Knee Repalcement, Part 4

I arrived at The Hyatt Residence (http://www.hyattclassic.com/go/palo-alto.html) on the Saturday following my surgery. I had a nicely decorated private room with TV, armoire, visitors chair, carpets and drapes and a lovely large bathroom (including an accessible shower). It was much more like a hotel room than any hospital room I’d even been in. The requisite adjustable bed was there with call button, reading light and that panel with connections for tubes and wires as a headboard. The whole place was carpeted and nicely decorated with pictures and real flowers. There was a TV room for meeting with visitors and a patio and garden that were beautifully planted. This facility was the ultimate level of a four level senior residence. Most of the other patients in this building needed fairly high levels of care. But there were also several like me who had just had a knee replaced and needed help for a week or so. One of my fellow victims had had BOTH done! That’s brave!
We got vitals monitored and medications delivered and mobility assistance and physical therapy and pretty good food delivered (until you can make it to the dining room). The first full day, Sunday, the OT got me into the shower which was a blessing even if it was strictly forbidden according to the doctor’s instructions (they are REALLY concerned about infection because it is the worst problem). We wrapped me up good and I shampooed and felt completely renewed. On Monday PT began and I was really surprised and pleased at how well it went and how fast I could progress. I used a walker most of the time because you really don’t feel confident about where that new knee thing is going at first. BTW, you don’t use a walker like a shopping cart with it pushed out in front of you as you see most of the time; it’s supposed to be right next to your hip so you can walk upright normally.
The hardest part of the rehab is trying to lift your new knee leg with the muscles of your thigh. It hurts and even if it doesn’t, it’s nearly impossible. Also, no heroics with the meds. Take the pills!!! People don’t get addicted to these things if they are just trying to keep the pain away. And pain relief is critical if you are going to work hard enough to make PT pay off. After my PT sessions I was strapped into an electric contraption that bent my knee for me for a couple of hours to keep it from stiffening up. And of course they ice the knee frequently to reduce the swelling.  I could go up and down stairs the first day and took a walk around the garden the second. I looked for a place to use my computer right away and found to my delight there was wireless in my room. I was urged and had no trouble taking a walk around the facility several times a day. People came to visit and I watched a lot of TV. (Italian TV is just gross so it was kinda nice to watch news and stuff without wiggling floozies.)
By the end of the week I was fully capable of fending for myself so my brother and his wife came to get me and I went north to stay at his house for the rest of my recovery. I used the walker to get in the door and except for a few trips to the bathroom, never used it again. Terry lent me a cane and I was able to walk three blocks home from the first session of PT in the clinic near their home.

Knee Replacement, Part 3

Waking up was not fun. When you come out of the anesthetic, I think you aren’t fully medicated since you aren’t awake to let them know when it kicks in so they must wait until you are awake to apply enough to keep you pain free. Also they need you to wake up and make you breathe. Always important. I also tend to shake rather seriously after anesthesia. So I had a short time of really intense pain but I have no idea how long it was because soon after I was medicated quite heavily and stayed that way for the next two days. After a few hours in recovery, I was moved to a regular room. This is the Gulliver part: I had surgical pressure hose on both legs, a pair of inflated cuffs cradling both my lower legs, an inflatable bed pad under me, both of which inhaled and exhaled every time I moved, more IVs, an oxygen nasal tube, a drain from the incision, a urinary catheter and a giant dressing on my new knee. Felt a bit tied down. I was quite swollen with fluid but dry mouthed. Dilaudid was the main pain reliever I was given but there were others in the mix. Dilaudid makes me quite nauseous so I was in a quandary about using the self administering system to keep the pain down. I found if I didn’t move much and slept a lot, hardly difficult, I could use the button less often since I was really nauseated when I dosed myself. After a day’s worth of retching every time I took a dose, they switched me to oral medication to reduce the nausea. It worked. Thus I passed the first and second post op days.
I felt more alert and focused on the second day. I still was unable to eat much but didn’t miss it. I could sit up a bit and greeted the various gangs that came through: the catheter gang (not that one) took out the nerve block after about a day, the pain gang wanted numbers more than once (Is it a 3 or a 5 or a 7?), the doctor looked in with his fellas (fellows?) and I had hot and cold running nurses. I got flowers and phone calls. I was way too stoned to answer the phone which made my family a bit anxious. No phone calls before day three seems a good rule. Toward the end of the day, or first thing in the morning I had first my catheter and then my wound drain removed. Bled like crazy.
The morning of day three (Friday) I got my first visit from the physical therapist who got me to try to sit up straight and even move my legs toward (but NOT over!) the edge of the bed. She came back in the afternoon and got them over the edge and me standing, for a minute. Then when I needed to go to the bathroom I could use the walker she provided at the edge of the bed. By that evening, I could make it. Food seemed a reasonable concept by now, so I ate my first food on day three. The clouds began to clear and I could answer the phone and talk to people although I have no idea what I told them.
My next stop was arranged by an efficient woman who told me there might be a place in a skilled nursing facility nearby where I could stay for the next few days while I was unable to really care for myself. This is standard practice for many people who don’t have a good situation at home: no one able to be there all day, or not strong enough to pick you up if you fall down, or too grossed out by staples in your knee, or so on. Indeed there was and Medicare covered it and they would take me tomorrow!
So Saturday am, after a slow but resolute walk 30 feet down the hall of the hospital corridor, I took a special taxi to the Radisson Suites Healthcare facility attached to a senior housing complex less than 2 miles from Stanford Hospital. I told someone that the taxi was special because they need to tie you down. Then I saw a look of horror on her face and realized she saw me strapped to the floor of a van! No, they tie the wheelchair!! It cost $65. And that is the total amount this entire adventure has cost me. Medicare for everyone.

Knee Repalcement, Part 2

I arrived in SF on 1st July to spend a few days with my brother who will put me up during my recovery. But since he and his wife both work every day, I rented a car and a hotel room and took myself to Palo Alto for my surgery. I had a preliminary appointment with my surgeon and another with anesthesiologists and still another with my personal physician who cleared me for my surgery.
On the night before surgery, I did not sleep well despite the elegant hotel room in Palo Alto. Woke about 5 and being NPO, no eating or drinking, I read and paced until 6, then showered again with the special soap. Completely germ free for at least 30 seconds. Began to see all surfaces as crawling with bugs! Paid my bill and exited just as my cab arrived.
As I strolled into the main entrance of the Stanford Hospital, I had the strange sensation of not really being there. I walked comfortably, no pain, no problems. What am I doing here? I don’t need this! This is for OLD PEOPLE! But I moved obediently toward the check-in desk where I had been only a few days before. Smart to get you oriented in advance. I was checked in and tagged (both wrists this time) and led, still obediently, to the surgery prep. I undressed and donned the famous backless gown. They’re bigger and more complicated now. And then was settled into a corner to wait to be prepared for surgery.
At least 3 nurses attended me: one added two bright red allergy tags to my wrist décor and the others asked me the same 10 questions I had answered for the last 10 days. A pretty child doctor from anesthesiology came with questions about previous surgeries. Another pretty one came in as the lead of the “catheter team”. Catheter team? It takes a team? God. It seems they will install a catheter in the femoral nerve bundle that numbs the whole leg from upper thigh to mid calf. More team mates arrived pushing an ultrasound machine which was used to locate the appropriate nerve. In a bunch they install the catheter without even a stick. Go team! In 10 or 15 minutes it feels as if someone has left a large dog in my lap. My leg has departed me.
More visitors: my doctor signed my leg; anesthesia angel again; vampire brigade (lab techs seeking blood); porters to take my goods away to my future room.
Finally, around 11.30am (original time was 10.15) I am laid flat and rolled into the OR. It is seriously cold!! Seems the surgeons must wear a lot of protective gear (they look like the boy in the bubble of TV fame) so they like it cold. It’s ultra bright. The room is crammed with shelves of tools. It looks like a clean bright hardware store. I avoid looking at the scary stuff. There’s a traffic jam of people: several nurses, three or more greened up doctors, orderlies. I am shifted like luggage to the table and set upon. Egg crate foam under the other leg, arm supports, more wires, another stick, wrap this, cover that, and then a mask and orders to “breathe deeply, it’s only oxygen.” I am bid sweet dreams, arms wide, eyes clenched, shaky and cold.

Well, I’m back. I have been gone for three months and then here for 6 weeks just in time for a whole passel of visitors: sister Melinda, cousins Fred and Takaya, friends Bob and Kate. Each visit was charming in a different way with hiking, eating and culture leading the list. But now I’m nearly back to normal with only one of me to manage. So of course, I came down with something! A sore throat at the moment and I hope that this is all I get given the horror stories about flu all over the US. No one here is as crazy as the anti-government “Don’t get your flu shot from those commie/fascist/totalitarians” wing nuts in the US. The media here are urging everyone to get shots and stay home if you are sick, but then they have this socialized thing called sick leave, so they might just do it.


Since returning I have traveled to Spoleto, Assisi, Feltre in the Dolomites and Venice with Melinda, Siena, Orvieto and Rome with Fred and Takayo and roamed the back streets with Kate and Bob. Had a big dinner party and went to eat big meat with Paolo and friends. Looked at naked men at the Accademia (that would be David and the Mapplethorpe photos). Reappeared at the Uffizi to continue my data job in the best work space in Europe. Ran off to Pisa to look at clearly the best Chagall exhibit in Europe. Had a happy reunion with Angelika and dinners and lunches with all my lovely friends. But first I need to fulfill my promise to document the most amazing knee replacement experience ever. Next post.

My adventure in Osteoland, part 1

I have been having pain and stiffness in my knees for many years. My right knee threw a bone chip in 1979 off of my femur and I had an open surgery to have it removed. I actually kept the piece in a jar for quite a while. Part of the cartilage and a bit of the bone at the end of the inside knob of the femur, about the size of a peach pit. The doctor told me then, “Well, you’ll probably need a knee replacement in 15 years.” But he also told me after the surgery, when asked about rehab, “Well, I suppose you could do some exercises.” No program, no planning, no recommendations, no nuttin’. Three years later when pain and limping began to really bother me, I called the 49ers and asked, “Who does your knees?” I figured if they could get a 300 pound football player back running full tilt down the field, they could help me. “All our surgery is done by Doctor Dillingham’s SOAR Clinic” they told me. I called right away. I saw Doctor Gary Fanton, a charming, no nonsense enthusiastic young guy who said “Let’s scope your knee!” BUT! I had to promise to do 6 weeks of rehabilitation: fours hours a session, three times a week. And it worked great! I had an arthroscopic, same day surgery in 1983 and the knee (right) was mostly trouble free for almost 20 years.
Cut to 2003ish. The knee began to bother me. I couldn’t walk right after sitting for an extended period. Had to swing it back in forth several times until it would hold weight. So in October of that year I began a no-carbs diet and took off 50 pounds. This helped. In 04 on a trip to Italy, I had some problems; mostly I couldn’t/wouldn’t stand for long periods of time. (The Elderhostel tour usually took us off the bus, zoomed us though the town and then left us on our feet for a 45minute lecture. Three times a day! I orbited mostly.) To try to extend the life of the original part, I had my right knee scoped in 04. Some improvement. In 05 while I studied Italian in Firenze for a month, I had significant trouble going down stairs. In 06, my friend Angelika insisted I must do something about my gimpy status. I saw a doctor who diagnosed sciatica in the right leg. I was happy since I knew there is treatment for sciatica but little to do for the knee short of replacement. Got better. In 08 in Italy the sciatica moved to the left side and that knee became seriously painful. Lots of pain especially at night. Finally after months of mobility decline, I saw Dr. Fanton in Nov. 09 and he said “I wish you’d let me replace your left knee.” This was the first time he said that. I was referred to a surgeon since Fanton had become the head of the Stanford University Orthopedic Clinic and was not doing this procedure. I couldn’t get an appointment before I had to leave for Italy where I now reside. So I returned in April 09, saw the new doc, Huddleston, and was urged to get the replacement done. I stalled, planning on doing it in the winter of 09-10. But the Greek chorus of coffee friends insisted: “Nobody stays here in the summer, it’s hot and crowded and full of tourists. Do it right away. They convinced me and I made an appointment for 15 July and a plane reservation for the 2nd.