“You DO
NOT talk about knee replacement surgery. With anybody.”
Failure to
follow the rules will result in confusion.
Dangerous,
tremendous confusion.
That is
especially true if you are an American expat living in Taiwan with contacts in
both nations who have undergone the surgical procedure and are eager to talk
about it. Add to that the ubiquity of YouTube videos from therapists and
patients alike, and you have a child’s recipe for muddle pies.
You see …
The
adventure that is a full knee replacement begins many years before the surgery
itself. It starts with the grudging admission that a knee, or both knees, have completely
lost their youthful vigor. I’m talking about that time when walking a mere 4,000
steps — what was once a friendly half-hour stroll — becomes a two-hour trudge
through discomfort. The feet get blamed, and they step forward to point
a finger — er, a toe — at the shoes. The shoes blame the socks,
and they in turn are unraveled by the indignities of impugnment.
When foot
massages, custom-made shoes, and high-quality socks fail to up the pace,
everybody blames the “bad” back. A local hospital bone doctor looks at the
X-rays and pounces upon the favored “lose weight” mantra. Om. My. God.
Then comes
the day when one of those expensive full-body checkups gives you the suggestion
that your knees, both of them, are truly fucked. A doctor you trust in a
hospital you trust passes you along to an orthopedic surgeon who turns out to
be greatly admired by patients and medical professionals alike. He orders
another set of X-rays and confirms: Yes, your knees are sincerely fucked,
forever and ever, Amen. Then he pulls out his New Year’s Eve Party regalia and
exclaims: “Out with the old, in with the new!”
As the
world’s most well-feathered chicken, you say thanks and refuse to commit.
You’ve already been forced into operating rooms by run-ins with cancers, and
none of these surgery experiences has been at all pleasant.
So, you
stumble and sometimes tumble face-first into another year. You walk. Slowly.
You even go to Tokyo, twice, managing some 14,000 steps daily upon blistered,
bloodied feet. And so it goes.
Then you
start talking to others.
You tell another
doctor you’re considering knee replacement surgery. “That’s great!” he says.
“My mother-in-law had it done three times!” He sees the look of confusion on
your face and rushes to explain: “She’s very active.”
You tell
your expat friend who’s had two surgeries.
You tell
your best friend in Taiwan whose mother in the island’s rice-growing region
knows plenty of old women who replaced their knees through surgeries.
You tell
your brother “back home” who over the course of three months has undergone two knee
replacement surgeries.
You tell
those Facebook friends you trust the most, and they speak of their own family
members who stood taller after knee replacement surgeries.
Everybody
says: Do it!
Rule One
and Two. Remember?
Silence is Golden?
The
consensus on knee replacement surgery is that the procedure can only end well.
(The only
exception being a British neighbor in Taipei who developed a post-surgical bone
infection that his doctor said was incurable — “Bad Luck, Mate — but which he claims
to have self-cured through a four-hour daily regimen of walking his dog outdoors.
…A year later he would be gone, a victim
of pancreatic cancer. The dog lives on. What a fucking travesty of misfortune.)
Rule One
and Two kick in when you get to the recovery stage. That’s exactly when you
should talk to nobody but your surgeon and the hospital’s physical therapist.
You see,
post-operative recovery and therapy experiences seem to differ for everyone.
Asking others about their post-surgical recoveries and therapeutic methods will
only sow confusion into your mind during the weeks that follow the removal of
your stitches. That’s especially true if your contacts are from different
backgrounds, ages, and nations. You’re not really going to know what to expect.
It’s better that you expect the unknowing.
The
confusion will be … unhelpful.
For me the
confusion actually kicked in a month or so before surgery. My brother in the
United States had both knees replaced, and he couldn’t stop singing the praises
of a mechanical device that wrapped around his knee and delivered a steady flow
of cooling ice water. You see, ice packing is still the most effective aid for
reducing post-surgical inflammation, the inevitable but unhelpful swelling that
hampers healing and recovery.
The device
is quite affordable when purchased in the United States, but the price pretty
much triples on the local Taiwan market. Naturally, I tried to buy it from the
United States. What I didn’t know is that this simple therapeutic machine is
listed as a “medical device” in Taiwan, and can only be imported if you have a
valid certificate to do so from the Ministry of Health. Having one shipment turned
away and trapped in Customs with no explanation why, I naturally tried a second
time. On that second go-around, however, I used a better shipping company, and
they explained the snafu. I was able to give them authority to deal with
Customs and have the package returned to the United States, enabling me to get
a refund on the product (but not the shipping charges). God Bless Transparency.
Lesson learned: don’t use the “free shipping” option and swallow the extra
expense of hiring the shipping agent yourself. You won’t regret it.
In the
end, using old-fashioned ice packs was good enough for my recovery. But the
cold water machine would have been really cool. Pun intended.
Continuing
on in the spirit of wickedness, let me share my own experience of recovery and
therapy after having a full-knee replacement using a combination of metal and
plastic inserts.
The
recovery actually began three months before the surgery, when the hospital
phoned to confirm the surgery date had been set for mid-October, as per my
request. I had hoped for seasonal weather that would be cooler and
less-conducive to a sweaty leg, a soppy bandage, and the discomfort of swinging
between a room that is either too hot or too cold. In this choice, I was right.
The three-month
head start also allowed me to strengthen my leg through a series of simple, but
sometimes challenging, exercises recommended by a therapist at the hospital.
Another doctor at the hospital also met me, and suggested I “lose at least 3 kg”
and ride the stationary exercise bike about 20 minutes per day. I ended up
doing about 40 minutes each day, and losing about 6 kg through the combination
of exercise (daily walking plus the bike) and drastically cutting back on white
rice consumption.
The
Experience
My surgery
took place in the early morning. Waking through the amnesia afterward was
difficult. Somehow I heard the recovery room nurse trying to rouse me from my
sleep, but it felt like a dream and I fought against waking. I recall thinking,
“I don’t want to wake up.” That was weird.
Having a
nurse’s aid in the hospital from surgery to release was required, and the woman
chosen to care for me demonstrated a “strong” character. Strong as in
forceful, easily infuriated, and short on patience. She was perfect for an
indecisive wuss like me.
There is
always a degree of indignity associated with helplessness, and under doctor’s
orders I was not allowed to leave the bed in the remainder of the day following
the operation. Unlike previous surgeries, however, I was not as weak as a
newborn kitten. Nor was I undone by pain, as an insert allowed the injection of
a painkiller directly into the knee twice a day in addition to the painkiller
dosed into me through the IV line in my arm.
In my journal
I wrote of that post-op afternoon: “The doctor came and showed me the ‘before’
and ‘after’ X rays of my knee, and only through the comparison did I finally
understand just how amazing it was that I could walk as much as I did over the
previous year.”
Over the
course of that afternoon separate nurses and a doctor came in, each with advice
on how to recover more swiftly. Unfortunately, some confusion existed, and that
threatened my working relationship with my private nurse’s aide.
You see, the
hospital had given me a massage device to encourage blood flow in the leg. This
device is potentially life-saving, as I’ll explain later.
The
problem arose when someone suggested I wear this mechanical device overnight.
This therapeutic
medical device seemed to be some sort of perverse combination between a
Scottish bagpipe and an Alien facehugger. It wrapped around my leg and hissed air
into successive bags with enough compression to push the blood flow through the
entire limb, working in stages as if three different blood pressure devices had
been set off one after the other.
On top of this
I told my nurse’s aide to wrap the blue ice packs that are important for the
reduction of swelling. The private aide said these two items together,
overnight, would be a bad idea.
She was
right.
What I
didn’t know is that every nurse’s aide is required to quit the patient if they
are unable to achieve a good overnight sleep for two consecutive days. My aide
got very little sleep that first night, and it was entirely my fault.
My
eventual discomfort in having both the squeezing massage device and the heavy
ice packs wrapped around my leg led to me waking her up so she could help me unwrap
all that stuff from me. At 3am I woke her again because, well, I’d had a bit of
an accident when using the plastic urinal jar. My cup overfloweth, if you know
what I mean.
Indignity.
My aide
achieved a special degree of grumpiness the next day, and reveled in saying, “I
told you so.” Nothing infuriates me quite as much as, “I told you so.” She
managed to say it many times.
This
wasn’t going to be a good day.
My surgeon
visited again in the morning, and found me seated, enjoying my breakfast. He
told me I could aim for a total of two hours, broken up into manageable
segments throughout the day. Sitting up is actually good for the digestive
tract, he said.
He also
said I should begin using the knee-bending machine, the “CPM” or “Continuous
Passive Motion” device. This device could also be rented for home use after
discharge from the hospital, but medical research suggested that it was
relatively unhelpful in achieving the degree of motion or flexibility
recommended by doctors. To get a full range of movement in my leg, I would have
to rely upon old-fashioned “hands on” physical therapy.
For the
days of hospitalization, however, the CPM was perfect in loosening the knee. It
could flex the leg to at least 110 degrees, and did so very slowly. The aide
said that on the first day, most patients could handle 90 degrees. Anyway, it
wasn’t a terrible experience and I had to do it four times each day, with ice
packing for a half hour before and after each session.
My notes
in the journal that morning: “Exhausted and lonely.” I was feeling sorry for
myself, even though physically everything was going well. And then, that first
afternoon after surgery, the painkiller being fed into my arm was stopped. A
slight tug of discomfort settled in. The doctor later confirmed that the second
day after surgery would likely be the most uncomfortable for me. Who ever
imagined I’d miss the IV drip?
That morning,
and again in the afternoon, my aide took me for a stroll in the hallway. I
wanted to do more, but she wisely held me back. I was too ambitious, a common
error among patients. While we were strolling a physical therapist came along,
and she led me back into the room to teach me the exercises I should perform
four times every day. Here again I was glad I had delayed the surgery for so
long, as the exercises she asked me to perform were the same I’d been practicing
daily over the previous three months to strengthen my muscles (while also
losing weight).
That
evening, I obeyed my nurse’s aide and slept without the squeegee device or the
ice packs wrapped around my knee. She in turn allowed me to keep two
urinal jars next to the bed, and I promised to stop sipping water after 9pm.
Our compact worked, and she got a good night’s sleep.
On the
second day after the operation, my surgeon came and found me walking. I asked him
why everyone was worried about deep vein thrombosis (DVT), and he said that
coagulant drugs had been administered during the surgery to make the operation
less messy. On top of that, the wound was very close to a major artery. This
explained the massage device and the DVT Compression socks on each leg, as well
as the knee-bend exercises I should be doing throughout the day.
I learned
something.
Three days
after surgery the doctor said I could be discharged the next morning. The DVT
sock was removed from my non-surgical leg.
The
therapist arrived to show me how to climb stairs. If this had been a test, I would’ve
aced it. You see, grabbing the banister and hauling myself up using only my “good”
leg was my normal way of ascension and descension for a couple of years
already. Yeah, my “bad” leg was really that bad.
From the
hospital I went straight into a hotel.
Mistake.
My home is
almost entirely stairs. When I’d had a major surgery a few years earlier, I was
not allowed to climb stair for at least a week, so upon my discharge from the
hospital I went to a decent hotel near my home. A friend arranged for me to
have three meals delivered daily. The room had a comfortable sofa upon which I
reclined while composing PowerPoint lectures that were forwarded to the
professor who was substituting for me in the final weeks of the semester while
I recovered.
Assuming
that my heavenly staircase of a home would not be conducive to recovering from knee
replacement surgery, I’d booked (non-refundable) a room in the same hotel for
five days. Foolish move.
What I
didn’t know was that the hotel was under new ownership, and the room I reserved
had very little furniture — certainly no comfy chair. The new décor was uncomfortably
sterile, almost industrial: a bed, a wicker chair, and a thin desklike
structure built into the wall. No carpeting, which I guess was good for a guy
who had to practice going back and forth with a four-legged walker. I was wrong
in assuming that I would have trouble with stairs.
The hotel
stay passed quickly enough, albeit somewhat uncomfortably. It was not always
easy getting someone to bring me bags of ice, and the in-room refrigerator had
no freezer compartment. Keeping my knee cool was too much of a challenge.
A good
friend came by once or twice a day to help me do the recommended
knee-stretching exercise that the doctor demanded. This was the only exercise
that was not part of my previously taught routine.
Basically,
my friend had to hoist my leg up and push the lower half — the calf — toward my
thigh. The knee inflammation made this nearly impossible, and the pain was
terrifying. The problem was that I was distinctly warned not to use my leg or
knee muscles to either raise the leg or bend it at the knee. It all had to be
external force.
Eventually
I found a way to pull my thigh up using a towel, and weighing down the lower
part of the leg with my other leg. I could judge how far to push into the
agonizing pain until it felt like I would be doing damage if I went any
further.
It was “therapy,”
but I called it “torture.”
Two weeks
after surgery I returned to the hospital for a checkup. The surgeon lay me down
and grabbed my leg, hoisting my leg up and shoving the bent knee toward my
face. Of course, I screamed. From my own “torture” sessions I’d thought I was
doing quite well, but he thought I was nowhere near the goal he’d set for me.
“After
surgery, when you were still under anesthesia, I bent your leg all the way. I know
you can do it.” Then he said the adage I hate the most: “No pain, no gain!”
Back at
home I discovered a new way to bend my knee without assistance from anybody. Grabbing
my ankle with a long cloth that had no resistance in it, I pulled my lower leg
toward my thigh, allowing the foot to slide along the mattress. Ten times for
each session, four sessions per day. Still “torture,” but somehow I increased the
ability to endure more stretching over longer periods of time. My friend would
visit each evening, photograph the “bend,” and measure the angle. (He actually
went so far as to consult an engineer about how to measure the angle of the
bend.)
Final
result: I could bend the knee about 146 degrees after almost two months, with
only limited pain at the extreme bend.
The First and Second Rule!
Early on
in this recollection I warned that talking to others about full knee
replacement surgery would only encourage unhelpful confusion. Here’s what I
mean:
1.) Unhelpful
Expectations. When I told a friend about my upcoming surgery, he sent me a
video of an elder woman in his village cycling away on a regular bicycle self-rigged
into a stationary exercise bike. The accompanying test assured me she was just
a week out of her own knee replacement surgery, and that other older women were
tootling through the streets on their motor scooters within a week of having
undergone the procedure.
And so I
assumed that within a week of my surgery I’d be able to walk the 3,000 steps
from my hotel room to the local cinema where I so desperately wanted to see a new
Horror film that opened the same week that my knee was opened up to the surgeon’s
expert hammer and saw. Once I was situated in the hotel, however, I realized
the futility of my expectation. The reports from my friend had to be exaggerations
or misunderstandings.
Cue the
music for my heartbrokenness.
2.) Therapeutic
Confusions. An acquaintance of mine had a serious cycling accident a couple of
years ago, and our mutual friend failed to understand that his injury was far
more serious than even the massive violence of the surgery I would be
undertaking. My friend spoke of the brace that was worn by this acquaintance
for many months, and on multiple occasions encouraged me to purchase one in
advance.
I knew the
brace would be unnecessary, but worse was the secret regret I felt. Many years
earlier a fellow “foreigner” had given me his discarded brace after his own
recovery from a heavy motorcycling accident. Like me, he had no idea what to do
with the expensive leg brace and was leaving Taiwan for other shores. I held
onto it for a few years, but left it behind when I cleared retired from my
teaching job. I asked a colleague if she might be able to donate it to a
charity organization, but I have no idea if that actually happened. All I know
is that I was embarrassed for having given away such an expensive piece of
medical hardware. Oh, guilt. Superfluous guilt, but there it is.
The
challenge of buying unnecessary equipment occurred again when I spoke to my
brother in the United States, hoping to learn from his experience. Aside from
encouraging me toward the cooling pad, he also advised I purchase something to
make using the toilet easier. He showed a device he had used in his home,
something that looked like a reversed walker that offered bars on either side
of the toilet to help the handicapped patient sit and stand. You might see them
in the “handicapped” facilities in public spaces like department stores.
I looked
locally for such a piece of hardware, and mistakenly purchased a rather
expensive thing that turned out to be ill-adjusted for my home. It was a stand-alone “throne” for patients who
cannot ambulate to a bathroom. It now sits in storage. The day will come, no
doubt, when someone I know — or, Gods forbid, I — will find this portable
toilet invaluable.
Once my
surgery was over and I had deposited myself in the hotel room, I videophoned my
brother to bemoan my therapeutic torture. My brother was surprised by my doctor’s
imposed goal of being able to squat like a youthful monk.
In the
same conversation I discovered the huge gap in recovery therapy procedures. My
brother was delivered by van to a therapy center at least three days a week,
where he was led through an hour’s worth of motions that included an exercise bicycle.
No tortured screaming at all though he did tell me it “hurt like hell.”
And then
there was the observation of a fellow American expatriate who had her surgery
in a different Taipei City hospital some years ago. She taxied her way to the
therapy center, and was never told about pain and gain. “They approach it
really differently at your hospital,” she said.
Making
matters worse, I turned to YouTube. Googling “therapy exercises two weeks after
knee replacement surgery,” I landed upon a bevvy of videos from “Hi, I’m a
professional therapist” therapists. I noticed in these videos some of the “do
it yourself” methods that my brother spoke of — approaches that he practiced
under the practiced hands of professional recovery practitioners. (It took a
lot of practice to write that impractical sentence.)
These
videos and my brother’s suggestions eventually resulted in the method I used to
bend my knee: the rope-around-the-ankle trick. Of course, the American
therapists displayed a specially designed rubber device that cupped the patient’s
foot, but my improvised long cloth worked just as well. Thankfully, it also
relieved my good friend of the daily burden of hoisting my leg up in the air
like Sisyphus and his punishment stone. Now I could scream in agony on my own.
What
disturbed me most at the time was the pungent disquiet of not knowing if I was
getting “enough” therapy or if the leg-flexing I was doing was damaging my new knee. Also, at the two-week mark I wondered if, as the YouTube
videos suggested, I should be doing “more” activity like squats, bike riding,
and stair stepping.
I was
overcome with uncertainty, with confusion.
A phone
call to the hospital case worker reassured me: “Don’t push too much too soon.”
I was told just to keep walking in circles at home, continue doing my leg exercises
(including crucial ankle bending) and flexions, and keeping the bandages clean.
“When can I drive?” I asked. “Drive?” the case worker asked: “Where do you need
to drive to?” End of that line of
inquiry.
Most
helpful was the good luck that my closest friend, who was visiting me in hospital after
my surgery, made video of the instructions given to me by the therapist and
doctor when they came to my room. If not for reviewing those videos that he
shared with me, I would likely have forgotten how to do even the least of the
knee-bending exercises. In looking at the videos now, I see that I was actually
offered a few different routines, including pushing my ankle back while sitting
in a tall chair.
Appreciated Encouragement
Writing
this at the end of four months after surgery, I look back once again with a
tremendous sense of appreciation for those words of encouragement from a couple
of highly cherished friends overseas. One of these dear friends told me her elder
brother had undergone surgery for both knees, and while the recovery was
painful, months later he was extremely grateful for having done it. He stood
taller and walked more easily just a couple of months after the second knee was
done.
Another
wonderful word of encouragement came from a physician in Britain who responded
to my text from the hospital the night before my own operation. “Just remember,”
she wrote, “this is not the first such surgery your doctor has performed.” My
surgeon “knows what he’s doing,” she said. In truth, my doctor was clearly
among the best in this field in Taiwan, and perhaps globally. My anxiety was
natural, but ultimately unnecessary.
And
besides, no pain no gain.
What did I
have to lose?
____
Graphic:
James
Ward (1769-1859)
“A Human Skeleton” (Open Access, Google Art Project)
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