Tuesday, September 29, 2009
My husband is still recovering from the total replacement of his left knee, and already, less than four weeks out, we can see years of pain and limitations begin to peel away. This surgery is a blessing.
But it is also a challenging recovery. The meds today can address the pain, but the patient needs to do the rehab, or the surgery will gain them little. The therapy, the work required to return your range of motion, and to unlearn old habits created by babying the bad knee--limping, walking crooked or bent legged, climbing stairs at odd angles. You nay not even realize the extent of the modifications you made, but in our case, my husband's back is straighter, he regained an inch of his previously-stooped height, his back pain has already decreased and his other knee--the one scheduled for a December surgery, is nearly pain-free because it is no longer bearing the majority of the work and weight. This is not unusual.
We know we had an outstanding surgeon. He had saved two of our sons whose legs had extensive trauma--one from disease and one from a devastating car accident. We knew going in that Tom was in excellent hands. And having seen many other knee replacement patients at the hospital, and now in therapy, we know all surgeons and surgeries are not equal. We've learned a lot, and we're sharing advice with patients considering this procedure.
1) Get referrals on surgeons. Even ask to see some photos of knees your prospective surgeon has done. Tom's scar is very narrow, straight and only a quarter of an inch deep. In some places it is nearly invisible. This is important not only for appearance. A neat, straight, thin scar means less scar tissue, and that will translate into easier therapy, less pain, quicker return of range of motion.
2) Make sure the hospital has a great orthopedic reputation. Post-op nursing care and in-house therapy is critical. Tom had his surgery at a small, community hospital but their reputation for ortho was excellent and his care proved it. The nurses and therapists were patient, caring, positive and skilled. His comfort was paramount, and they moved, shifted, medicated, cheered and challenged him to move--all with personal kindness. As a result, he worked hard, left the hospital leaps ahead of the curve, and maintained a great attitude--two critical components of this rehab.
3) Attend the pre-op surgery classes. If your hospital doesn't have them, ask for some pre-op consultation.
4) Get a pre-op home evaluation-This is the main thing I want to address and the one area that left us feeling completely unprepared. Some of these issues may seem indelicate, but the personal issues are the ones that create the greatest anxiety back at home if the patient can't be independent, so prepare, prepare, prepare.
5) First, what vehicle will you bring the patient home in? His or her leg will only be able to bend slightly, and they will be fearful of any bump. If they're an average-sized person, they should be able to slide into the back seat. But if their mobility is limited, or if they are tall or large, be sure you have a vehicle that will accommodate their total seated length.
6) Check your doorways. What size walker will the patient need? Will it fit through the doorways? Tom's wouldn't, and from the first minute, we had new stress and the fear of pain while struggling to get him through the hall, bedroom and bathroom doors.
7) The toilet trauma-Your patient will have a difficult time rising from a seated position. There are toilet risers that add a few inches to the seat, making rising more comfortable, but the construction of this riser leaves little space for attending to personal hygiene, and that will be a huge concern to your patient. We actually had dear friends who installed a handicapped or tall toilet with an elongated bowl. The rise took pressure off his knees when he sat and when he rose, the elongated bowl allowed him complete independence, and handicapped hand-holds were also installed on the wall opposite the toilet giving him him stability.
8) Have a comfortable, firm, high-backed chair with a tall seat and an ottoman. Again, rising is a painful effort in a low chair with a soft seat, and the leg needs to be elevated.
9) Have a good bed at the ready, because when your patient isn't in his chair, he will be in this bed. The mattress needs to be comfortable, and if you can get a bed that elevates, that will be a blessing. It will make transfers in and out easier and will provide some variety in positioning him since he'll be in here most of the day for the first two weeks.
10) Get the right tools--a sock putter-on-er,( ask the nurses), a grabber to reach for little things, a leg-mover, (again, ask your nurse), a sturdy, adjustable cane, comfortable exercise clothes and sturdy shoes for therapy.
11) Stay on top of the pain. It's a tough balance, not medicating in anticipation of pain while not getting behind. Catching up is agony. So maintain a regimen and start extending the periods between meds a little while the patient feels comfortable.
12) Take pain meds a half-hour before exercise or therapy. The caregiver will need to have good hands to massage the knee and the scar daily.
13) Ice, ice baby. . . We used frozen vegetables a lot because they're convenient and they pack nicely around the curve. Ice under and over.
14) Push the water. Drinking water helps flush the post-surgical body and will help reduce swelling.
15) Report any and all meds and supplements you are taking. Some OTC supplements can interact with blood-thinners which the patient will likely be on for two weeks. Even certain green leafy veggies can interfere, so report, ask questions and listen.
16) Prepare to lay low. The advice given to my husband--a man who makes his living traveling--is no driving or sitting for more than an hour at a time without a break and some walking, and no flying for 8-12 weeks. Previous health history will affect these times, but listen. They're trying to prevent blood clots.
That's about it. It sounds like a lot, but being prepared will take so much stress off the patient and the caregiver.