A Chronicle of Total Knee Replacements

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A Chronicle of  Total Knee Replacements

Foreword

My knees have been deteriorating for a lot of years now, and have slowly but increasingly affected my gait. I was able to ignore it (though those observing me didn't) up until six months or so ago, but things have progressed (regressed?) now to the point where I'm unable to walk at all normally. The decision to pursue the replacement was driven partly by the immediate discomfort in the joint itself, but also by the effect the modified gait was having on other joints; hips, ankles and feet have been forced to operate outside their design parameters (read: in a normal vertical plane), because my legs are no longer straight; x-rays show that the knee joints describe a slight side-to-side angle between the upper and lower major bones. Even a slight deviation from linear isn't not good for any of the transport sub-systems. The result is pain in other joints, and fatigue when walking, both from the knee pain and from other abnormal stresses that improperly load the supporting musculature.

Why did this happen? Apparently, the flaws were built into the original package; it wasn't apparent early on because normal knee cartilage cushioned the joint, as it's supposed to. Years and weight finally wore that out, so here I am. I've spoken with genetically-close family members who are apparently seeing the first signs of this same problem; I can offer encouragement - at least preliminarily, it looks like the corrective process isn't as scary as it was even five or ten years ago.

The link below accesses a very detailed outline of the patient experience, in case you're interested. Nice booklet, and a good source of information for those curious about/considering/anticipating replacement.

http://westchesterhospital.uchealth.com/wp-content/uploads/2010/11/Knee-Replacement-booklet-for-web.pdf

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Friday, May 25, 2012

This blog is being kept to document the process of my upcoming knee surgery. I'm posting it to keep friends and family informed, and to provide information for those who might be facing the same thing: knees with too many miles on them. My particular situation has degenerated to bilateral bone-on-bone contact, with no cartilage left; yes, I should have had it corrected years ago, and part of me is sorry I didn't. The rest of me is glad that technology has progressed to where it is, and that I can anticipate a less-invasive surgery and a correspondingly shorter recovery time. There's the option of having both done during the same surgery; that decision hasn't been made yet, though I'm leaning away from it. Should they be done separately, there would be a period of at least three months between procedures.

Wednesday, May 30, 2012

OK, back from my trip to Beacon Orthopedics. There, I was first interviewed by Sarah, Dr Chaudhary's Physician's Assistant, who was able to answer all my questions: what's the nature of the anesthetic? Local, in the left hip, which will keep the leg numb for a term many hours past the forty-five minute surgery; and Versed, which will help me not to care WHAT they do to me:) How soon will I be up and walking? The next day, with assistance; possibly sitting up on the side of the bed the same day, if the surgery's early enough in the morning. How long will I be in the hospital? 2 - 3 nights...though she didn't say as much, I believe it's to keep me from doing something stupid too soon. When can I drive? Probably two or three weeks. Therapy? 2 - 3 times a week for (I think) 4 - 6 weeks. That may be done anywhere I like, so I'll probably see if Bethesda Arrow Springs (Lebanon, OH) can take care of it. After she had answered my questions, I talked with Dr Haleem Chaudhary, the surgeon, who put me completely at ease - definitely nice and concerned, he examined the knee in question, had a few comments, and answered a few more questions; he also shared with me that he enjoys doing complete knee replacements (I believe he used the word 'fun'...maybe for you, big guy, maybe for YOU). Next, a young woman came in and scheduled the surgery date - June 18. All in all, a good morning, and a relief to finally have a timetable. The people at Beacon are real pros, and have this medical-care-with-customer-service thing well under control.

Monday, June 4, 2012

Tomorrow, I'll go back to Bethesda Arrow Springs in Lebanon to schedule my post-op therapy. I visited there last week, only to find that I need a doctor's order and diagnosis sheet before I can set up a timetable (I suppose that, otherwise, they'd have people wandering in off the street seeking therapy willy-nilly:)). I spoke with Beacon, who promised to fax the required paperwork to Arrow Springs; I'll know tomorrow if that happened. This past weekend also marked my last aspirin until after surgery; there can be no more because of possible interference with clotting. I can take Naproxen (Aleve)  until five days pre-op; it works well, at least for now. My brother-in-law, who had a hip replaced some years back, feels that the surgeon might impose these limits in part to keep the discomfort level up, so the patient won't be tempted to back out. I confess to having had the same thought.

Friday, June 8, 2012

One more step completed; yesterday, I had my pre-op physical at the internist's office; I'm pronounced healthy, EKG and all. Off to the hospital Monday for pre-admission testing; I have my first three therapy appointments set up, the first for four days after the Big Event. This coming Wednesday, there's a presentation at the hospital outlining what to expect pre- and post-op.

Monday, June 11, 2012

Just back from pre-admission testing at UC Westchester Hospital. Again, it was a very efficient and (as far as it can be) a pleasant experience. The hospital is maybe two years old, very bright and cheerful. The people who work there are extraordinarily nice, upbeat, and well-informed. The phlebotomist was skillful (something I appreciate in a phlebotomist); the nurse who did the pre-admission interview was a lovely, down-to-earth person, who had answers for all my questions. She told me, for instance, that I'll be standing on the replaced knee the day after surgery; not walking, but able to put weight on it. She went further into the anesthetic routine, too. Turns out I'll have even more drugs than I thought: Versed, Propofol, a spinal and a nerve block. She described the administration of all the above, and the spinal and nerve blocks sounded a little horrifying; when I asked about that, she told me that I'll get the Versed and Propofol first, and then I won't care WHAT they do to me. Nasal swab for MRSA, pee in a cup, and that's it. I'm expecting a call today to tell me what time the surgery is scheduled for; I understand that it'll be early in the day - typically between six and eight AM.

Sunday, June 17, 2012

Well, here we are. The surgery is supposed to take place at 10:30 AM Monday; I need to be at the hospital by 8:30, when they'll do a few housekeeping things (blood pressure, other nuts and bolts). At some point (early, I hope), I'll have the first IV anesthetics, Versed and Propofol; once these have me zoned out, the other drugs will be administered - a nerve block that'll numb the leg for ten or so hours, and a spinal that will quiet everything from the waist down. I believe they told me that I'll shed the effects of the first two with an hour or so of the end of the surgery, after which I'll be moved to my room. Presumably, when I come to, I'll be attached to a machine which passively flexes the replaced knee, to minimize/prevent adhesions as the initial healing starts. I've likewise been told that I'll probably be allowed/ordered/required to sit on the side of the bed in the afternoon, and standing (full-weight-bearing was the terminology) on the joint the next day. Next posting (maybe) Tuesday.

Tuesday, June 19, 2012

The deed is done. We got to the hospital at about 8:15 AM Monday, and I was escorted to a room where I was given the hateful, dehumanizing, universal hospital gown. After I was asked, for maybe the twentieth time, if I'm diabetic (I'm not; either these people don't communicate with one another, or they're hoping to catch me in a lie), blood drawn again, then I was loaded onto a sort of gurney, and taken away to the anesthesiology area, and an IV started; Versed and Fentanyl, and happy days. The nerve block injection and a spinal, and I remember nothing more until just past 12:40 PM. The rest of Monday was VERY relaxed; no pain; The next thing I remember, it was about 12:50 PM, the anesthesiologist was speaking to me, and I felt no pain whatsoever. When they tell you that a nerve block lasts a long time, believe it. I'm writing this at 9 PM Tuesday, I had visits with the physical therapist (twice) and the occupational therapist, who dealt with things like using the toilet, taking a shower, and getting dressed.

Thursday, June 21, 2012

I came home yesterday (Wednesday) afternoon. I'm in decent form with the walker, to the point that I can navigate around the house, and put a fair amount of weight on the new knee with surprisingly little discomfort. When I got up this morning, I wasn't so sure I'd get this far; I had a hard time getting settled last night, and tried various combinations of pillows and blankets to support the legs. (Comment, 7/23/12: a friend who has since had the same procedure told me that it was suggested to her that she try sleeping in a recliner until the initial (first week or so) sleep discomfort goes away. This sounds like excellent advice, and I'll apply it when I have the other knee done.) Somehow, I finally went to sleep, only to find that my kidneys are in great shape, and that I'm apparently doomed to getting up every two hours or so. I guess I can use the walker practice, but I'd rather it not be at two (and four, and six) in the morning. I have my first out-patient therapy session tomorrow, and I'm not looking forward to it; almost everyone with whom I've spoken who has experienced this therapy, or is related to someone who has, takes a positive delight in referring to the horrors of the process. If you catch me doing that, please, please, give me a swift kick in the ass; we should be offering encouragement to the patient, not suggesting some mysterious Gothic procedure aimed at maximizing discomfort. Yeah, it might be painful, but my imagination's overactive as it is, and needs no help.

Friday, June 22, 2012

Much ado about nothing. Unless upcoming sessions prove me 'way wrong, therapy isn't the fearsome experience I'd been led to believe it would be. I expressed my concerns to the therapist, who admitted that discomfort plays a part, but the level of discomfort seems to depend on the amount of correction to be applied, and the willingness of the patient to engage in the home exercises assigned by the therapist. I'll be doing these visits three times a week for (at least) the next several weeks. Range of motion and regaining strength of the supporting muscles are the aims of the program; Carolyn (the therapist) feels that I'm in fair shape to start, probably because of the quadriceps-strengthening pre-op exercises I'd been prescribed by Beacon. She said that there's a chance of advancing from the walker to a cane within a few weeks; I hope she's right. In short, while there have been pain and frustration and minor setbacks, nothing so far makes me sorry I embarked on the whole replacement program.

Saturday, June 23, 2012

Still using the walker, I'm bearing ever more weight on the new knee, with (after loosening-up steps) no pain whatsoever. Some part of this might still be due to the Percocet, but I'm allowed to take that every four hours, and haven't had it in since about 3 AM; it's almost noon now. It'll be interesting to see how the response is in another four or six hours.

Sunday, June 24, 2012

I tried doing my therapist-prescribed exercises before leaving bed this morning, and found that assuming the standing position was less uncomfortable all the way around. I'm seeing improvement every day, though it's slow. At least things are moving toward a positive state, and not slowly degrading, like they were before the surgery. I got a short note in the mail from the hospital yesterday, signed by a number of the people who had to do with my care - the anesthesiology nurse, and a couple of the floor nurses. I can't say enough good about the personnel there; they all seem to enjoy their jobs, and are without exception good, caring folks, from the housekeeping staff on up. West Chester UC sets a standard for efficient, patient-oriented hospital operation.

Sunday, June 24, 2012

I admit to qualms about the walker; I've seen 'Regarding Henry' a few times, and noted the trouble Harrison Ford had with it, but he was retraining both his brain and his legs, while I'm only dealing with one knee. He had the obvious incentive of having to live up to Bradley's (Bill Nunn's) unshakeable standards, so he may have had an advantage there...not at all to short-change my therapists, in-hospital or out - they're all great, challenging and encouraging by turns, just exactly what I need.

Monday, June 25, 2012

Today's session was more challenging; my therapist introduced me to a sophisticated exercise bicycle (this one probably isn't available at Dick's Sporting Goods, or Play It Again), which flexed my knee joints to angles they haven't seen in many a moon. I was finally able to rotate the wheel through a complete 360 degrees; I was told (then, not before I did it) that this would be the most painful motion expected of me throughout the therapy program. I was required to continue this exercise for something between five and ten minutes, and imagine that I'll be exposed to it further in future visits. I also did a number of leg lifts (getting better, but not great), and some hamstring and calf-stretching exercises. In short, PT's still not a show-stopper.

Tuesday, June 26, 2012

It's hard to measure progress in the course of healing from a knee replacement, in part because other aspects of walking and living are so influenced by knee health. Since I had no such health to speak of (at least on the left side), other systems were being affected by my irregular gait. I won't get into the emotional side of things, though it was always in the back of my mind that my age was showing, and I could only hang out in denial for so long.

The primarily-affected joint was a problem even when it wasn't being used to get me around; the bones 'rubbed' when I would move my feet while sitting, and I could predict the pain (which is now completely gone). Other areas have felt better since surgery, even before anything-like-complete healing; my back is less achy, the right foot (which, for whatever reason, had exhibited some pain) seems better, the whole system seems to work better together. It'll be interesting to see how this all holds together as time goes by, but given what I have to work with now, the remaining knee surgery seems like a no-brainer. This is not to say there are no negatives, but they're pretty minimal, and all, best of all, temporary in nature; for instance: surgical hose (emboli stockings), to be worn 24 hours a day for the first two weeks. Not my fashion style, but not too uncomfortable; still, for those familiar with the Boar's Head Festival at Christ Church, Cincinnati, I look a lot like one of the waits, as far as leg-wear goes. I'm just not as nimble. And I don't have to wear a funny hat.

Thursday, June 28, 2012

Therapy yesterday was an extension of everything we'd done before, with some new exercises thrown in. Still nothing immediately painful (well, not very, anyway), but some other groups being worked - one set of motions stressed my right hip, and made it achy. The biggest thing to come out of the session was that I was TIRED - just exhausted. I suspect that's because I'm so pitifully out of shape, and the motions under stress highlighted it. We had to stop on the way out of town so I could be measured for, and pick up, a spare pair of emboli hose (the trendy stockings I have to use for the next few weeks). Even something as simple as going into the pharmacy was tiring; I went home, Marg put the ice-water-cooled sleeve on my knee, and I slept for much of the afternoon; not EVERYTHING'S bad about this process:) All that said, I noticed in the night that I had considerably more pain-free range of motion, and I was able to sleep better; looks like the therapist knows what she's doing. Anyway, it's an off-day today, so I'll do the prescribed exercises, and try to be more ready for PT tomorrow.

Friday, June 29, 2012

I'm coming to the conclusion that therapy playlists aren't predictable. No two sessions have been the same, though there's some overlap in areas addressed. Today's was surprisingly easy, though it ran well over the expected half-hour; the therapists seem to be satisfied with my progress. She used the cold laser today - not a Star Wars device (I don't think); she explained that it helps align cells for optimum healing, and that it's of especial value in healing diabetic ulcers - not an application for me, but interesting information. I'll only have two sessions next week, because of the holiday; I also have my first post-op visit with the surgeon on Friday. I don't expect anything to come out of that visit.

Monday, July 2, 2012

OK, today I paid for the easy therapy session of last Friday. We did a few new moves, two of which worked structures which (seriously) hadn't seen any attention in years. The therapist had me sitting on a large elevated table, calves hanging over; she pulled them down and toward me; to say that she got my attention doesn't begin to cover it. The other drill involved walking alongside and holding onto the same table, raised even higher; I was to walk facing it, long sideways-steps, which doesn't sound hard, until you've done LOTS of them:) The result of all this is that my hips and thighs are pretty sore; I just took a dose of Tylenol, which should help. By no means were these all the fun activities we participated in; they were just the most memorable (and you can probably plug in any word for 'memorable' you want, as long as it doesn't imply pleasurable sensations). It's still nothing I can't cope with, but I want to record everything. The good news is that the replaced knee itself doesn't hurt. Two weeks post-op today.

Friday, July 6, 2012

This morning, I had a two-week post-op visit with Dr Chaudhary and Sarah, his Physician's Assistant. Both seemed pleased with my progress at this point, and I'll see them again a month from now.

Tuesday, July 10, 2012

I graduated from walker to cane at therapy today, 7/9/12; started driving this past Friday, 7/6 - the challenge is loading the healing leg in the car; it's getting easier. My range of motion is up to 96 degrees; Dr Chaudhary wants it to 105 degrees by August 8, my next visit date - that shouldn't be a problem. I can straighten to within six or so degrees; I assume that will come with time as well.

Saturday, July 14, 2012

This seems to be significant, and I probably should have realized it sooner: progress in physical therapy isn't linear versus time. Initially, the program looked insurmountable; I felt as if I'd be seeing my therapists (God love and keep the both of them, they're great) for months in order to catch up with my fellow sufferers at the facility. The fact is that when improvement comes, it builds on itself, and accelerates. Yesterday, I managed 110 degrees range-of-motion without a lot of discomfort. My therapist told me that I'm a little ahead of average progress; I don't know what that means in terms of graduating from the program, but I'm certainly closer to being able to get up on the tractor (which is one of MY goals, especially now that there's rain, and the grass may start growing again:)). Anyway (and I've said this before), when the therapist gives you homework, it's in your own best interest to do as much of it as you can.

Sunday, July 15, 2012

One thing I hadn't anticipated is this: surgery leaves the patient subject to quick fatigue during the healing process. As I've become more mobile, I've noted that my energy level is good for the short haul, but a half-hour or so of walking is enough to wear me out. The same goes for therapy sessions; the early ones weren't very strenuous, but they're becoming longer, and they're tiring. I attribute part of this to my reduced pre-surgery activity level, and the resulting generally run-down system. I remember that the nurse who presented the preliminary question-and-answer session at the hospital suggested starting to load protein into the diet; I did that at the time, but I've let it slip, and probably need to get back to it.

Wednesday, July 18, 2012

My therapist measured my range of extended motion at 1 degree ( 0 is straight), and 119 degrees flexed; I was told pre-surgery that I would probably see a maximum of 120 degrees flexed, so I guess I'm pretty much there, though I wouldn't be surprised if the therapists try to exceed that value. I was able to get on the tractor yesterday without discomfort (I hadn't been able to do that pain-free this mowing season), and finished the front few acres today, just in time for the rain to start. I've pretty much been able to abandon the cane, with official blessing and encouragement.

Wednesday, August 1, 2012

Therapy continues to challenge, and to show performance improvements. I didn't know it would be so hard to learn to walk down steps again; working with a four-inch (!) stair, I'm able to stand on the operated leg, bear full weight on it while bending to allow the heel of the opposite foot to JUST touch the floor and then be brought back up to the stair. Sounds easy; ten reps aren't. A week ago, I couldn't do it at all. My lead therapist has promised a progress report  that I'll take to my appointment with Dr Chaudhary a week from today.

Thursday, August 23, 2012

It occurs to me that I haven't mentioned a critical aspect of the knee replacement program, and that's the financial side of it. At this time (just over nine weeks post-op), the doctors' fees (pre-insurance) have totaled about $7500; this sum includes office visits with Drs Fox and Chaudhary; most of the amount covers the surgery itself, with charges for Dr Chaudhary and his Physician's Assistant, Sara Crookshank (and isn't THAT a name for someone involved in orthopedics:) - lovely young woman) coming to about $7000. At this time, I haven't received any billing from West Chester Hospital; in addition, I'm unclear as to how the implant device is billed: whether it's part of the surgeon's fee (seems unlikely) or is charged separately. The first bill for physical therapy also has arrived; to date (I'll be in therapy for about another week), I've had eleven visits and one evaluation, coming to $1583 (again, pre-insurance). As more bills appear, I'll update.

Thursday, August 30, 2012

The rest (I hope) of the billing paperwork has come through from West Chester Hospital; actually, what they sent was a 'balance due' form, with no breakdown as to itemized charges. I was able to go to mymedicare.gov and establish an account; this gave me access to complete itemization regarding the hospital stay. The total, including a $16,500 implant (the knee hardware), came to just over $48,900. This, with the surgeon's fee of around $7000 (see a previous posting) brings the subtotal near to $56,000; I say subtotal because I don't have a final number for physical therapy yet. When I've completed that (soon), I should have a grand total. Lest I leave the wrong impression, Medicare covered all except about $800 of the hospital bill. Thus far, I'm out of pocket about $1200 for the whole process.

Friday, September 21, 2012

To try to carry on the work the therapists had done with me, I've signed on with the YMCA (Ralph Stolle Countryside branch, Lebanon, OH). I'd belonged some years back, but lost interest and dropped out. There have been major improvements in the facilities since then, specifically a cardio-fitness center which incorporates something called the Fitlinxx system. This series of machines provides workouts for specific muscle groups, but it goes beyond that; each user is assigned a permanent five-digit code, used to sign in at the beginning of the workout; this code is then user-entered on a readout pad on each device. The readout pad tracks resistances and reps from session to session for each activity, allows the user to change the level of resistance tracked (though the actual resistance must be changed physically on the equipment itself), monitors the extent of the exercise activity, and guides the user to the next device. At the end of the workout, the user signs out, and learns how much weight s/he has lifted that session (I totaled 15000+ pounds this morning, and that isn't a lot - I'm definitely a beginner). A session is taking about 45 minutes or a little more; that should speed up as I get more used to the system.

Tuesday, October 23, 2013

I had my four-month follow-up visit with Dr Chaudhary last week; I mentioned to him that I'm experiencing a 'pop' in the joint when I climb stairs - no pain, just sounds and feels odd. He said that's not unusual, and it'll ordinarily go away after a year or so.

I've reserved a surgery date to have the right knee replaced; I'm set for February 4, 2013. It may seem far ahead (I was told that they're presently scheduling for Thanksgiving week), but I didn't want to interfere with the holidays.

Thursday, January 3, 2013

Activity update - in preparation for Round 2, the  replacement of my right knee on February 4, I've scheduled the required preop physical with Dr Baker for January 9. I stopped by Bethesda Arrow Springs this morning and set up physical therapy appointments for the two months following the surgery. I think I'm a lot more calm going into the process this time; I know what to expect.

Thursday, January 31, 2013

The second knee replacement (and I'm glad I only have two of them) is scheduled for Monday, 2/4/13; I'd asked, when I chose the date back in October (!), that the procedure be carried out as early in the day as possible. The time assigned is 12:30 PM. Pre-admission testing was Monday; it took the nurse three tries to get the required blood. I'm hoping the rest of the process runs more smoothly.

My plan is to post to this page as things differ from the first surgery/postlude, or if i get bored. I'm hoping for some boredom.

Monday, February 4, 2013

OK - all went well this morning; the surgery was a little earlier than scheduled, and I woke up at 1:30 PM. Very sleepy now (about 6 PM), and I know what to do about that. Pain meds are controlling as they should; thanks to all for prayers and good wishes. More later.

Wednesday, February 6, 2013

Wednesday morning, 4 AM. I still haven't slept a lot, but feel fine. Dr Chaudhary told me that I'll probably be let go today; no serious deviations from course. The scariest was yesterday; the surgical drain still hasn't been removed, and the tubing disconnected at a fitting under the blanket. The result was (what looked like, but wasn't) a major spill of blood on the sheets when I got out of bed. Easily cleaned up, and all is well. All I have to do is demonstrate to the physical therapist that I can go up and down four stairs; should be OK. Getting hungry, maybe a good sign:)

Friday, February 8, 2013

My brother Bob asked a good question, something I hadn't addressed - how do I handle taking a shower? He specifically wanted to know about stitches, staples, dressings - that kind of thing. Dr Chaudhary closes a knee replacement by stitching the inner layer of skin, then pulling the top layer together and applying an adhesive to the surface; these stitches are finally absorbed, and needn't be removed. A non-stick bandage (for want of a better word) is applied over the wound, and is held in place by the detestable surgical stocking . There's also presently a waterproof bandage over the site of the wound's surgical drain, which was removed just before I checked out of the hospital on Wednesday: I'll take that covering off in a day or two.

Thursday, February 14, 2013

Last pain pill (oxycontin) was about midnight thirty-six hours ago, and I’m beyond the ‘bone pain’ that lingers after a joint replacement. I’m ten days post-op, and walk (indoors) short distances without the walker. I’ll know more tomorrow, after PT, but feel that I’ll probably be driving by the weekend. My first appointment with Dr Chaudhary is set for Wednesday morning; I’m well past the two-week benchmark (90 degree range of motion) for a knee replacement, and things look good - no unusual swelling, no fever, incision is healing well. Two more days with the surgical hose, and I’ll say goodbye to THAT fashion statement.

If you see the TV commercial for Buick featuring Shaquille O’Neal, note how carefully he walks down the steps toward the car; I know exactly how that feels, and his knees will need to be replaced one of these days.

Monday, February 18, 2013

Things continue to progress well. I’m back on limited kitchen duty (cooking), and have been able to reduce surgical hose wear to overnights only.

Looking back, it was about a year ago that I was beginning to agonize and pray over the decision to pursue surgery. It looks like everything has worked out according to schedule.

One aspect of the long-term picture of the process I’ve neglected (not intentionally) is the input I received from other members of the medical community. A major player is my friend and chiropractor, Maureen Crotty Boylan; in the past, I’d consulted a couple of other chiropractic physicians for one thing and another, but Maureen is the only one I’ve encountered who is possessed of the integrity to limit her treatments to the scope of her practice, and, as appropriate, to recommend other areas of professional health care more likely to yield benefits to the patient. She was the first to see X-rays of the deteriorated joints, some years ago, and to tell me what the ultimate resolution must be. I didn’t want to hear it, but I paid the price. Thanks, Maureen:)

Tuesday, February 19, 2013

It occurred to me in the middle of the night that I haven’t addressed the differences I experienced during the anesthesia induction process. For the first-time experience, see my post of June 19, 2012; my memories of this round are more complete, but I’d mostly forgotten them until last night. For background, Dr Chaudhary had stopped by the surgical prep room to tell me that he was running ahead of schedule (probably a cancellation, I don’t know), and that I’d be ‘seen’ earlier. I believe this might have accelerated the induction process. I remember being rolled to the anesthesia area, and the IV (and, thus, Versed) hooked up. The anesthesiology doc was with me when the spinal and leg materials were administered; I remember feeling some apprehension (I know I asked a number of times about when things would start to fade away – I was a general pain in the ass), but there was very little discomfort associated with either. Finally, I was rolled to the OR, and lifted over to The Table; I recall helping align myself as requested, and that’s where it ended until I woke up that afternoon.

Saturday, March 30, 2013

OK...it's nearly the end of March, and time to finish this up. I've been discharged from physical therapy, and seen the surgeon for my last post-op follow-up visit; next one will be a year from now. All continues to heal well. The last bills have appeared - about $950 for the hospital, about $350 for Beacon. Everything else was covered by insurance; the total was maybe $55,000 for everything.

My previously-posted comments are still valid; the second procedure went much the same as the first, except that the incision healed much faster the second time. To all who stuck with these ramblings, thanks - and don't forget, you're welcome to share them with anyone who might be interested.

General Thoughts on Knee Replacement Surgery

1. This is not something to be afraid of. Your situation will only get worse until you do something about it. I was the poster child for medical cowardice, and I got through this; I’m not one to wear my religion on my sleeve, but prayer played a big part in getting me off top dead center and moving forward.

2. I can’t speak for any other orthopedic practices, but I can’t say enough good about Beacon; I’m including West Chester Hospital, where the Beacon surgeons operate. These are top-shelf personnel and facilities, all the way. My physical therapy at Bethesda Arrow Springs (Lebanon, OH) has been excellent as well. Now, these are only the organizations with whom I’ve dealt, so I can’t compare others. I’ve heard good things about other surgeons at Beacon, but I have first-hand experience with Dr Haleem Chaudhary, and he’s exceptional. I’ve heard that other surgeons in the group might do some minor things differently – for instance, I was told that Dr Kremchek safeguards against post-op thromboses in the operated member by discharging the patient with a course of self-administered injectable anti-coagulants. Dr Chaudhary (at least in low-risk cases) prescribes two aspirin a day to achieve the same end. Too, different surgeons use different ‘appliances’. My knee is a Zimmer NexGen (I asked); Dr Kremchek favors one made by Stryker. I doubt if (in the average case) there’s any detectable functional difference between the two brands. Thus far, I can walk on mine, and it doesn’t hurt:)

3. Prepare your dwelling for immediate post-op life. You won’t be able (at first) to use a conventional toilet – can’t get that far down, certainly can’t get back up unassisted. Go to a home medical care store, and equip your facilities per their advice; a little pre-op practice with the new equipment won’t hurt, either. The reassurance you’ll feel when you’re back home and still stressed will be worth it.

4. If the hospital you’ll be using offers any sort of pre-surgery course or presentation regarding joint replacement, ATTEND IT. It’s your chance to get questions answered, and to learn things you hadn’t considered. West Chester had representatives from Pharmacy, Dietary, Physical Therapy and Nursing, and all gave strong, meaningful presentations.

5. Be aware that you’ll be required to wear surgical hose even after discharge from the hospital; also, be aware that you’ll come to hate them. They’re an inconvenience, but they’re better than having to deal with a clot. I’d suggest, if you can manage it, acquiring a second pair so you can have a set clean and ready to go after you shower; a home medical supply place can measure and provide them. Oh, and these things aren’t easy to install on the legs. Seek help from someone who likes you a LOT.

6. Keep your therapy appointments, and do as much of the ‘homework’ exercises they’ll give you as you can stand; I believe you’ll be back to something like normal sooner if you do.

7. Delicate subject: the digestive system during the post-surgical period. Whatever you do, DON’T ignore this part of the process. The combination of spinal anesthesia, heavy-duty pain medication, lack of exercise and reduced appetite is made to order to shut down your system. Your primary weapon is Senokot, taken regularly; in addition, Phillip’s Caplets, two/dose, two doses/day will become a reliable friend. Nor must you cease taking these too soon; better err on the side of caution, and make them a habit. It won’t hurt you, and you’ll know when to discontinue. Trust me, if you don’t do it, you’ll regret it. If you do, you should thank me for offering this piece of advice.

8. Keep a positive attitude; things WILL get better, and you WILL be glad you went forward with it. Follow all professionally-delivered post-op instructions; the result will be a superior outcome. About two weeks after surgery, you’ll turn the corner; things will start to improve, and you’ll see the improvement. That’s when you’re allowed to say ‘I wish I’d done it sooner’.

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All right; that probably ends my postings on this subject. I would encourage you to revisit this journal if you see knee replacement surgery in your future, or in that of a friend or family member. I plan to leave this document up here, so it should be available for a long time if you want it. Too, if you’d like to send the link to anyone who might benefit from it, please do so. That’s what it’s here for. If any reader has questions about anything I've discussed or missed, please feel free to email me about it at rustic39@me.com, with 'Knee Replacement Question' in the subject line.