Total Knee Replacement
I want to take a break from simply listing what has happened to me and talk a little more about what I did do and what I could have/should have done before my knee replacement surgery. Having a knee replaced is a significant procedure. It requires frequent therapy and exercise sessions after the operation to regain both strength and mobility. It is possible to shorten the recovery time afterwards. One of the simplest things you can do is to exercise in advance of the surgery to build strength in the joint muscles.
Deteriorating knees move the patient into a destructive cycle that makes recovery more difficult. Increased pain leads to a reduction in activity. Reduced activity means a gradual weakening of the joints associated muscles. And weak muscles mean recovery afterward is prolonged and made more difficult.
Talk to your doctor about pain management before the operation. With reduced levels of pain, higher levels of exercise are tolerated by the individual. They can embark on a muscle strengthening program before the surgery, ensuring they are in optimum condition for recovery afterwards.
Fortunately for me, I was in little pain or discomfort before my operation, which meant I could use my home exercise equipment at a relatively high level of intensity. Lynn and I had decided last winter to outfit a home gym, since our work schedules, and our inclinations made going to an outside establishment difficult. We picked up a very good quality elliptical device and an all-in-one weight machine. The elliptical is a very good quality, basic model. We elected to spend more for a basic machine and are happy we did. It feels very sturdy, and is whisper quiet. The weight machine is leverage based. You add plates to the bars and have to rearrange things for the different exercises, but it is not a huge deal. And, most importantly, it allows you to do squats, dead lifts and all of the major pressing exercises safely.
The weight machine is built by Powertec, and the elliptical is by Eurosport. They both make it easy to exercise, but they aren’t essential. Body weight exercises can do the job quite well. I’ll talk about some I use.
Exercising for flexibility, while useful, is not as critical as exercising for strength. Simple exercises using your own body weight are sufficient to make a difference in post-surgery recovery. Two simple exercises that the individual can do at home are described here.
1. Leg Extensions - Sitting on a straight back chair, place one hand on your thigh muscle and simply extend your leg in front of you, pointing your foot back towards yourself as much as possible. You should feel your thigh muscle tighten up. Try and get your leg straight and level at full extension. Do ten repetitions, holding your leg extended for a count of 6 for each rep. If you can do this easily, try extending the length of time it takes you to lift your leg. That is, lift the leg very slowly, taking 5 seconds or so to get it fully extended. Then hold it for a count of 6. Then take a full 5 seconds to lower it to a relaxed position. If this is still easy, try putting on a heavy shoe or boot while you do the exercise, making the leg work harder. You can repeat this exercise twice a day in the months leading up to your operation.
2. Step Ups - Standing at the bottom of a set of stairs, or a step, facing the handrail or wall, and place your foot up on the next higher step. Do you understand. You are actually standing sideways on the stairs. Using your hands to balance yourself on a handrail or door frame, slowly step up by shifting your weight to the higher leg and extending it. The key here is to do this exercise slowly, until you have fully extended your leg. Then slowly bend at the knee and allow yourself to lower back down to your starting position. No additional weight is necessary for this exercise. If you find it easy to do, do it slower. If you find it hard to do, use the back of a chair or an extended cane to help boost yourself. Maintain an upright posture, avoid stooping or bending sideways and take it easy the first week or so you do this. Perform 10 repetitions twice a day.
3. Assisted squats - Find a sturdy door, not a closet door, but something more along the lines of an exterior door. With the door partially open place one hand on each door knob. Now simply squat down until your thighs are parallel to the floor. You don't want your knee caps extended past your toes. In fact, if you are leaning back a little, supported from falling by the door knobs, you will be able to keep the angle made by your thigh and lower leg close to ninety degrees, which is as low as you want to go. Once you get to ninety, stand back up. Now, the last thing you need to do is fall. So the door knobs (or whatever else you may choose to hang onto) must be strong enough to support you. I used a steel column in my basement. It held me just fine.
The key with any exercise program is to start slow and build gradually. Do not fight through high levels of pain. Pain is a message. Find the best time of the day to do the exercises. For many people this will be morning. Consider placing a cool pack or bag of frozen peas or beans wrapped in a towel on your joint after exercise. As with any exercise program, discuss this with your doctor. Follow your doctors recommendations and best of luck.
Here's a couple of links to websites that talk about post surgery exercises. You should get well familiar with these exercises before you go into hospital.
University of Virginia
American Academy of Orthoepedic Surgeons
Wednesday, November 14, 2007
Total Knee Replacement - Preparing for Your Surgery
Total Knee Replacement - Surgery Plus Fourteen Days
Total Knee Replacement
When I had my knee replacement surgery, they closed up the incision with staples. This was a first for me. Any incisions I’ve received in the past have been closed with stitches. I posted a picture of what the staples looked like in a previous entry.
Knee With Staples
Two weeks after the knee surgery I went to get the staples out.
Originally they were supposed to be removed at home by a nurse provided by the Health Care service. I was told, just before I left the hospital, that they were booked solid and I should arrange for my own doctor to do it. So that is what I did. Of course, my own doctor was not available for the removal, but the medical center where his office is located arranged for a resident to do the job.
I thought I was ready for anything. My daughter reassured me it was a simple procedure. “It was one of my favorite things to do when I was doing my placements. There’s nothing to it.” So I steeled myself a little. Thirty staples being released from their death grip on my flesh with some kind of pliers device didn’t seem like a “nothing to it” type of thing, but I’m a big, strong, brave guy. I could handle it. Until the resident walked in. He looked about 18 years old.
He seemed sure of himself during the introduction and I felt quite okay until we got to the point where he wanted to check out the staples. I hiked up my track pants and I swear his eyes actually bugged out a little. “Well,” he said. “You’ve got quite a few in there. The incision looks like it’s healing quite well. Could you excuse me a minute?” He got up and smiled at me as he left the room.
I looked up at Lynn. She had wanted to come along and see how staples are removed. “Do you get the feeling he just went to find a nurse and ask about staple removal,” I asked. She just laughed. “Maybe he’s gone to find the staple removal instructions.” Was I going to be his first? Was the young resident a staple removal virgin? Inquiring minds want to know.
I must admit that this was my first really queasy moment in the whole total knee replacement adventure. We watched him struggle to get his surgical gloves on. His hands were about two sizes to small for the gloves in the office, there was a lot of loose latex flopping around and he looked incredibly awkward as he slipped his fingers into the handle of the removal device. Check out the picture and imagine how it looked to me.
He was a little tentative as he approached his first staple, but he was trying hard to act confident as he slipped the tips of the device under the staples edge. One squeeze on the handles and the staple obediently let loose its clasp of my skin and came free. 
You could tell he wanted to triumphantly look up at Lynn and I, but he restrained himself and acted as if this was just what he expected. By the time he got to staple number 15 it was old hat, and the last few almost came out by themselves.
The whole process went smoothly, with virtually no discomfort for me, and only a little for him, right at the beginning. I was pleased that I had been his first. He said his intention was to work as a GP, so I was doubly pleased to be helping a young one help fill the gap in family doctors that exist right now in Ontario.
I want to reassure anyone that may be looking at staple removal that there is no pain associated with it. I had been expecting some kind of local, but nothing of the sort, nor was it required. I remembered Dr. Blastorah telling me that my knee would feel a little funny, with some loss of sensation on the surface, after the operation. And that is true. Maybe that's one reason there was no discomfort.
All in all I would say it was an educational day, all the way around. Last but not least, here's a look at my stapleless knee.
Wednesday, November 7, 2007
Total Knee Replacement - Doctor Payouts
It seems that the four companies have been making large payouts to doctors. as "consultants" to use their products. I'm talking about payouts of up to six million dollars to individual doctors.
The companies were charged with violating anti-kickback laws. The upshot is the companies agreed to post the names of every doctor who recieved "consulting" fees. In total we are talking about 1805 doctors, including 46 doctors or organizations that received individual payouots of over a million dollars. Read more about it here.
Health Care Renewal: A Few Answers, and Many More Questions About Device Manufacturers' Payments to Orthopedic Surgeons
Now, my doctors name wasn't on the list. On the other hand, I don't know the details of the agreement reached with the companies. Maybe it was only to reveal the names of American doctors/organizations, since only they could be charged with an American violation.
At any rate, have a look for yourself. Don't be afraid to question your own orthopedic surgeon about his affiliation, if his name is on the list.
Total Knee Replacement Surgery Plus Eight Days
Total Knee Replacement
Every day I have a little more strength and movement in the leg. My flexibility still hasn’t increased a great amount since the knee replacement, still less than 90 degrees of bend at my knee, but my strength has. The fear of having to independently move my leg has gone (okay, diminished). There are still twinges. Lynn was helping me take off the stocking and when it suddenly came off, my leg bobbed up about six inches, and then there was no support under it so dropped. I automatically tensed up and slowed the descent, but the knee didn’t like uncontrolled flight. Not really painful, just a clear reminder that things needed to be more controlled.
I really don’t have much appetite since I am not doing much. I guess all of the nutrients needed to heal a 10 inch (25 cm) incision in my leg are probably contained in a handful of food. I’m taking 3-4 one-a-days each day, a couple in the morning and another one or two each night. And a protein shake every morning, depending on whether Lynn has time or thinks of it in the morning, while she is getting ready for work.
It is certainly decadent-like to just lie there each morning, drinking the hand delivered coffee and juice/shake while she gets ready. Every once in a while I scratch the dogs on top of their heads or behind their ears. Lynn and I just chat about what’s on the radio or the coming day. She has the great good sense to make sure everything important that I am to do is written down for me.
The dogs start barking like crazy. I look outside and see a service truck. Then about 10 minutes later the phone rings. Bell telephone (or their contracted service rep I should say) tells me that the fuses in the junction box outside on my house wall had blown. They have been replaced. They no doubt saved me from significant damage inside and all is right with the world of telephone communications now. I thank him. Then smack my forehead. I should have asked him for the spec for those fuses. I need to get some for the next time. To think that a $2 part and 15 minutes of work would have saved me from 2 ½ days of no phone service. I will have to find out what is required. Once I get internet access again it shouldn’t be hard.
Now that I have phone service I make contact with xplornet again and once more we walk through all the reboot, power up and power down stuff. They decide it might be a problem with their equipment and assure me that they will assign a ticket to a local service rep. Here we go again, I think. There is nothing I can do. They are the only game in town.
I’m hitting the sack every night about 10:00. By the end of the day, I have had enough of hobbling around and look forward to resting in bed. I have been catching the odd ½ to 1 hour naps as well, usually after lunch. They seem to help with the energy levels.
Total Knee Replacement
Thursday, November 1, 2007
Total Knee Replacement _ Surgery Plus Five Days
Total Knee Replacement
We both have a tough night. I did more in 1 day, yesterday, than in the previous 5 combined. My knee feels like it this morning. In addition I had to get up and hit the bathroom a couple of times in the night. I reveled in my freedom from urinals until I started pushing my walker across the plywood floor. (We pulled up the white shag carpet the previous owners laid down and have the Peruvian Cherry hardwood downstairs, but there’s been no time to install it). The walker sounded like a train of grocery carts going over a badly repaired concrete road bed. I woke Lynn up for each trip to the can. So she didn’t get much more sleep than I did, and she has to get up at 06:30 to get ready for work.
Today’s a day for watching movies, reading and starting Season 1 of Deadwood (thanks Trevor).
Lynn is dead beat when she gets home. She calls on her way home and I suggest a ready made barbecued chicken from the grocery store and a salad. She is all over that. And so am I once she prepares it. So this is what Oliver meant when he sang “Food, Glorious Food!”
I cut back to one Tylenol 3 a couple times today, but started the day with two and elect to end the day with the same dose. My knee feels well used by the time the day is done, and even though I am throwing a towel-wrapped bag of frozen beans on it after each exercise session, it still seems more swollen by bedtime than it was in the morning.
The day doesn’t end smoothly. A tremendous downpour and thunderstorm, just before midnight and again at about 4:00 AM. On one lightning strike the flash and sound are virtually simultaneous. That means it was within a few hundred feet of the house, if not closer. I look outside but can’t see any smoking craters, and didn’t hear the sound of a tree coming down, so maybe we are alright.
Total Knee Replacement
Friday, October 26, 2007
Total Knee Replacement - Surgery Plus Three Days
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
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
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
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
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
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.
Wednesday, October 10, 2007
Total Knee Replacement - Surgery Minus 50 Days
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
My Total Knee Replacement
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
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.