Bilateral TKR La's new knees (recovery diary)

[Larosser]

Re: Tylenol and my poor liver - how much should I worry?

Thanks, everyone. It seems my least favorite nursie is not alone in her fear of Evil Tylenol. It did seem bizarre that she was in such a sweat about something that my surgeon felt was fine. To be fair, I know people who have been on liver threatening NSAIDS for years (my dad, for example, was on Lodine for 12 years) and I understand why people get frustrated with the "prescribe and forget" mentality that leads to that, but this is a completely different situation. And Bonnie: "pain pill police" - yeah. Sure seems like a control thing to me.

Best
La

 

[karmigirl]

Larosser,

Welcome to the other side. So glad to hear every thing went so well with your surgery. Now is the hour to rest and relax so that when you get home you can rest, relax, ice, elevate, take meds by the clock and then do it again the next day. Did mention be PATIENT

The first few weeks will be pretty trying but hang in it will get better.

 

[Larosser]

Re: La's new knees (recovery diary) Hospital life

I woke up in the pit of the first night in the hospital starving and nearly wept for joy when the nice nurse brought me what may have been the best turkey sandwich ever made. It was epic. I ate it, and nodded back out, only to be woken an hour or so later for pain meds (along with graham crackers and juice - YAY!) and then again shortly for vitals. This sort of set the pattern for the rest of my hospital stay - not really sleeping, not really waking, always someone coming to see me for purposes that had about a 50% chance of being pleasant (food, drugs, vitals, PT, etc). I watched a lot of TV on my iPod and am now re-watching some of it since I don't seem to remember it, ate lots of random small meals and snacks and measured and monitored like made. One annoying thing: my blood sugar rose after surgery, and so they pricked my finger several times a day during my stay to monitor it, and kept trying to give me insulin. The frustrating thing is, they wouldn't/couldn't schedule the insulin testing in relation to my food intake, and I'm not sure that a blood sugar reading of 130 an hour after you have orange juice and graham crackers tells you much at all except that you just had a snack full of sugar.

My hospital stay overall was pleasant and pretty uneventful - vitals, food, rehab (more on that shortly), sporadic rest. The rehab coach was pretty firm about not bending your knees in bed. I don't just mean not sleeping on your back with your knees bent over a pillow, he wanted NO intersection of bent knees and bed at all. And heaven help you if you got a pillow anywhere near your knees.

Other than that little quirk, Corey the therapist was pretty stellar. He came to see me shortly after brekkie, sat me on the edge of the bed and made me wiggle my toes, then before I knew it, got one of his buddies to help him get me up and had me take a short walk out in the hall. I was amazed at how well that worked. Not much left of the block and my legs were definitely sore, but honestly, walking hurt less than it had before the surgery. I was using a walker for balance (and I suspect, confidence) but there was no locking, no collapsing, and not a whole lot of hurt. It was hard for me to believe that my legs were actually bearing weight, but there you are! I was pretty stoked, and REALLY glad those gowns close in the back. Oh! Essential accessory for the stylish post op knee patient: gripper socks. Gotta have 'em. Hospital floors can be a bit slick. By the end of the day, I had made it all the way up and down the main post op hall, which I had been told was an essential for being released. Since I was hoping to go straight home, I figured I'd better get that one done right off. An end to end march up and down that hall with a bossy therapist (bend your knee....land with your heel and roll forward....exagerate the step a little, like you're marching...don't lean on the walker, just maintain normal posture [what exactly does that feel like?] and push it lightly along... don't grip so hard, you're choking it....) kind of wore me out, but honestly, I was surprised that it wasn't harder.

 

[Larosser]

Re: La's new knees (recovery diary) My first bad mistake

Okay, so before we get to life at home, I guess I need to talk about the bad part. :hate-shocked: On the evening of post op day 1 I experienced a series of unfortunate events that culminated in a Really Bad Time, and I think I'm still struggling with the aftereffects. I think I should relate them here, maybe someone can benefit from my mistakes.

One of the great things that happened in the afternoon of Post Day 1 was they took out my catheter. I was ready for that! The nurse told me it would be at least an hour or so before I needed to use the restroom, and offered to help me into a chair to sit. My plan was to sit for dinner get up and pee, and then maybe walk a bit and go back to bed in time for my meds. Just as I finished eating, a friend showed up to visit, so we sat and chatted about life the universe and everything - for about two hours. (first mistake - 30 minutes is probably a better duration for your first chair sit.) I noticed how long I'd been there when I started feeling two unpleasant sensations - pain in my knees and a need to pee.

I realized I was now slightly overdue for pain meds, so I called down to request them, and went back to being entertained by my buddy. My thought was that they'd bring the meds, I'd take 'em, wait a few minutes for them to kick in, and then hit the bathroom. Reasonable plan, except that it was almost shift change. I didn't see anyone for almost an hour - a tech who turned up to see if I needed to get out of the chair, but without meds. By now, I REALLY needed to pee, so I decided to just tough it..after all, the pills were only an hour overdue...how bad could it be? I asked the tech if he was gonna call for help to get me up, and he said, nah, it should be fine, and came over to assist. Okay, a few more mistakes here: I hadn't scoped this chair out thoroughly, so I wasn't clear on just how low to the ground it was, or worse, that it rocked. I wasn't completely comfy getting up with one assist, but I figured he knew what he was doing. And I didn't realize just how bad an hour late on pain meds could be.

So the tech came to help me up, I pushed off hard because the chair was so low, lost my balance when it rocked and fell backwards squallling with a pain level of about 10 on this revised pain scale. When McQ got back (he'd run some errands, assuming my buddy and I would be fine), he found me sitting in the chair sobbing that I was not moving untill I'd had my meds and that if it took so long I ended up peeing in their stupid low slung rocking chair, it was their own damn fault.

My dear one immediately began to unravel the situation. I got my meds and some ice, and sat sniveling while he hunted down Corey the Incredible Therapist, who did in fact manage (with the help of an assistance and m DH McQ) to actually get me out of that damn chair before I peed in it. He got me a higher, stable chair to sit in, and actually got me in and out of it a few times to prove to me that standing up from a chair doesn't have to be a train wreck. Intellectually, I get that. But still. Getting out of chairs is probably the hardest thing for me to do, and it's made worse when they are low or unstable, when you don't have a solid something to grab onto for leverage, or when my knees hurt already. Even as well as I'm doing, I've had at least two full on panics when trying to get out of a chair, and every single time, I feel a little fear in my heart. I keep doing it, and mostly it isn't awful, so I am slowly chipping away at that bad memory, replacing it with lots of successful out-of-chair experiences. But still, that sucked. Avoid it if you can. Watch out for low chairs and chairs that rock. Don't let your pain pills get delayed - request them 'way before shift chance. If you're not comfortable with the way someone's helping you, speak up. Don't sit in one position too long - in fact, I'm gonna go move around a little bit.

Best
La

 

[Jamie]

Excellent posts!!! Keep it up....this will help a LOT of people.

 

[Roy Gardiner]

La, fantastic posts, well said.

From the lofty Olympian heights of 4 weeks ahead of you I can identify with everything you say.

My hospital gave me adjustable bed (electronic, dead good, I could whirrrrr it up and down at will) and side chair (that was low tech but still effective) that I could set so high that my feet dangled in the air -- and I'm 6' tall. And for the first couple of days they didn't let me do anything unaccompanied. Looks like you suffered from a bit of bad luck in that respect

For those reading this who've not experienced it, the pain of getting up from a chair (applies to the lavatory, too) is NOT in the knee joint itself. It's from the force going through the tissues around the knee as the quads tense to try and get you to stand. Once you're up it's pain free, even in the first few days after surgery.

Helps are (a) as stated, high chairs (you can get risers for the toilet seat too, and should IMO) (b) help from staff and (c) using your arms to push yourself up.

A good preparatory exercise is to sit in an office type chair with arms and simply lift yourself up using arm force only.

 

[srn]

Very informative and interesting report. Welcome to the other side.

 

[Jazyb]

Brilliant and informative report La. This will be so helpful to everyone. Good luck with your recovery

 

[Josephine]

Re: Tylenol and my poor liver - how much should I worry?

La, I just saw your signature and had a good chuckle. I thought perhaps it could do with a tiny rewrite like this

Carpe that niem - just not too hard!

 

[goodasnew]

Welcome to Bonesmart La, that's a lot of information, how did you manage to get all that down and make sense so soon after surgery!!! I remember being very mentally challenged at your stage! You've learned a very important lesson already - take your meds by the clock around the clock!

Look forward to hearing more about your recovery.:rolleyespink:

 

[paulette]

I am one week today from my bilateral tkr - Jan. 26. What would be your best advice to me both before and right after surgery now that you are on the other side as they call it. Would love to hear from you.

 

[Roy Gardiner]

Before: don't worry
On The Day: nothing to worry about, you will be unconscious for the surgery and in a happy place afterwards
Next Few Days: relax, enjoy hospital as much as you can (watch telly maybe), they will look after you.

 

[kneeper]

Thanks for posting your story, Larosser.

 

[grabbit97]

Your story is amazing... thanks for posting, it will help lots of others in the flight to no pain.

 

[Larosser]

Thanks to all for the encouragenment.

Goodasnew writing is one of my hobbies so I tend to jot down notes and then later put together stories - I promise, this is not how the initial notes look.

Roy, thanks for the important assist: if there is one thing I would like to stress to everyone on the road to TKR: my knee joints already feel better and work better than before the surgery. My quads in specific endured some heinous insults during surgery and my legs overall took a beating but this is all temporary and will heal. My knees are already much better.

Paulette Roy gave you good advice. Try not to worry All you have to do is show up and let the professionals handle it. Here are some things that helped me before surgery:

- Live clean, eat healthy, take it easy on yourself. I worked out right up until surgery, but did not push too hard. I ate tasty, healthful food but did not count calories. I didn't consume anything (including alcohol) that had the potential to make mefeel icky. I slept as much as I wanted.

- Face your fears. If you are worried about the anesthesia, or post surgical pain, or whatever, talk to someone about it, either just to vent or to get info. For myself I was kind of weirded out by the thought that they were "replacing my knee" (what part do they cut out? Where does it go?) and it actuall did me good to look at photos ad video of the surgery and see that what they are really doing is resurfacing the knee. Not saying that's for everyone, just suggesting that what ever is bugging you, deal with it. Don't spend all of your pre-surgery time fretting.

During surgery, nothing for you to do.

After relax and let folks care for you. If you have a friend or family member who is will hang out at the hospital and advocate for you, that's great. Use 'em. Be very clear with the nurses, techs and other health professionals about how you feel and what you need. Talk with your doc and understand what his or her expectations are, and don't let the one weirdo on staff (it seems there is always one....) to derail you.

Anyway, back to my notes. I want to catch up to present day so I can start posting real time!

 

[Roy Gardiner]

Here are some things that helped me before surgery:

- Live clean, eat healthy, take it easy on yourself. I worked out right up until surgery, but did not push too hard. I ate tasty, healthful food but did not count calories. I didn't consume anything (including alcohol) that had the potential to make mefeel icky. I slept as much as I wanted.

100% apart from the one thing there; I just tipped it down:cocktail_martini::cheers_wine:

 

[Dawni]

Hi La
thank you for your mail, i will be having my TKR on the 28th it helps to read your input day by day you are a good writer keep them coming please, what meds have you been on. x

 

[Larosser]

Re: La's new knees (recovery diary) Things they make you take

So, before I move on to leaving the hospital, I was surprised at how many things they want to put in your body at the hospital. I was taking almost no meds before hand so I'm not used to all of that. For your info, here's a laundry list of the stuff they wanted me to take and why. Hopefully smarter folks will correct any of my errors.

Norco (Hydrocodone and tylenol) This was my main pain med. I took a ton of it, two at a time, every three to four hours. I ended up taking more tylenol than I ever have just riding along with the hydrocodone. There are other versions of hydrocodone that have ibuprophen instead, but I think the start with this one because acetometaphin (tylenol) doesn't decrease clotting.

Morphine They would stick morphine in my IV to help manage pain when needed. The best thing I can say about it is that it acted fast. I am not sure it really controlled the pain, maybe just made me so googly I didn't care. The nurses encouraged me to take it at night, saying it would help me sleep. Not sure about that, but it did tend to make me shut up, which they may have enjoyed.

Torodol NSAID and pain relief. This worked pretty well on inflamation, and was sometimes more effective than Norco when my legs would just ache from ankle to thigh.

Taladine GERD inhibitor I don't usuall have GERD, but they seemed to want me to take it, and it didn't seem to hurt anything.

Inoxoparin Sodium This is a shot they give you in your belly to prevent clotting. I was appalled when I head that...the only experience I had with belly shots was a rabies series, and those HURT. These weren't nearly as bad, although my tummy is covered in bruises - looks like someone's been poking me with a cue stick. They sent me home from hospital with ten more of these, oh, joy! Good news is, no blood clots.

Iron Makes sense. Lots of blood loss with this surgery, so you need to get that iron count back up.

Whole Blood My overall blood count was down after surgery (no surprise) and didn't bounce back, so the day before I left, they gave me two units of whole blood. I wasn't thrilled with that idea, but could see that it was necessary. Blood pressure was low, blood count dropping every day, I was weak as a kitten, lightheaded and could fall asleep while chewing a bite of food. So we went for it. Two units of blood took about six hours to get onboard. It's easy to get cold during this process (the blood is slightly chilled) so the wrapped me up like a mummy

Benadryl They gave me a dose of this prior to the blood transfusion, to prevent itching. It also knocked me smooth out. I missed the whole first unit.

Insulin I didn't actually take any, but they brought up the subject several times. I am not diabetic (this is why I'm glad I had the physical) but my sugars were elevated right after surgery, and they pricked my finger three times a day to follow up. At least once a day, it would be high (ref: graham crackers and orange juice) and the hospital doc would suggest a round of insulin. I've never had insulin in my life, and neither my OS or my PCP thought it was necessary, so I declined.

My main take away from all of this is: they are going to want to put a lot of things into your system. Make sure that and drug allergies are known and noted. If you have any preferences about meds, speak up. If something seems like a bad idea to you, you can decline. If your primary doc isn't going to be seeing you in the hospital, you might have a chat withi her in advance about these classes of meds and others that seem likely to come up. It's good to have some idea in advance what you may be called on to decide.

 

[karmigirl]

La,

Thanks for the great diary report, I just can't believe you can be so coherent at this point notes or not. I would have forgotten what my notes meant. Please keep your reports coming they should be very helpful to all those going into the surgery.

One thing I would like to add is when in hospital and you are being given your meds ask what everything you are getting is and what it is for. As La said you can refuse anything you don't want to have but you must speak up for yourself.

 

[Josephine]

Re: La's new knees (recovery diary) Things they make you take

Norco (Hydrocodone and tylenol) This was my main pain med. I took a ton of it, two at a time, every three to four hours. I ended up taking more tylenol than I ever have just riding along with the hydrocodone.

La, you do know the daily maximum for Tylenol, don't you? It's 4,000mg per 24hrs.