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Author: Howard Buchin The Write Place
POST SURGERY KNEE REPLACEMENT WRAP-UP
November 21/08 (Friday)
Today is the ninth day post-surgery and it has only been in the last two days that I have started to feel some measure of relief/progress. I returned home last Tuesday, spending the first six days in the hospital. Like many others, I'm not a big fan of hospitals, so I was very happy, and relieved to come home on Tuesday.
Along with the pain pills, the stool softener, I was also prescribed iron pills when I was released from the hospital. This was never fully explained to me by the doctor, but some mention was made of losing more than a pint of blood and therefore having to replenish my iron content in my blood.
Right now, as I am writing this I feel relaxed and comfortable, to some degree. More than I have over the past nine days. Of course when I awoke this morning I took my two pain pills (Oxycocet), to be taken every four hours for pain, and then I went back to sleep again. Just being able to sleep is something that I have had trouble with ever since my surgery was done.
How is the level of pain? That is a question I get asked quite often, and it is really hard to give an accurate answer. The level of pain fluctuates so much. Sometimes I feel pain in the lower part of my leg down around my left ankle; sometimes it is below the knee in the shin area, and other times it is above the knee in the muscles just over the knee. The pain is a sort of tightness that is deep. I understand that much of this is the tendons reattaching themselves to the bone. Remember there is some cutting that has to be done. Ouch, it hurts to even think about this aspect or write these lines.
I guess as far as being a typical male, who is overly pain-sensitive, you could justifiably place me firmly into that category. I recall how much moaning and kvetching I did for the first few days in hospital. The guy in the next bed to me must have wondered if I was in the throws of death or something.
Right at this moment, it doesn't seem like it was that bad. At the time I was feeling it however; it was horrific. This time around the pain after the surgery didn't seem so awful, but then, everything is relative to where you are at a particular time.
Since I wrote the last paragraph the pain has taken an upward spiral. It ain't feeling that great as I write these lines. It really is uncomfortable....
Day 10
November 22/08,3:33 AM.
I can't sleep because this evening there is no way I can get comfortable. I feel pain (significant) down the outside line of my leg somewhere below the ankle on top of my left foot. Pain is also sore around the kneecap area, and above the knee. I took pain killer meds (2 Oxycodene) about half an hour ago. I don't like to think of how I might feel if I was not on painkillers. This is awful right now. I can only hope that tomorrow is better. Today my wife and I took a drive out to the Future Shop to exchange the HD digital terminal for a new one. Those extended warranties are great sometimes. The cats are meowing behind the basement door. I feel as if I don't care much about the cats or about waking Nancy up right now, since I feel so lousy. My mouth is dry. I have tried watching late night television and that didn't put me to sleep. Nothing seems to have worked very well tonight.
I wonder why I ever decided to have this surgery done in the first place. The recovery period is absolute hell. Yeowwww!! I hope that I am not turning off anyone out there who's considering knee replacement surgery ...
Day 18
November 30/08 (Sunday)
Last night I was able to get to sleep (lazy boy chair) and with the help of a couple of pain pills, I was able to get back to sleep again. It was my first night of that being possible. This is some real progress here. I have begun to be able to reduce my intake of pain medication.
Day 19
December 1/08, 1:45 P.M. (Monday)
I have scaled back my meds to using only Tylenol No.4. I have been using the Vitamin E oil on the incision to try to heal faster. Apparently I am a fast healer, so I m told. I made the trek over towards the fitness club today. Once I got close I realized I was not ready for the fitness club just yet. I have a way to go. I am sleeping better, but I am still significantly stiff and sore at times. If I stop taking the pain meds then I really start to feel the discomfort. I am able to get in and out of the car better now though. It's hard to spend too much time concentrating on anyone thing. Reading I can do for short spells. It is hard to not be able to engage in very many activities involving other people. It's lonely here in our house all alone. Thank goodness for our two cats who are good company.
My next door neighbours are very good at checking in with me now and again. Pat encourages me to keep notes on my recovery so that I can write the wrap-up to diary of a knee replacement series. I've been off work since June 2007. It feels as if I have already retired. I am not sure what type of work I will be going back to once I am ready. The doctor said I need about three months recovery time.
That was about the point last time where I felt I could have potentially taken on some modified workload.
Luckily I have many pastimes such as writing, small engines, library tutoring, and the Toronto Zoo volunteer position. We take school groups around on guided tours of the Zoo. We also do workshops and try to include the areas that they are studying currently in their school program.
I look forward to getting back to my volunteering. I have never spent so much time alone with just my thoughts. Sometimes it feels weird. Sometimes it feels okay. It is just a bit too much I guess. I always wanted to be a writer since I was in the first or second grade.
Day 20
December 2/08
Today [Marni] the physiotherapist came to work with me and she noted that my leg is somewhat more in a bent position at the knee than it should be. She then worked at straightening my leg, by manipulating it. Marni recommended that I go back to the fitness club and do the stationary bike and the treadmill. I also purchased a weight for my left ankle. It was sore when I tried the bike and I continued on anyway. I fell asleep when I came home and when I awoke my leg felt really improved. My knee was much less sore, and was more flexible. I notice that it gets easier to get in and out of the car.
Day 21
December 3/08
Wow I feel so much better. I am even considering attending my night course tonight. There are only two sessions left. It is a fairly long walk from the parking lot to the school, but I almost think that I could make it. I like having to challenge myself. What else is there? I have cut down on the amount of painkillers that I am taking. Also I switched from taking the Percocets to taking Tylenol #4's. They are (at this point) srtrong enough to deal with the discomfort that I feel. The role of the painkiller medication is that it works well in conjunction with the physiotherapy that is required. Doctor's generally speaking do not like to prescribe medication such as Percocet since it is a narcotic, and very addictive.
Day 23
December 5/08
I took the home care physio’s advice and made my way to a physio clinic in Pickering since my knee was feeling rather stiff and the physio said the joint was fairly sticky. The physio out there (Cathy) conferred with this and said that my Tibia was not functioning quite the way it should have been. I have trouble getting full leg extension. In other words it is hard for my leg to lie flat. When I was taking a bath I noticed the difference between my right and left legs. When I went into the clinic I had a 20 degrees margin between where my leg was and where it should have been. Cathy was able to reduce this to 10 degrees through manipulation and some exercises. I also found out that the TENS machine that I had been using (a kind of Dr. Ho type) was not conducive to healing my wound since I have stainless steel joint. I guess the steel changes the ability of the electronic pulses.
One thing is for sure. My leg definitely felt better when I left the clinic. Cathy seemed to know her stuff. I am continuing to attend the fitness club and work on the bicycle and the treadmill. That is freeing up the amount of flexion that I have. I am currently at around 80% of where I should be.
I am curbing my use of pain killers but I still need them when I do my work-outs. I am off to the club now for more self-abuse. Day 28, December 10,2008
I had an acupuncture treatment yesterday and my left knee felt much better soon after the treatment but then it went back to the same stiff sore feeling. I don't know what to do at this point. I guess I should go back to the club and work out a little. I don't really feel like it.
I feel tired and worn out. I didn't sleep very well and my knee is extremely tight. I guess it is a sign that the wound is healing (inside).
Day 30,
December 12/08 5:45 AM. (Friday)
I had some difficulty sleeping last night. We attended the Christmas party from Nancy's work at the Bluffer's Park restaurant. I had my last home visit from the physiotherapist yesterday. She commented that my knee is still somewhat swollen and stiff. There is a fair bit of scar tissue on the inside of the knee, which will take some time to heal. I visited the fitness club yesterday, but I didn't really do much of a workout. I felt tired and not really up to working out.
Today I attend the acupuncturist for the second time. She really seemed to help the last time I went down there. Luckily my plan covers for the extra benefits like physio and acupuncture. It would be really hard to recover with having to pay for this stuff by myself. I guess I would be able to afford it.
I am going to have to push myself to do a little more of the workout stuff. Today I am going to try to visit my parents at their condominium and have a swim and whirlpool. I continue taking the iron supplement since I had lost a little too much blood during the operation and I need to increase my iron levels back up to what they were. Just writing this is enough to tire me sometimes. Yesterday I spent the afternoon crashed out on the sofa here. Not a very productive day I would say. I guess it is all a part of healing.
Day 32
December 14/08 (Sunday)
It is now 2:42 in the morning. I have started taking some Chinese medicine, a herbal pill that my acupuncturist gave me. They seem to help me sleep. They also assist to relax the muscles. That is what she told me. They seem to be helping somewhat. Unfortunately, I slept through the evening and now I am awake early in the morning. The acupuncture seems to be helping to relieve the stiffness in my knee. I have lessened up on the exercises for a couple of days until
I see the physiotherapist on Monday. I am not sure right now what I should or shouldn't be doing. The acupuncturist says that since the knee is so swollen it is not a good idea to do too much. The physiotherapist that was visiting me at the house recommended that the workouts were a good idea. It can get confusing sometimes. I am doing the stationary leg raises and that sort of thing.
Day 33
Dececember 15/08 (Monday)
Today my knee swelling is down. There is still some stiffness but I feel like I can extend the leg to the flat position so it is easier to sleep now. I return to see the physiotherapist at 2:00 this afternoon. I didn't sleep at all well. I ran into the doctor at the walk-in clinic who assisted Dr. H with the surgery. He said he knew my knee but not me!
I feel that I can walk better.
Day 38
December 20/08 (Saturday)
I attended Physiotherapy yesterday. The Physio was concerned about the amount of stiffness and swelling that I still have around my knee. She asked me if I was still applying the Castor oil to the knee joint? I told her I was putting vitamin E oil on it. I was not sure about the castor oil. Turns out I had not been putting Castor oil on the joint. I had some jolts from the inter-differential machine and the knee felt somewhat looser after having the treatment. I bought some castor oil and a bandage so that I could slather it on at night and this way it would stay there. This morning it does feel better than it has been feeling upon waking up. I slept a bit better too. I guess the castor oil really does help to heal the inside scarring. I did about 20 minutes on the stationary bike. She is being a little more aggressive with the knee. I saw the surgeon for the six week follow up appointment on Thursday. He says I will be ready to return to work after another six weeks. He thought everything looked good. I have more swelling than is normal.
Day 44
December 26/08 (Friday)
I have reduced my workouts because of the holidays.
Day 50
January 1/09
Ah I had a breakthrough. I visited my Chinese Herbal Doctor and was given some Chinese herb tea to drink. It seems that my leg has now improved where I can extend my leg straight and my knee is less swollen. The physiotherapist really noticed the difference yesterday. My leg is almost lying flat on the table when I lie down.
Day 67
January17/09
I continue to improve with exercises, physiotherapy and the Chinese Herbal tea that I am drinking. It seems to be helping to improve my knee joint and it's also helping with my sleeping. At first, getting a decent night's sleep was the hardest thing for me to overcome. I continue to do my exercises at home also. There is still some stiffness and swelling. I don't have very much trouble getting in and out of the car. At times if I sit for a long period it can become stiff. I try to put ice and apply castor oil at least twice per day. It seems like there are a lot of things to do, and I suppose there are. The more actions that you take to improve your knee the faster that you recover. It seems like my recovery from the second knee surgery, was a little slower than the first. It is now just over two months since I had the surgery. I attend the fitness club regularly and do at least fifteen minutes on the stationary bicycle and another fifteen on the treadmill. It does improve my ability to stand for longer periods of time.
I have started back at the Toronto Zoo as a volunteer there.
Sometimes there are periods where I feel a bit down, but at those times I get active and I feel better.
Day 104
February 24/09
It seems that my left knee is proving more difficult to heal than my right knee. I am now past the three month period and I am still finding my knee to be stiff and sore in the morning. It seems to be tight and somewhat swollen, more than it should be. I am attending the physiotherapist today and again on Friday. Then I will be back there twice next week. Fiona seems to think that even though I am having greater difficulty with this second operation, it is nothing to be overly concerned about. I am not so sure. Something about the knee joint seems to be improper. I am getting mildly concerned, since my first knee healed after about three months. I continue to attend the gym about three times weekly. I do the stationary bicycle and I apply the Castor oil to it daily, along with ice and other exercises. It is a long hard grind to get it back to being healthy. I am still off from work.
I feel that I have to stay positive or else I will slip into a kind of slippery slope where my health is concerned. I had hoped that things would have sorted themselves out by now, but unfortunately they haven't. I don't have trouble walking or standing but the tightness bothers me. I guess that is about all for now.
Day 114
March 6/09
It is now approaching the four month period since my knee replacement was done. My knee is mostly good. There is a small amount of swelling above my left knee, but it is slowly getting better every day. I have had some difficulty extending (straightening) my leg.
Day 119
March 11/09
I visited with the Physiotherapist again today who detected some tightness behind the knee. I mentioned to her that the area just above the knee is still swollen and kind of uncomfortable when I wake up. She said that possibly
since I am not getting 100% extension of the leg, this might be the cause of the knee swelling. I thought the swelling was the cause of the leg not extended fully. She said maybe it was a bit of both. Anyway, I guess my doctor saw me last Wednesday and he felt the knee looked fine. He didn't comment on the swelling, but he did mention that the extension needed to progress about another 5%. Well, I guess the thing is that only time will tell. It seems that my knee is kind of slower in healing than the first operation (14 months ago), but I guess that is to be expected.
Maybe I am just becoming more fed up. This time around I lost quite a bit of blood and was put on Iron tablets. I switched to Liquid Iron Supplement, which I must continue to take. The iron is hard on the stomach sometimes.
Some days it's seems hard to keep a positive perspective on my life. It seems that I have so much time to spend just mucking about. I really wish I could get back to some sort of a normal routine already. It's easier said than done. Maybe I just need a good massage. I think I will order another batch of Chinese Herbal tea to speed up my improvement.
Day 120
March 12/09
I spoke with my specialists' office and they told me that I had just been to see him last Wednesday, and that I should check with the physiotherapist if I think there is any reason for concerns. I recall the last time I spoke with her, she said that I need not worry. It's just that I did phenomenally well with my first knee surgery. The second is going a little slower, but that is a bit more like most people’s experience. It can take some time for the swelling to subside. The other factor is the weather. The last few days have been very wet and cold. This is normally a condition that affects the joints, especially artificially made joints like mine. It is really a matter of just keeping going. There are times when I feel bogged down with all the therapies and exercises and appointments. I want this thing to be over so I can resume a normal life again. It might take 3 months and then again it could take 6 months, there is no way of knowing for sure.
I am having no problem bending my knee, and only slight problems with straightening my knee.
Day 139
March 31/09 (Tuesday)
I visited the Physiotherapist again today for more physio and exercises. Fiona thinks that I am progressing very well. The only thing she noticed today was the tightness in my back, on the left hip. Apparently since my knee is still not extending completely, I am favouring the left side, which drops the hip on the left side and causes the back to go out a little. I made an appointment with the Acupuncture clinic for tomorrow morning. I think that maybe I need to solve my back problems and possibly I might get my knee to straighten out. I am not really sure. It seems like a long time to continue working on getting my knee back to where I would like it to be. I wonder if the Chinese medicine might hold some answers to solving this riddle of my muscle and body. It is hard to know what the answer is. I wish I could just go back to work already. It has been close to two years since I have been off work. Some days I feel like climbing the walls out of boredom.
Day 146
April 7/09
I went back to the physiotherapist today. These are my last two appointments at the present clinic and then I will be trying a new clinic that uses a cold light laser therapy. I was told by a friend at the Zoo that there are a good number of athletes finding success with the cold light laser. My knee is very slow to heal the last bit. There is still a small patch of swelling above my left knee. I have not found that much success with Acupuncture, or Chinese teas. Of course, I am comparing the knee to the quick success I enjoyed with my first (right) knee surgery. Maybe that is the problem. The first one went so fast, as I tore through rehabilitation therapy and I was back to normal function. This one's different, slower. I'm told that they are all different, each and every one of them. A lot depends on the kind of shape you are in, how regularly you do the required exercises, and so forth and so on. I think this time; I have not done the exercises as religiously since I have felt tired a lot of the time. The low iron has held me back from really exerting myself.
At least that is the excuse I am sticking to anyway. At this time I feel somewhat down, just because of how much time I have had to spend puttering around the house. I like to putter, but not as a full-time occupation.
Day 153
April 14/09 (Tuesday)
Today I am starting with a new Physiotherapy Clinic down in the Beaches. I am going to have an evaluation by the chiropractor there and then go from there. I still don't have the full leg extension. I understand they use a cold light laser therapy and apparently there have been good results with it. I just felt that I had stalled a little bit with my Physiotherapist and we just kept doing the same thing and the progress was too slow. I would like to see what the new clinic might say. It is now over five months since I had the surgery and I am still not fully recovered. My leg won't lie flat. Apparently this is not the biggest deal, but then again it is not minor either, while there is still swelling below and above the knee.
Day 154
April 15/09 (Wednesday)
I attended the chiropractor in the Beaches yesterday. Apparently my back and hips are out of alignment and there is some scar tissue on the back of my knee. It is nothing that is insurmountable, but all the same, it has been making the last part of my rehabilitation somewhat troublesome. I was noticing that I had a lot of lower backaches, and tightness on the back part of my leg. According to Dr. R., the scar tissue attaches itself to the tendons and creates a great deal of the tightness that I feel. My hips are kind of out of kilter due to the bend of my knee, so some adjustment needed to be performed.
According to Dr. R., it should only take about two to three weeks, of chiropractic therapy to get me to where I would like to be.
I felt much better when I woke up this morning. I wondered why I was having so much trouble getting to sleep. I guess it was because of the lower back pain that I was feeling. This morning I felt much more energized and wanting to partake in the day.
Day 159
April 20/09 (Monday)
I think I am finally making some marked progress with this slow-healing right knee. After having the first two treatments with Dr. R. (Chiropractor) I am happy to say that my swelling has started to decrease and my knee is actually feeling a lot better. There is less pressure in the area above the knee where I had the swelling. I have had two treatments and only one cold light laser therapy session. I guess I have found the key to making the last bit of progress with this stubborn leg. Unfortunately, I've come down with a nasty cold in the process, but that too seems to be improving. For a while there I was starting to think that this knee had extra-ordinary problems or something like that. I even went back and visited the surgeon's office thinking that I might have to see him again. I don't think that is true anymore. I just have to continue to ice and exercise and do therapy, and I think it is going to get better and better. Hallelujah!
There have been many glitches along the way. I've found that the toughest part has been to stick with the process and not lose faith in my body's ability to heal itself. There have been many times when I have just felt down and almost out of it. Being off from any regular work for almost two years now, makes me feel like I am lost in space or something. I have never had this amount of extra time on my hands. As long as I am busy doing something then it is fine, but when I don't then there's trouble.
Day 271
August 7/09 (Friday)
It's been close to nine months since my last knee surgery was completed on my left knee. I continue to do exercises, which my new physiotherapist (Janique) had advised me to do, as often as I can. I was finally able to return to the gym yesterday after it was shut down for a month because of the strike. It felt good to be able to work out on the machinery there using Janique's exercise routine. I've been doing a lot of bicycling but not so much walking. Last Monday I spent the better part of the day as a Zoo volunteer, first standing next to the Gorilla's outdoor enclosure, talking about Charles, Ngosi and company, and then in the afternoon observing the elephants for about three hours. Apparently the keepers are trying to determine whether Thara (the matriarch), Oringa (35 year old), Toka (35 year old) and Thika (youngest elephant), were exhibiting any unusual behaviours such as aggressiveness, and so forth. It was very interesting, albeit a bit tiring, standing around there for three hours taking notes every fifteen minutes, as I noted all the behaviours that were exhibited by all four elephants. I did fairly well considering that I remember not being able to stand for more than fifteen minutes prior to my having the knee replacements.
My left knee still has a little (2 -3% remaining) of extension that needs to be corrected. At present my left leg doesn't fall flat on the floor when I am sitting or when I am lying in the bathtub. This complication wasn't there with my first knee surgery, but it is not all that uncommon, and luckily it is fixable.
There is a lady who works at the local Sunoco gas station (where I go for gas) who I've known for years. She used to stand as she operated the coffee shop side of the kiosk, but now she works at the cash, as this allows her to sit down. I used to stop in for an occasional coffee when I was doing the letter carrier stuff. A few years back this lady told me that she too had problems with her knees. I guess her condition was exacerbated from so much standing. She had asked me about how it was going for knee surgery, because she thought that she would need the same procedure. I had explained that although there were some tense moments, in the end it was all worth it to be pain free. Nowadays I see her sitting behind the counter at the cash, and she looks uncomfortable. I had asked her one day how she was and she replied that her knees were quite uncomfortable. I wondered to myself why she didn't have the operation, and just free herself from so much pain. I guess everyone needs to make that decision for himself or herself. Once a person comes to the realization that their quality of life has deteriorated to such a degree that each and every task, like grocery shopping, or standing, results in too much pain. Especially the overuse of anti-inflammatory & pain medications becomes more and more, having a knee replacement done becomes less and less of a choice and more of a necessity.
Of course, coming from a chicken-hearted male like myself, I should be more empathetic to people who cringe at the very idea of anyone separating your knee joint to install some metal fittings, which should make you feel better. I think it is something that any potential patients are better off not thinking about, at that the very least, trying to visualize. My being a very visual learner I continually thought of how this whole thing might work. As soon as my mind saw a stainless steel implant installed within my bones, I began to feel uneasy. It was best not to think about, but of course I couldn't help it.
Regards,
Howard Buchin
.... Knee Replacement part 1
.... Knee Replacement part 2
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