Continued from the previous page.

MORNING OF SURGERY

I was surprisingly calm the morning of surgery. Even my blood pressure and pulse were low. I knew a seasoned professional was going to fix my knee and I put my trust in his expertise.

The hardest part was waiting and waiting for my turn to go into the operating room. Something came up that delayed it for a couple hours. Since I was already in some sort of anesthetic twilight zone, Jim was probably more uncomfortable waiting than I was.

Piedmont Fayette Hospital is just eight mostly-rural miles from home. After we took our younger two dogs to day care, we had plenty of time to get to the hospital registration desk. I went back pretty soon for pre-op preparations, which included the insertion of an IV tube in my hand and a lengthy nose swab ritual that was new to me to reduce the risk of a MRSA infection.

After I was in my gown and properly prepped, Jim was allowed to come back and sit with me.

As were the other medical personnel who had checked my blood pressure and pulse in various pre-op appointments, the pre-op nurse at the hospital was surprised at my low numbers. I always warn medical staff about my low heart rate before surgery -- I was a long-distance runner for many years -- so they don't freak out during operations and in the recovery room, thinking that I'm going to die because my pulse is down to 32 BPM or something they aren't used to seeing very often.

(Even though I haven't run for eight years, I've walked, hiked, and cycled enough in recent years that my resting pulse is still well below average.)

The anesthesiologist came in to brief me on the nerve block and general anesthesia she would be giving me, and Dr. Schmidt came by to talk with us. That was the last I'd see him until the next morning but he did talk with Jim right after surgery to assure him that everything went well.

I remember being wheeled into the surgery room but nothing else for another couple hours. Surgery itself took about an hour, I heard.

While I was in surgery Jim went home for a few minutes to get lunch and take care of Cody, then returned to the hospital.

THAT AFTERNOON

I got to the recovery room about 2:30 PM and woke up soon after that. I drank juice and ate some saltines but the nurse was afraid to give me too much to eat in case I threw it back up. I don't remember any type of anesthesia ever making me nauseous after surgery so I finally talked her into giving me more crackers.

Jim was eventually allowed to be with me in recovery. We had a very long wait until a room was available upstairs. We didn't get up there until 5:30 PM.

Above and below:  two shots Jim took of my room

With all the good pain meds in my IV, and a shorter-term and longer-term nerve block in my leg, I was feeling no pain and asked to get dressed and sit in my recliner instead of bed.

Why? Because I felt so good and being in a hospital gown in a hospital bed made me feel like I must be sick -- I wasn't sick!

I was extremely hungry by this time and made it clear that I wanted to order real food from the menu in my packet of information about the hospital. I didn't care that the doctor ordered a liquid diet that evening. I wasn't nauseous.

The nurse apparently cleared it with someone and I was finally allowed to order real food: stir-fried veggies (broccoli, carrots, peppers, mushrooms, and onions) with oriental sauce over rice, skim milk to drink, and chocolate ice cream for dessert.

By the time my meal arrived it had been about 23 hours since I'd had some solid food. That was one of the best dinners I've ever had, I was so hungry. All of it stayed down just fine and I went to sleep with a full tummy later that night.

Jim had left again about 6 PM to get Casey and Holly from doggie day care before it closed, feed all three dogs at home, and eat his own supper. He came back to visit for about an hour as I was finishing my dinner.

Since I felt so good, I asked the nurse if I could take a walk out in the hallway.

Dr. Schmidt's knee replacement patients are encouraged to walk as soon as possible, so why not? Well, that caused more work for staff because of the IV in my hand but Jim was able to accompany me and push the stand with the IV as I walked "around the block" on my floor -- with no problems.

I realized later that I'd broken more than one of the orthopedic ward's protocols during my stay.

Apparently most patients wear their open-back hospital gowns all night and until they go to group physical therapy (PT) the next morning, they stay in their beds most of the time, they always get assistance going to the bathroom ten feet away, they eat a liquid diet that evening, and they don't walk "around the block" on the orthopedic floor until the next day.

Happy after some tasty, solid food; I'm wearing one of my
Leadville 100-mile shirts as a conversation starter.  <wink>

Gosh, ladies, I'm sorry I feel so good! Be glad I was more self-sufficient than your average patient and didn't call you on the intercom all night.

Instead, they kept waking me up during the night to take my vitals, load more fluids and meds into my IV, and generally make sure I was alive on their watch.

When Jim had his knee surgery last winter in Brunswick the hospital really encouraged the "coaches" to sleep in the patients' rooms overnight. I did, and it was miserably uncomfortable on the hard foam bench that was my "bed." Lights were on in the hallway, the door was open, it was noisy, and the nursing staff kept coming in and out all night to check on him.

Neither one of us slept very much and there really wasn't anything for me to do except encourage him periodically to do ankle pumps (to avoid clots) and breathe into the spirometer (to avoid pneumonia).

This hospital allows spouses/friends to stay overnight but doesn't require it. After my uncomfortable experience last winter, I encouraged Jim to go home. The dogs needed him and he'd sleep a thousand times better in our own bed.

He didn't complain and I was just fine without him at the hospital all night. We'll do the same drill for my second knee surgery.

DAY 1: EARLY DISCHARGE -- YAY!!

Dr. Schmidt woke me up at 6:15 AM (I was actually asleep!) to let me know that surgery had gone well.

He asked how I was doing and I told him all the things I'd done within a few hours of surgery. He smiled and said, "So I've heard." 

I wasn't sure if he was proud of me or just amused. That's how I knew the nursing staff had told him about the apparent unconventional start to my recovery.

I probably broke more rules the next morning, too, but at least no one hassled me about getting into a different pair of shorts and t-shirt (the IV was still in my arm then), ordering a real breakfast (that hospital's food is pretty good!), or going to the bathroom and walking the halls again with Jim's help. He got there about 7:30 AM, after taking the two younger dogs to day care again, and stayed until my release at 10:30 AM.

I still felt good. The pain meds and nerve blocks were working just fine and I was getting decent food, but I wanted out of there. I assumed I'd have to stay for both the morning and afternoon group PT sessions, then get discharged late in the afternoon.

Walking with the physical therapist at my side -- the IV was disconnected now.

Turned out, there were only two of us for the morning physical therapy session so the therapist worked with us individually.

She demonstrated the twelve beginning exercises for range of motion and prevention of blood clots, then watched as I did each one. After the IV was removed from my hand she walked with me to and from the physical therapy room to see if I could use the walker OK. She also watched me go up and down several steps (no problem, as long as I had those good pain-killing drugs in me).

The twelve basic exercises are ankle pumps, heel slides, quad sets, gluteal sets, abduction and adduction, short arc quads, straight leg raises (those can all be performed lying down or partially sitting up in bed), knee extension/long arc quads, extension stretch, and sitting knee flexion (those three while sitting in a chair), standing heel raises, and standing knee flexion.

I'll show diagrams of all or most of these exercises on this and the next two pages.

I would be doing increasingly difficult variations of these basic exercises -- plus some others -- for the first five weeks in physical therapy and beyond that, on my own at home.

Ankle pumps =  flexing the ankle back and forth
to keep the blood circulating through the leg.

After the physical therapist cleared me from further PT, the charge nurse came in to ask some questions and give me more instructions. Then she formally released me with the doctor's permission. A man from transport took me downstairs in a wheelchair and waited while Jim brought the car to the door.

I couldn't believe I'd "escaped" so early, only 20 hours from the completion of my surgery. It was a bright, sunny morning and I felt on top of the world -- great drugs, whatever they gave me!

DAY 1:  AT-HOME THERAPY

I was so happy to get in our car, go home, and see the dogs. We never did have to confine them to any one room during my recovery because my balance and timing -- I was careful to look to see where they were before moving anywhere -- were good enough not to worry about tripping over "too many dogs on the floor."

After lunch I took a nap since I'd had so little sleep in the hospital. At 5:30 PM I had my first in-home physical therapy session.

I've never had in-home PT before, just out-patient therapy. The Ortho Atlanta practice encourages home PT for knee and hip replacement patients for two to three weeks after surgery. Medicare and other insurance companies apparently cover it just as well as out-patient PT, although the cost is 20-25% higher, per my EOBs.

Let me tell you, home PT is the best! It's very convenient.

The owner of the home PT company, who is also an MD, lives near us so he stopped by on his way home from work that afternoon to evaluate my range of motion, ability to walk, etc. He was here about an hour. It was late on a Friday afternoon, so I was impressed.

That night I slept in our spare bedroom so as not to disturb Jim. When he had knee surgery he was very restless for several weeks, needing to move around both in and out of bed periodically so his leg would feel better. That was a problem for me in the camper because we had only one bed. I often ended up on the sofa in the middle of the night. It's one of several reasons I wanted to be in a house when I had knee surgery.

The first night at home I wasn't feeling any pain in the leg yet but I sure did have the equivalent of "restless leg syndrome." It helped to do my ankle pumps and heel slides in bed and to get up and walk around every one or two hours. I definitely would have disturbed Jim if I'd been in the same bed.

Heel slides = easiest if both knees are bent; slide
surgery leg back and forth slowly until it just begins hurting.

I slept in our spare bedroom for over four weeks, until I was able to sleep for longer periods of time without having to get up and move around. Even after that I sometimes went in there during the middle of the night if I was really restless. That may continue for a while.

Restlessness while sleeping or sitting is common for several months or even a year after a total knee replacement. Five weeks post-surgery, it's also still hard for me to sit for more than 20-30 minutes without getting up to move around. My knee starts to ache and I'm stiff when I first get up. The longer I sit, the worse it is to get moving comfortably again.

It's also very important after surgery to move around frequently in order to reduce the risk of blood clots in both legs.

I've been warned for all these reasons to avoid any travel in a vehicle or airplane that requires sitting for long periods of time, for at least three months. That can cramp your style, so to speak, if you want or need to go a long distance for some reason.

It's something to consider if you're thinking about scheduling knee replacement surgery.

Continued on next page:  Recovery during Weeks 1 and 2

Happy trails,

Sue
"Runtrails & Company" - Sue Norwood, Jim O'Neil, Cody, Casey, and Holly-pup

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© 2017 Sue Norwood and Jim O'Neil