Update on Richard's medical adventures

[dreamshark]

He got a nice little Medtronic pacemaker installed on Friday and it went fine. The echocardiogram that they did before the procedure showed no additional abnormalities and good ejection fraction (60%). We had Dr. Schultz at Methodist Heart Clinic (highly recommended). His initial explanations were clear and his post-surgical follow-up was surprisingly hands-on. He said he had installed about 3,000 pacemakers, so I guess he knew what he was doing.

Since there isn't much else to do while sitting in a hospital room with an uncomfortable and grumpy patient, I watched the oscilloscope. The pacemaker is set to kick in whenever pulse rate drops below 60 bpm. Measurement is on a momentary basis, so there should never be more than a second between heartbeats. Before the pacemaker, there were some very obvious intervals of 3-4 seconds even in a time window of a couple of minutes. Once the pacemaker was installed, no more of that. The heart monitor displays the pacemaker beats slightly differently so you can see exactly what is going on. There is typically at least one pacemaker beat every minute. Sometimes these helper beats are very intermittent. Other times there will be a stretch of 30-60 seconds where pretty much ALL the beats are from the pacemaker. At these times Richard's pulse was precisely 60 bpm. So... working exactly the way it's supposed to. And he clearly needed it.

The biggest problem was back pain from the fall on July 3. X-Rays did not show any fractures, but there clearly is minor but painful bone damage (probably to the bone spurs that glue his spine and ribs together). The staff was very patient and did their best to find comfortable positions for him, but after a whole day of being shifted from bed to wheelchair to another bed or table he was in a lot of pain. He had a very bad reaction to the opioid-based pain meds (dilaudin), which just made him more miserable. Once the narcotics finally wore off, he was back to just Tylenol. From my personal experience I have always suspected that acetaminophen is just a big word for "placebo" but it does seem to work for Richard. Unfortunately the hospital nurses had never heard of doxylamine, an OTC sleep aid that works like magic on Richard. They gave him some other hospital type sleeping pill that didn't work nearly as well, so he had a bad night.

He was still very out of sorts when I went back to collect him on Saturday morning. However, he perked up a lot once he got home. His back still hurts, but now that he can move around on his own he is much happier. He's sleeping in a recliner, but that seems to work pretty well for him. The incision doesn't seem to be bothering him at all, and he is no longer having dizzy spells! It will probably be another month before his back has healed, but the next available date for the rescheduled hip surgery was in September, so he has plenty of time to heal. 

Comments

[mplsfish.livejournal.com]

Good news! Thank you for keeping us informed.

[seekerval.livejournal.com]

So glad to hear that he received his pacemaker so quickly and that everything went well. I hope all the aches and pains that go with surgery (and with falls) ease off and he feels better in all ways soonest.

[pameladean]

Thanks so much for the update! That is fascinating about the oscilloscope.

Tylenol works for me, too -- it never worked for menstrual cramps AT ALL, but it worked for a cracked rib and, weirdly, it works for migraines. It's terrible for inflammation but better for other things. But people are extremely varied. Anyway, I'm glad it did work for Richard.

P.

[mle292.livejournal.com]

Thanks for the update, I'm glad to hear that things went well.

I think the greatest thing about surgery is realizing how wonderful it is to sleep in one's own bed after the hospital stay is over.

I hated dilaudin, even though it made it possible to sleep. I think some people are really not opiate friendly.

[dreamshark.livejournal.com]

It's possible that the side effects diminish if you take it regularly, but Richard is clearly not going to get a chance to find out. After the projectile vomiting incident the poor nurse added Dilaudin to his list of "allergies." But even before the orange juice started coming back up, he complained that it not only didn't make his back stop hurting, it made him feel too anxious to sleep. Every time he started to doze off, he would jerk awake, looking startled. So really, completely useless for the intended purpose.

[mdlbear]

muscle relaxants like cyclobenzaprine and methocarbamol work well for my back pain, but it's almost entirely due to muscle spasms. Still, might be worth mentioning to the doctor.

When it comes to OTC stuff I usually rely on naproxen sodium (Aleve, IIRC).

As usual, your mileage may vary.

[dreamshark.livejournal.com]

For some reason, hospitals never offer naproxen or ibuprofen for pain relief, just Tylenol. I wonder why that is? It used to be thought that Tylenol was the safest of the OTC pain relievers, but it turned out that exactly the opposite was true.

[vgqn.livejournal.com]

Glad to hear that it went well! Hope his recovery is fast and that the pacemaker help.

Tylenol is more stomach friendly than aspirin or ibuprofen, so maybe that's why they offer it? (Or it's just legacy, they got into the system first?) I prefer ibuprofen myself. Dilaudid helped my dad a lot, sorry to hear it was bad for Richard.

Just curious, has Richard ever taken codeine cough syrup? I tried it once, was so looking to getting a good night's sleep after multiple nights of constantly waking myself up coughing. But the codeine cough syrup neither stopped the coughing nor helped me sleep. Instead I felt totally awake and stayed up reading (and coughing) all night!

[dreamshark.livejournal.com]

I can see why hospitals don't like to give aspirin because of the blood-thinning effect. Unless they're trying to dissolve a blood clot, that's the last thing hospitals want on their premises. But ibuprofen and naproxen don't have that issue, and they are much more effective against inflammation.

If you need a sleep aid again, maybe you should try doxylamine (an antihistamine with such a strong drowsiness side effect that it is marketed solely for the side effect). Going on the theory that there are always two types of people, you would be the Richard type: opioids do not work, doxylamine does. I'm the reverse.

[minnehaha.livejournal.com]

I am glad he is feeling better!

K.