Thursday, September 24, 2020

What to expect after surgery: Depression

Hello friends! In the last few weeks, I've answered so many questions about orthopedic surgery on Quora that people are specifically reaching out to me to answer their questions. (Sorry dude...I don't know when it's completely safe for you to smoke again after knee surgery, but I'm gonna say never.) As a frequent flyer in the orthopedic surgery center, I'm going to go ahead and proclaim myself an expert.

There are certain things that we all know that we should expect. We expect pain. We know that we'll need someone to help take care of us for at least the first day or two after surgery. But, the one post-surgical side effect that I always manage to forget about is depression. It happens every time, yet it's the one after effect that I put out of my mind.

I just had wrist fusion surgery on September 11 and all was going as well as I expected it to go. My arm was wrapped up, it was hard to shower and get dressed. I couldn't drive and, even if I could, where would I go? Plus, I'm in pain. I'm isolated, not really able to do much, having to count on my husband for many of my needs and exhausted. It stands to reason I wouldn't quite be myself. Plus, I've been taking pain medicine. I've been constipated. I already battle depression, so this is just amplifying an issue that already exists for me.

Finally, I opened to to my husband...really opened up. I told him that I was really feeling a lot of grief about my life not being exactly as I hoped it would be. I want to be able to be more active but find that so difficult. It sometimes feels that I have nothing to contribute to society anymore and that I have just given up. It felt good to tell him all of this, as hard as it was. 

I signed up for a pain and grief support group and then decided to start blogging again, since I feel that this is my contribution to society.  Then Scott made me go out for dinner. I didn't feel like it, but I was so glad I went. I really needed to get out of the house.

Here are a few recommendations for battling post surgical depression:

  • get dressed - that makes you feel normal again
  • get out of the house - go for a walk around the block, go for a ride with a friend
  • watch a funny tv show or movie - we've started watching Green Acres on Hulu and it always makes me laugh out loud
  • Talk with a friend - nothing makes me feel better than a chat with a friend. If you can't go to them, invite them to come to you, or call them

Surgery can be very jarring to the system. It makes sense that it leaves some emotional scars in its wake. Just remember why you had this surgery and take this opportunity to rest, recovery and take care of yourself.



Monday, September 21, 2020

Preparing for hand or wrist surgery

Every time I prepare for hand surgery, I go online to look for tips and am always surprised by how few I can find. Since I've now gone through several and am still in the recovery process of wrist fusion surgery, I decided that I should be the one to create the list of things everyone needs to know when preparing for hand or wrist surgery.


Before Surgery

Your surgeon has likely called in prescriptions for you. Don't forget to get those filled before surgery. Since this is a painful surgery, one of those prescriptions will likely be something for pain. The surgery staff will tell you to stay ahead of the the pain, but they probably won't tell you to stay ahead of the poop. When you're getting you're prescriptions filled, do yourself a favor and buy the following:

  1. Colace
  2. Senecot
  3. Miralax
  4. Prunes
  5. Apple Juice
  6. Other foods high in fiber
Do not wait until you're constipated before you start thinking about this. Get ahead of it. It is just as important as staying on top of the pain.

On the day of surgery, wear your comfiest clothes. My surgeon suggested elastic waist pants and a short-sleeve, button down top. Since this was not my first rodeo, I knew that I would likely be in these clothes for a couple of days, so I wore my pj's to the surgery center. Sure, I was the only person there in my pajamas, but they were super cute, comfortable and were exactly what the doctor called for. When you come home from the surgery center, you can just crawl right into bed without thinking about changing into something more comfortable.

Eating

Hopefully, you will have someone at home helping you. at least for the first few days. When they bring meals to you, ask them to bring you meals on plastic dishes. That will be lighter and easier for you to manage. If you're having surgery on your dominant hand, you may want to have your food cut into bite sized pieces for you. I also found it much easier to eat with a spoon rather than a fork. As much as I love sushi, I cannot use chopsticks with my left hand, so I make sushi a finger food now. 

For the bath

I have tried the fancy arm covers that you can get from Amazon and I find them so difficult to use that it's just not worth it to me. The best way that I have found to cover my dressing is with umbrella bags or bread bags. They are both very sturdy and usually a nice size to put over the arm. Tape it up and get in the shower. Just remember to hold your arm up so that water doesn't get into the bag.

I love using body wash and shower gel but post surgery, simplicity is key. I find that a bar of soap is easier to manage post surgery. Shampoo and conditioner is easiest to manage when you buy the bottles that come with a pump.

I also keep baby wipes so if I want a shower but don't really have the energy for a shower, I just have a little bird bath. I'm not going anywhere, so if I miss a day it's not a big deal. 

You'll want a good electric toothbrush if you're having surgery on your dominant hand, since surgery will make brushing your teeth very difficult. You'd be surprised by how hard it is to brush your teeth with the wrong hand.

Medicines

Since I have chronic health conditions, I have multiple medicines that I have to take daily.  I was surprised that I could open medications that were in child-proof containers, as long as they were in the regular sized bottles. Of course, I had to put the top of the bottle in my mouth and twisted with my left hand. I needed help opening the larger bottles. One of my prescriptions is dosed at 1.5 pills daily, and I can't break that pill in half, so my husband has to do that for me. 


Finally, I want to mention that it's taken me this long to remember that after every surgery I've had, I have a period of depression. I'm assuming that must be normal. I think part of it is the grief of psoriatic arthritis and the realization that my life won't be exactly like I planned it, but part of it must be from the isolation and the medication. Have you experienced that? I'll share my experience with this soon.

I'm sure that many of you have post surgical tips, so please share them in the comments. 


Saturday, September 19, 2020

Psoriatic arthritis pain described


What does psoriatic arthritis feel like? There isn’t really one answer for this question. It feels different depending on what’s going on. 

https://drive.google.com/uc?export=view&id=14z-r9CfdekMgu3FeiZGXaNJj1gnoFT-k
For example, I’ve had terrible hip pain the past couple of weeks. When I stand up from my chair at work or get out of bed in the morning, I struggle to walk. My hip is stiff and doesn’t feel like I can move it. As I start moving, it loosens up and movement becomes a bit easier. Each step hurts, but it’s bearable. With this type of pain, sleep is very difficult. I take a very low dose muscle relaxer to help ease me into sleep. Before I go to bed, I also use a CBD muscle balm that I bought while in Seattle. It’s the best!

In my opinion, pain in the larger joints like my hip feels more tolerable than pain in my hands or feet, or other small joints. I have arthritis in my toes, and when they start throbbing, I literally can’t even think. It’s hard to put a sentence together. My husband, Scott, will ask how I feel and it’s difficult to articulate my answer, so I usually say, “I’m okay.” Scott probably knows this, but I’m not okay when I say I’m okay. The pain is just too intense to describe. In those situations, I might use heat and/or ice, more of my magic muscle balm and often I will take two muscle relaxers before bed. I might even take a bath, though things have to be really bad to get me to this extreme. Remember that episode of Friends, The One Where Chandler Takes a Bath? Chandler says he doesn’t find baths relaxing because “You just sit in there stewing in your own filth.” I agree with Chandler, but sometimes I have no choice and I’m willing to go to this extreme.

When psoriatic arthritis first became part of my life, even before I had been diagnosed, my little finger was the target joint. It was so swollen and painful, and, during the night, the pain would wake me up. I always described this pain as feeling like someone was jamming an ice pick into my joint. So sorry for this shocking and graphic description, but that’s how it felt.

The moral of this story is that, even with psoriatic arthritis, no two pains are exactly the same. My pain over the past couple of weeks has been so intense that I have felt it necessary to apologize to my family for not being as involved as I feel I should. I forgot to make Nora’s lunch a couple of times. Scott has been trying to get our new home set up and get our boxes unpacked. And guess what I’ve been doing? I’ve been in bed or on the couch feeling guilty.

Tell me, what kind of pain is the most bothersome to you? Do you struggle with the feeling of irrational guilt?

Psoriatic Arthritis Infographic




Friday, September 18, 2020

Finding purpose when you have a disability



Here we go again! When I filed for social security disability, it was recommended to me that I not blog. In fact, it was recommended that I have no public social media at all. The thought is that if I'm getting out of bed in the morning, I must not be disabled. Anyone who has been in touch with me for the past year knows that this couldn't be farther from the truth.

I'm here at home today, recovering from wrist fusion surgery on a dreary day, feeling sorry for myself. I'm feeling that there is nothing that I can go out and do without pain, both from my surgery and my arthritis. I have family occasions to look forward to, but how much fun will they be if I hurt to much to join in family reindeer games (my husband's family is big on the reindeer games!) and I don't want to be the person there who can't do the thing that everyone else is doing. It would be great to get together with my friends, but I can't drive now and, if I could, would I be able to be comfortable? In my mind, they would have more fun if I wasn't there.


I know that there are some people who see my time off of work at a vacation. It't not. I am constantly working to try to make my pain feel better or get my mental health under better control. It's a constant battle. Today, what I realize that I need is a sense of purpose. That's what work gave me. I am good at my job and know that I made a valuable contribution.

So, I'm going to blog again. It's a reasonably short time commitment. I'm currently typing with my right arm in a full splint, so it's taken a long time. For some reason, every time I want to type an apostrophe with this big hand, a semi-colon happens instead. Every. Single. Time. This isn;t (see...I am gonna leave that one so you can see that it's true) easy for me, but if I can reach someone who is going through the same thing, I will have a purpose.



I'm curious to hear from other folks with similar struggles. How do you find your purpose? Tell me in the comments or send me a DM.


 

Monday, January 13, 2020

What happened when I quit my antidepressant cold turkey

I've done some pretty dumb things in my life, but I think I've bested myself. As you know, in addition to my psoriatic arthritis, I also deal with mental health conditions - OCD, Depression and Anxiety. Fortunately, I can usually get relief for all with one medication. As my physical pain has increased, my depression has increased, as well. Late in 2019, my doctor took me off the Lexipro I had taken for several years and prescribed Pristiq. Last week, I started noticing that my resting heart rate was high and it seemed to correspond with my Pristiq. Since I've been on this medication, I've also felt that my depression and anxiety were not under control.

Guess what I did? I did that thing that they always say not to do. I just stopped taking my antidepressant. Wouldn't that be safer than continuing to take something that makes my heart race? It would still be a few days before I could get in to my psychiatrist, so I thought I was doing the responsible thing. (I was not.)

The first day was okay. I didn't really notice any issues. Then, on day two, came the withdrawal symptoms. All day I struggled to keep my eyes open. I was more tired than usual. It's possible I fell asleep mid-conversation. Oops!

By the evening, I felt miserable. It was almost the reverse of severe allergy symptoms. My head felt like a balloon that kept disconnecting from the string. At one point, I was convinced that I had some illness that I would not survive.

It was surprising to me that this withdrawal was also affecting my OCD. I had a haircut and freaked out because I couldn't be completely certain that the stylist was using items (comb, scissors, etc.) that had not touched another persons hair. It was a massive freakout that left me near tears in the middle of Great Clips.

After reading that withdrawal from Pristiq can go on for weeks, I decided to get back on the medicine and then let the doctor help me get off of this medicine and on to something that will work better for me.

When they say not to just quit certain drugs, it's not just a scare tactic. I'm sure that there are other terrible things that happen when you quit, but I don't know what those are. What I do know is that it made me feel awful and I will never do that again!

Friday, December 13, 2019

The grief of psoriatic arthritis


Earlier this week, I went to visit my hand specialist. He’s an orthopedist with a specialty in hands and shoulders. I haven’t seen Dr. Erickson in several years, since he removed the ulna head from my right hand.

I had a fall the day after Thanksgiving and broke a small bone in my hand and another small bone in my ankle. The PA at urgent care told me to schedule an appointment with Dr. Erickson to follow up.
Even before the fall, I’ve had a lot of pain in my hands. That’s where my psoriatic arthritis started, after all. My right wrist dislocated many years ago and then fused into that dislocated position. That surgery to remove my ulna head (the little protruding bone that is on the side of the wrist) allowed me to use my right hand again. My fingers are permanently disfigured from the sausage-like swelling that happens from psoriatic arthritis.

I’m not sure what I expected that Dr. Erickson would say when I saw him. Maybe he would tell me that he could perform a surgical procedure that would alleviate my hand pain. That did not happen.
As he examined my hands, I closed my eyes and appreciated that the warmth of his hands was soothing to mine. He would occasionally push or prod something that caused me to jump or take notice of the pain.

Finally, Dr. Erickson showed me my hand x-ray and I could see hurt on his face. It was so obvious that he had something difficult to tell me. “There’s nothing I can do.” He said that we could do a wrist fusion, but it would, once again, limit my ability to move my wrist. It might help my wrist pain but would not help my hand and finger pain. It was then that he used a phrase that I can’t stop hearing. He said that I have end-stage arthritis.

After all these years with psoriatic arthritis, I have never heard the words end-stage applied to 
arthritis. I thought end-stage only applied to cancer and other diseases that are much scarier than arthritis. When I returned home, I googled these words. I learned that most of my joints are likely considered to be end-stage. It’s when there is no longer inflammation, but the joints are bone on bone.
Every time I think of this conversation, I find myself crying. I feel broken. It feels like my oldest and most loyal friend, psoriatic arthritis, is getting tired, right inside my body. It can’t even try hard enough to continue to produce inflammation. It’s giving up and living on only as pain.

I’m not sure why I cry. It feels like grief. It feels like I can’t even count on the one thing that’s always been a constant in my life to keep at it. Instead, my psoriatic arthritis has just given up and leaves behind a body of painful joints.

I don’t have any words of advice for anyone today. Only the story of my life with this disease.

Thursday, November 21, 2019

Psoriatic arthritis: Making movement joyful


All my life, I heard people say that the key to exercise is to find something you enjoy. When you’re living with psoriatic arthritis – or any chronic pain – that’s not as easy as it seems.

I’ve struggled to find an activity that I could tolerate, let alone enjoy. I enjoy walking, but not so much if the weather isn’t ideal. Or if my knee hurts that day. Maybe last time I walked, I got a severe foot pain and had to hobble back, and then the trauma of that sticks with me.
Sometimes, I enjoy working on machines, but again, the environment and situation must be right.

Over the past few months, I’ve been in physical therapy to deal with these back issues I’m struggling with. And guess what? I love it! I have always loved PT. After knee replacement, I fought to continue with PT, but it became increasingly difficult to justify.

It feels great to have specific goal that is not about forcing my body to change its appearance. (That’s a whole other topic that I’m not going to get into now, except to say that I’m trying not to let this be my focus anymore.) Someone is helping me and encouraging me. My physical therapist allows my pain to be the guide for what I can and cannot do. We don’t simply stop because something hurts. We evaluate how much it hurts and if I’m potentially doing damage to my body, we change it up. She challenges me and I want to do more in each session than I did before.

I’ve also learned to do new activities that I take into my personal workout routine. (You heard that right! I’ve got a personal workout routine!) It just so happens that my physical therapy is at the same wellness center where I am a member. So, I learn these activities and then take them out into the gym. My favorites are noodle cycle and my TRX workout. I've recently heard more about joyful movement and these are my joyful movements!

I bet you’re wondering what noodle cycle is, right? I get in the pool, sit on a noodle as if it were a bike and I pedal, pedal, pedal…back and forth through the deep end of the pool. I also use my arms for an additional workout. I found this video on YouTube where you can see what I do. I also add my aqua PT into this, as well.

I’ve only recently added land work back in to my routine. It’s much more difficult for me given my back and nerve pain, but it is so rewarding when I do it. TRX squats give me so much relief from my lumbar pain, even as I’m doing them. TRX rowing helps prevent my upper back and shoulders from giving me so much trouble. My newest activity is the leg press. I’ve always loved that, but it’s now harder than ever since my nerve pain has created so much leg weakness.

How funny is it that I thought that I hated exercise and then realized (and remembered!) how much I love it when I’m with a physical therapist. Could it be because I’m too hard on myself? (Bear with me here…I’m thinking this theory through as I type.) I’m not super nice to myself. I know that I’ve been to the gym before and felt pain and thought to myself, “what’s wrong with you? Everyone else is pushing through. You’re just too lazy to do it.” The truth is, I’m not lazy at all. I hurt. I have been trying to work own my own and then beating myself up for not knowing how to create exercise limits for myself. (I honestly did not know that exercise wasn’t painful to everyone until a couple of years ago.)

Another thing that I’ve found, and this may be the most important takeaway, is that I needed a facility where I could feel comfortable. And, I found it! If you’ve got chronic pain and are looking for a gym without judgement, look into area wellness centers. These are often tied to a health care system and tend to offer more than simply a workout gym. If you’re not comfortable at a facility, you’re not going to go. Also, I’m not saying that you can only work out at a health club. Maybe you’re motivated enough to just do your thing at home. I am not.

Now that I have realized that the key to really joyful movement is my physical therapist, I feel that I have more insight and ability to stick with it. It’s good for my body and my emotional well-being. Now, if you'll excuse me, I've got some noodle cycle to do!

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What to expect after surgery: Depression

Hello friends! In the last few weeks, I've answered so many questions about orthopedic surgery on Quora that people are specifically rea...