Monday, October 15, 2007

Total Knee Replacement - Surgery Day

Medical Tourism Guide

Click Here!

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.

No comments: