Joan Chiverton

In three years, but maybe it was longer, my knees just gave out. When the pain creeps up gradually I guess I just got used to it, but didn’t realize how bad it was. At least that’s what happened to me. Friends now tell me that to compensate I was limping and waddling and it made them sad to see me like this. I made light of it, but there was nothing funny about it.

I was always very active, not an athlete but active with work and raising three children. I teach at FIT and was somewhat concerned about my appearance, but lost perspective always wearing sneakers since a podiatrist I saw scared me into getting elaborate, high prosthetics that must only be warn in New Balance sneakers he said. I had to always wear slacks or jeans to cover these ghastly things. I had also gotten very bow legged, so much so that the prosthetics started rubbing and cutting into my outer leg and making it bleed. So the technician flared out the prosthetics even more. He then even tried a new mold. He'd said "avoid surgery, recovery from a knee replacement is terrible, so painful."

I had started seeing Dr. DiFelice, a knee specialist at the Hospital for Special Surgery here in NYC, he initially gave me a cortisone shot in both knees. This worked. When it wore off and I returned he gave me a new experimental shot of material taken from a roosters crest. It worked. When that wore off he said insurance would not cover additional shots until next year, and the shots were expensive to pay for myself. He said “consider surgery”. I almost fainted when he said that. I do recall he said "you'll look back and say why didn't I do this sooner." I procrastinated for a few months though I was in pain, then scheduled surgery for September, but rescheduled when there was a cancellation on August 1st.

In preparation:

Though I was not heavy, my surgeon had said recovery would be easier and faster if I did exercise and if I lost a few pounds. He said for every pound I weigh, it puts 3 pounds of pressure on my knee. That’s significant. Swimming was recommended as the best all round exercise, but I hate to swim. I decided to meet with Rebecca, a physical therapist I knew who I would work with after surgery and she suggested the exercises I should do now - at home, at the gym, and even in the pool. I joined a local pool in a local school and since I hated swimming so much she suggested I swim a little, walk in the pool and also hold onto the edge and just kick. In retrospect, I think this all paid off. Rebecca was pregnant so I was hoping she would still be working when I really needed her after surgery. Fortunately she was.

Pre surgery:

I found out in late July that I was scheduled for surgery August 1st. I had not realized how much pre surgery screening had to be done - it was crammed into 8 business days. My family doctor did not have access to HSS, so my surgeons incredible staff found me Dr. Magid, a HSS doctor who would take my insurance and oversee a zillion tests including: Blood, stool, urine, electrocardiogram, Holter probes I had to wear overnight, x rays of leg and chest, a nuclear cardiogram stress test (I was radioactive for a day), and probably a few more.

There was a mandatory 90 minute education session at the hospital which I thought was going to be one-on-one but turned out to be given to a group of 20 or 30 of us all getting new knees over the next few days. This was like a factory! The session was fascinating and so informative. Three points that really resonated with me were: 1. In the O.R. the doctors will look like astronauts with helmets that recirculate their air, this is to prevent infection. Do not be scared! 2. Two kinds of anesthetic will be administered. You will wake be - fore the epidural wears off… so when you wake you won’t feel your legs and they won’t move. Do not be concerned. You are not paralyzed! 3. Everyone will ask your name and birth date. Don’t feel they really don’t know who you are, it’s for security and it’s the law. Some brave or crazy patients were having both knees operated on at once, or had issues like diabetes, they were advised to go to a physical therapy facility for a week or two when released. Most of us were just having one knee done and would go home when released. They gave us all “gift bags” with an enema to use the night before surgery and iodine/shellfish soap to use when taking our last shower the morning of surgery. That turned out to be an important shower, our last for 2 weeks.

I had to do something good for myself. Realizing I’d look and feel terrible after surgery I got my hair done- color and cut, got a manicure and pedicure and got my eyebrows shaped, but then I also had to be practical and realistic and updated my will and health proxy, shopped for groceries and got some emergency cash to have on hand.

Surgery:

August 1st… surgery. I was told to be at the hospital at 11 for surgery at 2. Everything was very efficient, check in, wrist band, turned in health proxy, escorted to a room with beds and changed into a hospital gown. Dr. DiFelice, my surgeon, came in, asked my name and birthdate and signed the leg to be operated on with a Sharpie. I’ll be getting a Stryker Triathlon knee. It was all official. Then Dr. Booser, my anesthesiologist who I never met before came in. He discussed what he would be using. It was about 3 by then, everyone was running late, I was wheeled down a long windy hall to the operating room, I saw my x-rays on a light box and the next thing I remembered was I was in the recovery room.

Recovery room:

As soon as my legs were not numb I started the two very basic leg exercises we were told to do. Wiggle our toes up and down and press our knee to the bed to straighten the knee. Visiting in recovery was very limited. Only a 15 minute period every 2 hours and only one visitor each time.

My room:

Late at night on August 1st I was wheeled into my room. For two whole days I had a private room though I was sort of out of it on day one with a catheter and a blood drain from the knee and nauseous from the epidural. The view of the East River was great, but not truly appreciated. Day two was so much better, I was even eating, used the bathroom with the help of a walker, and was on an exercise machine “motion stretcher” in bed, for 2 hours 3 times a day (6 hours a day). A physical therapist came every day and walked me down the hall and around the nurses station, then into the PT room with steps to learn to climb one at a time. Each day we did a little more, walking further.

I felt weak and not self confident so when the PT asked how I felt about staying one extra day I said yes. It seemed like a good idea.

I had been warned about how painful the first few weeks would be but I must admit, after the epidural was removed and I no longer felt nauseous from that medicine, I was just taking Tylenol. The knee area felt a bit numb, ached some - times, but never really hurt which amazed me. It felt like a tight wide rubber band was wrapped around it. Was I unique? Did my exercising pay off? Whatever it was, I was not in great pain.

Discharge day was like graduation:

So many people had to sign off on me. My surgeons associate came early in the morning and woke me to check the progress. One of the physical therapists took me for a stroll and practice on steps since I have steps in my lobby. We discussed me taking home a walker and cane but I did not need to rent the “motion stretcher” since I was doing so well. Dana came with Visiting Nurse information and assured me they would call the next day to set up appointments. My last IV was removed from the back of my left hand and I waited for my son to arrive. When he did, a nurse took me down in a wheelchair and made sure I was able to get into the SUV, front seat, rear end first. I was going home with a new knee.

Home:

A good friend had agreed to stay with me for a few weeks which was wonderful. I used the walker to get around the apartment and got stuck on the couch the first night. It took two people to pull me up, tipping a vase of flowers in the process.

Visiting Nurses did call me the next morning and a gal came and took down vital information. That afternoon a wonderful young man, a physical therapist came. I had two things I needed him to teach me right away - how to get up from the couch and how to get in and out of the shower, though I was not to shower yet. He gave me simple tips that I still use every day. That first afternoon a nurse came to do the blood test needed to regulate the amount of Coumadin I take. This is a blood thinner to prevent blood clots. You need to take this for 6 weeks after surgery. She had a device to prick my finger, she got a few drops of blood that she inserted onto a slide, and inserted in a tiny machine. In about 2 minutes my INR numbers came up. She called this into my doctor, not the surgeon, and he would get back to me adjusting the dosage. Two or three times a week my Visiting Nurse team came by and soon I was walking more and even took a bus one stop and walked back with my physical therapist. This gave me a sense of freedom and so much confidence. Day 14: Took a cab to HSS to meet with my surgeon. He told me I could shower and to start with my physical therapist where everything will be much harder and progress will be even quicker. I knew I’d miss this amazing Visiting Nurse team but it was time to move on.

Physical therapy:

This made a big difference. I discovered massaging with creams, but not too near the scab, felt great. I did more strenuous exercises and used the gym associated with the PT office. There is so much progress every day since I also exercise at home in between the 2 therapy sessions a week. I use my cane outside but don’t feel I even need it. Rebecca said the cane is a good way to alert people around me to leave me some space, don’t bump into me and give me a seat on the bus or subway! Good advice I think. I can take the bus alone now. Day 36: I took the subway with a friend. 37 days since surgery I can walk up stairs using both feet, down is still one step at a time. My dog came home last week and I can walk her even though she is a big girl, a lab, who pulls. She seems to understand and to behaves most of the time.

Coumadin:

It’s almost 6 weeks since surgery. I’ve been taking this every day. Dr. Magid said I can stop taking Coumadin cold turkey, and I do not need any additional blood tests.

Day 42: Rebecca had a baby boy yesterday. I am forever grateful to her for cramming in so much work before taking time off. I have her assistant working with me now, we’re concentrating on going down steps. That seems to be my last real challenge.

I found the stationary exercise bike really limbers me up when I feel stiff. I think it will always be part of my workout. Day 60: Going down steps is still a challenge, but I’m doing specific exercises for that.

A warning:

What I must remember is that when I get any dental work done, even a cleaning, I must take penicillin since the knee can get infected. Fascinating. I must find out if this will be forever?

I look and feel so much better. Now that the swelling is coming down I can see how much straighter my right leg is. Dr. DiFelice said I’m also about 1/8 inch taller on the right side now. I realized this when I had to put a slight lift in my left shoe to even me off.

I’m planning to get my left knee done next year. Dr. DiFelice was right when he said I’d say, “why didn’t I do this sooner”. Did I mention that since I’ve been home I’ve only been taking Tylenol, and that only occasionally, and icing my knees when necessary. This surgery was so much easier than I expected.