Friday, June 24, 2011

John's surgery

The short form is that John had his surgery today and it went well.  The surgery was scheduled for 2 pm (we had to be there at noon) and we got home around 6.  The cathether can come out tomorrow.

The rest is whining.  They took us back, I undressed John, and the nurse started an IV quite promptly, but there was a backup in the operating room so we waited more than two hours before they took him for his surgery.  Between the problem this surgery was for and nerves, he had to pee at least 4 times during that waiting time.  I helped him turn on his side a little and held a handheld urinal for him.  After a while the nurse offered him sedation and he dozed listening to a book on tape and waking up now and then to request the urinal or help shifting positions.  The anesthesiologist came by and we confirmed again that John would have a spinal.  The anesthesiologist made a comment about spinals and epidurals that led me to say that I had had an epidural that didn't work but I understood spinals were more reliable.  He said they had a very good record for spinals and epidurals.

My frustration when they took him back is that they told me to be in the waiting room, that it should take less than an hour.  I had brought food for myself, but there were signs saying no eating in the waiting room or the lobby.  So I made a hurried trip to the cafeteria in the basement.

It was more than an hour before the doctor came back out and I learned that the spinal had not worked so they had had to give John general anesthesia.  I did say that I wished someone had discussed with us what they would use if that was necessary.  But we talked mostly about the surgery results.  The doctor gave me before and after pictures of the bladder mouth (more than I really want to know) and told me he had been able to do just what he wanted anatomically.  He cautioned that the symptoms would be worse until the tissue healed and that there might be continuing problems because of the Parkinson's disease, though he thought he could help them with medication.  I asked him for information on what anesthesia was used, and he said he would have the nurse write it down. 

The nurse-anesthesist then came out to talk with me because of my concern about the general anesthesia.  She said she had given him the absolute minimum to just keep him under, a combination of sevoflurane and propofol.  I said I wished we could have had the discussion beforehand because I had some information on what was safest for people with dementia.  She said that they always used what was known to be safe.  I said that the information I was looking at wasn't yet standard medical knowledge.  And instead of dismissing me she wanted to see my list.  According to the research I have done (which is clearer for Alzheimers but there is some evidence is relevant to Parkinson's too), sevoflurane is safer than isoflurane and halothane but desflurane is even better.  She said that John had woken up quickly and seemed to be with-it in the recovery room.  Length of time under anesthesia and how deep the anesthesia are clearly factors in the impact, but there is also some evidence that anesthesia can accelerate the brain changes characteristic of Alzheimers and Parkinson's.

When I went back John was not especially confused, but he was mentally very slow.  I don't think it is nearly as bad as the surgery three years ago, but we will see.  Some of it is stress rather than anesthesia--even before they sedated him before the surgery he seemed really out of it and not himself.

John couldn't really walk in the recovery room, but I assured them than I could handle him at home even if he was wheelchair bound tonight.  He was hungry and wanted a Starbucks smoothie.  My GPS led us first to one inside a business, and John insisted that he needed one right away, not the one I knew 45 minutes away near home.  I found one but there was a long wait.  I did get an extra smoothie out of it because the barista misread the cup and made the wrong kind first and offered it to me.  I thought the kids would like it, but John drank both.  He then wanted to stop at a pharmacy nearby and get his pain medication more quickly, rather than waiting until we got home.  I resisted that; I said he could insist on a smoothie right away or insist he needed his pain medicine right away but not both.  I didn't want to wait 15 or 20 minutes for the medication before heading home.  He decided he could wait.

I wanted to get the transfer wheelchair from his aunt, but he didn't want her to know that he had had surgery and so refused.  So we used the same system we have used before, wheeling him from the carport into the house in an office chair.  I told him that the wheelchair was easier for me so if he wanted to use the office chair he needed to make more effort to get himself around, not want to be pushed around the house.  He agreed to that and that is good for his recovery.

I quickly ate some dinner and hurried back out to pick up the pain medication.  But I was able to leave the kids to get John settled and fetch and carry for him.  Elizabeth just made him some oatmeal.  I have trouble being patient with all the details he thinks up of exactly what he wants.