Patient expertise…What does it require?…

Ms. Bushbuck and growing baby come to call.

“Sighting of the Day in the Bush”

They often stop by for pellets, apples, and carrots.

Note: Load shedding is back on.  We expect a 2 .5 hour outage within the hour.
We apologize for the lack of photos.  This morning’s rain and the trip to Nelspruit made photo-taking difficult.

With rain throughout the area, we decided to leave earlier than planned to make our way to Nelspruit for my first “after-care” visit with the thoracic surgeon who performed the triple coronary bypass a mere 17 days ago.

I’d made a list on my phone of my areas of concern which included the following:

  • Burning feet at night – What I’d assumed…peripheral neuropathy, at times diagnosed after this type of surgery, usually resolving in a few months.
  • Pain in right chest wall – A torn muscle from moving my arm too quickly on the night the power was out.
  • Bleeding incision – As Dr. Phillip stated on Wednesday, it’s a hematoma underneath the which bleeds when irritated during s shower but not bleeding from deep inside my thigh.
  • Side sleeping (which I prefer) – May be done as long as it doesn’t cause pain.
And so it went. My pain and discomfort are entirely normal at this point. I felt a sense of relief knowing my symptoms were within the range of “normal” based on this point in time. 
We spoke with the woman who’d had the same surgery on the same day I’d had who went into “theatre” several hours before me. She’s nine years younger than me and was doing much better than I have. But the doc explained that each person is different, and recovery will follow accordingly.  
This knowledge provided is with more peace of mind, and now I’ll sit back, doing my exercises and feeling more confident that I will fully recover from this challenging surgery in due time. We don’t return to see the doctor until four weeks from today.  
I will be patient and not push it too hard, gradually adding to my activity level, eating healthy meals, rest as needed, and maintaining a positive state of mind.
Speaking of being patient, today I’m posting my perception over this past week as to what it takes to be an excellent patient to my exceptional caregiver, Tom, making his tasks a little easier over this long haul which could prove to be as long as three months.
  1. The tone of voice -Sure, it hurts. Sure, it’s tough to get out of a chair, off the sofa, or into and out of bed when using arms and elbows are prohibited over these first few weeks. We don’t realize how much we depend on our arms and hands to assist us in moving from one position to another, from one room to another, etc. The tone of voice in asking for assistance is everything.  Instead of saying, “I need help,” how about, “Honey, can you help me stand up?” This pleasant tone may make all the difference in the world in the enthusiasm of the caregiver in assisting in all areas.
  2. No whining, whinging, complaining – The caregiver can’t change the terrible circumstances, nor can they make the pain disappear. Complaining provides no benefit other than when a groan or moan is precipitated by certain actions. After all, we are humans and tend to make it known to all surrounding parties that a certain task is difficult, exhausting, or downright impossible.
  3. Expressing thankfulness – It’s a huge responsibility to be a caregiver and seldom includes remuneration among couples or close parties. A heartfelt “thank you” goes a long way, especially when accompanying the completion of any task together. One can never say “thank you” too many times in a day, here again using a pleasant and sincere tone of voice.
  4. Don’t criticize how household tasks are performed, which generally the patient may have done. Each individual has their way of doing things, and attempting to “re-educate” the caregiver is unkind and selfish.
  5. Don’t complain about meals – Perhaps the patient was the sole preparer of food and meal planning.  Suddenly this task is taken over by the caregiver who a). May not know how to cook or b). Doesn’t enjoy cooking. Firstly, eat the food prepared as long as it fits within the parameters of any special meals as prescribed by the doctor. Secondly, make positive statements to the caregiver about flavor, presentation, or ease used in preparing the meals. Thirdly, if the caregiver asks what you’d like to eat, choose simple and easy to prepare items, not fancy recipes that require time and attention.  If there is something special you’re craving, ask the caregiver to find such prepared items on their next trip to the market. Try to suggest meals you know you’ll both enjoy rather than the caregiver deeming it necessary to cook two separate meals.
  6. Bathing, dressing, showering – Most likely, based on your condition, performing these daily rituals on your own makes the caregiver’s job much more manageable. Only ask for assistance in those areas you find dangerous to do on your own or complex during this period. Do not attempt to perform tasks on your own that only exacerbate your medical issues. You’re not doing either of you a favor.
  7. Each day set aside time when your needs are minimal to allow the caregiver a break – This may be while you nap, read or play a game on a device. Most likely, the caregiver is experiencing some stress, and a designated rest period for them may be all it takes to keep them upbeat.
  8. During periods of ill health or during recovery, there’s never a time that expressing love, affection, and gratitude doesn’t serve you both well. A gentle hug, a tender kiss, or a kind word or compliment will never be lost during this period and, of course, well into the future.
Memories of this recovery period can be a pleasant extension of an already great relationship. Negative comments, behavior, and attitude will ultimately tarnish the relationship.
And so, dear readers, we end today’s post with these thoughts in mind and hope, should you ever be the caregiver or patient, you can do so with grace, dignity, and a bit of humor thrown in on the side.
Happy day to all.

Photo from one year ago today, March 1, 2018:

This is most likely a lone male elephant as explained here: “Male or bull elephants have very different social needs than the females. In the wild, males leave or are driven out of the family group as they approach sexual maturity. Males spend as much as 95% of their lives alone or in loose association with other bulls.” For more, please click here.

Caregiver expertise…What does it require?…

Mom and Babies were hanging out by the recently cleaned cement pond.

“Sighting of the Day in the Bush”

Her attention and love of her offspring have been unrelenting since we first saw them in August.
There’s never been a time in my life that I required a full-time caregiver. Although I had surgery a few times, I recovered quickly and only needed help lifting heavy objects or grocery shopping for a week or so. In all likelihood, this is the case for most of us.
But now, I strive to recover from this dreadful and complex surgery with my sternum cracked, chest cut wide open, and numerous incisions are running the length of my legs, all of which are painful, making moving about the complex.
In addition, I’ve had two painful chest tubes since removed that have stitches to be removed tomorrow when we return to Nelspruit for an appointment with the surgeon.
No doubt, with only 16 days since the surgery, there is still a lot of pain and discomfort. It takes six to eight weeks for the cracked sternum to heal, as would be the case for any broken bone.  
In the case of most broken bones, the patient is wearing a cast during this healing process. It’s impossible to stabilize this type of break with a cast, and thus, I must move gingerly to avoid further injury.
Thus as described above, this is the time I need a full-time caregiver, namely my husband Tom, who’s had no significant experience in this area throughout his life.
I can do several things for myself; bathe, bathroom, getting in and out of bed (where I spend little time during the day as recommended by the doctors). I cannot use my arms for tasks such as folding towels, chopping and dicing vegetables, or performing many household tasks.  
Thank goodness we have Zef and Vusi (included in our rent) who come each day to make the bed, wash floors and clean the house. With all the animals kicking up their heels in the dirt garden, there’s more dust in this house than one can imagine. Here again, one more bit of serendipity that proves that this was the best place in the world for this to happen to me.
As a result, as the caregiver, Tom doesn’t have to spend time cleaning the house; other than doing dishes and picking up after us after they leave, his attention is not divided in my full-time care. This is another huge benefit for which we are both very grateful.
One of his biggest jobs in getting those darned compression stockings on my legs each morning. As tight as they are, it’s an athletic event. It’s not easy putting on these tight knee-high stockings when I have awful incisions in both of my legs, and he’s trying desperately not to cause further pain. But each day, it goes a little more smoothly than the previous day.
Over these past five days, since he took over as my caregiver, after my release from the hospital, there are a few things I’ve observed that truly define the quality of a caregiver beyond the basic tending to bandages, stockings, and mobility.
Let me add here; I requested an early release from the hospital. Once I moved (after eight days) from the ICU unit to the regular hospital, it didn’t take more than a few hours to realize the quality of care went from a 10+ down to a zero. At that point, I knew Tom could and would take better care of me. As a result, I only spent two days in the hospital ward, in a room to myself. 
During this period of high temperatures, some warthogs avoid cooling off in the cement pond when the water has become warm.
Most patients spend from three days to a week in the hospital ward after being released from the ICU unit. In my case, I spent eight days in the ICU and, as mentioned above, only two days in the hospital ward.
Back to the points that I’ve found have been most helpful in addition to basic caregiving tasks have been the following, in order of preference:
  1. Caregiver’s attitude: Nothing could be more distressing than having a caregiver who wasn’t encouraging, upbeat, and optimistic. A negative resentful attitude could, without a doubt, have an impact on the rate of recovery. Regardless of how difficult this may be, never attempt to make the patient feel guilty for putting them in this position.
  2. Willingness to prepare special meals: Many patients have a diminished appetite and desire to eat after bypass surgery. Healthful, familiar meals are a real boon to the patient’s recovery.  
  3. Replenishment of cold fresh beverages can be instrumental in recovery: The medications may cause extreme thirst and a dry mouth. Drinking plenty of fluids is required for recovery. Having stale water or beverages hardly inspires the patient to drink to replenish their needs during the healing process.
  4. Participation in the rehabilitation process: This type of surgery (and most others) require a committed and diligent walking program. By encouraging and gently reminding the patient as to this process is crucial in making a complete recovery. If the caregiver walks with the patient, especially if they’re fearful of falling, the patient grows more confident.
  5. Medication distribution and monitoring: Many times, patients find themselves taking eight to 10 new prescriptions, some of which are taken at varying times of the day and night. A conscientious caregiver will oversee this process to ensure correct dosages to avoid over or under-medicating. Some pain medications cause drowsiness and result in the patient becoming forgetful.
  6. Encouraging rest periods: Instructions after surgery may include certain activities based on the patient’s level of progress. Type A personalities may quickly become overjealous in performing such tasks. As much as the patient believes “more is better,” a good caregiver will monitor such activities encouraging rest periods and following doctor’s orders.
  7. Creating a comfortable sleeping and napping arrangement: If the patient is uncomfortable sharing a bed with their caregiver/spouse and if the space is too small for comfort, an extra bed in the same room might be suitable. Air conditioning in hot weather is a must, as is appropriate heat in cold environments. Avoid extreme temperatures to aid in healing. Ensuring bedding and pillows are placed for the utmost comfort is a must, even when the patient is out of bed and seated at a table or in a chair.
  8. Escape time. When going through a difficult recovery, everyone needs a period each day to escape from worrying thoughts and pain. Watching fun TV shows and movies, games to play, or other such activities reduces the time the patient feels stressed, here again aiding in recovery.
  9. Encourage feelings of self-esteem: Let’s face it, having one’s body mutilated from surgery is a difficult thing to meet for some patients. Only the caregiver will know if this is an issue and provide realistic encouragement during the recovery process and in times to come.
These points became apparent to me over these past several days, and I only have Tom to thank for making this trying time tolerable. Besides, a little laughter throughout the process can easily lighten the load for both patient and caregiver. There’s no shortage of that in this household.
Tomorrow, we’ll cover the patient’s responsibilities to aid in their recovery process and the willingness of the caregiver to carry on with love, support, and excellent care.
Be well, dear friends, and thank you all for “coming back.”

Photo from one year ago today, February 28, 2018:
Nearby at another tree, we spotted a rhino mom and her baby, born this season and still closely attached to the mother. For more photos, please click here.