Friday, October 10, 2014

Total Knee Replacement - The Surgery And The Recovery

It has been awhile since my last blog posting. Well, as some of you know, I have been in recovery from total knee replacement surgery.  And now I am going to update all of you on how things went.

As always, I am going to keep it real - very real.

The day of surgery began at 8AM.  My sister and I went to the hospital ahead of the surgery. I have to say that I was quite surprised by the beauty of the lounge where we were seated. This was my pre-surgical lounge, as well as where my sister waited during my surgery.

Below, are a couple of pictures I took while waiting to 'go in'.  Click on images for enlarged viewing.


At approximately 10:30AM, I was taken into the first prep-room, where I changed into the ever-popular johnny gown.  Was asked a thousand questions about my medical and surgical history and was given an I.V. prior to being wheeled into the stage two prep-room.

The second room was significantly more procedural feeling than the first. It was in this room where I was given the nerve blocker, which was placed into my femoral vein. I have to say that when the doctor stimulated the muscle in my thigh, and it began to pulsate - without my control - it was .... shall we say .... trippy!!

Following the nerve blocker, I was then given the spinal. This is essentially a glorified epidural. Those of you who have children are probably familiar with the epidural.  Well, this spinal was like the epidurals big brother.  Instantly I was paralyzed from the waste down. My legs felt like a thousand pounds each. It was such a surreal feeling. And kind of scary to be honest. I literally felt nothing below my waste.

At that point - approximately Noon - I was wheeled into surgery, where I was given Propofol - and was knocked out.

I came to, approximately 2 hours later. Now, when I say that I came to, I was technically conscious, however, I was slipping 'in and out'. I recall waking up in the operating room. I recall moments of the transport to post-op, I recall moments in post-op. But I was in post-op for about four hours before I really was able to stay conscious for any amount of time.

Long enough really to vito a boot that was placed on my non-surgical foot. It felt like it was made of Sherpa and had a steel soul. It was extremely uncomfortable and I begged the nurse to remove it. Thankfully, she did.  However, on my surgical leg, was a long, thick, pressure stocking that went from the top of my thigh down to my ankle. And it HURT!

This stocking could not be removed for 24 hours.

Sometime later that evening, I was transported up to my room. It was a semi-private room, but I was had it to myself for the majority of my stay. Another plus, was that it was the only room on the floor with its own air conditioning.  SCORE!!

The surgery was done on Friday, September 5th, and needless to say, the first 24 hours were hell. To say it was painful is a gross understatement. I had a wonderful nurse that night; Beth, who told me it would be better the next day once my stocking could be removed.

For pain control, I was on a Morphine pump. I was able to hit the pump every five minutes - as needed. And let me tell you .... it was needed.

On Saturday, the stocking was removed, and as promised, the the pressure was lessened by the removal of the compression garment. My family came to visit me on the Saturday, and my beautiful daughter brought me some beautiful flowers.

Let me stop here and say that although the surgery in and of itself, was a total success. The recovery has been a nightmare. Particularly the first three weeks.

If you recall in my pre-surgical posting, the plan was that I would be released from hospital on the Monday or Tuesday. Well, it did not go as planned. I could not even get out of bed until the Monday. Turns out that I had a reaction to the Morphine. I was sick and could hardly lift my head off of the pillow. It truly felt like the world's worst hangover.  Monday I was switched over to Hydromorphone, which is derivative of Morphine, but much stronger. The pain relief was wonderful and I did not feel the same side effects as with the Morphine.

I was able to get out of bed on the Monday and take my first couple of steps. I was able to hold my head up and keep my eyes open. I was in love with the Hydromorphone.

During one of my bandage changes, I asked the nurse to snap a picture of my knee.  Below is a picture I took with the bandaging, as well as the picture the nurse took of the unbandaged incision - complete with staples, bruising and surgical swelling. Which, I am told will not go down for months.

The first picture is taken while I was in the CPM Machine. (Continuous Passive Movement) Which was a part of my inpatient physio therapy. I was in this machine for a couple of hours each day. And to be honest. I was wonderful! My leg felt better after each session with the CPM. I really wish I had one at home. This machine got my range of motion to go from 40 degrees to 60 degrees in two days.

Below is another shot I took while in my CPM Machine.

From Monday to Thursday, I did the physio, which involved walking in the halls of the hospital, along with the CPM Machine as a part of my therapy. But because I was not yet ready - according to the doctors, a decision was made to have me transferred to a rehab hospital for an additional week. However, a bed was not available, which meant that I would have to stay at the hospital, just walking up and down the halls. I determined that I could do that at home and hand a consult with the surgeons and we all decided that I would go home on the Friday - September 12th.  So long as equipment was brought into my home ahead of my discharge.  Equipment included a raised toilet seat - which was substituted with a commode. A wheelchair, A walker and a cane. 

So, with all of the arrangements having been met, I was released on Friday, September 12th.  I was given ample supply of bandaging so that I could change the dressing daily. I was given prescriptions for more Hydromorphone to be taken every 3 hours as needed. 

And so, home I went. Easy Peasy - Right? Wrong!!! 

The wheelchair that was provided, was extremely low to the ground. In fact, my first words upon seeing it when my sister brought it to the hospital to pick me up were "That is sooo low! I will never get out of that!!!" 

In hindsight, I should have stayed in the hospital until an appropriate wheelchair was made available. But honestly, I wanted to go home!  Oh, did I mention that the wheelchair had no leg lift? It only had foot supports.  Well, the foot support was fine for my non-surgical leg, but the surgical one could not bend that far and therefore my foot could not reach the foot rest. 

My nurse took a pillow, tucking it under my surgical knee and it rested beneath my leg, as the back of my ankle rested against the foot rest. Sounds comfy right? Wrong!!!

Every curb we hit, every ramp we took, the bottom of my foot hit the ground and my knee was jarred. This happened about 7 times. Including being wheeled into - and out of - the wheelchair taxi. 

Within hours of getting home, my entire leg ballooned up - it truly looked like The Nutty Professor!!!

And so, essentially I could not move my leg for the entire weekend. My daughter went and picked me up bags of frozen peas, and I was icing my entire leg for the next several days.  It really wasn't until Tuesday before the swelling began to go down. 

To add insult to injury, and not to get too graphic, but in keeping with being brutally honest, I had explosive diarrhea. I was unable to eat anything without it shooting right through me. This lasted for two weeks. Until I discovered that although constipation is on the main list of side effects of the Hydromorphone, diarrhea is on the less common side effect list.  So, it really was not until the 22nd until I was able to start eating again. By then, of course, my stomach had shrunk to the size of a walnut, and since then I have basically been eating half a meal a day. The equivalent of a sandwich. And I'm stuffed!  

Prior to going into surgery, I had booked the staple removal for two-weeks post-op, which of course was the 19th of September.  I had been dreading this day. I just KNEW it was going to be awful. I was actually afraid of having the staples removed. And I was right to feel this way. 

My doctor had lost count, but he estimated that their were approximately 67 staples.  I will be honest in saying that 20 of them were nothing. They felt like having a hair pulled from my leg. Another 20 were painful, but still tolerable. The remaining 27 were pure agony!!! 

I was lying on the exam table, with my hands gripping either side. I was gripping so hard that I actually snapped off two nails!  My face was beat red, I was dripping in sweat, my tremors were in high gear. My entire body was shaking. My doctor was as wonderful as he could be under the circumstances, and we stopped after every ten or whenever I needed a break. He also mixed up the order as not to focus on a particularly sensitive area. But I'm not going to lie to you. It was AWFUL and I am never doing that again!!! 

Below is a picture of my leg, which was taken about two hours after coming home from staple removal. You can clearly see that my leg was not happy!! 

Once again, I was rendered immobile that weekend. I was beginning to notice a pattern forming. Surgery on a Friday - sick all weekend. Home on a Friday - in pain all weekend. Staple removal on a Friday - immobile all weekend.  The difference was that prior to staple removal, I was having a watered down pinkish discharge, which everyone said was completely normal.  Following staple removal, the discharge turned into a thick, slimy, yellow.  My leg was infected! Awesome!

I just could not understand how an infection could be possible. I was cleaning the incision religiously. I was so careful. How could this be!!??  Well, I found out how on Tuesday the 23rd when I went to the rehab hospital for the first time. 

Apparently and as if a reaction to the Morphine wasn't enough. And if a reaction to the Hydromorphone wasn't enough. If starving for two weeks wasn't enough. It seems I had an allergic, infectious reaction to .... wait for it .... THE STAPLES!!!  

Are you freaking kidding me!!??!!??

But it does explain the extreme pain I was in. It was the infection!! Which I learned is a different pain than the surgical pain. 

So, Now, I'm off of the pain killers, I have one week left of the blood thinners, (three weeks in total - following needles in my stomach while in the hospital) and now I'm on antibiotics. Fantastic!! 

As you can see, the first three and a half weeks of my recovery - were, well..... a nightmare.

The good news is that the infection cleared up. I am now off of all surgery-related drugs. I am able to eat once again. All over-active booty events have stopped. And I have started my outpatient physio therapy. And it is going wonderfully!

I just adore my PT and the PTA. They are magnificent!!! Along with the volunteers, the nurse, and all of the staff at Bridgepoint Health are so supportive, encouraging. Just Awesome!!

Today I had my 4th physio session, with 8 more to go. I attend twice a week - for six weeks. And I am now officially off of the wheelchair. I am in the process of transitioning from the walker to the cane, and should be fully off of the walker - and on to the cane by the end of next week!  My range of motion is now at a 100 degree bend. With a goal of 120 degrees or higher. 

Below is a picture of what my incision looks like today, and as you can see, I am healing quite well! 

Even though today will be five weeks since my surgery. Given that the first three + weeks have been hell, I really consider myself to only be two weeks in recovery. And when you consider everything I've gone through, and how well I am doing in my therapy, I am deeply encouraged! I've come a long way baby!!! 

I am not kidding myself, I know that I still have a long way to go. And It will not be for at least another three weeks that I will be able to bring my dog Bentley home again. I am hoping and praying that I will be strong enough at that point to be able to take him out three times a day. I am praying that my muscles will be strong enough, that I will be secure enough on the cane, and that my stamina will be strong enough to enable me to bring my baby home. I have not seen him in five weeks. And it is killing me!!! 

If you would be so kind, please keep me in your prayers, that my healing will continue. (With no additional setbacks!) That I will gain even more strength, security in the cane and in my new knee, and that I may have the stamina to bring my baby home at the end of October. Two months away from my boy is just far too long!! 

I will close this posting with some pictures I took of the physio gym at Bridgepoint. The hospital itself is only 18 months old, and the facility is really quite nice. I did forget to take a picture of the therapy pool, which I will try to remember to take next week. I should also say that these pictures were taken from my physio bed, so it is really deceptive. The gym is much larger than it appears. There are actually ten beds in the gym. Well, perhaps I will take a better picture next week along with the pool pics. But in the meantime...... here is where I will be recovering twice a week for the next four weeks. 

Before I leave, I want to thank all of my friends and family who have supported me in this journey. All of the visits, the notes, messages, emails, phone calls. Each word sent - each prayer whispered - a precious tribute locked away in my heart. It is with your good energy that I am able to fight through the hard times and finally see the light at the end of the tunnel. 

Love and Light....