Bed Rest in the Digital Age plus Over-Prescribing Meds

Today I learned:

1. Bed Rest in a Digital Age: Prior to yesterday’s ACL reconstruction, I had two previous arthroscopies on the same knee in the early-1990’s. It was almost 20 years ago but I have two vivid recollections:

  • Dialling my own home phone number from downstairs to make it ring upstairs so I could ask my mom to bring down some ice cream, without getting off my lazy butt. I remember this, partially, because she reminds me of it every chance she gets.
  • Watching ALOT of crappy TV.

As a high-school student who actually attended all my classes, this was my first exposure to the Soap Opera genre. Try as I might I never took to Days of Our Lives and General Hospital, but there just weren’t many other options in those days.

The world is different this time.

I stacked months of reading by my bed in preparation for the down-time but one day out of a general anesthetic and still hooped up on pain meds, my head is not so much into books.  Instead I have watched a few shows recommended by friends on Netflix – The Hour and Justified are favourites so far – and watched a work-related webinar.

As I look at myself now, surrounded by my iPhone, iPad, and macBook Pro, as well as my work laptop and blackberry, I have a sense this round of bed rest will be very plugged in. This blog may in fact prove to be therapeutic as it forces some form of daily creation, rather than consumption.

All the technology comes in handy too – this time I have 4 separate devices that I can use to Skype my mom to see if she can drop by with a bowl if Ice Cream.

2. Over-prescribing Meds:  On discharge from hospital I assumed I would be sent off with a small script for T3’s, but in fact I was given a prescription for a fairly heavy narcotic.  Interestingly, I was prescribed 60 tablets which my close friend (a pharmacist) described as “an awful lot for knee surgery.”

Taken at the recommended dosage of 1-2 tablets every 4-6 hours, the 60 tablets would be depleted at a rate of between 4 and 12 per day. Essentially, worst case I have 5 days of meds, but best case I have 15 days (or more if I don’t need them frequently).

This made me wonder: Why prescribe so many tablets?

Surely if I am in so much pain that I run through these meds at the fastest pace then someone should see me before 5 days to assess the problem. Alternatively it could be that I will have so many tablets leftover when I am done that they end up sitting around in my medicine cabinet long after I need them. This invites abuse by me or someone else.

I trust my doctor – I think he’s great and I am sure he did a good job on my knee – but I wonder how much thought went into the follow-up medications.  It may be that he assessed me and felt a large prescription was safe and low risk. I hope that is the case.

It seems to me though that it is more likely the script size was just a convenience factor for both him and me – an attempt to reduce follow-up visits just to write a new script. If that is the case then I am not too impressed. A smaller prescription would potentially catch and save problems at both ends of the spectrum.

Advertisements

Fasting Goes Slowly plus Before and After

Just a brief, knee-themed, post today as I spent most of the afternoon under general anesthetic for ACL reconstruction. I consider it a moral victory that I made it in under the wire today by blogging on my phone from the recovery room! Pardon any spelling/grammar issues. I will clean it up post morphine induced stupor.

Today I learned:

1. Fasting Goes Slowly: Apparently a blanket rule applies. No matter what time your surgery is scheduled for the following day, they force feed you the same message: No food or drink after midnight.

This hardly seems fair. I am sure the guy with the 8am booking barely noticed he missed his first coffee of the day, and he would have been in post-op recovery room before his tummy even started to grumble. On the other hand, with my 1:45pm time slot, I had to suffer through the entire morning and into the afternoon void of anything at all.

The worst part of my painfully slow fast was a toss up. It might have been making my kids breakfast – the little ones dined on vanilla yogurt with fresh strawberries and mangos, while I wasn’t even supposed to lick my fingers. I think though, the worst part was the caffeine headache that kicked in at 10:17am when my body realized it was not going to receive the latte that it has grown so fond of. If it wasn’t that, then it was the man in the waiting room openly salivating over his plan for a Denny’s Grand Slam breakfast at 1:03pm.

That all said, the question for me is this: Why is there an across-the-board midnight rule on fasting before surgery?

I can’t find a reasonable resource that explains why my fast needed to be 14 hours when someone else gets off with only 8 hours. In fact, Wikipedia even suggests 6 hours is fine. Without a plausible explanation then, I am left to assume this rule exists because some hospital administrator assumes I can’t do math and count back 6 or 8 hours. Next time I am going to beg for the early spot and then order a take-out brunch delivery to the recovery room.

2. Before and After: A knee looks very different in the morning before a surgeon starts digging around in it than it does afterwards. I suppose I didn’t really learn this – it seems rather intuitive – but I was able to obtain the photographic evidence to back up the lesson.

Before – right knee with all the pieces, sans a ruptured ACL, where nature intended:

After – right knee with a piece of hamstring tendon now fixed in place where the ACL once was. I assume the old ACL (not pictured) is in a waste bin somewhere. The rest is on ice:

20120220-185258.jpg