts of loss of reality.  I lost my mind and it is one of the things I most value about myself
~6/11 intubation comes out and I pull out my NG tube.  I don't remember the new NG tube going in but it did and would not come out again for almost two more weeks.
6/17 Stephanie and I both wonder how long we are going to be in ICU and are finally released to the 5th floor on 6/18

Out of ICU


6/18, released to 5th floor in the morning but don't get there until almost 8:30 in the evening and start liquid diet and don't know how you ruin Jello but, somehow, oschner, kenner ruined it.  I get tired of cranberry juice and continue the liquid diet for days but continue to keep food down in spite of the NG tube, only having to empty occasionally.
6/20, start full liquid diet and, again, am amazed at the horrid state of the hospital food.  Penrose hospital here in the Springs has provided some good food but Kenner is horrid.
6/23 start real food and have some of the worst 'meatloaf' I have ever experienced.
6/27, Dr. Boudreaux asks if I want to leave the hospital today or tomorrow and we are adamant that today is the day.  Stephanie makes plane reservations home out of Baton Rouge airport for Sunday and we leave the hospital.  My first time really outside in about 5 weeks.

Home:

6/28 starts with Ihop for breakfast, two pancakes and 4 pieces of bacon.  It was wonderful.  We then start driving to Baton Rouge (about an hour) and get there about 10am.  Catch our flight around noon and transfer in Houston.  Delayed in Houston for an hour and leave about 3:20.  Finally arrive in Colorado Springs just before 5:00.

Stephanie had gotten the whole family at our house for a 'skype' meeting because I need some support and her best friend Steph Schwenke picked us up at the airport and brought us home at about 5:30.  Walking in the house and surprising everyone was the most joyous moments in the previous 5 weeks.

Recovery:

This last week has been rough.  My left bicep has atrophied considerably in the hospital and I can barely hold my arm up with anything.  I have been around the block twice and it has almost taken everything I have to make it back home.  My water retention has been improving with my losing about 12 pounds in the last week of water weight.  I sit at about 162 pounds right now and have a great deal of strength to recover before returning to work and fun.

When can I get back to work?  I have a target of 8/1 and will see if that is full or part time.  When do I play hockey again?  I don't know but would like to try skating before the end of July and perhaps split a game with someone else in mid August.

These last few months have really ravaged my body and I need to work to get better again.  I will get there and my mind is starting to clear.  I have been watching American Ninja Warrior and there are so many inspirational stories that help me work through my own efforts.

It is wonderful to be home.  It is hot but not humid.  I love my mountains, the clear sky and my wife's beautiful gardens in the back and front yards.  I don't have an IV continually connected to me and can just get up and walk.  I got my hair cut yesterday for the first time in 3 months and trimmed my beard for the first time in a month and almost look normal again.

I am alive.  I have a wonderful family and my parents took wonderful care of my kids.  Life is good.

Wednesday, June 17, 2015

Finally back up in the main hospital building.

This one was brutal.  I had surgery on the 8th and this was another 14 hour enormity.  I don't recall many of the details but the tumors had once again entangled the intestines and a total of 64 or so tumors were removed.  I also got the new experience of coming out from surgery with an intubation, doing all my breathing and preventing me from talking.

I went nuts.  I was losing my mind.  I thought I was in another part of the world, I could not identify truth from fiction and I weaved extraordinary story lines in my mind. They had to restrain me to keep me from pulling out the tube and, once the tube came out, I then went psychotic again an pulled out my NG tube, forcing them to put in another one.

I have never felt so helpless or scared in my life.  What is a person if not for their mind and I could not find mine.

Additionally, my left arm has gone partially numb from about mid-forearm through the thumb and first two fingers.  It is weak and I am working on trying to restore it to normalcy (or something close to it).

We finally got moved out of ICU yesterday and are now in a nice comfortable 5th floor room.  I am still having extreme trouble sleeping and focussing but things are slowly moving forward.  I have started clear liquids and hope to progress to full liquids soon.

That is about all I can write at this point but want to let everyone know what we are slowly progressing.  Returning home will probably not be for a week or more yet but I am up and I can walk.  Looking forward to seeing everyone soon!

--Ron

Sunday, June 7, 2015

I think we are go for surgery this time

Everything is looking up for a surgery on Monday.  Dr. Boudreaux came through on Friday and said that he is pleased with how things are progressing.  The Horrid NG tube has drained off over 2 liters of liquid which means that he will have that much less in my bowels to fight through.  He also took out the chest tube on Friday which has made my days a bit more comfortable.

The NG tube is still my nemesis.  I have had it in since Tuesday night and not a single day has been pleasant with it.  It makes swallowing hurt.  I have trouble talking because that hurts as well.  If I lift or turn my head much at all, it hurts.  I know I will have it in surgery and will wake with it.  If history holds true, it may not come out until Thursday.

For the surgical consent, his list of goals included freeing up intestines, possible resection, possible tumor rebulking, possible ureter repair or rerouting, and possible colostomy reversal. Friday also included a CT of the rectum to see how difficult reversal may or may not be.  Everything he want to do would improve my situation from eating, to digesting, to kidneys and to pooping.  Hopefully he is successful and able to achieve a good portion of that list.

We have no idea what time surgery will be as we are the second surgery of the day and need to wait for the OR.  Again, it will be almost painful to wait these hours since you don't know when they will end and there is always the fear that things will get too late and they will delay it again.  I don't think this is will be the case but I cannot stop thinking about it.

Today, the other surgeon that will be assisting Dr. Boudreaux came through and I did not catch his name but he appears new to the neuroendocrine clinic.  Surgery should be late morning and it is going to be a long wait.

Obviously, I will not be posting again for the next few days so I want to refer you do my wife's caring bridge site where she will be posting updates as to progress both for her and for me in these next days.  Feel free to send some good vibrations her way as there is so much she wants to do to help even though there is nothing she can do.

Tuesday, June 2, 2015

Ready, Set, Delay...

I don't know if you can imagine how hard it is to write this post.  We arrived in NOLA on 5/25, expecting to have surgery on 5/27.  That was then delayed to tomorrow, 6/3 so that I could get stronger before the procedure.  Well, I am not stronger enough yet and we are delaying once more.

Right now, the target is Monday June 8th and there are a number of reasons.  First, my prealbumen blood level is lower than desired.  Prealbumen is a measure of nutritional sufficiency and mine is not as high as they want prior to surgery.  Second, I am severely anemic right now with a hemoglobin level of 8.  I don't know how it dropped so crazy low but that is a very bad place to be in and they are working hard to raise that with EPO shots and iron infusions.  Finally, I have developed a pneumothorax.

You may remember my post about putting in the chest tube to drain the pleural efflusion.  Well, it is draining but, at the same time, a non trivial amount of air has taken its place and this is what is known as a pneumothorax.  Today, they swapped out the old hose for a larger one, hoping this would help and they are going to have a cardio-thorasic surgeon look at the x-rays to see if there is something he can do to help.

For me, all this means is yet another delay.  Five more days.  The days keep getting tacked on and I don't know when it will end.  We could get to Monday and he could still want to delay again.  I know he is weighing the risk of surgery versus the potential with an improvement in health but I am having a hard time handling it.

Tonight, I understand I will finally be getting the NG tube.  I have dreaded this but he will be giving some additional meds to help me through the procedure of getting it inserted while conscious.  I don't know what other violations I will be experiencing over the next few days but a lot can happen in 5 days that I just can't imagine.

Five more days.  Stephanie keeps me upright while I am here struggling and the thought of returning to my kids must be kept up front of my mind as well.  I will make it but it is getting exceptionally difficult.  I appreciate all the emails of support and well wishes and hope I can bring better news on Sunday night.

Friday, May 29, 2015

Two days down, five to go

We slowly advance time here in NOLA and it never seems to advance fast enough.  We got moved across the building to one of the new larger rooms which is wonderful.  The other rooms were renovated but there was no room for Stephanie to be with me, especially when she stays the night.  We think we are actually in the very same room that we occupied when we came to NOLA for the first time ever back in April of 2012.

I still don't have an NG tube and, as long as I don't throw up, Dr. Boudreaux is going to delay giving me one.  My bowels are continuing to decompress from the bottom as more and more diarrhea is expelled and I don't add anything other than gastric juices to the top end.  Hopefully I will be able to delay the NG tube until the day of surgery and not have to get one inserted while conscious nor have more time with it in me than necessary.

On the negative side, he is concerned about the fluid on my lungs and wants me to be as strong as possible.  So, we drained fluid on Thursday and added a chest tube to continue draining the lung.  The draining was done under a vacuum and caused my shoulder to tense up worse than I can remember.  The pain scale that they ask you to use is 0 (no pain) to 10 (worst pain you can imagine) and this easily hit a 9 for a period of time before backing off to a 7.  They then gave me some toradol which brought it down to a 5.

Of course, then night came and I needed to figure out how to sleep with this thing in my back.  Sleeping on my left side causes my shoulder to hurt, sleeping on my back causes the tube to be uncomfortable and continue to hurt.  My right side is difficult and requires careful positioning to avoid laying on hard plastic valves.

Sleep would not come, even with my 10:30 toradol shot.  Finally, at 2am, I asked for something stronger and they paged the doctor.  He gave me a 10/325 percocet which is what I take at home and I was able to get some sleep with that in my system.  Percocet works but it is a narcotic and the big downside to narcotics for me is that it slows the digestive tract and that is one of the last things we want at this point.  We want my gut to be as active as possible so that it drains and empties, decompressing before surgery.

I am getting TPN again at about 2200 calories/day and they are giving me daily growth hormone.  Dr. Boudreaux will also be gave me some additional IV iron to help the EPO increase my hemoglobin production, again making me stronger for the surgery.  Last I heard, my hemoglobin was in the area of 10+ when it is desired to be much higher.  Hopefully the iron ignites with the EPO and gets my bone marrow hopping.

Just a couple more days is what I keep saying.  It is getting closer and I will get the surgery.  I know the days after the surgery will be even more difficult but the end will be in sight.  I have already spoken with Steph about what I want to do WRT food after surgery.  I want my traditional Popeye's mashed potatoes and gravy as soon as I can start taking solids along with one or two pieces of crispy dark meat chicken.  I also would like a Pizza Hut personal Pan Pizza Supreme if she can find one because they are just the right size for my appetite and would taste delicious.

In 2012, I did not plan where to eat when I got out because I did not really know the area nor did I know what my appetite would be.  I know now that my appetite will be limited so I can't eat too much but I want something that I have been craving for a while.  It will sound disgusting to many but I want some McDonalds french fries.  You know the ones, just out of the hot oil, crispy, golden brown with a good dusting of salt.  I may want a bit more so I may just get a cheese burger.  I would like a Big Mac but my appetite will not be equal to the task.

On a very positive note, Forrest graduated 8th grade yesterday and we got to watch it through the wonders of Skype.  At times I feel like that scene from the Incredibles (see this scene at about 50 seconds on) where Bob is complaining about celebrating mediocrity but I am glad to see my son move on from middle school to high school.  River (my daughter), took a wonderful picture of Forrest with his big brother.  Both will be freshmen next year, Riley at CSU and Forrest at Discovery Canyon.  I am very proud of both of them.