Strengthen the weak hands, and make firm the feeble knees. Say to those who have an anxious heart, “Be strong; fear not! Behold, your God will come with vengeance, with the recompense of God. He will come and save you.” Isaiah 35:3-4
It has been one month since my knee surgery. Sometimes, it feels like yesterday and other times, years ago. Four weeks is really not a long time, but when you are an overachiever and have high expectations for recovery, it can seem like a very long time. Here are some things I have learned that may help others contemplating the same surgery.
- If you need the surgery, don’t put it off. You aren’t doing yourself any favors by waiting. I saw a lot of people much older than me struggling through rehab because their bodies had weakened through disuse or they had learned a lot of compensation patterns that had to be overcome. As soon as my doctor told me that I had no cartilage in my knees, I agreed to surgery and though it was delayed a few months due to my work schedule, I took the leap as soon as possible. For me, it was an easy decision because for three years, I thought the pain was caused by my MS and while the MS is not fixable, the knees were. Joint replacement was the least of my worries. I think one of the reasons that I did so well in rehab is because of my age and the fact that I was still active and mobile. The original prediction was that I would be in rehab for two weeks, but I was able to leave after only one week.
- If you need both knees done, do them at the same time. I knew I would never go back for the second knee. My doctor confirmed that many people don’t and they have more problems with only one good knee than if they had not done either. The advantage of doing both knees at once is that you get much better care. With one knee, you go from the hospital straight home (at least with my insurance). Then, you do outpatient and in-home rehab. With two knees, you go to an acute rehab facility where you get lots of physical therapy and attention. I never wished I had only done one knee. If you are going to go through the pain, why not get it over with once than know you are going to have to do it all over again?
- Research your doctor, hospital and rehab facility before you commit. My doctor was recommended by my neurologist. He does over a thousand knee replacements a year. The reviews on line for him and for his practice were very good. I am not saying that those on-line reviews can always be depended upon. One negative review can spoil their overall rating and can be the result of someone being disappointed by the way they were treated by an office worker, not the outcome of surgery, but the comments on his bedside manner and how people felt months after surgery were important to hear. As for the hospital, I was lucky that my son works there so I knew the quality of care would be good. In addition, the rehab facility was in the hospital. My son toured it and talked to workers there so I was confident in the ability of its staff. Ask people who work there, ask friends their opinions, tour the facility. Don’t just go where your insurance tells you to go. Fight for what you feel you need.
- Prepare your body for surgery. When I knew the date of my surgery, I consulted my personal trainer for exercises to prepare for recovery. We focused on core and arm exercises to make my body strong enough to get me around until my legs worked properly. I also had a workout with her the night before surgery to loosen up my legs as well as a massage a few days before.
- Be positive but be prepared for some setbacks. My doctor is a very positive guy. He talked as though surgery and rehab would be a piece of cake. It was not easy, and I was surprised in some ways by how hard it was. That could have been a breaking point for me and at one point it was; I was discouraged that I didn’t just get up and start walking pain free. However, being positive and recognizing how far I had come was important to my healing and ability to walk as quickly as I did. Healing takes time. Keep remembering that.
- Set goals. Every night, I set goals for the next day. Instead of letting myself just float along and have others set the pace, I decided how far I would go, communicated it to the nurses and staff and then, asked them to help me get there. Whether it was getting away from the bedpan or walking around the perimeter of the rehab center, they were eager to help and my motivation helped them stay motivated.
- On the other hand, be flexible and cut yourself some slack. Sometimes, overachievers like me need to be reminded to rest. Sitting in a chair with your eyes closed is not being lazy. It is letting your body catch up with your mind. Remember that you had major surgery, are still feeling the effects of anesthesia and pain meds.
- Be Grateful. Being grateful was an important antidote for depression. Remembering the good things that happened even if as small as getting to brush my teeth kept me from slipping into despair when I couldn’t walk across the room. It also kept me looking for the good in each day instead of dwelling on the bad.
- Be Kind. I talked to a lot of health care professionals who were worn out from being treated unkindly by patients and their families. Asking nicely gets you a lot farther than making demands. I never felt that I was ignored or treated harshly, but in turn, I treated my caregivers patiently and kindly. I asked about their day, their families, how they chose their jobs and listened. In turn, they listened to me and treated me as more than a body in a bed.
- Push beyond what you think you can do. A lot of the exercises I was asked to do seemed beyond my ability, but once I let go of my fear and did them, I realized I was a lot farther along that I thought. Trust the therapists and nurses. They won’t ask you to do more than you can do and they are there to help so listen and follow through. That includes the bed exercises that they give you the day after surgery! You can do them!
- Advocate for yourself or if you can’t, make sure you have someone who can. I know I have a low tolerance for pain medication. Even the littlest dose makes me woozy. Though I was clear with everyone before surgery, the message didn’t always filter down. Glen or I had to ask about every medication offered to me to make sure that I wasn’t being given a dose that would normally be used, but would be too much for me. I had to argue with nurses and doctors that I did not need what they wanted to give me. It wasn’t easy, but it was what was best for me.
- Remember that a lot of what you feel emotionally and mentally could be caused by medications. Some days I woke up feeling foggy and depressed. I had to remember that it was not permanent, just a side effect of medication. I was surprised that it took almost two weeks after my last dose of pain medicine for my mind to fully wake up and for me to feel like myself again.
- Do what they tell you to do. The exercises, the rest, the using of “assistive devices” (walkers, canes, potty or shower chairs) are designed to help you heal properly. Use them, use them correctly, and understand that they will not be a permanent part of your life but are temporary measures to get you where you want to be in the end, walking correctly and pain free.
- Don’t expect to be back to normal as soon as you come home. I continued to seek help for housework, cooking and laundry and slowly, not even completely yet, got back into the routine. After four weeks, I went back to work for only two days a week and gave myself permission to take the whole day off when I had physical therapy. Ask for help. Don’t push yourself. Give yourself time to heal.
Looking over this list, I realize that most of my comments relate to mindset. I do believe that controlling your mind is the greatest way to promote healing. Be wise before you go into surgery. Make good decisions that you have confidence in. Then, balance giving yourself time to heal with pushing yourself through rehab. I do not regret having both knees done. The quality of my life has already improved. But, I see others at physical therapy who are struggling after the same surgery. This worked for me. While I can’t guarantee it will work for you, take what is useful and apply what you can to your own experience.