Week 7 - Up, Down, Up, Down...

After a pretty good week in Week 6 this week has been a bit of a mixture. Wednesday, Thursday and Friday were particularly bad days with a return to pain levels of a couple of weeks ago. The heat packs came back into use and my mood plummeted. I took things pretty quietly and just tried not to aggravate anything and it seems to be settling down.

I started the week pretty well with a long walk on Monday and a walk and a session in the hydrotherapy pool - my first - on Tuesday. The hydrotherapy pool was great, the water was warm and the gentle exercise with lots of my weight supported was great. Interestingly I clearly used muscles I hadn't used for some time as I could feel them the next day!

I'm not sure what caused things to go down hill later in the week but I found it particularly frustrating as I'd been going so well! Because of the progress in week 6 I'd also chosen Friday of week 7 as the day to start reducing my reliance on heavy duty painkillers. After a conference with my doctor we settled on a gradual reduction approach and the use of paracetamol as needed to take up any slack. Being stubborn I chose to continue with the plan and cut my daily intake by 25%. I've had to use paracetamol a couple of times to take up the slack but not in any continuous way. I also haven't yet suffered any untoward withdrawal effects from reducing the heavy duty painkillers. So that's all positive. Tomorrow I'm due to reduce intake by a further 33% so let's hope that goes as well!

Distance walked this week was 25.2 km which is a slight reduction on the previous week and reflects my "take it easy" approach over the latter part of the week.

How do you do that?

So out of the ward, down in the lift, across the road and we're at the car. I'm not allowed to bend at the waist, I'm not allowed to twist and I'm not supposed to sit with my knees higher than my hips. So how do I get into the car seat? Well gingerly for a start...I got the car door open as far as it would go and sat on the edge of the seat facing outwards. Of course all modern cars have seat bolsters designed to retain you as you circuit the Nurburgring at 200+ km/h. All very useful in that situation but for my purposes a pain in the arse. Once perched on said seat bolster I then pivoted my legs into the car, after having somehow got my head inside without bending, twisting or doing any of the other forbidden things. The result, if done well is a simple pain-free entry into the car. The alternative is, well let's call it a mess. It works well though, so well, that a friend still uses it 17 years after his operation.

The ride home wasn't as bad as I thought it would be. The surgical site and my back are remarkably impervious to bumps and jolts. I'm simply not troubled by most of what a modern road can throw up.

Of far more importance was the problem of getting on top of drug management. I arrived home in possession of 7 different drugs, each with their own raison d'etre, timetable and regime. Up to that point I'd been rattling back about 20-25 tablets a day, not to mention various potions designed to keep the trains running in the face of the constipatory forces of the other 7 drugs. A spreadsheet was the only answer. Each drug, it's maximum daily dose, suggested dose and timing was set out in the spreadsheet and off we went on the magical mystery tour.

Quite quickly it became apparent that firstly my requirement for pain relief was falling and that the spreadsheet was allowing me to target my drug use to periods of need. Monday the intake fell to 15 tablets, Tuesday it was down to 10 tablets and by Wednesday it was down to 6 tablets.

Two things became apparent at that point: firstly my pain wasn't quite under control and so I was wasting my time a bit. Secondly I was having bouts of what turned out to be withdrawal. Shakes, shivers, sweats, anxiety...as I weaned myself down from the high levels of drugs.

Thursday the total number of tablets is back up to about 9 and that seems, for the time being to be the right balance. I'm hoping that I can carve into that further over the weekend.

The other thing that has to be tackled is my rehab programme. This can best be described as the modified Forrest Gump programme. Instead of "run Forrest, run" it's a case of "walk CA, walk". Basically the idea is to start off slowly and to build up to several kilometres a day over a period of weeks. Of course me, being me, the idea became fixed in my head that if small walks were good, then big walks were better. I'm currently paying the price for that as well!!

Overall though, this surgery is a miracle so far. The only thing I can't do for myself is to put my socks on. I can't work that one out yet. I can do anything else I've tried so far with some ingenuity including picking things up off the floor. That involves squatting, down on one knee, down on both knees, pick up the object and then the reverse the process. Stairs are no problem, though they're treated with due respect and driving is out of the question. I'm carrying too much of a drug load to want to be out on the roads at the moment, though from a purely physical point of view I think I would be capable of it, without the drugs.

More to come as I explore the niceties of a recovery as opposed to mere functionality.

Ears yet again!

Day 14 is drawing to a close. I've just had my first 24 hours pain free and that is a bit of a revelation. I'm hopeful that it's all plain sailing from here. I was surprised at how painful the procedure was and how long the pain persisted. Since about day 10 the pain has reduced and my reliance on painkillers has also reduced. If there was one thing I hadn't counted on it was the pain - ears are clearly sensitive!

The other unexpected thing was the infection. I suspect that suture removal at the beginning of day 4, may have resulted in the infection. By day 6 I had a substantial infection and that ultimately needed both oral and then IV antibiotics. I finished the course of antibiotics on the morning of day 13 and the infection had certainly cleared up.

Now whilst the ear is tender to the touch it is vastly improved and the outcome looks pretty good as you can judge.

Day 6, two days after the sutures came out

Day 14, well on its way to looking like any other ear

The one outstanding issue is loss of sensation. I've got a large area that runs up the back of my ear and over the top at the centre that has no sensation. As well the area inside the auricle above the graft is also without sensation and of course the graft itself has no sensation. I'm told that this will resolve but it is certainly unexpected and mildly unpleasant.

So really that's the story! The surgeon says I'll get improvement in the look of the graft over then next 2 to 4 months. I'm pretty happy with how it's looking now. When the last bits of serous scab resolve and the surface of the skin renews over the next few days it will look almost indistinguishable from the rest of the ear.

The ear update!

Today is day 8 and all of a sudden over the last 24 hours things have improved. I'd really got myself into a little black hole with the unrelenting pain. All from such a little procedure!

After the sutures were taken out on Tuesday the ear seemed to get worse not better. I was getting a lot of serous exudate from the graft site and it was very painful and swollen. On Thursday morning things started to get a bit mucky. It wasn't readily apparent that I had an infection but I took myself off to the doctor. His view was that it was infected and that this was also the reason it was a bit swollen and sore. He prescribed antibiotics and within 8 hours life had taken on a whole new meaning!!

It's amazing how release from a bit of misery makes you feel so much more positive and happy.

I'm now looking for a hat to "shut the door after the horse has bolted" as it were. I want something that I can wear with a suit or casually to protect my ears and face in summer without looking more like an idiot than I do now! Any suggestions?

Ears and things...

Where's your hat? Stay out of the sun! I can remember my mother's refrain from childhood. I was a very fair skinned kid and sunscreens were really not available when I was young. Consequently I was regularly burnt and on odd occasions I developed sunburn blisters - unpleasant and painful.

As I've got older I've become increasingly obsessive about sun protection - hats, screen, sunglasses, long sleeves...The problem of course is that the damage is done. All that childhood exposure is now revealing itself in the way of solar keratoses, and various bits and bumps. The dermatologist removes them or freezes them off and I go away for another 6 months.

About 12 months ago I became aware of an area on the face of my ear that developed a small crust and wouldn't heal. The dermatologist gave it a blast with liquid nitrogen but it reappeared. A biopsy revealed a Basal Cell Carcinoma (BCC). These things are slow growing but can be difficult to completely remove. I was referred to a plastic surgeon. He said "you'll be surprised how extensive this is". I wasn't! By now it had stretched from inside the antihelix across the face of the ear and up to very close to the ridge of the helix. The decision was that it had to be surgically removed and a full thickness skin graft used to cover the defect caused by the removal.

The ear in question with the graft in place - day 5

The surgery was scheduled as a day procedure. When the time came I was placed on my back on the operating table and the anaesthetist gave me a sedative and a short acting narcotic painkiller through a canula, whilst the surgeon infiltrated my ear with local. I was aware of what was going on but the drugs prevented me from feeling the pain as the local was injected and made me happy to just lie there.

The procedure involved removing the neoplastic tissue and a 2mm margin around it. Then a full thickness graft was harvested from the groove behind the same ear. I could feel the pressure of the cutting, snipping and pulling as the graft was harvested. Then the graft was trimmed for size and sutured in place with lots of interrupted sutures using nylon. I chatted briefly to the surgeon while the graft was sutured in place.

Once that was done the ear and surrounding hair were cleaned up, the drapes removed and then I shifted myself from the table to the trolley to go back to recovery and then after a couple of hours off home.

My ear was numb from the local. As that wore off later in the evening the pain began. Initially the pain was from the donor site for the graft. It was closed with dissolving sutures and because it was quite tight it was very painful. It was reasonably easy to control the pain with Nurofen (ibuprofen) and Panadeine Forte (paracetamol and codeine). However I required regular pain relief every 4 to 6 hours and sleeping was a real problem. I could only sleep on one side and moving hurt - it's amazing how and where your face and neck muscles are interconnected!

The surgery was latish on Friday afternoon. The weekend required regular painkillers but it wasn't too bad. However the pain got worse not better! I removed the dressing on Monday morning as directed and showered as normal before going off to work. My ear was swollen and sore with areas of numbness where nerves had been compromised. The graft looked like something out of a horror movie and there was some bruising and tenderness in various areas. Enough to frighten small children and squeamish adults!

Monday was a big day and I was glad to get home after work for a nap. The pain on Monday night was worse and I spent a fair part of the night awake as I waited for various doses of painkillers to kick in. Part of the pain seemed to be from the swelling and part from the increasingly tight sutures. Early on Tuesday morning the surgeon took the sutures out which was a bit of an ordeal and left me pale and sweating. He cleaned up the graft and declared himself happy. He put a vaseline gauze and a simple dressing in place for 24 hours. After that he directed a daily soak and cleaning of the graft with saline followed by a smear of petroleum jelly to keep the graft moist and supple. I'm to see him in 16 days.

I managed almost a full day at work on Tuesday, despite feeling shaky and looking pale, I had lots that needed doing - the surgery having coincided with a critical stage in a big project. Finally in the late afternoon I had to give in to the pain and go home. Tuesday night was bad from the point of view of pain control. I woke on Wednesday morning, after limited sleep, feeling pretty crappy. I finally gave in to the inevitable and took the day off work. I hope that will let me get on top of the cycle of pain and sleeplessness.

I'm left feeling that I cannot for the life of me understand why people would undergo this sort of pain for cosmetic reasons. In my case the BCC had to be removed before it spread further. However I can't understand why people have facelifts, boob jobs etc. It's just too painful!

Secondly all I can say is: if you are young then please take care of your skin. This kind of procedure is painful, costly and despite the skill of the surgeon, it will never look like it did before.