And by the way, I have 0 degree flexion and 129 extension. I had 10 degrees flexion before surgery and 108 extension...so I have already come a long way.
So it's hi ho, hi ho, off to the "Y" I go!
Showing posts with label physical therapy. Show all posts
Showing posts with label physical therapy. Show all posts
Monday, July 2, 2012
Released! Total Knee Replacement Update
I am skipping. Okay, my legs aren't skipping, but my head and heart are. I finished up my physical therapy regimen at Southern Joint Replacement Institute, met with my surgeon, Dr. Hodrick, and passed with flying colors. He didn't tell me that exactly. But I told myself that. Yippee. Hooray. Now I just have two pages of exercises that I need to do at least three times per week on my own. And believe it or not, I have already started! Woo Hoo!
I want to give a shout out to the wonderful therapists at SJRI -- Che Che, in particular. She helped me so much. She is the one who got me through my first two days of therapy when I cried like a baby on one of them. Che Che also massaged the softball sized knot on the back of my knee after I fell in week two. I thought I was going to die then, but, alas, I somehow survived. Che is just the right mix of encouraging and firm. She is a good motivator and gives explicit directions. I also learned from watching her work on other people with IT Band issues that you certainly want to follow ALL of your physical therapist's directions. No going out on a limb. You cannot walk too early or too much, you cannot run, you cannot kick on a paddle board in the swimming pool and you cannot do water aerobics or work out with weights...YET. That is the operative word. Everything has to get stronger. Everything has to work together in tandem. You cannot strengthen just one set of muscles. You have to help them all get stronger.
This next phase of my recovery should be interesting. I have bona fide jello legs. Not pretty at any age. I have not had any operative quad muscles thanks to those bad knees for soooo long. I wear a lot of pants and long skirts. I no longer wear shorts and avoid bathing suits as much as possible these days. I don't know if I will ever really get over my jello legs that quiver and quake whenever I move, but I am so very thankful for a knee that DOES NOT HURT. It is the best. Honestly, the first two weeks were really hard. Lots of pain. Lots of frustration. Lots of nasty pain meds. But I am beginning to reap the rewards now.
And by the way, I have 0 degree flexion and 129 extension. I had 10 degrees flexion before surgery and 108 extension...so I have already come a long way.
So it's hi ho, hi ho, off to the "Y" I go!
And by the way, I have 0 degree flexion and 129 extension. I had 10 degrees flexion before surgery and 108 extension...so I have already come a long way.
So it's hi ho, hi ho, off to the "Y" I go!
Wednesday, June 6, 2012
My Diary: Insomnia and More
A Diary of Somewhat Random Ruminations:
Day 10 After Total Knee Replacement -- Insomnia....not a good companion for a TKR. I am finding it increasingly difficult to sleep in my knee immobilizer. In fact, we have declared war on one another. I am required by the physical therapist to be in the immobilizer at least 6-8 hours. Last night at 3:45 am, I freed myself from the aforesaid strait jacket and threw it against the wall. I am not kidding. During my wakeful periods last night I counted sheep. I recited Bible verses. I prayed. I wrote blog posts in my brain. I planned out my week: therapy, more therapy and even more therapy. I drank water. I got up to make multiple trips to the loo. And I watched the clock: 11:40 pm, 12:20 am, 2:05 am, 3:45 (immobilizer thrown across the room), 4:10, 4:40, 5:35, 6:30, and finally, 7:20. I don't think I hit any REM sleep last night. Oh well, there's always tomorrow night.
Day 11 -- Exhaustion. It's not as though I am really doing anything to be so tired (except not sleeping at night). My housework is limited to loading and unloading the dishwasher, doing a load of laundry here and there, folding, vacuuming when the fancy strikes me, wiping down counters and making up our bed. Nothing too taxing. I also spend what seems to be an inordinate amount of time icing my knee. I go to therapy three times per week. Once there, I spend a good 1 hour and 45 minutes working out or being worked on. Then on my off days, I try to work on my exercises at home. I don't miss any meals (!) I take naps every day. EVERY DAY. I am ready to have a little energy to do something else, but "tired" seems to be my middle name. The Husband laughs that after I shower and wash my hair, I have to recover with a one hour nap. Sadly, I think he's right. Yawn. Yawn.
Day 14 -- Pain FREE. I am stiff. I am sore. But I am pretty much pain free when in a resting position. The constant, annoying and sometimes debilitating pain in my leg is gone. GONE. Wow. It's been a long time coming. I get up now to walk and it feels as though I have had surgery. I can handle that. I say that my knee "grumbles" when I move around too much. But it really does not hurt. Thankful. Can I scream THANKFUL? I am. I really and truly am so very glad. Thank you, Jesus.
Day 15 -- Maybe I spoke too soon. I had a stomach virus and fell last night on my knee in a bent position. I could not get up. I had to call The Husband to come and help. Thank goodness he got there fairly quickly. The knee feels like a brick landed on it. It did. I am hoping that all is well. I have therapy tomorrow. See post on Calamity Jane.
Day 17 -- The knee is fine. I saw the x-rays. The implant is lovely and shows up prominently. It is reminiscent of an alien object. I wonder at the marvels of modern medicine that afford me the opportunity to even have a new joint. I am amazed on the one hand that my body does not reject this foreign object, but I digress. It seems as though I strained the surrounding muscles including the hamstring during my fall, but I have been icing religiously and doing my hamstring stretches. Everything feels as though it is settling back down. I hope so.
Day 18 -- Cabin fever is really bad. Shirley, my new friend at therapy, and I are sharing stories as we watch one another's progress. She is a day behind me, but our therapy is advancing differently. That's one thing I like about Southern Joint's Therapy Department. They see so many joint replacements (basically seems to be 90% of what they do) that they can tailor your therapy to meet your individual need, yet remain within the recommended protocol. In short, they know what they are doing.
Day 20 -- Pain flare up following Physical Therapy. We added 1 pound weights to the knee today and the top of my knee began to have some serious muscle spasms. It almost felt as though it wanted to lock up on me. Not scary, but just painful. Even the drive home was rough. I am alternating ice and heat today. I will try to massage later to see if I can get the cramps to ease up. I have been fortunate not to have much, if any, pain except immediately following therapy, but this seems to be sticking around. Ugh.
You never realize how "tired" you get with pain. I am developing great empathy for people who daily deal with severe chronic pain. I have a couple of friends who struggle with this. I am going to start praying for them more consistently. It's the least I can do.
Day 10 After Total Knee Replacement -- Insomnia....not a good companion for a TKR. I am finding it increasingly difficult to sleep in my knee immobilizer. In fact, we have declared war on one another. I am required by the physical therapist to be in the immobilizer at least 6-8 hours. Last night at 3:45 am, I freed myself from the aforesaid strait jacket and threw it against the wall. I am not kidding. During my wakeful periods last night I counted sheep. I recited Bible verses. I prayed. I wrote blog posts in my brain. I planned out my week: therapy, more therapy and even more therapy. I drank water. I got up to make multiple trips to the loo. And I watched the clock: 11:40 pm, 12:20 am, 2:05 am, 3:45 (immobilizer thrown across the room), 4:10, 4:40, 5:35, 6:30, and finally, 7:20. I don't think I hit any REM sleep last night. Oh well, there's always tomorrow night.
Day 11 -- Exhaustion. It's not as though I am really doing anything to be so tired (except not sleeping at night). My housework is limited to loading and unloading the dishwasher, doing a load of laundry here and there, folding, vacuuming when the fancy strikes me, wiping down counters and making up our bed. Nothing too taxing. I also spend what seems to be an inordinate amount of time icing my knee. I go to therapy three times per week. Once there, I spend a good 1 hour and 45 minutes working out or being worked on. Then on my off days, I try to work on my exercises at home. I don't miss any meals (!) I take naps every day. EVERY DAY. I am ready to have a little energy to do something else, but "tired" seems to be my middle name. The Husband laughs that after I shower and wash my hair, I have to recover with a one hour nap. Sadly, I think he's right. Yawn. Yawn.
Day 14 -- Pain FREE. I am stiff. I am sore. But I am pretty much pain free when in a resting position. The constant, annoying and sometimes debilitating pain in my leg is gone. GONE. Wow. It's been a long time coming. I get up now to walk and it feels as though I have had surgery. I can handle that. I say that my knee "grumbles" when I move around too much. But it really does not hurt. Thankful. Can I scream THANKFUL? I am. I really and truly am so very glad. Thank you, Jesus.
Day 15 -- Maybe I spoke too soon. I had a stomach virus and fell last night on my knee in a bent position. I could not get up. I had to call The Husband to come and help. Thank goodness he got there fairly quickly. The knee feels like a brick landed on it. It did. I am hoping that all is well. I have therapy tomorrow. See post on Calamity Jane.
Day 17 -- The knee is fine. I saw the x-rays. The implant is lovely and shows up prominently. It is reminiscent of an alien object. I wonder at the marvels of modern medicine that afford me the opportunity to even have a new joint. I am amazed on the one hand that my body does not reject this foreign object, but I digress. It seems as though I strained the surrounding muscles including the hamstring during my fall, but I have been icing religiously and doing my hamstring stretches. Everything feels as though it is settling back down. I hope so.
Day 18 -- Cabin fever is really bad. Shirley, my new friend at therapy, and I are sharing stories as we watch one another's progress. She is a day behind me, but our therapy is advancing differently. That's one thing I like about Southern Joint's Therapy Department. They see so many joint replacements (basically seems to be 90% of what they do) that they can tailor your therapy to meet your individual need, yet remain within the recommended protocol. In short, they know what they are doing.
Day 20 -- Pain flare up following Physical Therapy. We added 1 pound weights to the knee today and the top of my knee began to have some serious muscle spasms. It almost felt as though it wanted to lock up on me. Not scary, but just painful. Even the drive home was rough. I am alternating ice and heat today. I will try to massage later to see if I can get the cramps to ease up. I have been fortunate not to have much, if any, pain except immediately following therapy, but this seems to be sticking around. Ugh.
You never realize how "tired" you get with pain. I am developing great empathy for people who daily deal with severe chronic pain. I have a couple of friends who struggle with this. I am going to start praying for them more consistently. It's the least I can do.
Wednesday, May 30, 2012
Diary of a Knee Replacement Part IV
Let Me Introduce You
1. TED Hose -- if you have any kind of joint surgery, you will make TED'S acquaintance. TED's are the thigh-high compression stockings that you are issued when you leave the hospital. All SJRI patients are required to wear them during the day for 6 weeks. While I view TED's presence as a relatively minor inconvenience in the whole scheme of things, I have some friends at PT who are not so nice about TED. They hate him. And I mean hate him. I don't mind TED hanging around because I think he really helps me with the swelling, edema, and pain, so he has earned his chops in my book. I do, however, agree that TED totally wrecks your fashion aesthetic, but since my social life is largely confined to visiting with friends at the Southern Joint Replacement Institute's Physical Therapy gym, I don't feel too out of place sporting my bright white TED's.
2. The Knee Immobilizer -- while you met the knee immobilizer briefly when I was in the hospital, this chick's role expands exponentially when you get home. You are required to be strapped into this lovely strait jacket for legs for 8-10 hours per day. Miss Knee Immobilizer and I hang tight at night. I couldn't abide her presence during the day, but I guess it's feasible that you could get your hours in if you were persistent with it. She's not so bad as the monster I am getting ready to introduce, but she is definitely not a friend for life, if you know what I mean.
3. The Monster Man -- PAIN
This is the one guy we all want to avoid at any cost, but let's just face it, from the minute your surgeon makes his first cut with that scalpel, this guy has your number. He's a stalker. And he loves to do his dirty work at night. While Monster Man begins to invade your boundaries in the hospital as the nerve blocks begin wearing off, he usually waits to completely ambush you until you get home.
You are confident when you leave the hospital. Thankfully, the doctors at SJRI are firing some pretty big cannons in their arsenal against this guy, and they want you to take advantage of what they are giving you. In other words: TAKE YOUR PAIN PILLS. Everybody from the Discharge Nurse to the Case Worker to the Hospitalist to your Surgeon to the Physical Therapist -- are all saying the same thing, "Take your pain meds. Do not let the pain get ahead of you. Take them every day and take them regularly."
The only problem with this strategy is that once you read the label, you are not entirely happy with this advice. Deep down you are worried about the pain meds. The long and the short of it is that they are ADDICTIVE. And you know it. In fact, everybody knows it. But here you are...going home with a 90 pill supply of these boogers. You find yourself hoping, "Maybe that's one a day for the next 90 days." NOT. You are also encouraged by the in-the-know medical personnel not to try to be the hero. And you are thinking to yourself, "Yeah, right...you just don't know me."
My hip replacement did not kick my butt in terms of pain, but my knee replacement sure has. I thought my pain tolerance was pretty high, and it is, but this pain is on a whole other level. And I have even had natural childbirth, the standard by which every woman measures another person's ability to withstand pain. I did well for a couple of days, and then this searing, burning, clawing, pressurizing pain started camping out at my door. The Monster Man would remain dormant as long as I was completely inert, but if I moved around or heaven forbid, stood up, it was right there in my face breathing its hairy fire-breathing breath all over me. Sometimes I wanted to vomit. Sometimes I wanted to scream. And sometimes I wanted to quit. It was bad.
I threw everything in the book at this particular Monster Man, but he was not giving an inch. I followed the Doctor's orders. I pushed the envelope to its limit and took the maximum daily allowance. The Monster did not leave. I keep a diary/log of all medications I take because who can remember at 2 am when you last took something. I look back at the journal now and can track the steady progression of this pain. It was building and building and building until it was a consuming fire, burning a hole in my leg from the inside out. Talk to five different knee replacement people and you will find five different stories about the pain. Some are more fortunate than I was. Some suffered more than I did.
But the story isn't over yet. Every day when I walk into therapy (and you go five times at SJRI the first week) the cheerful therapist, in this case Che Che, asks you to rate your pain. Mine was usually in the 3-5 range until this Monster Man showed up and then I jumped to 8-9. A few times I even hit 10. That's usually where you hear the wailing and gnashing of teeth. The good thing is that my therapist listened to me. I mean she really listened to me. She helped me determine that my pain sounded more like nerve pain with its burning, clawing and licking fingers of fire. So I marched (that is a total lie since I could not have marched anywhere even if I wanted to), okay I slid my walker in front of me and dragged my knee behind it down to the nurse's station where I talked to my Surgeon's Assistant (Sweet Lindsay). I told her what was going on, she took one long look at my face and she said, "No problem, we will get you a prescription for some Lyrica."
Lyrica. Sounds like music to my ears. And music it is. Lyrica has proven to be my new best friend. Within three hours of the first round of Lyrica, I had a 30 to 40% reduction in pain. I went from an 8-9 on the charts to a 3-4.5. It went from unbearable to bearable. I went from being a monster myself to being a relatively nice human being.
At this point in time, I have weaned myself off of the heavy duty pain meds because they simply don't seem to work well on my pain. I was having to take so much that they were leaving me with cotton on the brain instead of normal brain cells...and I was still hurting a lot. Lyrica is not a walk-in-the-park drug, but it works for me and is one, that hopefully, I will not be tethered to for long.
All of the knee replacements talk seriously about our pain. We joke about the TED hose, the Immobilizer, the Walker and the other accouterments, but we don't really joke about our pain. We know the Monster Man in this case is all too real. Hopefully manageable. Hopefully not with you forever. But real enough to take him seriously.
I would that hope some Physical Therapist, or Nurse, or Doctor, or Patient Advocate somewhere is reading this and thinking, "I really need to let my patient talk to me about her pain," or "I need to pay more attention and consider other available options."
I sure hope so because there is more than one answer to the problem of pain. The Monster Man can be defeated or at least tamed. I am proof of that.
1. TED Hose -- if you have any kind of joint surgery, you will make TED'S acquaintance. TED's are the thigh-high compression stockings that you are issued when you leave the hospital. All SJRI patients are required to wear them during the day for 6 weeks. While I view TED's presence as a relatively minor inconvenience in the whole scheme of things, I have some friends at PT who are not so nice about TED. They hate him. And I mean hate him. I don't mind TED hanging around because I think he really helps me with the swelling, edema, and pain, so he has earned his chops in my book. I do, however, agree that TED totally wrecks your fashion aesthetic, but since my social life is largely confined to visiting with friends at the Southern Joint Replacement Institute's Physical Therapy gym, I don't feel too out of place sporting my bright white TED's.
 |
| This picture made me laugh. It's like they are trying to make these things look sexy or seductive. Trust me, there is nothing sexy or seductive about TED hose, especially when they get loose in the top and like to jelly roll down your legs. |
2. The Knee Immobilizer -- while you met the knee immobilizer briefly when I was in the hospital, this chick's role expands exponentially when you get home. You are required to be strapped into this lovely strait jacket for legs for 8-10 hours per day. Miss Knee Immobilizer and I hang tight at night. I couldn't abide her presence during the day, but I guess it's feasible that you could get your hours in if you were persistent with it. She's not so bad as the monster I am getting ready to introduce, but she is definitely not a friend for life, if you know what I mean.
 |
| Mine is black and looks great with the thigh high white TED Hose. It's a true fashion statement. |
3. The Monster Man -- PAIN
This is the one guy we all want to avoid at any cost, but let's just face it, from the minute your surgeon makes his first cut with that scalpel, this guy has your number. He's a stalker. And he loves to do his dirty work at night. While Monster Man begins to invade your boundaries in the hospital as the nerve blocks begin wearing off, he usually waits to completely ambush you until you get home.
You are confident when you leave the hospital. Thankfully, the doctors at SJRI are firing some pretty big cannons in their arsenal against this guy, and they want you to take advantage of what they are giving you. In other words: TAKE YOUR PAIN PILLS. Everybody from the Discharge Nurse to the Case Worker to the Hospitalist to your Surgeon to the Physical Therapist -- are all saying the same thing, "Take your pain meds. Do not let the pain get ahead of you. Take them every day and take them regularly."
The only problem with this strategy is that once you read the label, you are not entirely happy with this advice. Deep down you are worried about the pain meds. The long and the short of it is that they are ADDICTIVE. And you know it. In fact, everybody knows it. But here you are...going home with a 90 pill supply of these boogers. You find yourself hoping, "Maybe that's one a day for the next 90 days." NOT. You are also encouraged by the in-the-know medical personnel not to try to be the hero. And you are thinking to yourself, "Yeah, right...you just don't know me."
My hip replacement did not kick my butt in terms of pain, but my knee replacement sure has. I thought my pain tolerance was pretty high, and it is, but this pain is on a whole other level. And I have even had natural childbirth, the standard by which every woman measures another person's ability to withstand pain. I did well for a couple of days, and then this searing, burning, clawing, pressurizing pain started camping out at my door. The Monster Man would remain dormant as long as I was completely inert, but if I moved around or heaven forbid, stood up, it was right there in my face breathing its hairy fire-breathing breath all over me. Sometimes I wanted to vomit. Sometimes I wanted to scream. And sometimes I wanted to quit. It was bad.
 |
I threw everything in the book at this particular Monster Man, but he was not giving an inch. I followed the Doctor's orders. I pushed the envelope to its limit and took the maximum daily allowance. The Monster did not leave. I keep a diary/log of all medications I take because who can remember at 2 am when you last took something. I look back at the journal now and can track the steady progression of this pain. It was building and building and building until it was a consuming fire, burning a hole in my leg from the inside out. Talk to five different knee replacement people and you will find five different stories about the pain. Some are more fortunate than I was. Some suffered more than I did.
But the story isn't over yet. Every day when I walk into therapy (and you go five times at SJRI the first week) the cheerful therapist, in this case Che Che, asks you to rate your pain. Mine was usually in the 3-5 range until this Monster Man showed up and then I jumped to 8-9. A few times I even hit 10. That's usually where you hear the wailing and gnashing of teeth. The good thing is that my therapist listened to me. I mean she really listened to me. She helped me determine that my pain sounded more like nerve pain with its burning, clawing and licking fingers of fire. So I marched (that is a total lie since I could not have marched anywhere even if I wanted to), okay I slid my walker in front of me and dragged my knee behind it down to the nurse's station where I talked to my Surgeon's Assistant (Sweet Lindsay). I told her what was going on, she took one long look at my face and she said, "No problem, we will get you a prescription for some Lyrica."
Lyrica. Sounds like music to my ears. And music it is. Lyrica has proven to be my new best friend. Within three hours of the first round of Lyrica, I had a 30 to 40% reduction in pain. I went from an 8-9 on the charts to a 3-4.5. It went from unbearable to bearable. I went from being a monster myself to being a relatively nice human being.
At this point in time, I have weaned myself off of the heavy duty pain meds because they simply don't seem to work well on my pain. I was having to take so much that they were leaving me with cotton on the brain instead of normal brain cells...and I was still hurting a lot. Lyrica is not a walk-in-the-park drug, but it works for me and is one, that hopefully, I will not be tethered to for long.
All of the knee replacements talk seriously about our pain. We joke about the TED hose, the Immobilizer, the Walker and the other accouterments, but we don't really joke about our pain. We know the Monster Man in this case is all too real. Hopefully manageable. Hopefully not with you forever. But real enough to take him seriously.
I would that hope some Physical Therapist, or Nurse, or Doctor, or Patient Advocate somewhere is reading this and thinking, "I really need to let my patient talk to me about her pain," or "I need to pay more attention and consider other available options."
I sure hope so because there is more than one answer to the problem of pain. The Monster Man can be defeated or at least tamed. I am proof of that.
Tuesday, May 29, 2012
Diary of a Knee Replacement Part III
The Hospital Day Two
The morning dawns bright and early. I am already on a first name basis with my night shift nurses. I should be. They were in my room and in my face every two hours during the night. And that is not counting the visit from the night vampire: the tech who draws the blood. I know that there is going to be a shift change at 7, and the new crew is going to stop by to make my acquaintance. I want to get on good terms with them because I need to get my catheter removed first thing. FIRST THING cause this darn thing is driving me crazy. I already feel better today after being fortified by my dinner last night of chicken broth and orange jello. I am ready to face the world. But I have to get this catheter OUT.
I call ahead to the "Room Service" to order my customized breakfast: grits, bacon, coffee (yes!), and fresh fruit. I am not a big breakfast eater, but I know that I need to eat.
It's not rocket science to know that I am having a terrible hair day and my mouth feels like it needs a good scrub. Every woman knows that the finer details of one's toilette must always be perfected in front of a mirror. A bed does not suffice. I also want to get out of my gown and into the lovely outfit that Southern Joint provides (not free of charge, I am certain) for you: a navy t-shirt with the Southern Joint logo and a pair of gray gym shorts. Yippee. I also know that I will have Physical Therapy not once, but twice today. I am so excited. Not.
The young nurse assigned to me senses my desperation and tells me that I will get my catheter removed shortly. I hope her idea of shortly matches mine. She reminds me that I may NOT get up without assistance. I nod as if I comprehend.
I try unlooping my catheter bag, but I am not having a lot of luck with it. And then there's the IV pump on the other side of the bed. I determine that I really am going to ask for help if I want to get up.
She comes back. Yay! On her command I take a deep breath and whoopee, I am a free woman. I am no longer tethered to the catheter! I know I need to wait a bit to get up. I want to consolidate my bathroom trips to keep my time on my feet to the limits they have imposed. In the meantime, the tech helps me get dressed in my "uniform." I am already feeling a little more human and that's a good thing.
PT comes in and this time, I try not to pass out (as if I tried before). We make it all the way down to the nurses station where I wave to everyone. I feel sorry for my therapists. I have still not brushed my hair or my teeth. They are courageous men and women in my book. We head back to my room and I ask them to drop me off at the bathroom. They comply and tell me that I must use the call button if I run into trouble. I find what I need in the bathroom and give myself a quick make-over. In the hospital a make-over is brushing your hair and scrubbing your face and teeth. I even slather some of their all purpose cream on my face because my good stuff is in the bag beside my bed. Oh well.
The day passes quickly. I have a few visitors, lots of check-ins with the nursing staff and another round of PT. My extension and flexion amaze me. When Dr. Hodrick stops by I brag on myself. I know that he is thinking something that I can't quite grasp. Then I remember that the nerve block is still working. He reassures me that he was able to get great flexion and extension in the operating room so I should be in good shape as I move forward with my therapy. Yikes. My Hospitalist comes in later and spends some time talking with me about pain management because I am going home tomorrow. She goes over the meds that have been prescribed and what I can expect. I am still not hurting much, if any, at this point, so I am hoping her comments are superfluous.
Sometime during the night my block starts to wear off, and I have this dull ache and slight burning pain thing going in my leg. It won't go away. I start to worry how I am going to manage without my lovely pain medication. I am now having to ask for the pain meds. A couple of times during the night I am actually counting down the minutes until I can have my meds again. I am thinking that this does not bode well for the future.
Day Three and Heading Home
Even though I have brought my own pillow to the hospital, I am ready to sleep in my own bed. I know that I will be more comfortable. I am tired of making friends with the night shift. As a Southern woman raised right, I make it a point to be as nice as possible to everyone who enters my room, even if it's two a.m. in the morning. I know about everybody's children and grandchildren and why they wear each of the pins on their badges. It's a lot to keep in my fuzzy head. At this point all I want is sleep, uninterrupted sleep. And I know that even though I will have PT twice today before I go home, I will have a break on Sunday. I can't wait.
My gourmet breakfast of oatmeal, fruit and two cups of coffee (ahhh) arrives at 7:30, and the day nurse gives me her low-down on the best items on the menu. On her recommendation, I am going to have the chicken quesadillas for lunch. I wonder where she was yesterday when I was playing Russian Roulette with the menu. I ask her if she will help me get up to take a SHOWER. I am going to be a real person again. I will be clean. No more hospital smell. I have even brought my own soap, my own shampoo, and my own lotion. I forgot to bring my own towel, but I get the tech to bring me four or five of the hand towels that are supposed to double as body towels. The nurse agrees that I am ambulatory and off I go.
As soon as I got into the shower, I knew that I did not want to get out. The water pressure was great and the temperature was hot. If I closed my eyes, I could easily forget my surroundings and the fact that I was seated on a shower chair in a room with a drain in the floor and a two call buttons on the wall. I stayed in there until my hands were good and shriveled. It felt so good.
I put my uniform back on and decided to take a good nap. My PT session in the afternoon included a training session on how to get in and out of the fake car that they have in the little gym. Of course I tried to get into the driver's seat, but they reminded me that I will be the passenger for six weeks. I don't know whether I will survive. We also practiced going up and down steps on their little staircase. I passed all of their tests and was deemed capable of being released from the hospital.
 |
| See the stairs to the left and yes, that's the fake car where we practice getting in and out of the passenger side. |
We get moving. I have not seen the sun for three days. It feels wonderful. I make it up the steps to our house and down the hallway to our bed. I fall into its comfort. I am home. I have a new knee. I don't have PT again until Monday. God's in His heaven and all's right with the world.
Monday, May 28, 2012
Recovery From A Total Knee Replacement Part Two
The Hospital Day One
Waking up in the hospital. There's nothing wonderful or exciting about waking up in the hospital except the fact that you actually do wake up. The alternative is something I don't want to talk about just now other than to say that if I had not waked up in the hospital I know without a shadow of a doubt that I would be waking up instead to the glories of Heaven. Either one is great in my book. Here or There. Sometimes There looks a lot better than here. But I digress.
Betcha you didn't know that just waking up from anesthesia is hard work. I vaguely remember someone hollering my name and telling me over and over to open my eyes when all I want to do is go off and have a nice little nap. But no. You have to wake up. They don't really give you another option.
The next thing I remember is that I am in my room. And the comforting presence of The Husband is there. He pats my hand and tells me that everything went well. I look around. I have a drain in my knee, I am connected to an IV pump, there's an oxygen tube in my nose, and a lovely see-through catheter bag looped over the end of my bed. Finally there is a blood pressure cuff that looks like it's not going anywhere around my arm. I couldn't escape if I wanted to. The good news is that I feel NO PAIN. So I don't need to escape. Not yet, anyway. Okay maybe I am feeling a twinge of discomfort, but no real pain. They use these rating systems for pain now in the hospitals. It must be some universal protocol. They even gave me a sheet with little faces corresponding to the numbers on the pain chart. I guess you can always make the face if you are unable to talk. In the last two hours, they have asked me five times about my pain level. The nurses are hovering at this point. And they tell me that I can have some wonderful delicious ice chips to eat. My mouth feels like a really really bad hangover so I am excited to have ice chips, and since it feels like a hangover, I know that I do not want to eat...yet. By the way, I don't think my Momma knows that I know what a hangover is despite the fact that I am nearly 60 years old.
But wait, I have this headache. I have not had any caffeine for like 24 hours. I know that I am going to develop a migraine. I tell the nurse expecting them to just pat my hand because a headache is relatively minor compared to everything else that is going on with my body, but no, she takes me seriously and puts something in my IV for my headache. Maybe it was liquid caffeine. I don't know but I start to feel pretty good.
Some of my family comes to visit and then the doctor stops by. I ask about the femoral nerve block and he tells me that I got two blocks, so as far as the pain goes, I should be in pretty good shape...until it wears off, that is. He says the replacement went well and I ask him about my knee. He tells me that the knee was terrible and horrible. I immediately think about the children's classic, Alexander and The Terrible, Horrible, Very Bad Day. My knee has had its last Terrible, Horrible, Very Bad Day. I am thankful. The new knee has a good future. Maybe I should sing, "Happy Days are Here Again..."
We discuss that I will have physical therapy later that day, and that I will likely go home on Saturday afternoon. Today is Thursday. I dread the physical therapy. I look at all of the tubes and think about walking around and I don't feel very excited. But Dr. Hodrick is very reassuring.
Sure enough the PT folks - all three of them - come into the room late-afternoon. I think I am their last patient of the day. I am hoping that I will not be a doozy. We go through the exercises that I am supposed to be doing on my own in the bed: ankle pumps and butt squeezes. Exciting, huh. Then we do a few slides, and I actually get to see the dressing surrounding my knee along with my little drain. Then they tell me that they are going to get me up. That's why there are three of them. They drag out this knee immobilizer, strap me in and then get out this giant belt and tie it around my waist. It reminds me of something that has to do with a strait jacket. Mind you I have never seen a strait jacket and am not sure that they really use them anymore, but this belt reminds me of one.
I take a deep breath and up we go. Then I get cold. The room starts to spin and they are talking to me and saying open your eyes and look at us. I think I am back in the recovery room. They sit me back down on the bed. I get a break. Maybe we are not going to have to walk. But no, the belt is still around my waist. After I am fortified with delicious ice chips and some deep chest breathing, up we go again. I think I am doing well. One foot is going in front of the other, and I am using the walker to stabilize myself. Never mind that there is a therapist on either side and one in front of me. We start toward the nurses station. I am halfway there and all of a sudden I can feel my legs giving out. "Wake up, wake up, look at us." Who is hollering? They need to talk quietly. We are in the hallways of a hospital, after all. I come back to reality. I am standing upright. There are two people wedged up next to me and a third standing in front of me. We look like we are having an intense conversation. I finally put one foot in front of the other and make it back to the room. I think that they are all ready to go home for the day. I would agree. I am ready for them to leave. I make vague promises about doing my bed exercises and close my eyes. I am exhausted.
The Husband sticks around until dark and then heads out. I am not my usual brilliant conversationalist at this point. I have actually resorted to grunting in response to his questions. He leaves. I go to sleep. It is the end of Day One.
Waking up in the hospital. There's nothing wonderful or exciting about waking up in the hospital except the fact that you actually do wake up. The alternative is something I don't want to talk about just now other than to say that if I had not waked up in the hospital I know without a shadow of a doubt that I would be waking up instead to the glories of Heaven. Either one is great in my book. Here or There. Sometimes There looks a lot better than here. But I digress.
Betcha you didn't know that just waking up from anesthesia is hard work. I vaguely remember someone hollering my name and telling me over and over to open my eyes when all I want to do is go off and have a nice little nap. But no. You have to wake up. They don't really give you another option.
The next thing I remember is that I am in my room. And the comforting presence of The Husband is there. He pats my hand and tells me that everything went well. I look around. I have a drain in my knee, I am connected to an IV pump, there's an oxygen tube in my nose, and a lovely see-through catheter bag looped over the end of my bed. Finally there is a blood pressure cuff that looks like it's not going anywhere around my arm. I couldn't escape if I wanted to. The good news is that I feel NO PAIN. So I don't need to escape. Not yet, anyway. Okay maybe I am feeling a twinge of discomfort, but no real pain. They use these rating systems for pain now in the hospitals. It must be some universal protocol. They even gave me a sheet with little faces corresponding to the numbers on the pain chart. I guess you can always make the face if you are unable to talk. In the last two hours, they have asked me five times about my pain level. The nurses are hovering at this point. And they tell me that I can have some wonderful delicious ice chips to eat. My mouth feels like a really really bad hangover so I am excited to have ice chips, and since it feels like a hangover, I know that I do not want to eat...yet. By the way, I don't think my Momma knows that I know what a hangover is despite the fact that I am nearly 60 years old.
But wait, I have this headache. I have not had any caffeine for like 24 hours. I know that I am going to develop a migraine. I tell the nurse expecting them to just pat my hand because a headache is relatively minor compared to everything else that is going on with my body, but no, she takes me seriously and puts something in my IV for my headache. Maybe it was liquid caffeine. I don't know but I start to feel pretty good.
Some of my family comes to visit and then the doctor stops by. I ask about the femoral nerve block and he tells me that I got two blocks, so as far as the pain goes, I should be in pretty good shape...until it wears off, that is. He says the replacement went well and I ask him about my knee. He tells me that the knee was terrible and horrible. I immediately think about the children's classic, Alexander and The Terrible, Horrible, Very Bad Day. My knee has had its last Terrible, Horrible, Very Bad Day. I am thankful. The new knee has a good future. Maybe I should sing, "Happy Days are Here Again..."
We discuss that I will have physical therapy later that day, and that I will likely go home on Saturday afternoon. Today is Thursday. I dread the physical therapy. I look at all of the tubes and think about walking around and I don't feel very excited. But Dr. Hodrick is very reassuring.
Sure enough the PT folks - all three of them - come into the room late-afternoon. I think I am their last patient of the day. I am hoping that I will not be a doozy. We go through the exercises that I am supposed to be doing on my own in the bed: ankle pumps and butt squeezes. Exciting, huh. Then we do a few slides, and I actually get to see the dressing surrounding my knee along with my little drain. Then they tell me that they are going to get me up. That's why there are three of them. They drag out this knee immobilizer, strap me in and then get out this giant belt and tie it around my waist. It reminds me of something that has to do with a strait jacket. Mind you I have never seen a strait jacket and am not sure that they really use them anymore, but this belt reminds me of one.
 |
| This is the belt. See what I mean? They can tie you up good with this thing. |
 |
| This is not a picture of my knee. I wish it were. But this is a picture of one of my favorite devices (not)..the knee mobilizer. I will be sleeping in this monster for six weeks. |
I take a deep breath and up we go. Then I get cold. The room starts to spin and they are talking to me and saying open your eyes and look at us. I think I am back in the recovery room. They sit me back down on the bed. I get a break. Maybe we are not going to have to walk. But no, the belt is still around my waist. After I am fortified with delicious ice chips and some deep chest breathing, up we go again. I think I am doing well. One foot is going in front of the other, and I am using the walker to stabilize myself. Never mind that there is a therapist on either side and one in front of me. We start toward the nurses station. I am halfway there and all of a sudden I can feel my legs giving out. "Wake up, wake up, look at us." Who is hollering? They need to talk quietly. We are in the hallways of a hospital, after all. I come back to reality. I am standing upright. There are two people wedged up next to me and a third standing in front of me. We look like we are having an intense conversation. I finally put one foot in front of the other and make it back to the room. I think that they are all ready to go home for the day. I would agree. I am ready for them to leave. I make vague promises about doing my bed exercises and close my eyes. I am exhausted.
The Husband sticks around until dark and then heads out. I am not my usual brilliant conversationalist at this point. I have actually resorted to grunting in response to his questions. He leaves. I go to sleep. It is the end of Day One.
Sunday, May 27, 2012
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.
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.
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