Total Knee Replacement Recovery Part II

Total knee replacement arthroplasty recovery has been harder than I expected.  132 days watching slow healing, doctor follow up visits, physical therapy and I finally feel like there will be life after major surgery. Adverse reactions to adhesive, zipline closure, undissolved interior stitches, and possibly pain management injection, plus the complexity of the injury made my recovery a long arduous experience.

My first 11 weeks post surgery experiences are recorded in my previous post here.  Following the wound vac treatments I made weekly visits to Physical Therapy for wound care and some easy strengthening exercises plus biweekly visits to the surgeon for follow up observations of  the two wounds that have been stubbornly not healing.  

Week 14 the surgeon decided to remove necrotic tissue and stitch the top wound. During that procedure he removed an undissolved stitch from the original surgery and speculated that may have contributed to the slow healing.  The bottom wound shape was not ideal for stitching  and appeared to have begun healing properly so it was left to heal on its own. He speculated there may have been another undissolved stitch there that had finally broken loose.  A mere two days later that bottom wound made significant progress.

Week 16 the surgeon removed the stitches.  A small section of the would was soft and white. Probably from moisture (showering) under the bandage.   That little section proved stubborn but by week 18 is finally grown closed. Meanwhile I made larger strides toward flexing the knee in PT. I was overjoyed to measure a 105 degree flex. I no longer use my cane unless I'm going to be walking an extended period of time.

The physical therapy routine has been hard and sometimes painful. PT began weeks ago with reteaching my brain to lift my leg while in a reclined position.  That involved a couple weeks of electric stimulation. The process of  strategic placement of little 1" square pads connected by wires to a machine that makes you feel electrical vibrations causing the muscles to contract. 

 The first treatments were pretty mild. The intensity was increased over many days until I could finally "feel" the quad muscle and lift my foot off the mat on my own. Once that happened I graduated to exercises that strengthened  my quad and thigh muscles.  I currently use my cane only when I think my leg may become fatigued from longer walks or uneven ground. But the best news is I can now drive myself. 

I bought a new car two months before surgery so now I had to relearn all the gadgets in it!  What a joy.

Week 19 visit to my surgeons office felt like a big mile stone.  The wound is practically healed.  The skin is still dark and rough feeling along with a bit of scabbing and old dry pealing skin.  I will continue PT twice a week until he releases me but I don't need to see him every two weeks anymore.  Next visit = 6 weeks from now. 😉

Now that I'm driving I am doing some shopping and socializing with friends at club meetings. My mental health is greatly improved.  PT has improved my leg strength so I can climb steps and take walks alone.  I've been applying vitamin E oil several times a day and a night time scar minimizer. The scar is still prominent but I believe it looks better.  The physical therapist that I've come to know so well and appreciate so much told me yesterday that she believes I have met one of my many goals.  I can bend my knee enough to sit in an airplane seat... it's time to book a flight to the beach.

Total Knee Replacement Journey

 

Total knee replacement experience

February 14, 2023

 After years of knee pain, orthopaedical doctor visits, physical therapy, and steroid shots I finally came to the point of total knee replacement surgery. I am in recovery for that surgery as I write this and decided to document the process for you google searchers out there searching for all the information you can find before going forward with committing to surgery. I may include some product links for items I've purchased and deem helpful.  I am an Amazon affiliate and may receive a small compensation on qualified products.

Pre surgery for total knee replacement

In October I had a steroid injection then spent the next three months going to physical therapy (PT) to build muscle tone and my stamina just to walk a few blocks with less pain. I had an ulterior motive in that I was planning a trip to New York early December.  The PT helped  in that I knew how to stretch out the muscles that became stiff and painful but as the days passed in New York and I walked farther, climbed lots and lots of stairs and encountered more and more broken elevators the pain became almost unbearable.  I could tell the steroid injection was wearing off and the Ibuprofen helped less than I hoped.  Don't get me wrong here, I was still determined to enjoy my trip and kept going... just at a much slower pace with lots of sit down breaks. All the same, I kept in mind I had a scheduled appointment with my joint doctor when I retuned.

By the time I went to the scheduled appointment I'd made up my mind to agree to surgery.  Making that decision has been a long road of doubt and concern but once I reached it I felt a ton of mental relief.  We scheduled surgery 90 days out from my last steroid injection and I started the approval process. 

The approval process for total knee arthroplasty

The approval process takes time, so be prepared for that.  Here's a sample of my process.

• Surgeon gets insurance approval for x-rays, CT scan, surgery
• Surgeon schedules CT
• Surgeon schedules surgery day
• Surgeon schedules Pre-op registration
• Surgeon prescribes physical therapy and contacts your choice.  My chosen physical therapist contacted me after surgery.
• Primary Physician physical and surgery release
• Blood work up
• Chest x-ray
• EKG 
• I had a low heart rate so had to see a cardiologist for surgery clearance
• Primary sent clearance after getting Cardiology reports
• Cardiology surgery clearance after insurance approval
• stress test
• echo cardiogram
• heart sonograms
• results, clearance sent to Surgeon

It took several weeks for the approvals and all my doctors were very accommodating. 

After the approvals were all received I met with the hospital pre-admittance clerk the week before surgery. The entire visit took about two hours. Below is a list of what I did.

• tour hospital
• pre surgery blood tests, mersa swab, covid swab
• CT scan
• paperwork

I took time to enjoy the week before surgery going to club meetings and social visits with friends.  The grandchildren came to play and craft.  I stocked my fridge and freezer with easy meals  and snacks. I ate healthy and got plenty of vitamin C.  The weather was snowy but I got some sunshine when I could.  The snow melted away before surgery week but the threat of an ice storm had me concerned right up until the morning we drove the 30 miles to the hospital. I was first on schedule so my check in was 6:00 AM.

• Check in to day surgery
• sign more paper work
• answer more questions
• confirmation visit with surgeon
• meet and discuss process with anesthesiologist
• anesthesiologist administers spinal block and puts to sleep
• surgery 1-2 hours
• recovery room 1 hour
• spend 1-4 nights.  I was there 1 night.
• Hospital stay
• Pain management
• PT
• learn how to get up from bed
• learn how to use walker
• short walk
• learn how to go to bathroom
• sit in chair 30 minutes
• learn how to get back into bed
• day after surgery, longer walk, small muscle stretches, how to maneuver stairs
• Dismissal
• Go over pain management
• Go over PT
• Go home

Day 1: Total Knee Replacement Surgery

The Surgery went exactly as planned.  The team of doctors, technicians and nurses at the facility where I was were phenomenal. As soon as I checked into the day surgery waiting area I was given a hospital gown to change into.  Two nurses with great sense of humors kept me distracted from my nervousness and anxiety while we filled out more paper work and I answered more questions.  It felt like casual friendly conversation as they joked and asked more questions.  Simple statements I made led to notations they took down to inform the surgeon even more completely on my status.  I asked if I would have a catheter as I was concerned about incontinence. There would be no catheter but they made note for the doctor that  was a worry for me.  I kept my underwear on with an incontinence pad during surgery and thankfully there was no issue. They found out I am deaf in one ear and hard of hearing in the other and made note so that even after I was in my room the nurses were aware of it and made certain I was hearing and retaining all the instructions. 

   Pretty soon the surgeon came for a quick consult and confirmation I was prepared and ready.  I met his assisting nurse, the nurse that assisted the anesthesiologist and the anesthesiologist himself.  The anesthesiologist explained the spinal block process then rolled me to a room where I sat on the side of the bed while his assisting nurse wrapped her arms around me in a comforting hold while he administered the spinal block.  For me, that was the most stressful part of the whole process.  It only takes minutes but I was unnerved by it.  The nurse was very good at her job and rubbed little circles across my shoulders while encouraging me to relax and stay still.  The shots were done, the sleeping drug administered and I was out.  The next thing I knew the surgery was over and the recovery nurse was asking me how I felt. I dozed off and on then recognized my husband and daughters voices in my hospital room.

  I was given a lunch tray and ice packs placed on my knee.  This is where I want to talk about the ice packs.  At one of my doctor visits he talked about the advantages of icing the knee after surgery.  He told me about an icing machine that was available to rent and that insurance doesn't cover the expense.  He advised me I could rent that machine for about $350 for two weeks or they would utilize regular old frozen ice bags with similar results. There was no pressure at all about it.  I went home and discussed it with my husband and a couple of friends who had knowledge about the icing.  I googled advantages and disadvantages before deciding it was a good option for me.  I found a plethora of machine options on Amazon.   I chose one and ordered it so I could take it with me to the hospital and instructed.  At the hospital I found out the one I had purchased wasn't usable there.  It had an ice pad that had to be frozen and refrozen as it wouldn't stay cold long enough.  The hospital couldn't do the freezing/refreezing because of cross contamination.  So, they ended up providing disposable ice packs that worked fine while I was there. 

Approximately five hours after surgery a Physical Therapist helped me sit up for the first time.  She instructed me on maneuvering my leg over the side of the bed and standing up.  I made my first walk to the bathroom learning each technique I needed for standing, walking with a walker, sitting down without falling and getting up again.  I sat in a chair about 30 minutes then maneuvered back onto the bed and a reclining position.  I dozed quite a bit through the afternoon and evening.

Day 2: Home after total knee replacement surgery

We were still concerned about the possibility of a treacherous weather coming into our area so I had to make decisions about rushing through the morning of day 2 and checking out of the hospital or choosing to stay there during the duration of a possible storm 1-4 days.  I chose to go home.  

I needed some physical therapy instructions before leaving so was taken on a walk from my room to the PT gym.  I was pleasantly surprised at how easy that walk was. I spent about an hour doing some very simple exercises.  They included sliding my leg side to side, tilting my foot up and down, pressing my heel into the bed, getting up and down from the bed and climbing up/down three steps. (I have 3 steps into my home).  When that was successfully accomplished I walked back to my room and ate breakfast.  Nurses took vitals and removed IV's.  Instructions were given and repeated multiple times on follow ups, self care and pain management before I was released.  The weather held off for my trip home, thank goodness.  I was pretty tired when I got home and slept quite a bit. 

Day 3: Using the artic ice machine vs ice packs

The doctor and nurses all made sure I knew how to manage my pain.  They stressed that staying ahead of it was vital.  My daughter in law drew a simple chart to help me keep track of what medications to take and when. That has proven to be very beneficial.  Even though I heard and comprehended the repeated instructions from the doctor and nurses I became overwhelmed after I got home. I used the chart to check off each medication and even when I needed to do the PT exercises and apply ice.

  That ice really helped with the pain and swelling.  I quickly discovered that the ice machine I'd purchased was "OK" but inadequate.  I now understood why the hospital didn't use it.  The one I'd purchased was nice, but the ice pack melted after 30 minutes and had to be put back in the freezer before it was usable again.  Inconvenient!  I searched on Amazon again and read the descriptions much more closely.  After narrowing it down to a machine design that has a small ice chest with tubes that circulate cold water through a pad specific for the knee I ordered a new one.  While waiting the days until it was delivered I continued to use the disposable one I'd kept on my leg during the drive home.  It developed a leak after a couple of days so I was especially grateful when the new one was delivered.  The ice packs REALLY help relieve the aching and throbbing associated with the muscle healing.  I have the timer on the machine set to circulate for 20 minutes on and 20 minutes off through the night.  AH, sweet rest!

Day 4: After knee surgery home care 

Medications, sleeping, short walking. Pain is pretty well managed below level 3.  Some throbbing and nerve ending tingles.

Day 5: A level 10 pain experience

Taking medications, sleeping, short walking.  I have little to no appetite but can't seem to get enough water! I had a level 10 pain moment when lifting my leg off the bed.  I was using my good leg as the hospital therapist had shown me to support my surgery leg but it slipped off. My daughter quickly grabbed it as I couldn't keep it hovering in the air.  The pain lasted only minutes but my panic was astronomical.  The rest of the day my pain stayed under a 3-4.

Day 6: Using a chart to keep up with medications

Today I created a table with all the meds and things I need to do daily.  I heard and understood the instructions repeated to me several times but keep getting confused. The chart my daughter in law made is for 7 days so I typed one up and printed of a couple for the next two weeks.

  I'm still sleeping quite a bit but getting in the walking and toe wiggling exercises. Very little pain today.

Day 7: Another level 10 Pain moment

I'm sleeping a lot.  The knee itself has no pain but the muscles are very sore and even painful. The new check off schedule is helping me remember to take the proper medicines in a more timely manner. No appetite but very thirsty.   

  I went to the therapy center to get my bandaging checked.  Getting into the car was not easy.  I am unable to bend my knee enough so had to maneuver and wiggle my body until  my daughter could tilt my toe enough to slide into the car. Getting out was a similar ordeal.  They were unable to change the bandage because I should have been given a specific covering before leaving the hospital.  My husband drove back to the hospital clinic after therapy to pick some up for another trip to therapy tomorrow.  At the end of the therapy session I had a level 10 pain moment.  I had hooked the toe of my good leg under my surgery leg to support it as I moved it off the exercise table but inadvertently slipped it off much like what happened at home three days ago.  I didn't have the strength to keep it suspended in the air.  The muscles practically screamed out for me in pain. Fortunately the pain only lasted a minute or two and the therapist consoled me that I had not done any damage. Once I could breath normally again I was able to carry on.

Day 8: Changing the surgery dressing

I took all medications as prescribed and slept well.  Taking walks about every two hours helps with the muscle cramping and tingling in the nerves. The ice packs give a lot of relief for what I can describe as stress pain.  Pain that doesn't really hurt but feels like an irritating nagging knowledge it could.

Returned to rehab today to change the dressing.  The therapists gathered around to inspect my incision as it had a new stitching method with what my doctor had called "zip ties".  There were a some little blisters formed that the therapist photographed and sent to my doctor. I did some very gentle stretches.  The muscle along the outside of my leg and up my thigh is extremely sore as well as the back of my calf.

Day 9: At home knee replacement care

I took all medications as prescribed and slept well, even napping several times during the day. I feel pretty good, am in good spirits and having very little pain.

Day 10: At home knee replacement care

I took all medications as prescribed and slept well last night. I spent more time sitting up in a chair with my family in the living room today. I am not very hungry, probably due to the pain meds.

Day 11: A rehab visit and wound care

I slept well last night. I took all the medications as prescribed and made the drive with my son to rehab.  They had received instructions to lance and drain the little blisters that had formed along the edge of the incision and a couple along the bandage adhesive line. That was not pleasant but not painful either.  The muscle at the back of my calf is tight and painful as is the muscle along the outside of my knee.  The therapist helped me stretch the calf by pressing my toes up and in a bit.  I still can not feel the muscle well enough to lift the lower part of my leg.  I can swing it forward using my thigh muscle though so my walking gait is improving.

Day 12: Noticing improvement

I slept pretty well last night only waking to go to the bathroom twice. I took all the medications on schedule and performed the leg PT exercises plus walked. My daughter helped wash my hair in the sink.  I noticed I was able to hold my leg elevated in a straight position behind me as I stood at the kitchen sink without pain.

Day 13: At home knee replacement recovery

Another day of little muscle stretches, leg elevation, ice and walking. I decided to try a partial shower keeping the leg covered and dry.  It was difficult as the shower chair does not have hand rails making sitting down and getting up a task.  I can tell I am definitely improving. There's very little pain and moving about is getting easier.

  I skipped the morning pain med but not the night one. My leg felt achy and throbbed so I did as the doctor had instructed and kept ahead of the pain.  My appetite is beginning to return too.

Day 14: Maybe falling asleep with the ice machine is not a good habit

Last night I woke twice to a kind of tidal wave throbbing from just above my knee down to my ankle.  I also had pain in my left kidney.  I had gone to sleep with the Active Ice machine running and I think I had moved enough to push the ice pack down a couple inches causing a tightness from the velcro binding behind my knee.  I took a potty break then adjusted the ice pack into position, turned it on and took pain medication.  I played a game on my phone about an hour then slept really well after that.  This morning I did my stretches before getting up and taking a walk. I don't notice any pain so skipped the morning pain med.  

  When I got up I felt pretty good so used the little arm extension grabber rehab gave me to pick up some discarded clothing and put it in the hamper.  Since I am still in the compression hose I scrubbed myself down everywhere else with a hot soapy cloth.  Later I moved some dirty coffee cups and empty water bottles to the kitchen.  Whoo hoo! Never thought doing some simple house chores would be so fulfilling.

  I still needed help tilting my toe up to get into the car for the ride to rehab today but when I got there I was able to maneuver myself out all by myself.  The therapist changed my dressing again.  Cleaning and draining the blisters.  There were no new ones.  She sent photos to the doctor for confirmation that all is good. We completed some stretches and attempted some muscle stimulation with a little pulse machine but I couldn't handle it so she stopped.

  When I got home I slept a bit, ate a light dinner and watched a movie before bed.  I was unable to go to sleep so  took a pain pill for the irritating throbbing making it's way down my lower leg and did some computer stuff. I'm really ready to get these compression hose off and sleep on my side for a change.  

Day 15: A different kind of pain

Last night was not a good sleeping one as the nerve endings seem to be very active buzzing and hopefully healing.  Last time I looked at the clock it was 2:00 A.M.  As a result I slept a bit later and was groggy headed.  That could be because I took a pain pill at midnight and then took extra strength Tylenol two hours later.

  I realized my walking gait is improving today.  I was able to lift my foot off the floor several inches unassisted and could kick forward without pain.  I performed a few house chores without difficulty like putting laundry in the washer, wiping down the bathroom sink and sanitizing the toilet.  I am feeling confident my recovery is going well.😊

I'll give you an update after my follow up visit with the doctor.  I also hope this journal will help someone making the decision or in the midst of surgery have confidence you are not alone.

Week 11: Setback

I experienced an adverse reaction to the zip line used or possible the adhesive associated with it.  Big blisters appeared along the length of the incision that developed necrotic tissue. The dead tissue was surgically removed. I've been through two rounds of Bactrim and then three weeks with a wound vac.  The wounds have become smaller but still exist.  At this point the Doctor has removed the vac and I am cleaning, applying Neosporin and new dressings several times a day.  I am only this week allowed to start the bending exercises that will make it possible for me to drive and walk normally.  It's been a long and discouraging road that I hope no one else experiences.  My doctor is no longer using the zip lines on his patients.   

Post Script:  Part II Update

Provided below is an Amazon link to several ice machines for your convenience.  

after knee surgery ice machine

Keep a Clean House With Easy Mobile Schedule

My least favorite chore is general housekeeping especially in my retirement years.  Now I could make a long list of least favorites but really I don't enjoy cleaning up after myself or all the people that come through my house at all.  However, a neat and tidy environment puts me at ease and keeps my outlook open and fresh and really is important during flu and Covid quarantine.  The real plus is making a good impression when unexpected visitors pop in. My house keeping system has evolved over the years to make the job simpler.  Back when I first started keeping house as a young bride and was working full time I spent the weekends scrubbing and organizing along with doing all the shopping before I came upon a book (no longer published) written by two sisters that introduced me to a better way.  I took their plan and adapted it to me.  

Hot Tea Month and Keto Cheesecake

 I was taking out some tea for a virtual tea date when my mind began to wander. As I sorted through the shiny little packages of foil packed tea and checked on the keto cheesecake cooling I let the memories come.  This moment is just for me.  It's hot tea month and a wonderful excuse to reminisce. 

My Aunt Doris makes herself tea just about everyday.  She posts photos of her tea table on Facebook that remind me what a special moment we shared years ago when I took my oldest grand daughter on a tea date with her.  We dressed up, she wore a spectacular pink hat, and we sat together in Aunt Doris's sunny day room sipping hot tea from fine china cups nibbling on a lemon flavored cheese cake and talking about things from our childhoods.  It is a wonderful memory I sink into often as I sip tea in my own home now. That's why I have a keto cheesecake cooling on the counter.  If you look to the bottom of this post I've included my favorite recipe because it pairs so well with hot tea.

I live farther away from my Aunt Doris and I don't get to see my grand daughter as often as I'd like now that she's an adult and working as a flight attendant.  My grand daughter calls often and I have been very lucky to take some short trips with her where I get to sip hot tea at the end of the day watching sunsets or warming up from the winter chill.  Those moments are special to me and I hope the memories will visit her when she has her own children to share them with.

This evening I've taken out a favorite tea pot I received from Aunt Doris last year for my birthday.  I had admired and commented on a beautiful tea pot with a blue butterfly motif she posted on her Facebook so you can imagine my surprise and delight when a little box came to my doorstep that turned out to be a duplicate of hers!  

Just because circumstances keep us apart doesn't mean we can't share some quality time and a cup of steaming hot tea together so Grand and I are using facetime to laugh and giggle together! Every cup counts! I imagine her sorting through her tea stash just as I am and it makes me smile.

 

I poured hot water into my butterfly pot and opened a single portioned bag of Chamomile tea.  I adore the little foil packets it comes in and the tea fits just right in a little strainer inside the pot.  Of course I could steep it directly in my cup but I'm taking a virtual trip with Grand and every moment counts.  I dial her number and see her lovely face.  Three minutes of steeping time goes quickly and I pour the tea into my cup.  Then my favorite part... seeing that hot steam rise from the cup in little curls like the memories of all the shared moments with Aunt Doris and Grand.  

Are you a hot tea lover with some special memories?  I'd really like to hear about them.

Have a Pie, 3/14, Pi Night

 The Pie Party with Chicken Pot Pie Recipe

I haven't been this excited about in years. The family was displaced last year with new jobs, training out of state and time share with in laws.  This year it has all lined up and everyone was together. 

One of my grand daughters surprised me Thanksgiving.  I went to bed that night a little exhausted from all the cooking, cleaning and eating.  When I woke up on Friday morning my grand daughter had pulled out Christmas and done an amazing amount of decorating.  She put her personal spin on everything giving the decorations from my storage closet a whole new look.  That inspired me to make a lot more changes and come up with a new plan for Christmas this year.

The only thing I added to my décor this year is additional extension cords so I can use all the lights in my stash.  Grand daughter #3 directed me on all the light placements.  She's only five and her ideas are just as fantastic as her big sister's decorations inside the house. 

My adult grand daughter, my daughter and I were talking about how much we love pie which sparked an idea to have a complete meal of pies.  We joked and jested about it for a while naming all the kinds of pie we liked when I came to the conclusion I could really do this.  Thus was born a brand new tradition for our Christmas Eve Eve (December 23) family party.  Pie.  It's an idea that would work for any gathering: birthday, New Year's, Valentine, Football tailgating, you name it.  The sky's the limit.

It could be the theme for any large gathering.  Shepherds pie, Pot Pie, Pizza Pie, fruit pie, custard pie, nut pie. Yes, this can be fun.  I pulled out my favorite recipes and bought the ingredients.  I chose some pies that can be made ahead and frozen and some I'll make the day or two before our party plus the ones best made on the day of the party.  This may be the easiest party I've ever hosted!  Here's my list:

• Chicken Pot Pie (super easy, 1.5 hour prep and bake)
• Crock Pot Shepherds Pie (4 hours in crock pot on high)
• Pizza Pie (coming from a local store)
• Chocolate pie (made the day before the party)
• Apple pie (made ahead and frozen)
• Pecan pie (made ahead and frozen)
• and a Salad - because a fresh vegetable will be nice.

There's eight days till we party so... here is the first recipe, the easiest ever...

Chicken Pot Pie  

Ingredients:

1 Deli roasted chicken, skin removed and meat pulled off the bone, cut into cubes. 

1 Cup water

2 Cans Cream of Something Soup (chicken, celery, mushroom... your choice) or make your own

1 small package frozen peas carrots

1/2 cup frozen diced onion

1 package frozen cubed hash brown potatoes

2 cans of crescent rolls

Instructions:

2 hours before serving time:

Spray a 9 x 13 casserole dish with cooking spray.  

Open and roll out one package of crescent rolls.  press seams together then line the bottom of the casserole and press up the sides.

Bake 350 F 20 minutes.  Remove from oven and set aside to cool.

Meanwhile... In a large skillet over medium high heat cook chicken, onion, water, cream of something soup, peas and carrots, potatoes till nice and hot (about 10 minutes). 

Pour over the baked bottom crust.  

Unroll the other can of crescent rolls.  Press seams together and place over the top of meat mixture. If you want to get creative, try cutting the dough into chicken shapes to cover the top.

Bake 350 F 25 minutes

Now that is the easiest pot pie ever!  

I really hope you are inspired and have your own pie, 3.14, pi night! Let me know when you do.

2020  Lessons and Vision

The end of 2020 is almost here and it has me reflecting over this very unusual space of time in my life.  I learned my first facts about Covid19 on a return flight from Jamaica but all I really found out was there was a very contagious virus in China.  For the first time I saw people wearing masks on the plane and in stores. It was a few more weeks before the virus hit the US and we entered the Pandemic shutdown for the first time.  It took some time to wrap my head around what it meant to my community, my family and me personally.

Recovering with a Bypass Patient

 He started to rise from the dining room table after a nice meal with the kids and their families.  His balance was off and he almost fell as our son and grandson grabbed for his arms in alarm.  Our paramedic son asked how often that happened and when he said whenever he gets up too fast or from squatting in the garden he elicited a promise to talk to the doctor.  Two weeks later amid the covid19 pandemic we sat in our car outside a cardiologist office 90 miles from our home.

I still sat in the car talking on my phone and waiting while he went inside for a stress test when a knock on the window startled me but not as much as his next words.  My husband of nearly fifty years said he was to be admitted through the ER across the street.  I was confused and startled as he tried to explain there were three abnormalities to his stress test and there would be another test performed there.  

As I read aloud the paper work we were carrying over to the hospital we came to understand the next test was a "Cath" procedure that required a Covid test and overnight stay.  

Trying to rest the night before your spouse goes in for a medical procedure of any kind is not very achievable.  I wasn't able to stay with him so I drove the 90 miles home and back again early the next morning.  Then I waited, alone in the hospital heart unit while he was wheeled into surgery.  It's a weird experience even without the Covid restrictions.  One person per patient is allowed to be inside after answering a series of illness related questions and taking my temperature.  I sported a color coded bracelet for each day I visited.  In hindsight I wish I'd kept them as some kind of trophy like those vacation t-shirts that say "My parents went to Hawaii and all I got was this t-shirt".  Maybe I'll come up with my own t'shirt slogan. "My husband got a heart upgrade and all I got was some paper bracelets."

The Cath procedure only took about an hour but the look and hushed tone from the Doctor gave me immediate warning.  Multiple blockages and swellings made putting in stints a no go.  The Doctor explained simply and directly that I'd be taking my husband home today but he should not get too hot (the Texas heat was already soaring in the triple digits) or anxious about anything until a heart surgeon called to confirm yet another appointment for a heart bypass.  So, in silence we checked out of the hospital and drove home digesting the information given to us.  

A few days later found us back in the Heart clinic meeting the surgeon that would perform a triple bypass on my husband.  The seriousness of the procedure stunned me and thus began my first feelings of a panic attack coming on.  I held it together because I couldn't imagine what my husband must be feeling.  We were told that this is an elective surgery so the planned date for his operation could be postponed due to the availability of respirators and intensive care rooms for Corona patients.  As predicted, we'd barely pulled out of the parking lot when a call came that his procedure would be delayed because the hospital had a spike in Corona virus cases and all elective procedures were cancelled until further notice.  

Meanwhile we made another trip the following day to the hospital for a Carotid Doppler in preparation for the Coronary Artery Bypass grafting X 3. It was later I understood the purpose of this sonogram was to be certain the arteries in his neck were clear enough for a pic line during the surgery.  Five days later a call came re scheduling surgery in 16 days. 

The next 16 days I made preparations by scrubbing everything in our home hospital clean and distracting ourselves as best we could visiting with the children and grandchildren while staying socially distant from every one else so as not to be exposed to Covid.  

Seven days preceding surgery we drove again the 90 miles so my husband could pre-admit, give a lot of blood samples and get another Covid test.  The next seven days were full of stress for both of us.  At one point I wondered if I might be having my own heart attack but knew it was likely another anxiety/panic attack.  

On the Thursday morning of the surgery we left our home at 4:00 A.M. for 5:30 A.M. check in at the surgery center.  Our sweet daughter met us there and visited with her dad until he was allowed to go inside the building to start the procedure.  Once inside we were escorted to a pre op room where his vitals were recorded and we met everyone involved in the surgery and prayed.  We learned more about the ventilator that would be inserted to breath for him along with the pic line, catheter and wires that would re-start his heart when the grafts were completed.  Yes, that's right, they stopped his heart for surgery.   I waited in a calm peaceful area to stare at a surgery progress monitor.  Thankfully I received status updates via text messages from an attending nurse that kept me sane.  I shared the updates via text to our children, their spouses and adult grandchildren. Five hours later I was very grateful that when I saw the surgeon he was happy with everything.  The heart restarted just as it was supposed to and they'd try to take him off the ventilator when he awoke and could breath on his own.  Another hour later I moved to the Intensive Care room where we waited for my husband to wake up.  

Waking took several hours and when he did wake he was very confused.  In Intensive Care a nurse sat at a monitor in his room keeping a very close eye on him.  I felt confident enough to leave him in their care while I ate some food and slept in a nearby hotel with our daughter.  That night I slept very hard.  I guess I was exhausted from the weeks of waiting.  

He spent two days in ICU.  He had to be off the ventilator breathing on his own successfully before moving to a room on the heart patient floor of the hospital.  Even when that was accomplished he was still tethered to wires monitoring his oxygen, blood sugar, heart rate, pulse, and other stuff.  The pic line still dangled from his neck which bothered him tremendously.  A patient sitter/monitor was assigned to be with him 24 hrs a day until his confusion and agitation subsided and he ceased trying to remove the lines attached to his body.  That allowed me three more nights to get some much needed rest in the hotel.  

Sunday, the fourth day after surgery, the surgeon removed the wires from his chest.  That was terrifying for both my husband and me.  Luckily my husband couldn't see it and because of the medication wouldn't remember it. It would be too graphic to describe here, just know I realized again just how serious this whole thing is. A nurse removed that annoying pic line next and I started to see improvement in his awareness of where we were and why.

Monday, only five days following surgery, he was dismissed from the hospital and we made the long drive home.  I had stressed a lot with anticipation of that drive but my husband managed it amazingly well.  He and I walked up the sidewalk, up the three steps into the house and made it to our bedroom where he slept for several hours.  I sat in a chair by the bed and waited for him to rouse, which he did for a short while before drifting back to sleep.  I dozed on and off too.

The next few days he continued to experience moments of confusion and some agitation.  He had trouble swallowing and did not want to eat.  That continued for another week.  As the medication cleared from his body he became more alert.  His lack of appetite concerned me as he could only swallow a few bites a day. The weakness after so many days of very little nutrition was obvious to both of us.  He began to make concerted effort to eat something each time it was offered.  Ice cream, protein shakes, and broth were about the best he could manage. A telephone contact nurse assured me as long as he was getting some food down and his blood sugar remained in range he'd improve.  He did, slowly.

I wasn't sure if I was having more panic attacks or depression but my emotions were becoming overwhelming. I had been warned bypass patients often experience depression and to watch for it, but I had not expected to feel it myself.  I considered contacting my doctor but put it off until the weekend was over.  

Monday, 12 days post surgery, my husband woke and was fairly pleasant. His glucose tests started running a bit high so I added Glipizide back to his daily meds as I'd been instructed at the hospital. His swallowing was a bit better and he ate a low carb waffle with blueberries and sugar free syrup.  He kept mentioning fluctuating temperature changes.  Even though the room was consistently the same he alternately complained he was too hot or too cold. Often within minutes.  Our son and his 5 year old daughter came by for a very short visit.  Both my husband and I benefited from the visit emotionally.

The following day we had a phone visit with a transition therapy P.A.  He confirmed the  medication change and also confirmed that the body temperature fluctuations would level out in a few days.

On day 14 he woke hungry and wanted to walk to the den to sit up a while.  He was a little shaky so he used a walker we borrowed from friends. He ate a good breakfast then went back to bed for a long nap.  He woke again to eat another good meal for lunch, a 2:00 snack and 7:30 dinner napping between each.

Day 15 he ate a nice breakfast and showered, then I drove him to meet with a Rehab therapist for evaluation.  An hour later he was back home exhausted from the trip and slept several hours only rousing to drink liquids and fall back asleep.

He slept a lot the following day too.  Two of our other grandchildren stopped in for brief visits which greatly pleased him.  I realized I was feeling fewer stress attacks on this day and attribute that to the visits, calls, prayers and improved mood of my husband.  Because of this realization I am determined to call and visit friends going through similar events.  Also because I recognized that contact with other humans was proving so beneficial I started making at least one contact a day with a family member or friend.  My stress/panic attacks have almost receded to nothing.  Even the nightmares I was experiencing ceased.  

On day 18 Hubs started going to physical therapy for an hour twice a week.  Each session left him exhausted so he slept a lot the first week.  

The surgeon visited with us via a telephone video conference on day 20.  He was pleased with the healing progress of the incisions and reinforced the need to wear the heart hugging vest for six weeks.  Hubs really hates that vest because he feels uncomfortable in it.  

The following week, as instructed by the surgeon, we sat through another telephone video conference with hubs primary doctor to update him on progress and medication changes. 

After four weeks I see significant improvement.  Finally.  The incisions are healing, the bruising is almost gone. His appetite has returned. The hot/cold fluctuations are subsiding. Hubs is beginning to stay awake longer periods, walks to his chair in the den for some TV viewing and has even taken a couple of short walks outside with no walking aides.  I credit the physical therapist for giving him the confidence.  He's looking forward to the end of six weeks so he can go out to breakfast with his morning guy friends.  We've had no new cases of the Corona19 virus in our county for weeks, so I see that breakfast as a real possibility.

After six weeks and six days we met with the surgeon again via telephone video conference.  He released Hubs from his care and he can resume regular activities with caution and can drive himself again.  It was a trying six weeks but his future prognosis looks very bright.  I knew it would be hard, but the emotional ups and downs were more than I could anticipate.  I'm positive that our vows given fifty years ago "for better or worse" and our Lord brought us through this.