Pain, breathing and sleeping, have not yet mastered any of the 3

[jake]

So if those of you who have not gotten over here to the other side, and managed to regain a "normal" existence, to you all I have a question or two about breathing pain and sleep.

Please keep in mind that I know I get long winded, (writing wise) so I will try hard to keep it short and insightful.

Part of my problem is that every single practitioner seems to have a different opinion as to what I should doing 6 days post-op breathing wise. Some doctors have me thinking I should have like 80-90% of my pre-surgical capacity by now, I just can’t imagine how that could be possible. I am running no temp, I have a minor sinus drainage thing going (which is being treated and is clearly getting better), and no heavy coughing or crud in the lungs. I simply can’t get any real volume going. The finger clip thingie is reading 95-100% consistently, and the lungs sound clear as can be (or so I am being told). The chest X-ray from Monday was clear and everything seems to be in order.

The at home nurse came to visit, and she thinks that my pain is not being managed well and that pain is #1 at this point in improving the performance of the diaphragm and lungs. I have to admit, my breathing is VERY painful! I don’t need to tell you how much pain the early going is, but is it typical to have pain on both sides of the diaphragm during a “breathe in” exercise? I often sound like the kid in the wheelchair on Malcolm in the Middle when talking trying to get breath during a long conversation or phone call. Lots of pauses for breath and slowing to take a breath.

I know everyone will heel differently, and I’m likely just over thinking it. I want to exercise with the breathing apparatus they sent me home with, but when I was in the hospital post surgery (still in ICU) I was pushing almost 2000ml with improvements every day. Once I landed in the step down unit, I started seeing less improvement and some declines. Now, I don’t seem to be able to manipulate more than 1500ml of air with no real improvement. What has changed? When I was in the ICU, I was taking Oxy Contain (5-10mg) every 4 hours with quick release, and 10mg) extended release every 10-12 hours with IV dilauded (sp) occasionally to smooth out painful procedures (getting up the first time, sitting, walking removal of tubes etc). In the step down unit, no more IV pain medication, and the immediate release Oxy went to 5mg +Tylenol and still stuck with the extended release every 10-12 hours. They sent me home with Oxy (5mg) and told me 5-10mg every 4 hours for pain as needed. I can’t take 10 mg at a time without bringing on a bad headache so its 5mg oxy and Tylenol. Pain is tolerable but when I breathe in to exercise my diaphragm, it hurts in my entire torso from neck to gut. I am outside walking a couple times a day (16 degrees out there yesterday). But they said as long as I am warm, and it’s not slippery, to get to stepping! It seemed like I was walking more in the hospital because of the large open areas of indoor space.

Should I be pushing through the pain? Should I be calling for more/better pain meds? Man, I hate to sound like a baby, but a guy can only take so much! I just feel like I am making no progress improving lung functions. Or, am I simply being impatient and need to take a chill pill and relax a little bit? Again, sorry for the long winded posting, right now, long winded typing is pretty much all I have going for me.

 

[Duff Man]

I would definitely talk to them about the inadequate pain management, and ask them essentially the same stuff you asked us here.

 

[bigsidster]

Jake my friend ,sounds like my story.Pain,can't sleep,agitated and down right ready to ring someones neck.All do to lack of proper sleep.I went to my family doctor with the vitals paper they give you at the hospital upon leaving to give to your doctor .These vitals bring your doc up to speed.As she was reading it she saw that they were giving me LORAZEPAM 1mg at bedtime in hospital and i was able to sleep.So my doc had me take 1/2 mg LORAZEPAM during the day which calmed me down along with the extra strength tylenol so that i could walk around with little pain and I lost all my agitation.Again at night just before bed 2 tylenol and 1mg LORAZEPAM and i was off to sleep within 15 min.The LORAZEPAM is an anti depressent not a sleeping pill.I guess all the feelings we hold back pre op and post op to show we are MEN can catch up with you.I am 17 days pre op now and feel great.Chest is still sore but with daily exercise and pain meds it is fine and gets better each day.

 

[AgilityDog]

Pain meds and anxiety meds can help with the breathing. Hell dude, you're only 6 days out! Yes pain affects your breathing, as does lack of sleep, and anxiety causes more pain and sleep loss.
It took me a month at least, to be able to sleep well. If it's not the pain, it's the anxiety. I still had the anxiety with my second surgery, but not nearly what I had with the first one, when I was critical.

I still have some aches in the rib cage and sternum at night, and have to turn over carefully. Even that affects the quality of my sleep. I'm 4 months post surgery.

Really, it took me 3 weeks this second round, and closer to a month or more the first round, to get my full lung function back. Part of it depends upon just how ill you were before surgery.

 

[Lynlw]

IF the pain is that bad and your breathing exercises seem like you are doing worse not better, I would call the doctor, there might be a problem like fluid ect

the sleeping problems are very normal

 

[Mentu]

Jake, follow Lyn's advice! You should not be seeing a decline when you use the incentive spirometer. By 3 weeks post surgery, I stopped using it because I could consistently move it above 3500. If you are seeing a decline, it isn't normal and, as Lyn said, could indicate some fluid build up which can cause painful breathing. Your surgeon's office will have had experience with this problem. Are you walking, Jake? I found walking to be the most helpful thing for breathing; if this problem is limiting your walking, it is yet another indicator that something is going on that needs to be dealt with now.

I think you are wise to share everything with your family Doctor, who, after all will be caring for you full time before long. One issue to discuss with your family Doctor is that some weeks or months after heart surgery it is very common for one to become deeply depressed, especially, if one has any history of depression. Through talking about it with your own Doctor, that depression can prevented or eased before it happens...just one more unexpected event of the race. For many of us, Jake, this is the first time we have experienced this kind of serious health event so take care and don't worry about how many words you write....we are not counting.

Larry

 

[tprice54]

I did not come off prescription pain killers for 2 weeks, then to the tylenol. You need to manage the pain in order to accomplish all your other goals. PLease manage the pain, you will feel much better!

 

[Michelle D]

I was on prescription pain killers for 3 weeks. Your breathing exercises are important but don't get so hung up on the numbers. Get your pain under control and the breathing will come back with doing breathing exercises. I was breathing at about 1/2 my normal capacity at day 5. It slowly improved over two weeks.

 

[jake]

Called the Doctor, You were all 100% right!

Called the Doctor, You were all 100% right!

Howdy all, it’s almost bed time and I am relived to note that I have seem some great improvements after calling the surgeons office and an at home nurse visit. The Diuretic they gave me to take for my first post-op week gets me up every two to three hours to turn on the sprinkler system anyway, but I figured hell, if I’m going to get up every 2 hours anyway, I’m heading back into my own bed from the recliner. The office suggested that I infuse the Tylenol with the pain meds at strategic times and double up on the Oxy on my 2nd middle of the night trip to the head.

Results were dramatic! I got a bed wedge and something to prop up my feet, my wife and I worked and perfected a system of getting me up out of the bed and back in, I hit the 10 or so stairs (very carefully) down and back up and can be back in the sack in 3 minutes or less! LOL!!! I couldn’t do that back before I didn’t have the surgery!

Last night resulted in about 2 – 2 hour sleep sessions and on the second, I doubled on the oxy and added a single Tylenol and boom, almost 6 consecutive hours of sleep and no headaches. Sure, I woke up with a lot of chest and back pain, but only because I missed a dosing cycle. I got up, took a 1+1 and started breathing and within a half hour, I was watching TV comfortably.

As for the breathing, your suggestions were great! The nurse at the hospital also said to start doing the breathing exercises seated, standing, leaning forward, bottom line, find the sweet spot. My wife and I screwed around with it for a bit and VOLA' back to the numbers I was seeing earlier and even some improvements. The at home RN came over today, gave me the hard once over, and said that recovery was better than average thus far. Great news and encouraging after the previous couple days of agony. It’s been like 16 degrees outside so I have only been out there a couple times, the rest of the day, I just hit the stairs a couple times real slow and that gets me plenty worked up. If improvemnts keep on coming, they said I can get on the stationary bike next week for a few minutes a day.

Gosh, I can’t thank you all enough for the great support and ideas and encouragement. Despite the pain, the anxiety levels are far lower today and I am looking forward to a better night sleep tonight and a better more enjoyable day tomorrow. I know it’s a long road back, but as I see, it’s a road well traveled by friends. Thanks again to you all and to all a GOOD NIGHT!

 

[normofthenorth]

Yay!! I was going to suggest a coupla those things, glad they worked. My OHS pain experience has been a weird outlier, with shockingly little pain -- sorry! But my biggest argument during my hospital stay was with a Cardiologist who was wrong for me, but probably right for you and most folks. She said that patients won't work hard enough at the Spirometer exercises unless they had Codeine or something similar to block the pain. And everybody says you've got to stay in front of it. . .

 

[watson524]

Glad to hear you're feeling better!

 

[Lynlw]

I'm glad to hear things are going much better.

 

[Superbob]

It's great that you're doing much better! I was just going to say that I had difficulty regaining oxygen function to the staff's satisfaction and spent much of the fifth day in the hospital walking laps and then taking the breathing tests. Had to get up to the number they wanted before they would release me. So I think just 5-6 days out, this is not all that uncommon. One thing I didn't have, though, was much pain. So I would press them on pain management. Difficulty sleeping is a very common post-op problem. It should resolve itself. Try to take restful naps.

 

[bigsidster]

Yes Jake,now that you are getting some sleep at nite,you should be taking an afternoon nap (Maybe after a walk) Only has to be 20 min to 1/2 hour but they do refresh you.And at nite just before bed a hot shower will relax you and you are in ga land in mins.