Tuesday, October 30, 2007

Total Knee Replacement - Surgery Plus Four Days

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Total Knee Replacement

Morning, last day. The nurse gives me the option of showering here or getting one at home. No contest. I’ll do my last “warm paper clothe” wipe down here and then luxuriate in a nice shower at home.

The knee feels a lot better. I am amazed at what progress is made. Five days after a total knee replacement and it can take a fair bit of weight, if I am careful.

I’m all packed, ready to go. And in comes my baby, about 10:30. Sweet. Lynn grabs my bag and heads off to fill my prescription for blood thinner and pain pills and the nurse calls for a steward to assist me getting to the check out. This old guy shows up to take me down in a wheelchair. It’s his birthday today I find out. He’s 90 years old. He started volunteering at 80 for something to do. Incredible. He’s made my day.

My walker was supposed to be delivered this morning to my house. Good thing Lynn called, because they scheduled delivery for tomorrow. So we stop at the health services supply depot on the way home. One walker, check. One potty chair with high rise hand assist handles, check. How can I have surgery scheduled for a month and a half and then have them arrange to deliver the walker a day late? Lynn explains to me that they don’t actually maintain a file on me all that time. Apparently after the need for a walker is determined, they close the file. Then, once the hospital decides when I am going to be discharged they call the extension service and my file gets re-opened. And then they schedule delivery. I bet this is because the hospital(or regional health care unit) jobs all this stuff out, on contract, and they would have to pay some kind of ongoing charge to keep my file open.

That would also explain the little talk I had with the extension service rep. She explained that, though I was told I would be having the staples removed at home by a nurse, now I am on a waiting list and should make arrangements to go in to see my family doctor and have the job done. Why am I taking up a doctors time, having my wife leave work early, travel into and out of town, instead of having a nurse come to my home? I have worked too long for a crown corporation to not smell “budget” issue.

We get home after a short drive. My knee feels like it’s swelling up already. Just 30 minutes with my heel resting on the floor of the car, instead of up on the seat, level with my butt, the way it’s been for the last five days, is enough to get fluids collecting around the incision site.

Lynn and I live in the country, and though we’ve never had internal problems (gastrointestinal) with our water, we’ve sometimes come up with low quality when we sent the water in for testing. Concern for infections and the possibility of visitors not having our tolerance for the well water encouraged us to pursue a UV treatment system for the water supply. It’s been slow coming, but the guy arrives today, shortly after I get home. My luxurious shower will have to wait a bit.

I was encouraged to get myself a cane, since they are not supplied by the extension service, like the walker was. So this slight delay just means that Lynn can go shopping for groceries and pick me up a cane while I practice using the walker and wait for the UV system to get installed.

“Well, it’s all done, but we can’t use it,” Lynn explains to me. The installer, ever careful and solicitous of our health, has dumped a couple containers of bleach down the well, to wipe out any harmful bacteria, and now Lynn has to run around the house, opening taps for fifteen minute flushes, to make sure there is nothing in the pipes. Then, later on this evening, she has to run the outside taps for a couple of hours to help eliminate chlorine from the well.

Apparently we don’t want to shower or bathe in that stuff. A little sponge bath later tonight will be okay. Too bad. Well. I am used to sponge baths. Tomorrow is another day.

On the positive side, I am home, Lynn and I are together, and the meals are not delivered from some off-site catering service. Count your blessings as they say.

Friday, October 26, 2007

Total Knee Replacement - Surgery Plus Three Days

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Total Knee Replacement

I feel really good today. I woke up with lots of energy. And guess what? Oh my God! An omelet for breakfast, with a hash brown potato patty. These guys are going all out.

Did rehab. Energy level crashed. Here’s the exercise/pill conundrum. If you take your pain pills and then the therapist comes around, you are going to be able to push a little harder. Which is good, unless you push too hard, which will aggravate the surgery site, maybe increase swelling, and make it more difficult to achieve good flexion next time you exercises. So there is a bit of a line to walk.

Janet, my physiotherapist says that a total knee replacement can be harder to recover from than a hip replacement. There are many more restrictions on what you can do with a hip, so you are not as likely to try as much, and less likely to set yourself back. I don’t know, never having had a hip done. I do know that after ten reps of all four knee exercises I was sweating and worn out.

I’m on one T3 and one percocet now. I tried just staying on the T3s alone, once the morphine self administered pain control device came off, but they didn’t quite cut it. The perc/T3 combo is working fine.

Every dose of pain killer includes an iron pill. And in the morning I get my blood thinner, cumadin. Funny, I always thought of iron pills as something you took if your blood was thin. And the cumadin is a blood thinner, but there is a difference between anemia and stickiness. We want to build up the blood iron, avoiding anemia that potentially could accompany blood loss during surgery and food avoidance caused by the regular menu. At the same time we want to cut down on the “stickiness” that could lead to clot formation. Cumadin is a standard prescription for any total knee replacement, in fact for any surgery, as far as I understand it. Very little downside and lots of up side.

I wonder about all the supplements touted by alternative medicine newsletters and books for post surgical recovery; everything from immune system boosters to specific formulas that are supposed to help wounds heal better. Do none of them work? Hard to believe that the diet served here includes everything that a body needs to heal faster. I was just reading about a study done in which a researcher examined the eating/supplement habits of 11,000 dentists. He compiled a list of the amounts of common vitamins and minerals (the ones listed on your one-a-day bottle) that the healthiest 5% consumed. It came out to roughly 4 times the recommended daily amount of those nutrients. I’ll have to look it up. Normally I take two multi-vitamins a day. When I get back home, I’m back on my two-a-day regimen for sure.

They are supposed to deliver a walker and a toilet seat with raised arms to my house tomorrow. Lynn suggested she better call ahead to make sure it will be delivered by the time I get home; otherwise it’s crawling from the car to the house. I wouldn’t want Lynn to try and assist me across our uneven field stone front walk.

I don’t think I will need the seat. I’m managing fine on the toilets here in the hospital. Of course, for the one attached to our room I have to sit sideways so my leg has someplace to stick out. It feels weird doing your business on a toilet with the oval running in the wrong direction.

Saw Lynn this morning. Actually she was there watching me do physiotherapy. So no screwing around with how the exercises are to be done, once I am back in my own house. I know she will be watching. She brought my sandals so it was a little nicer using the walker. We even scooted out to the waiting room. Even with other people there if felt like we had more privacy.

Lynn is in the middle of a horse hunt. No mistakes this time (though her last horse was a sweet heart, it came up lame). She is pouring over the internet, on email regularly, on the phone with owners, trainers and other horse people regularly. Almost every trip into the hospital is preceded by or followed with a visit to a riding arena or stable. So we get custom made news to talk about on that score, every visit. I’m not a good patient for visitors. After about 30 minutes I start getting a little antsy. I mean, with people you know and love, and one of you restricted to a space about 7’x3’ the news is going to be limited. So the horse thing is good. I mean I could talk to Lynn all day. I love talking to her, but not in the confines of a hospital room, surrounded with 3 other people. Oh well, out of here tomorrow.

Shannon and her husband Gord show up for an afternoon visit. It’s outside of visiting hours but I scoot out to the waiting area and we visit out there. Shan was helping at a wedding in Toronto yesterday and she really enjoyed herself. She got some great decorating ideas, made some good vendor contacts and took some photos she can put up in her gallery at elegantevenstbyshannon.ca to help give people ideas.

Gord spent the week working on the house they are building, south of Buckhorn.
They are only in their mid-twenties but are getting a very good start for themselves. Both are hard working kids with good ideas. They should be able to move into the house in November.

Today I’m dressed in my running pants and a t-shirt. Just like a regular person. It feels good not to have the hospital gown on. I am also wearing a “compression stocking.” Sort of like the left side of a pair of white tights. Dr. Blastorah likes his knee replacement patients to wear them to keep the swelling down. I didn’t get it till today through some glitch or other. I wonder if the swelling would be less today, if I had it yesterday. Whatever. I think the stocking makes my leg look shapelier.

I mentioned already that they hardly shaved any hair off my leg. I wonder if it is some kind of “We don’t want to make the patient feel different or alienated about their body” thing. I shaved my legs half-way up to my knee in high school. We used to tape our ankles before every game or practice. Shaving sure would have made bandage changing less of an adventure. Actually, I just found out it is because they want to minimize the chance of opening any little razor cuts, and increase the chance of infection. Give me a break? I've got a slice down my leg that looks like it was made by Jim Bowie or Conan the Barbarian, and they are worried about razor nicks? Hey, take my advice. If you have to go through this, shave the incision area three or four days before the event. it makes changing bandages easier.

My buddy John called this morning. John and I have been friends for right around thirty years. It’s nice to get calls from friends. And being in the hospital is a good excuse. Johns pretty good about keeping in touch though. He called a couple of weeks ago because he knew I was going in and just wanted to check up.

Lynn called back this evening. We have a beaver wandering around in our backyard. The dogs were going nuts. She got them into the garage thankfully. I don’t even want to imagine what a beaver bite would look like on a dog. Lynn got assistance from the neighbor’s daughter-in-law. She had a large cage and together Lynn and she convinced the beaver to get in the cage and they have set it loose in a big pond on the father-in-laws property. Now we have a happy beaver and a happy Lynn and dogs. Sometimes stuff just works out.

Total Knee Replacement - Surgery Plus Two

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Total Knee Replacement

Friday night was restless. Not a great sleep. Having your leg wrapped in endless layers of gauze and cotton batting is a real pain. And not being able to move it very easily is also a hassle. But it is nice having the ability to adjust the bed controls to elevate your torso a little. I have to admit that even after what turned out to be 5 days in the hospital bed, I had no back problems. I would not be able to say the same about my bed at home.

I remember lots of periods of wakefulness between Friday night and Saturday morning. But the nurse managed to empty my little urinal three times between 12 AM and 6 AM without me noticing her, so I must have slept sometime.

Jeffrey is moving a little more slowly today, but he is up on his walker early, before breakfast. He likes his shave and wash. I am going to have to give serious consideration to whisker removal and shampoo today. This is a hospital, after all, not a canoe trip.

The nurse has already been around with a kind of warm wet nap, a very cool handy dandy clean-you-up-without-soap-and–water towel. A very heavy paper wipe, about 30 cm (or one foot) square that is slightly damp and impregnated with a little soap, glycerin, aloe etc. that can be warmed up in its own package in the microwave. I think there are 5 or 6 sheets to a package and the nurses hand them out and close your privacy curtains. (Hi Rachael, hi public corridor). Then you can give yourself a good rub down. The nurse comes a long a minute later to do your back and voila, country scented clean. Hey, I’ll take that, as opposed to standing over a drain somewhere, naked, hanging on to my walker while some helper hoses me down.

They just took the bandages off and unwound about 20 feet of gauze wrapped around enough cotton batting to outfit three Santa Claus imitators. They took off the bandage put in after surgery. Ouch. What…, no time to shave the leg? I remember after my original cartilage removal it looked like they shaved everything from ankle to groin. Here they barely took out a half inch (12 cm) wide strip. The cut is about 8-10 inches (20 -25 cm) long. There’s a little drainage tube that just disappears into the side of the knee and leads to a little liquid collection container that sits on the bed at my left side. That tube comes out now as well.

When they remove the drainage tube it doesn’t so much hurt as send a little jolt though my knee. Very similar to getting a shot of electrical current. Weird. There’s a little bleeding from the drainage hole, but not much weeping from the main incision. And speaking of the main incision, it looks like some mad, serial stapler got a hold of me and just had his way. There must be thirty staples. I’ve seen model railroad tracks with fewer cross ties. I wonder what they will feel like coming out.

A few minutes of work with a damp clothe, a little rubbing away of cotton batting residue, application of a new bandage (over the unshaved hair on my leg – how often are we going to change that bandage now) the disconnection of some fluid IV lines and I am a free man. Except for this wonky knee that doesn’t want to bend and leg that hurts too much to lift without support. Still, a new threshold has been crossed.

Today’s breakfast is special. A piece of toast with three slices of bacon, cream of wheat, juice…whoa. What are they trying to do, make me stay forever?

Physio is a little more interesting without having to fight through all the bandaging. I sense the therapist isn’t that pleased with my progress. I try and explain to her the greater difficulty in lifting and straightening a long leg like mine, as compared to the little short legs she mostly deals with. It’s a simple matter of leverage. We all studied this stuff in school. She is not that impressed with the argument.

In Jeffrey’s conversation with his doctor this morning the possibility is raised, of him going home today. The doctor says, sure, why not, as long as the physiotherapist agrees. Jeffrey’s wife says “what am I going to do with you at home.”

Suddenly Jeffrey is an over-achiever again for the therapist. Last nights sweats and chills are banished from his mind. He meets all requirements and is gone by lunch time.

The therapist and I got up for a little scoot around the hallways. She is just a small thing. Maybe 5 foot high, maybe 90 pounds. But mean. Like an agitated rattler. During the rehab exercises, I go to assist my injured leg with the toe of my good one and her hand lashes out, giving me a smart little slap on the ankle. “There’ll be none of that,” is all she says. She obviously knows her stuff.

My hallway scoot is exhilarating, except for the fact that I am barefoot. I didn’t think to pack slippers or sandals for my stay. Of course, I didn’t expect Lynn to take the clothes I arrived in home with her on Thursday. They go in a separate plastic bag labeled “Personal Belongings” when you gown up for surgery. Lynn thought I would have no need for them until check out time Monday, so why leave them lying around in the hospital? Good thinking except for the no shoes dilemma I now find myself in.

Of course, I can’t catch her by phone before she leaves to come visit. It’s going to be an early visit today because there is another horse to see afterwards. So the visit winds up being a little broken. After the initial chit chat, Lynn takes off to find me a pair of cheap flip flops or equivalent at the closest store. Naturally, nothing has my size (13) so it takes a while. She finally gets back with what we used to call “bedroom slippers” in the old days. You know, the ones with the sponge rubber sole, plaid uppers over the toe and black stretchy material around the heel. Comfy. They really were a good fit, and felt secure under foot with the rubber sole, but anything with a back on it is a problem for straight legged people (like recent knee surgery patients). It’s a good thing I was able to touch my toes before the operation, so I can just barely bend enough to put the things on and slip the heel of my left foot comfortably into them. Sandals would have been handier. But now I have a pair of “bedroom slippers” that are the foot equivalent of comfort food.

Today was another stretch in the chair. Two hours today. It got cut short because I asked for help to get up and into my walker so I could travel across the hall to the handicapped “patients only” washroom. A lot more room in there and it is possible to sit on the toilet with your leg extended. My first bowel movement. I normally wouldn’t be so forward with this kind of information, but let me reveal a little secret. If you don’t manage on your own, then the nurses will provide medication to assist. My philosophy re: BMs shifted when I got that bit of info. Laxatives work differently for different people. They tend to work really well for me, so I preferred doing without.

Of course, I needed no assistance using the walker, and once I was done my business, I just walkered my way back to my bed (already made up) and got in. No need to be stuck in the damn chair for 4 hours again like yesterday.

Total Knee Replacement

Sunday, October 21, 2007

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Total Knee Replacement

Supper was a huge surprise. Cream of chicken soup, but I was hard pressed to identify the tiny granules floating in the liquid as pieces of chicken. Now the nurses are talking about the importance of having a bowel movement before I go home. So far I haven’t had enough solid food to make up a quarter of a bowel movement. Well tomorrow I start with the roughage apparently.

I just got a good example of what can happen if you push too hard. Jeffrey has been tossing and turning for hours. First sweats, then chills all evening. Earlier on he was in great pain. Seems as though, in addition to pushing too hard with his exercises, he also cut way back on his pain medication. They took him off the self medicated device and IV in the morning, and he also refused several percosets.

It all came tumbling down starting about 7 PM. His shoulders were really giving him grief. Using a walker is not easy when one of your legs is virtually useless. It is the functional equivalent of doing dips. Anyone contemplating getting knee replacement surgery would do well to start practicing some modified form of doing dips at home before the event. Jeffrey wound up with ice packs for his shoulders. Then the pain in his knee. Then the sweats and chills. Of course, he immediately was worried that he was suffering from an infection.

Turns out it’s a false alarm. His body temperature remains stable over several hours. But he iss now convinced he won’t be getting out maybe even until Monday. The disappointment is obvious.

The room temperature is something else. I swear they have it hooked up to a yoyo powered thermostat. The temperature outside the building has a pretty high impact on the temperature inside. So it is normally warm by evening and then gets cooler as the night goes on, but the variance feels like more than that. Of course, I’m just 32 hours removed from major surgery, so maybe my body is acting funny.

Overall, Friday feels way better than Thursday. I feel a lot more awake. I was able to dig into the pile of books I had brought with me and got a lot of reading done and a lot of writing on my projects. The one thing I didn’t spend much time with was my iPod. I have several audio books loaded up, but just never seem in the mood for them. With all the coming a going, it’s a lot easier to just put a book down to speak to someone, then pick it up again, skim back a few paragraphs to pick up the train of thought, and carry on with a book. Maybe I’m just not as used to the iPod.

My memories of hospitals from days gone by and the medications nurse coming around are all fantasy now. There is a completely new process in place I am told. They have this machine, like a big vending machine. You punch in a patients name and it dispenses the required medication for that patient, if it is time for the medication. The nurse must deliver that medication and come back and indicate that it is delivered before that nurse can get another delivery. It slows the whole process down of course. I guess it also makes it far less likely to deliver the wrong meds to somebody. Progress is a wonderful thing.

So are self medicating pain control devices. They can really take the edge off when your meds are wearing out. As a matter of fact, when your meds are wearing out is the time you are most likely to give yourself a couple of shots in short order. Of course, it almost goes without saying that just about the time you finish delivering the second shot is when the pain pills arrive. You can’t say, “Oh thanks nurse, I’ll just put these little devils away until later.” No, you must take them right there and then. You wind up with a nice little glow. For a while. I guess I should have included a wrist watch in my list of things to take to the hospital.

There was no clock up on the wall in the room. Time takes on a really fluid quality when you start judging it using meal deliveries, pain intensity, visitor arrivals and increasing or decreasing sunlight outside.

Saturday, October 20, 2007

Total Knee Replacement - Surgery + One

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Total Knee Replacement

My day starts early. Right about 04:00. Time for the nurses to wake you up and take your vitals and distribute required medication. I’m glad of that. Just before the 24:00 set of readings the nurse informs me that earlier, while I was asleep, my respirations had been at a very low rate. So they were going to shut off the self medication button for the night. I still got my two Tylenol 3’s, but I can tell you that by four in the morning, they weren’t doing an excellent job any longer. I can see developing quite an affection for the T3’s, I can tell you.

Couldn’t get back to sleep after the 4 AM visit from the nurse, and it wasn’t because I am into nurse fantasies. My brain was just spinning with what I was going to do during the time off work, recovering at home. There is a lot of reading I want to do. (There’s always a lot of reading I want to do). There are some online courses I want to take. My son Trevor and I have a couple of writing projects we wanted to pursue. I have a completed book my son-in-law Gord and I have finished that I realize needs more work. And I thought about doing this blog.

I wish I thought of it right from the beginning. It wasn’t until just one or two days before I was scheduled to go into the hospital that a couple of people told me how interested they were in how things might go. Seems both of them were up for total knee replacements as well. I wondered if maybe a number of different people might not be interested. Why not blog it? Why not indeed? Already I had figured out some things that I could have done differently. Anyone reading this blog should be able to learn a few lessons based on someone else’s experience. Definitely the best way to learn. What’s that saying, a smart man learns from his experience. A really smart man learns from every body else’s.

At 06:00 the nurse agrees to hook my pain button up again. I don’t waste time getting that sucker going. Breakfast shows up around 08:00 with the next round of vitals and pills. Mmmmmmm, porridge. Last nights supper was cream of mushroom soup. So far, everything is falling in line with my plans to have no solid food at the hospital. I cut back on my eating Wednesday before coming in. I absolutely want to avoid having a bowel movement before the weekend; possibly the whole five days if I can manage that. The nurses let me know how constipating my pain control buttons morphine and the T3’s codeine were. So far everything is going according to plan. This porridge didn’t look like it was the high fiber kind. More like the Charles Dickens gruel type. That suits me.

After my breakfast, a hurried phone call home ensured that Lynn would show up with a box of granola bars. The good yogurt coated kind. Now they can do their worst, I’ve got enough supplies for a couple of days. Sure, granola bars aren’t really no-BM friendly, but the roots, berries and nuts that make up most bars would take a couple of days to work their way through my system. I calculate they would achieve their desired effect about the time I was back to the friendly throne in my own house.

Jeffrey is way more mobile than me. He assures me that this is what I should expect. “I was just like you yesterday. Tomorrow you will be just as mobile as me.” Off he goes in his walker for a spin down the hall. Hard to believe I’ll be that mobile tomorrow, but Jeffrey’s definitely the expert.

When the physiotherapist shows up she makes us both go through our exercises. They are for strength building and flexibility. It’s hard to imagine how much strength you lose when they make 25 cm slice down your leg and cut the ends off of two leg bones. The physiotherapist takes Jeffrey through his paces and he amazes her with his range of motion and recovered strength. (By strength I mean the ability to hold the injured leg out straight without jiggling too much for 5 – 10 seconds before resting, and repeating nine more times. The definition of strength changes after a total knee replacement).

Now they are talking about Jeffrey getting out early. He’s scheduled for Sunday release, but he really wants to get home Saturday. Maybe I can get out early too? Monday morning, my scheduled time, means Lynn needs to take another day off work. Sunday would work better.

My daughter Shannon calls. Thank you Darling. She’s having a reasonable day at work. She has received a couple of more enquiries about her wedding planning services, through her website at eleganteventsbyshannon.ca. And she’s getting pumped about helping out at a wedding in Toronto tomorrow. It’s at a place called the Old Mill. They can do 4 weddings at a time. We have a nice chat. She knows exactly what’s going on because of her nursing background. Bye Doll, talk to you tomorrow.

Now the physiotherapist tells me it is time for me to get up into a walker. I blink my eyes a couple times until she explains it is just going to involve getting out of bed into a standing position, inside the walker, rotating 180 degrees, and then sitting down in a large mobile chair. They don’t explain that I will be stuck in the chair for several hours. Getting me out of bed cuts down on the chance of bed sores developing and, I think mostly, it gives them a chance to change the sheets, do some cleanup around the bed, and establish dominance over you. I mean I was getting to feel like the bed was my little territory, my home away from home. Oh well, so much for THAT level of comfort.

Lunch arrives while I am in my chair. Cream of mushroom soup again. So far my plans for no bowels movements are falling directly in line with their plans for feeding me.

Nice visit with Lynn. She has taken Thursday and today off as family medical days. What a great idea. Why didn’t they have those years ago? I guess they did. Just not paid.

I’m not really a good patient. Not that I am fussy or anything, but I don’t like people fussing around or for me. That means my inevitable response to “Can I get you anything?” is generally a “No, I’m fine.” This doesn’t make the person offering feel very helpful.

There aren’t even any chairs in this room. I don’t know if that’s because all the mobile patients have been going on late night scavenging runs and stealing chairs, or if the hospital is trying to actively discourage visitors.

I offer Lynn my pudding, so she checks it out. Apparently pudding aficionados can tell if it is actually cooked or mixed. This is cooked. But two spoonfuls are enough to convince her it isn’t cooked particularly well. The pudding goes back on the tray.

Lynn says goodbye and heads off to check out a horse she is considering buying while I am still in the chair. I wind up spending four hours in it. I am still essentially unmoving, with the bulk of my weight on my butt and back. Of course, the chairs extendable legs can’t extend enough to accommodate someone who is 6’4” or around 182 cm, so my leg is braced on a pile of pillows to get past the foot rest. I’m not sure how this is all better for me than lying comfortably in bed, but hey, I’m dealing with trained professionals. The nurses are probably just following some orthopedic surgeon God’s instructions.

Trevor calls. Nice surprise. He’s doing okay and let’s me know he has a get well present. No clues though. We joke around on the phone for a while. Then it’s time to move me back into bed.

Moving back into bed was easier than getting out. The 30 seconds or so of effort it required to get out of bed and into the chair left me sweating, light headed and encouraged the nurses to put the chair in a reclining position. Jeffrey assures me he went through exactly the same thing the previous day. Hard to believe. Watching him with the physiotherapist, he was obviously going to the next level. His range of motion and ability to do the lifting and bending repetitions were unreal to me, feeling the way I am. Jeffrey was doing all this with his bandage cut away. Next he went off for another scoot down the hall, with the physio in attendance. Hard to believe that man had gone through a total knee replacement only two days previous.

Wednesday, October 17, 2007

Total Knee Replacement - Surgery Day Afternoon

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Total Knee Replacement

The room is a constant hive of activity. With two total knee replacement patients, another with both legs in casts and a less than completely aware hip repair in the last bed, we are all getting care pretty steadily. Both Jeffrey and Bob get regular visitors. The nurses are by on their regular four hour schedule, as well as other more frequent visits to refresh water, answer the alarms from the IV’s that are constantly going off. Physiotherapists come by. Doctors visit. Meals get delivered, and then dirty trays get taken away. Nurses are by to give your backs a wash. It all makes using the bed urinal difficult if your bladder is a little shy under Grand Central Station like conditions.

Nurse John tells me not to worry. “You had the nerve block didn’t you? It always affects the little valve in the urethra that way. You lose control of it. If you don’t get going again by tomorrow morning, we can always put in a catheter.” I don’t remember having the catheter discussion with the nerve block guy. Wouldn’t this be a relevant piece of information?

Of course, having a fair impression of what my condition would be after the surgery, I made a point of not only avoiding anything but “clear liquids” after midnight on Wednesday, but I didn’t even drink anything other than a tiny sip of water Thursday morning. I wanted an empty bladder.

“We’ll come by a little later and do a scan,” was John’s response after my explanation of why I didn’t need a catheter. They have a little portable ultrasound device that can be used for bladder scans and even prints out a little picture. The whole thing is about the size of a portable debit card scanner.

I managed to sneak that little urinal bottle under the covers for another attempt. Of course, the beds all have three privacy curtains around them. When mine are closed I get excellent coverage except in the two corners, where they come away from each other, and provide a clear view of Rachael’s bed through one gap, and the main hallway outside my room though the other gap. But Bob and Jeffrey can’t see what I’m doing. The nurses are sympathetic. “Yeah, these curtains are bad like that. The Velcro’s come loose.”

John is unimpressed with my 100 ml of orangey yellow liquid. “We better take a scan.” Out comes the tube of gel, room temperature by some miracle. Good news. I’ve only got about 160 ml in my bladder. Later that night, when the room seemed less like it was on the planned route for scheduled stampedes, nature has its way. There, I thought. That’ll show John. Must be 350 ml, at least. No catheter for me.

Total Knee Replacement

Monday, October 15, 2007

Total Knee Replacement - Surgery Day

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Total Knee Replacement

We got to the hospital about 08:00. I gave Lynn a kiss at about 10:00, and they were wheeling me into surgery by 10:30 – a little faster than expected. It seemed kind of last minute, but just before wheeling me into the room I had the nerve block injection explained to me. They give you a needle at the upper end of the leg they are going to work on and it stops all sensation for a day or so. It helps with pain control. Sure thing, I agree. Sign me up for pain control. After all, you are sawing through my bones here.

They were a happy crowd. Playing Credence Clearwater Revival and Neil Diamond. I don’t think any of them were out of grade school when those tunes were burning their way up the charts. Some of them looked like they might not have been born. This just confirms a clear impression I had during the ‘80’s. A lot of crap music was released during that decade. I mean, which would you rather listen to, “Willy and the Poor Boys” or “Like a Virgin”? Clearly, no contest. So there’s a whole generation forced to listen to some other generation’s tunes if they want to play music.

Anyway, they go through this little ritual of introducing me to everyone in the room. I guess that reassures you that they really are medical people, not strangers off the street. Then they insert the IV.

On my previous visit to the hospital the anesthesiologist talked about the two options, a general anesthetic or a spinal. A spinal removes all sensation from the waist down, but you remain conscious! “Don’t worry about staying awake. You’re well sedated. Nothing will bother you.”

Dr. Blastorah talked about this in my final pre-hospital visit with him, three days ago. “We do patient satisfaction surveys and the knee replacement patients that get spinals generally rate their satisfaction as higher than those who get a general.”

I know that nausea is an issue for some people when they get a general. It was a long time ago, but I don’t recall any problem last time I had one done. And call me crazy, but the idea of lying there awake while they put their power tools to the bones in my leg just isn’t appealing. I don’t care how stoned I am.

“Give me the general”, I tell the anesthesiologist. I don’t even remember getting groggy.

And I have no recollection of an extended period of coming around after the operation, though Lynn and my daughter Shannon have a somewhat different story to tell. Apparently I woke up enough to ask “What does a guy have to do to get a kiss around here”, and then passed out for a while before coming to completely. In my mind it was a totally seamless transition from pre to post surgery awareness.

It was a real joy having my wife and daughter there after the surgery. I’m not the kind of person who wants a whole lot of care when they are sick or recovering. Let me go to my room, don’t bug me and I’ll come out when I’m better, is my routine. Of course I’m appreciative of help, like meals and handling the regular domestic stuff, but don’t be checking in on me every half-hour to see if I need anything. Drives me up the wall. Both Lynn and Shannon know that by now, so they are perfect recovery companions. Lynn has been a rock through all of this. Providing support in the exact amounts I need and want it. And coaching me as required, without hectoring.

The first day in the hospital is an eye opener. The staff are fantastic. And overworked, but that has kind of become a way of life in the health care field. And a lot of them are young. The result of the hiring push that began a few years ago. And there are a lot of students accompanying the nurses in their rounds. The students are surprisingly competent as well. Almost every nurse had a student. Bodes well for the future.

My leg feels like somebody has attached a dead weight to my hip. No sensation or control. I can’t move my foot or wiggle my toes. Of course, one of the lessons hammered home by the physiotherapist was how critical it was to do my foot wiggling exercises every hour to ensure blood circulation in the leg and prevent clots from forming. Somebody should hook the physiotherapist and the nerve block guy up and let them sort this one out.

Despite the dead meat feel of my leg, I can tell something had been done to my knee. So, Thank you, Mister Self Administered Pain Control button. A handy little device, preprogrammed to allow you to give yourself little dose of morphine without overdoing it. Isn’t modern technology wonderful? I wonder what William Burroughs would have thought of this.

By the end of the first day you are eagerly looking forward to the time when the pain decreases, because you are tired of the not quite clear consciousness that accompanies the morphine use. Of course, the self administered pain control device is in addition to the like-clockwork administration of pills from the nurses. You have your choice of percosets, or Tylenol 3’s. In addition you get an iron pill and Gabapentin, a pain pill enhancement product that originally was released as a treatment for epilepsy. And once a day you get Cumaden, the blood thinner. Another clot prevention measure. I am supposed to keep getting the blood thinner for at least a month after the treatment. It is one of the prescriptions that is going to come home with me.

I am in a room with 3 other patients. Jeffrey, in the bed next to mine received a total knee replacement the day before me. He’s had five of them, as it turns out. Since the surgery he’s thrown up 4 times. It happens each time he starts one of his meals. By todays supper they figured out it is the Gabapentin. Pills and meals are both delivered on that four hour schedule, and the pills are administered almost immediately before the meal. One of Gabapentins side effects is nausea. Funny it didn’t come up the other times he’d been in. Or maybe they weren’t handing the gaba out those times. Of the previous knee replacements he received, Jeffrey fell and busted open the staples one time. He’s had infection set in the other two times. If the infection is caught early enough, it gets the ‘antibiotic and let the pus out’ treatment. If it goes too far, you need to do the whole process over again. I pay careful attention to all infection prevention instruction I am given.

Across the aisle is Bob, semi-retired accountant. Bob’s in his mid seventies and hurt his Achilles tendon playing baseball. He didn’t get it looked at and three days later it gave out on him going down stairs. He fell four steps or so but tore his quad, on the other leg. So poor Bob has a condition, in each leg, that precludes him from putting any pressure on either leg. Bob is stuck in bed or wheelchair for the next 30 days.

Rachael is in for a hip job. I didn’t really get the story on Rachael, since she is out of it a lot of the time and struggles the rest. But she doesn’t complain. She tries hard to do what the nurses ask and her level of awareness varies.

These are my companions. Jeffrey is one day ahead of me with regards to progressing through recovery. Bob has a great sense of humor and is a good sport about it all. And Rachael is quiet and brave about her circumstance. I could do worse for hospital room companions.

Sunday, October 14, 2007

Total Knee Replacement - Surgery Minus 3 Days

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Total Knee Replacement

So I’ve had to make time for a host of other visits and activities leading up to the surgery. Meet with home care, to get the residence assessed for post surgery use. Found out which rugs would have to go (hall runners mostly), which walker I would need, and sorted out the need for a toilet seat lifter. Apparently most home toilet seats are so low that post surgery knee replacement patients, who have some difficulty bending the knee, are happier with a booster. Not sure how I feel about that, but hey, these people are experts. If they recommend it, it’s pretty hard to say no. We also go through the list of exercises I will have to do, both in the hospital and after I get home.

The period right after surgery, it’s important to quickly start working on strength and flexibility or you run the risk of having the leg more or less heal with a diminished range of motion. And freeze into a less then optimum resting position. Well, I already had that, as a result of the high school football injury that started me down this path, years ago. This would be my chance to start fresh. Nice to get a second chance.

The pre-surgery trip to the hospital isn’t any more exciting. I meet with the rehab unit in the hospital, meet with the home care rehab people, meet with the total knee replacement education unit who goes over what to expect in the hospital, make you watch a video and explain about self administered pain control. I like the sounds of that.

How to use a walker; how to use a cane; how to go up and down stairs, I guess they have to cover all that. I get one very specific warning from the physiotherapist. “Don’t fall.” Makes sense to me, and definitely one of the things I already had on my list of things not to do after knee replacement surgery.

Oddly enough, since I made my initial visit to Dr. Blastorah, I’ve started suffering with knee problems. I mean, it had been a bit of an issue before. I had to give up basketball a year ago, part way through the season. And sometimes after a lot of walking and stair climbing in the plant I’ll get some swelling, but I don’t wake up in the morning hating the idea of getting out of bed and putting weight on it, or anything like that.

My knee is pretty grotesque looking, with an obvious misalignment. No cartilage on one side means that the joint has started slipping. There is quite the protrusion on the outside of the knee joint. But it hasn’t affected my daily life until now. Now it’s almost as if the knee is saying, “ I’ve done the job all these years, I can finally start letting go.”

Stiffness, soreness, limping, swelling all are becoming part of my daily routine. I guess this is what most other people put up with before getting theirs done. I’m lucky. I’ve only had about three months of it.

Total Knee Replacement

Wednesday, October 10, 2007

Total Knee Replacement - Surgery Minus 50 Days

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Total Knee Replacement

I finally get a call the first week in August. September 20th was going to be the big day. Good enough. I let them know at work. I have no clue how long I will be off. I didn’t bother asking in my first visit with Dr. Blastorah. But a total knee replacement would have to require what…4 to 5 weeks recovery time wouldn’t you think? Once the decision was made, I became strangely uncurious. I don’t spend hours pouring over the Stryker website, reading up about knee replacement procedures, or their artificial knee, the Stryker Triathlon.

I have found a location, during some non-serious cruising, where you can see the whole process illustrated, with video footage right there, streaming on the website:

Not for me. I’m not particularly squeamish, but now I’ve decided to get it done, I don’t need the gory details. I mean it truly is kind of freaky to think about them cutting the end right off one bone, capping it with a new artificial end, and fitting a matching piece onto the end of your other leg bone. The less imagining, the better, as far as I am concerned.

You can find an interactive cartoon version of the process at:

Very easy to understand explanations for the whole procedure.

Total Knee Replacement - Surgery Minus 101 Days #2

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My Total Knee Replacement

Doctor Bernie has been the surgeon on 200 knee replacements. There were another 2 or 3 doctors also doing them. The Peterborough Regional Health Center (what the health care professionals and the fund raisers called the Peterborough Hospital) was well practiced. That means the nurses, the physiotherapy department and their whole interface with outside support agencies who would be doing home visits, everything to do with total knee replacement ran like a top at PRHC. At least, that’s how I choose to read it.

Okay, let’s get it done. Dr. B sent me out to see the front desk to schedule the procedure.

“Can you come in the middle of August?” Another surprise. It was June 11th this visit, and they were ready to schedule the operation in 2 months. That’s not how it was supposed to work. What about the months of dragging it out? The weeks of agony I was supposed to suffer? What about priority on the waiting list? Maybe our health care system was working.

“The medical community has come to the conclusion it makes no sense to put patients through a long drawn out waiting period when they obviously need the work done. If you can’t make it in August, we’ll get in touch about another date in the fall.”

Our vacation plans to travel out to Vancouver Island to visit friends means the leaves will be turning when I get my new knee, but that means I will still be mobile all summer. Seems like a good plan.

Tuesday, October 9, 2007

Total K ee Replacement - Surgery Minus 101 Days

Medical Tourism Guide

My surgeons face had a surprised look on it the first time we met in his examining room.

‘From the look of the X-rays, I thought you were an 80 year old man.’ Dr. Bernard Blastorah, orthopedic surgeon extraordinaire. Master of total knee replacement surgery.

I found out later he installed the very first ‘Stryker Triathlon’ artificial knee in Canada, about two years previous. That was the model I was going to get. Incorporating the best features of two different previous favorites, Stryker had high hopes for the Triathlon. Me too.

Dr. Bernie left me no doubt that I was getting a new knee…or at least needed one. Go for it now or suffer through months of aggravation and pain and go for it later. Those were my options.

Twelve years ago, I was at the York University Sports Injury Clinic and Doctor Bull, at that time team doctor for Canada’s national hockey team laid it all out. “Give up jogging, give up basketball and be a little careful and you can go for a knee replacement when you’re 65. That way you’ll be dead before you need another. This isn’t the sort of thing you want to do twice.”

The way Dr. Bull explained it, everything I did from that day forward would just wear out the knee a little more. Jogging and basketball would wear it faster. Sitting on my ass in an easy chair watching TV or reading would have very little impact on it. I gave up jogging. I couldn’t give up basketball. I mean, it was just old-timers leagues. Twice a week, starting in October and running through till the end of March. I mean the Thursday night crowd was a little competitive, and they also had a spring league that tended to attract younger guys since there wasn’t a lot of other ball being played in Peterborough. But how much could that hurt.

So I’ve missed Dr. Bulls target by 9 years. I always kind of hoped I wouldn’t need a total knee replacement. Surely somebody would come along with a new artificial cartilage or something. It didn’t happen, so here we are.

Dr. Blastorah has some good news for me. “The Stryker Triathlon has some real advantages over the old models. There’s a little wear pad in there. In the older models, the wear would release larger particles that got wedged in where they weren’t supposed to be. Over the years that created leverage that could loosen the attachment points. That’s one of the reasons people having total knee replacements needed new ones. This new model wears with much finer particles. They don’t expect the same problem. So 20 years after your knee replacement, we might be able to get away with just replacing the wear pad.”

Dr. Bernie goes on to say how knee replacements had first started getting done in a big way about 12 years ago. At that time the expected life of a knee replacement was anywhere from 12 years up to 20. So this year he had kind of expected to start seeing patients coming in, in large numbers, for new ones. But it wasn’t happening. The numbers were much lower than expected. The knees were lasting longer than expected.

“Your new one is expected to be good for 20 years, but it might last years past that. We’ll know for sure in 20 years.”

Well, I’d take that.
Total Knee Replacement