Friday, March 19, 2010

Moving from "Crisis Energy" to "Sustained Energy"

When Steve became acutely ill a couple of weeks ago and requirerd open heart surgery to replace his aortic valve and bypass four of his coronary arteries, we all operated in "Crisis Mode." He was in perilous straights and something had to done urgently -- so that he would live.

Now that the surgery has been completed, Steve -- and all of us -- switch into the longer-term "Sustained Energy" mode.

It's the difference between a sprint and a marathon. Both are important -- but at the right times.

Now, for example, we are focusing on the following:

1.  How can we support Steve's rehabilitation in the best ways possible? Clearly, he must recover from a major surgery; but he still needs dialysis on a regular basis.

2.  How can we prevent new problems, such as skin breakdown, pneumonia, or infections in his central IV lines?

3.  While he isn't alert now, we see that he is moving in that direction. How can we re-orient him to the events he's experienced, even in absentia?

4.   Nutrition changes, as he moves from TPN (Total Perenteral Nutrition through his central IV line) to "formla" through a naso-gastric tube, later to return to real food. If anything, his nutritional requirements will increase with the demands of wound healing.

5.   Deconditioning is a very real risk; we rapidly lose muscle tone -- and even bone mass -- with prolonged immobility. (As a nursing student, I remember reading an article entitled "The Dangers of Going To Bed." I'm sure in my early twenties, I had different dangers in mind!) So Physical Therapy enters into the mix tomorrow. Later, Steve will transition back to Cardiac Rehab.

As an Emergency Room physician many years ago, one of the most valuable lessons I learned was that there are really very few true emergencies.

Certainly, true emergencies include things like airway obstruction, profound hypotension (low blood pressure), hemorrhage, anaphylactic shock, potentially lethal heart rhythm disturbances, and my personal favorite: "Baby coming NOW!"

But for most other matters, you do have a moment to think, to organize, to Google up information you need, or to call someone who's smarter than you are!

For Steve, this period of re-equilibration: moving from Crisis to Sustained Energy comes as an enormous relief.

Take care. Linda Gromko, MD

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