Monday, March 9, 2009

Whacked, Part II

Every surgery is different, even if it’s the same kind of operation, and that was certainly true of my second knee replacement surgery. The first one took about 90 minutes, but the doctor said with the second one he encountered something he’d never seen before in this situation – one of the bones was trying to re-grow a cushion where the cartilage was supposed to be. It took two hours and 19 minutes to get it all taken care of. I had a different anesthesiologist this time and told him I wasn’t interested in hearing the whole thing again. He was good. I heard nothing, but I felt the mallet again. It was kind of reassuring, in a way, that the prosthetic was there, was mine, and was firmly in place.

Because it was only four weeks after the first surgery, recovery has been a little slower and a little more complicated. Oh, they had me up and on an elliptical bike within 24 hours, and I thought I was going to collapse a couple of times, but there were some other differences. I was transferred over to rehab as before, and my room was closer to the physical therapy room this time – not such a hike to get there twice a day – but in its infinite wisdom, my primary insurance decided I didn’t need to stay in residential treatment as long and after a week they sent me home. I was lonesome for my husband and friends and familiar things, but in a panic because going home meant going down stairs and I didn't think I was ready for that. Home health care (i.e. therapy) was arranged for me, but again my sweet Heather came to my rescue. She went to the patient advocate at the rehab facility to arrange for me to go to LaVerkin instead, where there are no stairs. I spent the last couple of rehab sessions practicing stairs so I wouldn’t be afraid when I actually went home.

In the meantime, Roger scurried around getting the rails on our stair replaced, adding a second one on the lower stairs. He moved me from the rehab facility to Jordan and Heather’s house on Friday afternoon when he arrived for a visit. That night we got on a three-way iChat-type connection with Elin and Jen and talked for quite a while about my recovery and the changes I’m going to have to make in my lifestyle. It’s all rehab all the time from here on. In high school PE I learned to hate exercise, so I have never done much on my own. Walking in the water at the pool has worked well for me so far, but I’ll need to do some other things as well. Jen and Elin decided to come out to see me and help me get back on my feet. I’m going to love that!

Since both Richfield and St George home health care is under IHC, I could be admitted in one place and treated in both. The nurse who admitted me changed the bandage and we observed a lot of pinkish drainage from two or three spots along the incision. Heather didn’t have any hospital materials but she sent Jordan out to get over-the-counter stuff that worked pretty well. The drainage continued, annoying but not large amounts. I figured at my Wednesday follow-up appointment with the physician’s assistant, a very nice fellow named Bruce, he would be able to deal with it. I was still on Coumadin, the blood thinner knee replacement patients take to avoid blood clots. I was supposed to be on it two more weeks, but when Bruce took the bandage off, he decided the drainage might have something to do with the Coumadin. He called the pharmacy at the hospital, which controls the use of the drug, and found that the numbers from my last blood draw were good enough that I didn’t need to take it anymore. I was glad of that. Bruce put butterfly bandages along the incision and covered it with a thick non-stick pad that he taped on securely. He also wrapped an elastic bandage around the leg to add some compression and gave us some supplies to change the dressing and keep it as dry as possible. He also put me on an antibiotic to avoid getting an infection.

When we got back to LaVerkin, the bandage was loose and drooping, so Heather re-wrapped it much tighter, using two elastic bandages, and by the time I got home to Richfield that night and descended the stairs without incident, the drainage had slowed noticeably. It has continued to diminish. One thing I learned is that my skin doesn’t like adhesive tape. I’ve developed a couple of sores where the tape was. I noticed before that the skin around the bandage itched, and absent-minded scratching made it worse.

A very nice therapist came to see me on Tuesday in LaVerkin and he had me walking around the island in Heather and Jordan's kitchen without the walker, just holding onto the edge of the countertop. He was right there with me, of course, but it was a grand feeling, something like being on a precipice where I could launch into flight.

Without such luxuries as a big kitchen island at home, therapy is a greater challenge. Someone from home health came on Thursday for a therapy session and will come again Tuesday. Getting up from low chairs is still a challenge but I'm developing strategies. I try to move and stretch and wiggle my feet and legs as much as possible, and do the muscle stretching exercises the therapist taught me. Right now I'm house-bound (literal translation: stir crazy) but hope to get out and walk down the block with a friend if the weather will allow.

My followup appointment with the surgeon is April 1, and I've set a goal to retire the walker by then.