Diary of a knee replacement

Knee Replacement Diary by Dorothy Case, wife of David Case who had the replacement, beginning January 13, 2011
Dr. Linda Rasmussen performed a knee replacement of David’s right knee around 11:00am Friday 1/13/2011. It took her 39 minutes to perform. She said it went perfectly. However, his knee was really a mess. She said from a 1 to 10, his was a 10. She said other doctors send their problem cases to her. Hopefully that is true and this is a success.
Day 1: David came back to his hospital private room in the Ho’Okipa ward at Castle Medical Center in Kauai, HI around 2:30pm. He felt great. He had a hearty lunch at 3:00 and then ate the regular dinner as well. I left around 4:00 to beat the H 1 traffic. He was doing well on all the drugs. He could feel his feet and could move his toes. He did his breath exercises and sat up in a chair.
Day 2: Saturday, I got there in the AM early and he was sitting in a chair. His PT was bending your ankle forward and back and sliding the knee up and back using a cheat sheet in bed. He had PT in the afternoon. He achieved a 108 bend and almost able to straighten it to 180. Nothing hurt. He shaved. He ate heartily lunch and dinner. I left a little later. He had an okay night. His hgb was 8.6 – low. He used the urinal and bedside commode. He put on his own shirt and the black baggy pants which ended up being a problem maneuvering what with the knee drain and leg squeezers and the IV tubes.
Day 3: Sunday, his hbg was 7.6. I called and he was up walking to the bathroom with a walker. He was feeling weak. They gave him a shot of Procrit. They offered to give him a transfusion. He consulted with my brother David and agreed that he needed it more than the risks. They began the transfusion shortly after I got there. We were supposed to have a celebratory lunch together provided by the hospital, but David didn’t even want to eat. His leg was cramping a lot and it helped to massage it. You could tell that the whole leg had swollen a lot. He could no longer straighten his leg or bend it as much. I think the pain meds they injected right into the knee finally wore off. He lay in bed and slept most of the time for the transfusion. About 3:30 after it was infused, he started to feel better. He shaved. He ate a light meal. I left at 5:30 and felt guilty I had to leave. He seemed to rally the rest of the evening and tolerated some more PT. He used the urinal and bedside commode.
Day 4: Monday. I got a new rental car, a Chevrolet crossover which has a hand hold and bucket seats that are higher so he can get in and out. When I got to the hospital, he was much better. He had already shaved. PT included instructions on walking with the walker: you don’t have to look down, take even steps, Up with good leg, down with bad. Going up stairs can be one step at a time, good leg first, or sideways. More ankle pumps and knee bends with the cheat sheet. Saw a going home movie and got the walker he can take home. He achieved his goals of walking up and down three times, own personal care, bowel movement, knee flex of 88 degrees, up from bed while flat, ate dinner in a chair.
Day 5: Tuesday. Marriott provided a shower chair, a toilet riser, and a wheel chair. Discharge day spent talking to Dr. Rasmussen about therapy. Got prescriptions but their pharmacy wouldn’t fill them so we went to Costco. David took a shower and ate lunch, leaving about 1:00pm. We stopped at Costco for pills. Not open. Took him back to hotel and I returned alone and got the pills and shopped for two weeks of food.
Day 6, Wednesday. David spent most of his time in bed, got up to the deck, ate dinner at the table, iced when down, did exercises, was very concerned about bowel movement. He ate papaya, took the senna tablets, and made a lot of noises. There are a lot of sound effects associated with this recovery. His voice is softer again, and he coughs a lot. He is getting stronger. He took a shower. I am sleeping in the other bedroom. The ice pump is going, he is up and down, using the urinal, etc. I don’t see how anyone could sleep in the same bed as a knee replacement patient for quite awhile.
Day 7: Thursday. I made Hawaiian sweet bread French toast for breakfast. Then we went to PT in Kailua with Kelly at 1:00PM. Dropped David off and I went to the beach. Had a disagreement about how much help he needed. He didn’t want me to be telling him what to do or help him, so I didn’t, but then I didn’t help him when I should have. Hopefully we have worked it out. My neck, shoulder and elbow are sore and I could not lift the wheelchair into the car which it turned out we didn’t need. I was surprised that PT was all the way on the 2nd floor, impossible to get to without a wheelchair. We switched the appts all to that one location, but for some reason, the next appt isn’t until next week. This week is crucial for the therapy, so he will have to work extra hard on his own. He has three sets of exercises to do a day. This was a frustrating day for me.
Day 8: Friday. He wanted an egg for breakfast. He says his body is craving certain foods which he never remembers doing before, mostly protein and fruit. He did his exercises, took a shower and shaved, and then we went to the Ihilani Hotel for lunch using the wheelchair. Along the way it broke, so we exchanged it. Had a nice lunch at their pool and watched the high surf crash over the rocks. The lagoons are closed for the first time ever because of the heavy rains Monday night (that I drove home in) that washed debris from a dump. It is a real disaster for the resorts. No one has been on the beach for a week. We spent 2.5 hours on our outing, so we came back and he did his exercises in bed and iced. My routine is getting ice for the ice bucket, ice for the water pitcher, feed him etc. It is actually a good thing we are here for me because I don‘t have to worry about distractions like wanting to go walking, work out, bridge, OLE classes, etc. Since I’m not there, I can’t do them! So I am free to just have the stress of taking care of David and nothing else.
Day 9: Saturday Jan 22: I started writing this diary. David is learning when to take the pain pills and how much. Papaya and lots of fruit is helping the constipation. He still craves eggs and protein and is doing his exercises faithfully. We put a pressure sock on last night and this morning to help the swelling. They didn’t tell him to keep it on after he got out of the hospital and the PT wondered why he didn’t have it on.
Day 10: Sunday Jan 23: David is better and better he says. He walked from the walker about 3 steps to the wheel chair. We spent some time at the pool; he was on a pool recliner. He wheeled himself in the Naia tower to check out the location of our new room. At sunset he wheeled himself to see it at the end of the wheelchair ramp. His exercises are better; he can initiate lifting his leg straight, and sitting in a chair. It looks like the swelling is going down, maybe 1/3 what it was. Swelling is still preventing further bending progress as is the scar tissue. He knows he has to take a pain pill before doing the exercises. He does them 3 times a day. We moved rooms which was quite a hassle and tiring.
Day 14: Jan 27, Thursday. Today David had his therapy. He was told he could graduate to a cane now instead of the walker. His extension is pretty good. They had him do stuff on a bike. They tried to push his flexion and got to 108 degrees. That is the part that is very difficult and painful because of so much swelling still. He still has bruises. They told him to move the tissue around the incision to break away the adhesions there. We read that he should be using compression socks for 4 to 6 weeks. He hasn’t been using them for a week. He goes again tomorrow, so I guess they are going to push on his leg more to get more flexion and it will hurt. He is still coughing and has fevers at night. His hip is hampering and so is his ankle. I don’t see this as being a piece of cake for him. Kelly said he’s seen better and worse at this stage. He was going to do some work on the computer at Nancy Shannon’s while I played bridge but he walked around in the yard and got tired and rested. He gets pooped out at night.
Day 17: Sunday, Jan 30¸2011. The big move day from Marriott to Paradise Bay “Resort”. We had to pack last night and get out of there early in order to take the car to Avis and get over to the Windward side before the ProBowl traffic, which we did. We hung out at Nancy Shannon’s while David iced and did his exercises. Then we checked in over here. So we do have two bedrooms, a kitchen and TV and even a handicap type of bath. The manager bought David a nice walker but he is now using the cane exclusively. We gave up the wheel chair. Yesterday at Ko’ Olina we went on a long walk/wheelchair ride where he got out and walked for awhile. Then we went to the pool and he swam a little. The routine is he exercises in the am before I am awake, then ices after. Exercise in PM, ice, evening, ice, with icing, walking, daily tasks, in between. The swelling is down but not gone, the scar is getting less red; he is using mucinex expectorant to get the stuff out of his chest, and taking pain meds on a regular basis. I guess he has the constipation under control with the senna they gave him and fruit. He seems to be tireder than usual today. Nancy says there are good days and bad. It was really nice of her to let us hang out there. David achieved a lot of bend the other day, and there is a wrinkle at the top of his knee scar where the skin allowed the new movement it seems. He also wears compression socks all the time now. We are here now for a month and I have no idea what we are going to do. It is a cramped space and nothing to do around here. There is a pool. Everything is really run down but they are slowly fixing it up. We walked down the road among the feral chickens, cats and peacock. Across the street is a teal colored parrot.
I have to have a paragraph about Nancy Shannon and how wonderful she is. We literally couldn’t have had this surgery without her and all her help and hospitality. It was her knee doctor, and she recommended David get the surgery in Hawaii. Several times we stayed at their house and David rested and Nancy cooked dinner. We really enjoyed her and Don’s company. They made it happen.
Day 19: Tuesday Feb 1: yesterday we walked around the property. Then we went into town to the P.O. and shopping for groceries. Then we went to Frommagio’s for lunch, risking our groceries. We took the frozen stuff inside the restaurant! Drove home. David rested and iced. Stayed in room resting until after Ellen TV show. Then we walked down to a park and watched fishermen who had walked way way out into Kaneohe Bay. Then walked back. David was exhausted. They were sawing and pounding with electric tools all day here but they say the main building will be done today. It is a little quieter now. Anyway, yesterday, he did a lot and got really tired. He is taking pain meds all day long. We are massaging the scar and he wears compression socks all the time and elevates his leg. He just uses the cane.
Day 20: Wednesday: Therapy at 2:45. He went all the way around on the bike. Kelly had him lie on his back to get the leg straighter; do stuff with his back to the wall, and with his legs on the wall lying on his back. He only took one pain pill. We went swimming a little. The cool water is nice and he can stretch. He gets really tired. The routine is activity, rest and ice, exercises, rest and ice. Had the Wednseay night dinner and Hawaiian music. Very nice evening. He pooped out early. Bruising is almost entirely gone. The glue used to close the wound is now gone from scar.
Day 21: Thursday. Went to see Dr. Wakasuki, the ankle doctor. He has done 5 replacement ankles. There are two ankle replacement surgeries, the star and the agility. Agility you need to have a bone fuse. Star has been done in Europe for years. Dr. Roger Mann does it in San Francisco. Howie and Barb told us about him. He does the Star. Both surgeries make an incision down the center of the shin to the foot, midline. The Star removes the bottom of shin and top of talus. No bones are required to fuse. Two metal plates with a plastic device in-between. Biggest problem is the healing of the incision. Need to choose patients with good circulation (pulse, hair on toes, see veins.). David has limited mobility in both of his ankle joints, one that goes up and down, and one that goes side to side. He may need to fuse the side to side one. Tower said that was okay, but maybe not now. Both require no pressure at all on foot for two weeks or so for the incision to heal. That has to heal before anything else. You will have more mobility with replacement, but not be able to do anything. If David got a fusion, he may need to do both joints. Fusion is what would happen if the replacement fails. Plastic can wear out and can be changed. Can’t do impact sports, but walking, hiking, dancing, maybe skiing, biking for sure.
David’s x-rays show bone on bone and very little space in the other joint area.
Star: In hospital for at least two days. Surgery takes 2 hours. Use crutches. After stitches are out, you move to a boot. No weight bearing for 2 to 3 months for fusion.
David can go back and forth if living in Kona. Would have to stay in SF for a month or so probably.
Came back home, set David up in the deck with computer and went to play bridge. He worked, took nap, swam again, sat on deck, and rested after dinner. He really rests a lot. His voice is getting very soft, yesterday and today it is very bad. He just has one small scab to come off the scar, swelling down, bruising gone.
Day 23: Saturday, February 05, 2011, had a massage. Then we got some Epsom salts to use on the top part of David’s wound. Still swelling around the knee itself. He still takes pain meds. Went in the water. That looks like it would be really good for his leg and knee. He got tired. Seems a little better. He is walking without the cane sometimes. He is trying out one pill every 4 hours, except yesterday he took two before therapy. The therapist, Jill, massaged his knee and scar first, then had him do exercises. Then she offered a cold pack at the end. I thought she was very good.
Day 24: Sunday. Drove into Waikiki to the Royal Hawaiian. Brought the cryo cuff and stuff but David seemed to do well. We had lunch with Judy and Larry and then drove to Nancy and Don Shannon’s to watch the Super Bowl 45 P:ackers vs Steelers. Other than his voice which you can barely hear, he seemed to be alert and able to have the stamina to go all day like that. The Shannon’s have a nice chair that leans back and he could ice. Went out to dinner and back to watch the half time show and got home at 8:30pm, about 10 hours later. Swelling now mostly in knee.
Day 25: Monday Feb 7: Went to therapy. She massaged first. She measured 115. David forgot to take his pain meds until the actual time of the appt. He did okay I guess. Had lunch in the cafeteria, then came home to rest and ice. He had a telemeeting in AM and in afternoon did work. Went back to see Dr. Rasmusson at end of day. She took Xrays and they gave us a copy of the before and after and the ankle on a CD. She said he was good to go, to do whatever he felt like doing. Got the meds renewed and the PT for another couple weeks. Then went to meet Nancy at the mall at Ruby Tuesday’s for dinner. Walked through Macy’s. It seemed strange to me. My former life. David got really pooped and came home and crashed. Rainy all day.
Day 27: Wed: I set David up on the porch with computer and ice and he did his thing all day while I went into town and hung out with Sharron and Bill at Alamoana Beach. Went to the mall and Nordstrom rack. Came back over at 1:30 to go to the Macy’s in Kaneohe and get Davids’ drugs. Got a pedicure. David wrote one letter for work, got the laundry, moved himself back and forth and seemed to survive okay. Steve & girl came for dinner. He pooped out. Leg hot, just knee swollen.
Day 28: Thursday February 10, 2011 PT with Kelly. He didn’t massage or warm up, just wanted to see his numbers. Had him do standing on one leg to strengthen his quads and hamstrings and then had him step up and down on a step. Both in front of a mirror. No cool down after. Went to Nancy’s while I played bridge. He did some work but is in pain. Made appts for next two weeks in Kaneohe.
Day 36: Friday, Feb 18, 2011. Today is the 5th week from the surgery. David has been walking without a cane now for a few days, and going on short walks, up and down stairs, and doing a lot more exercises including standing up without arms from a seated position, ones on his tummy on the bed, massaging the scar, etc. The scar still has some stuck parts, and the knee is still swollen. He is down to one pill every 6 hours for pain. The thing that is disturbing is his hoarse voice. We went to Dr. Tan who found a bump on his right vocal cord and said anything to be done about it was beyond his expertise. He showed David how not to cough and clear his throat, and to gargle often with water. He is doing that now. But when he talks to people he strains his voice. The Dr. said a tincture of time, and I interpret that as also resting his voice as much as possible. I try to get closer to him so he doesn’t have to strain. It is difficult to get into these new habits, and is just one more thing on top of all the other things. So far he has managed to get ahead of one problem and another one appears right away or even sooner. He has good spirits and is still looking forward to going to the coffee farm, but you can’t help but think that the Big Island vog can’t be good for someone who already can’t talk. We are experiencing the vog here, but I am sure it isn’t anything like over there. We’ll see.
Day 40: Tuesday, February 22, 2011 Therapy at 8:00am. He measured straightness off one degree, with a push, he got to 123 bend. He is concentrating on making sure David gets all the correct muscles firing to walk correctly. His ankle still makes him walk slightly off, however. But he is concentrating and trying very hard. Went swimming and he does lots of exercised in the pool. Then he is tired. He is taking 1 pill every 6 hours, but I think he would like to take more, at least more often.
Day 48: Thursday, March 03, 2011. We are at the Braund farm. David had therapy yesterday and she said he had edema in his calf. He slept with me in the queen bed and didn’t elevate. He is not using ice as often either. He wasn’t able to do his exercises as much. Ie he is getting out of his routine of exercise, ice elevate and rest, do something, exercise, ice and rest, etc. He was able to stop taking the oxycodone finally and he doesn’t have the withdrawal symptoms anymore I guess. He is taking Aleve now. He is getting therapy at “the Club” here in Kona which is connected with a gym so he is getting transitioned to doing stuff in a gym. His weight is about 170 with clothes on. His knee still looks way bigger and different than his other knee. It may not ever be the same. He used two hiking poles yesterday to walk around the farm which is volcanic rock and very unstable.
Day 53: March 8, 2011 We walked all the way down the steep road to the newspaper mailboxes as well as around the bottom of the farm. David uses two poles and says he feels safe that way. Yesterday we walked this route twice and the day before once. He has not used ice afterwards or needed to rest like usual. Yesterday he went to therapy and then we went snorkeling after, and no ice or rest after. He seems to have his stamina back. They are using the “electric” machine on his knee to reduce the swelling. I forget the name but I used to do it at MPFC. He says it helps. We picked some Noni leaves to wrap around his knee, but he didn’t do it. He said the adhesions from the scar seem to be better. It doesn’t sting anymore. He is concentrating on walking correctly. He goes pretty slow and steady.
Day 54: Left Hawaii for Anchorage.
Day 79: April 3, 2011. David has been back at work, more than he would like. He has a hard time getting to the athletic club to workout, and probably only does some knee exercises once a day. The ENT doctor here said he didn’t have a bump on his vocal chord and that it was just thin from aging. His voice has steadily gotten stronger and better able to be heard, except you can tell it is worse in the evening.
The black and blue on the back of his leg was gone way before we left Hawaii, but there is still swelling. The scar is all flat and even straight, although at first it was a jagged thing. He no longer uses the ice. Now the exciting thing is what happens to him at the airport. So far they have always patted him down completely. He has to get to the airport early. We go for walks, but he is slower, however not as slow as in Hawaii by any means. He was back at full speed I would say after we got home, which was day 54, or eight weeks post op.