SURGERY IS EASY
Surgery itself is the easy part. There is basically nothing you need to do. You arrive at the hospital, check in, take some tests, become unconscious, and allow your surgeon to make incisions on both sides of your chest, implant the Nuss bars into your thoracic cavity, and close you up. Your part in the procedure is basically a passive one – that is, until the moment you wake up from the anaesthetic. It is only then, my friends, that your journey begins. This is where the rubber meets the road. And look out if you’re not prepared because you could be in for a very bumpy and unpleasant ride.
DURATION OF HOSPITAL STAY
The length of hospital stay after the Nuss Procedure will vary from person to person. Generally, however, it appears that patients in the United States typically remain in hospital for 5 to 7 days. This is a terribly short period of time. There is absolutely no way I would have been able to leave the hospital after such a short period. I was still in the Intermediate Care Unit on the fifth day following my surgery. At Helios Klinikum Berlin-Buch, the philosophy is somewhat different. Patients stay in hospital for as much time as is required. A typical stay is between 10 to 14 days.
With older patients, or those with more severe Pectus, and whose pain is expected to be greater, even longer hospital stays are normal. I was in Helios for a total of 18 days. The doctors want to ensure that you completely fine to travel. Many patients come to Germany from abroad for the operation so it makes sense to keep them there until they really are fine to leave. Those who experience complications, such as infection, will also normally stay longer to ensure they are all clear. To my knowledge, the record for the longest stay at Helios is 46 days. This record is maintained by my good friend Randy, another adult Nuss patient that I have come to know from the pectusinfo website. Randy had some serious complications which caused him to stay for such a long period of time.
GOING BACK TO WORK
I was told that I would most likely be able to return to office work after 3 to 4 weeks following surgery. This was quite accurate. I ended up returning to work 5 weeks after surgery and for the first few weeks back I was lucky enough to be able to do half days. I think each person will be different but for an office worker I think 3 to 4 weeks is quite a standard time frame. Manual labour is a different matter altogether. Adult patients who earn their living as carpenters or builders, for example, would possibly not be able to return to full work mobility for several months following surgery. This is certainly a matter to be taken into account when making a decision about whether surgery is right for you.
RESUMING NORMAL ACTIVITIES
For about 6 to 8 weeks there should be no running or strenuous physical activity, and lifting is normally limited to ten pounds or less. Also, it is generally accepted to not play sports where impact to the chest is likely, such as hockey or boxing.
At first, day-to-day activities are difficult to perform. Getting dressed, showering, putting on your shoes and socks, getting in and out of bed, as well as many other daily tasks that we all take for granted, can be very difficult. Give yourself time. Slowly but surely, as you recover, you will notice that it becomes easier to do things. Even at 6 weeks post-surgery I still find many of these daily tasks quite difficult, especially getting in and out of bed. It is literally a real pain!
RECOVERY TIPS FOR ADULT PATIENTS
Recovery has been very tough for me. The pain has been quite constant despite taking morphine. I am constantly looking for ways to ease the pain and speed my recovery. Here is a list of things that I have found helpful during the recovery period. try them and see if they work for you, too.
I have found breathing exercising to be absolutely crucial to my recovery. I am very lazy with The Coach incentive spirometer. I prefer to use my own deep breathing techniques. I take a very deep breath in through my nose for a count of 8, hold the breath for a count of 12, and the release the breath through the mouth for another count of 8. I do this for five minutes several times per day. I should probably do it more than this. Breathing exercises ensure that full lung volume is attained in the reconfigured chest cavity. The lungs and heart, which previously were compressed by the deformity are now are expected to accommodate this increased space. The patient must breathe deeper to force expansion of the lungs to the chest wall. Compliance with these exercises not only increases oxygen reserves but also helps keep the chest cavity expanded outward. This ensures greater success after the bar is removed. Many doctors say that these breathing exercises must be performed once an hour while awake after discharge and continued during the entire time the bar is in place. Most patients, on the other hand, are lazy. It’s difficult to always remember to do your breathing exercises but you should try to do them as much as you possibly can.
Stretching and Yoga
My whole body ached after surgery. It still does. Particularly, I get aches in my back, my shoulders, and across my chest. I have found that stretching really helps alleviate many of these aches and pains. I am also told that yoga is very beneficial. I decided to learn a few very basic stretching exercises for the back and basic stretching exercises for the shoulders. For the back stretches, you may want to lay on your bed rather than on the floor. I do these stretching exercises in the morning when I wake up and in the evening before bed. I always feel a great deal better after doing these exercises. Try them and see if they work for you.
Aerobic exercise helps you maintain fitness levels, are good for your heart, and help you expand your lungs. All of these things are very good for someone recovering from the Nuss Procedure. You may not be able to run for a couple of months afer surgery so please make sure to take it slowly. If you are in a gym setting, a fast walk on an incline would be fine. if you are outdoors, even better. There is nothing like fresh air and a good brisk walk. make it a regular part of your recovery program.
Maintaining Correct Posture
Many people with Pectus have poor posture. It is important after surgery to try to maintain correct posture at all times. Doing so will help reshape your chest and will help you to obtain the best results possible from your correction. When I was in Helios, Professor Schaarschmidt pulled me up several times for poor posture. Since then I have been trying to walk shoulders back, chest out as much as I can. I do believe that it helps with the results a great deal.
Warm Baths and Hot Compress
I have found a warm bath before bed to be very relaxing. It also helps soothe sore and aching muscles, whether in your chest or your back. If you do not have a bath tub, then a warm shower would also be useful. I also highly recommend a hot compress or hot water bottle. Take it to bed with you and pop it on your chest. Just don’t make it too hot or you are likely to scald yourself. I have found my hot water bottle to be extremely soothing. Very highly recommended!
Research shows that Glutamine aids in the healing process and boosts the immune system. I take 5mg of glutamine power two times daily, usually with my protein shake. I also take 120mg CQ-10, 1,000mg vitamin C, one multi-B vitamin, some milk thistle for the liver, and a magnesium tablet. This little supplement combo works very well for me and I make sure that I take it daily for maximum benefit. I have noticed that I am lacking in energy on days that I miss my vitamin cocktail, but this has only happened once or twice so far.
A healthy diet is important at all times, especially when recovery from a major surgery such as the Nuss Procedure. I did quite a bit of research following surgery and found that a diet low in carbohydrates was best for reducing inflammation in the body. As such, I try to stick to a simple diet of lean meat and fish, vegetables, and fruits. I have tried (sometimes with varying degrees of success) to eliminate all refined sugars from my diet. I have also eliminated bread and anything containing flour, such as pasta. I have fallen off the wagon a couple of times but generally I believe that following a balanced, healthy diet is the right thing to do for anyone, whether you are recovering from surgery or not.
This is a controversial topic. Many people, including those who have been through the Nuss Procedure, advocate getting off all opiate-based medications as soon as possible following surgery. The grin and bear the pain approach. I completely disagree with this approach, as does my pain specialist. You need to give your body time to heal. Being in constant pain does not help you do that. In fact, pain puts great stress on your body and it also lowers your immune response. I am a firm advocate of staying on pain medications for as long as necessary, as long as you are being properly supervised. Why put yourself through unnecessary pain?
Advocates of the grin and bear it approach say that pain medications are for the weak or that the longer you stay on pain medications the harder it will be to get off them. I disagree completely. I am planning to stay on pain medications for as long as I need to. My pain specialist agrees with this approach. When the pain decreases, I will decrease the dosages of medication until such time as I am medication free. I am looking forward to the time when I am off all medications but I’m not in any hurry. Why would I be?
As I have discovered, this is the number one recovery tool, and one which I have failed to employ as much as I should have. The operation can be brutal both physically and emotionally. It is so easy, in my opinion, to spiral out of control into a quagmire of negativity. The pain, dissatisfaction with results, immobility, impatience, and the medications – all of these can add up and make you feel very negative. Try to surround yourself with positive, strong people. I was lucky to have a very good support group from all of my friends at the pectusinfo forum. Without their constant support and encouragement, and that of my partner, I don’t know how I would have coped with the stress of the operation and the recovery.
Think positive thoughts as much as you can. Things can and will get better, even if they look terrible from where you are standing. Trust me. I’ve been there and I know this is the truth. It just takes time and patience and an attitude of strength and positivity. You’ve struggled with the Demon for your entire life and now it’s your turn to be the winner.