The Knee From Hell

“You need a knee replacement”, said Dr. Cooley in a particularly unemotional way as if he had been dispensing this sort of commentary for years. He was in his sixties, a slender, wizened man who looked as if he had done this sort of thing before and rather pitied people for the condition of having a bum knee; I read his bio online and knew he had hiked all the Adirondack high peaks so I knew he was accustomed to having all his parts work well. I sat there looking at him with tears streaming down my face and knew that he was right; my general practitioner uncle had warned me that my knees would wear out prematurely and apparently they had. Too many nights of dancing, extreme gardening and plyometric lunges during Boot Camp had taken their toll on a knee that had been compromised by a horse-related injury years ago. Back then my mother told us to ice pack it and get back to the barn; in those days there was no such thing as seeing an orthopaedic surgeon which was reserved for professional athletes and people with broken bones.  Somehow I had known my knee was in trouble when I ran my last 5K wearing an ace bandage so tight I could barely feel my leg but I had been in denial about doing anything about it.

A hyperextension while trying to reach into my pickup truck for something nearly leveled me with the pain and became the impetus for this latest round of visits to the specialists. Dr. Cooley was no longer performing surgery, but a Dr. D’Ascoli was and he was a doctor I was familiar with at least having operated on the professor’s knee several years earlier. He had a good reputation, so we began the discussion about what a knee replacement would entail and the risks involved. An x-ray showed a complete loss of cartilage on the anterior side of the knee and he concurred with Cooley’s findings but was very concerned about my age; knee replacements last between 15 and 30 years so there was a good chance I would need another in my lifetime. He wanted me to try a round of Celebrex which was more of an exercise in getting me to really think about the surgery and a non-invasive stab at making me more comfortable. Cortisone shots were out if I was considering surgery within three months so I decided to give the Celebrex a try and forego the cortisone so as not to paint myself into a corner. He gave me a three week supply and told me to let him know.

The sample boxes exhausted, I wasn’t noticing much of a difference except for a slightly better time sleeping. By the time I decided to try a course of anti-inflammatory the knee pain was waking me up in the middle of the night , so having the inflammation subside during the night was nice. But it wasn’t enough to weather the potential liver damage that usually accompanies such a drug and I began researching knee replacement surgery in earnest. My first resource was our receptionist Jeane, and amazing woman who walks forty to fifty miles a week on her knee replacements; she has had both knees replaced and one of them was done by Dr. D’Ascoli. She spoke very highly of him and I was grateful to her for all the nuggets of information she passed along. Jeane pulled no punches when describing the pain and I have been grateful for her honesty. I can vividly recall my grandmother telling me it was the most painful surgery she ever had, and she had undergone several including open heart surgery. I knew it was going to hurt, but a few weeks of Big Hurt balanced precariously against years of nagging pain became a relatively easy trade. As my colleagues heard about my knee replacement research (and watched me limp around the office) I began to hear other success stories of people who said it was the best thing they had ever done for themselves; somehow they had gotten past the pain and emerged to the other side in much better shape. I wanted that. And I wanted it on this side of my life, not on some un-promised time down the road.

Joint Class

Deciding to go ahead with the surgery set in motion a series of doctor’s appointments and consultations that made me really realize the gravity of the surgery I was about to undergo. The hospital where the surgery was taking place scheduled a Joint Class which was to give me a good overview of what to expect when undergoing joint replacement surgery; their logic was that it was better to impart this information when a patient was lucid and I was grateful. There were nine people in the class and they were all quite a bit older than I was. The woman on my left was a retired nurse who had the surgery three years prior and said it went extremely well; she was transporting a friend who didn’t drive. She counseled me to ask the anesthesiologist for “the block” which I was to discover later may buy me a few hours of physical therapy with less pain. The woman on my right was getting ready to have her second knee replacement and said her first knee was well worth the rehab and she was looking forward to getting on with her life. I appreciated her no-nonsense manner and the fact that she walked three dogs each day.

The class consisted of three medical professionals: a physical therapist, an occupational therapist and an RN who works exclusively with joint replacements. They outlined the expectations they had of the patients on the floor and the OT went over things that would be helpful once you are home. Of particular fascination was an actual joint prosthesis which was passed around; the titanium part was surprisingly weighty and it was not hard to see why it can be a problem at airports. The medical personnel were frank about the kind of pain I could expect and stressed the importance of taking meds at the right intervals so the pain does not get ahead of you. Clearly pain management is the key to successful rehabilitation, since it’s impossible to do the required exercises without it; pain medications scare me to death, but I was beginning to realize what a valuable tool they could be in getting better and I knew I was going to need to make my peace with them.

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