Monday, June 22, 2009

Elbow injury - "terrible triad" - surgery and recovery

This is part 2 of 4 posts I have written about my elbow surgery. You can read them all here:
Part 1: The Emergency Room 

Part 2: Surgery and Recovery
Part 3: The Ketamine Experience

Part 4: Follow Up
In my last post I described how I broke my arm/elbow and the experience of the emergency room. This post describes what happened after the emergency room.

After the Emergency Room
In the days following the visit to the emergency room, I was drugged up pretty heavily on oxycodone. I was also taking some over the counter medication to counteract some of the side effects of the oxycodone. Oxycodone is a diuretic and can cause severe constipation. (I bet your glad you know that now.)

My arm was now pretty stable in a sling and splint made of cast material. The splint wrapped about 3/4 of the way around my upper and lower arm. My elbow was about 90 degrees. If I moved my arm away from my body it would hurt quite a bit, but as long as I didn't move it too much it felt okay. Again, I was on pain killers.

On Tuesday I went to the hospital to take care of all the
pre-surgery data. I met with a nurse practitioner and she talked with me about what I should expect the day of the surgery. The procedure I was having involved three steps. The surgeon was going to be doing an "open reduction and internal fixation" which from what I understand means that he would be opening my arm to put the elbow back in socket. Also, the surgeon would be reconstruction two ligaments. And finally, the surgeon would examine the end of my radial bone and determine if it needed to be replaced. We also discussed anesthesia and that I might get a "block" in my shoulder. From what I understand, it is a numbing agent (maybe Novocaine, I don't remember) that is injected directly into the nerve that goes to your arm. Essentially, it means you are under less general anesthesia, which can be good. The pre-surgery meeting was pretty quick and efficient.

Day of surgery 
My surgery was scheduled for 11AM, I believe. I could not eat or drink after midnight the night before surgery. I think they said I could have clear liquids or coffee, but I just avoided everything.

My mother went with me to the hospital. We checked in and went to the family waiting room. It was a little isolated from the rest of the hospital, had a pretty big library, televisions, free snacks and side rooms where you could get a little privacy if wanted. They gave us a pager, like you get at a restaurant and told us it would go off when they were ready for me. My mother would get the pager while I was in surgery and she
would be paged when the surgery was done. I haven't had a lot of experience with surgery in other hospitals, but I was very impressed by the efficiency and thoughtfulness that went into the process. It really made the process a lot more tollerable.

The pager went off and a tech took me to get ready for surgery. I was brought to a changing room where I changed into a hospital
jonny and robe. I was taken to pre-op. Here, they gave me an IV. I met the anesthesia team and circulating nurse for my surgery.

[My girlfriend works in the operating room at this hospital and she was able to request most of my surgical team. We had wanted a nurse
anesthetist (we have two friends who are nurse anesthetists), but instead I had a resident anesthesiologist.]

They gave me some drugs and wheeled me into the surgical room. I think they gave me the block in the
pre-op room, but it is a bit fuzzy. I remember being wheeled into the surgical room and looking around at all the people and equipment in the room. They knocked me out and the next thing I remember is waking up in my hospital room.

Post surgery 
I don't remember being in post-op at all, but I guess my mom was there briefly to say hi. Obviously, I was still out of it. I woke up in my hospital room and don't remember anything in between. It wasn't at all like the experience I had with Ketamine, which is good.

In my room, they gave me a "
PCA" (patient controlled analgesic), also called a pain pump and showed me how to work it. Essentially, I had a button that was hooked up to a machine and I could request more pain meds by clicking the button. The machine is programmed to not over medicate and I could get a dose every 7 minutes if I needed it.

I was very warm in the hospital. I don't know if it was really warm, or if it was because I was on a plastic mattress, or if it was a side effect of the surgery or drugs. Who knows for sure. Anyway, at one point, with the nurse's permission I changed into my boxer shorts and took off my hospital jonny. That made me a lot more comfortable. So, if you're having surgery, I would suggest bringing some shorts or boxers to wear.

Kate, my brother and his Fiancee, and my mom came to visit. I was still in a bit of pain and I probably wasn't too much fun to visit. After a while I decided to get some sleep.

PCA - torture device?
 So, at first I thought the PCA was a great idea. If I was in pain, it would help me out and I had some control over it. My opinion changed later that night. The PCA is configured to only dispense once every 7 minutes. I think they do this so you can't easily remember when you can hit the button again. The night after surgery was horrible. Here is what happened all night long. I would hit the button a couple times and get my pain under control. I would then fall asleep for a small amount of time. Then I would wake up from my sleep in severe pain. I would then have to click my PCA button and wait seven or 14 minutes to hit the button multiple times. Eventually my pain would be under control and I could fall asleep again only to repeat the process. Sometimes, I would use the pain pump too much and it would start beeping. I would have to page the nurse to get the beeping to stop. I don't remember how many times I went through that process, but it felt like the night took forever to pass.

The PCA was horrible. I had no information about when I could get another dose. I had no information about how many doses were left, and the doses didn't last long enough for me to get a decent sleep. By the time morning came I wanted to throw that
PCA thing out the window.

The Morning After 
The following morning, I was still in a decent amount of pain. The surgeon came and visited me and did some evaluation and explained how the surgery went. It turned out that the end of my raidal bone was broken into so many pieces it was beyond repair. He had to replace it with a fake bone. Because of the pain I was in, he thought I might have to stay another night in the hospital. That was a little disappointing.

My mom came to visit and said I should ask the nurse if she could do anything for the pain. The nurse took gave me some IV pain killers and started me on some
oxycodone pills. She took me off the dreaded PCA machine. The pain killers kicked in and I felt a lot better. I really started to feel like myself again -- the pain wasn't bothering me at all.

The occupational therapy person came to show me some exercises and how to take the sling on and off. I said I was thinking about leaving the hospital that day and she said that was fine with her and got the ball rolling to get me released. Kate was getting off from work at 7 that night and my brother was coming to visit at the same time. I was released from the hospital and my brother drove us home.

I spent the next several days taking my pain
meds every two hours and sleeping a lot. I spent most of the time in bed or on the couch watching television. My surgery was on Wednesday. I came home on Thursday and did essentially nothing until Monday. I slowly reduced the amount of pain killers I was taking. On Monday I was able to do some work (I work from home) and it made me feel much better to be doing something normal. It also made the time go by much faster. 

This is part 2 of 4 posts I have written about my elbow surgery. 
You can read them all here:
Part 1: The Emergency Room 
Part 2: Surgery and Recovery
Part 3: The Ketamine Experience

Part 4: Follow Up


Unknown said...

Iteresting...Your injury seems more severe than mine< though mine is also a terrible triad elbow injury. I was on a ladder and was cautiously putting one foot on my ceramic tile roof when the ladder slid out from under me. The ladder fell and landed on the ground on its side< standing 2 feet or so above ground level. I fell on top of the ladder wiyh mr left arm pinned between myself and the ladder. I broke the ulna, the radius and tore the MCL>\...also broke at least one rib. The elbow dislocated to break off a part of the ulna but popped back in place. I have 3-4 fragments that look like "floaties" in the X-Rays. No surgery (yet) will determine need when I go back for follow up. I have a hard spliny which I can remove and do some flexing exercising to try and keep joint flexible. Most painful part of this has been the ribs..a cough is excrutiating> Im only a week out from injury so I'm hopeful I heal and dont requie surgery. Hope your recovery has been going OK...

DM said...

Hi Kevin,

Thanks for the note. I'm sorry to hear of your injury. That sounds like it was painful. Hopefully, you will not need surgery.

My recovery is going well. I should write a follow up, now that it has been a couple months since my injury.

I'm probably not going to be able to fully extend my elbow, but I'm pretty close. I think I'm about 5 - 10 degrees from full extension. I still have to stretch it every day.

For me, I think the biggest problem was that I shattered my radial head into little bits. This was beyond repair and needed replacement - so now I have the prosthetic radial head.

Good luck!

Felix said...


How is going the recovery of your elbow?
4 days ago also my brother had a terrible triad elbow injury and his surgery is scheduled for tomorrow.
It should be very useful and important for us if you could share your experience and recovery stages

Really thanks in advance


sharpshoota said...

I had the same injury also from falling while clipped in. Luckily 2 months out and 3 days a week of therapy my flexion and extension is almost symmetrical. Supination of my hand is off by 10 degrees and pronation is symmetrical. I will never use clipless pedals again. I'm also going to wait at least 6 months before getting on my bike. Thanks for writing about this as it was great to find someone with the same experience.