Friday, March 27, 2009

Day 32

Yeah, I'm back already. I guess I'm the one that really needs this blog, that it's as much a part of the therapeutic process as the exercises I'm doing.

I had my second outpatient therapy session this morning, 90 minutes of fun, fun, fun. Not really. It was difficult and painful.

Jim the Therapist is pushing me hard, but the results are there. Flexibility has increased in the left leg and I should soon be able to straighten it completely. There was a window yesterday afternoon where my knee felt better than before surgery.

Unfortunately, by the time I went to bed, it was throbbing, which made for another tough night of not much sleep. That's slightly discouraging, but as Jim the Therapist confirmed, I'm ahead of schedule and I'll have to stay motivated and continue working hard to remain on the road to a full and complete recovery.

Wednesday, March 25, 2009

Day 30

I survived. No, I'm not talking about yesterday's first session of outpatient PT. I'm talking about the estrogen fest known as a 7th-grade sleepover that began last night and is lingering into the early afternoon. My daughter is having a great time, which makes me happy.

Physical therapy, on the other hand, was just as tough as I expected. Dave the therapist introduced new exercises far more arduous than those prescribed by John the Therapist, including a few using weight machines. One of his big aims is to get my leg straight and more flexible. Lying down on the therapy table, the back of my left knee was an inch or so above the surface. By the time I left, my leg had straightened further, which made the hard work (and pain) of therapy worth it.

I go back on Friday for another session and will be doing the new exercises in between. Dave did say that I seemed to be doing well. I think he pushed me to find out how far I could go. I managed to complete everything, but it was indeed hard work. I was sore afterward, but nothing too bad. Dave reminded me to apply ice often.

Dave was insistent that I should no longer keep a pillow under my knee at night because that inhibits the leg from straightening. I followed his advice and, despite all the sleepover hullabaloo, I actually slept sounder by trying to keep the leg straight for most of the night. I'm a little sore today, but I got my walking in this morning and plan to do my exercises soon. Also took a few more swings in the driveway. Still feels good.

Finally, I'm not sure how much longer I will be maintaining this online journal. It's only getting a handful of hits, although the larger purpose for creating the blog was to keep track of my progress and to provide information for anyone considering or about to undergo a knee replacement. I had found such a blog before my surgery and found it informative. It's my hope that people out there will find this blog months or even years from now.

Each knee replacement experience is no doubt unique. Mine, obviously, has been good. I'll probably check back on occasion when something significant occurs. Until then, take care.

Monday, March 23, 2009

Day 28

I guess I just had to try to scratch that itch. After doing my morning exercises, I iced the knee and then made a last-minute, executive decision. I walked outside, picked up my trusty practice 5-iron and decided to take a few easy swings in the driveway just to see if could do it. No problem.

I then decided to swing with a little more authority. Still no problems. By the time I was through, I was swinging the club with nearly as much authority as I do normally do. The knee was holding up fine, which is fantastic news.

Afterward, I ran inside and called my longtime golfing buddy, Ron, to report that I'm back ... almost. I'm still a long way from being able to play a round of golf. But it's not unreasonable to think I might be able to hit a few balls next weekend at the driving range. Again, I'll start slowly with some half wedges, but it will be way ahead of schedule for when I thought I might begin golfing activities.

Sunday, March 22, 2009

Day 26

I'm getting out and about more. I made it through my son's first scrimmage of the season yesterday on a chilly day. (A sophomore, he made his varsity debut, pitching two scoreless innings, striking out three. He also hit a ball to the warning track in right field that normally would have carried for a home run. I'm not too proud of him.)

The pain hasn't been bad, despite the stepdown from Perocet (every four hours) to Vicodin (every six hours). I went without painkillers for over eight hours yesterday without ill effect. While I'm fine during the day, sleeping remains a problem. I've not been able to sleep through the night or for very long stretches the last week. I'm apparently putting the leg in some awkward positions at night that is causing additional pain. I need to do work on sleep positions in the hope of eliminating some of the pressure (and pain).

We went out to dinner last night for the first time since surgery, which was great. Another step toward normalcy. And this evening, I'll be returning to my Sunday night cooking duties. It has always been a tradition in our household that I cook something extra nice for Sunday supper. (Cooking is one of my great loves.) I'm doing something simple, pasta carbonara, a longtime family favorite. It will be nice to get back in front of the stove.

Friday, March 20, 2009

Day 25

Woooot! I'm legal. The physician's assistant for Knee Replacement Guy just gave me permission to drive to outpatient physical therapy, which is due to begin Tuesday morning. She went along with the plan knowing that it's my left knee they replaced and that I'm stepping down from Percocet to less potent Vicodin as my pain medication du jour.

The pain persists. Despite not getting to sleep until late, I was awakened this morning with some sharp pangs, which forced me to take a pain pill and get an earlier-than-planned start to the day. I got through my exercises and walked the same distance route as in the previous two days. I'm not sure I can go much farther at the moment, although it felt slightly better today after my walk.

I'll have to push myself to go a little farther soon. John the Therapist is coming for his last home visit this afternoon, so the knee will receive more than enough work today.

Wednesday, March 18, 2009

Day 23

I've progressed to the point where John the Therapist says we've maxed out on home exercises and that it's time for me to hit the gym. If everything goes as planned, I should be starting outpatient physical therapy next week. The sticking point is whether the doctor will allow me to drive. The nurse sounded optimistic when I spoke with him on the phone today.

Confession: I have driven a couple of times to watch the high school baseball team practice and to hang out with the other coaches. It's about a mile there and back. And I was careful. I'm in no hurry to start driving on a regular basis, but I do want to be able to take myself to PT or the baseball field or on an occasional errand.

Speaking of being on the move ... after completing my exercises this morning, my cane and I went across the street and walked a little over a quarter-mile in the park. The top of the knee puffed up a bit afterward and there was additional stiffness, but otherwise I did fine for my first walk. I'm planning another one this afternoon and will try to add a little distance each time.

Sunday, March 15, 2009

Day 20

I woke up again this morning in a fair amount of pain. I guess it shouldn't be surprising. The knee tends to stiffen when I'm not moving around. But the pain has been more acute the last two mornings, prompting me to gulp a pain pill first thing. It takes about 20 minutes for the drug to do its magic. Walking around helps loosen things up as well.

This extra pain should not be a source of discouragement. My recovery overall remains ahead of schedule. I'm walking more upright with the support the cane provides. Technically, I'm supposed to be still using the walker at this point. Continuing the theme of getting ahead of myself, I've already switched from baths to showers.

The surgery scar has nearly healed except for a few scabby patches along the incision line. The last Steri-strip is stubbornly hanging on at the bottom of my knee. My scar will be less impressive than I originally thought it would be. Knee Replacement Guy's fine work and the body's ability to heal itself will leave me with a faint, thin line through the knee, not some Frankensteinian scar. My daughter still can't look at it, however. "It's disgusting," she says.

I could not and should not be any more satisfied with the rate of my recovery. The knee is regaining function and the swelling has shrunk too the point where there is a faint outline of definition. I felt some tiny pings of pains in the knee last night similar to how your arm or leg feels after it has fallen "asleep." It was if the leg were waking up. Those little bits of pain caused more comfort than distress.

I've been meaning to address the "P" word in more detail for awhile. This seems as good an opportunity as any. While I'm too lazy to look, I'm fairly certain that the word "pain" appears multiple times in each of my blog posts thus far. It's a word, concept and reality that cannot be ignored. It's part of the program. You don't get a knee replaced if you are not in pain. And once it's replaced, pain is either warming up in the wings or is singing full-throated arias center stage. Pain becomes the background music of your life.

I'm not writing about pain to discourage anyone from getting their knee replaced. Far from it. But to ignore the subject would not be an honest retelling of the experience.

The sonuvabitch hurts. A lot.

But it won't be long before me and my knee reach a tipping point where the pain becomes less acute than before surgery. I will know that I've truly recovered when that day comes. It is, after all, the reason I agreed to this drama.

Nearly three weeks later, the memory of the pain I felt immediately after surgery has almost faded. Yet a faint recollection remains of just how much it hurt. I do recall just how much it hurt. The button on the pain pump became my savior. There were times that I looked up at the clock wondering if my six minutes were up and I could deliver another dose of Dilaudid. (Interestingly, the pump made the same noise when you pushed the button whether or not you were getting medicine. I'm wondering if they designed a placebo effect into the machine.)

The pain had grown less severe by the time they unhooked the pain pump on Day 3 and began giving me two Percocets every four hours. The pills took over pain management nicely, which is not surprising. Percocet is a strong narcotic. The next step up in the pharmaceutical continuum is Oxycontin, which doctors hailed as a wonder drug that would allow people to take one time-release pill to manage their pain for as long as 12 hours. (It didn't take long for people to figure out that if you'd get a mighty buzz if you crushed the pill and then smoked or mainlined it. "Hillbilly heroin" sells on the street for as much as $80 a pill. Percocets are an extremely popular black-market drug as well. An untold number of Americans are paying big bucks and committing various crimes to get stoned on Percs.)

I'm hooked on Percocet at the moment. I shudder to think what life would be like without them. I won't use the word "addicted," given that I'm using them appropriately, but I am drug dependent. I now understand why painkillers are the most abused drug in the world. They provide a warm, pleasant glow and make you feel pretty darn good. I look forward to the day when a simple Tylenol or Motrin will get the job done.

This need for painkillers explains, in part, why you have to wait so long to drive after surgery. Physicians don't want people with a head full of Percocets behind the wheel. The drug impairs cognitive power and reasoning. Writing is hard enough when the mind is clear. It becomes an even more difficult task under the influence, something I hope you will take into consideration as you read this blog. (While I do edit these entries, they don't receive the same attention my writing normally does. Please forgive my grammatical lapses and awkward sentence constructions.)

It's important to realize that there is a mental aspect to pain management. You have to stay busy. The less time you have to think about pain the better. I think I've done a good job in that respect. I've been reading, playing online poker and writing this journal. I've kept the television off during the day and have taken surprisingly few naps, which no doubt has helped me sleep more soundly at night.

So yes, there is pain. Lots of pain. But it's manageable. My wife explained how the pain of childbirth felto so horrifically intense one moment and then disappeared the next. With a knee replacement, the real pain begins once your new knee is born. I'm optimistic that my new knee will grow up soon and the pain will have moved out of the house. And while it will be expensive, I won't have to send my new knee to college.

Thursday, March 12, 2009

Day 17

I reached another important milestone this morning, an event that has nothing to do with my knee or rehab. I turned 50 today.

I'm not much for celebrating birthdays, and this one is no exception. But I'm okay with turning 50. It doesn't bother me that I'm AARP eligible. Nor am I too not freaked out that a big chunk of life on the big blue ball is behind me. I've got a lot on my plate at the moment, and the the plan is to remain focused on each individual day, accomplishing what needs to be done. The "long term" for the time being is watching my son play his first season on the varsity baseball team and getting ready for my return to work and golf.

While I've obviously done well so far, I'm still cognizant of the fact that I cannot get ahead of myself and do too much. That happened Tuesday, the day the staples came out. My leg was especially sore and stiff yesterday morning, to the point where I could not get through all my exercises. That's the first time that has happened. The knee had loosened up a bit by the time John the Therapist arrived in the afternoon. He added a new exercise that stretches the hamstring muscles (behind the thigh) and things improved further.

John is ready to send me to outpatient therapy, but unfortunately I don't have an easy way to get there until I can drive. I should get my driving "privileges" backc after I see the doctor April 2.

As John had recommended, I did a few exercises before getting out of bed this morning. It made a difference and I feel pretty good this morning despite it being the first day of my 50th year.

When you need to stretch just to get out of bed, I guess you really are old.

My first outing since the surgery is tonight. My daughter's middle school theater group is performing the musical Pippin. I'm a little anxious about how far I have to walk, but should be fine if I take it slow and steady.

Tuesday, March 10, 2009

Day 15

More than two weeks have passed since they replaced my left knee and I could not be any happier with the results. I've regained something that resembles "normal" function in the knee again. I'm genuinely surprised I'm doing this well this soon.

I went off the walker and onto the cane a few days ago, a move that John the Therapist reluctantly agreed to after the fact once he saw me walking around the house without difficulty. I can put my full weight on the leg now, which a week ago would have been impossible. I could walk short distances without the cane if I wish. But I'll keep it by my side for the foreseeable future.

I reached another big milestone in my recovery today. The nurse removed the staples from my leg, a rather unpleasant experience for the minute or two that it took to pry them out. It has made a difference. My leg simply feels better with the staples gone. (The nurse replaced those 18 staples with Steri-strips that will eventually fall off.)

Getting rid of the staples means two things: I can stop taking Coumadin, an anti-coagulant designed to prevent blood clots, and I can finally bathe. I had been conscientious to wash myself as well as I could inside our cramped downstairs bathroom, but it's not the same as immersing yourself in a tub. Someone at work had offered to lend us a seat that goes into the bathtub, and my wife is bringing it home this evening. But ... I didn't wait for her. Instead, I marched upstairs, drew that hot bath and took a good soak. Wonderful. I'll hear about it later, but I figured it would be one less thing for my wife to worry about after she got home.

I had had some trepidation a few days ago about going up and down the stairs. Our old house, unfortunately, has only one full bath and it's upstairs. But John encouraged me to give it a whirl during therapy yesterday and I made it up and down without any problems. I won't be using the stairs much for now, but it's great to know I have access to a bath when I want or need one. The switch to showers will come later when the leg is even stronger. It's still hard to stand in one place for more than 10 or 15 seconds.

Here is an odd and unexpected result of the surgery. I'm taller. When I mentioned this to John, he said I may have "grown" an inch. I topped out at 6 foot 3 when I was 20, but in recent years I've been measured at 6 foot 2, a shrinkage I attributed to the effects of gravity. John said it appears that the loss of cartilage and subsequent support caused my body to sink into the knee. The knee replacement served to straighten my leg and give me back my full height. I doubt I'll be able to dunk a basketball again once I've fully recovered, but I'll take the extra inch just the same.

Saturday, March 7, 2009

Day 12

After a couple of s0-so days, I'm back on track physically and mentally. What had been an ascendant line of progress dipped downward on Days 10 and 11 thanks to some unwelcome soreness and fatigue. It was discouraging. I muddled through my exercises and morning routine on Friday and could not muster much enthusiasm for John the Therapist’s afternoon visit. My decision to cut the Percocet dosage in half probably did not help my state of mind.

John arrived and began putting me through the therapy regimen, which mean gently pulling and tugging the leg to break down scar tissue. It did not take long for the leg to start loosening up. We got my leg to flex beyond 90 degrees, an important benchmark. When the staples come out on Monday, it will able to flex even more. John pointed out where the swelling had subsided and proclaimed me ahead of schedule in my rehab. A crummy day got a lot better.

I reminded myself later that “no pain, no gain” is the reality of this rehab. I need to push myself a little harder, knowing that small amounts of pain is a necessary evil. I can’t baby this thing. The scar tissue won’t disappear on its own.

I got my best night of sleep since surgery last night. Now that some of the swelling has gone down, I can rotate my knee and leg more easily and can find comfortable positions for sleep. It was especially satisfying that I did not need to wake up in the middle of the night for a pain pill. And the leg felt good this morning, with little pain or stiffness.

The two bad days were, as it turns out, expected and not very meaningful in measuring my overall progress. There's no rush. I'm doing well. And today, finally, I'm getting a glimpse of what life with a brand new knee might be like.

Thursday, March 5, 2009

Day 10

While it wasn't a setback, I don't think I made much progress today. The knee is a little sorer than usual. I didn't help myself when I reached awkwardly for my phone while I was walking toward it. I didn't need to hurry, but I did. I stretched my quad muscle and the suture site a little more than I should have. There's no damage, but I caused myself some unnecessary pain. I need to be more careful. Now is not the time to do something stupid.

Here is the remaining stuff about my hospital stay. It's long and full of detail. I hope it will give knee replacement candidates an idea of what they'll experience.

The following takes place between noon, Feb. 24, 2009 and noon, Feb. 27, 2009. (Cue ominous music.)

It did not take a Jack Bauer effort to survive my hospital stay. And at no point did I find myself fending off terrorists with a bedpan and an IV pole. But a knee replacement is an adventure in its own right.

I'll first start with a slight rant. If J.D. Power & Associates called to rate my overall customer satisfaction with the level of nursing care on the ward at OBCH (One of the Big Cleveland Hospitals), I’d be inclined not to give it high marks.

Once the surgery is over, doctors (or someone from their staff) do drive-bys to make sure your leg is still attached and leave the rest of the care to nurses and nurse’s aides. Many of the nurses and aides seemed nice, some seemed competent and others … not so much. I assume there is a written protocol for knee-replacement aftercare. But I’m not certain everyone on the orthopedic ward at OBCH bothered to read it. I'm fine and have made good progress. Perhaps I expected too much.

I was wheeled up to my (single!) room around noon on Tuesday. There still was not much sensation in my right or my left leg at that point, but I could feel the epidural wearing off. That became fully evidenced when pain began to radiate outward from my knee. These were no minor twinges. This was, “Holy crap, that really hurts,” kind of pain.

As mentioned previously, the anesthesiologist had hooked up a pain control device while I was in post-op. These devices allow patients to push a button every six minutes that safely delivers a small dose of high-powered Dilaudid through their IV. I was told numerous times that I should not be afraid to push the button, that it would not turned me into a tweaked-out lab monkey if I kept pushing the button.

Everyone said that there would be pain, but I wasn’t quite prepared initially for just how much pain there would be. I quickly embraced the junkie monkey in me and pushed the damn button whenever I could. I spent the first 24 hours in a gauzy haze, which is not a bad place to be after doctors have slice opened your knee and have spent an hour or two sawing, hammering and stapling your body.

I couldn't get past the first page of the John Irving novel I had brought with me. My wife brought the kids for a short visit and I slurped down a liquid lunch and ate a little of the fruit and yogurt tray I had ordered for supper. The rest of the time was spent sleeping and pushing the button.

The Dilaudid made the pain bearable, but the nerve block was not doing much at all. It was supposed to alleviate pain through the top of the knee. The anesthesiologist resident upped the dosage slightly the next day, which helped immensely.

The hospital bed became a warm cocoon, a good thing given the condition of my knee and the fact I was strung up like Neo in a pod. Attached to me at that point were an IV line, the nerve block, a Foley catheter and a drain that removed blood from the surgical site.

My first physical therapy session came Wednesday morning (Day 2) after a not-so-pleasant breakfast. I felt hungry and decided to give an egg, sausage and cheese sandwich on shot. Wasn't ready for that. Should have stuck with the Jello.

The physical therapist and a therapist in training stopped by and asked me if I could do some jumping jacks. (Not really.) They tested the amount of strength I had in my leg and had me stand up with the aid of a walker. Fail. My leg wasn’t strong enough to support even a portion of its own weight. I got back in bed, slightly discouraged.

The therapist team, two-thirds of a wholesome Charley's Angels team, returned in the afternoon and we tried again. This time I slowly inched out of the room and about 30 feet down the hall before turning around and returning to my room, exhausted. Progress had been made. Day 2 also brought a clearer outlook on the world. I still needed my button, but not quite as much. The pain was not as bad and I found myself able to read. I went with liquids for lunch, but at a nurse's urging, tried solids again for supper. A toasted cheese sandwich and bowl of tomato soup never tasted so good.

By Day 3 (Thursday), I had even grown accustomed to the catheter that had been conveniently emptying my bladder. (There is no other way to get that job done after a knee replacement.) But by Day 3, that puppy needed to come out. That task fell to a young nursing student early in her hospital training. The instructor had a slightly devilish look on her face when she told the surprised student that she’d be pulling out the catheter. She probably got some pleasure from the panicked look on my face. The catheter slipped out without incident. My outlook on life improved immensely at that point.

An orthopedic resident changed my dressing and pulled out the drain. That gave me my first opportunity to view the incision. It looked impressive, about 7 inches long that runs through the center of my knee. The skin was held tightly together by 18 surgical staples. The doctor said it looked good, that there no signs of infection.

Finally, the unhooked all of the IVs, including the pain pump. They'd be giving me Percocet tables from that point on. And when the nerve block went, I became completely untethered of lines and tubes. That meant I could get rid of that ghastly hospital gown and put on some underwear, sweat pants and a golf shirt. Life was good. (And praise be, as if I wasn't already the luckiest guy on the planet, I even had a bowel that morning. Yes, yes. TMI overload. But if you get your knee replaced, you’ll know just how blessed an event that will be.)

My new therapist, Dave, arrived Thursday morning and led me on another spin down the hallway. I cruised past the stopping point for the previous day’s jaunt and made it to the end of the hall, where we practiced getting up and down stairs with a cane. “Up with the good (leg), down with the bad.” My knee buckled on the way up. Thankfully, Dave was there to support me. We took the same walk in the afternoon, only this time, I went up and down eight steps without a hitch.

Day 4 (Friday) involved some breakfast, another round of therapy and some last-minute instructions. I was home by noon, extremely grateful and a little anxious to be there.

Wednesday, March 4, 2009

Day 9

John the Therapist came late this afternoon and spent about 40 minutes putting me through my a workout. He said I'm ahead of pace and that he'd be satisfied with the amount of my knee flex three to four weeks out from surgery as opposed to nine days.

The exercises are not very complicated, are low impact, and primarily involve strengthening the muscles around the knee. While I can't lift my left leg from a reclined position yet, it feels as if it's functioning again and not just a dead cod attached to my hip.

John wants me to do at least a couple of the exercises every hour, a regimen I've followed conscientiously so far. I also get out of my recliner every hour or so and do some laps around the house to build up endurance.

Some of the swelling has subsided, giving the knee a slight bit of definition. Flexibility is supposed to increase further once the swelling has gone down and the staples have been removed. The latter is supposed to happen next week. (Alot of the pain from the flexing exercises comes from the suture site, where the skin has been pinched together.)

I used shuffle steps when I came home from the hospital on Friday, but now can walk with a more normal, albeit slow, stride. John thinks I might be able to switch from walker to a cane in a week or two, which will make me more mobile and willing to go out in public. I am admittedly vain.

I asked John how long it might take for the knee to feel "normal" enough that I can go after the ball aggressively with the driver. (I might not be the straightest driver of the golf ball on the planet, but I can hit it a long way.) He thought it could be as late as September before I'll have reached that point. He suggested that I start slowly, which is what I've intended to do.

My plan is to follow the Tiger recovery model and progress from putting to chipping to half wedges to full wedges to short irons to mid-irons/hybrids and finally the driver. I'm hoping this starts in May, which would put me on schedule to begin hitting drivers by June 1. If I can start this program sooner, great. But I'll be satisfied with a rollout on May 1.

Tuesday, March 3, 2009

Day 8

I was about to flush this blog, thinking no one would find it when, alas, I discovered a comment from someone scheduled for a knee replacement. With confirmation that someone is actually out there, I guess I have reason to continue. (Of course, I would have real evidence whether I'm getting any hits if I could make Google Analytics work.)

Now, a week removed from surgery, I can say that each day is better than the next. The level of pain is slightly better. Flex and strength in the knee is slightly better. And I've also been sleeping slightly better. I am more than happy to accept incremental improvement at this point.

I've established a routine since returning home that has chiefly involved help from wife. Unfortunately, she'll be returning to work tomorrow and I'll be on my own for much of the day. It complicates things slightly, but I'm sure I'll manage. Life is not too complicated at the moment.

I'll take some time now to discuss a portion of my hospital experience, from surgery through post-op. When I have the energy to do so, I'll write about my time on the hospital ward. Knee replacement and the need to take a steady dose of pain relievers, in this case, high-powered Percocet, makes writing a chore. I'm hoping less pain and fewer drugs will make writing a bit easier in the near future.

And I think I've settled more-or-less on a format for this blog. I'll return as often as I can to detail various aspects of the surgery and recovery with an eye toward providing a level of detail that someone who is contemplating knee replacement might find useful.

Tuesday. Feb. 24, 2009

M.L. and I arrived at the hospital at 6 a.m. as scheduled and were directed to a waiting area outside the operating suite. Within a minute, myself and another man led inside to a changing area where we would strip, don hospital gowns and bag up our clothes and belongings. I asked the other fellow what kind of surgery he was having. He said he hoped to have a biopsy. After 10 years of battling bladder cancer, doctors had detected a mass on one of his kidneys. That reality made my knee replacement look like a minor procedure.

Once in my gown, I was directed to a hospital in an area where doctors, nurses and anethesiologists gathered around patients. The room had an air of quiet urgency. An older nurse stopped by first and asked a litany of questions. A different nurse managed to insert an IV port and draw blood despite shaky hands. (That one was a bit odd.)

An anethesiologist nurse then explained to me that I would be receiving an epidural, which would block all sensation from the waist down. The epidural would be given in concert with some kind of sedative that would make me unaware of the shenanigans occurring at the far end of the table. I half-joked with the nurse that I feared waking up to find the doctor cutting off my bones. She assured me that would not be a problem, that I'd be out for the chain saw portion of the program.

A surgical resident talked with me for a few seconds and placed his initials above my knee with a felt-tipped marker. That gave me confidence that they'd be operating on the correct leg, although the right will be a candidate for replacement some day as well. Just not yet.

Finally, they allowed my wife to come back and visit with me for a moment. I gave her my wedding band, she gave me a kiss and off I went into surgery.

I have but a vague recollection of the operating theater itself. The room seemed small and cramped, but for all I know now it was the size of Carnegie Hall. Someone immediately pushed the sedative (don't what kind) through my IV and I was off to Dreamland.

I was told that I would be in the operating room for about 45 minutes before the actually surgery would begin. It was during that time that they cleaned and shaved my knee and the surrounding area and inserted a Foley catheter, a device with a balloon on the end that is inserted through your penis into your bladder to redirect urine into a bag. I'm quite grateful for having missed that nasty piece of business.

Ironically, I did regain consciousness at one point during the surgery to the unmistake hum of a high-powered surgical saw. I couldn't feel a thing, but I certainly could hear it. My recall having had a brief conversation with someone standing at the head of the operating table and then quickly being pushed back to oblivion.

When I woke up next, I was being wheeled out of the operating room for a short trip to the post-op area. I was surprisingly clear-headed, able to converse without difficulty. It was far preferable to the emotional and physical discomfort that surrounds emerging from general anethesia. When I complained I was thirsty, the nurse fed me a few ice chips.

I felt no pain at that point. In fact, I felt nothing at all from the waist down. I tried desperately to wiggle the toes of my right foot as soon as I realized this but could not. I told myself to breathe, that it was no time to panic. I have a few phobias -- enclosed spaces and heights are the big ones -- but I guess we can throw paralysis into the mix. I was told that this condition would only last about another hour, yet remained anxious until I could finally command my right foot to move.

My left knee was bound by ace bandages that I'm sure at least doubled its normal circumference. As I recall, a blanket or something had been rolled up and place underneath the knee.

The Knee Replacement Guy, still in his scrubs, stopped by to tell me that everything had gone swimmingly. The resident had come by earlier. I asked him how badly damaged my knee had been. He said it was bad, but provided no details. (I had this weird fear that they would open my knee and discover that it was actually fine. I admit that was not a rational notion.) I later learned from yet another surgical resident that there was considerable bone damage and spurring caused by the loss of cartilage. (Spurs are areas where the bone develops growth where it comes in contact with other bones.)

I had to remain in the post-op area an extra 30 minutes, probably longer, to wait for a busy young anethesiologist. She finally arrived to insert a thin wire-like catheter near my groin that would pump extra pain medication into nerve bundles at the top of my knee. They said it wouldn't help with pain beneath my knee. Someone had already connected me to a pain control device -- a machine that allows a patient to push a button and direct a small quantity of dilaudid, a high-powered narcotic -- through an IV line once every six minutes.

"Don't be afraid to push the button," more than one person told me. I'd soon learn how much button pushing I would need.

Sunday, March 1, 2009

Back home again (Day 6)

As promised, I’ve returned both physically and figuratively. I began drafting a long post about surgery and the hospital post-op experience, but have lacked the energy and concentration to bang it out. That will have to come later, I’m afraid. In the interim, I’ll try to provide some brief updates.

Knee-replacement surgery has been an overwhelming experience thus far. The pain is considerable, as is the extent to which you’re temporarily debilitated. But 5 out of 5 dentists say I’m doing very well thus far. The surgery went smoothly and there have been no complications. The physical therapists had me up and walking (with a walker) the day after surgery and my leg has grown a little stronger each day since. I'm hoping my age and relatively good physical condition will speed up the recovery process.

I was initially a bit nervous about coming home, but my wife and kids have done a great job of preparing the house for an invalid. They are, of course, taking great care of me. The therapist and nurse came to seem me yesterday and will be back on Monday. The therapy itself is not too taxing and I’ve been conscientious about doing my exercises. It’s difficult to describe just how much I want to be back on my feet and feeling “normal” again.

I'm guessing that it's a byproduct of the trauma that knee replacement represents, but I've been irritable, especially today. Finding a comfortable position in which to sleep has been my biggest challenge. The therapist suggested placing a pillow underneath my knee, which helped some last night. But I managed to twist it a few times (it doesn't take much), leaving me sorer than usual this morning. It's an annoyance, but no big deal. I'm obviously hoping that it will start to feel better as the day progresses.