Wednesday, September 29, 2004

Postop: home alone

While postop planning is important for any of us, I often see questions from women who have recently moved or are otherwise alone and facing recovery on their own. While recovering solo is not the optimum, real world constraints sometimes mean we don't get to pick the very best options and just have to muddle through as best we can.

All other things being equal, being able to stay with someone for a couple days or having someone stay with us for that time makes for a safer transition from the hospital. Of course, this means someone tolerable. This isn't the time to have your evil ex-mother-in-law who expects you to wait on her hand and foot, or a worthless kid who will spend all their time out visiting old highschool friends, or a dear friend who will actually tell you she's busy with her kids right then but do call back any time you need help.

What is it that we will need help with, in those first few days? Let's look at that. First of all, you will need someone to bring you home from the hospital. You will most likely feel overwhelmed by just the minimal baggage from your hospital stay, and it's likely there will be a stop on the way home to pick up a prescription for pain meds (will your pharmacy let your doctor call it in and deliver to your home? check it out beforehand). Just sitting in the car (with a thin pillow between your belly and the seatbelt, for a little protection) will be about all the thrills you'll be up to, right then.

Another benefit of having someone pick you up is that they can help listen to your discharge instructions and take charge of the paperwork. You'll have some sort of written instruction sheet, usually, plus a card with your followup appointment and a prescription. I can't tell you how often women mention losing one or another of these by the time they get home. You'll have enough to do to get your body swathed in some sort of undemanding clothing and into the car; let someone else do the detail stuff.

Once you're home, you'll want to head for bed. Nothing in the world feels quite so wonderful as getting home to your own bed. Nothing. But is that bed up a flight of stairs? Climbing is difficult because you actually use belly muscles to help life your knees, so your doctor may advise you to limit the number of times you go up and down in a day (you'll discuss this at your pre-op, right?). Regardless of the number of trips you're allowed, you can greatly ease the burden on your belly by backing up and down the stairs. That's right: going backwards. Obviously you'll need to hold onto the rail, you can't carry anything, and you need to keep your wits about you and go slowly. But it really does force you to take the lift with your thigh muscles, not your belly. The first time you do it, it's nice to have someone standing by to help steady you if things get too wobbly and exciting. It gets better with practice.

Some of the other challenges you'll be facing in the first couple days at home are getting to the bathroom, getting yourself fed, and taking a shower. Pretty basic things, these are, but they are all fairly demanding to a fresh postop.

It's important to prevent complications and encourage healing for you to walk frequently. In the first few days at home, that's fairly well taken care of just in bathroom and kitchen trips. But if your bathroom is on a different floor from your bed, you may want to reconsider where you sleep for awhile. While some women camp on a sofa or recliner during the day to be close to the bathroom, I feel it's the nighttime trips and the first morning trip with a cranky "I can't wait" bladder that expose us most to haste, trips and possible stumbles or falls. This is a bad idea. Think this through beforehand and make sure that you can sleep someplace on the same floor as a bathroom until you are thoroughly steady and reliable on the stairs before you cut yourself off from the bathroom this way.

One of your major tasks in the early postop days is getting enough to drink. How much is enough? Enough that your urine is very pale. This means that every couple hours or so you'll be making a potty stroll. That sounds like a lot, but since exercise is another of your goals, this is a nice twofer. And while some women recommend keeping an ice chest next to your bed with drinks and snacks, that begs the problem of how it gets there if you're on your own. In fact, walking down to the kitchen to get a snack or another drink is more good exercise. So going to get a drink and walking to the bathroom to get rid of your last drink should provide a nice little perpetual motion effect for you.

And then there's the shower (assuming you've been cleared to do so by your doctor--ask before you leave the hospital). Showering feels wonderful, but includes some special perils so it's good to have someone standing by outside the bathroom in case you need to call for help. What kind of perils? First of all, you're not going to be nimble climbing in and out, especially if it's a bathtub shower such that you have to climb over the side of the tub. Take your time and hang on. Putting a waterproof kitchen chair in the shower may give you something to steady on plus a way to sit down if you get woozy. This is a good time to get one of those ucky old rubber tub mats, too. With your balance thrown off by a wonky belly, you need all the help you can get staying on your feet. And remember to put towels within reach so you can dry off before you try to climb back out. You can do all this alone, but someone "on call" for the first time is just good sense. A fall or even a flailing about attempt not to fall is not a good idea.

So, to prepare for these early needs, you'll need to walk through what's needed in your home. In your bedroom, do you have a variety of pillows and covers available? Where are the spare sheets—you'll be wanting clean sheets at least once before you can comfortably root around in a crowded linen closet's upper shelves. Can you reach a reading light from in bed without stretching? Is your bedside table big enough for a drink, kleenex, book, glasses, music device, laptop, TV remote? If not, move one in, move a reading lamp in, pile spare linens around on the furniture. Don't be worrying about a little clutter, since what is much more important is conserving your energy for needed tasks. Believe me: tidy matters not nearly as much as convenient when you are postop.

And while you're looking your bedroom over, how about clothing? At least a couple clean gowns/jammies need to be grabable without pulling out a heavy dresser drawer. Where are your robe and slippers? You may want some loose caftan-like garments or sweats to wear during the day so you are presentable for any visitors.

How about your bathroom? A couple rolls of toilet paper and maybe some moist wipes (you may be dealing with some constipation) within reach of the toilet? Several sets of clean towels out where you can reach them? Mild bath products in small enough bottles to lift easily and toiletries out of tricky cabinets? Tub mat? How about making sure you have a selection of reading at hand by the toilet? How's the light at night—will you need a night light or a temporary lamp near the toilet? And while you're thinking nightlights, how's the route between bedroom and bathroom lit? When you're foggy from drugs and in a hurry with a crabby bladder, you may not want to stop to fiddle with light switches in the dark.

And then, the kitchen. You'll be wanting lots to drink, of course. It's good to limit caffeine, just because that is a bladder irritant. Fruit juice (cranberry is especially good because of it's infection-resisting qualities), diet sodas, powdered drink mixes are all good things. But remember that you can't life the big bottles: things need to be in small containers. If you use a powdered mix (like Crystal Lite and those sorts of things), mix the full package in a very small, say 8-oz container, and just dilute it with tap water to make up the strength to taste. If you're a fan of ice, can you easily get to your freezer? Before you leave for the hospital, how about getting several trays of ice emptied into a container so ice doesn't require wrestling with a tray?

Most women tend to want fairly simple, blandish food in the first couple weeks postop, no matter how spicy and exotic their taste normally is. It's fine to eat more frequent small meals, but it's very important to make sure you get lots of fiber and nutrients. This is a good time to stock up on small yogurts, dried fruit, and other (wholesome) nibbly stuff as well as freezing single-serving meals. Make sure you can get to the utensils you'll want to prepare/serve/eat with. And if your dishwasher takes a lot of bending/twisting to fill, consider a small stock of paper plates to tide you over the first week or two. In the first couple weeks, opening a package or nuking a single serving are going to be about the level of your enthusiasm for eating. Smoothies are a great recovery meal too, if you like them and can keep frozen fruit easy to reach.

After a week or so, the level of chaos and dust may start getting to the tidier amongst us. Personally, I can ignore the dustbunnies up until they are large enough to trip over, but I appreciate that others may have more delicate sensibilities. If you know that you are going to be unable to resist grabbing a dustcloth or vacuum, please plan ahead. This is not something you'll be cleared for yet and really isn't a good investment of your healing energy. If you just can't live in chaos, arrange for a maid service, offer to pay a college kid, or ask a friend or church group member for help doing the heavy tidying up and laundry for the first few weeks.

And if you have pets, you'll need to plan ahead for their needs as well. A dog on a leash is more than you can handle, even if they are very well-behaved. If you don't have a fenced yard or a long tether for them, you'll need to arrange for someone to come in to walk them however many times a day is needed. If you have hard-to-control dogs, especially ones that are incorrigible jumpers, you may even want to think about boarding them out for the first week or so of your recovery. If their food involves lifting heavy cans or bags, consider parceling out those kibbles into smaller plastic containers you can keep on a counter for a few weeks and/or freezing single-portion dog meals. For cats, make sure that the litter box is something you can reach without serious effort (bending/twisting is especially difficult). If you frequently change the whole box, you may need to arrange for someone to do this for you. Alternatively, consider clumping litter that will allow you to scoop the used out (into a covered pail you keep by the little box till someone can dump it for you) and refill by scooping a small amount from an open bag you keep nearby. If your cat food is in a heavy or awkward container, consider repackaging it for easier access. And to protect your belly from enthusiastic jumpers (it is a frightening thing for all concerned to be dozing on a sofa postop and have your small dog or cat suddenly jump up for a snuggle and land on your incision), get in the habit of resting a pillow on your belly whenever you are sitting or lying.

Communications are another thing to think about. If you're going to be spending most of your time alone, make sure that what you'll be wearing has a big pocket that will hold your cell or portable phone. If you fall or get too woozy to leave the bathroom or anything really scary happens, it will be well worth the inconvenience of carrying that phone around to have it right on your person. Program in a couple numbers for people who can come in an emergency, in a hurry. The odds of your needing this are very low, but it will give you a sense of control that can be a comfort. Otherwise, having your phone on you lets you answer the phone without feeling the need to heave yourself up out of wherever you just got settled to take another call from yet another telemarketer. Don't feel you have to be at the world's beck and call--if you don't have a recorder of some sort, this might be a good time to get one. Leaving the volume up so you can hear it wherever you're hanging out so you can screen your calls is a great way to husband your energy for your own needs.

It's also a good idea to think of other household chores you may not be able to manage. Does the yard need to be watered or mown? Will you need to have the front walk shoveled free of snow so the postman can bring your mail? Who's going to refill the birdfeeder or water the potted plants on the deck (no, it will not be you picking up that bag of feed or full watering can for a couple months)? How far away is your mailbox? Can you let a few days' worth of mail accumulate or should you have the Post Office stop delivery for a few days? Do you need to drop a rent check at the condo office? Will your library books need to be returned (most libraries will let you renew by phone, so check with them on this)? Is there a newspaper delivery you will need to put on hold? How about your garbage/recycling pickup? Got enough furnace fuel and cooking gas to last the next couple months?

And of course you'll want some entertainment. If the weather's good, you'll be able to walk outside as soon as you can extend your range beyond the bedroom-bathroom-kitchen circuit. This is a big boost to the spirits, so even if you're not normally an outdoor walker, go for the air and sun. Remember that in the winter the footing will be tricky, though. A (light) cane or walking stick plus good boots will make a lot of difference in your stability.

I'm sure you can figure out getting movies/DVDs, or a big haul of books from the library. Don't make this the occasion for all those weighty and improving books you've always meant to sit down and tackle, though. Anesthesia and drugs have a clouding effect on the brain, and for the first couple weeks, at least, you'll find that only the most trivial, easy to pick up and put down froth will hold your interest. And light reading refers also to the books themselves: a paperback is easier to lift and rest on your chest while you read reclining than a great unwieldy hardcover. Ditto projects. This will be a good time to get photos sorted and put in an album, but only if it really engages your interest. Simple needlework or crafts that can be done reclining are appealing, but anything that requires that you sit at a desk and work attentively, not so much. Sitting itself will not be comfortable (it's very fatiguing for the belly) for several weeks. A sofa you can sprawl on (put a hassock out if you have one) or a recliner with a good side table are where you'll be spending most of your time, and so your entertainment and projects will need to work in that sort of setting. This also goes for your computer, if you use a tower rather than laptop and plan to use it much.

After a couple weeks you'll be feeling friskier, even though not quite ready to drive on your own (that depends on what your doctor and insurance company have to say). This is when you'll want to take up those folks who offered to do things for you by asking for a lift to the grocery store. You won't be able to lift your bags or carry them into the house, so be sure your ride is okay with giving you a hand. It's also challenging to push a shopping cart, and many women report that the motorized carts are absolutely the way to make your first few shopping trips. Remember, if you've done your preop shopping well, you'll only be out for fresh vegies and fruit and dairy and such on this trip. Right?

So, really, your greatest needs for other folks are when you first are ready to go home plus rides on other needed errands, a little early supervision, pets/chores that you can't handle, occasional cleaning and laundry, and backup in case of problems. By preplanning and setting things up before you leave for the hospital, then, you should be able to handle your hyst recovery fairly independently if your postop course is typical. It's a good idea, however, to at least rough out a fallback plan in case you develop some sort of complication or find that because your surgery did not go as planned, you aren't quite as able to manage on your own as you'd hoped. Overall, though, your greatest challenge will be the same as women living with any size of family will face: moderating your activity to only that which you can manage without injury or robbing yourself of energy needed for healing. Please repeat after me: I will get only one chance to heal well, and so I'm going to do a conscientious job of it.