TKR: Pre-Surgery Journey Part 1

 Pre-Surgery paperwork, it's there, but for me it wasn't that bad. Meeting with Dr. Tripi's RN to go over and through the paperwork was a breeze, she is knowledgeable, articulate, friendly, helpful and very personable. She provided me with a notebook that had all sorts of helpful information regarding before, during and after surgery. (I hope your health provider does the same where ever you are having this done). We covered paperwork on tests that need to be done, such as MRSA and a pre-surgery physical, no Covid test this round, because we hadn't heard about it yet. Was able to pick a time frame for the surgery, which was January/February 2020. 

We went through the different parts of the notebook, and she always asked if I had any questions. We also went through a checklist of what needed to be done, including authorization from the insurance company. She explained how long I would be in the hospital and why (more detailed in future post). 

We discussed Physical Therapy options; either at their facility with their health care group, at home therapy option or another health care group that just happened to be less than 1 mile from my home. I opted for the one near my home, mainly due to potential issues with snow and bad weather, since my surgery would be in January. 

Even though it had been over 42 years since I had been in a hospital to have surgery, I wasn't nervous or worried about this surgery (with the exception of one minor aspect, the epidural; will talk about that later also). I had full faith and trust in Dr. Tripi and her team, that is why it is so important to make up your own mind, and not always listen to what other's tell you (good or bad, including me). You need to take responsibility for your own health and choices, you need to be proactive.

There is a lot of good information in the notebook I was given, but I am going to now share some thoughts and lessons learned from preparing for the TKR, whether or not you get a notebook like mine. 

1) Consider your home. In my case, I live in a 2 story house with a steep staircase and 15 steps. There is no way to manage those stairs right after surgery. I took a small suitcase and put 2 weeks worth of clothes in it. (Clothes, yeah for me it was mostly sweat pants, athletic shorts (for PT), sweatshirts and long sleeve shirts; comfort and warmth, it's January!). I stored it in the bathroom and was able to get dressed after my showers. Did laundry weekly, so it worked out pretty well. If there was something I needed that wasn't in the case, my husband would get it for me. But overall, I was pretty independent after the TKR.

2) Unless you have an ADA commode, get a riser toilet seat, believe me, it helps. Also, depending on where you live, be prepared if your stores or restaurants don't have ADA bathrooms. I almost got stuck in one, but that's a story for a later post!

3) Shower chair! Yes! I used mine for a long time and even though I don't use it because of TKR surgery need anymore, I still use it to sit on, if I need to do something that would otherwise require me to sit on the floor or kneel ( I can't kneel comfortably yet, but my knees are still new, and there is a chance I won't ever be able to kneel comfortably, but here again, that's a post further down the line). It is especially useful when I need to clean out the refrigerator or rearrange stuff.

4) Highly recommend that you have a recliner to sleep in. Sleeping in a bed can be very uncomfortable for the first 1-2 months(at least for me it was). We did purchase one of those inflatable beds, because I hate sleeping on my back or upright. Waste of money for us, could never get comfortable, was painful, couldn't sleep for any length of time, but it is up to you. If you don't want to spend money on a recliner, you may be able to make up a makeshift angled sleeping arrangement on your couch. I didn't have a couch, only a loveseat, and am too tall to make that work. We got a pair of nice recliners (not the big hulking things usually found in spare/TV rooms), for the living room, and that's where I lived!

5) I bought a 16 x 16 x 4 inch foam chair pillow, highly recommend, it helps to get out of the recliner and the dining room chairs. I drug it around from room to room a lot!

6) A walker. YES definitely! You can spend quite a bit of money on the stuff I have listed here. It's up to you. Check thrift stores for some of the stuff. I found a really nice great condition walker at the thrift store for $15, and added a basket on the front. There may be places you can rent one, I'm not sure, but the walker really helps for 2 reasons. 1) Your knee is going to be in a lot of pain in the beginning, so full weight on that leg may make you a bit unstable, and  2) You may be on some heavy pain killers for a week or two, the walker will help you keep your balance. Don't waste your money on the tennis balls they have 'special' for walkers, expensive! Buy a tube of tennis balls from the sporting section in Walmart or wherever and just cut an X into the ball to push onto the walker feet. Even though the fuzz wears off after a bit, the actual ball doesn't wear out that quickly (mine are still in great shape, and that's after 2 TKR's).

7) A cane. Yes, you will need it when you graduate from the walker. Here again, the thrift store is a good option. I used a cane a lot to help me get out of my car, when being driven to PT and doctor appts,  and then when I started driving again. Even though I don't use a can anymore, I do keep one in the trunk or behind the seat in my vehicles; you just never know what might happen, and as far as I'm concerned, it is better to have one available and not need it, then need it and not have one!

8) Make sure you really have someone there to help and support you. Don't lie to your doctor or health care team about home support. If something happens, and you need help, you don't want to be calling around to people or family trying to find someone to help you. Make arrangements before surgery with someone if you don't have a spouse, significant other or older children you live with, or in near proximity. Believe me, I can't imagine going through the TKR surgery and recovery without someone, in my case, my husband; he was helpful, supportive and kept my spirits up when I got frustrated or depressed (another post, later).  

9) Not a topic I am especially fond of going into, but it is important. Get some kind of incontinence pads or single use underwear. Why? 1) Depending on how far your bathroom is from your TKR living space, you are not going to be able to run to the bathroom. 2) You may have issues with food, drugs, supplements right after surgery. Just better to be safe than sorry. I had an iron deficiency after my first TKR, my primary care physician, put me on iron supplements. Umm, my system was not happy about that for about 2 weeks, so it's just one of those preventative measures, I was thankful I had in place before hand.

10) Got hobbies? Love Reading? I bought some 12 by 12 inch storage cubes and filled them with embroidery, hand sewing stuff, pattern books, my kindle, and anything else I thought would keep me busy. They were stored near my chair, for easy access and kept everything neat and organized.

Below are some pictures of the projects I completed during my first TKR. 

This post is long enough (maybe too long at this point), so I am going to close this one out, but the next post is going to cover at least one more aspect of the pre-surgery journey, that I consider to be very, very important. 

Have a great day.

TKR: In Search of an Orthopedic Doctor/Surgeon

 TKR: In Search of a Doctor/Surgeon

Before I begin this section, another bit of history. I live in a rural area, a valley that is at an average elevation of 7500-8000 feet. That being said, the only ways out of the valley require going through a mountain pass, with the exception of one direction,( south), which leads out of the state. Being a rural area, we are fortunate to have 3 small hospitals, but options are sometimes limited, and necessitate finding medical care outside of the valley. 

Also, Just a note: In all instances except one, I will not be using the names of the medical practioner's that I talk about in this blog. The reason for this is very simple, I have not asked any of them for permission to identify them in this blog. I have the highest respect for these people and would never make the assumption that they would not care whether they were talked about in this blog. 

As I talk about my search for a Orthopedic Surgeon/Doctor, I can't stress to you enough, how important it is to find one that;

 1) You have confidence and trust in

 2) Works with you, treats you as a person and not a 'number'

 3) Answers your questions/fears/doubts/concerns/etc. (you get the picture).

 4) Explains not just the positive (rosy picture) aspects of the procedure, but also addresses problems/issues that could arise (no matter how slim a chance).

In the beginning of this journey, I really wasn't in search of an Orthopedic Surgeon, I had one already selected.  I had seen him before (he gave me the 2nd set of shots in my knees), I trusted him, and although he wasn't in the valley, he was working in city that wasn't a huge metro area. Sadly, when I called to see about an appointment with him, I found out he had retired recently. That was a bummer, for me, but I was happy for him. Now what? Well, I had one phone number (from my initial consultation on TKR) and I had the website to the Orthopedic Center my retired Doctor had practiced at, and of course the whole internet available to help me in my searches.

I really hadn't considered looking for a an Orthopedic Surgeon in the valley, as several of my friends dissuaded me from that search long ago, due to issues/serious problems they had had with some of the doctors in the valley. So that was stuck in the back of my brain as I began my search.

I started looking at websites of Hospitals and Orthopedic Clinics outside of the valley to see what and where my options were. In my search, my plan was to pull together a number of potential doctors and basically conduct interviews with them, and then make my final decision. 

I happened to be at an appointment with my Bonecracker (endearing term I use for my Chiropractor), and after the usual catchup chat, I mentioned that I had finally been recommended for a TKR. He asked me if I had a doctor selected, so I explained the situation. He told me about an Orthopedic Doctor here in the valley that he knew and worked with, she had been here about 6 years and he was very positive about her. By the look on my face, (he knew about my longstanding aversion to some of the doctors here), he said, 'Do you trust me?' Well, I have known my Bonecracker for 11 years now, so yes, I do trust him. So he asked me to give the clinic a call and make an appointment. 

So, I made the call and set up an appointment with Dr. Tripi. This was in the beginning of October 2019, so Covid wasn't on the radar, publicly, yet. We went to the appointment and I was blown away! I had a series of questions to ask her after we got through the preliminaries of this initial knee consultation, (looking at the x-rays, hearing my knees crack when bent or straightened),  she answered all of them before I could even ask. She talked about which knee I wanted done first, or that I was a candidate to have both done at the same time (which I will talk about a bit later in this post), the before, during and after the surgical procedure, she covered the positive aspects of the surgery and also the possible negatives. There are doctors (in my experience), that lightly brush over the negative aspects, or in some cases don't even talk about them, unless you bring it up. Not Dr. Tripi, she made sure that we understood the possible issues that could come up. Blown away, yes, definitely; her confidence, her honesty, her forthrightness, her questions, her answers, all showed me that I had found my Doctor. My husband and I looked at each other, and the decision was done. We wanted to move forward to the next step. 

Not everyone is a candidate to have both knees replaced at the same time. I have friends that have had knees replaced at separate times and a few that have had them done at the same time. Mostly with positive results in either case. Not exactly sure of how this was going to pan out, I opted for having my knees replaced one at a time. Things I took into consideration in making this decision included; the Victorian home I  live in (2 story, 1 bathroom, steep staircase inside, and stairs to maneuver in and out of the home), my vehicles, my age, my physical/health level, potential issues, the weather (it snows here), etc. Anyway, the journey had started...…

Dr. Tripi had me see her RN so we could get started by picking a date for the surgery and initial paperwork, questions/answers, etc.

Should I have interviewed other doctors? Maybe, but I don't regret my decision. I felt immediate trust and confidence in Dr. Tripi, and my intuition has never failed me in that arena. It doesn't matter if friends/coworkers/ others have given a doctor glowing reviews, YOU need to have that trust and confidence level. If you leave an appointment with too many questions about the procedure or even the doctor; I recommend interviewing other doctors, you can then make a final decision based on comparison and your trust level.

There are many sites that offer ratings on doctors, and while searching for a doctor you can ask friends, associates, family members and even visit these ratings sites in your search. Regarding the doctor ratings site (and even others who give you their opinion on a doctor), I would offer a word of caution/advice. If there are one or two star ratings given to a doctor without an explanation (and I have seen a number of those over the years), think twice about using those one stars as a decision making tool. My first question would be; why didn't the reviewer support their one star rating with a written review of why they were awarding such a low score. I am very skeptical of no written support reviews, and you should be too. Second, if there is a written review, read it! What were they unhappy with? Was the doctor really a bad doctor that destroyed that person's life? Or was it that they didn't like the doctor's bedside manner, or was is that the doctor wouldn't go along with what the patient was asking for. I have seen doctor reviews that the patient didn't like the doctor's bedside manner. Good grief, (sorry, my opinion), I have had family and friends that have told me not to see a doctor because they didn't coddle and only give happy news. Some of my best doctor's over the years have gotten rotten reviews because of their 'perceived bad'  bedside manner.. Sorry, that isn't what I see a doctor for. Ok, rant over, finding a doctor that you trust and works with you is basically the bottom line. 

 Next post: TKR: Pre-Surgery journey

TKR: A Brief (sort of) Backstory

 TKR: The Sort of Brief Backstory leading up to my TKR.

In my 20's (long time ago), I was fairly active with Sports, hiking, swimming, oh, and on Active Duty in the US Navy. Being physically active (and being somewhat accident prone) also means having sprained ankles, falls on knees, other typical sports related injuries, oh and the military takes its toll also. I initially hurt my right knee while on active duty, but that's another story.

In my 30's, I started having a few issues with my right knee, it would like to lock up or go out on me during hikes, camping, or any other activity that required strain on my knee. Playing sports was drastically reduced. Then my 40's, while working on my Geology degree ( paleontology), more knee issues occurred. Slipping down slopes or losing my footing on roadcuts (fossil hunting and my thesis area), twisting the knee (not a good thing) to the point that I had to slow down even more. It was during this time that I got my first knee brace, it helped, along with my first series of shots in the knee. I was told at the time that the shots would give me relief for anywhere from 6 months to a year or two. I was one of the lucky ones, it lasted almost 9 years. 

However, because I was favoring my right knee, guess what!? Yeah, the left knee started to have issues also. I was told at the time that the cartilage in both my knees were in pretty bad shape, but hey, that was kind of expected. What wasn't expected was that I was told that I was still too young to have my knees replaced at that time. So, I had a second series of shots in both my knees when in my early 50's. Worked great, but only for about 3 years. I was wearing braces on both knees at this point, hiking hurt like h***, walking was getting more difficult, and I was grinding bone on bone. How do I know? 1) It hurt, 2) you could hear my bones grinding from 6 feet away. and 3) X-rays and MRI's confirmed it. But guess what! Still too young to have TKR's done. Exercising was getting all but impossible to do. Burpees, Mountain Climber's? Yeah, those don't do well with bad knees. As my ability to walk degraded, so did my activity, and unfortunately, the weight went up. (This is not good for knees). 

At the end of 2019, I could hardly walk, I was 60 (the magic age for TKR)  and had a 3rd set of shots, which did nothing, except annoy my insurance company (we ended up paying for the shots). My husband said it was painful to watch me walking. And it was. 

So the final step and the first step, I made an appointment with an Orthopedic Specialist, to see what could be done. The specialist I saw didn't do surgeries anymore and was only working as a consultant at the time. He looked at the X-rays, MRI's and shot history and said, "Congratulations, your knees are bad enough, and you are old enough to get TKR's. He suggested one of the Doctors on his team, and gave me his number. 

That's the backstory, I hope I didn't bore too much. Next post, the first step: finding a doctor. 

TKR: Introduction to this blog

 Hi! Happy New Year 2021!

 I have been thinking about creating a blog about the journey I went through (and am still going through) on having 2 Total Knee Replacements (TKR) in one year (2020). I have read a number of TKR blogs over the last year, and it always seems like there is something missing, or people have tons of questions...So here I am, and here is the start of the blog.

 This first post is just an introduction, explaining what you are going to be reading about in future posts. We're all busy, so I don't want you wasting your time if this isn't the right blog/information for you. I will talk about my backstory, briefly (How I got to the point of 2 TKR's), I will go through the stages of the TKR; Finding an Orthopedic Surgeon, Going through the pre-surgery elements, Preparing for surgery and after surgery at home, the Physical Therapist, the follow-up appointments, what you need to take responsibility for, and yes, the difficulties and pain. I will also go through the personal elements of, frustrations, fears, goals, successes, and any failures. 

Disclaimer: (Sorry, but in today's society it's a necessity). I am not a Doctor, Nurse, or any type of Medical Practioner, etc. I am just a person who is and was a TKR patient. Before you attempt to do anything I have described herein for myself, YOU NEED TO SPEAK WITH YOUR OWN DOCTOR/HEALTH CARE TEAM to ensure that it is safe and effective/productive for you to do. Every person is different, both physically and psychologically, you may respond to a TKR differently than I have. I will be posting this disclaimer in future posts where I talk about things I have done and any recommendations I have, to get where I am today. Walking!

So, here we are, at the end of the Introduction. Please read on if you so desire. If this isn't what you were looking for, I wish you the best in your continuing searches. Note that you can just pick and choose which posts you want to read, that may cover information you are looking for. Title of the posts should help narrow your search.

As of today (01/04/2021), this blog is a work in progress (under construction). I will get this blog completed as quickly as I can, so please bear with me! 

Have a Great Day and a Great year, 2021.