Medication - Or Lack There Of

I'm not a big fan of pain medication. I've always stopped taking pain medication as soon as possible. It inhibits thinking and alters moods. I've felt that the pain medication has slowed recovery from injury since I can't always differentiate the effects of the pain medication from the injury itself. The sooner I stopped taking the pain medicine, the faster I would recover - WRONG!!!

This recovery was no different. A week after surgery, I stopped taking Vicodin and thought that the Tylenol would be sufficient. I was wrong. When updating THE surgeon during the visit today, I described my pain as very significant. He asked what I was taking, and I said just Tylenol. He very kindly pointed out that perhaps I should reconsider my pain killer of choice to something a bit more powerful. He also pointed out that the greater the pain, the harder it would be for me to rest and recover. (As my kids would say - DUH!!!)

I'm now taking Tylenol with codeine and it seems to provide more relief than straight Tylenol. My plan at night is to take the Vicodin in hopes it will contribute to restful sleep. We'll see.

The decision to continue the stronger pain medication should have been obvious, and looking back, I made the wrong decision to stop. But, we are who we are. I expected the recovery to be difficult. On a scale of 1 to 10, I expected a 9. 9 turned out to be about right. I've had other rough recoveries in the past - operations, broken bones, bike crashes, etc. Perhaps those recoveries would have progressed faster by taking advantage of modern medicine.

Note and acknowledgement to female readers: I've never given birth - so any pain I've experienced is relatively minor to compared to "real" pain resulting from having enjoyed that first apple.

Music

Today's Whining

What's got to be one of my biggest challenges is the ability to focus. Most activities take more energy than I can muster - reading, TV, movies, conversation, etc. I haven't figured out if it's the discomfort or the energy level that make concentration difficult.

I've never been able to just "hang-out" and listen to music. Now, that's all changed. I've come to enjoy spending hours just lying around listening to music. With the ability to "stream" familiar music from the web, there is almost an infinite content.

To feel more energetic, I've tried to expend more energy as well. I took three 15 minute walks yesterday, and did my best to clean the kitchen after dinner. Today, I'll increase my physical activity just a bit more.

Burrito vs. MMA Patient

The Burrito Won

The burrito is the ultimate meal: lean chicken, black beans, avocado, tomatoes, wrapped in a whole wheat tortilla. What could be healthier? When the family had burritos last night, I had one too. It looked delicious with all the yummy fixings. Knowing that I would need to make mine extra "smudgy", I added sour cream and cheese (I figured the calories would be a bonus too). By adding enough chicken broth and salsa, I was in for a wonderful treat. And I was.

With the help of the magic bullet, and 14 ounces of chicken broth, I pulverized about a quarter of the burrito. It was a bit too thick. Fortunately, I have leftovers and will try again today, but without the tortilla.

Another Lazy Day

It's an absolutely amazing beautiful day. Anticipating the afternoon heat, the temperatures will be in the 90s, I spent the entire morning outdoors. I took a walk and spend the rest of the morning relaxing on a lounge chair in the backyard listening to music.

Nothing remarkable with the recovery. My chin has two sensations - complete numbness on the skin, and a pressure/tingling pain on the the bone. Combined the sensations are a bit bizarre. I'm still challenged in getting sleep and wake up with headaches. I expect the sleep will continue to improve as the pain diminishes.

To My Children - I'm sorry and...

... I would do it to you again the same way

That's right, I'm talking about the liquid medicines we force our children to take. I've been taking liquid Tylenol and Ibuprofen, and all I can say is that I should have tasted this dreadful stuff before having forced my children to swallow it when they were sick - YUCK!!!

On the positive food front, I've discovered how to pulverize food with the blender. I just had a savory chicken thigh. Deb decided to avoid cooking in the afternoon heat and cooked a chicken in the slow cooker all day. The house smelled delicious. So, throwing caution to the wind, I took out the Magic Bullet (a must for all MMA recoverers) tossed in a thigh (minus the skin and bone)and added some chicken broth. The first "solid" food in about 10 days. Hopefully this will create a turning point in energy as well. Getting concentrated calories will be a real plus.

More on the numbers

Yesterday I was able to achieve the eating goals that I set. I consumed 2200 calories and 3 liters of fluids. It was exhausting to keep up on the food all day long. Between 6 a.m. and 7:30 p.m., I consumed 13 beverages, including 6 ensures, apple juice, orange juice, fruit replacement supplement, and lemonade. Normally it wouldn't be a big deal to drink 3 liters of fluid - I regularly consume 4-5 liters a day. The challenge in drinking so much now is that I need to sip each drink with a straw. Since my lower lip is still completely numb and my teeth are still immobilized in the "closed" position so it's too hard to use a glass and drink quickly. I would not fare well in a beer chugging contest today. Perhaps with the larger airway, I may be able to pick up a new sport...

I'm hoping to vary my diet today and introduce some soup. Any good tasting soups that fit through a strainer will make a great meal.

Today - another 2000 calories and 3 liters.

5 + 3

8 hours of sleep last night. That's got to be more than the grand total of what I have slept in the prior six nights combined. Thank you Ambien and generic pharmaceutical manufacturers around the world. I did wake with a terrible headache, which I'm attributing to poor nutrition and liquid intake from yesterday. Perhaps the surgery procecure and the recovery contribute to the headache as well.

Nutrition has got to be a key part of the recovery. While I've been making efforts to drink enough, I could be doing much better. Today, my goal is to consume 2000 calories and 3 liters of fluid.

The Little Loop

I just returned from a walk around the little loop - just a short 15 minute stroll through the neighborhood. It was great to get out.

We visited the doctor this morning. He cleaned things up a bit and suggested that I try to ease back into a regular sleep pattern, avoiding sleeping all day long. In my case, I'm going to avoid being a zombie all day long and try to concentrate the sleep during the night, if at all possible.

In addition, I'm going to switch to over the counter Tylenol and Ibuprofen, away from vicodin. The vicodin makes me tired, groggy and slow, none of which can be good for the healing process.

With regard to food, I'm drawn to sweet drinks (with protein powder) and ensure. Soups do not yet appeal to me, but I'm hopeful that will change soon.

Just a quickie...

Sleep remains elusive (although I did have an exhausting dream during the afternoon nap) and the food hasn't really changed. I have tried to drink without the special implement and it works better sometimes than others. I had hoped to consume everything from a biking water bottle, compliments of Steve and Lance Armstrong, but it's just a bit too ambitious this early on in the recovery

Weight seems to have stabilized down at 10 pounds, and I can fit in the "skinny" pants. Fortunately, they don't make my butt look too big - a major concern for most of us males.

The Big Reveal

Before

After

So there you have it - the before and after pictures. (The "bars" on the after picture are "Arch Bars." They are stainless steel braces that immobilize the jaw. Patients typically wear the arch bars for about 4 weeks.)

Today was busy. Prior to leaving for the doctor's office, I ventured on my first walk. I had a plan, and over did it. The plan was to walk 5 houses down the hill. I went 7. Upon my return, I crashed for the post walk nap. - Let's just just say that I should have stuck with the original plan. Those 2 extra houses were a killer.

The doctor visit went well. He said all looks good, and come back in a few days. On the way back from the doctor, we stopped at the grocery store to expand my diet. We settled on liquid fruit (8 Oz = 1 complete fruit). The grocery store visit was far beyond what I should have done. We came home, and I only made it as far as the couch before passing out.

In an effort to keep my energy going, I ventured out on a second walk. I had a plan, but ignored it - again. The plan was to go 7 houses up the hill. I went 11.

The weather here in the San Francisco Peninsula has been spectacular. While we drove to the doctor's office, we passed more bicyclists than I've seen in a long while. It's great to see all those people hammering hard up the hills and putting in a few miles for me.

Not the biggest loser

After a quick weigh-in, it looks like I've gone below the yellow line and gained a pound since yesterday. For this competition, that's a good thing.

Two Course Breakfast

Mother's Day 2009

Deb seems to get a raw deal on Mother's day. Next year, we're going to have a great day that doesn't involve any surgery recovery.

Each day continues to be a significant improvement from the previous day. I haven't hit the scales this morning, but as of Saturday, I'm down 11 pounds. Sleep remains elusive, I mainly get short naps of 30-60 minutes.

Most of my day is spent trying to acquire calories. If it comes in a clear liquid, and is the consistency of water, it's on my list. The hospital sent me home with 2 ounce syringes for feeding. As you can see in the photo below, breakfast was Ensure (vanilla-we're running low on chocolate) and Cytomax (an electrolyte mixture used when cycling - it's Sunday of course). Truth be told, I had seconds of each course. (30 cals/ounce of ensure, and 15 cals/ounce of Cytomax).

Thanks again for all your kind words an well wishes. They make each day go a bit smoother.

Home

They sent me home today. Stanford's a great place for outstanding medical care. My hospital stay had me in the ICU for 1 night, and a regular room for the second. The ICU provides really outstanding care. They have you wired so well that they don't even need to wake you to take your vital signs. The have 1 nurse for every 2 patients The regular room was fine, a bit noisier, but not too bad.

I graduated from the clear liquid diet to the "full" liquid diet today. With all the liquid, I've still managed to drop 8 pounds in 2 days.

On the way home from the hospital, we stopped by the doctor's office, and he removed the nasal congestion, providing much relief and making it easier to breath. The doctor asked that we return on Saturday morning so that he can clean out the sinuses again. That doctor's visit on Saturday will be the highlight of my day.

Thanks for all your well wishes, and kind thoughts. It's nice to go through this with a wonderful community behind you.

I'll try to post more tomorrow.

No pain.

Pretty amazing that I have no pain. Soon they will move me from ICU to a regular room.

Slept only 45 minutes last night.

Yum!!!

And peanut M&Ms

Last Supper

What would you request for your last meal?

As you would expect, the question came up. My kids were pushing for burritos or Indian buffet. Those are great choices, and certainly high on my list. But they just don't compare to the great meals Deb makes. She puts so much love and care into everything she prepares.

So when I was asked what I wanted to eat, it was an easy answer - anything Deb makes works for me. Well almost anything. For some reason, the turkey chili just doesn't do it.

The meal is still a mystery, but whatever it is, it's going to be great to sit down as a family and share our experiences from the day, tell stories and jokes, and see how the kids try to get out of doing their chores.

It's all good. I wouldn't trade with anyone.

A Bit About Me

Who am I?

When I went off to college, I thought that the smart kids studied engineering. And that turned out to be true. What I didn't know was the clever kids studied finance.

Armed with an engineering degree, I began my professional adventures working for start-up and emerging companies in the Silicon Valley. Shortly after I started my first job, I realized that the world would be a safer place if I didn't practice engineering. I transitioned into a sales role and have spent the better part of my career as a serial entrepreneur working at start-up companies. I specialize in selling new technology products to emerging markets - mainly software and electronics. While there may be easier ways to make a living, I wouldn't trade what I do. Often, I joke that if I won the lottery, I would be late in claiming my prize because I wouldn't cancel my sales call the morning following the drawing.

My career has brought me around the world. The travel started the day I returned from my honeymoon in 1989, and hasn't let up since. When people describe how many miles they travelled, there are usually two descriptions: the total frequent flyer miles including bonuses and the AOS miles. It's the AOS miles that count. I've accumulated more than 1,500,000 AOS miles. For those of you that haven't figured it out, AOS=Ass On Seat.

At first, I thought that being tired all the time was the result of many flights, long days, and jet lag - not the case. It's the sleep disordered breathing that made me feel so tired.

In case your wondering about the URL name "pedal-MMA", it doesn't refer to being a peddler, but rather a pedal-er. I enjoy riding my bike. One of the benefits of not sleeping well is that I get to ride my bike early in the morning and return by 6:30 a.m. before everyone in the house wakes up.

Many people sleep late on their weekends. I ride my bike. During a good week, I'll train over 150 miles. 50+ on Sunday, 50-75 during the week, and 25 on Saturday. It's been quite a while since I've had a "good" week of training. As part of my planned MMA recovery, I'm hoping to ride the November Solvang century. Setting the goal for the 100 miles should be excellent motivation.

Reservations

Will this work?

In a nutshell, that's my major concern. Most people get some benefit with either CPAP or the oral appliance. I didn't. We have not yet found any way to releive the symptoms. Just knowing that one of the other therapies had worked would give me a bit more confidence in this procedure working.

Making the MMA Decision

I just want to wake up rested

You know when it's time for surgery. Why? Because you've tried everything else.

The last time I woke up rested was in December 1991, the day after my brother's wedding. It's such a vivid memory since I had the flu the weekend of the wedding, and had to drive 200 miles after the wedding in a heavy rain storm at night. I woke up the next morning after the big day thinking "what a great night's sleep."

It's that rested feeling that I'm after. Whatever it takes, I'm going to wake up rested again.

Many have asked me why is it so important to wake up rested, and why can't I just get by being tired. The answer is simple: I deserve a better quality of life. Imagine how you would feel if you only slept a few hours each night, and the hours you got, weren't that great. Basically, you wake up with a dull headache, have little energy, become grumpy and irritable, and can't wait to get to sleep that night. Some days have all these challenges and other days have only a few. But you know it could be better. Throw in the reality that you need to put all your energy into a successful work day. I put every bit of energy into work. Being too tired to work was never an option.

When you come home to your family after work, if you've got nothing left and you're snappy with the wife, short tempered with the kids, and just want to lay down on the sofa - you miss out on all the best parts of having a family. The family deserves to see you at your best, not your worst. Being tired all the time just isn't fair to the family.

The first time I seriously thought about sleep surgery was in 2007 after seeing the most distinguished sleep doc. Since he's the guy who wrote the book on sleep apnea, and if he thinks surgery is going to help me, I had to believe that he's probably right. However, in 2007, I wasn't ready to have any surgery. I knew that surgery might be part of the journey to getting a better nights sleep.

The internet became the best resource to learn about sleep surgeries. The discussion boards, blogs, and medical studies provided more details than I could consume. Reading about other people's success and failures with sleep surgery made me think that perhaps surgery could help me.

Before surgery, I had to exhaust every possible option at least one more time -CPAP , oral appliance, medication , and outstanding sleep hygiene. Having tried all these therapies multiple times, surgery became the only remaining option.

Wired for March 2009 Sleep Study