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Medical Forum / Diseases and Disorders / Prostate Cancer / April 2008During surgery recovery
I'm reading Walsh's book right now, and he's going into things one needs to do to prevent deep vein thrombosis during recovery. One, if I remember correctly, is to sleep with the legs elevated. This would indicate I need to sleep on my back, which I can't because of positional sleep apnea. How does one work around this? Are there other points, either immediately post surgery, or thereafter, where one would be required to sleep on one's back, either due to drip lines, or catheter lines, etc? > I'm reading Walsh's book right now, and he's going into things one needs > to do to prevent deep vein thrombosis during recovery. One, if I remember [quoted text clipped - 8 lines] > where one would be required to sleep on one's back, either due to drip > lines, or catheter lines, etc? I would not worry too much about thrombosis. They will have sleeves wrapped around your legs that constantly squeeze and release. Or, you can constantly flex your ankles for blood flow. However, you will have a couple of tubes sticking out of you and at least one IV going into you. It's very difficult to lay any way but on your back. If you haven't already checked into it, I would look at a C-Pap or B-Pap machine; at least for while you're in the hospital. > I'm reading Walsh's book right now, and he's going into things one needs > to do to prevent deep vein thrombosis during recovery. One, if I [quoted text clipped - 8 lines] > where one would be required to sleep on one's back, either due to drip > lines, or catheter lines, etc? I had no catheter or drain problems sleeping on my side, and no docs or nurses cared how I slept. (No nurses cared WHETHER I slept, until my surgeons got in their collective face, but that's a different story.) They provided pressurized stockings to prevent DVT in the recovery ward, and gave me snug stockings to take home. No one ever told me what position to sleep in at home. Does your sleep doctor/CPAP provider know your CPAP isn't doing its job when you're on your back? Have you added a chin strap to your CPAP so your jaw doesn't drop and allow your mouth to open? In the long term, sleeping on our backs isn't advised anyway. We should sleep on our sides with a pillow between our knees, to help prevent back and hip problems. Some guys here bought recliner chairs for recovery and loved them, but they (or at least mine) leave the legs below heart level, and I don't see how these guys get out of the chair (the easy way out of bed is to roll onto our side or stomach so we don't have to use our abs to stand up). I.P. > Does your sleep doctor/CPAP provider know your CPAP isn't doing its job > when you're on your back? Have you added a chin strap to your CPAP so > your jaw doesn't drop and allow your mouth to open? I don't have one. I just found out my insurance won't cough up for the overnight in the sleep lab, so I may need to test the effectiveness of the CPAP emperically (how the hell do you spell that?). I saw that some places rent CPAPs. That might be the way to go. > In the long term, sleeping on our backs isn't advised anyway. We should > sleep on our sides with a pillow between our knees, to help prevent back [quoted text clipped - 4 lines] > see how these guys get out of the chair (the easy way out of bed is to > roll onto our side or stomach so we don't have to use our abs to stand up). Yeah, I was thinking about that process of standing after surgery. >> Does your sleep doctor/CPAP provider know your CPAP isn't doing its >> job when you're on your back? Have you added a chin strap to your CPAP [quoted text clipped - 4 lines] > the CPAP emperically (how the hell do you spell that?). I saw that some > places rent CPAPs. That might be the way to go. CPAPs require a sleep test to a) determine whether you have apnea, b) determine whether your apnea is treatable by CPAP, c) determine the specific pressure YOUR pulmonary system requires to relieve the apnea, and d) justify and quantify the prescription required to obtain a CPAP. Considering how harmfully, often ultimately deadly, apnea is, not covering a sleep test and/or necessary CPAP is like not covering ANY medical exam pursuant to ANY life-saving or life-prolonging procedure. Would your ins company pay for an X-ray, a lab test, or an EKG if you break a leg, turn green and become pregnant, or have severe heart symptoms? Then it should pay for apnea testing if your PCP recommends it. You can appeal a coverage refusal that threatening and short-sighted. > Yeah, I was thinking about that process of standing after surgery. Lie on your side, facing the edge of the bed. Slide your top leg off the bed until that foot reaches the floor, slide that foot towards the head of the bed so it's under your torso to support you. Let your remaining leg slide off until that foot reaches the floor. This will roll your torso facing almost face-down. At that point you just stand up. Real simple, no effort involving your injured abdominal muscles, no pain. It's all done slowly and in full control so you can keep your abs relaxed. To get in bed, just reverse the procedure. I still can't figure out how one gets out of a recliner without using his abs. I.P. > CPAPs require a sleep test to > a) determine whether you have apnea, [quoted text clipped - 4 lines] > > Considering how harmfully, often ultimately deadly, apnea is, not If you die, they don't pay at all. Nuff said. > covering a sleep test and/or necessary CPAP is like not covering ANY > medical exam pursuant to ANY life-saving or life-prolonging procedure. Looks like the outpatient diagnostic services they cover are "Laboratory/Radiology/X-Ray" and "Therapeutic Services: CT Scans, PET scans, MRI, Nuclear Medicine" Now that "Laboratory" could give me some wiggle room. > Would your ins company pay for an X-ray, a lab test, or an EKG if you > break a leg, turn green and become pregnant, or have severe heart > symptoms? Then it should pay for apnea testing if your PCP recommends > it. You can appeal a coverage refusal that threatening and short-sighted. I'll first wait for them to cover my cancer care. I don't want to get into a pissing contest before that. > I still can't figure out how one gets out of a recliner without using his > abs. I'm with you; can't figure it out. However, I bought a LazyBoy rocker/recliner just before my surgery and it was by far my most comfortable place to be. Furthermore, I never had a problem getting out. I also found recently with a severe back problem, I could not lie in my bed, stand, sit, walk, or do much of anything else without a stabbing pain in my hip or back. But, I felt just fine in that, now old, recliner. Maybe I shouldn't say "old". The LazyBoy before that lasted 13 years. > I had no catheter or drain problems sleeping on my side, and no docs or > nurses cared how I slept. (No nurses cared WHETHER I slept, until my > surgeons got in their collective face, but that's a different story.) They > provided pressurized stockings to prevent DVT in the recovery ward, and > gave me snug stockings to take home. No one ever told me what position to > sleep in at home. I had a terrible problem switching to and staying on my side. Maybe my tubes were too short. I totally agree with Steve Kramer's response. TED socks take care of the thrombosis problem - and help keep the feet and legs warm at the same time. I have never been able to sleep on my back, either, but the stuff going in through the tubes helped me get through it just fine. Not to say that the first few days are a lot of fun, but we got through it OK. You will too. Best wishes to you, Dwight. Burney >I'm reading Walsh's book right now, and he's going into things one needs >to do to prevent deep vein thrombosis during recovery. One, if I [quoted text clipped - 8 lines] >where one would be required to sleep on one's back, either due to drip >lines, or catheter lines, etc? RP in 1995 (age 52) RT in 2000 ADT (Casodex) 10/06 - 8/07 Latest PSA - 0.18 > I totally agree with Steve Kramer's response. TED socks take care of > the thrombosis problem - and help keep the feet and legs warm at the [quoted text clipped - 4 lines] > say that the first few days are a lot of fun, but we got through it > OK. You will too. I'm slightly worried that if I'm on my back, and sedated, that might be a bad mix. I did wake myself up night before last, gasping, on my back. >This would indicate I need to sleep on my back, which I can't because of >positional sleep apnea. > >How does one work around this? I'm usually incapable of snort-free sleeping on my back but there was no prob at all immediately post-op....probably all the drugs and an exhausted body. Once home, I was sleeping on my side again. It would certainly be worth mentioning the apnea - I hear there are some efficient work-arounds. >> This would indicate I need to sleep on my back, which I can't because of >> positional sleep apnea. [quoted text clipped - 7 lines] > It would certainly be worth mentioning the apnea - I hear there are > some efficient work-arounds. Thanks, everyone, for the feedback. Use of a recliner is the best. It takes a bit to get used to, but will be fine...... Also, plan to get up and walk............Even after surgery, or shortly thereafter, walking prevents blood clotting. They do provide socks that help prevent problems also. I was walking around the hopsital at 3:00 a.m. because I would wake up, and wanted to get up and go...... Good wishes......jloomis > I'm reading Walsh's book right now, and he's going into things one needs > to do to prevent deep vein thrombosis during recovery. One, if I remember [quoted text clipped - 8 lines] > where one would be required to sleep on one's back, either due to drip > lines, or catheter lines, etc? > I'm reading Walsh's book right now, and he's going into things one needs > to do to prevent deep vein thrombosis during recovery. One, if I [quoted text clipped - 8 lines] > where one would be required to sleep on one's back, either due to drip > lines, or catheter lines, etc? Before my wife's back surgery, she couldn't lie on her back at all. But during one test before her surgery she had to be on her back. They managed to adjust the bed so she was not too uncomfortable. I recently spent the weekend in the hospital because of a bad fall, and was having problems lying on my back at the time. They also wanted my legs up even though they put the pressure device on. Again, they managed to adjust the bed so I was not uncomfortable. Those hospital beds are pretty well designed for coping with a variety of problems. or the few days you will be there recovering from surgery, lying on your back will probably be the least of your problems. By the time you get home, the main precaustion to avoid a blood clot in a leg will be to get up regularly and move around for a while. Since I tend to sit at my computers for hours at a time, I got an interval timer which rang an alarm after half an hour or so to remind me to get up and walk around. > Since I tend to sit at my > computers for hours at a time, I got an interval timer which rang an > alarm after half an hour or so to remind me to get up and walk around. I dispensed with my computer chair months ago, and now sit down primarily to eat my meals. Otherwise I'm on my feet all day, and my back and metabolism thank me for it. It took maybe a week to adjust, and now my old aching back doesn't ache any more. Then just last week an article appeared in the media about a guru who promotes this in industry and home. I.P. > Before my wife's back surgery, she couldn't lie on her back at all. But > during one test before her surgery she had to be on her back. They [quoted text clipped - 11 lines] > computers for hours at a time, I got an interval timer which rang an > alarm after half an hour or so to remind me to get up and walk around. I'm not sure if you understand sleep apnea. When I sleep on my back, my throat collapses and closes off my wind-pipe. I can't breathe without eventually waking and gasping for air. Hopefully, under sedation, I could still wake for air. > I'm not sure if you understand sleep apnea. When I sleep on my back, my > throat collapses and closes off my wind-pipe. I can't breathe without > eventually waking and gasping for air. Hopefully, under sedation, I > could still wake for air. Even if you have tp pay for the sleep test yourself, it could save your health, even your life, if it leads to a solution. I presume you're aware its very significant impact on diabetes, weight, heart health, cognitive function, automobile wrecks, job performance, and other functions and systems. My nurses gave me simple OTC Benadryl to help me sleep. The combination of Benadryl and the narcotic drip befuddled me to the point that even when I awoke I was unable to roll over; I couldn't figure out how to do something that simple. As the man said, be certain your doctors and recovery ward staff know you have apnea. I asked for extra pillows to build a contoured nest to hold my legs and torso in a comfortable position. Slept like a log even without the Benadryl once my docs solved most of the recovery ward problems. I.P. > I'm not sure if you understand sleep apnea. When I sleep on my back, my > throat collapses and closes off my wind-pipe. I can't breathe without > eventually waking and gasping for air. Hopefully, under sedation, I could > still wake for air. That's my wife's problem. C-Pap didn't work well, so she graduated to a B-Pap. Now she has one that runs the air through heated water. Almost makes me wish I had apnea. >> Before my wife's back surgery, she couldn't lie on her back at all. >> But during one test before her surgery she had to be on her back. [quoted text clipped - 17 lines] > eventually waking and gasping for air. Hopefully, under sedation, I > could still wake for air. Sorry, I missed the sleep apnea. That particular ill I've managed to avoid so far, and I have much useful useful to say. I know my dentist claims to be able to prevent it by an appropriate device. I understand it is roughly similar to a bite guard, which I do use, but works differently. I do have GERD, meaning my stomach regurgitates fluid into my esophagus. That is controlled by medication which reduces acid levels, but the basic mechanical problem remains. So I get GERD laryngitis from the fluid that gets far enouugh up. Sometimes that happens when I fall asleep and I get a harrible coughing fit. The best I've come up with to avoid it is a pillow arrangement which keeps my head up high enough. That helps with the GERD also. > I do have GERD, meaning my stomach regurgitates fluid into my esophagus. > That is controlled by medication which reduces acid levels, but the [quoted text clipped - 3 lines] > avoid it is a pillow arrangement which keeps my head up high enough. > That helps with the GERD also. The literature says GERD responds far better to torso inclination than to a raised head. Tilting my whole bed by raising the head by about 6" helped, but my 100% cure comes from the PPI you and I take. I had to have my esophagus dilated (think having baseball bats driven down your throat), and they made it clear that if I don't stay on the PPI, I'll need to repeat the dilation. Haven't missed even one pill now in 10 years. That's one nasty procedure. My concern, which docs pooh-pooh, is that our stomach acid serves many important purposes, including the digestion and assimilation of many nutrients and protection from food poisoning. I.P. >> I do have GERD, meaning my stomach regurgitates fluid into my >> esophagus. That is controlled by medication which reduces acid [quoted text clipped - 10 lines] > throat), and they made it clear that if I don't stay on the PPI, I'll > need to repeat the dilation. Sorry to hear about the dilation. The worst I had was an endoscopy, but because of the drugs they used, I remembered nothing about it and was fine afterwards. I was experiencing unpleasant, persistent dry mouth, which might conceivably been caused by the PPI. My gastroenterologist, who has been write about everything else he has told me, said he doubted it was the PPI, but just in case I tried reducing the dose. He said the only guide was symptomatic, and I found I had no heartburn or osther esophageal symptoms if I took it every third day, so I've been doing that. On rare occasions, if I have some heartburn, I either take an additional pill, or I use an antacid pill. But, as I noted before, the PPI doesn't control the regurgitation into the esophagus which can get up in my throat and irritate my vocal cords, hence the GERD layrngitis. I gather the only treatments for controlling regurgitation involved surgery. This can be done through an incision in the chest, but that is major, major surgery, and only undertaken in extreme cases. Gastroenterologists can also do something from inside the esophagus, and my gastroenterologist is an expert in that, but he will only do it in cases where the patient has serious difficulty swallowing. > Haven't missed even one pill now in 10 years. That's one nasty procedure. > [quoted text clipped - 3 lines] > > I.P. >>> Before my wife's back surgery, she couldn't lie on her back at all. >>> But during one test before her surgery she had to be on her back. [quoted text clipped - 31 lines] > avoid it is a pillow arrangement which keeps my head up high enough. > That helps with the GERD also. I have GERD. Another thing to do is to raise the head of your bed. I have cinder blocks under the feet of the head of my bed. After you do that, don't put slick sheets on the bed, or you'll feel like you're climbing Everest all night long. >>>> Before my wife's back surgery, she couldn't lie on her back at all. >>>> But during one test before her surgery she had to be on her back. [quoted text clipped - 37 lines] > that, don't put slick sheets on the bed, or you'll feel like you're > climbing Everest all night long. I would have to get one of those fancy beds that allows you to do different things on different sides. I suppose my wife and I could use twin beds, as all married couples once did in Hollywood movies because the Hayes Office insisted. (I always wondered about that because my parents and all the parents of my firends used the same bed.) But we have shared the same bed for almost 50 years now, and I don't want to separate. What I did instead was to find a large wedge shaped "pillow" to which I add extra pillows. That seems to do the job well enough. > I would have to get one of those fancy beds that allows you to do > different things on different sides. I suppose my wife and I could use [quoted text clipped - 3 lines] > have shared the same bed for almost 50 years now, and I don't want to > separate. We didn't notice the raised bed. The recommended 6 inches isn't that noticeable except to my GERD. But your wedge should do the job as long as it inclines your torso adequately. It's certainly easy to try it out. I.P. |
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