Setback

My patient suffered a setback this weekend. After a walk around McGuire Lake, his other knee became inflamed and he ended up in bed for the next two days. During the past week he had insisted on two walks each day, more exercise than in his pre-op days.

My nursing diagnostic skills explored the idea of gout in that knee although he had been on a daily medication for over one year to reduce uric acid levels. In a desperate attempt, after a consult with the pharmacist, I prescribed colchicine. In the past this drug has made an immediate improvement. This time, it wasn't the answer.

Now operating on two crutches again, my patient made his way into the kitchen for breakfast on Tuesday. This was his first trip out of the bedroom in three days and I was worried about the recovery impact on the knee replacement knee. He slowly managed the stairs and into the car for a physio appointment.

The physiotherapist seemed to think that the inflammation was due to additional stress on the knee and that over time, with icing and rest, it would improve. Back home we rested on the back deck, in the sun, with cups of tea before I tucked him into bed for a much needed nap!

Two days later he is doing much better and is back to a "one crutch walk" at the wharf!

Successes

Well, we have had a week of successes! Even baby steps are recognized as big steps in recovery. Last week we walked halfway down the wharf twice and today(due to rain) we traversed the inner sanctum of Piccadilly Place Mall, in both directions.

At the last physio session, the knee bend had increased to 95%. She advised him that she expected a 5% increase each week! Wow! My patient has been quite diligent with his exercises and hopes to meet her expectations. He is managing the stairs on a daily basis and swinging his leg in and out of the car with more ease.

The surgeon was pleased with the healing process but cautioned that infection could happen at any point in the future. No one told us about that possibility!!

Feeling optimistic, we booked our trip to Mexico. As the cool temperatures of Fall have descended on Salmon Arm, we are looking forward to the warmth of PV. The pool will be the site of ongoing therapy for my patient!

The wound(not for the faint of heart)

It's time to expose the wound. This is not something for the faint of heart!! This photo was taken on the day before the rest of the staples are scheduled to be removed. The Doctor only removed every second one last week to give the incision a bit more healing time. Despite the appearance of the knee, his leg is actually almost "normal" size again!

My patient has been improving steadily this past week. This morning he put on shoes and socks before making his first visit in three weeks to our local coffee shop. Sundays are quieter days with less risk of being bumped or jiggled between tables. After coffee/tea and muffins he insisted on a short walk at the wharf, assisted by his helpful crutches!

Devoid of energy following this big outing, he reclined for a few hours with a Sunday schedule of football before being forced to leave his semi- horizontal position and make his way to the dinner table. He assures me that he is constantly doing his exercises between touchdown passes! Hah!!

More physio tomorrow and Wednesday before a final appointment with the surgeon on Friday. I have my fingers crossed that my nursing days will come to an end soon.

Flutterby blessing

Fanned by a touch

as light as my soul

I gasp with delight

as you perch nearby

flashing your colours

freed from conformity

raised by the wind

you hover in sight

then flutter a blessing

against my skin.

In the passenger seat

It was a big day today. My patient rode in the passenger seat of the car for the first time, no more cramming into the back seat! He had a good meeting with his physiotherapist who advised him to get up and move around more frequently. Sounded like an echo of Nurse Ratchet's advice!

His range of motion is good for two weeks post-surgery. She gave us a couple of new exercises and sent us on our way with the next appointment scheduled for Friday morning.

Between our two appointments we shared lunch on a shady park bench while listening to the life story of a passing cyclist. His life experiences made our lives seem absolutely ideal.

After waving farewell to our new friend, we made our way to the Doctor for staple removal. He wisely decided to remove every other staple, leaving the rest for tomorrow at the surgeon's office.

Back home, my patient was drained of energy but managed to hoist himself back upstairs and onto the bed for some much deserved rest. More stairs and vehicle travels tomorrow as we head to Vernon for the surgeon's assessment.

Innovation

Being a mistress of innovation, I managed to fit an outdoor chair into the TV room with a modified drafting table chair for a leg rest! 

The small TV is (blessedly) out of the bedroom and back downstairs. Does he look comfortable?

Tomorrow we face the challenge of stairs again for a visit to the physio department at our local hospital followed by a visit to John's doctor. Maybe he'll remove some of the staples??

Wouldn't you know it?!

Yesterday was not easy for my patient. He had spent a restless night on the makeshift bed downstairs, almost rolling onto the floor on a couple of occasions. Forced out of bed and into the back seat of our neighbour's vehicle (a much larger, higher Toyota) for a trip to the lab, both of his knees were screaming!

When we returned, he faced the challenge of climbing our back stairs. Collapsing on the bed, I promised that he wouldn't have to get up again until the morning. More icing, elevating and pampering followed by the awareness of feverish cheeks around 5pm. WTF!

While he napped, I attempted to straighten out the downstairs but couldn't manage to drag the single mattress upstairs. A plea for help resulted in friends dropping over in the evening, carrying the mattress up for me and visiting with us for an hour around the bed. When they left, the fever had disappeared!

Today is better. No fever! Breakfast in the kitchen with my patient and the promise that he'll join me again for afternoon tea. Another loaf of freshly baked banana bread delivered by friends.

Checking emails, I discovered a request for a house viewing on Monday! Wouldn't you know it?! Nothing for weeks and now someone wants to invade our privacy! I explained the situation and said that my patient was in no shape to tackle the stairs in order to vacate the house...but...that we are prepared to sit on the back deck while they look around. No problem apparently!

Failure of the back seat revision

The back seat revision did not live up to its inventor's expectations. The entry wasn't too bad. His pants stayed on while wiggling his bum across the seat. It was the seat belt that I hadn't taken into consideration. We managed to get it into position, around the large mattress for the trip to Vernon but on the way home it had a strangle hold on my patient.

The surgeon was mystified by John's symptoms and hopes that the bladder infection is contained. The incision looks normal. He wants to see John again next week. Nurse Ratchet asked "why?" Handsome young surgeon replied that he didn't make house calls. I was tempted to suggest that the least he could do was update the waiting room seats, circa 1970, requiring patients to lower their bums to about 14" above the floor! Wake up!...this is an Orthopedic office...for hips and knees!

My patient now has two screaming knees and the warning on the Cipro antibiotic is that the medication may "rarely" cause tendon damage. Nurse Ratchet called the GP who suggested that we "wait and see".
Maybe it's just pain caused by compensating and exerting more pressure on the "good" knee that also has no cartiledge!

So, my patient is currently installed on the lower level of this care facility. I hauled the single mattress from upstairs and placed it onto the queen size bed downstairs to give him some elevation. The small TV is back in place for his viewing pleasure. He has been medicated, iced, exercised, watered and fed in a series of approximately 92 trips up and down the stairs.