Tuesday, June 05, 2012

Total Knee Replacement

The stairs became ever increasingly difficult to climb. They were only five steps, but caused Co-Pilot so much pain, that the trips and times of visiting countless interesting sites and improving our geographical and economics education about the USA, during Travel in the Motor House

  • became less and less enjoyable. It has been in storage but routinely maintained for over six months. After much trepidation, the decision was made for Total Knee Replacement Surgery
  • No longer padded nor lubed by a meniscus, the bone to bone damage over the years became unbearable. As a relatively healthy individual, taking care of her own health by educating herself on the subject of MS and controlling the symptoms, she was deemed a worthwhile candidate.

     Scheduled classes for the recipient and caregiver (a 'caregiver' is extremely important within the first painful week at home), were mandatory. Shown were the correct procedure to lift the leg after surgery. First by the person in assistance, then by placing the other foot under the leg and assisting in the lift until gains are evident in strength and pain is controlled.

    Medication was described and the need to stay ahead of the pain by scheduled dosage. The procedure itself described in a small brochure. The time for recuperation and rehabilitation was thoroughly covered. The necessary facilities required for the shower (a bench and flexible sprayer head).  The commode accessory to raise the level of the seat. A 'Walker' to enable a steady walk and prevent falling. The removal of all 'throw' rugs. A communication system from patient to caregiver.

    With all in order, the days leading up to surgery were filled with preparations such as dental exams and repair of any cavities. IMPORTANT: Dental infections migrate into the site of surgeries causing severe consequences. The anti-bacterial shower soaps used for a period Before surgery. The freedom from any colds or symptoms that could endanger the surgery. Staph infections are deadly serious and the hospital has 'Clean room' facilities for this 'now routine', procedure. The local doctor that was recomended and we met before deciding on the date, is well known for his expertise in these operations, holding top certification and doing several each day.

    On the morning of the procedure, we were to arrive at the hospital at 5:30am, already a line was present. Filling out more forms than previously done, is always expected, but no additional forms of identity were necessary, seeing as all were duly recorded in the days before surgery. I was slightly, well more than slightly concerned. I experienced a rare nausea during her entire day of surgery. I was not allowed in the room for several hours afterward. The Doctor came to the waiting room and said "all went well". My rarely upset stomach, began to feel better.

    The frontal nerve of her leg was deadened by an arterial 'drip' as well as the general anesthesia. A drain tube carried away the liquid residue from surgery and any excess bleeding. Warfarin to thin the blood, preventing clotting, was held to a monitored regimen begun previous to surgery. Oral pain killers were prescribed. The three day hospital stay was on schedule for her release, depending on the therapist evaluation. The evening before, did not look promising for release the third day. Co-pilot called me early the next morning and told me to come to help her get up and walk in preparation for evaluation. By the later examination of therapist, wife had managed to walk the required distance. Amazing feat within hours. She definitely wanted to go home. :>)

    Getting into the back seat of car, even with hospital attendants assistance, was not without difficulty and pain. Arriving home was more pain until prescription meds eased the discomfort. The next day was more rehab and exercise but the strong pain meds caused dizziness, so regular non-aspirin, carefully monitored to Warfarin, was found to suffice better. Having another condition that requires close care, complicated the procedure, but dealing with the complications is taken in stride.

     I had to assist with lifting the painful leg whenever movement required. The raised commode helped her, as did the shower bench. A CPM machine was delivered and set up in another room, to provide movement in graduated degrees of passive, perpetual knee bending. Scar tissue forms rapidly and by 12 weeks, no additional movement, or degrees of bending is possible. All degrees of bend back to normal Must be accomplished before that time, preferably by 6 weeks. If not, a radical 're-bending' to tear the scar tissue is required.

    Schedule of 6 hours a day on machine is recommended but not always possible, due to fatigue, dizziness and pain circumstances. Sciatic nerve pain is often a result. Each day saw more gains in degrees of bend, as programable keypad is advanced through the numbers. Four days after surgery, she was able to get from bed to commode and back unassisted. Quite remarkable. The dizziness was caused by blood pressure fluctuations, now monitored and better controlled. Meds interact and cause unforeseen problems. the 'Home Rehab' was deemed better for her, seeing as the hips and other knee are problematic, causing difficulty getting into and out of transport.

    Each day see's more gains. Therapy nurse removed stitches. This caused great concern to wife's vanity, depression in seeing the 8 inch scar. Trips to the kitchen to help prepare a desired meal were a high point, as well as laundering a few clothes with assistance. The showers are welcomed and relished now that pain is not the intense issue as first experienced. Tylenol is managing the pain, but must be monitored in compliance with the Warfarin blood thinner. Protection from bruising and risk of cuts, are adhered to.

    The dizziness and fluctuating blood pressure was a concern for the therapist who upon each visit took blood samples for anylysis. After transmitting the data from the little anylizer to the nurse in the lab, the adjustments were made. A visit to the Dr was made as well. Not too difficult, but tiring nonetheless. On return home, bed rest was mandatory. Each evening a bit of 'Blue Emu' gets massaged into her spine, by using a little hand hand held microwave device she had ordered from the internet. 'US 1000 Third Addition' seems to allow restful sleep, by calming the typical MS sensations of random electrical impulses coursing through her body. We follow with a small electrical 'Oster' massage unit, manufactured in the USA long ago. Can't argue with success, so it is a nightly ritual, along with lots of prayer from her caring friends.

    On a special day of gain, as she desired, I brought home and we shared a nicely prepared evening meal from Applebee's.  Each day gets better, but with minor setbacks expected. No real outside trips, other than one Dr visit to regulate the dizziness medications. Tests confirmed the meds interactions caused the low blood pressure problem. The Sciatic nerve is affected by the CPM machine. It now is facing reduced time constraints. The return of machine is approaching in any day, so no problem foreseen.... if exercise regimen is adhered to. A day outside for 15 minutes of sunshine (Vitamin D) was enjoyed for the first time.

    CPM machine was picked up by vendor at three week date. Therapist did several tests and listed new routines for home exercise, including recumbent peddling machine. She is now released from 'in-home care'. Swelling is a problem that must be addressed by elevation of leg and icing with pack wrapped in towel. Too much Salad is a 'no no', especially if containing really green leafy plants, such as spinach. The Vitamin K (a blood thickener) offsets the anti-coagulant, anti-clotting in the Warfarin, requiring a higher dose. Even Green beans has the same effect.

    It has been three weeks and the home therapist has run her tests for agility advancement. All is well for release from her services, as wife can use the cane somewhat to walk short distances. Now the real work is to keep up the therapy prescribed, in order to regain the full range of motion to the knee. The recumbent exercise machine that I had found at a local thrift store, is now to be used to force the knee to bend past the 90 degrees required for sitting and stair climbing. Therapist suggested several sessions a day. We now will see how that coincides with the chronic hip pain on the same side as knee. So far the pain in hip prevents much progress.

    At least a short trip to visit family, gave a break to the home bound patient. For a couple of hours, a pleasant lunch visit with grandchildren and their parents, was a nice respite out and about. MS fatigue is still a factor that demands frequent periods of laying down. A nap is like a battery charger to an MS sufferer. MS and hip complications interfering in this 'now routine' process for others, have been a concern that delays recuperation in wife. 
  • Tearful realizations periodically break the stoic attempts to heal this procedure in a timely manner. Each week is better, in spite of the doubts she occasionally expresses. At this point, doubts linger as to it's being repeated on the other knee, or even a future hip. MS patients are not the very best candidates, as we were forewarned.
  • There are now visits to the Chiropractor. The hip joint is problematic and requires adjustments. This eases pain without excess medication. Supplemental vitamins also are a substitute for pain meds that can have lasting side effects.
  • The little 'butterfly', tapes that were placed by the therapist (after she removed the surface staples) have now all fallen off. Vitamin E (coconut oil is less inflammatory) is sometimes applied to the scar, as well as the use of the small handheld microwave on the area surrounding, to reduce healing time. Short trips to social functions and ride alongs while errand running, relieves the 'home bound' feeling, as well as periodic depression. It has been four weeks since the day of surgery. The gains in mobility with far less pain are noticed.
  • 5th week, the walker is used less often and the cane is the primary aid for trips through the house. Hip is still giving pain which causes exercise time to be reduced. Degrees of bend are increasing, but at lesser amounts. Saturday before Father's Day, the family all got together and attended a Car Show at Sagebrush Church on west side, with a service following. The wheelchair was used, because of the prolonged time on the parking lot. Lots of 'old'? cars from the 1950's. Fun time. We slept well that night. Sunday was a nice dinner on the patio of Son and family. His wife is a gourmet type cook, always trying different recipes, so we always eat well at her gatherings.

    As the progress advances, I will add the gains as well as setbacks to this story. We are Praying that the end result will be a vast improvement, worthy of the pain and suffering.

    Blogger tisanjosh said...

    In general, the surgery consists of replacing the diseased or damaged joint surfaces of the knee with metal and plastic components shaped to allow continued motion of the knee. Knee Replacement Surgery

    1:57 PM  

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