The Final Countdown

Well, this is it... the night before surgery, and all through the house, it has been rather chaotic trying to get everything done that I wanted done.  This has been my week to go without NSAIDS.  Wasn't too bad at first, but as Thanksgiving approached with a birthday party the next night, my poor knees were miserable and were not kind to me.  Note to others, do not do that kind of stuff the week before your surgery.  Being the end of the month, I am furiously trying to get all bills paid and finances taken care of.  Also, getting all laundry done.  Too miserable on Saturday to clean up from the party, so I still have some of that to do.  Like I said, not a good idea.


I have already apologized to Rick for my future behavior.


Got my bags packed. In the event that I get to wear my own clothing, I am taking summer pj's since running a fever is to be expected, and hospitals aren't known for being overly cool.  My plan is to wear winter pj's home if it's cold outside.  That way I am ready to just hop, ha, in my bed.  I really don't like the idea of going to bed with hospital germs on my skin, but I may not have the pain tolerance or energy to do anything about it.


Got my portapotty with arms, walker, and CPM machine. (it bends my knee up and down)  These were delivered the day before Thanksgiving.  My shower seat, bathtub mat, and reacher/grabber came this week, too.  I told Rick that the shower seat and portapotty could provide extra seating at our party--he didn't go for it.


Had my Dial shower.  Waited one hour and used the 6 wipes for different parts of my body.  I will have to repeat this in the morning when I get to the hospital.


My intention is to continue this blog in the hospital, but realistically that might not happen.  You've already seen my typing errors with hydrocodone.  I'll be getting the big guns of pain relief there, so I may be totally incoherent!  Maybe I can dictate to Rick.  Heck, maybe Rick will add his own view--that could be very interesting. 

I think I am physically strong. I did not reach my weight loss goal of 30 pounds, but I'm pleased with what I have accomplished.  I have lost 69.6 pounds off my knees. (17.4 real pounds) I wish I had had more time for flexibility exercises.  Still apprehensive about doing 2 knees, but I am ready to get this all over with. I am so looking forward to getting my life back.  I really hope I can go to Brad's graduation without a cane.   I have great help.  Looks like I'm ready.




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A great blog to peruse--definitely worth your time

http://greattkr.blogspot.com   

Knee-plus-eight-months anniversary: progress continues after my total knee replacement 

http://greattkr.blogspot.com/2005/05/knee-plus-eight-months-anniversary.html 

 I found this blog late in my research.  Otherwise, I probably would have never started my own.  I have not read all of this blog, but what I have read has been really good and helpful.  I would love to copy and paste this guy's blog entry to mine, giving him credit of course, but I don't know if that's cool or not.   So please go to the above posting on 5/24/05.  He gives a great summary of the positives and negatives of having knee replacement, his fears that were unwarranted, and things that he wasn't told ahead of time that would have been helpful information.  I would think that that he even has some stuff that those who have already had knee replacements would like to know.  For example, one of the ladies I do water aerobics with was telling me about how her replacement knee makes "noise", and she guessed that was normal.  He's got an answer for that. 

 He  also has a link to a discussion forum related to orthopedic surgeries.  Of course, there is all the good and bad one can imagine, so read there with caution.  You will be convinced to have surgery in one posting, then reconsider immediately after with reading of the next posting!  It is not for the faint of heart.

This time next week, the deed will be done!

This time =next week i hope to be toatlly doped up and in la las land with my surgery behind me.  Then the REAL WORK begins!  I have had a cold for the past almost 4 weeks that started out pretty benign, but ended up in my larynx plus I have had a pretty bad cough.  It was improving along about week 3, then turned bad again, so I went to the doctor over the week-end and got an anatibioti shot and steroid shot and came home with an antibiotic prescription and hydrocodone cough syrup.  I said all that to say this.  You would not believe all the mistakes I am making writing this little entry.  The brain does not work well with hydrocoodone.  I could be on pain killers for as long as 6 weeks after my surgery.  so if my blog does not make sense,  if it's fuull of misspellings and bad grammar, chalk it up to the influence of drugs.  I've made some corrections, but I think I will leave the others just to give you an idea of how I function on narcotics!

Be Prepared-- the Sequel

http://www.arthritistoday.org/treatments/surgery/post-surgery-recovery.php


Obviously I have not had my surgery yet, but this very good article from "Arthritis Today" is about getting your home ready for when you come home from the hospital. Most importantly, I have someone to care for me.  Rick did a super job of taking care of me after my foot surgery, so I have no qualms there.  Then there is a teenager to run errands.  Fortunately, my bedroom and bathroom are on the first floor, so I don't have to make arrangements for that.  I have been thinking about what kind of equipment I might need just to get along.  The hospital will send me home with a walker and a raised commode seat.  I have safety bars installed from a bathroom remodel--I didn't need them at the time, but I figured I might someday, so I got the white unobtrusive ones around our tub.  I plan to purchase a shower seat and a rubber mat to put on the bottom of our tub.  I have a 21 inch deep soaker/whirpool tub, and I already know getting in and out of it will be a real challenge. A hand held shower head will be a real plus.  I will miss my hot baths in my whirlpool--it will be at least 3 months before I can get down in a bathtub.    I read somewhere that you are not supposed to put your full weight on the replacement for a time.  With 2 knee replacements, I haven't quite figured out how that is going to work getting in and out of a tub.  Guess that's something my PT will have to help me figure out.  I plan to have commonly used clothes items stacked on my dresser to make dressing easier.  I plan to stock up on protein bars.  Protein bars are something Weight Watchers introduced me to, so I have been experimenting with different brands.  One author, Dr. O'Neill?, said that I won't be very hungry, so I need to make everything I eat count--hence the protein bars.  And hey, if I have ice cream, I can survive!  No, I'll try to do better than that!  I do plan to pay attention to my liquid intake.  So lots of water, juices, teas--possibly protein shakes to be stocked up.  Today I bought a Living Social coupon online for $16 of food for $8 at Holiday Ham.  I have been watching coupons and "deals"  for food for Rick to buy.  He'll be the first to admit that he is not a wiz in the kitchen.  He knows a lot about a lot of things, but whipping up a meal in the kitchen is not one of them.  I am also taking note of offers of food from friends that I plan to cash in on.  When my mom had back surgery, we bought her satin sheets to make it easier to slide around in the bed and hopefully make turning easier.  I think I will borrow her sheets to see if that is helpful. I have plenty of home made bed buddies in the freezer--tube socks mostly full with rice and a knot tied in the end. Another suggestion for cold therapy is frozen peas or corn, so I will probably invest in a few bags of that in case my bed buddies are too heavy.  One thing this article mentions that I would like to get is an office chair with wheels to wheel around the kitchen! Superb idea that I wish I had already thought of pre surgery; I might have done more cooking if I had thought of this.  This article also says some thought needs to go into the car that will take you home.  Rick has a small SUV that is hard for me to get in now, much less with 2 surgical knees.  Fortunately I have a bigger sedan that will do the trick.  The article ends with the dreaded bills.  I'm pretty savvy about that, but there are some terms explained that might be helpful for the lucky inexperienced. There are other tips that should be checked out, but these were the ones that were significant for me.

I don't want to beat a dead horse......

but I will anyway.  Here's a quote from this article from Arthritis Today about prehab.www.arthritistoday.org/treatments/surgery/prehab-for-surgery.php

Fifty percent of outcome success is due to the surgeon, and the other 50 percent is due to the patient’s commitment to recovery – starting with pre-hab,” says Vonda Wright, MD, assistant professor of orthopedic surgery at the University of Pittsburgh’s Center for Sports Medicine.

It is recommended to start exercises 6 weeks prior to knee surgery.  I imagine that most of us have been involved in physical therapy prior to making this decision.  If so, time to pull out all those exercises and do them faithfully.  If you haven't had previous physical therapy, there is a link in the above article for exercises to do prior to surgery.

It's getting closer, and the plans might be changing---

I saw my doctor today.  I like him.  There was no reason to see him today, except the fact that it did not feel right to have this big surgery done by someone I had only seen once.  I took Rick with me to meet him and ask questions.  This doctor answered bunches of my questions and never once, by word or deed, made me feel like he had rooms full of other patients. 

You may notice I now have an X-ray on my blog.  Those are my real, anatomical knees.  Notice how the insides of both knees have the thigh bone (femur) sitting right on top of the leg bone. (tibia)  The outsides of both knees have cartilage in between so that a space can be seen between those bones. My pain is caused by bone rubbing bone with every movement.


Here is the plan-- I hope to get 2  partial knee replacements, i.e., replacing only the parts that are bone on bone.  If the other parts of my knees look diseased, then I will get total knee replacements.  Whether or not I get 2 totals is still up in the air.  Our original plan was that if the first knee is a partial, then he will operate on the second knee.  If the first knee is a total (TKR), then he would do just one.  Today he said he would consider doing two TKRs.   Something to think about.  This is BIG!  My physical therapist thinks I have the "fortitude" and "work ethic" to do both. Most days I think I do, too.

18 days and counting

Today I went to a "Joint Class" at St. Francis Hospital for those future patients who are scheduled for joint replacement surgery. (knee or hip) St. Francis has a new Joint and Spine unit of which they are very proud.  All but 5 of the rooms are suites.  They have combined 2 rooms to have a patient room and a coach's room. ("coach"reminds me of childbirth) It is tastefully done in calming colors.  By not having a rollaway bed in the room, it makes for more room for getting around using a walker, crutches, etc.  The coach has his own plasma TV, sofa bed, bathroom, and phone.  His room will be separated from mine with  French doors.  He might even get some sleep since a nurse will not be coming in all night to check on me in HIS room. If it weren't for the pain, this could have possibilities!


Here are some miscellaneous tidbits I picked up today.


1.  In the early 70's, 51% of patients with osteoarthritis in their knees got replacements. Today it is 92%.  Fascinating. Guess the airports have had to make concessions for all the alarm beeping knees and hips!


2.  The night before surgery, after a shower, I will wipe myself down from head to toe with antibacterial wipes that the hospital gave me.  Then I will don clean PJ's and sleep on clean sheets. (A friend of mine was told by her doctor to wash with Dial soap for 2 weeks prior to surgery.  I will do that, too.  Can't do too much to avoid infection.)


3.  Before leaving the house for surgery, place frequently used items at waist level. (remote control, phone, clothes, shoes, etc.)   Dr. O'Neill in his book had mentioned getting pots and pans, food, etc. out on the counter tops for easy access. My friend, Carolyn, who has had knee replacement, said that a grabber/reacher was indispensable-- to use for grabbing/reaching items above or below your waist.


4.  There will definitely be pain to be dealt with.  I will have use of a PCA pump (patient controlled analgesia), a femoral nerve block, injections and pills as part of my armamentaria.  Oh, and ice packs.  I should take pain pills at breakfast and at lunch because I will be having physical therapy after breakfast and after lunch.


Obviously there was much more to be learned, but these are the things that impressed me.  They also gave us a large handout by the National Association of  Orthopedic Nurses about knee replacements.  Very excellent and full of practical and useful information. Oh, lucky you, I just found this wonderful handout on their website to download.  http://www.orthonurse.org/ResearchandPractice/PatientEducation/tabid/490/Default.aspx

The above link no longer works.  Go to this link and download the Total Knee Replacement Patient Education Manual. It is fantastic.
http://www.orthonurse.org/p/cm/ld/fid=29 

A Minor Setback

It may seem that all I do is tout the virtues of exercises for knee health and pre-surgery.  Now I have been given a little insight into why it is so important.  About 2 weeks ago, I had a scratchy throat that settled there and gave me a bad case of laryngitis and an awful cough.  Because of my terrible cough, I went a whole week without going to the pool or to the gym to ride the bike and work-out.  I'm pretty sure I would have been asked to leave since I sounded incredibly infectious! Keep in mind that I am continuing my yoga routine and presurgery exercises.  Ten days later, I rode the bike and that wasn't nearly as bad as I had expected.  Some stiffness that took a few revolutions to work out.  I tired sooner, but overall not a bad ride since I cut back my minutes to 20 minutes.  The next day, my cough was moving all the stuff that had been causing me grief, so I had to stay home and cough and rest between coughs. This past Saturday, I went to the pool.  I can do movements in the water that are difficult or not possible on land.  Ordinarily, it takes 5 minutes or less to get the ol' joints lubricated and moving without pain.  My first day back in the water, it took 25 minutes.  I did my usual hour and expected to pay for it later in the day or that night.  So far, so good.  Then on Sunday,  I was incredibly sore and stiff.  It took about 4 or 5 hours to work it all out and walking was not fun.  Then today, I got in the pool, and it was back to "normal".


So it looks like exercise needs to be consistent, but if I have to miss, I can get back to normal pretty quickly. I noticed today that I was lacking some strength, but I expect I will regain it soon.


By the way, at my medical clearance visit for surgery, my doctor told me to not ignore any infections because of my impending bone surgery.  Infection is a big no no for bones. Anyway, I made 2 unnecessary doctor visits for this illness knowing full well it was viral, but I wanted someone else to make that decision. I sure don't want my surgery--which just happens to be 3 weeks from today-- to be canceled because I have a bacterial infection.

I was listening to my body, but I misunderstood

I have been doing Range of Motion (ROM) exercises from the aforementioned book for the past week. When I first noticed that I had a problem with my knees, the backs of my knees were stiff.  Gradually over the past 2 years,  I noticed that I could not pivot, that it was increasingly more difficult to get up and down off the floor, that I was incredibly stiff in the mornings when I would first get up.  There were just too many ways that I noticed the stiffness in my knees which prevented me from doing what I wanted to do.  I thought that was my body telling me to cool it, give it a rest, this is the limit, you will pay if you keep this up, sister.  Then I read Dr. O'Neill's book where he says how important it is to do ROM exercises because the greater your ROM is before surgery, the better it will be after surgery.  Well, that motivated me, and I did the first exercise/stretch.  It was very uncomfortable, and I could not wait for it to be over.  I had a burning sensation and most of my left leg was very warm, even minutes after I finished the stretch.  My left knee is not only stiff, but it also had numbness in the back of the knee.  About 3 inches above the knee and 2 inches below the knee is numb.  The next day I repeated the exercise with less discomfort and less warm sensations along the leg.  Several days later, I am able to straighten my legs in ways that I thought were impossible.  Not only that, I would say that the numbness is about 75% improved. (Do you know how weird if feels to shave your leg and not feel it?  The razor would be cruising along, and then all of a sudden, it felt like it entered a dead zone and then the pressure of the razor reappeared again!)  Here is a picture of Passive Extension. 

Looks simple enough, but it is almost impossible to relax your stiff joint to go into as straight a position as possible.  Then after your muscles relax, you must "fire" or tighten up your quad muscles while you are pulling your knee downward and hold for 5 seconds. This is not a pleasant stretch, but I am already reaping benefits.  Dr. O'Neill states that this is the most important stretch to do during the first two weeks after surgery. He says to do it 15 minutes of every hour.  Hope I have lots of pain meds!