Diary of a Total Knee Replacement (TKR)

Diary of A Total Knee Replacement (TKR)

Prelude
   I swear that I took my first step down this road when I was 13 and my knee dislocated in gym class. I was the new girl in school (I had been there one whole week), and the last thing I wanted to do was to draw attention to myself. No such luck. And then to complete the saga of ignominy, I had to wear this hideous total leg cast for 8 weeks. That's when I earned the beloved nickname, "The Stork."

  In the ensuing years, I have continued to struggle with the knee. Two laparoscopic surgeries later along with 7 rounds of Sinvisc, Supartz (you know the fake lubricant stuff that they inject into women's faces to even out the creases) and far more than my share of Cortisone shots, I knew that I was getting close to the end of the road. So I should not have been surprised when after the last round of injections, I broke down and cried like a baby. And I am not a crier. At least when it comes to physical pain. I pretty much endure. But I had hit the wall. When my doctor learned about my breakdown, he said that he was surprised I had made it the two additional years.
   So, we scheduled the TKR. In the practice where I go, there is a highly developed protocol that must be followed. Southern Joint Replacement Institute is ranked fourth in the United States with joint replacements (this is based on success, not on numbers of surgeries) and number one in Tennessee. I know that I am in good hands with these guys. And I also like my doctor, Jeffrey Hodrick. He's the one who did my hip. He is young and smart and personable and cute. That helps.
   So as I meet with the scheduling nurse, she gives my SJRI Knee Notebook, my pages of instructions and my appointments, which she schedules while I am there. I will have a pre-op evaluation with a Physical Therapist, a blood draw from the lab, an EKG, and a total health work-up with a Hospitalist (an Internist who is affiliated with a hospital and sees patients in the hospital for the doctor). I am also supposed to attend a Joint Class but I get an exemption since I have had a joint replacement within the past three years. The Joint Class is good. You are required to bring the person who will be assisting you with your care, and they spend a lot of time going over what you and your helper can expect following surgery. It's a lot of information, but is well presented and thorough. You also have an opportunity to talk one-on-one with a nurse from the hospital as well as a physical therapist.
   Instead of going to the class, I decided to be a good girl and read my notebook from cover to cover. I am not kidding here. I wanted to know exactly what to expect because after all, knees and hips are different parts of the body.
   In the days before surgery, I begin rounding up the necessary equipment I will need: a walker, a cane, and a shower chair. I also take up the bathroom rugs and go around the house and put all the scatter rugs out of the way. I also clean off my bedside table. Ugh. And then I try to make my bedroom presentable. However, I mostly put the clutter in the closet!
    My daughter sets up a Care Calendar (www.carecalendar.org) for me to arrange for meals three times per week along with rides to my thrice weekly physical therapy appointments. It's a huge help since I won't be able to drive for six weeks.
   I decide to do my PT with the folks at Southern Joint. When I went through my PT with my hip at Southern Joint, I watched the progress of the folks who were recovering from knee replacements. I don't know how to describe the particulars of their protocol, but all I can tell you is that it works. They even have a ton of people who drive 80 to 100 miles each way to do their therapy there. And then there are the unfortunate people who come because they are not making sufficient progress with the PT they have chosen and have to come to SJRI to "undo" what has been done. Ouch.
  So it's a no-brainer for me. I also like the fact that my doctor is right down the hallway and if something comes up, he and his nurses are available. So if it sounds like I am selling Southern Joint Replacement Institute, you are right, I am!

The Night Before
   I always go light on the last meal before surgery. I don't want to take my chances with post-surgery nausea. I have my bottle of Steris and I carefully follow the instructions about bathing with this stuff. I do it that night and then I do it again the next morning before the surgery. I have also removed my rings, all make-up, and all polish from my toenails and fingernails. I have also refrained from using any lotion, deodorant and powder on my body. I am not sure how I smell at this point.

Day of Surgery
  I don't sleep well. I never do. But I figure I will be getting some real good sleep in a few hours so I am not too worried. I get out my sheet that the Scheduling nurse has given me, and I take the medications she has circled for me to take. I also bathe again with the Steris stuff again and get dressed to go.
  We are arriving at 6 am and my surgery is scheduled for around 8:30 am. We go first to a holding area where I undress and get into my lovely hospital gown. My husband gets to stay with me during this phase. I spend the time teaching him how to get online at the hospital so that he can work on the computer while I am getting my new knee. After about two tries, I think he has it down. The time passes quickly. I learn from my nurse that mascara and fingernail polish are flammable. No worries there. I am totally naked in that department. After all, I don't want to take my chances with a stray spark from a drill.  In about 30 minutes The Husband and I say our goodbyes, and then I head out to the surgery waiting area.
   The surgery waiting area feels a little like a runway with planes taking off. It's a busy place. Every patient is assigned to a space that corresponds to the number of their operating room. The nurse asks you lots of questions, starts your IV, puts on your Ted hose, and goes over your allergies, etc. The surgeon comes by and marks your leg and gives you the final pep talk. Then the anesthesiologist comes. This is when I start to get a bit nervous. There is always a huge discussion that ensues because I have a weird allergy to Lidocaine, Benzocaine, and Novocain with Epi. I am hoping that I will be able to get the femoral nerve block. The anesthesiologist says it's a go. I am relieved until he shows up with two huge needles and two large vials of medicine.
       I say with confidence, "I will be asleep when you do the block, won't I?"
      He looks at me and says, "Oh no, I am getting ready to do it now."
      The panic starts to rise like bile in my throat.
      He catches my deer in the headlights look and says, "No worries, I am going to give you a little happy medicine called Versed before I do it."
     "Wait a minute," I say, "Versed works on memory, but I will still feel the pain."
     He pats my hand paternally and repeats again, "Don't worry."
  Another anesthesiologist has come over to join the party. He seems excited. I have my doubts. He has the doppler and is chatting away. The next thing I know they have laid me down flat, pulled my gown up around my chest (forget any shred of modesty I have clung to at this point) and seem to be doing something around the top of my leg. I feel NOTHING. He looks up at me.
     I ask him, "When will you do the block?"
     He pats my hand again and says, "We are already done."
    WOW. Strike one for the scaredy cat. I whiffed that one. And I even saw the size of the needle. I guess the Versed worked. I just hope the nerve block works. I really don't remember much after that until I woke up in my room. I know you have to be bored out of your gourd if you are still reading this. Syonara. More later.