Recuperating at Home and The Slow Journey of Physiotherapy

(I was operated on 27th Dec 2013. Day 1 is 28th Dec 2013, one day after the surgery)

Day 7: Friday 3rd Jan 2014
Discharged from SKSMC. My nephew Atan picked me up. Went for lunch and went to Bukit Raja Shopping Centre. Bought a new microwave oven as my old one was not working properly. I was walking slowly, still very much dependent on the walking stick. I easily become tired if I walked a bit far.
We hang around at the shopping centre while waiting for Mickey Benjamin's vet to open at 3.00 pm.
Picked up my orange boy and arrived home at 4.30 pm. He was quiet on the way home, as if knowing that he would be home soon.
My fridge was almost bursting with all kinds of foodstuffs.
Mickey did his inspection of the house inside out. Even checked the neighbour's flower pots, waste paper baskets, the kids' bikes, everything.

Day 8: Saturday 4th Jan 2014
The operated joint still felt very tight. Remembering the doctor's I walked and walked around the house. Every hour I tried to walk at least 10 minutes. Walking will prevent DVT ( deep vein thrombosis) and it would also help bring down the swelling around my feet. I also did all the exercises recommended by my physiotherapist, over and over again. I also keep wearing the compression socks day and night. I am stickler for complying to all my doctor's and therapist recommendations. Well, all in all, the surgery cost me 27K, so I should stick to the proper advice and recommendations so that it would not all be a waste. Well, the walking around was definitely not a waste as all the swelling on right foot subsided almost completely.

Day 9: Sunday 5th Jan 2014
I realised that I still have quite a journey with the physiotherapy. It would take a lot of patience and determination. Because the right knee was not able to bend before the operation I would need lots and lots of exercises in the physiotherapy. I really really hope my spirit will never be dampened by the cramps and the soreness of muscles in my right knee.

Day 10: Monday 6th Jan 2014
A lot on my mind today. The osteoarthritis had changed me. From someone who always walked fast I became dependent on the walking stick and I have to walk slow. Did I become more patient? A little bit I supposed. There were times I felt frustrated at my own slow movement, especially going up or down staircases. However I do realised that there are people worse than me. It is my choice whether I want to be grumpy and irritable because of the arthritis or I can go on doing things I love as usual even though perhaps at a slower pace. Life is about making choices! In reality my life changes only a little because of the arthritis. I still went places, I went window-shopping as usual, I went out with friends now and then, I went to see movies as often as I did even before the arthritis. Now I have had the operation. All I have to do is keep attending physiotherapy sessions and do whatever is advised by my therapist. And.......... it is good to lose weight too!

Day 11: Tuesday 7th Jan 2014
First physiotherapy session, Atan sent me to SKSMC. After a few light exercises the therapist placed me on the bike. It was a difficult to make a full circle with my operated knee. What the heck, I thought, just try make one circle. With all my might I pushed myself to make a rotation. There was a very very sharp pain and I suddenly felt clammy, queasy and I felt like I was about to pass out. They took me to a room to lie down, while they gave me some food. Reason for that was because I didn't have any breakfast before the session. If your stomach is empty, intense pain can make you pass out. I didn't know that. After about 20-minute rest and some Milo and biscuits I was ok to continue.

Day 12: Wednesday 8th Jan 2014
Drove to the train station in Port Klang. First time I drove after the surgery. Took the train to KL Sentral and then took a cab to MidValley  Megamall. Bought some Clarks shoes. There were sharp shooting pains from time to time around my right knee. Sitting down for the 80 minutes journey from Port Klang to KL was uncomfortable. There was no pain on sitting down, but the muscles felt tired, very tired especially on the return journey. I had to massaged my leg and my thigh often to lesson the cramps. At night too the cramps still bothered me. I was a little worried about these cramps.

Day 13: Thursday 9th Jan 2014
I had a follow-up with my doctor as well as second physiotherapy session today. Dr. Ong was happy with my progress I think, even though some of my right leg muscles are rather stubborn and refused to bend to a much better desired degrees. Physio session was ok, I had a rather big breakfast, no more almost passing out moment.
After therapy and follow-up session I walked slowly to the commuter train station. I hold the the walking stick just as a precaution, but as far as possible I try not using it. I should slowly try putting weight on the operated knee. So walking to the train station, I took the train to Subang Jaya station and I then I
walked to the Empire Shopping Centre. Took me half an hour to get to Empire as I walked quite slow. I considered this confidence building walk as I felt more confident to put weight on the operated knee.

Day 14: Friday 10th Jan 2014
Woke up at around 5.30 am and realised that I have slept very much better last night. The tiredness in my right leg muscles are very much diminished. Continue lying down to savour that beautiful peaceful feeling. There is much less heaviness in the operated knee.
Met with Darling, Dear, En. Loh and Siti at Bukit Raja. Just meeting the gang, before En. Loh and Dear fly to Yokohama this coming Sunday.

Day 15: Saturday 11th Jan 2014
Did some washing in the morning. The cramps in my right leg were back. I think it was because I did a lot of the exercises recommended by my therapist. The muscles responded rather angrily because they have got used to not being so much active before the operation. Ever since I got inflicted with the osteoarthritis in August 2012 I could not bend my right knee much. Being rather idle those 14 months the muscles involved in bending my right knee became rather stubborn and protested by giving me the cramps.

Day 16: Sunday 12th Jan 2014
I stopped doing some of the exercises recommended as they gave me those cramps again, to the extent that I did not sleep well. Perhaps I did too much. Well, I can always walk around the house. So I walked and walked.
Dear and En. Loh flew to Japan for their one-month training programme.

Day 17: Monday 13th Jan 2014
Today is my third physiotherapy session (supposed to be Tuesday, but Tuesday is a public holiday, the Prophet's Birthday). Tried the stationary bike. Could not make one round with my right knee. Okay, I did like three quarters of a round, time and time again. I still did not bend my knee properly, still painful. So I walked dragging my right foot. It was very hard to bend actually.

Day 18: Tuesday 14th Jan 2014
Today is Maulidur Rasul holiday. Woke up early, slight cramp only in my operated leg. That is good. Any improvement is good and can be used to motivate me further with the physiotherapy and all the exercises.
Drove to Port Klang town to get my hair cut. I waited until 11.00 am near the hair salon, it still did not open. Some other time then. I felt like I can walk longer without feeling easily tired. That is good too. Found Tam near a grocery shop. Took her to the vet in section 7 Shah Alam. She was dewormed and given flea spray and I would have to take her again for vaccination in two weeks time. Will write about her later.

Day 19: Wednesday 15th Jan 2014
Saw Dear's and En.Loh's photos in facebook. Japan is a wonderful country, there are just loads of things to see, to compare and to wander at. Still remember about my stay there back in the late eighties.
Did the recommended exercises until my muscles felt sore.

Day 20: Thursday 16th Jan 2014
Went for my fourth physiotherapy session today. At last I could cycle with the stationery bike although with some cramps in my right knee. It took me 20 days after the operation to be able to do that even at a very slow pace. The movement that I took for granted before I had the osteoarthritis has now become like learning a new sophisticated and complex sport. It made me realised how complex human beings and other animals are as a species. That small thing as bending your knee actually involved many complex smaller operations. The thing about muscles, on being left idle for some time, they will become lazy and have to be coaxed and pushed into action again.

Day 21: Friday 17th Jan 2014
Went to see movie today. The first movie after my surgery called The Legend of Hercules. I thought, well, just see any movie whatsoever it is. Turned out the movie was not bad actually with Kellan Lutz playing Hercules and Liam McIntyre playing his loyal subject Sotiris. Kellan Lutz if I'm not wrong shot to fame playing Emmet Cullen (one of the five adopted children of Dr. Carlisle Cullen and Esme Cullen) in the popular Twilight films based on Stephanie Meyer's books. I thought Emmet had become a bit rounder than his Twilight days because I would not have recognised him if I hadn't read the poster outside the cineplex beforehand.
Bought some toys for Tam and Mickey from Daiso. Hmm.....it is good that Bukit Raja Shopping Centre has a Daiso now.
There are positive signs that Mickey and Tam may become good friends. Not so much hissing and growling anymore when there are in the same room. Of course I made sure Tam is inside the cage before I let Mickey into the room. I am still a little worried that Mickey might be bothered by Tam's feisty attitude and extreme playfulness. Mickey is always curious and always wanted to go into the room where I keep Tam. He is clearly very interested in the newcomer.

♡♡♡♡♡♡♡♡♡♡♡♡♡♡♡♡♡♡♡♡♡♡♡♡♡♡♡♡♡♡♡♡♡♡♡♡♡♡

It has been three weeks since the operation. It was not a very easy journey and many times I have to push myself to be positive and not to be discouraged by the slow progress of the operated knee and muscles associated with it. I still have a few months more of physiotherapy to go and I am determined to make the very best of it.
Thank you everyone for all kind words and encouragement

The TKR Experience

View of Jln. Tengku Kelana Klang
from my hospital window (after the rain)

Sitting by the window 30th Dec. 2013, third day
after surgery. 

Ajun brought me this lovely lovely cube book
entitled ADORABLE CATS knowing full well his
Wan Nyah's passion for felines. The other book
is a travelogue by Hong Weixi which has
gorgeous pictures and lots of sound advices
for solo lady traveller.

My other companions I brought from home

I would consider myself a rather calm individual nowadays. Age has somehow mellowed me down and usually I am comparatively calmer upon dealing with stressful situation nowadays compared to when I was younger. But on the eve of the total knee replacement (TKR) surgery my blood pressure was playing havoc with me. First it was 148/70, three hours later it was 150/80 and still three hours further it shot up to 176/93 beside me dutifully taking the Micardis 40mg. Some people have experienced BP above 200 (top reading) and above 100 (bottom reading) but  not me. I was worried the surgery might be postponed but the doctor assured me a lot of patients experienced that before their operations.

My doctor, Dr. Ong Eng Sen came to talk to me, evening before the surgery. Then later the anaesthesiologist Dr. V came to discuss with me what kind of anaesthesia I would prefer, whether it is regional anaesthesia (RA) from the waist down in my case, or whole body anaesthesia also known as general anaesthesia (GA).  GA usually used in long medical procedures is given either by injection or inhalation and the anaesthesia works on your brain and your nervous system  and puts you in a deep sleep. Your doctor will have to monitor closely your heart and breathing rate during surgery. GA dilates your blood vessels and there is a possibility you will bleed more. A oxygen tube is pushed down your throat to assist your breathing during the surgery and it can cause you to have a sore throat and hoarse voice for days after the surgery. Other side effects are nausea and headaches.

Before coming to the hospital I sort of made up my mind not to have the RA as I thought I would freak out upon hearing what is going on with my body down there even if there is a screen obstructing my view and even if I can't feel anything with my body that is being operated. That last part was actually scary enough already, realising you are paralysed, albeit temporarily, from the waist down, isn't? What if I scream the shit out of me during the surgery? If I am really a hyper nervous individual then of course I should choose the GA according to Dr. V. However if I am not perhaps the RA is better choice. I will be sedated and will sleep through the whole procedure even with RA but I will be breathing on my own and from observations RA seemed to be a better choice for TKR. Pain management immediately after surgery is also supposed to be better with RA. Moral of the story, the choice was mine and Dr. V left me to think about it for the night. It was after that discussion about the GA/RA that my BP shot to 176/93. Musing about it throughout the night I decided to have the RA. I thought minimising the risks is more important even if I was not very sure myself about the freaking out business yet.

Friday 27th Dec 2013
Fasting from 12.00 midnight last night. After doing my toiletries and putting on my hospital gown I was wheeled in the operation theatre at around 8.30 in the morning. Informed Dr. V of my decision. So RA it was. I was briefed  again that I would be given the anaesthesia by epidural block and I would also be given a sedative to help me sleep throughout the surgery. Okay give it to me guys!
Last thing I remembered was Dr. V poking my backbone for the epidural block procedure.
I woke up from the sedative when the surgery was not quite finished. I could hear muffled voices and some hammering. Must be adjusting the metal parts to fit my knee size. No freaking out, I was calm. Everything completed I was wheeled into the ICU. First hour okay, second hour too was okay, no pain only slight discomfort. The hours following the first two there was considerable pain that I was groaning and crying. Ajun came to see me and later on Atan and Normah. Dr. V came to administer some pain killer intravenously. I managed to catch some sleep here and there throughout the night. The pain lessened a little. I began to have serious doubt about doing the TKR for the other  knee at this moment. At this much pain and discomfort?

Saturday 28th Dec 2013
Still in ICU. Very uncomfortable as I had been lying on the bed for 24 hours. My stomach was empty as I threw up whatever little food I was allowed hours after the surgery. Food was the last thing on my mind. All the gadgets in the ICU began to very much bother me. Made a little movement and the oxygen regulator (or whatever contraption) began ticking loud and fast, made a big movement with my finger the whatsoever device began beep-beep, beep-beep, beeep-beeep ................I felt like wrenching everything out of their sockets and hurtling them down the hallways (there were no windows in the ICU, may be there had been cases). There were extra pain to bear every time the drainage catheter was released. By the end of the day I was moved out of ICU into the surgical ward. Atan came at night and was happy to see me in a a better shape and not groaning in so much pain anymore.

Sunday 29th Dec 2013
Sunday morning and the 48th hour period was crossed and the curtain of morbid pain was lifted. Not totally gone but was lifted enough to enable me to smile and be cheerful and to have an appetite again. The physiotherapist came and taught me how to come down from the bed and go up again and to walk using the walking frame. I could go to toilet by myself now, yahoo! For the day no other physiotherapy exercises was given except for me to walk with the walking frame. Ice was to applied the knee to reduce the swelling every two to three hours.

Monday 30th Dec 2013
I was well enough to be discharged today and move to Columbia Asia Care and Extended Hospital in Shah Alam. That was my original plan. After talking to some of the staffs here I decided to ask Dr. Ong to let me stay until Friday so that I could focus on the physiotherapy here. He agreed.
In terms recovery from surgery I thought I had made a remarkable progress. I was cheerful and I was up and about and the pain had almost totally subsided leaving only some discomfort. However among the exercises given in the physio department was one using a CPM (continuous passive motion) machine. I was not able to reach the 120 degrees desired but only up to 100 degrees. I just could not bear the pain anymore as the CPM pressed my knee against my body not because I was manja or anything of the sort. For the other exercises I was okay.
Darling, EA and Bala my old workmate in ILP Prai came to visit at night while Atan and Ajun came in the morning.

Tuesday 31st Dec 2013
En. Loh came to visit in the morning, Atan came too. Mi and Ajun came to visit in the evening. Lots of stories about the family back in Ipoh and KK. At night I watched a lot of fireworks as the world ushered in 2014 as my room was on the 8th floor of the hospital.
What will 2014 brings me? To me, life is always about making choices. You can have tons of good opportunities but if you make bad or uninformed choices, for whatever reasons there are, you will still end up nowhere. Then again if you make a mistake, consider it a learning experience, move on, there are still plenty of things life can offer. I did make some bad choices here and there in my life, well who didn't? Those unwise choices helped me learn more about myself, who I was and perhaps who I am now. One thing I realised is that in order to improve yourself, you really have to know yourself first.
Whatever 2014 brings I am okay with it and I am determined to make the best of it. Actually it is not what 2014 brings us, it should be what we ourselves bring into 2014. Life is short and not to be wasted with petty, irrelevant issues. I love myself and I am going to take very good care of myself and of course my very beloved Mickey Benjamin too. And, yes, once fully recovered from this TKR I have decided to adopt another cat, a female to be Mickey's companion. It will be a rescued feline, either from shelters or from the street itself and hopefully a young kitten just like the adorable, cute and lovely Gollum of TTDI Jaya when she was first adopted by her Mak Andak and Uncle Amir.

Wednesday 1st Jan 2014
New Year 2014, in the surgical ward of SKSMC. Monday onwards I had physio morning and afternoon every day. Some of the physio exercises left my thigh and lower leg muscles cramped and uncomfortable sometimes to the extend that I cried. I knew it just had to be done, the muscles have to be taught to be as flexible as possible to ensure smooth and as much movement as possible later on. I also need to attend physiotherapy at the hospital twice a week for about 2-3 months upon being discharged. Despite the cramps I walked about in my room, round and round that was, as I noticed the swelling on my feet lessened when I walked a lot.
I was given a pair of compression stockings to wear at this point to prevent deep vein thrombosis (DVT).. Blood thinners were also prescribed to further prevent blood clot in both feet.

Thursday 2nd Jan 2014
After my morning physio, I had my lunch of  fish with mashed potatoes. It was rather tasty actually. The hospital menu was quite good, there were a lot of choices, even though taste wise it was rather mediocre.
Then my CIAST gang came (Darling, Dear, PA and En. Loh). They were happy to see me in good spirits. Noticed somebody's new cute Clarks shoes! Thank you for coming guys. Atan stopped by too later on.
In the evening Dr. Ong came to change the dressing. Advancement in medicine has made it simple, peel off the present dressing and place the new one. We talked for while, him giving me advice here and there as I would be discharged tomorrow and he would not be able to see me in the morning because he has surgery.
Reflecting upon my TKR, I think I have made a remarkable progress in terms of the surgery itself. But there is still a lot to be done, as the actual functioning of the operated knee will only be known in a few months time after the twice weekly physiotherapy.

Friday 3rd Jan 2014
I was discharged. Only using the walking stick, no more walking frame. Atan came to pick me up. Even though we left the hospital at around 12.00 noon, it was only at 4.15 pm that I arrived home as Mickey's boarding facility opens only at 3.30pm on Fridays.

Just before being discharged

Very very happy to be
home at last