Friday, May 13, 2011

Joint Replacement Update - Recovery by the Numbers

It's my second time around and I am thinking recovering from joint replacement surgery is a numbers thing.  My corner of the world has gotten smaller and everything in my small world is associated with a number.  So here goes:

0 (zero) --- The degree the surgeon and therapist wants my knee to be when lying on a flat surface - that is the back of the knee touches the surface and can be measured at zero degrees.

1 ---  Times per day to take oxycontin and Celebrex although I reduced that to zero once I had experienced the side effects full on......dizzy is one thing, full blown shivers and itching like I'd been in poison ivy is another.

2 --- Times per week the health nurse comes to draw blood to test the warfarin/coumidin levels and there is a corresponding 2 times per week that the pharmacy calls to advise of the number of pills for the next dose of the far, 3 pills 1 time per day.

3 --- Times per week the physical therapist comes to do the official therapy and exercises. This is not to be confused with the 2 times per day that I am supposed to do the exercises on my own.

4 --- Miligrams per dose of dilaudid I can take for pain as needed,  Or, is that 8 MG in up to 4 pills...will have to ask my trusty care-giver on that one.  (I have to say that I would be lost without my wonderful husband who it turns out is an excellent care-giver.  He keeps up with all the details, keeps up with the chores and meals, helps me in/out of bed, and keeps me sane.  I feel nothing but sympathy for those who have to go to a rehabilitation center after surgery or who do not have someone close to them to help with the recovery.  This is a hard thing to go through alone and I am so blessed to have a wonderful husband here to help me. He is, of course, number 1.)

4 --- Four (4) is also the pain number that the doctors say is the pain management thresh hold.  On a scale of 0-10 with 0 being no pain at all and 10 being totally intolerable and excrutiating, they figure 4 is a somewhat tolerable level and the goal is to keep the pain at 4 or below.  Personally, I would prefer to keep the pain at one and below but I am finding that there is no such thing as a pain killer; there are only pain "dullers" that kind of knock the edge off so you don't sit for hours rubbing your knee and moaning, groaning, and asking yourself if the arthritis pain was really so bad that you really needed this surgery.  At a pain point of 4, you might ask the question although you already know the answer - the pain was bad enough and the limping was problematic enough that you needed the surgery...but it is a question that I have asked myself often in this past week. But everyone feels their pain differently - four for me is not good; for others, their four might be barely noticeable.

1 --- Back to 1 as in "one day at a time" which is how I am coping.  I feel a little like this is a 12 Step Program for arthritis sufferers and I am nearing the last steps (no pun intended) with this 2nd knee replacement.  I know that, given enough time, the body heals unless you have a disease or cancer that evolves too quickly for the body to deal with.  But joint replacement, barring an infection or blood clot causing nasty problems, is one of those injuries that will heal over time.  And the therapists tell me that, given enough exercises, the knee will heal very well and I will be walking around good as new (maybe better) before long.  But in these first weeks after surgery, there is no room for too much optimism - just get through another day and I am one day closer to recovery.  And, given the body's propensity to forget the pain and dull the memory of traumatic injuries (even surgical ones), I am looking forward to the day when I will be able to tell all my friends what a great decision it was to get the surgery and all about how I should have done it sooner.  Actually, the decision was "to walk without pain" in the future as opposed to walking with pain or not walking at all...not really a decision at all.

89 -- This is probably my favorite number.  Absolutely everyone I know or have met or talked to about my surgery knows at least one 89 year old woman who was back on her feet in no time and shopping at the Super WalMart within 2 weeks or back to working full-time within 3 weeks after surgery.  It is astounding how many 89 year old women are out there roaming the aisles testing out their new joints and not having any trouble at all.  I imagine that every 89 year old woman I will ever meet will have had a joint replacement and we can share stories around the camp-fire.  I suppose the intent in telling me about this possibly fictitious Super Woman is to encourage me and remind me that I too, being nothing more than a wimpy 58 year old who cries at the drop of a hat, hates physical therapy, and who struggles to push the walker around the living room let alone a distance equal to the Indiananapolis Speedway, will also heal.  But, as you may surmise, it doesn't encourage me at all - it annoys me that I cannot measure up to this Walmart shopping Super Woman (and why particularly the Walmart - don't they ever shop at Super Fresh or Home Depot?)  I will say that mostly I try to smile and offer congratulations and best wishes to all those 80-something year olds who recover so quickly.  Maybe there is something about turning 80 that gives us all super powers to heal...sorry, I couldn't wait to find out - my knees were shot at 50-something. But I am looking forward to experiencing the healing powers that will envelope me on my 80th birthday!

300 - 500  ---  Speaking of walking.  I received a joint replacement handbook from my surgeon that provides all the information you need to know but were afraid (or too ignorant of the whole process) to ask.  It shows all the exercises one should be completing 2 times a day for up to 12 weeks after surgery.  Right now, I am in weeks 1-2 and the exercises are appropriate for me at this stage....more or less.  I actually think this handbook was written by an over-achiever (perhaps 89 years old) or someone who is just mean.  During this period I should be walking (with my trusty walker) 300-500 feet 6-8 times per day at a pain level of 4.  Now, my math is rusty but, let's see, if I carry the naught and cipher on this a bit, that works out to be 1800 to 4000 feet per day (broken up into bite-size chunks, of course).  Now if 5380 feet equals a mile, then I should already be walking almost a mile per day and the staples are not even out yet. At this point, when I am awake enough (since the pain killers also put you to sleep rather nicely), I can maybe get out to the mailbox and back maybe twice.  Then I try to work through the other exercises (leg lifts, quad crunches, and such) and then I try to sleep through the pain all that movement caused.  And by the third week - lo and behold, I will be adding more distance and exercises to the plan and moving from the walker to a cane.  Stick with me, folks, by the end of this program, I might be running marathons.....according to the handbook.

90 -- This is the range of motion number.  The knee should "flatten" to 0 degrees and, in the beginning, bend to 90 degrees.  Ultimately, the goal is 120 degrees.  I learned the hard facts with my first knee replacement.  The numbers seem innocuous enough but you do not want to know what the therapists do to help you achieve these goals.  They put the "pain & tortune" in PT.  I will, no doubt, have another opportunity to experience the thrill of having to do it all over again in future so I will leave that posting for another day.

I am running out of numbers to share so I will end with two final ones -

25 --- the number of staples down the front of my knee holding it all together.  There are inside stitches for the muscles that will dissolve over time and who knows how many but the skin on the outside is held together by the staples that will be removed at my 2 week check up next week.  And, I have to say, that with all the pain otherwise associated with this procees, the staple removal is practically painless - the nurse had about half of them out last time before I even knew it.

AND finally, "As many as possible" - yep, this is the number of naps I try to take during the day (and night).  If I can get comfortable at all during these first two weeks, then I fall asleep.  One must sleep when one can.  And, you guessed it, I feel the timing is right for a pain pill and a good nap coming on.

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