Mandatory in-patient rehabilitation?!

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cuoricino

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I've done it. I've graduated through all the levels at the hospital and got my discharge papers today. Go me! 🙌 Then I learn they're really transfer papers. I'm going to a rehabilitation center. Ok. Hmm.

This is my 2nd operation and I didn't have to do this the first time. I'm young (36) but my roommate in rehab is younger and has been here 2 weeks!! When I ask the Dr. how long they think they'll keep me she says 15 days. Panic.

Disclaimer: I'm in Italy and specifically asked my cardiologist about this rehabilitation practice before my surgery date because I saw on online forums that many previous patients had been sent from the hospital to rehab. His response? "You're young, I doubt you'll get sent there... if you do maybe a day or 2." No hospital staff gave me any specifics during my time in the hospital. It was always, "let's see how you're doing tomorrow."

I'm so bummed!!! I just want to be in my own bed. I feel about as good as I did last time I was discharged for this surgery (discharged this time 6 days post op, last time 8 days although they kept me a couple extra days as a precaution back then.) Has anyone else experienced this? I feel completely blindsided. 😩

I have a young daughter and don't know what I'll do if I have to wait another 2 weeks before seeing her. They're being really strict about visitors due to COVID 19.... no kids allowed. 😭

Apologies for the negativity. I'm feeling pretty down about this.
 

Paleowoman

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Hi cuoricino - congratulations on getting your discharge or rather transfer papers !

I've heard that some countries give rehabilitation after surgery, after several types of surgery in France at any rate. But certainly not in the UK - rehabilitation is beyond the NHS !

But with this virus going round it is not good that you can't see your little one. Can you discuss all this with the medical staff at the rehabilitation centre when you get there - explain how well you're feeling and that you have a young daughter and that you want to get home ! Perhaps they'll let you go ? Otherwise, can you do Skype or Facetime or whatever with your little girl ?

Best of luck, and wishing you a continued speedy recovery !
 

tom in MO

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Congratulations on your continuing recovery!

I cannot remember anyone in the US going straight to rehab after OHS. Usually it's straight home, cardiac rehab as an out patient after 2-3 weeks. Can you just leave and go home? I come from a family of stubborn people, my wife has left the emergency room w/o seeing a doctor when she decided it wasn't for her.
 

Astro

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Inpatient rehabilitation makes sense for people who would struggle to look after themselves at home. Clearly this doesn't apply to you. They can't keep you in against your will. Good luck sorting out a plan that makes sense for you. I was 45 and went home on day 6.
 
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Stowegirl

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I’ve just been reading how bad this coronabirus is in Italy. Have you thought they want to keep you safe while newly operated on?
 

cuoricino

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I’ve just been reading how bad this coronabirus is in Italy. Have you thought they want to keep you safe while newly operated on?
Honestly in all this, this is the only silver lining here. Not just COVID 19 but also all the germs my daughter and husband tend to bring home (someone always has a cold in my house). I'd rather avoid risking getting sick so I'm telling myself a few days here won't hurt.

Unfortunately one of my roommates has dementia and was up "fighting" with someone only she could hear until 3.30am. Then they came to take a blood sample at 5.30.

This isn't healing. This is torture. I'm going to try for a room change, but probably try to sign myself out against Drs orders if that's not possible. I don't know why I'm here or why no one explained this to me as part of the process pre-op.

I may be ultra cynical after all my years in Italy, but I have to believe someone is profiting off of all this somehow.... keeping people in beds who the public health system pays for, even if this is a private rehab center. 🤔 Two weeks here seems downright ridiculous.
 

Suckyvalvegurl

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That seems crazy. Honestly, the safest place is home. Any inpatient facility has all kinds of germs.

I have never heard of this being done unless someone was elderly and infirm.
 

tom in MO

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...I may be ultra cynical after all my years in Italy, but I have to believe someone is profiting off of all this somehow.... keeping people in beds who the public health system pays for, even if this is a private rehab center. 🤔 Two weeks here seems downright ridiculous.
You may have it right there. It's not unique to Italy. In the US, they do the same thing. A bed filled with a patient paying less money is less of a daily loss than an empty bed.
 

ForeverThankful

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This is crazy, you can't heal where you are. It's not good physically because of germs and it's not good emotionally.

If it were me, I would first talk to a person in charge, explain the situation and hopefully they would discharge you. If they didn't want to do a discharge then I would just sign myself out.
 

Protimenow

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Here's a way that may make it easier to get discharged:
Corona Virus is apparently a problem in Italy. You're much more at risk in the rehab facility (visitors bringing the virus on their hands), close proximity to others, and shared ventilation in the facility. The risk of death for heart patients is supposed to be as high as 10%.

Tell them that you'll feel much safer at home than you are in that higher risk facility.
 

catwoman

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Unfortunately one of my roommates has dementia and was up "fighting" with someone only she could hear until 3.30am. Then they came to take a blood sample at 5.30.
The roommate is “sundowning,” and I can’t imagine any medical facility not giving a dementia patient a room to themselves. And asking for a family member to stay, at least at night.
Two years ago my husband, who has Alzheimer’s, required hand surgery and, being a heart patient, was on a cardiac floor of a hospital about 60 minutes from our home. I stayed with him. A patient across the hall started screaming about 7:30 p.m. I remarked to a nurse that I thought someone was sundowning, and she confirmed that.
Unfamiliar place + familiar caregiver missing + dementia patient = nightmare for all. No one — patients, nursing staff, doctors, next of kin — gets much-needed rest. BIG MISTAKE!
That’s why I always stay overnight with my husband. I do not want to ”inflict” him on the medical providers.

And I can’t imagine why inpatient rehab is routinely needed. My FIL (age 74 and a widower) had inpatient rehab in 1990, but he had just undergone 4 bypasses, ascending aorta repair, a 2nd MVR plus his first AVR. He also lived 75 miles from the hospital, without anyone to care for him while he recovered, and was put on warfarin for 6-8 weeks. He NEEDED rehab to build up his strength to return home.

Fight the system.
 

cuoricino

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Ok, hive mind. I've had it.

All my vitals are good and all my meds are taken by mouth, no more IV. My INR is in range. When I asked the dr (again) to leave, they said they keep folks here standard 15 days. No. I just can't. My mental health is suffering.

I've been consulting with my doctor and nurse friends in the States for tips on what to do before my elective discharge. Could you help me, too?

What tests did you have done before they discharged you (echo, x ray, etc)?

What questions should I ask? (Med management, activity at home, when to call a dr etc)

What other information did you receive upon discharge?

Something that showed up on my last x ray (1 week ago) was pleural fluid. Have any of you been discharged with pleural fluid or do you think that's reason enough for me to stay?

I fully understand I should be seeking medical advice above whatever any forum participant could offer, but they've been so adamant here about me doing the full 15 days that I'm worried I won't get the "full treatment" if I elect to discharge myself. I'm trying to arm myself with all possible info.

Any other thoughts or suggestions welcome.
 

tom in MO

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For me I got a lecture from the pharmacist on warfarin and my INR. I also got a page or two on restrictions, such as:
  • Don't lift anything heavier than a gallon of milk (e.g. 4L).
  • Don't drive if I am on opiate pain killers.
  • Take it easy, eat well, sleep.
I got a workbook with exercises, but was told not to do them until I started cardio rehab. This started up about 2 weeks after discharge. You can find a lot of this type of patient care information on line. The british health service used to have some booklets.
 

daVinci

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Well done on everything so far!

Did you manage to escape rehab?

I hope you're doing well and your pleural effusion has resolved. Definitely best not to leave if it's a big or recurring one
 

Protimenow

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Don't drive if you're on opiate pain killers? Really?

You probably shouldn't drive when you're drunk.

Maybe you shouldn't drive at all -- if you're in an accident, the seatbelt may pull on your sternum, the airbags wouldn't be good for your chest, either, and being thrown against the steering wheel is a definite no no. Maybe you should just stay home, don't lift anything, and vegetate for a while.

Perhaps while your sternum closes up, you should be careful about lifing weights bigger than four liters of milk -- but after it heals completely, weight shouldn't be much of an issue (up to a point).
 

tom in MO

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I forgot, I was given a pamphlet on sex after heart surgery. Basically just easy does it for awhile as your sternum and heart needs to heal.
 

cuoricino

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Florence, Italy
Thanks everyone. I've calmed down a bit from my last post.

I let my dr know that I'd be signing myself out Monday. This would give my husband time to prepare the house, and I could come home on a day my daughter had school, giving me a few hours in the quiet house to settle in.

The dr responded by fast tracking the exams I needed, allowed an exception and let my daughter visit with me in the coming area on Saturday, and urged me to consider staying until Tuesday for my own good. They did xray, echo, and took my drainage tube stitches out on Monday. Mentally, this all put me in a much better place.

Sunday my husband and daughter came down with a bad cold, so I thought twice before signing myself out into all those germs. New timeline is Friday discharge - the doctors are meeting me in the middle and letting me go home 3 days earlier than usual. I'm actually relieved I have a place to stay until my family gets over their cold.

Did I mention I'm in Italy and COVID19 is a real concern? Ugh.... anyway, I was able to reach a conclusion with my doctors which felt good. My progress has been great and I feel stronger everyday.

This has been a big lesson in shifting from my American go-go-go mindset to the more intentional Italian, "slow down!"

Prima di tutto la salute!! (Above all else, health)
 
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