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2 of 3 Surgeries Completed

Surgery No. 2 went well, from a surgical standpoint (or so my Mom was told). Again, Dr. Stoneback performed the removal of the antibiotic nail from the previous surgery, performed a deep-bone biopsy, and replaced it with another antibiotic nail and also performed the formalization. Dr. Greyson, the plastic surgeon handled dissection of my nerves and their reinnervation through the TMR component of the surgery.

It all started when my Mom arrived to my room around 10AM. Literally 20-30 minutes later, around 10:30AM, the people from pre-surgery had come down to prepare to whisk me away to the pre-surgical area. After the 15-20 minutes that involved locating an O2 tank and tubing situation with my PCA, we headed straight down. I waited along with my Mom is the pre-op area. The normal slew of dozens of medical professionals responsible for and transferring my care onto the next professional came to and fro. I agreed with Ian, the guy from anesthesia that I blew up at the day of my surgery for not listening for my preference of epidural, came by to share his idea of trying the epidural a second time (from the first surgery not working), but agreed to the idea that they would place me back onto the regular PCA if a) it didn't work, and b) transition me back to the regular PCA within the first 24 hours, or so - since the first epidural fell out of my back. This Ian guy also informed me that while ketamine use to treat phantom limb pain is usually limited to inpatient use, there is one pharmacy that fills prescriptions out of pocket to patients. While it is my intention and in my interest to transition from then hospital to inpatient physical rehabilitation (literally move to a separate room on this floor - baring availability - only 10 beds available), this idea of continuing the oral ketamine to treat the phantom limb pain is not only very well a necessity, but moreover an actual option. While undergoing. the TMR surgery today will temporarily increase pain over the course of the next week, it will take the next three months for the benefits of TMR to take the full-effect. Again, it was the intention of having the epidural to help with the pain and phantom limb sensations and after it was further clarified that I was going to be provided a high-dose bolus, as before, he was expecting this time would be a better experience with pain better controlled upon awakening. Ian was again the one to place it, but this time at pre-op bedside, rather than all former experiences in the OR. It was placed rather quickly, which I found shocking. I was trying to tell my Mom that, but she insisted the Versed destroyed my concept of time. But she was missing the point of my observation.

I was taken back into the OR, same one as before. While I wasn't offered the choice of radio station (essentially to DJ), like last surgery with my choice of telling Maria - Dr. Stoneback's PA - for my choice of artist "Chrome Sparks"... they just kept me in my bed and got immediately to work with induction of the anesthesia. I was wheeled back there around 1:40PM and they started the surgery by 2PM.

Maria was nice as always and loaded me up with two warm blankets, asking "are you cold?" I was like.... uhm... yeah! Then offered one more. Around this time they were also placing a second set of heart rate monitoring stickers (even though I had the ones on still from pre-op). Right after that, they removed my regular/covid-19 mask, along with my nasal cannula and immediately began administering oxygen through the anesthetic mask. He handed over the responsibility of holding the mask over to my face to my OR nurse (that wheeled me in). I kept telling them both that it was too high, and I kept pulling it down. Within a minute (or two), once the IV line was placed, he flushed it. Around this time, I was glancing/staring over over at Maria on the phone with someone responding "uh-huh..." I began to wonder myself why all of the delays, why I didn't see Dr. Greyson yet, let alone Dr. Stoneback or any of the other OR staff. Their absence felt strange. I also I wondered why they hadn't moved me over to the operating table first, like they had like all other times before. Moreover, I noticed what I thought was a head mount (a place to piece my head during the surgery). I presumed I would be supine for this surgery, not prone... and thus thought the head mount was for the supine position. But, more on that a bit later (and why it possibly matters).

Yet, I heard the anesthesiologist say something about me, said to me, but in the 3rd person. It wasn't this statement, but for instance him saying: he is getting his anesthesia. At this point, I could feel it coming on. For a good minute I held up against it, but then I could slowly hear my hearing beginning to go, along with my eyes lids getting heavy and taking longer to open and close... but unlike last time don't remember the exact moment of losing consciousness.

Waking up, just like the time before was in absolute agony. So much so, I didn't bother to open my eyes. However, the observation I made this time is the visualizations don't appear to be part of the ketamine because prior to surgery they said they would give me some when I asked, but said that I was on a higher dose than they would give me for surgery anyhow. I am connecting the dots and starting to think this "visual noise/distortions/static" as color, shape and form start to appear on the back of anyone's eyelids if they look close/long enough. Although, I do personally think this is my visualization of pain.

What I noticed was a leg that was very much in pain and sticking right up in the air with my other foot practically lifting it straight up and perpendicularly off of the bed. They kept injecting more and more into my epidural line, retesting and watching me agonize over the course of two or so hours until they finally gave up and gave me a larger bolus of dilaudid straight into my IV line and noticed an immediate improvement in scores, unlike the small IV boluses and larger epidural boluses. Thusly they decided at this time to send me up on constant-delivery PCA on my epidural, along with on-demand boluses of dilaudid on my regular PCA. Additionally during my time in the recovery room, when determining it not only numbed below the right-side waist, (unilaterally: aka not both legs), I also noticed numbness elsewhere. I pointed out the numbness in the area of my right breast, upward on the right side (including that side of my arm in the anatomical position - which in this position would exclude numbness in my arm downward from my right elbow). Furthermore, this numbness moved upward alongside the right-side of my head, ear, shoulder, and 90% of my neck (including most of the left-side (aside from 10% of the left side). At the time of being in recovery, I didn't investigate any of this further to notice other than generally, most of my right side aside from below the breast to above the waist not being numb, the rest was. Initially, I chalked this up to an incorrectly placed epidural having not investigated or coalesced all of the other details together. My initial noticing of the more complete problem, which I didn't share with them as I sat there with my eyes closed, verbalizing my agony and answering my questions was the left side of my chin being numb/hurting and my right ear being swollen/hot to the touch and numb.

On the way upstairs, we took a brief detour to the X-ray department in the basement. Even with what at first glance appeared to be a wide-hospital-sized-door: with everything hooked up from the O2 tank, to the epidural line to the PCA line, was too much to negotiate. Sort of haphazardly they pushed/pulled together my PCA pump right in and it clipped the pain pump button cord and connector. Once we got upstairs, they quickly discovered it wasn't working. Finally, after I got them to listen: "please listen, it will save you a ton of time and pain, especially for me since I'm getting far behind on my pain" (I then went on to account what had happened to the pump so they would avoid wasting the time troubleshooting it at length (with medicine still inside of it, thus preventing me from getting my meds. Thus for that reason, I guess that's one of the perks of waking up easily from anesthesia in general along with the bad pain... I'm very much awake and notice things. The only things I tend to notice less is when the pain is so out of control that my eyes aren't open and the whole world - outside of my hearing alone - is staring at the back of my eye lids).

Finally, after getting back upstairs and my Mom seeing me at closer glance that she thinks I might be suffering from an allergic reaction. At first, it looks that way to me too. I begin to notice as I'm offered my first chance at it (having been coughing a lot and weirdness in the back of my throat while in recovery) that my face was severally swollen and while it did feel hard to breathe, I wasn't having difficulty with the breathing aspect; however, I was experiencing problems with swallowing. So I avoided dinner last night. My surgery having lasted 5 hours, the surgery starting at 2PM and ending at 7PM and the additional 3 hours in recovery, put the time at 10:30PM by the time I arrived back upstairs. My night nurse, although she turned out to be somewhat nice, was also somewhat anal retentive. For instance, any interfering/or even simple questioning about the approach to something, or her last say in the matter lead to an immediate emotional stonewalling/drill Sargent personality to emerge. For instance, I asked why my pain medication had been placed in the IV catheter in my left arm (the one placed during surgery) and why I had it in the first place? And why wasn't the vacant lumen in my PICC being used?

That line of questioning lead to nurses have the right to do what they want and how she isn't comfortable with mixing medication. Since there was only antibiotics and PCA/pain meds, what third class of medication was not compatible. To which she argued, deal with it, every nurse has the right to practice however they see fit, even if tomorrow's morning nurse (or I, the patient, decides to not follow that rule). I apologized to her and let her do her thing. The other thing was one time she said all my pain meds were due and that she was bringing them in; but then, I asked about the oxy to which she replied, I am not going to give all of them to you at once because if it doesn't treat it, then there is nothing more we can do. While I agree with the latter example, I don't like her dictatorship-like attitude to her nursing. While I did see some actual good in her, I think her unwillingness to meet half-way with the patient will eventually get i nthe way of treatment and possibly be ruinous to future relationships with her patients. For now, I'm just glad I don't have her.

Now time to wrap up this beast/word salad of a blog post/health update to say right now, Tuesday afternoon... pain is stabilizing and slowly getting ahead. My plans were to not move at all today, or tomorrow. Naturally, while the epidural was removed this morning by Ian, I don't plan on giving up the foley until the pain has improved and moreover, most importantly, pain has improved in response to movement. Right now, having my nerves chopped up and sewn back together feels a lot like the same sort of pain you'd experience when pulling your clothing over shingles nodules. Moreover, just sitting feels extremely swollen, stretched and bulging at the seams... much the way it appears with my shrinker attached and holding this bundle barely together with it's elastic fibers.

In regards to the numbness/swelling/heat through various regions of my skin, including left and frontal part of my chin, all along the back of the back side of my cranium, almost the entirety of my neck (aside from a very small sliver on the left-side) , into all of shoulder, ear, whole right chin, and whole right breast and finally the underside of my left arm. I have been told, independently (although through my interest in investigating this) by the anesthesiologist that took over half-way through my case Dr. Anas Ibrahim-Hamdan that this sort of thing happens all of the time during surgeries involving the prone position, that it will get better and they are mostly concerned in the case there is permanent nerve damage. He also went on to say, since it's the anesthesiologist's job to position the patient that they go to extreme efforts to minimize these risks.

As to the concerns regarding the swelling/wam in my throat, inability to swallow fully