Susan, 69 “One After the Other”

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Susan, 69, is married with two children and four grandchildren. Susan had one knee that bothered her and tore her meniscus in the other. She had a surgery to repair her meniscus but it wasn’t very helpful. Susan began to feel more pain and a “deep sense of loss” when she was kept from doing the things she loved. She finally had an MRI on her good knee but there was no cartilage left in that knee. Susan went to an orientation before her surgery and saw a physical trainer to get as strong as possible before her surgery both which helped in her pre-op and post-op journey. Susan would ultimately have both of her knees replaced with just a couple of months between surgical procedures.

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Susan, 69, is married with two children and four grandchildren. Susan had one knee that bothered her and tore her meniscus in the other. She had a surgery to repair her meniscus but it wasn’t very helpful. Susan began to feel more pain and a “deep sense of loss” when she was kept from doing the things she loved. She finally had an MRI on her good knee but there was no cartilage left in that knee. Susan went to an orientation before her surgery and saw a physical trainer to get as strong as possible before her surgery both which helped in her pre-op and post-op journey. Susan would ultimately have both of her knees replaced with just a couple of months between surgical procedures.



SUSAN: Uh, my name is Susan. I am almost 69 years old. Married my husband almost 50 years ago and we have two grown children and four grandchildren. And they are obviously the delight of our lives.

SUSAN: I have always um, been an active person. Have loved swimming and walking and did sports as a kid. Eight or nine years ago I had a little bit of a cranky knee that would give me trouble when I would be coming down off the mountain and started using a knee brace and continued to get worse. I developed a torn meniscus in my other knee and about four years ago had arthroscopic surgery to repair the torn meniscus. And that was not very successful.

SUSAN: I did a number of regimes of injections in both knees and that I found to be a little helpful initially but within the last three years developed not a terrible amount of pain but uh, certainly discomfort and swelling when I overdo. But it's what I was really becoming aware of was instability in my legs. I would put weight on legs and um, always was a bit careful that it wasn't going to go out from under me. And you reach a point where you cant' do the things that you were able to do so easily. There is a-a really deep sense of loss in that and an awareness that this body is at some point not going to function in the same way that it has for all of these years.

SUSAN: At the time I decided that the arthroscopic surgery had not been very successful I felt it was important to see an orthopedic surgeon to have an assessment and he did x-rays and discovered a lot of osteoarthritis. It was causing some pain and issues in the joint. If there was a trip planned that I wanted to be quite active I would get a cortisone injection and that would calm things down enough to enjoy the trip.

SUSAN: But it became clear to me that we were moving towards needing to really think about surgery and just see what's really going on with this other knee. So we did an MRI uh, on the knee that I had considered the good knee and I went to see him when the results were ready to look at and he walked in an had the MRI high up on the screen and said-shook his head and he said this is just a no brainer. This is absolutely bone on bone. It was hurting enough so that I was not really, really shocked.

SUSAN: I had a very good friend who was thinking about a grand adventure doing a walk in Spain. And she came to me and wanted to have coffee one day and said I want you to be my roommate. And I know you've got some knee problems but I would just love to share this time with you. And I found myself knowing immediately that I couldn’t do it; being just desperately sad about that and thought this is the time. I made an appointment. The next week I went in to see the surgeon and I said I want to get this taken care of. With the anticipation that I’d be pretty much kind of normal after I'd had the surgery.

SUSAN: The uh, first surgery was scheduled and I appreciated a lot of the opportunities to sort of prepare. There was a conference orientation, um, at the hospital that was very useful letting me know what equipment I need, what kind of care I was going to need immediately post surgery. I had gone back to a trainer and had gotten as strong as I knew how to get over a period of six months. So I had the surgery.

SUSAN: The biggest difficulty uh, with the surgery was the anesthesia. I was okay for about the first 12 hours post surgery and then just started vomiting and it was two days of just being desperately sick. But the um, hospital physical therapist was in that first day and they want you to begin sitting up. You get on the bed. Uh, there isn’t a great deal of uh, pain in the knee at all because uh, they used a femoral nerve block that was very, very helpful. It kept any kind of localized pain around the knee down. I was just not aware of that at all. It was the second day that everything begins waking up. And you think oh this is pretty significant. So the um, nursing staff was very good about being responsive; they would come in and check what is your pain level. But I did have this terrible vomiting so obviously was on an IV and so they were able to use that to keep me comfortable. And I did get up and I had the walker. They're very careful about not wanting you out of bed at all without assistance. So you have to call the nurse every time you need to get up. You have a catheter for the first 24 hours. And so that helpful. And I was up and they would challenge you a little bit to keep moving and head out into the hallway. And i think the first day the goal was to get from the bed to the doorway of the room. And the day after that we're going around the hallway and making a circle. And so that actually builds a lot of confidence. Three days later uh, I uh, was able to go home which was a wonderful thing. I used the walker at home for certainly the first week.

SUSAN: I think because I had been so sick with the vomiting we put off the in-home physical therapy for about three days after I returned home. And the in-home physical therapist was absolutely fabulous and I think was one of the things that was most essential in having good outcome because she was skilled and experienced. I had just a lot of confidence in her ability to use the right exercises, to push me just far enough without hurting me. So we had cushions on the couch that I was able to sit on and then had a straight um, angle on a little table. So I was able to keep my leg at the right angle and even elevated a little bit. Ice was my friend. It's 20 minutes on, 20 minutes off and there was not very much time where I didn’t use ice. After I started the in home PT it was important to be comfortable enough to push yourself a little bit through the exercises. And the in home physical therapist suggested that I try a little bit of pain medication about 30 minutes before she arrived. She came three times a week. Every day I would do the exercises routinely that she had me do when she was with me. I knew that physical therapy was the key to getting as much mobility back as quickly as I could and getting strong and healthy because I had a second surgery coming up that I had to prepare for.

SUSAN: Our bedroom was upstairs but I created a little bedroom downstairs in a guest room because I couldn't navigate the stairs for oh, probably three or four weeks. It's just a-a daily kind of grind of making sure you're doing the exercises, making sure you're staying strong, eating well, staying healthy and fortunately I was able to do that.

SUSAN: Then I'm uh, back in pre op for surgery number two. And when I saw my uh, surgeon the week before the second surgery he walked into the room and said you either have to be the most courageous person on the planet or absolutely insane. I said well I'm motivated.

SUSAN: I will say that the second surgery uh, felt far more daunting than the first surgery because you know what's coming and you know uh, what the challenges are. Uh, you know that it's going to hurt. They were careful to give me anti nausea medication before surgery and that was a great, great help. So I had a totally different experience um, with both the anesthesia and the pain medication in the hospital. And was actually out of the hospital in two days. I was up, I knew what I needed to do. I said get me out of here and headed home.

SUSAN: I was left with one very recently done surgery and one knee that was only about seven weeks out from having a full knee replacement. I used the cane more than I had the first time because I really wanted to be careful. And I was also aware of infection. My brother-in-law had had an experience of having a staph infection after knee surgery and had a terrible, terrible struggle with that. So I was hyper vigilant about everything they told me to do. And I had absolutely no trouble at all.

SUSAN: After the second surgery I obviously was still rehabbing the first knee but I went back to being at home with the in home physical therapist three days a week. I don’t know why that was but I got range of motion back more quickly with the second knee and it also hurt more than the first knee which doesn’t make sense to me but that was my experience.

SUSAN: The sleeping at night was really difficult so knew when to take pain medication. I knew that I needed to have ice in the middle of the night and I didn’t want to get up and get that and I didn’t want to disturb my husband at three in the morning to have to get an ice pack for me. So I took one with me that was in a little container that uh, made it possible for me to grab an ice pack. I think you just get better at knowing how the pain is going to intensify and just to stay ahead of it which is really important.

SUSAN: In terms of identifying a surgeon uh, that I felt a great deal of confidence in was huge. I have a very good friend who referred me to a particular in home physical therapist that she said made all the difference for her in her recovery. And I was a little fierce in asking for this particular person. And I would say she was one of the key elements in getting me off on the right foot. I had a very similar experience when I transitioned to the clinic physical therapist. Uh, he was wonderfully supportive. Every time I went in he would do these measurements and say oh my goodness this is just fabulous and you're doing great. And for me personally because I'm someone who needs that; having uh, the encouragement from them that I was doing well, that recovery was going well, that I was ahead of schedule, that was all really, really helpful. And so I began believing that yes I'm going to have a really good outcome.

SUSAN: Going into the surgery I expected that I would come out; that there would be uh, a lot of recovery and rehabilitation and that would take some time. But my expectation was within three or four months I would be kind of normal. Within six months I would have my 35 year old knees back and be you know just marching around doing anything that I wanted and that has not been my experience. I've been back to see the surgeon several times. I went in last summer which was about six months out from the surgeries and as he walked in the room I said I am here for a reassurance appointment because this is not quite what I expected. I still have tightness. I felt like there was sort of a band around these
knees. So there was a frustration to that.

SUSAN: I think a year plus at this point I think that I have realized that there are going to be ongoing limitations. And I just have to live with that. I'm up walking around, doing a lot of things; running errands, taking care of grandchildren and doing all the things that i do in life and at five o'clock at night my knees are hurting. And I pull the bag of frozen peas out of the freezer and have to sit down and have my knees up and-and ice them. I did not expect that at all. I thought that the hard work would be getting through the surgeries, doing the rehab. Uh, at six months out this was all over. It was behind me, over and done with. And I'm realizing that that probably is not true. And that I am going to have some knees that will be strong and sturdy and get me where I need to go but they will not feel like they did when i was 35. And you just have to reconcile that so I am still working on that.

SUSAN: My husband as I said was a wonderful caregiver and that is not his tendency. So uh, it was lovely for us actually that I couldn't do anything particularly the first week or so after surgeries except sit on the couch. Fortunately he's a wonderful cook, he fed me well, he took good care of me, he'd go to the market and get anything I needed. I had moved downstairs so that I wouldn't have to deal with stair. But we did have a little system that we developed. I made sure that I had my cell phone and could call him on the house phone upstairs if I found that I really needed him. He sleeps soundly and so it felt prudent to know that if I needed something he would be responsive. He couldn’t do enough and he was just wonderfully helpful.

SUSAN: I have no regrets about doing the surgeries. My knees were compromised to the point where I was really limited in the activities that I could do and things I wanted to do. And the surgeries were challenging and required a lot of my time, my energy, my strength and dedication, focus. Life sort of goes on hold particularly when you're doing two surgeries so close together. But I have no regrets that I did it. I feel like I am healthier, stronger, more able to do all the things that I enjoy doing; getting outside and walking the dog, working in the yard, being active with grandchildren, planning trips that involve walking that I knew would not be possible over a year ago. I'm grateful for that. I'm particularly grateful for the surgeon, the people that helped with rehab and to have access to that kind of quality medical care is just an enormous privilege and I'm very grateful for that.

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