Update At Week Six – Free At Last

“Oh, no”, I moaned. “I bet I need to be NPO for this.”

“Well, we told them you were coming in to get your stomach tube out. Don’t you think they would have told us if you needed to be NPO?” Cheryl returned.

I usually don’t remember my dreams, but it seemed ever hour, I’d woken up not to a nightmare precisely, but just to dreams of worry and obsession about getting rid of this last external connection. It had been a month since I’d had the tube put through my side into my stomach, and a week since I’d needed to feed myself through it. The Interventional Radiologist who placed the tube had said, “Usually, we like to have them in at least 6 weeks, so the tract gets fully epithelialized,” (whatever that meant). But the General Surgeons on the trauma team said they could usually get them out in as short as a month.

All I knew is I wanted it gone. Every step I took, I could feel the stitches on the plastic tube tugging at my side, and I could imagine my stomach, stuck to the inside wall of my abdomen, jiggling up and down with every motion. I couldn’t easily sleep either on my left side, or front, which diminished greatly my options for comfort at night. Then there was the whole idea of just being stuck with this 10 inch long plastic snake angling out of me and needing to be both hidden from the world, and cared for so it didn’t get infected, or jammed closed. Oh, and sometimes the tube inside would scrape against my stomach lining the wrong way, and send off pain waves a little different, shall we say, from the swelling of my broken wrist or neck.

So I’d been obsessing about getting rid of the G-tube ever since it was put it. Now, as we were heading downstairs to get in the car on the way to the Trauma Clinic, I had one last fear – that the receptionist who made the appointment didn’t really understand the procedure, and had neglected to warn me to not have anything in my stomach the night before. After all, I’d been NPO for 12 hours before it was placed. If there was a hole going right into my gut leading out to my skin, didn’t it make sense to reduce the risk of drainage by being as empty as possible when the tube was taken out?

Cheryl opted to trust the process, but for me, it was just a reflection of my overall dissatisfaction with the slow pace of my improvement. Sure, I had my C-collar removed two days before, and I’d been given clearance to move around freely by the neurosurgeon at my appointment two days earlier.

Brief digression. When my father was in his early 70s, he had an inguinal hernia repair. A week after the outpatient procedure, he returned to his surgeon, who pronounced that he was healing well, and could resume his normal activities. I guess he looked at my father and figured, what trouble can an old man get into, anyway. But what he didn’t realise is that, it was winter there in the mountains of Colorado, and my father was in the habit of going out for an hour or two to cross country ski from his house almost every day.

Two weeks later, he returned to the surgeon, his hernia popping out again, needing BOTH sides repaired, with mesh this time. And a longer recuperation, I guess.
So another obsession of mine before the neurosurgery appointment had been about making sure the doctor understood the level of activity I was used to and expected to return to, as soon as possible. Because the doc seemed so smart and understanding of the neurological impact of my spinal cord injury, I guess I neglected to point out to him my athletic history.

When the topic of return to function did come up, he said I was free to move around, and should not worry about my “broken” neck. The spinous processes were healing, they were not displaced, the central cord symptoms were improving; after all I do have full motion, function and sensation. Just these damned parasthesias  of deep numbness, pain and temperature sensitivity in my index fingers, as well as a slight weakness in my triceps and finger and wrist motion. He was confident I was “healing” and not in any danger.

He was about to close the visit by telling me he expected my goal of returning to work by mid-December was reasonable. Then I explained to him what “work” actually meant to me. Being a gynecologic surgeon was only half my job, I said. I spend an equal or greater amount of time training for and competing in Ironman triathlons. And not just competing – I let him know the level of success I’d been having, and that my intent was to return to that level, of 2+ hours a day of running, swimming, biking, and weight lifting, sometimes at pretty intense effort levels. He made the same mistake my father’s surgeon had.

Looking at me, I’m emaciated, a little stooped, at that time still with the G-Tube in place, pencil necked from the collar’s restrictions, with a caved in lower lip and repeated hacking from my poor excuse for swallows. I certainly do not LOOK like the guy who won three straight IM races in course record times, nor do I feel or act like him. But after I described the workload, he announced, no, you shouldn’t be trying to run or swim at full effort level for about 12 weeks after the injury.

And my immediate reaction was (to myself), no way I’m gonna wait THAT long. I’m ready to go today! I’ve told that story about my father at least 100 times to patients to remind them to take it easy after surgery, but I guess it just hasn’t fully sunk in with me.

So that G-tube was IN THE WAY of my rehabilitation, and it had to come out. The Physician Assistant at the Trauma clinic knew that, and just laughed when Cheryl asked about being NPO. No way, not needed, he said. We just pull it out, and cover the hole with gauze and a bandage. Change it as needed, should heal closed within a week or so.

After a few intense barbs as he jabbed and probed trying to get the sutures out, the tube was gone and in the trash. He quickly covered the hole, releasing his pressure every now and then for some “burps” to come out – just air, no food, and only for about 2-3 exhalations. Then, the smooth muscle of the stomach wall did its job, and sealed over the internal opening, leaving just a narrow – and short, ‘cause I’m so lean (skinny, gaunt, scrawny) – tract in my skin and muscle wall to heal up.

I walked out of there a free man, ready to start phase two of my recovery, my rehabilitation to regain myself as a doctor and an athlete.

………………..

Here’s the more orderly summary of my status which I gave to the Endurance Nation forum yesterday:

I am now free of all external devices: C-Collar is gone from my neck as of Tuesday, and the gastrostomy tube is outta my stomach as of Thurs. I am “eating” (drinking) 3000+ calories a day, but still weigh 9-10 # less than my racing weight. Swallowing is still one of my two major problems; I can only handle single textures at a time, and seem to be progressing at a glacial pace. I see the speech therapist for additional evaluation of this on Monday.

My other major issue is the continuing evidence of spinal cord contusion at levels C 6 and 7: parasthesias (numbness, pain, temperature sensitivity) in my index fingers, and weakness which I feel in my forearms. PT and OT are on tap for early next week.

I will see the dentist on Monday to get impressions so they can make me a temporary partial lower plate, to use during the 18-24 month process of multiple operations to repair my lower jaw (bone grafts needed) and implant permanent replacement teeth.

I lifted weights for the first time today – sheesh, 3 (three!) pounds is all I can manage with my left triceps weakened by the spinal cord bruising, and sit ups were out as my G-Tube site is still healing. I went very easy, about 1/3 the weight I usually do on all other exercises, and hope to build to normal routine there within 6 weeks. Tomorrow I will try to swim for the first time, then put the bike on the trainer for 10-15 minutes on Tuesday. I’ve been walking 5-7 times a week, up to 3.75 mi/one hour now. I will try to jog (without letting my head bob up and down too much – perfect running form, actually) a minute, walk 9 minutes, or less running if necessary, on Wednesday. My goal with S/B/R is to be able to start actual training sometime between Dec 15 and Jan 1.

I will be going to Tempe Nov 18-22 to watch Ironman Arizona. I am already signed up for the event, and they (a) don’t really have an effective refund policy and (b) allow registered athletes to sign up for the next year’s race (a big perk, as the races sell out in less than an hour when they are opened up online). Also, I want to get some Endurance Nation and Ironman mojo, as well as see a swim start for once in my life!  So far, the only triathlon goal I have for 2011 is to finish Ironman Coeur d’Alene at the end of June. I just don’t know yet what I will be capable of, or when.

I plan on returning to work right after Thanksgiving, or when I get my temporary dental plate, whichever comes later. My goal is to be able to perform fully at a half time level as an Ob-Gyn as of the first of the year.