The Driving Force

So when I saw Dr. Kerina last Monday at my 2-wk post-op appointment, I asked him when I could drive, mentioning that I had been driving the golf cart since the first week.  He said one month, which is one week from today.  Truth be told, I cheated.  I drove myself to PT today, and to the other errands Bill and I ran afterward.  It feels good to drive, and it is not in the least bit uncomfortable, nor do I feel I am putting Bill or myself or anyone else in any danger.  I would prefer to have an automatic transmission instead of my stick shift, but oh well.  Nothing to be done about that.

Out Patient PT - 21 days post-op

Today was my first outpatient PT session.  I am going to Florida Rehabilitation Specialists in Lady Lake.  I chose this location for two reasons:  Forwen Dela Rosa was recommended to me by a friend who lives in The Villages and is a very active person, as am I.  I knew that her expectations for a PT would be very high.  She had her 2nd knee replacement 6 weeks or so ago, and told me how pleased she was with Forwen.  The second reason, is that it is very close to home.

So, I met Forwen today, and we began.  He measured the range of motion, and I am already on the high side at 2 degrees to 120 degrees, the desired ultimate range being 0 - 120.  He thinks I should be able to get to 125 or 130 before we finish, and maybe -2.  He does not think I will need PT very long, a month at most.  He worked me, and I am sore this evening for the first time. . .a good kind of sore.

I'll be going three times a week.

To Sleep or not to Sleep: 20 days post-op

I have always had a relatively good sleep pattern, and generally speaking, I sleep well at night.  But things have changed in the past three weeks as far as sleeping goes.  First of all, I found myself, especially early on after the surgery, needing naps during the day.  Generally, I am not a napper, but since the surgery, naps rule.  I have spoken about this with any number of people, including the nurse, Karyn, and Bud, the PT.  The short answer is that surgery takes a lot out of you, anesthesia can remain in your system for weeks, and therefore, you get tired easier.  Makes sense.

So I've been going with the flow, and napping as necessary.  But now, almost three weeks post surgery, I am finally feeling better during the day, and not in need of as much mid-day rest.

But the other side of that coin is sleeping at night, and that is a problem.  Common wisdom says that if you nap during the day, you might not sleep as well as night, but I don't think that is my problem.  What bothers me at night is an inability to get comfortable.    It's not so much Pain as it is discomfort.  It's best described as follows:

• I feel as if there is a sock full of sand in my knee.  It is heavy, thick, it doesn't bend the way it should. There is an alien in there. This creates a discomfort when I'm trying to get settled in bed.
• Following the surgery, there were black and blue marks from my buttocks/groin/thigh down to my ankle/foot.  These have been a minor annoyance in the overall scheme of things, but they exist nonetheless, and they make themselves known when I move around in bed.
• I have lost skin sensation in the front of my lower leg.  It is almost numb.  This adds  to the list of strange sensations.
• The staples are out, but the scabbing creates a tightness that rubs against the sheets/blankets.
• The quads are sore.

All of this adds up to a problem trying to sleep.

During the first week or so, I was taking pain meds, and this allowed me to sleep.  But once I realized the pain was minimal, I stopped the pain meds, to the detriment of a good night's sleep.  So last night at 2 am, tired of tossing and turning, I took a Percocet and slept well for 5 hours.  I chose to sleep.

14 days Post-op

The nurse, Karyn, came today to remove the staples.  22 staples later:

I am staple free and I can shower! Oh, and look how straight that leg is!

Pain - Eleven days post-op

Pain is very subjective.  My criteria for the level of my pain dates back six or seven years when I had severe back pain. The pain itself was in my left thigh, but it emanated from my back and that pain is the worse I have experienced since childbirth.  I spent 6 weeks flat on my back.  But I learned what a ten was on my personal scale. The pain in my leg went from a murmur to a whisper  to talking,  to an angry voice and then to YELLING.  But when that leg would SCREAM at me, it was a nine. It was unrelenting, and was hardly ever a 2 or 3 for that period of time, and that is also when I was first introduced to pain meds, and the pain meds were what allowed me a few hours a day of normal activity.  The rest of the time I was in bed or on the couch.  So I had my own personal pain scale for when the hospital staff asked me my pain level.  Today is 11 days post op, and the highest it has been is maybe a 6, and that was the second night when the femoral had worn off and I hadn't yet gotten the pain meds right, and that included PT.  Much lower than my expectations.  Of course, earlier, I had "kept ahead of the pain" with pain medications, but that's what they are for, and if taking the pain meds allowed me to put in a better effort to get better results, go for it.  Now, though, I am taking maybe two a day, one at bed time to help get a good night's sleep, and one before physical therapy.  And my pain level has been practically nil.  The most surprising to me is that I was in more pain before the knee surgery than I am now.  Yesterday, after going with the PT to the fitness center here at HH and trying out the bicycle, Bill and I went to Target, and I could walk around Target in less pain than I did prior to the surgery.  This is a result I expected to achieve eventually, but not ten days post op.  

The Cool Machine - A Tip

This little baby was one good investment.

As we were leaving my last appointment with Dr. Kerina before the surgery, he told us to go pick up an ice machine from OrthoCare, for which he gave us a prescription.  We rented it for two weeks for $50, and were told to bring it to the hospital with us.  I think the hospital can provide it, but Medicare does not pay for it, so Dr. Kerina tells his patients to rent one.  Just put ice and water in the cooler, plug it in and wrap the magic suction wrap around your knee secured with the wrap provided.  The motor then circulates the cold water through the octopus-like wrap.  The hospital staff kept it cold for me and applied it as necessary.  It works to keep the swelling down, and it is easy to use at home.  We put 8 bottles of water in the freezer, and each morning Bill puts 4 bottles of the frozen water into the cooler with water to the water line, and it is ready to go for the rest of the day.  The other 4 bottles go back in the freezer.  I find myself regularly going and elevating my leg with the wrap on it, and it is very soothing.

Dressing change - Not for the weak of stomach

The nurse came by Tuesday afternoon to change the dressing on my wound.  She cleaned it off, and before she applied the new dressing, Bill took this picture:

There are 22 staples, which will be removed next Monday.  The wound is clean and I think I looks pretty good, if not pretty.  

8 Days Post Op

The physical therapist, Bud, came this morning and we took a little walk around the neighborhood.  I am using the cane, and he was helping me get all the movements sychronized.  He is pleased with my progress.  The leg is straight, and that is a six-week goal reached.  I can bend to 95 degrees and I think the goal is 120.  It's still swollen, of course, but all in all the experience so far is not as bad as I had anticipated.  The pain is tolerable, and I'm taking fewer pain pills.

Bill and I went to Publix to do our shopping, and I was introduced to the wonderful world of battery-operated shopping carts, which I like, since without that, I would not be able to go.  And my appetite is back, at least for today, so food shopping was fun.

The nurse is coming by this afternoon for a dressing change, and then a week from today she comes back again to remove the staples.  Then, I can shower.  AAHHHHH!

So, I am slowly getting back into the normal routine of daily living, and sooner than I expected.   The house is still a mess, but I'll get to that soon enough.  Housekeeping was never my forte; dust is, after all, a protective coating.

THE HOSPITAL

Day One (Monday, November 8, 2010)

The surgery took about 1 1/2 hours.  I don't remember a thing from the time they wheeled me out of the preparation room until I awoke in my "private" room, and not much after that.  Bill was there, and my leg was in a machine that kept it moving continuously,  and my knee was in an ice wrap attached to a cooler that kept the cold water circulating.  I was in and out of awareness, more out than in.  I had a PCA, an IV, and a catheter, and when I wasn't in the machine that keep the leg moving, both feet were encased in boots that keep the blood circulating.  I wasn't going anywhere.  The hospital offered room service, so I was able to order my meals from a menu, although I had no appetite, and only ate a fraction of what I ordered.  Bill was with me, but I slept most of the time.

Day Two (Tuesday, November 9, 2010)

I slept OK; I don't remember much about the night.  The Femoral block was still blocking.  It was supposed to last 18 hours or so.  My GP came by to see me early, and Dr. Kerina also popped his head in.   The Physical Therapist came in twice:  once in the morning and once in the afternoon.  Ingrid is from Belgium and it took me awhile to stop calling her Bridget.  She massaged the quad, which wasn't too soothing.  It was very sore, but she said the surgeon had cut it; hence the pain.  Then she gave me various exercises to do, which I could manage with her help.  She measured the angles that could be reached and explained the goals.  The instructions are to take the pain meds at least 1/2 hour before she gets there, so once the PT appears on the floor, the staff sort of alerts you. The object is to "stay ahead of the pain."  But I did find a disconnect between the advice given by the PT and the actions of the nursing staff.  I found you must ask for the meds, they will not come in and tell you it is time for your pain meds.  And it is very difficult to keep track when you are out of it.  There are clearly mixed signals being sent.  The nursing staff does ask frequently about your pain level on a scale of one to ten.

Bill arrived early afternoon, but I was not very good company.  I'm sure he enjoyed watching me doze off.  But I enjoyed knowing he was there.  And Val and Dixie stopped in to see me late in the afternoon.

Another dinner from room service.

Day Three (Wednesday, November 10, 2010)

First thing this morning both the catheter and the PCA are disconnected.  So begins the transition to oral pain meds and getting out of bed and into the bathroom.  I took my first walk with the walker, but didn't go far. I was nauseous and feeling very weak.  I hadn't been able to eat much, and I was continuously sick to my stomach, though I didn't throw up.  My morning blood work (which they draw at 4 am) indicated that I needed a transfusion.  (7.9; and normal is 12 or so?).  So they worked that in around my PT.  The first unit would go in after the morning PT and the 2nd unit after the afternoon PT.  It was a slow process, followed by Lasix injected into the IV.  I was told its purpose is to rid the body of the elements of the blood transfusion that are not needed, so it makes you urinate frequently for 4 or 5 hours.  Tomorrow I go home, so it's important to have the blood level where it should be, or I'll be another day in my private room.    I was feeling even sicker after the transfusion, but I did take a few walks down the hallway to try out my new knee.  I was told on Tuesday that the goal was to walk to the nurse's station and back in order to be discharged, so I had acheived that goal.  Now, I just had to be sure the blood is ok tomorrow.  Bill came in the afternoon and I think I was a little more fun to be around, but not much.  I cherry picked from the veggie and side menu for dinner.  No wine though the apple pie wasn't bad.

Day Four (Thursday, November 11, 2010)
 HAPPY ANNIVERSARY!

What a great anniversary present:  to go home!

Today I go home.  I was told I needed to wait for Dr. Kerina to come by to release me so the plan was I would call Bill once I got the go ahead.  The blood (again, drawn at 4 a.m.) came in fine, so all signs were good  I got the word around ten that I could go home, and  I called bill to come fetch me.  So I was wheeled out of my private suite around noon, and happy to be headed home.

Bill's Omelet

Every day is a new adventure.  As I become better at feeling better, as I did this morning, I'll be able to post more about my experiences.  But first things first.  This morning I was feeling much better than I had felt in quite awhile.  Friday morning I felt great; both the PT and the nurse came by, and the PT was pleased with my progress so far and gave me some assignments for the weekend.  Come Monday, we could get down to business (see:  chills running down my spine).  Anyway, an upset stomach and swelling of the leg was keeping the discomfort level high all afternoon and last night, so my appetite was poor.  But this morning, I awoke hungry!

Voila!  Bill cooked me an omelet to order, and it's the first morsel I have eaten in the past five days that I really enjoyed!

The Hospital Experience, or, What I remember of the Hospital Experience

La La Land is a nice place to visit but I wouldn't want to live there.

But I felt as if I have spent a lot of time there for the past three days. (Just ask Bill).  We arrived at the hospital at 7 am, hurry up and wait.We did the due diligence, made the decisions about anesthesia (general) and femoral block (yes) and off we went.  By one o'clock I was in my room (private).  A private room in this case means there are two TVs, ergo two remotes and two phones, but only one bed.  The remotes control the TVs, the lights, and the nurses' call button.  When the phone rings, though, you have to find it, and the first one you find, might be the wrong one. Now, the lights are a different problem, because the aide may give you one nearby, but it does not mean that that one controls the lights that are on or off, which, of course, you don't find out until you need to, and then it's too late.  And let's not forget about your cell phone.  So much to keep track of with only 1/2 a brain functioning.

I awoke in a device that moves your leg into positions you are not sure it wants to go in yet, but drugs are a wonderful thing!  Who knew.  And now at least it's moving.

Arden's Gong

Happy Anniversary

As fate, or choice, would have it, I will be in the hospital on our anniversary.  Bill and I were married on November 11, 1993, admittedly an easy date to remember, since it is Veterans' Day.  We chose that date partially because I worked for lawyers and always had the day off (when the court house is closed, the office is closed.)  So our early celebration today consisted of some time on the tennis court followed by a good lunch at Glenview.  

The rest of the day, though, was full of shopping and preparations so that the house would be stocked with the necessary vittles and such.  

And while my knee is throbbing, Bill has gone outside to do some work in the yard.  The man is incredible!  I call him an anomaly; his so-called friends, though, call him a freak of nature.  He's almost 82, he is constantly in motion, and nothing hurts.  What's that all about?

  

Expecting the Unexpected

It's Friday night.  Surgery is Monday afternoon.  The phone rings at 8 pm.  Be at the hospital Monday morning at 7 a.m.  The doctor has moved your surgery up to #2 in the queue.

Rats!

TKR minus 4

Yesterday afternoon, Bill and I went to my final pre-op appointment with the surgeon.  After waiting the obligatory hour, we visited with Dr. Kerina.  He went over all the things that can go wrong, including, but not limited to, death. Most of the other possible, but not likely, outcomes were not so dire.  Not being a pessimist, however, I'm expecting it to go fine, while still expecting the unexpected.  He said the surgery itself (his part) should be 35 minutes or so, but 1 1/2 or 1 3/4 hours all-told.

We are to be at the hospital at 11 a.m.  Surgery is to be at 1 p.m.

Joint Registries

I found the below information posted on a bulletin board.  I learned in the seminars I went to that Sweden and Australia require a registry of every knee operation done by every doctor including the brand and type of device that was implanted and the results, including revisions.  This post includes the links to the two registries.  While I have looked through these, this is the kind of research that takes a lot of time, and since I have already chosen my doctor, and by virtue of that choice, his preferences, or contractual agreements or whatever arrangement exists between physician and implant manufacturer, my new knee is already determined.  So, I have not sorted through this.  But, I am a firm believer that this country should have a registry as well.  What better way to track the success or lack thereof, of these various devices and implants, not to mention the ability of the physicians?

This is a quote:


"I posted this on the total knee board, but as the registries also include unicompartmental results, I thought I would duplicate it in here. Some of the prosthesis in these countries are not sold here, and vice versa.
Following a previous post, a number of people have asked me to post the links to the Swedish and Australian Joint Registries. Hopefully the mods will make this a sticky. 
In Sweden and Australia, it is a legal requirement that every operation and knee is recorded. The UK also has a registry, but suppying information is voluntary (20% of cases go unreported, you can make your own mind up why some might not be reported)

Every company likes to tout figures on their success, normally studies by surgeons who are friendly to them, however, the registries include every single surgeon using the device, good, bad, or indifferent. They include tens of thousands of operations so will help nullify unusual events.
Its incredible to see that some knees that are commonly used in the UK have more than double the failure rate of others, must cost thousands in recovery costs.
Anyway the reports are below, 

The Swedish Joint Registry 
  http://www.knee.nko.se/english/online/uploadedFiles/113_SVK2009ENGL1.0.pdf
Gives results to 10 years, total knees are page 30-33 (or 34- 37 in acrobat). There are also some easy to understand graphs
Uni knees are page 34 (38 in acrobat)

Australian Joint registry
http://www.dmac.adelaide.edu.au/aoanjrr/documents/aoanjrrreport_2009.pdf
Total Knee results to 8 years are on page 145 (161 in acrobat)
They have a list of knees to avoid on page151 (167)
Uni Knees are on page 123 (139 in acrobat)"


Australian Orthopedic Registry

The Swedish Knee Arthroplasty Register

Pain is Your Body Telling you Not To Do Something

This is a saying I have always sort of believed in.   I considered twinges of pain, or more severe pain, as a sign to stop doing what I was doing.  It would seem that philosophy is being summarily thrown out the window.

Nurse Cindy said yesterday that the good news is that this pain is "operational" pain as opposed to arthritic pain, difference being that arthritic pain is continuous, while operative pain gets better every day, so you have that daily improvement to look forward too......except for the occasional step backward.

I hate the exceptions.

Orientation

Today I had an appointment at the hospital for an orientation.  As it happens, I was the only person present for the seminar, which was given by Cindy, an RN.  She originally had 3 patients scheduled, but two had their surgeries cancelled/rescheduled.  There was also a PT student observing.  We met in a classroom, and she went through the entire hospital stay from the time you walk into the door to the time you go home.  I was able to ask questions as we went along, and the experience was very enlightening.   For instance:

A femoral drip is an option.  It is a one-time injection that lasts from 24 - 48 hours and numbs the operated leg, which sounds pretty good to me.  The alternative to the Femoral is not to have it.  It works in conjunction the the PCA (patient controlled analgesic), which is a narcotic.  With the femoral, they have found that patients require less of the PCA pain reliever than would a patient who chose not to have the femoral.  The only down side is that it may make the muscle lazy so that it will not hold you up when you stand or walk.  The PT tests for this, and provides a supportive brace if it is necessary.  This is something I will consider and will discuss with the surgeon on Thursday.

General anesthesia or nerve block?  I always thought I would prefer not being put to sleep with a tube down my throat, that a nerve block and medication to put me in la la land would be adequate.  But, when I asked why one vs. the other, she said the operation is loud (read:  electric saws and drills!) and some patients would prefer not to hear those noises.   I'll have to give this some more thought.

Foley catheter:  apparently this is normally done, but this is a subject I will discuss with the surgeon during Thursday's appointment.  It is inserted into the bladder once you are under the anesthesia, and remains in place until the 2nd day after surgery.

The surgery is 1 1/2 to 2 hours, longer than I thought.

I was provided with "THE BOOK" during my first appointment, and I have found it very helpful.  I have been doing the pre-op exercises, and the book offers other useful information to help in the planning process.

Then, a Physical Therapist came in and filled me in on exactly what to expect from the PTs after surgery.  I'm not sure they will be my favorite people; they are very demanding, but it's the PT that will make or break this surgery, so bring it on!

Being a visual person, I asked Cindy if I could see the Ortho Ward, so we took a field trip through the hospital, where I saw the intake area, waiting room, and then up to the ortho floor.   There are some private rooms available (one of which I have requested), and I walked through one.  They have converted semi-private to private, so they are fairly good size.

As for the walker, cane, etc., these items are ordered before you leave the hospital, along with the in-home PT and nurse.  The doctor recommends a provider for these services, but you don't necessarily have to use the one he recommends.  I am on Medicare and have a United Healthcare supplement.  It is my understanding that all of these services are covered, but the hospital has an account/insurance person available if I have any questions.  I will be assigned a Case Manager on intake, and that person will follow my progress.

I had decided early on that I wanted the surgery early in the week.  I would prefer not to be in the hospital (any hospital) on a weekend when 1) my doctor may not be there; and 2) when the hospital my be shorter staffed than during a weekday; hence operation Monday, go home Thursday.....if all goes according to plan.

Preparations (1)

I was told that the hospital experience includes providing you with the necessary "implements" to make it through the recovery period.  However, who pays for that goes through my mind, so I paid a visit to the local charity resale store and picked up a walker for $2.  I was looking for a toilet seat "booster" or whatever you want to call it, but didn't find one of them.  Now, if I could just find a reacher......