KNEE REPLACEMENT DIARY: DAY TWO

Two weeks before his surgery, Odel and I attended a two and a half hour long class about knee and hip replacement, offered by Sutter General Hospital.  Among the many aspects of the surgery covered in this useful class, there was much emphasis on the importance of pain management.  They introduced us to an easy to remember pain management graphic illustrating the 0 to 10 scale of pain.

A smiley face represents Level Zero – no pain.  Around Level Four – starting to hurt consistently, but still manageable – the smile turns into a flat line… pain is intruding into well-being.  By Level Eight, the expression is quite dismal and at Level Ten, all hell has broken loose – big frown with copious tears.

Ideal pain management means taking another pill as you approach level Four, the flat-line mouth.  EVERYONE stresses the importance of staying “ahead of the pain”, which allows you to take LESS pain medication and to participate fully in rehabilitation, which begins the day of surgery.

When I called Odel at 7 am the day after surgery, with the help of Norco (a no doubt addictive pain killer), his pain level was One, almost non-existent.  Good news! 

I arrived at room 4101 around 10 am, practically running into Ron Ulm who was wrapping up another visit to Odel (Ron works at Sutter).  Odel had already been seen by Dr. Bargar (surgeon), Dr. Tak (primary care physician), and Brian, Dr. Bargar’s assistant.  As I took a seat, in walked Douglas, the physical therapist.  No rest for the weary (which Odel was, after being awakened every two hours during the night) - time to get to work on therapy again!

Both of Odel’s legs were wrapped in long, pulsing sleeves that help prevent blood pooling and clots.  Doug removed the sleeves and got to work bending and straightening Odel’s leg.  Both Odel and Doug moved slowly, their faces reflecting concern over possible pain… which never materialized.  Before long, Doug had Odel sitting on the side of the bed, and soon he was up, walking slowly around the room with his walker.

Once again, Doug emphasized range of motion and the importance of exercising the knee to improve its range.  Walking, other than “functional walking” (as opposed to recreational walking), is discouraged because it promotes swelling, the enemy of range of motion.  Sitting around with bags of peas on and under the knee to fight swelling is good; going for a pleasure walk in the springtime sunshine is bad. 

Doug introduced us to the goniometer, a little plastic gizmo that measures the angle of bend in the knee, and was impressed to find that Odel could already bend his knee at a 92 degree angle.

After practicing with his walker, Odel sat in a chair while we talked with Doug about living in an RV, favorite places (Doug is very interested in paranormal activity, and entertained us with a few stories of strange encounters while staying overnight at the Copper Queen Hotel in Bisbee), and the problems we might encounter when Odel comes home (currently anticipated to be Wednesday afternoon).

When the work was finally done, Masial, the nursing assistant from Panama, arrived with a warmed pack of wet wipes and I was able to give Odel a sponge bath.  We pulled the curtain across the entry and got to enjoy some private time.  It felt good to me to do something useful and intimate, and we both laughed over the moaning noises Odel made as I scratched his back with fingernails wrapped in a soft, warm wet wipe.  After he was dressed in a fresh hospital gown, Masial returned to change the sheets on his bed and he brushed his teeth.  At last, he was presentable for his photograph.  :)

I took off to continue preparing for his return (mainly, setting up a place for him to sit with the kind of easy access and support he needs).  Our good friend Becky took Odel a Diet Pepsi (for which they share a fondness), and calls came in from various friends.  Douglas returned for the afternoon therapy and exercise session and the goniometer showed an improvement, from 92 to 95 degrees.  When I called at 4 pm, Odel sounded groggy – he told me he was just drifting off to sleep, very difficult to come by in the busy hospital environment.  

So far, only one aspect of his care has been less than optimal: the hospital food!  Breakfast was cream of wheat (which Odel hates), dry (overcooked) scrambled eggs, a slightly warmed English muffin, apple juice and milk.  No fruit, fresh or otherwise.  Lunch was an open faced turkey sandwich with mashed potatoes and gravy and – finally – some steamed vegetables.  Where are his minimum five fruits and vegetables each day?  When I pulled out an apple to eat while I visited, Odel’s eyes grew big, round, and expressive.  Something fresh, juicy and crunchy!  We shared it, and I’m gonna take some REAL food on my next visit!

KNEE REPLACEMENT DIARY: DAY OF SURGERY

Knowing you need to be out of bed at 4 am for an early morning trip to the hospital is not conducive to a night of sound sleep.  We both tossed and turned for most of our short night; it was rather a relief to get out of bed and get our long day started.

While Odel took the last shower he will be allowed until 24 hours after his staples are removed (which will be a week to 10 days), I had a quick breakfast.  Nothing for Odel – his last food and drink was prior to midnight.  At 4:45, we stepped outside into darkness and drove the short distance to Sutter General hospital (usually a 10-15 minute drive) on roads eerily empty of commuters.

5 am: Check in time.  After a brief wait in the main lobby, we were escorted upstairs to the joint surgery unit, to join another half dozen patients and their caregivers in a smaller lounge.  One by one, the patients were called, and soon it was Odel’s turn.  After he was prepped for surgery, I joined Odel where he waited on his gurney.

Between 6 and 7 am, Odel was questioned, wired to machines, and outfitted with a thicket of needles and tubes.  The big toe on his left foot was marked with a big black dot that meant “work on this side”.  Nurses came and went; the entire suite of ten curtained cubicles was a beehive of pre-dawn activity. 

Around 6:30, Dr. Mystery (that IS his name, but I think it might be spelled differently), the anesthesiologist, arrived.  He confirmed information gathered about Odel over the past two weeks of medical tests and consultations, and explained which anesthetics he planned to use: a spinal block to eliminate all feeling in the lower extremities and a light sedation that would allow Odel to respond without being totally conscious.

6:50 am: Dr. Bargar arrived to visit with us, mark Odel’s left knee with a special pen, and give us the chance to ask any last minute questions.  We both were feeling as confident as possible, and Odel was ready to get the surgery behind him.  At 7 am, the nurse rolled Odel down the hall on his gurney, and I went in search of the surgery waiting room, where I would learn the news once Odel’s surgery was finished.

Once I knew where the waiting room was, I headed back to the car and home for breakfast and a shower.  Two hours later, back in the waiting room, Dr. Bargar arrived with fresh X-rays and the EXCELLENT news that he did a partial (medial) replacement, along with the removal of a bone spur and a “kissing lesion” under Odel’s kneecap.  As he has done each time we have met with him, Dr. Bargar consulted as though he had no other place to be, as if Odel was his only patient and he had all the time in the world to answer questions.  After he had answered all of mine, he advised me to take advantage of Odel’s recovery time to take a walk outside to enjoy Sacramento’s beautiful spring day – good advice that I promptly took.

As I stopped in the parking garage to pick up Odel’s hospital bag after my walk, my phone rang: Odel was in his (private!) room* and wondered when I’d show up!  Ten minutes later, there he was, groggy but smiling, in no pain.  Let the healing begin!

The remainder of the day crept slowly by.  I met Odel’s nurse and nursing assistant, both in and out of the room constantly, adjusting machinery, making sure he was comfortable and doing his jobs: “paddling” his feet frequently as feeling returned (to keep the blood moving) and deep breathing into a plastic doo-dad that measures his lung capacity (to keep fluid out of his lungs).  Before long, Odel made me breath into it, too – so he could glory in his ability to take a deeper breath than I can.  That guy is SO COMPETITIVE!  I can see that keeping him from overdoing his walking during recovery will be a challenge.

In mid-afternoon, I went home for a much needed nap.  While I was away, the physical therapist arrived for the first workout: sitting up on the side of the bed, standing in the safety of the walker, and taking two steps in each direction.  Odel’s first visitor, our good friend Ron Ulm, stopped by with magazines for Odel, and I returned in time for Odel’s first solid food, a dinner of soup, a pathetic looking hamburger, and a piece of cake.  He gobbled it down while the nurses worried that he might throw up… I can see they don’t know Odel.  :)

I left at 6, when the final matchup of March Madness came on.  Odel looked happy and drowsy in his bed, in full control of his TV remote.  It couldn’t have gone better.   As of 7:30 pm, when we talked on the phone, he had experienced NO pain, even as the spinal block dwindled away.

Now the real work begins!

* When I asked Michelle, Odel’s nurse, how he happened to score a private room, she said that Monday is the best day to schedule your surgery – most of the rooms empty out over the weekend, so those who have early surgery on Monday morning has a good chance of a private room assignment.  Good to know.

ALL READY TO GO!

The classes, the checklists, the doctor visits, the vials of blood drawn and analyzed… the X-rays, scans, tests… it’s all done.  Odel has pre-registered for the hospital admission, which is scheduled for the gawd-awful hour of 5 am tomorrow.  His bag is packed, checked, and double –checked.  He has watched the DVD we received from the hospital, and we’ve gathered the equipment we are most likely to need (and that fits in an RV).

Latest word from the surgeon, after the most recent X-rays, is that a partial knee replacement is a good possibility, with fewer days in the hospital and a faster recovery schedule – welcome news.  Pre-surgery instructions call for a shower tonight, and one tomorrow morning (which means 4 am to make that 5 am admission!) with special attention to his feet (bacteria removal)!  No food after midnight. 

We took a leisurely walk along the levee in the sunshine today; Odel couldn’t stop hamming it up when I wanted a photo.  He is in good spirits, ready to get this over with.  It will be so nice this summer to be able to walk pain-free!

P.S. (edited at 4:22 am as we get ready to leave for the hospital): In a burst of true love and dedication, I learned how to dump the black water tank!  No crawling around on his knees for awhile… :)