Life on the Other Side of the Knife: The First Weeks

February 17, 2012
I often say that my hard work as a surgeon is actually the easy part of the whole equation. I get to go home on my own two feet (usually), exercise, and participate in family life and work – all the regular things that define quality of life for me. For the surgical patient, in this case me, all these normal activities are in suspended animation until the body heals. The recovery process for my surgery (peroneal repair + brostrom) can be broken down into separate distinct stages each important but different. 
First, safe execution of surgery, anesthesia and pain control. As the patient surgery is the one you have the least control of. My advice is to pick a surgeon that you can trust and trust that they will take care of you. I trust all of my partners and any one of them would have done a great job. For this surgery I put my fate in Dr. Hyers’ hands. Anesthesia is best in the calm, relaxed and trusting patient. I chose to have a regional block at the level of the knee, the same as I recommend to my patients. Although somewhat scary to thi nk of someone giving me needles at the knee the experience was very good. Dr. Donovan sedated me (ok I fell asleep like a baby with a small dose) and when I was aware again my foot was numb. The idea behind numbing before surgery is the concept of pre-emptive analgesia. My brain was not to feel any pain stimulus at the time of surgery and for quite awhile after. I used to say to expect 12 hours of numbness but for me the block lasted 36 hours – and I loved it! I was still sedated for the surgery and the first 12 hours or so are somewhat a blurred recollection even though in the recovery room I felt wide awake and alert. 
Secondly, my recovery at home. I went home the afternoon after my surgery and the first 36 hours were spent in a quiet state with my foot elevated. I watched TV, read a book and wrote some emails (not sure the intellectual content was real high on these in hind site). Everything I did, I did with my foot elevated. The tricks of the trade that helped me: I used the cold therapy frequently and my family was kind enough to keep the cooler water cold. We used frozen water bottles instead of ice cubes that turned out to be a great trick and avoided running to the store for ice. I used an anti-inflammatory to keep the inflammation down. Pain and inflammation are directly linked and although you need some inflammation to heal (normal healing pathway for your body) my goal was to prevent excessive inflammation. I had pain medications available if I needed them. Narcotic pain medications are a double edge sword and my bias was to minimize their use. They do not help you heal but rather help you deal. Pain medications come with side effects like constipation and drowsiness. For me I was able to avoid them by using all the other strategies. Electrical stimulation was my last trick. Electrical current, via leads attached to the skin, can deliver a low level electrical current (tens unit) as an effective strategy that has been used for years as part of chronic pain management and physical therapy. These same leads can deliver a higher current to keep a small contraction in my calf muscles so as to avoid some of the atrophy inherent in surgery. The low level contractions can also enhance healing by decreasing swelling (muscle contraction helps pump blood). For the first 7-10 days after surgery go SLOW. Control the swelling and pain and it will pay dividends for your entire recovery – it did for me. And…. be nice to your family – you are their hostage! Next topic: Using crutches and the scooter safely.
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