We expected Sean to spend the first few days after surgery on the couch. We knew he was going to need the pain medicine he was prescribed at discharge. What we didn't expect was for there to be no-nada-zero improvement in the way he felt by the end of the weekend. The surgery was on Wednesday. He totally expected to be back at work on Monday. We were even prepared with a wheelchair for the NCSU v. Va Tech game that Saturday. As the first few days past, we kept thinking the pain would improve. I've always heard that the third day is the worst. But the fourth day brought no improvement.
Early Tuesday morning Sean woke up feeling sweaty and nauseous. His blood sugar was crazy high by 5am he had started vomiting. Can you imagine? Bad leg and bad belly! Not a good combo! I had spent the first few nights on the air mattress next to him, but since I was planning to work on Tuesday and the kids had been having their own night-waking issues, Sean suggested I sleep upstairs to try and get a good night's sleep. When I came down first thing that morning, I felt so bad that he had been awake and sick and all alone. We really weren't sure what was causing his symptoms, so we made an early morning call to the endocrinologist on call. He advised Sean to use a syringe to take insulin, in lieu of the pump, and to see how he responded to that. Fortunately, his blood sugar began to come down after the syringe of insulin, but not before he was zapped of all his energy. Sean concluded later that morning that the problem was with a bent cannula connected to his insulin pump, which was causing the insulin to not deliver properly. We also called the orthopedic office and they advised us to come in that day.
Dr. Silver, the orthopedic surgeon, examined Sean and agreed that the swelling was still quite significant and he felt Sean's pain could actually be nerve pain. He explained that the swelling could be putting pressure on the nerve thus causing the pain. Or, the nerve could have been caught up in the retractors during the surgery and may be recovering from the compression, which could also cause pain. Either way, it seemed the pain Sean was feeling was nerve related, not meniscus related, so Dr. Silver prescribed him Neurontin, which is used to treat nerve pain, and a steroid pack to help with the swelling. He also recommended Sean begin physical therapy as soon as possible. He acknowledged that beginning physical therapy seemed like a crazy thought, but explained that they would start with techniques to improve the pain and swelling reduction, rather than working on his range of motion. We left the office that day hopeful that the new med would relieve some of his pain and thankful that his blood sugars had come down. However, the next few days went on with no improvements with the swelling or pain.
Sean continued in the same excruciating pain through the weekend. Once he would finally get comfortable on the couch, he would have to get up for the bathroom. And that was about all the moving he would do. The pain when walking on his crutches was awful -- and I just watched. It seemed that every move his leg made was unbearable. Just touching his leg would send him through the roof. I wanted to help so much, but there was nothing that could relieve the pain.
The next Tuesday (almost two weeks post-op) Sean went back in for a follow-up with Dr. Silver. Since the only noticeable effect the steroids had was on his blood sugar (over 200 and not moving), Dr. Silver suggested aspirating the knee to try and relieve some of the swelling. Three syringes and 140 cc's later, Sean had a visible knee cap for the first time in almost two weeks. Dr. Silver was confident Sean would feel some relief. And he did. For about 8 hours. The relief he felt was isolated right around the knee. The nerve pain was still there. Then the swelling came right back and with it all the pain.
Wednesday night (10/13) Sean started running a low grade fever. When he continued to feel clammy throughout the night, we decided to check in with Dr. Silver that morning. Since infection can be a very serious side effect associated with surgery, and given Sean's condition for the past two weeks, Dr. Silver wanted to see him right away. He examined Sean's knee and suggested running some tests to eliminate possible concerns. He wanted to aspirate the knee again to send the fluid off for labs. Sean was not thrilled about that idea b/c he knew how little it helped before. And the additional pain from having a needle jabbed into his knee was still lingering. Dr. Silver ended up aspirating twice -- he didn't get much fluid the first time, though he did get enough for the lab work. Sean reluctantly agreed for him to aspirate a second time, and even then he didn't get much more. He said it could be clotted around the knee and just not flowing well. Not a concern, but still not cool b/c that meant Sean had endured a total of three aspirations with essentially no improvements. Yuck! Dr. Silver also ordered some blood work and an x-ray of the knee. Everything came back normal. The pain was still Sean's primary concern at that point. Dr. Silver gave Sean a prescription for a longer lasting narcotic to use in conjunction with the short acting. He also recommended that Sean make an appointment to see the pain management specialist within his group. We had hoped to see that physician later that afternoon, but it turned out that he couldn't see Sean until the following week. Really? He's in this much pain and we have to wait yet another weekend! Not cool!
We went over to Wilson Friday afternoon b/c Pat and Beth had planned a party for the NCSU v. ECU game. We all thought a change of scenery would be great for Sean, so I was really looking forward to the weekend. Amazing how things can change. By 11pm that night I was frantically calling Dr. Silver on his cell phone, asking for advice on treating Sean's pain. Nothing he was taking was touching the pain. We followed Dr. Silver's recommendation for the increased narcotic dosage, but the pain was still unbearable. I was mentally exhausted at that point and ended up crawling in bed with Jackson. Pat stayed down next to Sean and when the pain continued into the early morning hours, Pat made the call. He came in and woke me to get Dr. Silver on the phone. We were getting Sean to a hospital and needed to know where to take him. Dr. Silver didn't answer the 2am call, but it didn't matter. The Wilson EMS arrived and informed us that it was there policy to transport Sean to the nearest hospital. It was a good thing too, b/c once in the WilMed ER Sean was given IV narcotics that finally began to relieve some of his pain. By 5am, he was resting comfortably and Pat was busy making sure that our next steps were the right ones.
to be continued...
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