4 weeks Post-Op

Overall it was a good week. Despite the busy schedule, work was very productive and I had an opportunity to meet with old colleagues. In terms of my condition, I had a slight setback due to some carelessness on my part and met with my Endo which hasn't provided any results yet. With that, here's where I am with my current list of issues.

List of issues:

• Headache - slight setback
• Insomnia - tolerable

New to the list:

• Twinges of numbness in my limbs

Although I did have a good week, I did make a big mistake during football practice towards the end of last week. We were trying to teach our kids the long-snap rather than hiking the ball up close and personal. Our little center (hiker) was doing great unopposed but in tackle football, that's hardly realistic. Since I had been feeling better, I grabbed a pad and decided to pop him when he snapped the ball. As soon as I did it, I knew it was a mistake. He barely moved from my hit but the jolt rang through my head like church bells and that familiar sharp pain in my forehead came back (dammit!). I paused and waited for it to subside and it did subside from its peak intensity but not to the normal dullness that I could ignore. Instead it retained a bit of a sharp edge to it and it was no something I could simply dismiss. Damn, damn, damn, damn! I asked another little boy to take over my opposing duty but the damage was done. As the days passed, it remains, to the extent that by Friday, I had to take a pain pill. I had been able to avoid taking those for over two weeks and now I'm back on them. (Dammit!) The good news is that my headache doesn't worsen when I bend over or stand up any more. Now it's just there all the time.

The twinges in my limbs are weird and they coincidentally started happening a day or so after that regrettable decision. I can be moving or sitting (it really doesn't matter) and then I'll feel a twinge of numbness in my knees or elbows. Not at the same time, just random (and weird).

The office visit itself went fairly well. They were encouraged that I wasn't experiencing any fatigue and I had weened myself off the hydrocortisone over the weekend prior to my visit. It was a good sign that my pituitary gland is recovering and generating the necessary hormones to keep my body going. (I'll have to do a better job of writing down the hormones they keep talking about, it's all still very new to me.)

The visit again tested my dislike for needles. Not only did I have to allow the vampires (aka phlebotomist) to take more blood, the sweet nurse had to inject me with something before the blood draw. "Left arm, right arm please..."

I delayed publishing this post in hopes that I would have received results from my Endo but 4 days later, I still don't have anything...

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3 weeks Post-Op

I returned to work this week and I didn't have any issues that prevented me from working in a sedentary environment. To be clear, my physical activity entails all of sitting at a desk, typing and using the phone. I did need to walk to conference rooms both upstairs and down but these are all activities well within my limits. My doctor recommended that I stay home for another week or work part-time but being at a new job, I didn't have any vacation time (or sick time) and I didn't trust my employers patience. Three weeks is a long time for a new guy not to be at work. If there was physical labor involved, I would have stayed on disability. For me, my bigger issue was staying home. I have projects coming out my ears and while I was sitting idly wasting the day, I was continually tempted to install solar panels, rebuild the XR100, wash and wax my car, repair sprinklers, straighten up the garage and clean my 50 gallon fish tank. All of which require a fair amount of stooping and lifting which still hurts like hell. My reasoning was simple, go to work and avoid all of it. My list of issues is considerably smaller now but I'll provide an update from my previous list.

• headache/head pressure - dull/tolerable
• extreme neck pain - 100% gone
• sharp pain in ribs - 100% gone
• Slow bowels - still present but under control with meds
• Insomnia - still present but sleeping better than before

Of my original list of issues, only the headache remains. It's dull and always present. It would sharpen to intense pain when I would bend over or if I stood up too quickly. It got to be predictable and I would brace for it, and wait for it to pass. As of Sunday, two days before my 3 week anniversary, it stopped altogether. I can bend over slowly and stand up slowly and there is no subsequent pain that follows. The dull portion of the headache is still there but the sharp waves have disappeared. Wahoo!

The insomnia remains and it is my biggest concern. I need to work (during the day), which means I need to sleep (in the evening). I asked my doctor to suggest a sleeping aide and he deferred me to my Endocrinologist. He then suggested that I start weening myself off the hydrocortisone, basically omitting my evening dosage. That helped a little in that I seem to be able to get some sleep, it's just not a sound sleep and I'll wake up throughout the night. The important part is that I do fall back asleep and get a decent number of hours (4-6 hours) before getting up in the morning. I figure that I'll eventually get tired enough to sleep all the way through.

Coincidentally I met with my ENT on this day and he had a look at stitches (Aha! Proof!) and he subsequently removed them. (Damn!) He said I healed up nicely and he doesn't need to see me any more. He also mentioned that my nose was a bit swollen and crusty (which I already knew) but he wasn't worried about it. Okay, thanks doc!

My Endo is next week!

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Milestone: I drove today

It struck me odd that I felt compelled to write about this milestone. It had little to do with my health but more to do with what I enjoy. I recall that stunned feeling when the hospital discharge instructions said "no driving". Say what??? Okay, whatever... (They obviously were not aware of my acquiring red just a few days before my surgery.)

But there she sat, waiting...

I checked on her repeatedly when I would come and go. As my friends came to visit, I would point to her. When I went for a walk with my son, I looked again and again but it wasn't time.

But today, it was time. I had been off my pain medication for several days now and my mobility was no longer an issue. It was time.

Despite sitting for 2 weeks, there was no hesitation to start. I wasn't surprised just silently pleased to confirm that we were both ready. As I casually drove down the street, Pon De Replay was playing lightly in my speakers. "Come Mr DJ, please Mr DJ, won't you turn the music up..."

Yes, indeed. And up it went. And for a moment, it was a brief moment I reached heaven. So much so that I pulled over to close my eyes and enjoy every little bit of it. And my son, bless his little heart, just laughed and said, "dad, you're weird."

With a huge smile on my face, I agreed, and we were off to finish our simple errands.

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Post Op MRI results

Great news, the MRI results of my spine revealed fluid in my epidural space which they are guessing is probably blood. They speculate that the lumbar drain used to control the pressure in my head may have allowed blood to enter the area near the incision. That's as much as I understand at the moment. My doctor is inclined to not do anything just yet and see if this plays itself out. As a result, I am forcing myself to get up and move around more. I can walk around and sit down at the table for meals. It's not the most comfortable feeling but it's a start in the right direction.

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Milestone: I can smell again!

It has been 10 days since my surgery and while I had the packing removed from my nose after the second day, I had no sense of smell until about 2 days ago. Sadly, all I smelled at the time was ammonia. It was fairly strong and followed me everywhere I went. When it occurred, I just took note of it. I didn't think there was anything I could do about it and since I had other issues, this was the least of my concerns. When I awoke this morning, I smelled breakfast, the bacon and eggs. What a relief! I still smell a hint of ammonia but either I'm getting used to it or it's fading on its own. My taste buds seem to be coming back as well. It feels different, almost like they have changed also but at least they are coming back.

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Milestone: No pain meds

Well, today marks another important milestone for me. Despite my other adventures, I did not need to take any pain meds today. My activity level was light, all in all a good day for pain. To contrast, yesterday my neck pain was exceptional yet again and so was the headache after about mid-day. By evening it was time for some relief. But not today.

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It's the little things

So I had to take a break from my normal thread to interject today's revelation and important milestone. Today I moved my bowels. Let me say from the beginning that I do not generally speak of such things and I do believe these are truly private matters. But, if I could help even one person by documenting my ordeal, it would be worth all my tribulation and embarrassment. What you need to know Bowels need to move, regularly. If you don't, it's just a matter of time before something goes horribly wrong. Percocet (my pain med) has the side effect of hardening your stool. While I was at the hospital I was given a daily dose of stool softener. After I left the hospital I was not, nor was there any mention of it. It was not on my prescribed list of drugs which also includes over-the-counter meds. In short, I didn't think about it. While I was at the hospital, they checked my urine output every hour, measuring how much urine I was producing but there was no mention of bowels. Well today, it reared its ugly little head, 9 full days after surgery. I'll be brief but to the point They were like little rocks the size of marbles and they were stuck together to form a giant rock, solid and immovable. It did move to a point but then it got stuck, in between, something, somewhere, I don't know. All I know was that it felt like I was trying to pass a large object and the pressure was well beyond what I could tolerate. My head felt like it was going to explode, I couldn't stand up, I couldn't sit down, I was in bathroom hell. After about an hour I realized I was in big trouble, I finally called for my wife. She was horrified (as was I) and she blames the hospital but we discussed our options calmly. We could go to urgent care (but I didn't think I could make it through the requisite waiting room) or we could call the pharmacist to see what they would suggest. The pharmacist suggested an oral stool softener and in the meantime I could sit in a hot bath to hopefully soften things a bit. So I did, for over an hour, but it wasn't helping. My wife in the meantime had enough time to drive to and from the pharmacy twice, the first time returning with Senakot (a laxative), the second time with Senakot-S (stool softener). I took two and waited. I didn't know what I was waiting for, I just waited, in the bath. The ugly I went ahead and removed this portion since I didn't see how it would benefit anyone but a very select few. If you would like to know how this story ends, I'll be happy to email it to you. It's sufficient to say that after 2 1/2 very long miserable hours I ultimately found relief. The lesson is simple, be aware of your meds and make sure to include a stool softener if you are using pain killers.

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1st week Post Op issues

If anyone attempts to allude to Endoscopic Transphenoidal surgery as being anything other than brain surgery or even "minimally invasive", don't buy it. Make no mistake, this is brain surgery and it is invasive. There is a reason that a neurosurgeon is performing the operation and he has a team of specialists assisting him. I guess in some respects I convinced myself that this was less than what it really was. The risks are many, the complications are great and it involves the neurological system which we really don't know much about. Consider the complexity of the pituitary gland and how easy an imbalance occurs. Our bodies and how it regulates itself is miraculous by design. A man with specialized training had to go in there, remove this thing which insisted on growing and somehow not disturb anything. How realistic is that??? As I mentioned previously, my symptoms prior to surgery were minimal. Here is the list if issues 1 week post op in order of observation:

• Headache/head pressure
• Extreme neck/muscle pain
• Pervasive ammonia or no sense of smell
• Distorted voice/sounds
• Stabbing pain in left ribcage

It took a day or two before I began discerning the different things I was feeling. The first day felt more like one big train wreck. I hadn't taken inventory, heck, I didn't even know I needed to take inventory of what worked and what didn't. As the days passed, I learned to distinguish between the head pressure, the nose pain, the neck pain, the soreness from the lumbar drain, the discomfort of the urethral catheter, and sleep deprivation.

First on the list was the headache and/or head pressure. This was to be expected and it supposedly will pass. My nose it tender at the location of the surgery but it rather blends in with the pain around my forehead. It can be described as an extreme headache but isn't localized to just the area of surgery. The pressure seems to encompass my entire head. The upside is that you have at your disposal a variety of drugs to control the "comfort".

Next is the neck pain. It reared it's ugly head on the very first day and is above everything else, the thing I feel the most. The only relief is to lay down and not move. Turning to one side or the other doesn't help. It's best to just lie still, face up. No amount of drugs contains it. If I lie still and try to rest, the intensity does pass. My doctor ordered an MRI of my spine to see if there something visibly wrong. In terms of pain or discomfort, I was well enough to go home as long as I remained laying down. Upon sitting up, however, the pain becomes overwhelming after about 5 mins.

Next is my sense of smell. My ENT came in 2 days after my surgery to remove the "packing" in my nose. Up to that point, I could not breathe through my nose. When he removed these gargantuan cylindrical gauze pads, it was like two large wind tunnels were opened up that led straight to the my throat. Never have I been able to breathe so freely through my nose before (or since). The removal of the pads themselves were uncomfortable but it went quickly and I think I had enough pain meds in me to take the sting out of any direct pain. Despite the ability to breathe freely, I did not notice any particular smell. In fact, it wasn't until well over a week later that I began to smell anything at all. And when I did begin, the smell was ammonia. I'm not sure what to make of it but I have other more pressing things to worry about.

Next is the distorted voices. I noticed this, mostly coming from the TV, during my stay in the hospital. It's subtle and I didn't think much of it at first. In fact, I rather dismissed it as possibly a defective speaker in the hospitals TV speaker. Upon returning home, it continued and I've asked others if they hear the same distortion but they do not. It sounds very similar to a distorted computer voice. I'm sure if I revisited computer movies made back in the 80's I could find the voice. There was one with Matthew Broderick where a computer wants to "play a game". That's the voice, it mostly comes from the TV but sometimes I'll hear it in my wife and kids voices.

Last on the list is a stabbing pain in my left ribcage which started the day after coming home from the hospital. I don't know what to make of this yet and I haven't had an opportunity to talk to my doctor about it. It it precisely located underneath my arm, about even with my nipple, and it is sensitive to direct pressure. The weight of my chest when I walk aggrivates it and I seem to able to avoid the pain by just supporting my left pectorial with my hand.

Well, that's it. During my recovery, the nurses made sure to check that I had my strength and sensation in my both my arms and legs (which I do). I can hear from both ears evenly(?), I can see directly and peripherally and my eyes dialate when light is introduced. I'm urinating the correct amount of volume so diabetes is no longer a topic of concern, my bowels are working (albeit stubbornly). I'm eating and sleeping.

Just taking this simple inventory, I'm again reminded that there are so many functions that our bodies perform naturally by miraculous design. I'm watching the Beijing Olympics and I'm observing these highly tuned, trained athletes. Talk about perfection, talk about ochestrating perfect harmony, talk about miraculous design. As I said before, our bodies are highly complex and as an engineer, I wish we were given the devine blueprints. That would eliminate a lot of the guesswork and I am convinced more than ever that our doctors are employing nothing more than educated guesswork.

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