Saturday, May 8, 2010

Echocardiogram and Joint Replacement Class

Like I mentioned in my last post,Friday Rick and I went to Dartmouth Hitchcock Medical Center in Lebanon,NH for the first of his pre-operative appointments.

We left at about 8:15,and arrived at 10:10,just shy of an hour before Rick's 11:00 AM appointment. We wanted to get there a bit early for a couple of reasons: 1) parking is an issue. There are at least four entrances to the hospital,and when they mail you the appointment date and time,they also tell you which lot to park in (the lot depends on where in the hospital your appt. is,to save walking all over). Ours was by the Main Entrance,and we usually find one in the back row. 2)We want to make sure we have time to find where we are going,since we have only been in the hospital once,and this place is BIG! They do have an information desk right there in the Main Lobby,if there is a problem.

We had no problem finding where our first appointment was. His first appt was an Echo cardiogram. This is standard procedure at Dartmouth before any surgery,to make sure the patient will be able to tolerate surgery. With Rick,it was not only trying to see if he could tolerate it,but if he could tolerate having both knees done at the same time.

The staff at Dartmouth are the nicest,most helpful people in any hospital we have ever been in (and with Rick's medical history,we have been in quite a few over the years). When we checked in,the receptionist thanked Rick for his service,which I thought was nice. It was still 15 minutes before our appt when the receptionist came over and informed us that the nurse who was doing the test was running a bit behind because the Dr had an emergency,so it might be an extra 10 minutes. No problem. Then a few minutes later the nurse (whose name,sadly,I can't remember) came out and apologized for the delay,she only had to clean and redo the room and we would be
all set.( We wound up getting into the room at 11:04-to me,that's not late at all...we have had appts where we didn't get in until over 30 minutes past our appt!)

When she came out to get us,I stood up to go in with Rick,as I usually do,and she said,'We normally don't let spouses come in,but if you would be more comfortable having your wife there,that is no problem whatsoever." Rick said that he would,so we both went in. The nurse told me while Rick was out of the room for a moment that they usually don't let extra people in the rooms during testing because most of the time,resident students come in to observe ( Dartmouth Medical School is in the same building)and that other Drs come in and out,and there isn't much room. But she had read Rick's file,and since he has PTSD and TBI,she figured he would be more comfortable with me there.( She was dead on. Rick gets very uneasy in new places,plus he has a hard time remembering what he is told,so I am his advocate. Even if she had said I couldn't go in,I would've insisted and would have done so,anyway.Legally I have that right.)

Rick laid down on the table,and removed his shirt. The put some electrodes on his chest,and hooked him up to a couple of monitors. Because he can't run on a tread mill,which is how they normally conduct this type of stress test,he had to have an IV in which they inject a medicine to get his heart pumping fast. Before they inject anything,they take pictures of his heart,with an ultrasound. I was sitting behind the gentleman who was taking the pictures,and I must say it was really cool to see Rick's valves,chambers,etc and how the blood flow goes in and out. Even though it felt like it was just the four of us,in the next room there were cardiologists watching their TV screens which were showing them what Rick's heart was doing.They wanted to see certain angles,because 1) Rick had heart surgery in 2008 after his stroke. A hole was found and they fixed it and 2)Rick has a 30% block in his left bundle branch of his heart.

At any rate,once they took the photos,they then injected him with the medicine,and his heart started beating faster,which was also cool to watch. It wasn't beating fast enough,so they wound up giving him more medicine. His heart rate had to beat 147 beats a minute,the same as if he had done the treadmill.He had to tell them if he felt pain,if it was hard to breathe,etc. Happily,he had no bad effects. The whole thing took about an hour. We should get the results at the beginning of the week,but we got nothing but positive comments,including from the Dr who popped in,a Dr Forrest.He is the one who will read the results and send them to Dr Bernini,Rick's surgeon. I wish I could remember the nurse's name,she was wonderful,and I thanked her for her kindness when we left.

Our next appt was at 2:00,so we had time to truck down to the Food Court and eat a leisurely lunch. It was nice not to have to rush. I had no idea where "AF" was,which was where our "Total Joint Therapist" appt was,so we asked at the information desk. Right down the hallway on the left with the rest of the Auditoriums. Auditorium? So this was a class? We really had no idea what the appt was about until she said that. We thought it was a one on one appt with a therapist. So this was the class we had to attend. Auditorium F,here we come.

There was quite a few people in it,mostly folks in their 60's or so.Some people were having hip replacement,some single knee,and some were planned for bilateral knee,like Rick. The lady who began the class was a nurse for 30 years,worked in the field,and was a joint replacement patient herself. She explained about what to expect before,during,and after the surgery,and right up to the first appointment 4-6 weeks after the surgery. She told everyone that their lives were about to change-a life without pain,and when she said that,Rick and I looked at each other and gave each other a high five. Poor Rick,his daily meds were kicking in,so I had to keep poking him to wake him up throughout the session.( If he is not doing something and just sitting,he will fall asleep after he takes his noontime meds.)

The second speaker was a Physical Therapist,who spoke about what they were going to do to get them up and moving at the hospital. He discussed climbing stairs,using a walker,getting in and of bed,and exercises. The third speaker was an Occupational Therapist,who showed what the patients would need at home-a raised toilet seat,a seat for the shower,etc. The whole class was about 2 1/2 hours,with a 15 minute break. We also received a binder with all kinds of information,and a DVD.

We left at about 4:20 and got home around 6:30. Though the day was long,it was a good day. It is making the surgery more of a reality,and Rick and I are getting more and more excited about it. We know he will be in excellent hands.

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