United StatesHi all
Occupational therapy provides a wirelss intenet connection so I thought I would check in with everyone.
Surgery was June 3rd and what could go worng did.
Started off ok though convencing the anesthiologists I did not want sedation did take a bit of doing. The guy who put in the femoral block had the same thought.
The femoral block was ok, he just had problems locating the nerve as due to the previous surgeries alot of the nerves had bee cut .
The anesthestist was great. She rearranged some of her equipment and pushed the drape back so that I could see the computer. It was really interesting. They places these little markers in several parts of the leg and they use a wand which takes the readings off and you see on the screnn the knee being bulit, where all the areas are and where the implant should go. They they move the want around till it is all in alignment. The left one was not too bad looking, the right one was another story.
The doctor started with the left one, I thought he did that as it would be the easier of the 2, he told be later it was because he it harder as a right handed surgeon to maniulate the computer for the left side. Things appeared to go pretty smooth and it took abut 70 minutes. to get the implant in. Then we went to the right and he told me on Tuesday night if he had started with the right he would have never replaced the left that day as the right took so much work and much longer that he had planned. You could tell the OR staff was getting nervous as the anestetist started calling out the toriquent time. It took about 1 hr and 40 minutes to get the implant in and another 20 or so to close but they could do that without the turniquet on. You could hear alot of talk going on and mumbling which I am sure was closer to swearing.
The doctor stopped in today (Sunday) and said it was like doing a revision. Nothing was where you planned on it, the space was really tight, the previous movement of the patella tendon and the bone graft were major trouble. He told me on Wednesday that when they were trying to get the tibia portion in alot of force was required and he ended up with a compressed fracture of the tibia. Luckly it was not the whole bone and it is on the same side as the nonuinon foot fracture. It means I can only put 50% body weight on the right side for awhile.
Also there was alot of brusing and bleeding and my calf and knee are about 3 times the size and the thigh about 2x. The problem is the calf is so tight it is like a 24 hour cramp and trying to do things like quad lifts are close to impossible. Good thing that side is only 50% weight bearing as I can barely get my foot down.
Don't let the above scare anyone as I am sure none of you have knees in that condition.
Surgery went 4 hours and a few minutes, an hour longer than planned.
I though since I had no sedation, I wuold be out of recovery in an hour or so. Well I was fine when I arrived, 100 % saturation. Then I took a few ice chips as I was so dehydrated. (The anestitist had not started drinking out of her bottle during surgery so a couple of times, she did wet a gauze pad and wipe the tounge). Well that started nausea of major portions which only got worse as the spinal wore off. They were trying every antiemetic in the book and finally had to go from intravenous to direct injections. About 2 hours in the lab work came back and the numbers were in the pits even though bleeding was not bad. They started to infuse the 1st unit of blood from the cell saver and the blood pressure also bottomed out. I was in recovery for 6 hours before they got things under some control. Once in my room, they infused the 2nd unit from the cell saver. Needless to say, I was not up that day.
The femoral block really did not to much except make by leg very dead. The next day that started some IV pain killers and in a couple of hours I was bright pink. full of hives and itching like crazy. Good thing bendryl worked pretty quickly but it did wipe me out. Since they had been using a wide number of things it took awhile to decide it was the Ocycontin. Though there is an outside chance it was the antibiotic.
On Wednesday the blood pressure was still in the pits and they said I was as white as the sheets, so since I had done autologous transfusions, they infused those 2 units back. So I finally started getting color back. Pain control was hard as nothing seemed to work they used a combination of IV and oral. Finally seems Delauide (not spelled right) works enough, I just have to stop waiting too long to take it. So on Wednesady I got up from the bed and took a few steps to the commode and later on we actually made it to the bathroom. No hallway walks for me. I have been spending 6 or 7 hours a day on the CPM. On Wednesday, the rehab nurse and case manager started working on the insurance company as they said there was no way I could go home in 4 days with all the complications.
On Thursday they finally got the insurance comapny ok for inpatient rehab. I had to tell them to get the company on the case as we do have coverage in extreme cases. I was suppose to move up to the rehab floor on Thursday afternoon but the calf was so sore they wanted to run a doppler to make sure there were no clots. Of course the machine was down and by the time they got it up it was too late in the day. I did manage to walk to the nurses station about 100 steps in all. I was also doing the standby leg exercises
On Friday, I talked with the rehab doctor so they could get a plan in place, then waited for the hospitalist to clear me off the surgical floor. Well around 2:30 pm (they called him at 8 am) he called and said he would clear it on the rehab floor. So on Friday afternoon, I was set up on the rehab floor and started meeting with PT, OT and everyone else.
The OT people really have some neat little toys, the leg loop is great as you can use it pull up your leg. The socker putter on also is great though it still is a bit hard with the TED stockings. The best was on Saturday when I could take a shower and wash my hair. They have all the stuff to protect the incision so you can do it. Getting in and out of the shower was a bit tricky as they really need more room for the wheelchairs and walker. This is a 12 bed rehab unit and there are 9 people on it. They have all your stuff marked and customized for you, like putting on extension rods on the wheelchair lock. Today It was alittle easier get out of bed, it is the part of getting the feet down on the floor that is really hard but everyone is patient and lets you go at your own speed. They scheduled PT/OT for 3 hours a day and have the rehab nurses doing things during the day.
I will be on the rehab floor for at least 7 days but more likely 10 days.
Well please don't get any of you worried, I am just one of those people who Murrphy likes.
Good luck to all you.
Simon
Vermont
Occupational therapy provides a wirelss intenet connection so I thought I would check in with everyone.
Surgery was June 3rd and what could go worng did.
Started off ok though convencing the anesthiologists I did not want sedation did take a bit of doing. The guy who put in the femoral block had the same thought.
The femoral block was ok, he just had problems locating the nerve as due to the previous surgeries alot of the nerves had bee cut .
The anesthestist was great. She rearranged some of her equipment and pushed the drape back so that I could see the computer. It was really interesting. They places these little markers in several parts of the leg and they use a wand which takes the readings off and you see on the screnn the knee being bulit, where all the areas are and where the implant should go. They they move the want around till it is all in alignment. The left one was not too bad looking, the right one was another story.
The doctor started with the left one, I thought he did that as it would be the easier of the 2, he told be later it was because he it harder as a right handed surgeon to maniulate the computer for the left side. Things appeared to go pretty smooth and it took abut 70 minutes. to get the implant in. Then we went to the right and he told me on Tuesday night if he had started with the right he would have never replaced the left that day as the right took so much work and much longer that he had planned. You could tell the OR staff was getting nervous as the anestetist started calling out the toriquent time. It took about 1 hr and 40 minutes to get the implant in and another 20 or so to close but they could do that without the turniquet on. You could hear alot of talk going on and mumbling which I am sure was closer to swearing.
The doctor stopped in today (Sunday) and said it was like doing a revision. Nothing was where you planned on it, the space was really tight, the previous movement of the patella tendon and the bone graft were major trouble. He told me on Wednesday that when they were trying to get the tibia portion in alot of force was required and he ended up with a compressed fracture of the tibia. Luckly it was not the whole bone and it is on the same side as the nonuinon foot fracture. It means I can only put 50% body weight on the right side for awhile.
Also there was alot of brusing and bleeding and my calf and knee are about 3 times the size and the thigh about 2x. The problem is the calf is so tight it is like a 24 hour cramp and trying to do things like quad lifts are close to impossible. Good thing that side is only 50% weight bearing as I can barely get my foot down.
Don't let the above scare anyone as I am sure none of you have knees in that condition.
Surgery went 4 hours and a few minutes, an hour longer than planned.
I though since I had no sedation, I wuold be out of recovery in an hour or so. Well I was fine when I arrived, 100 % saturation. Then I took a few ice chips as I was so dehydrated. (The anestitist had not started drinking out of her bottle during surgery so a couple of times, she did wet a gauze pad and wipe the tounge). Well that started nausea of major portions which only got worse as the spinal wore off. They were trying every antiemetic in the book and finally had to go from intravenous to direct injections. About 2 hours in the lab work came back and the numbers were in the pits even though bleeding was not bad. They started to infuse the 1st unit of blood from the cell saver and the blood pressure also bottomed out. I was in recovery for 6 hours before they got things under some control. Once in my room, they infused the 2nd unit from the cell saver. Needless to say, I was not up that day.
The femoral block really did not to much except make by leg very dead. The next day that started some IV pain killers and in a couple of hours I was bright pink. full of hives and itching like crazy. Good thing bendryl worked pretty quickly but it did wipe me out. Since they had been using a wide number of things it took awhile to decide it was the Ocycontin. Though there is an outside chance it was the antibiotic.
On Wednesday the blood pressure was still in the pits and they said I was as white as the sheets, so since I had done autologous transfusions, they infused those 2 units back. So I finally started getting color back. Pain control was hard as nothing seemed to work they used a combination of IV and oral. Finally seems Delauide (not spelled right) works enough, I just have to stop waiting too long to take it. So on Wednesady I got up from the bed and took a few steps to the commode and later on we actually made it to the bathroom. No hallway walks for me. I have been spending 6 or 7 hours a day on the CPM. On Wednesday, the rehab nurse and case manager started working on the insurance company as they said there was no way I could go home in 4 days with all the complications.
On Thursday they finally got the insurance comapny ok for inpatient rehab. I had to tell them to get the company on the case as we do have coverage in extreme cases. I was suppose to move up to the rehab floor on Thursday afternoon but the calf was so sore they wanted to run a doppler to make sure there were no clots. Of course the machine was down and by the time they got it up it was too late in the day. I did manage to walk to the nurses station about 100 steps in all. I was also doing the standby leg exercises
On Friday, I talked with the rehab doctor so they could get a plan in place, then waited for the hospitalist to clear me off the surgical floor. Well around 2:30 pm (they called him at 8 am) he called and said he would clear it on the rehab floor. So on Friday afternoon, I was set up on the rehab floor and started meeting with PT, OT and everyone else.
The OT people really have some neat little toys, the leg loop is great as you can use it pull up your leg. The socker putter on also is great though it still is a bit hard with the TED stockings. The best was on Saturday when I could take a shower and wash my hair. They have all the stuff to protect the incision so you can do it. Getting in and out of the shower was a bit tricky as they really need more room for the wheelchairs and walker. This is a 12 bed rehab unit and there are 9 people on it. They have all your stuff marked and customized for you, like putting on extension rods on the wheelchair lock. Today It was alittle easier get out of bed, it is the part of getting the feet down on the floor that is really hard but everyone is patient and lets you go at your own speed. They scheduled PT/OT for 3 hours a day and have the rehab nurses doing things during the day.
I will be on the rehab floor for at least 7 days but more likely 10 days.
Well please don't get any of you worried, I am just one of those people who Murrphy likes.
Good luck to all you.
Simon
Vermont
