Tuesday, June 18, 2013

Arthroscopy Day 1 - SURVIVOR tips for staying alone

June 10th 2013

I picked up my painkillers, Percocet, days before. I live essentially by myself. So I have to reorganize my bedroom a little to make sure I have most of the necessary things at my bedside: a water flask full of water, my pain meds, my books, my readings, pencil case, a small trash bin and my laptop with power cable and iphone charger.

I took a shower in the morning before heading out. Since I reckon I won't be able to shower for the next 2 days at least, I took pains in scrubbing and cleaning things out twice and hard.

No breakfast. No water still.

LA came to pick me up at 9 in the morning. I planned to reach there way ahead of time. The surgical center is in Branford. I was expecting rush hour, but there wasn't! So we reached there way before.

After some time in the waiting room, they started prepping me for the op. I changed into surgical gown. The nurse C was extremely cordial, asking if I am cold and if I wanna watch TV. So I have blankets, even though I wasn't very cold and there was TV. Channel surfing isn't my favourite pastime but it's better than stoning. She gave me 2 pills, 1 Reglan and 1 Zantac, for the stomach, since I didn't have any food since 12 yesterday. And then she taught me how to use the crutches, which she got one pair for my height. I was then put on saline IV. C was commenting on the bruises I had from the pre-op blood-taking. Because they took twice (they forgot they had additional tests..) side by side, she said they look like a vampire bite LOLX. Haha, either it's due to the 'True Blood' and 'Twilight' frenzy or otherwise, I feel slightly amused. She could have likened that to a viper bite or dragon bite or simply a fanged bite or said nothing at all, which is probably what many nurses would have done. We and some nurses laughed and the mood lightened a lot.

Throughout the whole thing, I felt really taken care of - which is the general feeling I got out of the whole COS experience. I don't feel neglected and rushed, which I thought was a good change from public hospitals back in Singapore haha, even though I must say the nurses did their best there too. Though I could say less for the doctors...

One of the nurses came to ask me if I am allergic to pain meds and other meds. I was pleasantly surprised they asked me if I know if lesser dosage is required for me since I am an Asian. Some people might find this offensive. However, as a scientist-in-training and having my previous work being on ethnicity influences on drug effects (there is a substantial influence) and their clinical uses, I must say I am absolutely impressed.

Then Dr Diana came to mark me on my left knee with his initials 'RD'. Kind of like branding haha (too much 'Spartacus') but it's comforting to know that they take precautions to make sure they don't open up the wrong limb or the wrong person or both. I think that's what patients need from the clinicians - that sense of reassurance to entrust part of us to him, even if it's fleeting/temporary. Put also confidence and soothing words of encouragement into the mix. Oh, since I am on local anaesthesia, and I opted to watch as he does the menisectomy =) I saw a video online, but nothing really beats watching a video of your own surgery as it unfurls right there =p You can watch a sample right here and more info here.

The surgery is only about 30-minute long. The nurses in the op room were amazing! They kept me relaxed. Even though I am sedated locally, I could feel my senses dulling down a few notches... Throughout the procedure, Dr Diana walked me through what he is doing. He first made 2 incisions on the skin of my knee cap to push the instrument through. I did feel a sharp pain, maybe just before the anaethesia sets in. After I sounded out, all's good thereafter. Then the surgery proper. He pointed to the meniscus and the bones (watch the video above). He pointed to a hole that was my tear. Imagine white thin fabric against the sun, and there's a medium-sized hole in the middle. That's how I saw it. There was some snipping, and some 'vaccuming' of the debris. Then it was done. Faster than I expected, maybe because the watching took my mind off the time elapsed.

I was wheeled into the recovery room. There, I was given an energy bar and water!! I was pleasantly surprised by this gesture haha; my stomach was growling by then. I still felt light-headed. LA came in to help me remember things that the nurse was about to say. She taught crutches again, for normal walking and up and down the stairs (very important since I stay on the second floor); icing and compression devices, which they provided (pleasant surprises everywhere). I am going to list them below later if anybody might find useful.

Keep yourself hydrated all the time!! I will provide more stuff in later updates.

***A very important thing to do is to flex your foot while you are icing to increase circulation.
***Do not stay in bed all the time, walk about for meals and bathroom to increase circulation. Increasing circulation prevents blood clots (which the doc says is something people neglect)!!!

A huge shoutout and thank you so much to LA, for ever being such a great great friend for driving me there and sending me back and making sure I was properly settled in. And also helping me to remember things.



Check that crutches are of good height, just below your armpits.

Normal walking:
Since I can exert partial pressure on my 'bad' knee, and full pressure on my 'good' knee,
1) 3 things go forward together, the foot with bad knee, and the 2 crutches, then your good foot goes forward.
2) crutches are always kept on the bad side.
3) to turn around, walk in an ellipse
4) to sit down, walk to forward to the chair, gauge, turn around using (3), then inch back till your leg touches the chair, move your crutches to the bad side, hold the handle of the chair, lean on your good foot, stretch out your bad foot. Never bend the knee beyond 90 degrees.

-- good detailed video here to demo how to use the crutches.

Going up stairs:
1) crutches level with where you are standing
2) good leg up first
3) then crutches + bad foot

Going down stairs
1) crutches + bad foot down first
2) then good foot

-- good video here



I have to spend the next 48 hours icing and compressing for 30 minutes then leave off for 30 minutes then repeat. This reduces swelling.

***A very important thing to do is to flex your foot while you are icing to increase circulation.
***Do not stay in bed all the time, walk about for meals and bathroom to increase circulation. Increasing circulation prevents blood clots (which the doc says is something people neglect)!!!

I didn't know they were going to provide a compression device (the link I provide from Amazon, with the pump, comes only with one ice gel I think) and 2 ice gels. I got the one I had for my ankle and bought another one from Amazon. So I rotate between these 4, very well keeping the gels cold all the time. My ankle gel needs about 2 hours or more to be really cold (it's got a really a lot of gel in there), so I guess having 4 is good. Check how long it takes to cool them if you are buying them online.

1) I have to apply ice gel.
2) layer the compression OVER the ice gel then pump air to compress.
3) lift the knee above heart level on bed by propping up 2 or more pillows.
For 30 min.

Then fallow for 30 min before repeating.

At night, I don't follow the cycle. I put one ice gel before I sleep then I remove only when I wake up for bathroom. I will also swap out the old warm gel for a new cold gel from the freezer.

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