Knee Replacement

On April 9 I had surgery to replace my right knee. Because arthritis had done so much damage, there was so little cartilage and my knee was practically bone-on-bone. I had finished a round of antibiotics for an upper respiratory infection on April 6. After my surgery, I was put on another antibiotic to safeguard against any infection entering my body and traveling through my bloodstream to my surgical site.

The day after surgery the physical therapists came in and taught me a few exercises to strengthen the muscles supporting my knee and get my knee to flex and extend. They also taught me how to transfer from the bed to a walker and get to the bathroom. I was supposed to have two nurses help me make the transfer from bed to walker each time. However, one day only one nurse came in to help me. I had a nerve blocking anesthetic catheter in my groin area to block the pain from the surgery, and that meant I couldn’t feel my right leg. That particular day my left leg felt weak and I wasn’t certain it could hold my weight, and I was telling the nurse I’d feel more comfortable if she had another nurse with her when both my legs went out from under me. I don’t know whether my right knee hit the floor or not, because I couldn’t feel it. Both of my knees were about four inches off the floor as I clung for dear life to the top of the walker with my arms and hands. I couldn’t get my left leg under me; it wouldn’t support my weight. I couldn’t push up with my right leg either. The nurse couldn’t pull me up and said maybe she should just lower me to the floor. I reminded her that I’d just had knee surgery and I wouldn’t be able to get back up. She started calling for help, and three other nurses came running into my room. They all started talking at once, trying to figure out how I’d fallen and how to help me get back up. Finally they managed to hoist me up and lower me onto my back across the bed, walker and all, because I was afraid to let it go. They peeled the walker from my fingers and set it aside. Then they turned me around so I was vertical in the bed and started to put the covers over me. I said I still had to use the bathroom. Not willing to risk another fall, they brought me a bedpan. Sometime after that, they put a yellow band around my wrist that read, FALL RISK. I was bleeding from the bottom of the incision, so they bandaged it. The nerve blocker had pulled out, so they removed it. From that point on I was on oxycontin and oxycodone, which made me so drowsy all I wanted to do was sleep.
 

On my last day at the hospital, my two nurses helped me transfer from the bed to the walker to the restroom. I told them I might be a while because the stool softener I’d been given had started working. They left me on the toilet while they attended to other patients. By the time I was finished, my legs and feet had gone to sleep. I knew that I risked falling again if I tried to stand up by myself, so I pulled the “help” cord in the bathroom wall. A voice on the intercom on my bed asked me if I needed help, and I told her I needed my nurses to come and help me get off the toilet. She said she’d tell them. They didn’t come. I pulled the cord again and got the same response. I began to panic because my feet and legs felt really dead by this time. I pulled the cord again, two more times, and each time was assured that my nurses “would be there soon.” I pulled the cord again and screamed for someone to help me in the bathroom, and then I started crying hysterically. I felt like my nurses had abandoned me and everyone else was too busy to come help me. When one of my nurses FINALLY reappeared in my room, she seemed surprised that I was still on the toilet and was sitting there crying. When I told her I could no longer feel my feet and legs, she seemed even more bewildered and went to get the other nurse to help her. They got me from the bathroom to the bed, all the while explaining that they had been assisting another patient who had needed to go to the bathroom at the same time I needed to, as if justifying leaving me on the toilet for so long. I told them that if they hadn’t been able to come to me right away, they could have gotten someone else to help me. It took me quite a while to calm down after that.
 

I had thought that when I was released from the hospital I’d go home and start having nurses and physical therapists come to me from At Home Care. When the physical therapy department at the hospital concluded that I wasn’t making sufficient progress to justify that, they transferred me to a skilled nursing facility for physical therapy and rehabilitation on April 12. I felt betrayed. The first weekend the staff let me rest, and then I started physical therapy on the 15th. The narcotic pain relievers I’d been on since surgery made my brain so foggy that I couldn’t stay awake and couldn’t carry on a conversation, so that same day I made the decision to discontinue them. Tylenol and my Donjoy Iceman machine then became my best friends.  I learned that the ice not only makes the swelling go down; it also makes the bruising heal faster.
 

The whole time I was at the rehab center, I felt anxious and depressed because I didn’t want to be there. I was lonely because all the other patients were geriatric and feeble long-term residents. My daughter’s work schedule and college classes kept her from visiting more than twice, and my son never came. My mother and my sister came to visit me a couple times. I spent most of my time in my room wishing I was home and feeling deeply depressed. My emotional distress elevated my blood pressure. I had to take warfarin (Coumadin) to prevent blood clots following the surgery, so a nurse came in twice a week to check my blood and adjust my warfarin dosage accordingly. Pre-surgery lab work had indicated that my blood sugar was elevated, suggesting that I was pre-diabetic. The doctor at the rehab saw that and ordered that my blood sugar be checked two or three times a day, which I found to be very annoying. After enduring it for several days I finally called my orthopedic surgeon, who had ordered those labs and who had done my surgery, and asked him to speak to the doctor at the rehab center and explain to him that the blood sugar checks were unnecessary because I was not diabetic and not at risk for diabetes. He must have done so, because the next thing I knew, the nurse came into my room and announced that the blood sugar checks had been discontinued. Then the upper respiratory infection returned, causing me to have a low-grade fever for several days. Two different times the doctor had an x-ray technician bring in a portable x-ray machine to take x-rays of my chest and make sure my lungs were clear and I wasn’t in danger of catching pneumonia. The nurses kept commenting that my surgical site was warm and still showed signs of swelling, which they thought indicated an infection. I was on two different antibiotics at once, which caused diarrhea. Then the doctor wanted to get a stool specimen from me to make sure I wasn’t suffering from an infection in my colon, but I refused because I was so tired of being poked and prodded and x-rayed and scrutinized. The doctor prescribed probiotics to counteract the effect of the antibiotics, and I started eating yogurt twice a day, and that helped make things a little better. 
 

By April 17 I had progressed so well in physical therapy that I could go for a daily walk around the inside of the building without assistance. Twice a day I made three circles around the building with my walker without stopping. I figured that was the only way to convince the doctor and nurses that I didn’t need to be there. Nurses and physical therapists took notice and shouted encouragement. Every day I bugged the in-house social worker to make arrangements for my discharge. She kept promising me she would, but I felt like her promises were empty because I never saw any results.
 

On April 19 my blood pressure and pulse were so high from the continual stress and anxiety I felt, that my physical therapist decided to forego the usual exercises and play a game with me instead so I could relax. I saw the social worker enter the physical therapy room and called her over. I asked her again about making arrangements for my discharge. She reminded me of the high blood pressure readings and low-grade fevers and bowel problems I’d been having since I arrived, and went on to say that she thought she could convince my insurance company that I needed to stay a few more days until I was healthier. Her tone was meant to reassure me, as if she was trying to tell me that she wasn’t going to let the insurance company kick me out before I was ready. I told her it had been three days since my last fever, my bowel problems were clearing up, and my blood pressure was elevated because I was stressed. I told her I didn’t have to be a resident in a skilled nursing facility to have physical therapy when I could go home and have outpatient PT with At Home Care or at any PT clinic in the area. I knew she had seen me on my daily walks, and she was one of those who had shouted encouragement. So why did she seem so reluctant to see me leave the facility? Then I looked her straight in the eye and said in no uncertain terms, “I want to go home!” She was taken aback. She stared at me uncertainly while I glared at her, and then promised to make the arrangements.  This time I knew she was sincere.
 

That weekend, I learned that skilled nursing facilities dealt mainly with patients who were elderly, feeble, and perpetually ill, and the longer the facilities could keep the patients, the more money they got from the insurance companies. At age 50, I wasn’t like their regular long-term residents; I was a temporary resident who didn’t even want to be there. They didn’t know how to deal with me. Their usual ploy to get more money from the insurance company wouldn’t work with me because I wouldn’t let myself be a pawn in their game. I felt like a prisoner and kept fighting for my release. But I couldn’t discharge myself against medical advice because the insurance company might refuse to pay for the care I’d received at the facility. I couldn’t afford to pay for it out of pocket. So I had to wait until the doctor discharged me. Seeing how depressed I was, the head nurse suggested that I call a friend or relative to take me to a movie or shopping, anything that would give me a change of scenery. So I called my sister, who took me to lunch and a movie. When I got back I felt much better. But the rehab facility still had to communicate with the insurance company and the insurance company had to fax a “cut letter” to the facility telling them to let me go.
 

On April 22 the “cut letter” finally came, but they still weren’t ready to let me go. The nurses told me that my latest labs had indicated that my sedimentation rate, which shows the level of inflammation caused by rheumatoid arthritis and should have been between 0 and 20, had shot up to 85. I thought it was no big deal, and I told them it wasn’t unusual for my sed rate to be so elevated because my body had just been traumatized by major surgery and it had probably aggravated my RA. Come to think of it, the same thing probably happened after each of my rotator cuff repair surgeries last year, but nobody thought to check my sed rate then. My two-week follow-up visit with my orthopedic surgeon was scheduled for April 25, but because the doctor and nurses at the rehab were so anxious about it (and the fact that my blood pressure and temperature had been elevated for so many days) and thought I was really sick, they called him and asked him to see me right away. So I went and saw the nurse practitioner, who said my incision looked good and was proud of my progress because I was up and walking around with a walker. She filled out the paperwork for the rehab facility to discharge me. When I returned to the rehab facility and handed over the paperwork from the doctor’s office, I was discharged. I went home the next morning. I had physical therapy and nursing care with At Home Care personnel until May 17. I’ve graduated from a walker to a cane, although I’ve gotten to the point that I don’t need the cane all the time.
 

On May 14 my mother had the same surgery done by the same doctor at the same hospital. On May 17 she was transferred to a rehab facility in Waverly, VA, not far from her home in Ivor. She’s 75, and not as resilient as I am, so she’s having a rougher time than I did. I keep in touch with her, encourage her, and pray for her, and plan to visit her often. I will write more updates as often as I can. Please keep her in your prayers.

UPDATE ON MOM-- June 18, 2013

Mom has been home since June 3. She's been having physical therapy at home with Frances Murphy, the same therapist I had from At Home Care. I liked working with Frances and highly recommend her. Mom likes her too. Mom seems to be feeling much better and getting around pretty well. Her recovery from surgery has been helped by the fact that since she's been home she's been finding a lot of things to do that require getting up and walking around.

UPDATE ON ME--June 18, 2013

I started outpatient physical therapy at Mike Kelo Physical Therapy on June 3. I'm still working on bending and straightening my knee, but now I don't have to use my cane so much. I joined the Silver Sneakers program at the local YMCA yesterday. It's a free program offered by my insurance. Now I can use the gym equipment and join water exercise classes to help me strengthen my body and lose weight. I'm determined not to be lazy this summer because not only would I lose mobility in my new knee but I'd be really bored and then I'd get depressed! I am so ready for a change in my life, and it's time to make it happen. From now on it's physical therapy, gym, and writing for me.