Sunday, March 28, 2010

Post-surgery update

Barb and I visited Dad yesterday around 11am. He had been moved from the recovery area to his regular room. He was having an ultrasound to look at his heart. Apparently there were some possible indications of an enlarged heart which the internal medicine doctor wanted to get more details on, to see if there may have been some congested heart failure. We spoke to Dr. Lai that morning as well and he explained what he was looking for. It appeared that there wasn't anything seriously concerning after the ultrasound. Dad came in and out of sleep while we were visiting over the next 3 hours. He was given some morphine to control pain, and seemed to be relatively comfortable and not complaining too much - although a couple of times when asked how he felt or was doing - he replied 'pretty bad'.

There is concern after surgery about digestion, so we first fed Dad a cup of ice chips to make sure he could swallow properly and that his stomach would tolerate intake. He was then only allowed to have a clear liquid diet, so lunch consisted of chicken broth, juice, jello, and sherbet. He was quite hungry and especially thirsty. Even though he was sometimes half-asleep, we could rouse him and he would usually respond yes when asked if he was still hungry, so he went through most of what was provided. He occasionally had some difficulty with sucking on the straw (chewing instead of sucking), but still managed several cups of juice/water. In fact he downed almost a whole can of Gatorade in one go (resulting later in quite a large belch!). Even though he was responding to us, it wasn't clear if he recognized us at all.

We asked about probable timeline of recovery care and were told that once the surgeon assessed him post-op, he would determine when PT would try to get him up and assess a course of rehab. Assuming all is well, he would likely be transferred to a transition care unit for PT/OT work. Difficult to know how long that would last until they see how he proceeds, and therefore when he might be released back to the care home (where he could still get some in-home therapy). We'll get more details as we see how he does.

We left around 2:30 or so, and then returned at 7:30, hoping that he would be able to eat more. However, at that point he was so soundly asleep that we really couldn't rouse him. The nurse said that they had been able to get him to eat some of his dinner (full liquid style - which means still all liquid but with cream soup and milk, instead of broth and juice). We don't know how much he took though. We stayed for about two hours, and although he opened his eyes once or twice, never roused sufficiently to respond much and so we didn't try to give him any more food. He had not had any further pain medication since the morning, so the nurse administered another dose of morphine. We assumed he needed to rest, being so tired from the surgery. Before we left, the assistant was taking the routine vitals (temp, pulse, oxygen, bp) and discovered he had developed a fever (101.6). He didn't feel exceptionally hot, but the temp was retested and he clearly had elevated temp.

We returned this morning just before 8, hoping that we might see the doctor doing rounds, and also assuming he would be more alert after the night and ready to eat breakfast (now a 'soft' diet, including oatmeal and custard). He was in pretty much the same state as he had been when we left - soundly asleep and we were unable to rouse him with talking and gentle shaking. We inquired if he had roused at all during the night and were told no. All of his other signs remained good (bp, pulse, etc.). His fever had continued, but just before we left when it was tested, it had reduced to 99.4. Because he has not shown any further signs of pain (even when his position is shifted by the nurses), no further pain medication has been given. The doctor had prescribed a single dose of vancomycin (1000mg) earlier in the evening for the fever. We decided to return home and asked the nurse to call us if he showed signs of being more alert, and also if either of the doctors visited.

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