Disjointed

 TMI about My TKR

I like to plan ahead. When it comes to medical stuff, I want as much information as I can get, so I will be prepared with facts on hand to deal with whatever the issue may be.

For my May 13 total knee replacement, I had no lack of sources, including the experiences of three close friends who had their knees replaced since March – and one, the day before mine. I found that checking in with people who have gone through the experience was extremely helpful. So, I’m sharing my experience with you so you can be ready when it is your turn.

1.    I shopped, cooked, and got a haircut and my toenails done in advance. I found all the shorts I owned and put them in a bin I could easily reach. And I had the house assessed for grab bars and had several installed -- in the bathroom and by the garage steps. The shower one enabled me to take a shower the first day I came home from the hospital, sitting on the shower chair I borrowed from my alumnae friend Kathi Love. My walker and high toilet seat were provided by my Canal Walk friend Angela Horan, and my cane was provided by my sister Nancy and belonged to her late husband, as did the “rollator” walker, a souped-up version of the original walker. I have gone through two sets of tennis balls on the walker legs in four weeks.
2.    I assumed my knee would be stiff and in pain, but I didn’t realize how stiff my leg would be or the level of pain I would face. I have progressed from feeling like someone is hammering a spike into my knee to advanced leg fatigue and achiness, which makes it tough to do my exercises, walk around the house or sleep. I’m a bad sleeper to begin with, but constant pain takes its toll. In trying (that is the word) to sleep initially, I was told to keep my leg straight. Don’t prop it up on a pillow and whatever you do, don’t be comfortable! If my foot would rotate 5 degrees either way, that meant it wasn’t straight. I slept in the family room on the recliner for about a week. Now I am mostly in bed, but my bed is so high that I need a step stool to climb in. I know how to step on the stool with my good, right leg, and propel myself into the bed. Any movement after that is a challenge. I have mostly mastered the skill of “scooting” into position. My in-home physical therapist from Community Visiting Nurse Association in Somerville, Jennifer, was here for about 2 weeks and she showed me all the tricks of getting into bed and getting into my sister’s SUV. I served on the Board of CVNA for about 30 years and I knew what a great resource they are to the community, and my first-hand experience with them just made me admire them more.
3.    The doctor and my outpatient physical therapist, a nice, knowledgeable and patient man named John, no longer care how I sleep. They just want me to sleep. We are in agreement on this subject.
4.    The PT says they want my leg to get completely straight AND that I need to bend it to a certain degree (which he has declined to share). I told him to make up his mind – I can bend or straighten, but not both. He says that your progress after 12 weeks of PT is probably where you will end up. He has a little plastic tool that looks like something we used in high school geometry class that measures the bend. I’m not expecting to crouch behind the plate like the catcher for the New York Yankees. My goal in this rehab is to be able to walk down the steps to get from the concourse at Jersey Mike’s Arena to my third-row seat for Rutgers Women’s Basketball games that begin in November. I could only go one, slow step at a time prior to the surgery, holding on to the handrail for dear life, so I’m sure improvement will take place as I go to physical therapy several times a week and do exercises at home. First they work on range of motion and then move more to strength. I’m not auditioning for the ballet, but I need to be able to walk a distance.
5.    The new knee went into the left leg, which makes it easier to drive since that leg is just along for the ride and isn’t needed for the pedals. But swinging the leg into the car is not easy. My brand-new car, picked up the day before the surgery, allows me to put the driver’s seat way back to get in (never lean on the car door, they told me in occupational therapy), but then I have to adjust the seat all the way up or I can’t reach the pedals to step on the brake to start the engine. Being short might help in swinging my leg in, but it doesn’t help much with much else. 
6.    I soon realized that sitting with my legs down for more than 10 minutes is very painful. So, if this essay seems disjointed (pun), it is because I had to write it in fits and starts of 10 minutes or less so I would be able to walk at the end of the allotted time.
7.    I was walking with a walker the day of the surgery and the day after, which amazed me. The nerve block is still in effect, so the pain hadn't quite hit home at that point. Immediately after getting home (I spent one night in the hospital before discharge), I had to keep my leg extended when I sat down – in a chair, on the toilet, etc. It got easier to sit more normally after a few weeks so it doesn’t look like I’m trying to trip anyone, but it remains painful to keep my leg at a 90-degree angle while sitting – and I have a lot more degrees to go before we hit whatever normal may be.
8.    Ice, ice, baby. Ice is your friend. The hospital provided a two-compartment gel pack that I can wrap around my leg for relief. I also borrowed an ice machine from my basketball friend Nancy Young, who has had both knees replaced. You fill a reservoir in what looks like a cooler with ice (or frozen bottles of water), add water and a pump gets the water to flow through a tube to a large pad strapped to your knee. No more running to the freezer for more ice – but running anywhere with the tube strapped to your leg is not possible. I have more ice packs than food in my freezer these days.
9.    Besides the icing, I was given three levels of pain relievers to take, depending on the severity of the pain. When it felt just regular pain, Extra Strength Tylenol was the best choice, but when it felt like someone hammering a spike into my knee, my options were to take prescription drugs Tramadol or, even more potent, Oxycodone. Here’s where you say to yourself, “Billy, don’t be a hero,” and take the drugs. Relief isn’t complete or immediate, but it helps to calm things down. Like all of these kinds of drugs, the side effects are real – drowsiness is OK, even welcomed, but constipation can be a real pain in the ass! 
10.    My incision was initially covered with a waterproof bandage that was removed after a week. The surgeon used glue, not staples, to keep it together (the stitches were done internally), and I still have globs of glue all over my knee, along with some scabs. There were times when I felt like everything inside was bursting at the seams as I moved my leg or exercised, but I have been reassured that it is all neatly closed up and not in danger of opening. If you say so.
11.    The doctor said I could go back to my aqua class after two weeks, but there was no way I would consider getting into a pool with other people’s bacteria floating around, at least until the scabs healed. Besides, how am I supposed to get out of a wet bathing suit in the locker room – on a wet floor, no less – without fear of falling? I’m also not sure how to master the ladder to climb in or out of the pool with one leg that isn’t ready for bending quite yet.
12.    When I went for my one-month post-op visit, the surgeon did little more than admire his handiwork. He grabbed my leg and straightened it, pronouncing it a success, and then bent it to more than 90 degrees (barely more) and said I was doing fine. I told him part of my knee is still numb, and he said that might continue. We both decided it didn't matter. At PT, where the therapist massages the knee and coaxes it beyond 90 degrees, I’m doing more exercises, using the recumbent bike, which is more like a sitting elliptical machine that doesn’t require my knee to use the circular motion of a regular exercise bike. And now I am pushing and bending on the leg press machine. John said we would start to use weights on my ankles soon and I asked him to let me know when so I can be accidentally absent that day.
13.    I’m certainly making progress in my recovery. Initially, I couldn’t put on my socks and getting my shorts on was a challenge. I never realized I was right-legged, which makes sense since I am right-handed. I always want to put my pants on right leg first, but you learn quickly to do the surgical leg first. I had no idea how mentally tiring this whole thing would be. I kept hearing the lyrics “every step you take,” because you have to think about each step to make sure you are moving safely, especially in the bathroom and shower. That really wore me out (yet I still couldn’t sleep). 
14.    One final piece of advice if you are thinking of having major surgery like this is to get someone to stay with you for a while, at least initially. My sister stayed with me at my house for nearly 3 weeks and was a huge help. Not only did she help me with every step, she drove me to my doctor’s appointments and PT, did all of the shopping and prepared the food, did the laundry, checked the mail, brought out the garbage and was my lifeline. She was down on her hands and knees strapping me into the ice machine – which I’ll never be able to do for her since I doubt that kneeling will be in my future. And I hope she knows we are not out of the woods yet. I have arthritis in my “good” knee, too, and someday I’ll probably need to have that one replaced. I don’t know what I would have done without her! And no, she is not available for hire.