Thursday, August 7, 2014

Total Knee Replacement - What's Next, What To Expect

Today was a long day. A very long day. It was pre-admission day. My appointment was a 8:30AM, my alarm was set for 5:45AM and I had only fallen asleep around 2:30AM.  Needless to say, three hours of sleep was not nearly enough for me to spend all day in a hospital. Alas, this is the hand I was dealt, so it was the hand I played.  And consequently, I am exhausted!

I was not sure how the day was going to unfold, only that I was expected to be there for at least 5 hours, and would be having several tests, and various consults. Uncertain if I would be limping all over the building, I brought my friend with me.  The plan was that if need be, she would push me around in a wheelchair all day long - from clinic to clinic.

Thankfully, and mercifully, everything was done in one clinic. PAF - The Pre-Admissions Facility. And actually, to make things even better... I was put into a private room and there I sat as a parade of people took turns filing in and out of the room.  

I did the pre-surgical physical. Blood work. An echo cardiogram. Medical and surgical background consultation. A meeting with the Anesthesiologist. And after the parade was over, everyone who was attending the clinic today was ushered across the hallway to Conference Room 1, for a short movie, followed by a lecture given on what to expect prior, during and after surgery. Followed by a Q&A session.

I have to say that the people in the PAF were extremely lovely. Caring, thoughtful, considerate, professional, and just made the day as painless as possible.  It was really quite remarkable how fast 5 hours had flown by. Needless to say, however, my knee is on fire this evening, and so I am doing precious little right now. Essentially just resting until it is time to take my Bentley for his evening trip outside.  

It is really quite interesting - the avalanche of information that is given. Between the books, pamphlets, brochures, loose-leaf papers, and the orientation, well .. it is a lot to process. 

The day before surgery, I am to call the hospital, to find out what time my surgery will be the following day. Slot 1,2 or 3.  And therefore what time I am to check in prior.  The night before surgery, I am to shower with these special anti-bacterial sponges that were provided today.  The morning of the surgery I am to take a second shower with another sponge. No powders, deodorant, lotion, perfume, make-up, nail polish.  
Basically, wash off, throw you hair in a pony tail, get dressed and leave.  

Surgery day is considered Day 0.  I will check in, Change into a johnny gown, and get prepped with an IV, etc.  Then await the actual surgery.  I was told today that I have a choice between the route of anesthesia. I can opt for the full and typical anesthesia.  Or, I can be knocked out with Propofol and a spinal epidural, which will render me as equally put-under, but apparently with the ability to be aroused. If this occurs, I simply raise my hand and I will be knocked out again. This is not to say that I will be aware of the operation, or feel anything whatsoever, it is a deeper level of conscious sedation and ultimately results in quicker recovery time in post-op. And will leave me less groggy the next day.  This decision has to be made within 30 minutes of the actual operation.

Either way, I will have the nerve blocker in my femoral vein, to numb the leg, and will be hooked up to a self-administering morphine pump. I will be able to dose myself with 1mg of morphine every 5 minutes, up to 30mg in a 4hr period.  While being monitored by a pain management team, who will adjust the levels accordingly to my level of pain following the operation. 

When I awake, I will of course have antibiotics and saline via an I.V. as well as a urethral catheter, and a second catheter in my leg to drain any excess fluid from the incision site.  My leg will be heavily bandaged and covered in a compression stocking - from the top of my thigh to my ankle. This bandaging will apparently be quite impressive in size, but will be removed the following day.  

The remainder of Day 0 - surgery day, will be spent resting, and eating ice chips, while being monitored by nurses around the clock. 

Day 1 - the day after surgery, I will have the bandaging removed from my leg, and possibly the urethral catheter as well as the catheter from my leg - assuming it has stopped draining any fluids.  I will begin eating and will meet with physio, who will help me to get out of bed and walk for the first time with my new knee. This is going to be extremely painful and will no doubt be a short trip. Probably across the room to the washroom, and back to my bed.  I will also sit up in a chair for an hour, just to get me up and insure that I do not get any blood clots from staying in bed for too long. At this point, I will hopefully be able to use the washroom, and no longer require assistance with a catheter.  Additionally, I will be placed into a CPM (Continuous Passive Motion) Machine, which will continually bend and extend my leg while I am in bed. The machine will be set by the physiotherapist to bend my leg to a certain degree, typically beginning at 10 degrees, slowly expanding as my knee becomes use to the motion and more flexible.  This will take time and I could be in the machine for two hours at a time, several times throughout the day. 

All of this in in addition to bed exercises such as foot pumps - simply bending my foot forward and backward, pressing my knee down into the bed, and then raising it back into a natural straightened position. As well as knee bends, sliding my foot upward along the bed, to bend my knee.  

Frankly, all of this is going to be very painful, but the more I do it, the harder I work, the quicker the healing process will ultimately be. And although my surgeon is concerned about my Fibromyalgia, which amplifies pain, causing me to feel more pain than the average person might feel in the same situation, it is my plan to work as hard as I possibly can - in order to get through this as quickly as I possibly can!

Day 2 will be the same as Day 1, just more. More walking, more exercising, longer periods of sitting up in a chair. I will also begin practicing stairs with the physiotherapist. On this day I will also have the nerve blocker and epidural removed. The bandaging will come off of my leg and I will have thinner bandaging placed over the incision, which will be changed daily until the staples are removed. 

Day 3 - Judgment day.  It is on this day where an assessment will be made to determine whether or not I am on schedule in my recovery, thus able to go home on Day 4.  If it is determined that I am on track, I will continue with my in-hospital physio, in preparation to go home the following day.  If it is determined that I am not on schedule and require extra time to recover before going home, I will be transferred via ambulance to a rehabilitation hospital - where I will stay for 7 days. 

So, in a nutshell. I will either be going home from the surgical hospital on day 4, or I will be going home from the rehabilitation hospital on day 10.  Needless to say, I am going to do my level best to insure that I am released directly to my home on day 4!

Assuming that is what happens, I will be continuing my exercises at home, and continually working to increase the range of motion of my new knee.  At night I will be wearing a Zimmer Splint.  This is to keep my leg straight as I sleep, as they want to insure that I do not sleep with my knee bent all night. This will cause harm to my new knee, as it could set in a bent position and cause me extreme pain when I attempt to straighten it in the morning.  This situation will force me to make an emergency run - via ambulance - back to the surgeon, who will then have to force my knee to extend again.  Clearly, this is not something I want to happen, and will be a situation to avoid at all cost!  I will wear my Zimmer Splint like a champ!  

14 days after surgery:  I will see my family doctor, who will remove the staples from my leg. Do a general post-op check, insuring there is no swelling and that everything is looking as it should. I have this date already booked for September 19th. 

The following week I begin physio at a rehabilitation hospital - twice a week, working with a therapist, with machines. This will continue for up to six weeks, depending upon my progress. It could be shorter or extended, as needed.  At the six week mark, I will revisit the surgeon to do a post-operative examination to determine how my recovery is progressing. This appointment has been set for October 21st.

So, in a nutshell, this is what I have awaiting me. What my next two months are going to look like. It is scary, and I am not looking forward to the pain. But I do know that it will be a healing pain, which will eventually get better. And ultimately I will be better off than I am now.  I will be doing follow-up postings through my journey, with pictures of my leg over time.  I am doing this because I learned today that a thousand of these TKR surgeries are done each year here, and so, I am certain that someone, somewhere, is beginning their own journey. And it is always better when we know that we are not alone in what we are going through. 

Until next time.....

Love and light.