KNEE +1

My surgery was YESTERDAY!  Can’t believe that it is over, I am so happy.

I didn’t sleep a lot during the night, although the pain was not that bad.  I don’t think it ever got beyond a 5 on the 1 -10 scale.  It was probably the fact that the “sisters” were continually in and out of the ward administering medication to the six of us.

The Floor Nurse was one of the first ones on the scene when everyone was getting up.  He was concerned with getting a couple of us dismissed that day.  He said that unless something changed, I would be out of there by noon.  That did sound good to me, but I have to admit that is also was a bit concerting to me.  I was only 24 hours removed from surgery, and they were sending me home?  The OS had explained to me that his goal was to get his patients out of the hospital the following day if possible because he felt that it decreased the chances of infection.  His words, “After all, this is a hospital and sick people come to the hospital.  Who knows what germs they are carrying!”  Sounds good to me!

One of the sisters came in to dress my knee and remove the drain tubes before my departure.  Yikes!

Drain tubes

Incision

So, with everything ready, all the paperwork signed, a list of prescriptions to be filled at the hospital pharmacy on the way out and my wheelchair driver dutifully waiting – away I went.  If I thought this would be easy I was mistaken.  Getting into the car was by far the biggest challenge to this point in time.  With the help of my driver I finally made it though.

Getting home and situated inside was not difficult.  I was so tired and drained that I went straight to bed.  I am not sure how long I slept, but I did sleep!  After I woke up I walked outside around the parking lot.

Knee Day

The big day! Nurses were in the ward by 5AM administering medicines to all of us. The first one that came to me asked, “And what are we doing for you today?” I thought it a bit strange that she would ask that question, especially since she was holding my medical chart, but I told her that I was having a LTKR. She gave me pills, started an IV drip and then put an “X” above my surgical knee with an ink pen.

"X" & smiley face mark the correct knee for surgery!

The ward was very active, and I was number one on the surgery list for the day. By 0730 an attendant arrived to wheel me to the theater (name used for operating room in South Africa). Upon arrival, I was greeted by a new sister (name used for a nurse in South Africa). She looked at my chart, asked me my name and DOB, then asked, “And what are we doing for you today?” Really, doesn’t anyone know what they are doing for me today? I kissed my wife and told her how much I loved her, then they wheeled me to the coldest room I have ever been in.

And away we go!

OR holding

In the theater, I was asked three more times, by three different people, “And what are we doing for you today?” Finally, when the last one asked this question I asked the OS if there was no one on his staff that knew what was going on. He laughed and assured me that it was standard operating procedure to ask the patient repeatedly what was taking place.

"And what are we doing for you today?"

Okay, I'm ready!

The anesthetist had me sit up as he administered the spinal block. He told me that my bum would start to feel a bit tingly and then it would travel down my legs – it did! They laid me back down and a sister put a breathing mask over my face and told me to breathe deeply – that’s all it took, about 5 seconds of that and I was totally out.

"Are they finished yet?"

The next thing I remember I was being wheeled back to the Orthopedic Ward. I don’t even remember being in the recovery room. I was a little groggy, but alert enough to know that my wife was with me and that was what mattered the most. I had no feeling in either leg or feet. The dressing around my surgical knee seemed enormous and there were two drain tubes extending from the wound. I had also been catheterized during the procedure. The bag collecting urine seemed to have an excessive amount of blood to me. I asked the sister about it and she had someone come to look. The head sister deflated the internal bulb a bit, stating that it might have caused a problem. About 20 minutes later another sister came by to check it and the tube had completely disengaged itself from me all on its own.

Can you wiggle your toes?

Within 4 hours most of the feeling had returned to my legs and feet, with the exception of my surgical foot. It did not seem to have much feeling at all. The sister explained to me that during the operation the OS “freezes” some of the nerves that run from the knee to the foot and it would take longer for the feeling to return to that area. Using a walker, “frame”, I was able to get out of bed and walk to the toilet with help. I passed a lot of blood in my urine.

The physical pain during the day never exceeded a 5 out of 10 for me. I was fairly comfortable all day. The OS came by to check on me, telling me that all went well and that he saw no problems except the blood in my urine. He said that he talked with the sister in the OR and she told him that she inserted the catheter with no problems and there was a good flow of urine. The OS seemed to think that they might have inflated bulb in the upper bladder. He also said that it could have inflated on a polyp. He said that he would probably order an ultra-sound on my bladder in a few days to make sure nothing was going on there. I was able to eat and walk to the toilet two more times throughout the day.

Knee -1

Today is the day.  This has been a very long time in the works, but the time has finally arrived.  I check into the hospital in about 5 hours.  Tomorrow morning, I will receive a new left knee!  I do not anticipate any problems and, in a way, I am looking forward to this process.

Being able to walk without experiencing the popping and grinding of bone-on-bone will be quite a change.  I hope the right knee will be able to pick up the slack while my left knee becomes strong again.  And just think, I get to do this all over again in a few months when I trade in my right knee!

Checked in at 1500hrs to Life Wilgers Hospital in Pretoria, South Africa.  I faced the normal barrage of never-ending paperwork, only to discover that I could have (should have) come a few days earlier for pre-admission which would have avoided this process.  After being admitted I was handed a folder containing all my medical information and then sent to the second floor to the Orthopedic Ward where I was assigned a bed.  This was a six-bed ward, and I filled the last open space.  One gentleman was there for the same reason as me - LTKR; one was there for a left shoulder replacement; one young man was there with complications of a hip replacement gone bad; one man had already had a RTKR and the final one had some sort of back surgery.  We all became acquainted quickly and exchanged pleasantries.

I must have been more anxious than I realized.  When the nurse took my BP it was 197/84.  I do experience high blood pressure - even take meds for it - but it has never been 197 before to my knowledge.  They took my BP several more times before bedtime and it did recede, some.

My wife was able to stay with me in the ward past the posted visiting hours, but she left in time to return to our place of lodging prior to darkness.  After her departure I was visited by a gentleman who measured my legs and gave me a pair of the compression stockings to wear.  I was to put one on my non-surgical leg immediately, then instructed to put the other one on my surgical leg after the surgery.

Then the anesthesiologist came by to explain that he would be using a spinal block and he would put me to sleep, but it would not be general anesthesia.  In his, and the OS, words, "Recovery is much better using the spinal rather than a general". 

After visiting hours were over, I rested well throughout the night.

Putting in a line for the IV drip

Finished

Ready for surgery

The Orthopedic Ward

5 Days...

I had a meeting with a third doctor and my physiotherapist yesterday.  This doctor is acting as a liaison between my insurance carrier, the hospital, OS and myself.  He is a God-send.  I do not have to deal with a lot of issues that would normally be overwhelming. 

The physiotherapist was very nice and reassuring.  She told me that I would probably be in the hospital a day or so longer than what the OS indicated.  She will meet with me just a few hours after the surgery and begin PT almost immediately.

I feel very comfortable with all that I am facing.  Can’t wait until Sunday afternoon when I check into the hospital.  Surgery will be the following morning.

Here is a video of what is about to take place:

7 Days and Counting

In exactly one week I will be in the theater having my left leg opened at the knee.  This should be a frightening thought, but really it is not.  I am anxious to get on with this process, even though I realize it will be long and it will be difficult.  Again, I will be glad to start AND finish.

The appointment with the physiotherapist today has been changed to tomorrow.  I will meet him/her in the morning.  From most all that I read this person could be my worst nightmare, but hopefully that will not be the case.  This person could turn out to be my new best friend.  I will think like this presently, and wait until the actual rehab starts to make a final determination.

July 20, 2016

An appointment with the primary care physician is the priority of the day.  The doctor conducted a complete and thorough physical including a stress test for my heart.  With the exception of a slight infection in my nasal passage, which will be dealt with by an antibiotic ointment, everything was in order and the doctor gave his approval for the surgery.
The physiotherapist is the only remaining appointment that I have prior to the surgery.  The PT will give directions for pre-op activity as well as setting up the schedule for post-op rehab.

My wife and I are staying in a two-bedroom apartment during our time in RSA.  It is comfortable and so much better than a hotel room.  There are a few areas of concern though, such as the sofa which is fairly low to the ground and difficult for me to rise up from.  Since sitting and standing will be difficult after surgery this could be a challenge.  One of the bedrooms is furnished with a king-sized bed and the other is furnished with two twin beds.  The king-sized bed should be fine, but if it is a problem I can always move to one of the twin beds.  Another issue will be the fact that there is no shower in this apartment, only a tub with a hand-held shower wand and stepping over into the tube may prove impossible.  Considering all these issues, I am truly grateful for the accommodations, it could be so much worse!

It is winter in South Africa.  I know, you don’t consider that Africa can have a winter season but it most certainly does.  The nights and mornings are nippy to say the least.  Temperatures hover around 37 to 40 degrees.  It does warm up in the day time, but the rooms remain cold.  All in all, it should be perfect for those short mini-walks that I will be taking throughout the day during my recovery.

July, 2016

Planning for major surgery (TKR) can be difficult anytime, but when you live in Liberia, West Africa it is even more difficult. The issues with insurance, doctors, hospitals, logistics and location are quite formidable, and communication is another major issue all its own. 

You are probably wondering why I would deal with all the obstacles, why not just travel to the States and have the surgery performed there especially since that is where our permanent residence is located. The answer to this question is the easiest part of the entire ordeal, insurance. Our medical insurance encourages us to have all of our medical issues taken care of outside the continental United States. In fact, 100% of this TKR is covered by our insurance IF we have it done outside the USA. If we go to the States our insurance covers the normal 80% of allowable charges which means the remainder of costs are out-of-pocket for me. Considering all the issues, I opted to have my TKR done in the Republic of South Africa. RSA has some of the best medical care in the world and rivals most options in the United States. My wife and I departed Liberia on July 16, and arrived in South Africa on July 17th. 

My first visit with the orthopedic surgeon was on July 19. All of medical records, including the x-rays from the orthopedic surgeon I visited in the States, were sent to my surgeon here in RSA prior to my arrival. Upon arrival at the surgeon’s office, I was directed to the radiology lab for a complete set of new x-rays. To my surprise, the radiologist handed me an envelope containing all the x-rays after they were developed, and I was instructed to carry them back to the surgeon’s office. 

The meeting with the surgeon went quite well. He is very personable, well-disposed and knowledgeable. He performed an extensive exam, viewed the x-rays and without any hesitation at all agreed with the diagnosis given me, almost a year earlier, by the orthopedic surgeon in the States. Surgery was scheduled for August 1, 2016.

The surgeon’s office staff sent me to the on-sight lab to have blood drawn and a complete analysis work-up for the primary care physician that I would see the next day.

July, 2016

If you have decided to join me there is no doubt you are facing the same journey, or you have already traveled the path, of TKR (total knee replacement).  Either way, you are welcome.  Please feel free to leave comments, words of encouragement and of course prayers.  There is an African expression that says, "If you want to travel fast, go alone.  If you want to travel far, go with others."  Together, we can travel far.

Hard work has been a way of life for most of my 63 years.  Lifting and carrying heavy loads in the West Texas oil fields certainly placed a lot of tension on my knees, and I felt that this surely was the cause of my problems today.  My doctor assures me that my condition is more probably due to genetics than the hard work.  For many years my mother endured the pain of bad knees, but it was long before TKR was even a possibility.

For longer than I would like to admit, ibuprofen and pain were my daily companions and they have finally forced me to face the inevitable, an appointment with an orthopedic surgeon.  His diagnosis was really no surprise: degenerative joint disease (osteoarthritis) with the recommendation for TKR in both knees.  I decided to wait before I made any rash decisions.  After all, I have been suffering with this for several years, why get in a hurry now?  So, after another full year of pain and limited mobility, it is time for action.

When I decided to embark on this journey I began to research TKR, and I looked for people that had walked this path before me hoping to glean from their experiences.  A lot of information was available in fact, there was enough to throw me into information overload.  But it seems that the personal stories of others were what brought me the encouragement I needed.  For this reason, I have decided to keep a blog of my own journey through TKR.  Maybe someone will find encouragement in my story, and I will find a way to express my victories, failures, bad decisions and good ones.

Come on, let's travel!