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I Just Journeyed to the Wonderful World of Stent Surgery

ideologyhunter

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Yesterday I had surgery to put a stent into the politeal artery in my right leg. (It's an artery that branches off from the femoral on each side. It's on the underside of your knee joint.) I'll have to get the left leg done after this first incision heals.
After I knew I had surgery coming up, I turned into the old geezer who has to tell everyone about his joints, bones, arteries, etc. I don't care for those guys when I'm at the coffee shop. After a minute, I've heard enough. So, after I realized what I was turning into, I slammed on the brakes and disciplined myself. I forced myself to talk to people without bringing up my upcoming surgery.
I also decided to write about it here, because you who read this can instantly skip to something else if you don't want to hear my story. And there might be someone with a similar condition who has the decision to make about surgery. So I intend to tell you about the unpleasant parts and the parts that turned out better than I expected.

As a preview, here are a few things that changed me in the past few weeks:
1- I've now taken fentanyl, propofol, and oxycodone. Talk about bucket list fulfillment.
2- I've always hated IVs placed in me, but I've gotten used to them and no longer dread them. I've had 3 recently: once for a procedure on 9/8 that the doctor halted partway in (more about that later), once for a CT scan, and once yesterday for the OR.
3- I got used to teams of nurses and interns working over me as I lay back like, essentially, buck naked roadkill. They position you, clip you, mark you with special markers, paint you with cold disinfectant lotions, poke you. I learned to trust all those people (I had great teams at every procedure -- hope you do, too, if you have this to go through.)

Brief back story: Last year an ultrasound found thrombus (clot material) in both my legs, in the popliteal arteries. My other major blood vessels had normal results, knock on wood. This year, on a recheck, I was assigned to a new doctor, a vascular surgeon, and he told me I needed stents placed, because otherwise a loose piece of clot could mean I'd have a leg amputated, or I could drop dead, depending on where the clot lodged.
On 9/8, the surgeon tried the non-invasive method on me. This meant a small puncture wound in the groin, which the surgeon uses to introduce a stent tube into the femoral, then across the base of the aorta (where it splits) and down into the opposite femoral and down to the knee. In other words, a puncture in my left groin to treat the right popliteal. I know -- sounds crazy -- but if they try to tap the right femoral and go straight down, it creates a risky or even impossible angle for tube insertion.
To backtrack, when you have this kind of procedure, you start with imaging, in my case both ultrasound and a CT scan. This gives the surgeon a good idea of the terrain. My doctor told me that my aorta displayed more curvature than your everyday aorta, but he still thought he could get the tube through.
On the procedure day, I showed up an hour early. In pre-op, you change into nothing but the open-backed gown. They check all your vital signs, put in the IV, and wheel you down to the procedure room, which has an enormous TV screen. They will inject you with dye, use imaging on the spot, and guide the tube while they track it on the screen.
But wait -- there's stuff I left out. After they wheel you in, you slide from the rolling bed to a narrow operating table. Then they do the final preps on you, and they work so fast you don't have time to be embarrassed. At least I didn't. Yes, they shave your pubic hair for this procedure. So, three minutes of snip, buzz, snip. Oddly, they left a curly little patch on either side of Mr. Johnson. For two weeks, I had a Larry Fine dick. Just picture those balls of hair above each of his ears. And his big bulbous nose was -- you get it. (Yesterday's nurse was more thorough, as she shaved off both the hairballs. I guess it's now a Curly Howard dick. It hasn't said "Whoob, whoob, whoob!" yet.)
Then they wiped down and painted my entire pubic region and more (from maybe an inch below the navel to the top five inches of my thighs) with a cold, jelly-like antiseptic that is colored bright orange. I took one look and told them, "Great, you've put Trump's face on my crotch." I was given a local anesthetic for the procedure, although I was told later that one of the drugs was fentanyl, which I thought sounded strong for a local. Midway through I was very spacey. Out of the fog came my surgeon's face. He told me that he had stopped the procedure because he couldn't find a safe way to get the tube through my curvy aorta. Back to the recovery room, and I went home that night.
Recovery from a puncture procedure isn't bad. The actual puncture site is small, you get to shower right away, and you are restricted from lifting anything more than 10 pounds for a while.

A week later, I had to show up for Pre-Surgery Testing, because now the plan was a conventional surgery in the OR with general (i.e. total unconsciousness) anesthesia. For Pre-Surgery Testing, they do the EKG on you, with all the sticky pads on your chest. They draw blood to analyze all the panels they need to know about.
Yesterday was my big day. This time the prep time was two hours. Change into the gown, vital signs checked, IV placed, Curly Howard created down below. Then the team comes to meet you, one by one: first the anesthesiologist. I had a list of questions for him -- would I be given fentanyl? propofol? (Definitely yes on propofol.) Would he tell me just before he sent me into dreamland? (He said he would, but I probably would not remember it, and he was right.) For my final question, I asked him if, when I was coming out of it, Trump was still President, could he give me an extra hit of something? He said he would meet me in the parking lot for that.
My surgeon came in. I had already had a sit-down with him, with a written list of questions, so I only had a few more to ask.
(BIG ADVICE: come to any consults with a notepad and have your questions in writing, with space to write the answers. It's invaluable. You'll never remember everything, otherwise. I also provided him with a xerox of the questions, so we could go over it together.)
The OR nurse came in, and also the anesthesiology nurse, and I asked whatever I could think of. Then, at about 11:40 A.M., they wheeled me back to the OR.
This is enough for now. I'll put in a second installment soon.
 
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Thursday is the follow-up for my TAVR(aotic valve replacement). It's been 5 weeks. A lot of what they did to you is very similar to what I had.
How is the bruising? Mine was quite impressive.
 
I haven't had much bruising at all. With the puncture site, it was sort of a pooched-out little bump.
I still have on the surgical bandage from yesterday (I can take it off tomorrow), but I don't see any discoloration around it. I'm curious to see the incision, which he said could be 2 to 3 " long, but I'll be a good boy and wait. It was sealed with surgical glue!! Who knew? This stuff will peel off a little bit on the surface until all the excess stuff on the outside has gone.
 
Hopefully in this post I can tell the rest of what happened yesterday.

First, I misspelled popliteal at the top of the OP. It's a weird word; never knew I had one until it went bad. Doctors call it the PA.
Second, I left out a little incident that started while the surgeon was talking to me in the prep room. He mentioned casually that they would place a Foley in me. Some guys don't know the word, but when you know what it is, you want to avoid it at all costs. It's the catheter that is inserted all the way up into the bladder. Here was one of my top phobias, coming true. I asked if I'd be awake when it was placed and removed, and he said no. So I don't have that memory to relive. I have had urination problems in the past 24 hours, almost certainly from the Foley, but I was told these should ease up over the next day or so.

Then to the OR, and because I was given general anesthesia, I have zero memories of what I saw there. I was probably not sedated for a minute or two, but nothing is stored in my memory. The surgery took an hour or so, and I came to late in the afternoon. I felt some tightness on the right leg, but no pain until I first tried to walk on it, around 7 p.m., in my hospital room. And then...yikes. Deep throbbing pain when I walked. I walked sideways, like a sidling crab, to get to the john, leading with my left foot and dragging my right foot after. Getting back into bed was murder, because I had to use the right leg muscles to lift it over the edge. I got up about five times during the night, and each time was an ordeal. I got better and better at figuring out the moves and postures that would not provoke the pain. (Today around noon, I took off the hospital gown and managed to dress myself in my street clothes, figuring out from the shoes up to the shirt how to do it without torturing myself. Things had progressed enough with my understanding of the pain that I was able to get myself dressed with no help.)

The surgeon stopped in my room for a minute early this morning, and I asked him about the operation (I think they call it a femoral cutdown, which has a brutal sound, to me.) I asked him if muscles were affected, because the pain felt like a deep muscular ache. And, yes, he used surgical retractors to hold some muscle mass away from the artery. There is also a main nerve in that area that got moved over. So picture muscles and a nerve being clamped into a new position for an hour, and you have a reason for a profound ache. He told me that I should keep moving, that moving would help the tissues become flexible and return to a non-inflamed state. I'm also using an ice bag on the wound. It's now been about 25 hours since I first tried walking on that leg, and it is better. I should be able to drive in under a week (he said perhaps in four days); it will depend on how long it takes the wincing pain to go away and for the leg to give me free and accurate motion. For about two weeks I absolutely can't lift anything above 10# or so, and I should keep to moderate activity interspersed with rest.

I know full well that are worse surgeries to undergo, and some readers will have had major surgeries directly on key organs in the body. This is my first experience with a standard incision, so I've learned a lot and I will have no reservations about getting the job done on the left PA sometime around Halloween, if all goes well. My true goal in all this is to get back to the YMCA pool and be swimming again, hopefully in early December.

I always have respected medical professionals, and the teams I had in the past few weeks understand that patients who walk in the door are almost universally frightened people. They treated me with respect and understanding.
 
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Glad you made it thru. Hope the next will simply be more of the same.
 
I'll add a Day Five postscript for anyone who has surgery coming up and wonders about recovery time.
My surgery was Monday about noon; today is Friday about noon, so the surgery was roughly 96 hours ago.
I had a femoral cutdown to send a stent down to my popliteal artery.
Incision: just a tad over 2 inches long.

The good news: On Wednesday, I began to make rapid, noticeable improvement in pain abatement. I think I am well over the really deep, throbbing pain.

Day by day:
Mon. night/all day Tuesday: Definitely the roughest. Walking was painful; bending the right leg was horrible; dragging the right leg up over the edge of the bed to get back in -- a nightmare. When I get the left leg done in November, I will definitely bring my own cane to the hospital.
Wednesday: The day when motion became easier; I did a few tasks outside and was able to use the stairs to my basement, although I was very sleepy all this time and took frequent naps. On Wednesday, on the advice of an RN I know, I started to alternate Tylenol and Ibuprofen on a five hour switch-off. Still doing this.
Thursday: The big hurdle that remained was using my right leg muscles to, say, lift my foot up if I wanted to put a sock on. That was painful, and it is today, only less so.
Friday: TODAY -- I felt up to driving, and I have taken the car out on three brief errands. My right foot functioned just fine; I kept the base of the foot anchored on the floor between brake and gas, so all I had to do was move the top of the foot over, and I felt I had the same reaction time as before surgery.

Okay -- TMI time -- I'll tell you about urination/bowel complications, so everyone tune out if you're not interested. I'm including this because nothing in my discharge documents alerted me to the possibility of these phenomena, and I was truly freaked out when they happened. I do like the entire hospital staff, but I think a discreet paragraph on two on these functions would help. I ended up googling my symptoms to be assured that they happen all the time.
Urination: My surgery was long enough that they put a Foley in. I only know because the surgeon said it would be done while I was under. Foleys can give you strange symptoms later -- blood in the urine (I saw just a trace, and only once) and very halting urine stream. The halting business hit me Monday night and all-day Tuesday. Normal function returned on Wednesday. One more after-effect of the Foley, and this was the absolute weirdest: urinating air bubbles. Too strange!! My penis actually made a fizzing sound, and the urine came out in bubbly spurts. If this happens to you, it will probably go away within a day; just let the attending nurse know. But that fizz -- I will never forget that.
Bowel Function: I was 100% constipated after surgery. I'd gone in after a 14 hour fast, and didn't eat until early evening on Monday, but the constipation lasted until about 4 p.m. on Thursday (!), by which time I was seriously wondering if I should call the hospital for advice. Anyway, normal function took over at that point. Google will tell you that anesthesia, especially general, can knock your bowel function back and temporarily stop the intestinal action. I also learned that oxycodone can prolong your bowel stoppage. I did take one oxy tab from the nurse, around 5 a.m. on Tuesday; only did OTC after that. At discharge they would have sent me home with 25 oxy tabs, but on reflection I declined, and I am so glad. The Tylenol/ibuprofen have sufficed, and it is possible that oxy use would have prolonged the constipation.

My conclusion at the 96 hour mark: It was rough for two days, but much easier after that. It is something to get through, and I can do it. I still have about ten days where I need to cut back on my activity and do light, moderate tasks and avoid heavy lifting. Definitely not a fun experience, but I have learned so much about pain, physical recovery, mental attitude, and I have increased respect for those who go into the healing arts.
 
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^
I would advise avoiding oxycodone, if possible, for anyone due to the constipation. After my bypass surgery 9 years ago, it was bad. Good thing my sister had a good supply of stool softeners on hand.
 
Agreed unless you're at some level of pain I didn't reach. When I did get bad pain, I could make it go away by lying down. I've always believed in using OTC painkillers when possible. I think most MDs have that opinion also. (However, as I said, the hospital would've let me use an oxy prescription.)
 
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