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A

AndyChas

Well-known member
Joined
Dec 26, 2008
Messages
69
Location
Armidale, NSW, Australia
Bookjp?s ?post-op tube? thread is getting slightly scary but if all you heart surgery veterans can cope with a few other queries about the hospital experience I?d appreciate some advice.

Firstly, how does the self-regulated morphine supply work in the ICU? I assume you can?t take too much, but other than that I?m completely ignorant. And yes, I?m also a coward and a wimp and I want to make sure that I?m well protected against pain when those other tubes are yanked out.

Secondly, and still harping on about potential post-operative pain, are effective back and neck massages able to given by non-qualified people? My cousin has almost finished chiropractic training and one of my sister?s friends is a masseuse, so I was thinking that one of them could show a family member what to do. Does this sound feasible, or should I just cough up some money and try and find a therapist who has worked with heart surgery patients before?

I think I?m coping rather well with pre-op anxiety, but if your reply contains an account of vomiting in ghastly circumstances I don?t want to know!:eek:

Andy
 
Hi Andy. Make sure you know what your pain meds will be in ICU. I wasn't on the self-regulated drugs while in ICU (I think they were giving me injections or pills) and by the end of the night was in massive pain (8-9/10). I threw a mega hissy fit and demanded the self-regulating drip - within 20 minutes my pain had dropped to a 2-3/10, so not sure what they were giving me before then, but it sure didn't work!

Anyhoo, the drip set-up was great! I was able to administer a shot every 5 minutes with a maximum of 12 shots per hour. If you pressed the button before the 5 minutes elapsed it wouldn't release the drug, but would record the attempt which helped them gague how well pain was being managed. While I was on the drip my level of pain was very low and I was able to sleep quite well too (I think they gave me other meds to help with that so I wasn't fully reliant on the drip... I can't remember for sure, but I was never in more than 4/10 pain while on it - quite managable!).

When I started doing better with the pain (after the drainage tubes and catheter was removed) I was only self-medicating every now and then... which was just as well, because my drip packed up after a day or two and I was back on pain pills, but by then that was all I needed.

So no - you can't OD... and yes - they do make sure you've had a dose of pain meds before they take out the tubes (if they don't, make sure to ask for a hit and a bit of time). It was not the most pleasant thing in the world, but certainly not that painful or unbearble.

As far as family/friends giving you some massage, they told me that was OK. My BF was quite reluctant since he was afraid he'd hurt me, but I assured him as long as he kept to my back and shoulders there wasn't much he could hurt. If they're a bit unsure, start out gently and slowly increase pressure and if you've got some "pros" to give them some tips I'm sure they'll do just fine! I also found a heat pack IMMENSELY helpful, so it would be worth investing in one before you go in.

No vomiting!! Just a bit of dry heaving at the smell of the disinfectant they used when prepping for needles (but that's a smell I personally have HUGE issues with... when I figured out that's what was causing it, I just held my nose until they were done - no more dry heaving! :) ).


A : )
 
The self regulated morphine works as it will let you have a small dose of morphine every 10-20 minutes or so - you will press a button yourself and receive it - it's safe. But youll be on LOTS of other painkillers which will really take the pain away and make you pretty spaced out anyway - I wouldn't worry about the pain straight after the surgery - they keep you pretty doped up for the first half day or so.

Also even with the morphine drip it is only a short term solution - you are unlikely to be on this any longer than the first day - I was on morphine the first day a little, but it made me sick and the pain wasn't bad at all so I asked to come off it as soon as I was aware enough to realise it was making me drowsy and I never had the self administered drip.

The pain really aint that bad mate - youll never believe me, as of course getting your chest, tissue and muscle cut into and then having your sternum bones broken will be painful... but it really aint that bad... supprisingly :)

Also as for the massage thing - youre probably over thinking it again - I had a little upper back / neck pains, but that was mainly from sleeping funny / differently - if someone can give you a bit of a massage I'm sure that will help, but imo I don't think youd NEED to go anywhere professional - and probably not for any sort of prolonged period afterwards..

I think youll be suprised how mobile / flexible you are and how much you can do - and I KNOW you'll be suprised at the acceptable levels of pain - oh and as for getting tubes / wires taken out of your belly they might not even offer you any extra painkillers - it usually happens in the first day when you are pretty spaced out anyways - again, this sounds HORRIBLE, and scared the life out of me, but its more a strange feeling when they come out rather than a lot of pain...

Hope some of that calms your nerves :)
 
Hi Andy,
Dont worry about the pain too much, you'll be given such a lovely cocktail of drugs plus the Morphine that on the whole it's not a problem. As others have said the Morphine is button fed... As I had little else to do, I ended up watching for the green light on the trigger to light up and clicking it like some kind of demented lab rat!
The drain tubes and pulse wires were pulled out a couple of days later, now that was weird ! The nurse who did it was so matter of fact that I was put so at ease. She had one hand on the pipe and the other cupped around it aginst my tummy and pullllllllled... Voila, out it slides, no pain just weird like a scene from alien ! There were a couple of them and then onto the wires. "I'll just pull these two out if I can, but sometimes they get cought between your sternum when it's wired back together, in which case I'll just snip them off with wire cutter and leave them in there" she told me calmly !! Thankfully they both came out, another weird sensation but not painful.
I cant help with the massage thing but it would be welcome on the shoulders cos they can really ache sometimes.
 
I am just like you Andy, a big wimp lol ! Please don't think your alone on that one. Good luck!
I am sure you will be fine.
Brian
 
They did a great job of keeping me out of bad pain. I do not remember anything for 2 days after surgery and even the third day I don't remember being up, I think I was. It is not near as bad as you think. It is not a walk in the park but considering what they do.....my highest pain level was probably 3. I was lucky.
 
The first question the nurses will ask you EVERY time they come into the room is "How is your pain ?". Priority #1 is to make sure your comfortable. I had the drip in ICU and when I first was moved upstairs. The only issue I had is that when they moved me upstairs they cut my dose in half and THAT didn't go well at all. I had a bit of a hard time for about the first 12 hrs but then they took me off the self medicating drip and put me on Percocets which certainly did the trick :) My advice would be to understand what your dosage is in the ICU and then what it is when you first get moved to a regular room. If you start getting uncomfortable, ask for more meds, they will give them to you without issue.

The only real "pain" I had from that point on was in my back and shoulders and that was from laying in a bed all day. My wife would rub my back and shoulders for me which was of great help. I also had a heating pad that I put behind my shoulders.
 
Both my OHS I used percocet after the first 24 hours and it managed my main excellently both times. Immediately post op, my first round I remember almost nothing but do not remember any excessive pain aside from when they pulled my chest tubes. I had three and they pulled them all at once without warning me or telling me what they were doing. I came in as an emergency so had no pre surgery education. I have never felt such awful pain. The nurse immediately gave me morphine when she saw the pain I was in and it worked quickly. From that point forward, I was kept comfortable and had very tolerable pain levels.

My second surgery I remember immediately post op better and recall during the first night after my surgery, in CICU, I told my nurse I was starting to feel a fair amount of pain. He checked my chart and saw orders were okay for what he called 'good meds'. :) I didn't ask what it was but within short minutes after he gave it to me, I had no pain at all and had a wonderful sleep.

Before removal of my FOUR chest tubes at my second surgery, I told them how awful it was for me the first time. They said that shouldn't have happened and will be sure I don't suffer this time and they were good to their word. I felt slight discomfort at worst. I had my percocet about 20 minutes before they removed the first two (the others came out day 3) and it was a very different experience.

Speak up. Don't be shy and don't suffer needlessly. If you think they will be removing your tubes, ask for extra meds. You will get them.

The nurses do not want you to be in any pain they can relieve.
 
Everyone is different and everyone has a different pain threshold ?. Nearly three years post op I can honestly say that pain was not an issue ? I was kept well medicated in the hospital and needed very little pain meds after leaving ?. If you are healthy you should not have and major issues ?. Please do not upset yourself over the pain issue, I think you will be amazed as most of us were at how little pain was involved in recovery.
 
I honestly don't know how you people on the pain pumps managed to be with it enough to push the button. I was so spaced out on everything that just remembering to push the button didn't work for me, they had to manually give me meds.
 
My surgery was almost 3 years ago and I don't think I was even given the option to self-medicate. They just kept me completely comfortable the whole time with the IV drip.

I remember very little about ICU. A very stoned-like moment trying to get a cup of ice off the little bedside tray (which was immediately retrieved by the ICU nurse who I think, was there most of the time), my husband and daughter smiling down at me (the singly most lovely sight I've ever seen) and then the drainage tubes being pulled out. That gave me no pain. Was just like Woodbutcher said...like alien schlooppy things. She told me it would hurt abit, not much, told me to exhale when she reached counting to 3, which I did, and schloopp! They were out!

I wonder if I was given the drugs that keep you from remembering. I think you can request those. If so, it was great! If I had any pain (which my husband concurs, I did not, really) I sure don't remember at all!

I had no back pain or shoulder pain ever from this surgery. Several months post-op I had a full body therapeutic massage and it set off such severe (but all benign) heart arythmmias that I was miserable for weeks. Haven't had a massage since! Probably won't ever. Pretty sure I'm strange that way.

And I'm an overweight, middle aged mother of 3 (now all in their 20's). Surely a tough bruiser like you can figure out a way to get confident about the pain management. ;) Not meaning to be dissing you.... just know that you can trust us on this, okay? Honest. We're telling you that it is very very very manageable and easy to overcome. The drugs are fantastic!

Best wishes.

Marguerite
 
I was given a drip that gave me pain meds on a regular schedule but my first night in the ICU was horrible b/c I was stilin a lot of pain. The nurse was supposed to set up a pca device for my individualized morphine pump but failed to do it when instructed. So there was a period of time that night (very early the next morning actually) where I was bawling from the pain, banging against the bed rails and unable to speak because it HURT so much. When the nurse (the mean incompetent one) finally got the PCA set up and I was able to use it I felt a million times better and so much more comfortable.

Supposedly the PCA devices will not let you overdose because it will only allow you to pump so much into your system. However, I think I am very sensitive to morphine (this was my first time being prescribed it) because one of the nurses (the nice one) said that I had obviously taken too much than my own body could reasonably handle because on day 3 in the ICU (spent 5 full days in icu) I was a groggy mess and many of the things I was complaining of the nurse said was due to the amount of morphone I had given myself. I think that after the incident where I was in so much pain I just wanted to make sure I didn't feel that again so I kept pushing the little button they gave me at any slight twinge.

It took me a while to get the whole pain management thing under control for me and in the end it was because I stopped listening to the nurses and went with what my body was telling me. For example, when I was discharged the nurse said only take the painkiller for when I am in excrutiating pain--although the bottle said to take 1 to 2pills every x hours. When I finally made it to my sister's house, my bil was in shock that all I had taken that day was motrin and no painkiller and what bad shape I was in. He said it was obvious that I was in a lot of pain. So he immediately made a chart and started giving me a painkiller every 4 hours, then a few days later changed it to 6 hours, then 8 etc. Now I am on 2 painkillers a day and I just started my 6 week postop. It may seem like a lot to take so far out but my pcp told me it was fine because she said I have been doing a lot of physical activity and that the more I exert the more I will feel the pain and that rather than be uncomfortable and sit around doing nothing she would rather I take the meds so I heal in a comfortable fashion and exert myself as I please (within reason).

Anyway, pain management is very important but I don't think you should make this your pre-op worry. Just make sure you have a good surgeon, that you take care of any important admin issues (like taxes, important bills, etc) and get a lot of fun books and stuff you like to do for when you are in recovery.
 
Hi Andy,

Pain meds are great and I had no problems other than the one time I refused the meds thinking they were not needed. A few hours later I was back on the pills and life was lovely.I did not self medicate but is was never a problem getting any pain killers I needed.

Like Marguerite I was given drugs that give you a little amnesia (confirmed by my surgeon) so there are things I just do not remember.Pain was never a real problem.

As for the three chest tubes being removed. I never felt it.The nurse did a wonderful job.
 
Andy, first of all, sorry if my story of vomiting scared you or grossed you out. I had fentanyl in my pain pump and pumped it every 10 minutes or so some days and then not for hours on others. I was allowed to keep my pump up until about an hour before I checked out of the hospital and then they gave me a big ole shot of it in my IV line right before they took that out. I can say my actual "pain" was never more than a 2/10, however, there were times that I was more "uncomfortable" than that (does that make sense?).

While I was in ICU and not really with it enough to push the button, they would give me shots of fentanyl in my line even though I still had the pump. I think most of us experienced very compasionate nurses who are very concerned with your pain levels and trying to control them.

Good luck and sorry again.

Kim
 
Immediately post op I was given morphine in my drip,then after 24hours
or so they gave me percocet. I was pretty much ok,even when the pain
meds were wearing off at the 4-6 hour mark. For me the pain was not
nearly as bad as I had expected. After the immediate post op period,the
only time I even aked for the pain meds was at night,so I could move in
my sleep without being uncomfortable.
As far as someone massaging you--just make sure the nurse knows
so they can teach your friend the do's and don'ts.
 
My son had to be put on Fentanyl (stronger than morphine) which really freaked me out. They told me that younger people typically experience more pain. His hospital was great about managing his pain. He had the button and if that wasn't enough the nursed would come in and give him a bolus (IV injection) of more pain meds. His second OHS was only 9 months after the previous so he really knew what he was in for and he was a lot more resistant to the pain meds. Again, the hospital and nursing staff was great about keeping him comfortable. I think you'll be surprised at how well you do.
 
Anna: you’re a sweetie for always taking the time to answer all my queries! So, I can take a happy shot every five minutes and still not have to worry about ending my days in an opium den? Sounds good. By the way, if I was in 9/10 pain I’d also be freaking out! Thanks too for the heat pack tip; that might be just as good as massage.

Dan: I never thought I’d see the word ‘flexible’ coming up in this context, but reassurance from someone else who has so recently gone through it all is heartening. It’s also great to hear that you are recovering so well.

Justin: your ‘demented lab rat’ analogy is a scream!! And Brian: we might both be wimps, but some of the things we’ve gone through recently like the angiogram and TEE perhaps show us that we shouldn’t be too worried about the big one coming up? I can’t remember feeling any pain whatsoever when the catheter tubes were removed from my groin; I was also really surprised at how easy the TEE was. I know that you aren’t feeling too well at the moment, but you came through it with no problems as well? I’ve decided that the lung vent, if I’m conscious of it, might still come as a bit of a shock, but to just go with the flow…

Deb, Scott, Jkm7, Cooker, Ross, Marguerite, CP, Dina, and Deanne: thanks so much for your personal perspectives, and the further reassurances. I’m sure that pain and painkillers have been discussed here lots of times, but the importance of the interaction and support given so freely to new members like Brian and myself shouldn’t be underestimated. Marguerite: do I really look like a ‘big bruiser’?

Sparklette: I’m a little surprised to hear that you still need painkillers, but your recovery path from the ICU has obviously been harder than some (most?). Your ICU extreme pain episode, as awful as it must have been, seems to come down to incompetence. Perhaps Anna’s did too?

As for choosing surgeons, we don’t get that luxury here (public patients like me, at least). However, I’m not sure whether I’d be getting much better care privately, apart perhaps from having more privacy. I do know that the hospital I’m going to is one of the leading cardiac centres in the country, and I’m assured that my surgeon is very experienced in valve repair/replacement, and very good at his job.

Kim, don’t be sorry; I was just trying to be light-hearted about your horror story (I haven’t quite got the hang of the whole emoticon thing yet). 2/10 pain: that sounds better! On the whole, I’m actually feeling pretty relaxed with a week to go.

Andy
 
Sparklette: I’m a little surprised to hear that you still need painkillers, but your recovery path from the ICU has obviously been harder than some (most?). Your ICU extreme pain episode, as awful as it must have been, seems to come down to incompetence. Perhaps Anna’s did too?
Click to expand...

I'm still taking some painkillers at night (Nurofen Plus) since I'm still getting a bit of discomfort when changing positions (I think the lack of movement makes everything stiffen up and a bit awkward). The panadol they had me on was - and always has been - totally ineffective and any my GP and I agreed it was important to have comfortable sleep to aid recovery. Otherwise I don't require anything more than a nice shoulder rub ;)

I also think whatever it was they gave me in ICU was just not effective for my system (I unfortunately have a ridiculously high tolerance to a lot of drugs) and as much as my nurse was sympathetic to my pain, it seems the doctor never came in to see me first hand (until I chucked the hissy :D ). As has been said here already - dont' be shy when it comes to letting them know if you need anything. Generally they are very responsive.

Glad to hear you're coping pretty well :) I think being able to hear other people's experiences is an enormous help. It sure was for me.


A : )
 
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