Tuesday, August 7, 2012

#KatoKnee: You think therapy's tough? Try getting some sleep

We all agreed. The hardest part of joint replacement is the therapy; the second hardest part is getting a good night's sleep after surgery. For many of us, that still hasn't happened even two weeks later. And, in one case, the sleep deprivation lead to slight hallucinations and a trip to the emergency room.
It was a rehab camp "reunion" today in the waiting room of Orthopaedic and Fracture Clinic. Four of us who had surgery at the same time were together again this time to have our staples removed. We had shared a couple of days of pretty intense therapy immediately following surgery and quickly grew to know each other. Comrades in pain tend to bond pretty fast.
And rehab is like Vegas for gimps. What gets said in rehab stays in rehab so don't look to me for any hints on identity. But they are pretty interesting people.
For instance, the patient with sleep deprivation knew enough about it having been trained on surviving such torture while in the service. His body took enough beating back then the future holds a few more joint replacements - one more hip and both knees.
In his most recent case, he was sent home and told to take some 5 mg of melatonin, an over-the-counter herbal supplement that is supposed to bring on sleep. It helped. His wife said there was no way he was taking Ambien. Her relative, while on the drug, got up in the middle of the night, cooked breakfast and went back to sleep not remembering a thing. At least that's what she said.
In my case, the longest stretch of sleep I got actually came in the afternoon after therapy. It was for one hour and 45 minutes. When I awoke, I was disoriented, grumpy and still tired. That also ruined it for me that night not getting more than one-hour stretches of sleep.
I'm told this is not unusual so if you are contemplating joint replacement, ponder how you will deal with this. First off, it's best to have your own bed and your own bedroom if you can manage it. You will be up often and your mate doesn't want to hear you whining and grunting in the middle of the night. She needs her sleep too just to take care of you the next day.
My earlier readings of others in similar situations found that most patients get beyond this after about four weeks. Great. Two more weeks to go.
This was my first visit with Dr. Kyle Swanson since the hospital and I knew he would be glad to see me. I had my left knee replaced eight years ago in Indiana and already can tell a big difference with this one. I didn't need the walker once I got home. I've been walking without a cane now for a few days, much earlier than the Hoosier knee. When I told him this surgery was four times better than the last, you'd thought I just scored him a perfect 10 on the uneven bars. "It really makes my day to hear we did better than the last guy," he beamed. I love competition.
Dr. Swanson showed me the X-ray taken immediately after surgery and it was beautifully straight. He said may leg extension looked fantastic for just two weeks out, told me to stop taking naps or I'll mess up my sleep cycle and gave me my permission slip for the principal so I can return to class.
"You want it for when? You know you can take six weeks off, don't you?"
"Yes but I'm going stir crazy."
He was still reluctant for such an early return so I relented.
"OK, I'll give you no more than four hours a day starting next week. No lifting. No sitting for prolonged periods. And take off when you need to."
"Can you add that no one should piss me off?" It's political campaign season, you know. He didn't but he did prescribe more Percocet. And there you have it - going for the symptoms not the cause.
I did get to keep the staples, all 31 of them (see photo below) but I couldn't retrieve my original knee. Hey, it's not that weird. I still have all my kids' teeth having rescued them from that cheapskate tooth fairy. Yes, I'm that kind of guy.
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