Features 1999

Helping Hand on the Road to Independence

... I could hear the whine of the saw
as the surgeon cut my tibia and femur bones.

by Dorothy S. O'Connor

TKR!! [Total Knee Replacement] Many seniors have had this surgical procedure; many more will experience it in the coming years.  Developed in the late 1950's by an Englishman and first performed in Sweden in the 1960's, this surgery has become almost routine. What does it feel like?  Does it hurt?  How long is the recovery period?

The Surgery
On April 2, 1999 I had a TKR at the Brigham & Women's Hospital in Boston. As you know if you've recently had surgery, the pre-operative testing is completed several days ahead of time.  Therefore, on the appointed Friday morning, Russell drove me to the hospital for a 12:30 p.m. date in the Operating Room. The anesthesiologists and I had mutually decided against general anesthesia. Instead, I had a spinal block which rendered me totally numb from the waist down.

The top half of me was covered with a tent-like apparatus for several reasons, one being to protect my eyes and face from the bright, hot lights used with the glue. My lower body was insensate but my mind was clear.

It was a fascinating experience. In the room were two surgeons, two nurses, and from two to four anesthesiologists at various times. It felt as if giant hands were shaking my leg violently. I could hear the whine of the saw as the surgeon cut my tibia and femur bones, followed by a noise like a huge fingernail being filed and the sounds of something being gouged out. At one point I heard Dr. Schaffer comment to his assistant, "An excellent fit!" From time to time a comely young woman anesthesiologist stuck her head into the tent and asked, "How're you doing?"

About 2 1/2 hours later it was all over. The tent was removed.  Dr. Schaffer held my right limb aloft and instructed me, "Say hello to your leg!" At the time, it looked like a cartoon leg, totally swathed in bandages, although the dressing was removed quickly in the next few days to give the incision exposure to the air.

I have since learned of the existence of a 90-minute video from PBS which shows a TKR. It is on order; I am eagerly awaiting its arrival so that I can see what happened to me.

The next day was one of those "lost days" one sometimes experiences after surgery. I didn't even eat the three meals delivered to me!  However, on Sunday I got to dangle my feet over the side of the bed and on Monday I was allowed to sit and dangle while I ate my meals. That represented the first baby step on the road back to independence.

Late on Sunday afternoon a pleasant physical therapist arrived with a walker. She helped me stand up and asked me to take a step with the operated leg. It was one of the most frightening things I've ever been required to do and I wasn't wildly successful. That night I received a transfusion of one pint of my own blood, which I had donated a few weeks before surgery, and the next day I felt stronger and was able to walk 30 feet with pride and a feeling of great accomplishment.

Did it hurt? Yes, but it was not unbearable. When the "Pain team" asked me to rate the pain on a scale of 0 - 10 (10 being the worst), the highest number I gave during the whole hospitalization was 5.5, right after I "came to." In retrospect, I would say that the feeling is more like a dull ache in the knee and surrounding area than any sharp pain. Surprisingly, the pain isn't in the knee area, but rather in the BACK of the knee as therapists work to stretch the hamstrings so that one can hold the leg straight. Judging from my  experience, I believe the medical profession is sincerely concerned with alleviating pain.

The Rehab Interlude
Four days after the TKR I was feeling livelier but in no way confident enough to go home and manage the tasks of daily living.  I was, therefore, transferred to the New England Rehabilitation Hospital in Woburn. The nine-day stay there proved to be a totally positive experience.

When I arrived at the Rehab I had no confidence that I would ever walk unaided again. In a panic, I asked myself, "How are you going to get in and out of bed?  Go to the bathroom? Take a shower? What if you drop something?" By the time I left New England Rehab, my self-confidence was fully restored, thanks to the caring and capable staff there.

During that time, I had several new adventures.  At age 70, I first rode in an ambulance, learned to "drive" a wheelchair, used a walker, and was lowered into a therapeutic pool on a ratchet-powered chair.

Once settled at the New England Rehab I met Heidi, my Occupational Therapist. She taught me how to use a wheelchair. I was hardly an outstanding student; I kept maneuvering myself into a corner with the rolling table in front of me, blocking any further movement. Using the chair, however, DID give me a measure of yearned-for independence. Instead of sitting in bed bathing from a bowl of hot sudsy water, I could, with assistance, get into the wheelchair, ask a kind helper to put the basin of toilet articles into the bathroom, wheel myself into the room and then proceed to wash up on my own -- just like a real grown-up!

Next I met Sharon, the Physical Therapist assigned to work with me. She carefully instructed me how to use a walker properly, staying cognizant of the fact that I was "PWB." That stands for partial weight bearing. As we walk, each leg bears 50% of the weight alternately. I was not to put myself in any situation where more than 50% of my weight was borne by the operated leg.

Some people were in the category of zero weight bearing on the affected leg. An Indian gentleman had broken his pelvis in a fall on black ice, and he couldn't put ANY weight on that side. One day the "Ortho Group," (a group which met with an occupational therapist) assembled in a little mock-up of a house containing all the important features -- sofas, hard chairs, a table, a bed, a sink, refrigerator and stove, and a bathroom. While we watched with rapt attention, the gentleman from India demonstrated how to get into bed. He lay down and then placed his inert leg onto the bed by using his strong leg to lift it. We rewarded his skillful presentation with a round of applause.

Life is extremely busy for rehab patients. After all, you're there to learn new skills, not to lie around reading or watching TV. Here is a typical day:

7:00 a.m. Get up and dress. At 8 o'clock breakfast arrives.

From 10:30 to 11:30 a.m., "Knee Group." There were four or five of us in this group. We were wheeled to a room equipped somewhat like a gym. Along one wall were five or six exercise mats, about the length and width of a bed, 18" off the floor, with a mat on the surface. Under the direction of a Physical Therapist and a PT Aide, each of us lay on a mat and went through our prescribed exercises, bending our knees, stretching those hamstrings, flexing our ankles.

Also in that room was a little "flight" of four wooden stairs with a railing on each side; a "stoop" about five inches off the floor; parallel bars; some thresholds to practice walking over; a bicycle with no resistance; AND dear old MacLeod.

MacLeod is a quarter-car made of wood.  It consists of the passenger seat and back, foot space on the floor, a dashboard, and a door. Our therapists patiently taught us the safe way to get into and out of a car, using a walker. What a valuable lesson! Having mastered that, you realized that very soon you would be climbing into a real car for the trip home.

This "toy car" was the brainchild of an Occupational Therapist named Patti Motyka. Therapists formerly took patients outdoors to practice getting in and out of real automobiles. Patti, who did not enjoy going outside in cold or rainy weather, thought it would be wonderful to have a make-believe car inside the building.  When she called a junk yard, the owner readily agreed to donate the passenger seat of a used vehicle.

The project was completed by Dick MacLeod, a maintenance worker at the Hospital. He designed and built the rest of the car around the seat, and as a final touch, created a license plate with MACLEOD painted on it in big, visible letters. When Dick MacLeod retired in the mid-'90's the little car attended his farewell party.

One of my fellow patients in the "Knee Group" was a 94-year old woman named Maureen. Maureen grew up in County Cork, Ireland. She is thin and sprightly and has a positive attitude. She called everyone "lovey." Maureen had had a total knee replacement about the time I did, and she was just as eager as I to learn enough coping skills to go home.

One day Maureen was lying on an exercise mat lifting her operated leg up and down with vigor. Her doctor, about one-third her age, came along, sat on the mat and studied her. "Maureen," he pronounced, "you are a STAR."

I couldn't agree more. I looked forward to "Knee Group" in order to see Maureen in action. One day Russell came to observe the group. Much to my delight, Maureen flirted with him. Let's hear it for a 94-year-old with enough pizzazz to be a coquette!

After the Knee Group meeting, we had lunch. At first, meals are delivered to new patients in their rooms, but after a day or so the staff decided that I could go downstairs for the midday meal.  This involved being pushed to the cafeteria in my wheelchair. On two occasions my husband joined me there.

And speaking of meals, although I am a fussy eater (I can't abide poorly prepared food), I found the food at New England Rehab to be of high quality. Part of the trick is learning how to order from the menu, furnished to the patients a few days ahead of time. One day a friend was visiting. When my supper arrived, Erna commented, "Oh, isn't that a cute toy meal!"

After lunch on our typical day there was an hour's session with another group, focusing on Occupational Therapy. In my case the facilitator was Rick Frank. Mr. Frank led discussions to prepare us for the "real world" when we went home. For example, in planning to go out to eat with friends, one should choose a restaurant carefully. Is there a ramp? How many stairs are there inside or out? Where is the restroom, and does it have handicapped facilities such as raised toilet bars? Rick encouraged us to be assertive and make phone calls to gather such information, rather than going unprepared and facing an unexpected crisis.

Hard on the heels of the O.T. group I had an individual session with Sharon, my Physical Therapist. Whereas Occupational Therapy concentrates on what might be called "housekeeping" skills, i.e., managing daily life while recovering from surgery, the P.T. instructors taught us a series of exercises designed to strengthen the muscles and tendons. Most of it was rather enjoyable, but there was one part that we all dreaded. It is necessary for the P.T. to measure the angle to which the patient can bend the knee. A 100-110 degree angle is the goal.  Even more important is the patient's ability to lie on a bed and flatten the knee so that the angle behind the knee is 0. The therapist would press down on our knees while counting to ten (seemingly interminable, because it hurt so much), but we understood that it was necessary pain."

The best part of the therapy, the highlight of the day, was an hour in the therapeutic pool, in my case, from 3 to 4 p.m. After getting into a bathing suit in my room, I was wheeled to the pool in the nether region of the building. The pool is 3 1/2 feet deep; the water is kept at 93 degrees. Oh, boy, did that ever feel good on sore bodies! In the pool we carried out bending and stretching exercises designed to strengthen our joints, muscles and tendons.

In between sessions, knee patients had to lie in bed for an hour or two daily, using the CPM machine (continuous passive motion). It slowly and gently bends your knee to its outermost range and then straightens out the leg.

While I was at the New England Rehab Russell brought me the mail from home. I read an article in the AARP Newsletter which pointed out the beneficial effects of laughter. It seems self-evident to me, but researchers are beginning to learn that laughter can lessen pain, reduce stress, stimulate the immune system, and improve mental functions.

An example of humor in my own convalescence occurred when Kerry, my nurse par excellence, discovered a "pressure" sore on my right buttock. It is not unusual for bedridden patients; the hospital has a routine of photographing the sore and then applying a healing salve twice a day. When Kerry aimed the camera at my bottom and said, "Smile!" I did indeed derive the benefits of a good laugh.

There were various milestones along the way. Immediately after surgery, one is totally dependent on others for everything. Little by little independence is restored. I was very proud when I "graduated" from needing to call a nurse at night who was required to watch me go from my bed to the bathroom with my walker, to the glorious moment when I could just GO, on my own, without anyone's supervision. In "civilian" life we take such things for granted, but in the hospital setting, every little step brings one closer to beloved independence.

Another first experience I had was learning about elastic shoelaces. One day, in somewhat of a panic, I said to the Occupational Therapist, "How am I going to manage my sneakers when I get home?" and she acquainted me with elastic laces. No need to untie and retie shoes with those babies!

Sharon, the P.T., not only taught me how to manage stairs with a four-pronged cane, but gave me immeasurable confidence that I could do it. Several friends told me that the mnemonic device is: "The Good Leg Goes to Heaven; the Bad Leg Goes to Hell." However, I created my own slogans. For going upstairs: "Good Bye Cares" (good leg, bad leg, cane, in that order), and going down: "Corned Beef Gourmet" (cane, bad, good). Works wonders.

The personnel at New England Rehab were unconditionally helpful and caring. Special kudos to those I have already mentioned, plus Maura and Marie, both unfailingly cheerful and helpful, and to Fran, a no-nonsense person who plunges the blood-drawing needle in right on target.

The Aftermath
Now I'm at home, having follow-up P.T. at the Melrose-Wakefield Hospital Rehab Center. I am grateful that such an institution as the New England Rehab exists, and appreciative of everyone's kindness and teaching skills. Thanks to the fine work they did, I realize that each day I get stronger and more confident.

If the day comes in your life when your surgeon thinks it's time for a TKR, go for it! You may have some bad days along the road to recovery, but the end result, being able to move more freely and without pain, is well worth the discomfort.

July 2, 1999

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