Thursday, June 11, 2009

Knee Resurfacing (Replacement) Surgery

I was in Manchester Memorial Hospital (MMH) for 4 days. My knee resurfacing surgery was was a great success, but the process is every bit as uncomfortable as I had been warned about. I received a "nerve block" (the block) to avoid general anesthesia and, in fact, my orthopedic surgeon Dr. Daniel Veltri (who is also my friend) told me that it was a successful strategy, permitting him to perform the surgery nearly without anesthesia, which was very positive.

I migrated from Vicodin to Dilaudid for pain. I then weaned to only extra strength Tylenol. By 7/23 I wasn't even taking Tylenol. I learned, the tough way, that RX drugs and a TBI don't go together well. It was a tough battle.

I have experienced some strange effects from meds in my recent past, due to my TBI. I am blessed to have a very conscientious physiatrist, Dr Feingold, who prescribed two pain meds for me to evaluate prior to my surgery. I was fortunate to discover that I almost hallucinated on the weaker med and I dealt better with the stronger. However, not being in severe pain, I couldn’t really judge the pain relief effect of the RX meds.

The effects of the block were quite strange. I virtually had no feeling below the waist in my left leg (where I had the knee resurfacing surgery). I had been advised, by Dr. Dan, to stay ahead of the pain by beginning to take more pain medication when it was offered in an effort to stay ahead of the pain as the block began to wear off. I tried my best to follow his advice but it's not easy to accept pain meds when the block still has its numbing effect. However it was quite significant when the block no longer had its numbing effect.

My friend Lappie spoke with Dr. Dan after the surgery and Dr. Dan remarked that "it's a good thing that I did the surgery when I did it". When Dr. Dan saw the inside of my knee he was surprised that I'd been able to complete any recent bicycling activities. I feel that I am a very fortunate man. Thank you Dr. Dan.

**** 7/3/09 Modification start ****

After my stay at MMH, I transferred to a local rehabilitation facility, Glastonbury Health Care Center in Glastonbury, CT. on Hebron Avenue, for 6 days. The GHCC staff professionally referred to my surgery as knee re-surfacing. I became friendly with director (David Sones) of the facility and I shared my website and the documentary film, "Joe's Progress" with him. David then shared the documentary with his staff.

I enjoyed my stay at GHCC. I was fortunate to have had many nice visits and diversions while I was there. My wife even brought Stella along to visit me for 5 consecutive dinner times. We had picnic dinners of take-out restaurant food. We enjoyed the on-site gazebo and at other outside common areas.

My good friend Al brought me out in a wheel chair and we jokingly did some off-road riding, on some uneven gravel paths. Surprisingly, within 2 days my rehab PT’s brought me on the same paths, first with a walker, then they graduated me to use of only a cane. In fact my PT, Karen, brought me for a cane walk on the same path to evaluate my use of only a cane on uneven surfaces.

I did at-home rehab from 6/5 to 6/12. I watched VCR tapes of the Giro d'Italia, a professional, multi-day bike race in Italy (thanks to my brother-in-law, Dave) while I recovered at home. I can't wait to be back on my bike but I will exercise patience.

I watched all of the VCR tapes of the Giro d’Italia ’09. It was a very exciting Giro. None of the marquee names stood out. Several of the stages were a little too close to my cycling past in Italia of 2004, 2005, and 2006. I frequently bicycled on some of the same roads that were used in the stage on the Amalfi coast and the stage began in Napoli, very close to the U.S. embassy and passed directly in front of our palazzo/apartment. That was too much nostalgia of a wonderful, care-free time in my life that I may never experience again.

**** 7/3/09 Modification end *****

I had an appointment with doc Dan 6/8 and I had the staples removed. Dr. Dan then looked at the remaining bow in my right leg and he cracked “when should we schedule the other knee?”

<-----Here is a photograph of my legs before the surgery : note my left leg before the knee resurfacing surgery. When I have fully healed I intend to duplicate this shot to produce a before and after comparison photograph.
The left knee was the subject of the resurfacing surgery. I have more after-surgery photographs, but they are not for the faint at heart; please request.

Interim Healthcare provided in-home rehab services to me. My Interim Healthcare nurse and PT came nearly every day. They were wonderful and they helped me make rehab progress. I began more rehab with Integrated Physical Therapy at their facility on 6/15.

Here is a photograph of the home-grown Peonie flowers, that were given to me by my neighbor when I returned from the hospital. <-----
Unfortunately, I snapped this photograph when the flowers were past their peak. <-----

I've attached another photograph of a beautiful floral bouquet given to me by a friend. The beautiful bouquet is arranged in a fine glass vase, next to an empty plastic water pitcher. When my friend presented me with the beautiful bouquet, I had quickly placed it in the plastic water pitcher. The wonderful staff at GHCC noticed my bouquet in the plastic water pitcher and they arranged the beautiful bouquet in the fine glass vase, as pictured. Thanks, GHCC.

***** Appended 6/29/09 ******

I now go to outpatient physical therapy with a good friend, Eric. My surgeon and friend, Dr. Dan, and Eric have both confirmed that my body is getting accustomed to my corrected, normal gait and that I may take some time to adjust.

I now have to concentrate on my every step. Over many years, as the arthritis in my knee progressed, I stepped (limped) heel-to-heel and now I'm able to step and roll heel-to-toe, but I must consciously make it a habit to do so. Getting better is hard work.

One must consciously think about taking a step up/down to/from a curb or stairs. At GHCC they taught me the mental trick “the good go to heaven and the bad go to hell", meaning when you’re about to take a step up, lead off with the good or strong foot/leg and when you’re about to take a step down, begin with the bad or weak foot/leg. After many years of walking it became natural to walk. It's difficult to plan every single step.

Similarly, after naturally taking stairs “one foot over the other” but suddenly one must take ½ steps (i.e. first step right foot up, then step left foot up to meet the right), one must consciously think about climbing or descending stairs.

One only makes the mistake of attempting to support the body’s full weight on the bad leg/foot to learn that one should plan-ahead every step.

**** 08/07/09 - Knee surgery conditioning prep. ***

I attended a knee and hip replacement class at Rockville Hospital, put on by ECHN. I was by far the youngest class member. In my ignorant opinion, I was the only participant who was having a joint replaced due to past athletic activities. Many of the class attendees were older people who were physically unconditioned. It’s hard to imagine how difficult this surgery would be for a physically unconditioned patient. I am real happy that I was well conditioned and prepared for my knee resurfacing surgery!! The hospital personnel explained the procedure. I confronted the reality of my surgery. Even before I attended this class I had anticipated my serious surgery. I was already in the midst of a physical conditioning regimen. In preparation for our house-to-condo relocation I had down-sized my weight training equipment. Before we moved I’d given my weight disks, my leg weight bench, my chest and back weight bench, and various weight barbell configurations to my nephew who planned to use many of them to condition for high school athletics (baseball). Many members of my family joked that I merely “Indian-gave” my weight equipment to Chris.
Shortly after we moved into our condo I designated a section of our basement as an exercise area. I installed my triathlon bike onto my Minoura Mag850 bike trainer and I habitually pedaled my bike. I accepted the challenge of improving my physical conditioning quite seriously.

I exercised my legs and built up the muscles by repeatedly riding my bicycle up the hill from Rt17 to the top of our condo community. This hill is ~100 feet in elevation. To begin, I had a drink of water and started my stop-watch, and then I rode to the top of the hill, clicked my stop watch and had a drink of water. Then I descended the hill to the parking lot behind South Mill Tavern (on Rt17) and immediately repeated the hill climb, a minimum of 5 times. My best performance was 8 consecutive hill repeats. I look forward to completing a single hill repeat after my knee resurfacing surgery.

My worst and most common recovery problem was that my leg muscles weren't stable enough to support my weight. Better weight conditioning would have helped to avoid that issue.
One night, I got up to use the bathroom and I fell down and bruised my “sit bones”. My left leg wasn’t strong enough to support me and my 'TBI wobbles' are compounded by the knee surgery.

**** 08/14/09 - Left Quad muscle atrophy ***
I went to see Dr. Dan for a follow-up appointment the other day. Regardless of my pre-surgery conditioning he noted the obvious difference in the quality/strength of my left (surgery affected) and right quadriceps muscles. I am now hitting the leg weight bench press to strengthen that quad muscle. I realize that I have so much further to go until I can (if ever) resume my previous activity!

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