Surgery Day +2: Home Sweet Home

Saturday, May 25

This may have just been the worst night of my life.  I can’t get comfortable, and the pain grows worse and worse.  After the puking incident yesterday, we backed off the pain meds to simply Tylenol.  WTF.  Tylenol barely handles my frequent headaches.  In the middle of the night, while rearranging the pillow that they''ve put between my knees, I knock over a glass of juice on the bedside tray, and the sticky stuff is all over the tray, the bed, the pillow, the floor.  And I just don't much care.  Anyone who knows me well knows that I am fastidious, but I am just too worn out from the pain to care.  I am growing more and more discouraged, and thinking that having this surgery may have been the worst decision of my life.

But everyone else seems to think I’m doing well:  my blood pressure seems to have stabilized, my oxygen levels are good, I’m alert and sitting up.  OT comes in again and has me demonstrate that I can brush my teeth.  Hallelujah!  Damn, that felt good.  But then the cadre of nurses and therapists decides that all that is necessary for me to get discharged is to do another, longer walk. 

This time we walk down the same hall - but with my walker instead of yesterday’s crutches.  Just to be safe, they take my BP while I’m sitting, and then again standing up.  It’s not great, but good enough to go for a walk.  I get to practice going up and down a curb, and then it’s over to practice on a set of stairs.  I pass these tests nicely, but then the world starts imploding on me again.  Everyone quickly recognizes that I’ve gone pale again and my eyes are starting to roll back in my head.  So it’s the same routine:  dump me in a wheel chair and get me back to my bed.  Today’s blood pressure is an all-time low of 71/48.  Really, are people still alive with those low numbers?

There are more conferences with docs and therapists and nurses, with talks of keeping me yet another night.  But really, I’m too exhausted to even pay attention.  I fall flat on my back in bed and sleep solidly for the next hour.  It’s the best sleep I’ve had in days, and when I finally wake up, I’m starting to feel slightly human again.

Dr. Hallmark comes in to explain that the swelling in my leg is going to continue to get worse for at least the first seven days post-surgery.  WTH?  Why didn’t any one else mention this?  Crud.  Then in days 7-14, things may stabilize.  But for me to make progress, I really need to continue the PT, and I need to be able to sleep, so I agree to try the serious pain meds again, making sure to do so only on a full stomach.

My new PT, Mo, comes in sometime early afternoon and takes me for another, longer walk around the hall.  She’s great, and encourages me to walk faster than my slow shuffle, and amazingly, that feels better.  I survive without my BP bottoming out.  Woohoo!  My nurse of the day, Meghan, comes into my room and asks how I’m doing.  When I say, “I’m ready to blow this pop stand”, she gets a huge grin on her face and hurries off to process my discharge papers.

Ed brings the car around, a CNA wheels me to the front of the hospital, and within minutes I’m home on my couch, with my knee raised above my heart, and the ice machine hooked up.  It’s the best I’ve felt in the last couple of days, and I’ll take whatever small victories I can get.

Surgery Day +1: Crash and Burn

Friday, May 24:  Crash and Burn

Oh. Holy. Mother. Of. God.  Somebody shoot me now.  Seriously.  Shoot me now.  Hang me.  Poison me.  Bring on the guillotine.  Anything to stop this pain.

Last night didn’t start off badly.  My night nurse, Marta, brought in pain meds around midnight, and cautioned me that I shouldn’t take them on an empty stomach.  She brought me a cup of applesauce, and I was soon back into la-la-land.  The CNA came in at four to take vitals, and then Marta was back around 5:30 or 6 with my next dose of pain meds.  No mention of needing food, so I swallowed some pills, and tried to get some more sleep.

Now, anyone who has spent time in a hospital knows that sleep is hard to come by.  Between nurses and CNAs bringing meds and taking vitals, and docs stopping by at random times, and food delivery at even more random times, and PT trying to get you up to walk, and the need to get help getting to and from the toilet:  it’s just a lousy place for sleep.  Add to that an increasing awareness that the nerve block and spinal deadening anesthetics are wearing off and the pain is just starting to ratchet up, sleep is a precious commodity.

This morning, I try to sleep, but my stomach is reeling.  I try deep breathing and positive visualizations, but I'm too far gone for any of that to work.  I yell at Ed that I’m going to throw up and he frantically tries to find a basin.  He calls my new day nurse, Kelly, in, and she slides the basin on my lap just in time.  Ugh.  There is not much in this world I like less than puking, but there you have it.  Now everyone tries to get food into me, but nothing at all appeals.  Finally I eat a few bites of yogurt;  it stays down, and there is celebration among the medical staff that I’m doing well again.  But I’m now spooked by this reaction to the pain meds, so I back off and try to get by with just Tylenol.

PT and OT come in to check me out:  the plan is for me to get through their lessons and tests, and get on my way home by ten a.m.  I get another stroll down the hall, and into the room where they’ll teach me how to navigate stairs, this time with crutches.  I manage my way up and down the stairs.  Ed and the PT are engaged in a fun small world conversation about people they know in common, and - standing at the foot of the stairs - the world starts to go bright around the edges of my eyes.  I say, “hey guys, I don’t feel so well” which is a massive understatement, but the most I can get out.  They plop me in a chair, but I’m still spiraling down, and finally it’s pretty much lights out.  Ed has, in the meantime, run frantically down to the nurses’s station and shouted to Kelly that I’m passing out, and she’s there in a flash.  Somehow they dump me in a wheelchair and hustle me back to my bed.  My blood pressure is 88/57, and that’s just not good enough to get released.

They call in the hospitalist, Dr. Hallmark, and he comes in, does his doctor thing, and pretty much scuttles my plans for going home today.  He explains that it’s the perfect storm of reaction to all the anesthesia even as it wears off, the pain meds on an empty stomach, and essentially the beating my body took in the surgery.  I have a giant bruise on the calf of my surgical leg, and it has me concerned about blood clots.  Dr. Hallmark takes a look and just says that the surgeons are pretty brutal when handling legs for knee replacements, and that I should expect bruises to continue to show up on that leg.

 The biggest complication about the plan to extend the hospital stay is that it’s Friday afternoon, and they close the Joint Replacement Floor at the hospital on weekends - especially this holiday weekend - because they don’t have enough patients to warrant the nursing staff.  So they unplug my medical paraphernalia, and take me up a floor to the orthopedic spine center floor.  My room is nearly identical, with a slightly better view, but really, who cares?  I pretty much want to curl up (something I can’t do - this damn new knee won’t bend that way yet) and die.  This may be the absolute worst physical day of my life.  It can’t be over soon enough.

All dreams of going home today:  dashed.  All those great measurement results from yesterday:  all so much fake news.  Rock star, indeed.  Crash and burn is more like it. So much for home sweet home today.

Surgery Day: Rock Star!

Thursday, May 23rd, 2019.  D-Day.  The Day of Reckoning.  The day I’ve been anxiously awaiting - and it’s finally here.

We’re up at 4:15 so that I can shower with the prescribed antibacterial soap one last time before making the short trip (less than a mile) to the hospital.  We’re checked in before our assigned time of 5 a.m., and then we wait.  Waiting is not something we were prepared for, so it’s odd, very odd.  Ed faithfully came with me to all of my exploratory and pre-op appointments, and one of the things that most impressed us about this practice was how attentive and respectful everyone was.  Until this morning, we’ve never waited more than a couple of minutes for an appointment.  Today, we watch winter storm warnings on the local news channel (honestly, it’s late May, folks!) until I’m finally called back into pre-op at 7:20.

The prep is orderly and relaxed.  The pre-op nurse Sandy affixes my wrist with a number of bangles:  ID bracelets, “fall risk” bracelets, allergy alerts, and a few others.  No wonder they told me to leave all my jewelry at home - this is enough bling for any one person to handle.

Sandy then has me strip down and swab myself from head to toe with yet more antibacterial scrubs.  A different nurse comes to install my IV, and another comes to see if I need a leg shave.  (The prognosis is that I don’t need the shave, and moments later I hear the electric shaver going in the cubicle next to mine.) There are nasal swabs (oh fun!), vital signs, hospital gown, a first dose of prophylactic pain meds, and most fun of all - Sandy puts a TED stocking on my right leg, and it’s a complete bear of a process.  I wonder how I’ll handle that on my bad leg post-surgery?  But there’s not much time to wonder, since the parade of medical folks keeps coming through.  Another pre-op nurse, the surgical nurse, the anesthesiologist (a hottie named Dr. Betts;  how can someone who looks like he should still be in high school be certified at this level?  but oh, he’s a cutie, so what’s to worry?), and more.

Surgery is scheduled to start at 7 a.m., but my surgeon, Dr. Miner. hasn’t been in yet.  So I watch the clock and get increasingly nervous.  Then about ten minutes after the appointed time, he comes in, gives me a chance for any last questions, and autographs my left - the surgical one - knee.  He walks away, and all hell breaks loose.

The director called Action, the general roared Charge!, the umpire said Play Ball!

They kick Ed out, and then after a quick kiss goodbye, the whole team descends on me with a whirlwind of activity.  Someone is hooking up heart monitor leads. Someone is attaching the nasal cannula.  Dr. Betts is back, giving me the nerve block in my leg, and a spinal in my back.  My pretty blue hat goes on.  Dr. Betts injects yet another med into my IV, telling me it will help relax me.  Well, hello, good times!  It goes to work right away, and I tell him that it makes up a bit for the fact that - according to the instructions I was given - I couldn’t have a nice glass of red wine with dinner last night.  Dr. Betts smiles and says, “consider it your morning margarita”.  Oh yeah.  I’m buzzing now.

I’m fast losing touch with the world:  the cast of thousands wheels me out of pre-op, into an elevator where I get that roller-coaster stomach blip, and into the OR.  I look up at an elaborate array of overhead lights, and then it’s lights-out for me.

I’m out of surgery at 9, and by 10, I’m awake in pre-op.  An x-ray tech comes in to film my new bionic knee.  Nurses tell me I did great.  (Really, all I did was lay there and sleep.  I hope the docs did great.)  I’m in my room by 10:30.

And most amazing of all, I have zero pain.

The physical therapist comes in a noon.  Noon!  That’s just three hours after getting out of surgery.  She introduces me to three simple exercises and tells me to do ten reps of each three times a day.  I do that handily.  Look at me!  I’ve got great extension (5 degrees)!  My flexion is almost past the maximum they want me to go (I’m at 108, and they don’t want me to go more than 110).  Damn I’m good!

They take me for a walk in my walker, down the hall and back.  No problem!  I am, dammit, a Rock Star!

The rest of the day melts away.  Ed comes to stay for the duration, and friends Doug (and his dog Hank, the most wonderful and gentle chocolate lab around) and Allen come at separate times.    I watch some bad TV, read a little, and just before going lights-out, I wonder what all the fuss was about.  I've got this.  Easy-peasy!

Bonus Days - the road to Total Knee Replacement

A week or two ago, Ed and I were walking home from our favorite coffee house on a brilliant spring day.  Ed said: these are bonus days!  What he meant was that we were blessed that I was able to walk as far as the coffee shop on that gorgeous day - a walk that was a small fraction of the distances I used to run - distances I ran without giving it a second thought.  Who ever thought that I would struggle to walk less than a mile or two?

But time has not been kind to my knee - the left one - and I’ve grown accustomed to dealing with orthopedic docs.  X-rays, MRIs, prodding, twisting, checking range of motion.  Then the questions start.  Does this hurt?  Or this?  And this one, always:  When did the pain start?  

Well, that day was in 1994.  I remember it vividly even now, twenty-five years later.  I lived in the mountains west of Denver at that time, and it was a glorious summer day.  A fine day for a run.  From our house on the side of the mountain, you had two choices for where to run:  up or down.  Actually, the choice was: do you run UP first (and down coming home) or DOWN first (and struggle up coming home).  On this day, I chose to go up first, and was running up Witter Gulch Road.  The road was nicely maintained asphalt with no shoulder to speak of, but with almost no traffic, who needs a shoulder anyway?  Suddenly, with no warning, my knee screamed at me.  It was a pain that stopped me in my tracks.  I looked around.  I had not stepped off the road, had not stepped on a rock, had not tripped over any crack in the road.  My knee just decided to hurt. 

I walked a few steps, and tried to run again.  Ouch!  So I babied that leg, and walked a bunch more, slowly, gingerly.  After some time, I was able to run again, but ever so carefully - I didn’t want that pain again.  And I got home just fine, and didn’t bother to think about that incident again.  Until.  The next morning, I awoke to find the knee swollen up to the size of a cantaloupe, stiff and sore.

That sent me off to my first orthopedic doc, and my first arthroscopic surgery.  Over the years, there have been many more visits to orthos, and just about every treatment available.  I’ve had cortisone shots, and multiple rounds of hyaluronic acid injections, and last year, an experimental treatment called Platelet Rich Plasma, or “PRP”.  I’ve run on treadmills to be fitted with the right shoes and the right insoles.  I’ve had orthotics fitted (and then rejected!).  I’ve iced the knee.  I’ve had low power laser treatments.  I’ve done stretching, and Pilates, and physical therapy.  I’ve rolled that IT band with a foam roller, and another plastic-roller-thingamabob.  Three years ago, when my knee was in a particularly bad spell, I had another scope (arthroscopic surgery). 

The one thing I’ve never done is stop running, stop being active, stop skiing.

That first ortho, back in 1994, told me that I should stop running.  I tried that for about four or five weeks, but it didn’t work.  I’m an addict.  I started running in college - if you don’t count the years of track in junior high and high school.  Running was my salvation:  it was the answer to losing my Freshman Five (or ten, or twenty, but really, who’s counting - they all went away when I started pounding pavement).  It was my excuse to get outside.  It became my meditation, my problem solving, my solace.  Marathoning - when I got to that stage of my running life - became the nexus of my social life.  Orthos have told me time and again that I shouldn’t run, and I’ve always just looked at them and said, “I’ll stop running when I’m dead”.

But earlier this year - in early February - I woke up one morning with my knee swollen to the size of a cantaloupe once again.  Just like that day back in 1994, it seemed to come from nowhere.  And it hurt.  A lot.  And a lot more than normal.  I had become so accustomed to a knee that hurt, that I forgot to notice it.  Not on this day.  

Next followed more visits to the ortho, where I had fluid drained, and another cortisone shot.  Cortisone shots had always been golden for me:  I would get the shot, then the next day I could run up and down the stairs like nobody’s business.  Not this time.  It took about ten days before I felt any benefit.  So I went snowshoeing a day or two later (I mean, really, who wouldn’t?), and the following day I couldn’t walk down the stairs.  Seriously:  I got stuck on a step about halfway down, and couldn’t put any weight on that leg to save my soul.  Ed had to come carry me the rest of the way down.

That was the beginning of the end.  My knee didn’t just hurt now, it went on strike.  Not only couldn’t I run or ski, I could barely walk.  I couldn’t walk to the coffee shop.  Heck, I couldn’t walk to the bathroom without a walking stick.  One Sunday morning, I woke up and kneeled on my knee on our bed to watch one of our cats playing, and something in my knee screamed at me, and I couldn’t move.  Could. Not. Move.  The pain was so great - unlike anything I’ve ever felt - I thought I was screaming.  Ed told me later that I was just quiet and getting paler by the moment.  We almost went to an ER - but there was the fact that I couldn’t move, and then a friend who is a doc told us that there really was little to be done when you have bone-on-bone, so it would have been a wasted trip.

I made one last trip to the ortho who had been with me for ten or more years.  He just looked at me (oh yes, with his dreamy blue eyes;  it’s okay, Ed knows I had a crush on him) and said, “we’re out of options”.  Just like that.  He fired me as a patient.  He does not do knee replacements, so he sent me off to find a surgeon to do the replacement.  After interviewing three highly recommended surgeons, and seeking all the advice I could find, and reading everything I could on the internets, I found a surgeon I like a lot, and scheduled the surgery for May 23.

In case you’ve lost track of the days, that’s tomorrow morning.

One thing that everyone seems to agree on is that knee replacement surgery is no walk in the park.  It’s tough.  It’s painful.  The estimates are widely varied:  recovery will take 2-6 weeks.  No, it will take 3 months.  Well, actually, it will take 6 months to get to normal.  No, make that a year.  Okay, at about two years, you won’t even notice that you have an artificial joint anymore.

One thing that nobody seems to agree on is what you can do with a new knee.  I’ll be honest:  most of the docs say “no high impact activities”, which includes running and skiing.  But a number say, “go for it!”  The reality is that nobody knows for sure how high impact activities affect the piece/parts (particularly the plastic parts) of an artificial knee:  the materials change and improve all the time, and true long-term followup studies take, well, a long time.  Who knows how a prosthetic installed today will hold up 20 or 25 years from now?  So, if you know me at all, you already know how this is going to go:  I’m going to do my damnedest to run again.

That starts with getting through this surgery, and through the recovery, and through all of the rehabbing.  I’m planning to share my progress here.  Are you all coming along with me?