Blog changes

Thanks to everyone who followed Training Because I Can! over the last nine years. This blog started with Addison's Disease, hypothyroidism and a crazy idea of doing an Ironman distance triathlon. My life has changed and so has this blog. I am using this blog strictly for Addison's Support topics from here on out. I hope to continue providing people with hints for living life well with adrenal insufficiency.

Sunday, August 10, 2014

Failure and surgery and recovery

Long time no post, as usual.  I hurt my shoulder on June 20th, 2014 and I DNFed (Did Not Finish) Vol State for various reasons.  I hope to post about Vol State some other time.  I have some great pictures.

I injured my shoulder badly enough that I needed surgery.  I am hesitant to post anything about this because I am NOT looking for sympathy in the slightest.  I DO want to post about my surgery because it's the first time I've been under General Anesthesia since being diagnosed and I think it will help others to know how I handled it.

I have to apologize to others on my forum and in the past for acting like, "Well, just print everything out and tell them how it is!"  That was not how it worked for me (although close) and I can see how things could have gone very differently.

First, I printed out two of the below documents.  I am at a loss as to how to link the documents here.  My brain is not working

Surgery Guidelines
NADF Guidelines

When I met with the surgeon about the surgery, I gave him the Surgery Guidelines with my procedure requirements circled and he immediately called the anesthesiologist.  The anesthesiologist insisted on testing my sodium the day prior to surgery (fine but, in my opinion unnecessary).  I did not meet with the anesthesiologist until just prior to surgery.  I did not end up handing him any of the guidelines.  

Here was our discussion.  

Me, "I have adrenal insufficiency and need 100 mg Solu-Cortef prior to surgery."
Him, "OK, that's what I usually do, sounds great."
Me, "I present differently than many people with AI when I go into crisis, my BP goes high."
Him, "Yes, that's different, most of the time it goes low, right?"
Me, "Yes.  Would you mind giving me 50 mg Solu-Cortef through the IV after surgery so I don't have to worry about trying to take it orally?"
Him, "Do you want Solu-Medrol or Dexamethasone?"
Me, "No, I need the mineralocorticoid and fast acting Solu-Cortef."
Him, "No problem, you've got it.  I'll let them know in post op."

I have to say. there was more  and I felt very comfortable with his knowledge and that of his coworkers as far as AI goes.  Perhaps this is how people get in trouble?  Regardless, everything went fine.

Here was my protocol on the day of surgery:
10/10/10 HC in the morning before surgery (no food or water after midnight)
2 hour surgery at 2 pm with 100 mg Solu-Cortef
50 mg Solu-Cortef post surgery
2 hour car ride home

Results:

Day of surgery (Wednesday)
For the first time in my life after surgery, I was NOT nauseous.  I asked for a hamburger and fries as I was waking up.  I ate the whole way home in the car and had meatballs when I got home.  I actually did not feel terrible.  The amount of HC I got for surgery might have been slightly too much for a 1-2 hour procedure BUT I am glad that is what I got. 

Day 1 post surgery (Thursday)
Took HC (65 mg or so?  My usual is about 35) and pain killers as needed.  Felt better than I should because of the block on my arm.  No nausea.

Day 2 (Friday)
HC about 55 mg and painkillers at the end of the day.  No nausea.

Day 3 (Saturday)
Forgot 10 mg of HC in the morning that I should have taken and got nauseous.  Pain killers after noon.
50 mg HC.

Day 4 (Sunday)
I will have taken 50 mg HC by the end of the day and pain killers before bed.

Struggles:
Apparently, with shoulder surgery and rotator cuff injuries, sleep is a big issue.  The last 6 weeks have been tough sleeping.  Since surgery, sleep is about two hours at a time for about 6 hours.  Good thing I can function OK on very little sleep. Pain is not terrible considering the damage was extensive, they did extra procedures and put in extra hardware.  

If you have any questions, please let me know in the comments.
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