Time to Rock n Roll

“Thinking will not overcome fear, but action will” 

-W. Clement Stone-

Surgery Day Approaches

As the surgery date approached, I no longer had the defense of denial helping me ward off the anxiety of having both my knees replaced and so my mind started to reel.  How was I going to manage alone, what would the pain be like, what if it didn’t work, how will I ever be able to climb stairs again (trust me, after about a month I was flying up and down stairs better than I had in years). And of course the biggest fear, what if I died and left my daughter with no parents?  Logically, I knew the answers and probabilities to all these what-ifs?  If I had to stay in a rehab facility I would. If I needed anything, I have amazing friends.  And of course there is always the risk of something that could go very wrong during surgery, but I had more of a chance of getting into a fatal car accident, falling down the stairs, or being mugged at gunpoint than I did with knee replacement. Plus, my surgeon is a rock-star who has performed this type of surgery thousands of times.  I was going through with this.  If I backed out, all I could look forward to would be a life of pain, misery and anger as I became less and less able to do even the most basic activities of daily life, let alone do the activities I loved doing.

I also had to shut out the unsolicited comments from people- “You’re doing both at the same time-you’re crazy!”(Actually I was just being practical and now I don’t have to be thinking about a second surgery) “You’re going to have 9 Inch scars up the middle of your legs” (Actually they are about 6 inches if that, and have become less and less visible every day. And anyway, who really cares?).  And I know, I should have stayed off social media where almost everyone shared a horror story.  But I also knew at least 3 people personally who had both done and they all said almost the same thing, “You’re going to wish you had done it sooner.”

A few weeks before the surgery they set me up with gear.  I was measured for a walker and was told to bring it the day of surgery.  The vision of me having to use a walker was not a pleasant one.  But with the help of my daughter, we decorated the walker with small reminders of my athlete identity.  A heart with a face, arms and legs saying “Go Mama!” drawn by my daughter when she was about 7 or 8.  I preserved it and it was taped to my bike for the past 12 or so years . I also had a picture of quote from a fortune cookie that was taped to my garmin for many years that read, “You are almost there”.  I’m no stranger to pain but I thought these would be good reminders of grit and pushing through the pain during the early days post-surgery.

And so it was the day of surgery.  I was dropped off at the hospital with my backpack and walker.  I walked into the hospital lobby and there was a pianist at a grand piano playing music.  I can say with certainty I’ve never been in a hospital with a piano in the lobby. Before I knew it, I was in my lovely hospital gown, given my IV and all I could do is wait. The surgery before me was delayed so mine was pushed back 2 hours later.  I was waiting and waiting which was ok because I really had nowhere to go, but I could feel my anxiety mounting.  Then came the flurry of activity and it started to get very real. The anesthesiologist administered the nerve block and all of a sudden my legs were basically paralyzed.  I don’t know why I kept trying to move them because I knew the paralysis was the purpose of the medication. I guess it was from feeling a diminishing sense of control. He must have noticed the look on my face because he told the nurse to hit me up with the entire syringe of happy juice.  But I guess I was so nervous, I was not even an iota happier.  The operating room was a frenzy of activity.  All I could see were masked people in scrubs quickly swirling around and talking.  Even though it was all about me, it was almost as if I wasn’t there.  They put the oxygen mask on me and told me to stretch my arms out because they need to secure them to arm boards.  So basically, I’m paralyzed from the waist down, have a mask over my mouth and my arms are tied down crucifix style.  Talk about feelings of vulnerability. That’s the last thing I remember about the OR.

Yay I Made It Through Surgery!

Now I didn’t write about the OR experience to scare anyone, because all of this is happening in a matter of minutes and the next thing I knew was I was  in the recovery room groggy and with cotton mouth, my knees with layers of bandages and  hooked up to compression boots.  I was brought to my room and noticed I had big bright yellow bracelet with “FALL RISK” on it.  Excuse me?  Isn’t that reserved for unruly  patients who are told to stay in bed but won’t?  I know it was for safety reasons, but I just couldn’t fathom why I would be a fall risk.  Oh, until I tried to stand up.  Before actually standing up, I got a lesson in standing up using the walker.  Since I couldn’t bend my knees at all (and I didn’t have a non-surgical knee for support), I had to first extend them and as I pulled myself up on the walker I brought my legs towards me and leaned  forward as far as I could.

It all seemed so simple as they were explaining this until I had to do it.  I had four people standing around me!  One person holding my gown and shorts from the back and pulling up like they were giving me a wedgy.  One person was holding the walker and the third and fourth person were standing next to me on either side holding my arms.  There were five people, including myself standing in an area that was about 2 ft x 2 ft.  I’m thinking how bad can this be?  And so with the help of four people I stood.  The first thing I thought was whose legs are these and why do they feel so heavy and not connected to my brain. We take for granted the split second it takes for a signal to go from muscle to brain back to muscle-it happens in thousandths of seconds.  In the time it takes you to read this sentence, at least 10 billion neurons have fired.  Well evidently not after a surgery such as this.  The second thought I had was ok, now I know what I’m dealing with (sort of) so it’s no longer abstract.  Heavy dead legs that could barely move. Thankfully I had worked on my core and upper body strength so suspending myself on the walker was not a problem.  And then I took steps that were literally one inch at a time and all five of us shuffled to the toilet which seemed like it was a mile away but it was maybe less than 10 feet from my bed.  And then we shuffled back again and I learned to do things in reverse.  I was sweating and freakin’ exhausted. The first night was not terribly painful because the nerve block had not worn off–yet.  I think because I had so much adrenalin running through me, I was wide awake all night.  Then came dreaded day two which everyone talks about.

Day Two and the Pain Demons

Day two started off pretty ok.  The physical therapist, who looked like he was about 12 came in at about 7am, just as I was dosing off, telling me we were going to take a little walk—without four other people assisting.  With the help of my 12 year old physical therapist and my walker, I stood, and shuffled about 30 feet down the hallway.  My legs felt like concrete slabs, but I did it.  I had my knees replaced and less than 24 hours later I was “walking”. I took a little walk twice that day with my PT.  The staff loved me because if there is anything I am good at, it’s being compliant, doing all my exercises and just showing kindness to these overworked, underpaid health care workers that just don’t seem to get the recognition and respect they so deserve.  I couldn’t go home quite yet because I still had to be taught how to go up and down stairs with crutches and knees that didn’t bend, which is a whole different story I will save for another time.

Around 8pm it was as if some force of nature unleashed the Pain Demons.  The pain kept getting worse and worse.  It was as if my legs were in a cylindrical vise that just kept getting tighter and tighter. This continued throughout the night, so it was night two of no sleep.  I couldn’t understand how I could be so pumped up full of drugs and still be in pain.  I mean I expected some pain, but geez.  However, this level of pain is not unusual on day two.  For the first time since this whole endeavor started, I cried like a little weeny.  Then I did something I never do; I prayed to my mom (who passed away 15 years ago) to help me get through this night or to at least help me feel like she’s around me.  As bad as the pain was, I also didn’t want to forget the feeling that night of total helplessness and of not being able to stand on my own two feet by myself. I wanted to remember those darkest moments so I could at some point later, revel in the strength of my body to heal. And that’s what got me though the night.  To keep telling myself in between the whimpering, just make it through this next hour, this next minute, even this next breath.  You got this.

It was now about 6am, similar to Dracula who must retreat to his black hole before the light of day, the Pain Demons fled. The night ended and I survived. In walked my favorite nurse.  A younger woman, probably not much older than my daughter, with a  very sunny disposition and a whole lot of patience.  She would always greet me with, “How ya doin’ dahlin’?”  It would make me smile and be thankful for humans like her who are so full of compassion. She told me I was going home later that day!  I’ll save the ambulance ride story for another time, but I’ll just say that laying on a gurney that was probably the same width as my butt, in an ambulance with no shock absorbers and hitting every pothole on the highway, all I could think of was, ok this will be a funny story someday, maybe in the very distant future.

Home Sweet Home

I made it home.  Since then I’ve been on the path of recovery, which has had many twists and turns over the months.  Physically and emotionally.  Even though as a psychologist I knew there would be emotional challenges, it still felt like a rollercoaster ride.   One minute I would be full of gratitude and motivation (maybe it was the oxy talking), the next minute I would plunge into darkness, feeling discouraged and helpless and very negative.  The emotional pain we experience in response to a surgical procedure is known as postoperative or postsurgical depression (and/or anxiety).  It’s a very common, real response, and is treatable.  Most people after surgery don’t make the connection between the stress of surgery on the body and changes in mood. My call to action would be for surgeon’s offices and physical therapists to screen for any emotional distress following surgery.  The orthopedic practice where I had my surgery done (which is an amazing practice) would periodically send questionnaires that maybe had one question about mood, but I’m not sure what they even do with that information.  While some people may think that it’s not up to the surgeon or physical therapist to monitor for distress, I would argue that physical healing and emotional healing have an intimate and direct relationship.  Studies show that a poor mental state and negative thinking can impact wound healing and progress in physical therapy.

Tips on Dealing With Postoperative Depression

Dealing with postoperative depression after knee replacement can be challenging, but there are several strategies that may help:

1. Communicate with your healthcare team: It’s important to let your healthcare providers know how you’re feeling. They can offer support, monitor your progress, and recommend appropriate interventions and referrals if needed.
2. Follow your postoperative care plan: Stick to your prescribed medication regimen, attend physical therapy sessions as recommended, and follow any other instructions provided by your healthcare team. Adhering to your care plan can really help your recovery process and may improve your mood over time.
3. Stay active: Engage in light physical activities as recommended by your healthcare provider. Regular exercise, such as walking, swimming or gentle stretching exercises, can help improve your mood by releasing endorphins, which are natural mood lifters.
4. Set realistic goals: Break down your recovery process into smaller, achievable goals. Celebrate your progress along the way, no matter how small the achievement may seem. This can help boost your confidence, mood, and motivation.
5. Seek support: Talk to friends and family members about how you’re feeling. Sharing your concerns and emotions with others can provide emotional support and help alleviate feelings of isolation.
6. Stay connected: In addition to connecting with friends, family and your community, participate in activities that you enjoy and that are reasonable and realistic given where you are in your healing process. Whether it’s reading, listening to music, or resuming a hobby, engaging in activities that bring you joy can help improve your mood and decrease anxiety.
7. Practice self-care: Take time for self-care activities such as relaxation techniques, mindfulness meditation, or deep breathing exercises. Prioritize your mental and emotional well-being during your recovery process.
8. Consider professional help: If your symptoms persist or worsen, consider seeking help from a mental health professional such as a therapist or counselor. They can provide additional support and make recommendations to help manage your symptoms.

Please remember, it’s normal to experience ups and downs during the recovery process, but if you’re struggling with persistent feelings of depression or anxiety, don’t hesitate to reach out for help. You’re not alone, and support is available.