TKR Josephine's 2nd knee story - short version

[Jean]

Josephine just rang me 6 pm and we had quite a chat. She sounded great and was just enjoying a glass of milk and three rounds of toast and marmalade!
I know this is not her recovery thread but perhaps somebody can move it over - thanks.

I am sure she will post very soon.

 

[Jamie]

Jo's thread was in pre-op, so this IS her recovery thread.

Dear Jo....when you get home, you can change the thread title to anything you like. I'll be happy to help you if you need it....

I also talked with Jo briefly today and she is doing very well. Pain is well managed and she'll have some new procedures to tell everyone about that she observed in the operating room. You know Jo....always the orthopedic professional.....rarely only a patient!!!

She hopes to be home Friday.

 

[Jean]

Just to update:
Jo had a very good night, her pain is well controlled and she ate a 'hearty' breakfast.
She can't wait to get home tomorrow to tell you all about it.

.

 

[Jean]

Jo had a bit of a set back this afternoon so not definite but still hoping to go home tomorrow.

Another good night's sleep will probably help her to feel better tomorrow.

(I will leave it for her to tell the story)

 

[Jean]

Jo has another night in hospital and all being well discharge tomorrow.



....................................................................

 

[Jean]

Had a call from Jo just over an hour ago but unable to reply as my netbook and laptop are being repaired at the moment. So have dusted my desk-top and switched it on.

She was in the waiting room for an ambulance to taxi her home. The trouble with this arrangement is that they don't give any specific time and you just have to sit and wait until one becomes available. She might even be already home as I type this.

I am sure there will be a post on here very soon, after she has had a nice uninterrupted doze. Funny how when you settle down for a snooze in a hospital bed somebody always comes to ask something, do your BP etc.

 

[Josephine]

Finally and at last - here I am! Thank you everyone for your good wishes and encouragement - it's meant such a lot. Jean has kept me posted.

So you all know me pretty well by now so will also know that I don't post insignificant posts!

Here's my tale ....

Arrived at the hospital at 12:30pm and had a short wait before being taken up to the pre-op admissions suite. I am very impressed with the new arrangements at Sunderland Royal Hospital (D level theatres but more on that as I go.

Was taken to a small room to be admitted and changed into my op gown. Here the admitting nurse, the registrar, the anaesthetist, the ODP (operating department practitioner) and the surgeon came to see me, each checking details and giving me their own bit of spiel! The surgeon came back a couple of times because, since I was first on the list, he wanted to get on and was getting irritated by the delays.

So eventually I was taken through to the 'block room' where it seems all the blocks and epidurals for the department are done which was quite reassuring as you then knew they did nothing else. However the lady doctor who actually did it had a little difficulty and when I heard her ask for a 'longer needle' I had to laugh and say "No kidding!".

So spinal successfully accomplished, they then injected a large amount of lidocane into the back of my knee. The consultant told me was a new procedure as evidence had shown that most of the pain experienced post-op appeared to be from there. Ah well, can't argue with that! Then they did the femoral nerve block. Both these procedures were totally pain free because, of course, they were done in the area that was numb from the spinal. All three were very effective.

I was then wheeled into the anaesthetic room where a nurse came and catheterised me (at my request) and that's when I must have been given the knock-out stuff as the next thing I knew I was in recovery!

Sorry, I just took some pain meds and am now so sleepy I can't continue with this just now.
Next instalment later!

 

[Ellejay]

Welcome home Josephine, I hope you feel better now you are in control.

 

[Josephine]

Oh I do, I do! So much nicer to be rid of those bossy nurses who have always got something else for you to do!

Part 2 - the surgery:
His nibs told me it was pretty much of a replay of #1 except he had to put in a patellar button as there was quite a bit of wear in mine. That's perfectly okay with me - I'm of the proactive mentality and would much sooner treat that now rather than later.

Was cold in recovery so had a hugger blanket which is really, nice plus foot pumps to do the anti-clot thing. Also had a hypo as didn't have any diabetic meds that day but a couple of tubes of glucose gel soon put that right! However, when the nurse asked if it was okay I had to admit I'd sooner have had a Mars bar!

So after visits from several ex-colleagues, back to the ward where I found I had a room to myself! Drainage was moderate but I did get one bag re-infused which was pleasing but sadly it ran too slow and kept getting blocked so I only had about 300 out of 500mls of it. It was very satisfying to have your own product back into your veins! It was also great not having to worry about having a pee on account of the catheter! Had foot pumps on until the next morning.

First night was good with more than adequate pain meds. Had oxycontine 10mg SR twice a day and could have oramorph 10mgs every hour. Prety good I'd say!

Now feeling drowsy again - so will be back in a while

 

[Hoppy Nanny]

Great news Josephine...glad you are home and ready to start your recovery. Looking forward to your next instalment...Chrissie x


Sent from my iPad using BoneSmart Forum

 

[referee54]

It is great to read how up-beat you are and that you are at home, recovering!

 

[Lovestoread]

Even though I knew you were out of surgery, I still found myself wanting to read an actual post from you! Glad to hear things went well. Intrigued by the lidocaine behind the knee.....love hearing about new techniques! Rest up and keep us updated when you are able!


Sent from my iPad using BoneSmart®

 

[Josephine]

The lidocaine worked really well. Haven't had any where near as much pain as I did first time around. I believe it's referred to as a popliteal block but don't quote me yet as I shall have to confirm it.

There is probably a leek pie calling your name!

Most likely, Jamie, but my stomach appears to have developed a significant hearing loss!

So here's part 3 of the saga.

I have to say that today I am still feeling weak and wobbly but then I am only 5 days out so hardly surprising! It's just I don't remember feeling it this much at home before but again, I didn't get home until day 10 so also not surprising. But it's amazing how much it can rock your confidence.

So after the op day, the next day was full of busy, busy! Had dressing changed, drain out, foot pumps off and IV and oxygen removed. What a relief! Then the physios came and got me up to walk.

It quickly became apparent that the femoral block had not yet worn off but the physios told me how to cope with that and to be careful not to walk without somebody in attendance. This was fine until later in the evening when I needed to go to the loo. A rather self-important staff nurse came to see to me and after about 4 steps, decided I was perfectly okay to manage on my own and before I could stop her, she left! So I managed the last few steps on my own, fortunately making sure the arms were down on the loo. Having turned and backed up to the loo, I went to sit down and mistakenly tried to put weight on the left leg which, of course, wasn't 'there'. As a consequence, I took a less than graceful and fearsome stumble onto the toilet where, not being properly positioned, promptly deposited my bladder-full on the floor! I was so unnerved, scared actually, I rang for the nurse and waited what seemed like an age for one to come. It was with some trepidation I got up again and back into bed. Later the nurse who had left me came back to get my meds and when I told her about the tumble and boy! did she ever undergo a personality change! She was on the defensive, insisting that the block was 'out' and no longer effective and that the physios had told her I was okay for weight bearing. When I tried to debate the point she got even more incensed and told me she'd been doing this job for 10 years and knew what she was talking about! I told her I'd been doing it for 50 years and one things I'd learned was to listen to the patient first before applying any blanket protocols or rules. I should say the exchange was 'somewhat heated'! Of course, I ended up in tears!

It was a shame because all the other nurses were so sweet and caring and this one spoiled it!

There was also a contretemps with another physio as I prepared to depart. Having been told I could take the cuff home with me, I drained it to pack it in my case and a physio ran across the room and demanded to know what I was doing. I told her and she insisted I was doing it wrong. Puzzled I let her rant on in the hopes she would eventually explain herself but she didn't. I told her I was taking it home and first she said I couldn't, then said it wouldn't be any use to me. I explained I had a bucket at home and she waved the connecting end of the tube at me saying "you don't understand, you have to have the correct kind of bucket with this connector on it". Even though I said I had she still didn't seem to hear me and eventually stomped off muttering "okay, obviously you know best!" I resisted the temptation to say "Yep - sure do!"

 

[Josephine]

Here's some photos of my op - some are on 'spoiler' so if you don't want to see them, don't click!

Here are the foot pumps that emulate the muscle action to reduce the risk of clots, left has a bootee, right has two calf wraps

These are photos someone kindly took for me in theatre!

Femoral jig in place

Spoiler: femoral jig

And the tibial jig

Spoiler: tibial jig

inserting cement in tibia

Spoiler: cement insertion

suturing the wound

Spoiler: suturing wound

 

[vinny]

Josephine I am glad to see that you are home and on your way to recovery...Your presence was missed ....after viewing the photo of your Femoral jig I am glad they did not do that to me....did they? I am kind of hoping the implants were somehow magically installed.... Best Wishes for the speediest recovery and no more tumbles off the loo......

Vinny

 

[Roy Gardiner]

Jo, just think how brave that nurse was to argue with YOU. It's like trying to out-draw Clint Eastwood. Still, maybe she didn't know who you are.

Also had a hypo as didn't have any diabetic meds that day but a couple of tubes of glucose gel soon put that right! However, when the nurse asked if it was okay I had to admit I'd sooner have had a Mars bar!

Back into Education Mode, already.

My medicine helps to prevent HIGH sugar, not low. Low blood sugar AFAIK can be caused the natural way, i.e. by not eating enough, or by overdosing on insulin. I've never heard of lack of diabetic meds causing a low; please enlighten me (I'm a Type 2 taking Metformin and Gliclazide).

 

[Josephine]

I've never heard of lack of diabetic meds causing a low

Well, that's actually correct, Roy. What I get is more of a pseudo hypo really. I believe it's caused more by the gliclazide. I do take quite a high dose, 80mgs twice daily.

 

[Josephine]

Oh yes ..... the shower was brrrrriliant!

 

[kneeper]

I'm sorry you had this bad experience with the one nurse, Josephine.

I had a much better experience with nurses with my 2nd knee. I noticed that my hospital is now MAGNET recognized. Are you familiar with that program?

btw: thanks for posting those OR/theatre images in spoiler. I couldn't help myself and looked at the first one, but didn't look at the others.

 

[Josephine]

That's funny - it's just what sister Jean said - how can a person resist when you see a 'don't look at this' message!
I'm glad some found them informative though.

Been feeling a bit sorry for myself to day. Pain is controlled up to a point but grinding and persistent. I'm taking my meds are per this chart but it doesn't seem to be enough. I shall have to rethink it for the early weeks.

I also got a new connector tube for my Cryo-cuff and was able to get it working finally. Then realised the value of it compared to just ice packs. I also happened upon this article "cryo cuff vs ice packs" which was very revealing albeit it a very small study.

"Pain and swelling, which may lead to inhibition of the extensor mechanism and ultimately a delay in rehabilitation, are common complications of knee arthroscopy. Cryotherapy is the most often used means of decreasing both knee edema and discomfort. A number of methods have been used to provide cold pressure dressings, including ice and elastic bandages. Commercial devices, such as the Cryo/Cuff, also have been developed to provide similar beneficial effects.

This article describes a multicenter randomized study undertaken to determine whether the Cryo/Cuff or the ice and elastic bandage offers the greatest convenience and relief of pain. 102 patients between the ages of 18 and 65 scheduled to undergo knee arthroscopy were enrolled in the study. Postoperatively, the Cryo/Cuff patients required significantly less pain medication than those patients using the ice and elastic wrap.

The Cryo/Cuff patients also expressed a higher level of satisfaction with the effectiveness and convenience of the therapy. There were no differences between either group in the amount of pain reported, or preoperative and postoperative examinations in regard to knee range of motion and thigh circumference. These results indicate that the Cryo/Cuff is a useful adjunct in the rehabilitation of knee arthroscopy patients."

Not bad, eh?