Diary of My Second Knee Replacement

   Yep. I just had my right knee replaced. Eighteen months or so ago, I replaced my left knee (and six years I replaced my right hip). In case you are wondering I am planning on giving Lee Majors and Lyndsay Wagner a run for their money. Not that you would know that to look at me. However, I digress. Back to my knee. My First Knee is currently very happy and doing her job, this new knee is not so sure.

Cute isn't it...

I am now on Day 10 of my recovery. I am going to try to give you the run-down to date of what has been happening thus far. Warning: this could definitely boring for those of you who do not have or are not contemplating the addition of artificial joints to your life. So feel free to move on whenever you can't take it anymore!

Some things to keep in mind as you read this:  I was definitely not overconfident going into this knee surgery; in fact, truth be told, I was dreading it and had waited as long as possible to schedule it before year end, but I believed  I was emotionally prepared to handle the recovery process. I was not. In fact, this knee replacement has thrown me for a loop! Why, you ask? The pain. The pain. The Pain. Are you getting my drift?  This knee replacement is totally different from what I experienced before. Sadly, my recovery thus far has seemingly been defined by said pain. I don't want to scare anyone off, I am just trying to be truthful. Stay with me, because I am confident that the picture will change and the pain will no longer dominate my life. I am on that pivot point. I can feel it.

Pre-Op
   My surgery group, Southern Joint Replacement Institute, is the best in the Southeast. They are amazing and have a tried and true protocol both for surgery and for the rehab that is phenomenal. I know. I've benefited from it three times. Before I had my first hip surgery and then again before my first knee surgery,  I investigated all of the local doctors that conduct these respective surgeries, and I could not find anyone else who offered the comprehensive level of services that SJRI does.
    After you meet with your surgeon and determine that the joint replacement surgery is a go, several things happen. You meet with the Surgery Scheduler (Susie Ashley, in my case) and she gives you a date for your surgery (you won't be given the time because that is set the week before with Susie and the Dr.); Susie also gives you a time to come to a Joint Replacement Class, an appointment for a blood draw, an appointment with a hospitalist for a physical check-up, and a time for an evaluation by a physical therapist You feel a little like you are going back to school. You are.
    At your joint class, you will be given a notebook. Then you know that this was not an illusion, you really are going back to school. Definitely take the time to read it cover to cover. But do not obsess over the contents. There are no tests. You will just need to be aware of the fact that for the six weeks after your surgery, your life will not be your own. It will almost totally be controlled by that lovely metal and plastic artificial joint that your surgeon has implanted in your knee. It is calling the shots. Trust me on this!
    Six weeks. Get a calendar and mark it off. Make sure that you do not plan anything of any consequence (for example: Thanksgiving or Christmas-- two holidays that fell during my recovery period.) or you will regret it. I will tell you when I get through this, if my timing was as bad an idea as I think it was and is. But I am not there yet. I am in the middle of it!
   I'll be back at some point with info on the hospital stay. Headed off for a required (in my book) afternoon nap!

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.

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.

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.

     Now is where the itchy pants come in. I have cleaned up my room, gathered up all of my possessions and am roaring and ready to go. No husband in sight. As the last man standing in corporate America without a cell phone, there are times when I am ready to ring The Husband's neck. He is nowhere to be found. Just as usual, he is off the grid. I am fussing and fuming. I think about calling the grocery store and having him paged but I have been there and done that too many times already. I also discard the notion of calling our local Y to see if he could possibly be there. I go over my discharge papers with the nurses and think about hitching a ride down to the patient pick up area, but then I realize that he will not know to look for me there. I call my children to complain. This eats up 30 minutes. I have four children. Just about the time I am ready to pull out my hair, The Husband breezes into the room all happy and cheery. My chicken quesadillas look so good (my leftover lunch was still there) that he wants to finish them first. He is definitely not in a hurry. He does not understand that I am propelled by visions of the comfort of my own bed in my own house.
   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.