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