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 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.