Mothers are right: wear nice underwear when going to hospital...

Day of Op:
That was a very long day: due to arrive at the clinic at 1.30pm for a 2.30pm OR time. NPO (Nil per Orally) from midnight, and only clear fluids till 8am. So I had a few sips of coffee, some juice and water and that was it. My poor stomach was not at all impressed as I usually feed it well and on time. So of course, by 9am it was protesting so darn loudly that I was thankful no one else was in the office. Then come 12pm the Asian students down the hall open their lunch bags and out come the intensely mouth-watering smells of home cooked Dim Sums, Moo Shu pork, and stir fried black beans. Oh, how utterly cruel! 

At 1pm I had enough so packed my bag and walked really slowly to the clinic, which is literally across the road from the hospital. Now here is where the fun starts. I already had found out the day before that my physio Paolo was to have surgery at the same clinic and around the same time as me...talk about strange times. You know your physio is perfect when they go through the entire surgery process alongside you! Paolo was to have his meniscus trimmed and when he turned up half an hour after me we realised that are surgery times where both scheduled at 2.30! not only where we going to be in adjacent operating rooms, but we would probably wake up near each other!

Being on the "other side" is rather strange. Normally I am the one looking down to the patient, smiling, stroking their hair as I apply their leads, take their vitals, or put in their IV. Now it was my turn to be lying on my back looking up to my carers. Everyone knew I was an ICU nurse so my anaesthetist was telling me what drugs she was giving and dosage. I was making them all laugh by telling them how tall Kevin is and that I have already demanded a tall baby as the "midget-ness stops at me!" The poor anaesthetist had to tell me to stop making her laugh so she could put in my IV. 

"1 mg of Midaz Sarah"
"Hey so the lamp looks really pretty..."
"75 mg of Fentanyl Sarah...here, take a nice big breath from this mask"
"Hey, your ambu-bag is too big for my tiny face...." 
Enter sleep...Enter intubation...


I woke up to a "Sarah, it's all done. Are you cold? You look it, let's get you the bear-hugger"
I was intubated through the 2 hour surgery, which to be honest, scared me a bit when I was informed I was going to be. I assist in this every week with our ICU patients, and no, it was my turn to have the "breathing tube" Apparently I was an easy patient...Awesome! 

I hear my monitor beeping; I look over..."oh hey, I'm saturating at 79%!"
Excellent Sarah! The bear hugger is cosy, so I snuggle in more, hearing the nurse say, "remember to take big breaths Sarah"
"Yup, in a moment, I'm just getting cosy"


"Sunshine!" I look over and there is Paolo in the cubicle right besides me. How utterly strange yet awesome. I can barely get a sound out so I manage to rummage my hand up and out from the bear hugger and give him a wave. Looking over to the monitor again, everything is gold. Knee hurts like hell but only a moment ago I had some dude drilling into my knee in 2 places so what else is there to expect? 


Paolo and I eventually graduate to the lazy boys where a nasty wave of nausea hits me upon moving from the wheelchair to the lazyboy, associated with the room frantically spinning. 
"Sarah can we bring Kevin in?'
Frantic shaking of head and making a fish face made the nurse realise that if she did I might throw up on him. She gingerly smiled, brought me a cold face cloth and I did my yoga breathing and managed to hold it down. To take my mind of my stomach I was allowed to see my OR and anaesthetic record sheets.
Drugs: Midazolam, Fentanyl, Ketamine, Roc...nice choice! Rapid intubation sequence
Vitals: rock friggen solid! 


My better half comes in and I tell him that Paolo is next to me, so while they chat I again try to not throw up on Kevin's expensive Pea coat.
Surgeon dude visits: 
* The ACL was totally ripped, barely hanging on
* MCL - partial tear but did not warrant surgical repair
* Meniscus intact!!
* Knee joint in excellent form, strong and solid.


He took 2 ligaments from my hamstring, wrapped them around each other to make a ribbon and managed to use one end of the original ACL's start point as a guide for his drill hole (tibia). He then threaded it through, wrapped a part of the old ACL around the graft to incorporate them together, then drilled another hole in the femur. The graft was then pulled through and secured with a screw at each drill hole site.


In case you haven't realised, I am writing this on DAY 1 POST-OP and I am quite high, so please ignore the sentences that make no sense whatsoever. I have learnt that when I am high, I do not stop talking until I literally pass out. Poor Kevin, I think I kept him awake last night talking about jacket potatoes with baked beans, bacon, chives, and sour cream? Odd...


Anyway, I did say that this was going to partly educational, party talking out of my bum so lets move up towards the brain! From the car drive home to bed I did my foot and ankle stretches. This is the simple movement of flexing and relaxing the foot, moving forward and back, in order to assist the movement of oedema. I no doubt will get an effusion at the back of the knee joint so this will help reduce swelling and pooling, especially around the ankle joint.

Notice the ankle already becoming a "cankle"

I set my alarm clock for every 4 hours last night to take my pain medication as I did not want to wake up in agony. When I would wake I would also put the "Cryo-cuff" on for 30 minutes, and removing just before I dosed off. I woke up quite frequently as I am a light sleeper despite being loaded up with pain meds, and so I would do my ankle and foot stretches: 12 reps.

Squeezing the thigh and lifting the leg gently, then lower. Repeat as much as you can. 

I also included Isometric contraction of the quads...

Goals for the first 2 weeks:

• Eliminate swelling due to activity
• Progress from partial weight bearing to full weight bearing exercises
• Regain normal range of motion
• Increase quadriceps strength
• Increase hamstring strength
• Use of cryo-cuff every 3 hours for half and hour
• Ankle, knee, and hip flexion and extension every 1 hour for 15 minutes
• Short walkies to the kitchen and back every 1-2 hours.
• When lying in bed, the leg is to be straight!!
• No pillow under the knee whatsoever even though you are craving it

  

  Start with a straight leg on the side and slowly bend at the knee bringing the foot upwards

  
  

Kind of hard to see here but I am lying on my right side with my right leg as straight as possible.

• Flex the ankle back and forth 10 times 
• Bending at the knee bringing the foot back and forth slowly, 10 times 
• Flexing from the hip and knee, slide the foot up towards your bum and back slowly 10 times.

Do NOT be alarmed if you here a gurgling sound coming from the knee! Post procedure they usually clean out the wound and check for any leakages by squirting saline into the area then suction most out. So that funny gurgling is most likely extra saline in the knee.

Ok, so here we are lying flat on our back.

• Straighten the leg and hold, then relax 
• Tighten the quad on the effected side, breathe, and slowly lift up the leg using the quad.
• Relax down slowly.  
• Repeat 5 times... Gradually I'll increase the amounts I lift.

 Up you go Shep! 

It might seem like a big chore doing this every hour, but it is worth it in the long run.
Yes, it is only the first day but suck it up!!

Do not forget to have a smile and a giggle. Laughter is healing and even if it means you make fun of yourself and your fuggly little foot and clothing choice, just do it. Believe me, it does help!

Ok, so this one really should be done whilst sitting on a chair:
Gentle lower leg lifts. Try 5... simple? 

Pain relief:

• 4 hourly Tylenol with codeine
• PRN Hydromorphone 2-4mg

• Pain present? Hell yes! Feels like I have kicked and rucked-up hard in the hamstrings. Can also feel stabbing from the sites where he drilled into me...
• Bone pain is in it's own classification...bone pain due to being drilled at his something I have never experienced before
• my pain tolerance is high but this time round, I'm not going to suck it up too much. 4/10 I can deal with. 5/10, ok take your breakthrough. 7/10? Sarah, stop trying to be tough. 
• Remember: you are not going to become addicted, nor build up a tolerance to opioid in the first few weeks of taking them. Pain control is superior here. No being a superhero...you'll only set your rehab back and piss off your boyfriend.

  

  Checking out what's underneath!

As the title stated: wear nice underwear to hospital. Why? Of course no one is going to be checking out your cute little ass in your ruffled pink panties but yourself. So when you come home looking all groggy, with tape residue around your mouth from the OETT tube, and drool marks down the side of your face, make sure to look in the full length mirror and check yourself out in those nice ruffles. You will realise that despite feeling like hell and feeling sorry for yourself, your bum still looks good. This will prevent those tears from rolling down your face in utter disappointment of your mistakes. Instead a small wave of pride will wash over you, you will take a deep breath, smile, and go to sleep with it on your face.
Plus, it will remind your partner that despite her having horrible anaesthetic breath, looking like she wants puke all over me, her bum does look mighty perky and cute!