We were quite apprehensive about Ellen recovering from her total knee surgery in a fifth wheel trailer. Friend Judy and cousin Gail offered us other alternatives for places to stay, but we decided to give this a try. It worked very well, but only because of significant support from professionals and people who have been through it before. This blog highlights the lessons learned.
Lesson One: Prep Time Takes Longer Than You Think
We arrived in Spokane two weeks before the surgery, per directions from the doctor and hospital. We did some form of preparation every day. In our case the prep was complicated by the fact that we had not been in Spokane for a year, and planned to do all of our other annual doctor visits while in town, primarily to get all of her prescriptions renewed for another year. Since Ellen didn’t want to hobble painfully into each of these, we tried to squeeze all of these into the two-week pre-op window.
Between all of our appointments and prep, we filled up the entire two weeks with non-stop activity. A good deal of time was spent assembling things we would need after the surgery. This leads to the second point.
Lesson Two: Recovery Requires a Ton of Support Items
Fortunately for us, we had two local resources, friend Judy and cousin Gail, who had been through this surgery recently. Both of them said, “here, you will need these” and supplied us with both supplies and advice. We found it all very helpful. If you ever have to go through this, consult this list for ideas:
Face it, we don’t usually have room for a lot of extra pillows in the RV. And you need a lot. The knee needs to be elevated often; it hurts and needs cushioning when lying down; some exercises need pillows. And the patient will be moving often to different locations, and it is extremely helpful to have pillows already there. So friend Judy offered a supply of about 7 extra bed pillows. We used them all and found them very helpful.
Walking Assist Devices
Within the first few hours after surgery, they have you up onto stairs, and full range of motion walking becomes your obsession for the next several weeks. Ellen used three different devices in some form or other:
- Crutches. Ellen didn’t use these for long, but in the first week or so, these were very helpful in getting up and down the three steps inside the fifth wheel. At the suggestion of the hospital, we picked up a set at the local Goodwill. They were cheap and useful.
- Walker. Friend Judy supplied us with the device that would be Ellen’s best friend for about the first month or so following surgery. It was a sturdy, foldable walker. Initially we had it set up with no wheels, for stability. Then as she progressed through PT, we put the wheels on the front and she was able to go most anywhere with it.
- Cane. We already had a normal cane, but thought it might be safer to buy one with four feet. But our PT advised us to return and stick with the simpler choice, which better supports practice in a more normal gait.
Within 8 weeks, she was done with all of these, but all were useful at the time.
ICE is the first acronym you learn. To get swelling down, you need Ice, Compression, and Elevation (i.e., getting your knee above your heart). Fortunately, our RV has a residential freezer, which allowed us the luxury of being able to freeze significant quantities of ice in two forms:
- Ice packs. A patient will need a half dozen of these, preferably in different sizes. We were loaned two large pads, and we made several of our own, using gallon-sized bags (doubled) filled with, of all things, Karo syrup. The Karo stiffens, but remains pliable.
- Ice machine. Again, we had this loaned to us. If not, I would have seriously considered purchasing one of these. The picture will help visualize this. It holds 4 frozen water bottles, and is then filled with water. The pump then circulates this ice cold water to the pad which straps to the knee (or other body part). It is VERY cold, so requires an insulation layer from the skin. This was most helpful at night, since it lasts 4-6 hours before needing new ice. It was also helpful before or after PT.
Lesson Three: The RV has Pros and Cons
The biggest advantage of the RV is that it is compact and readily accessible. For about 4-6 weeks, Ellen’s life consisted of rotating from bed to couch to recliner to bathroom. In the RV, the distances are short, supports handy, and accessories (TV, kitchen, cabinets, etc.) readily accessible.
The disadvantages are the steps outside and the stairs inside. Fortunately, I was able to use the ramps we had for loading the motorcycle to address the outside steps. I made a simple deck (1.5 sheets of plywood and some 2x4s) and attached the ramps. It worked very well.
Inside steps turned out to be a minor hurdle that was overshadowed by the aforementioned advantages.
Lesson Four: Don’t Expect Uniform Progress
In recovery, every day is different. Sometimes you get comfortable and sleep, sometimes you don’t. Sometimes PT is very painful, sometimes it’s not too bad. Sometimes it seems like the next step is a mountain, sometimes it’s a molehill.
I saw improvement almost every day as we ticked off the milestones, but the patient had a little different perspective. Advice to caregivers: when your spouse is grimacing from overwhelming pain, don’t ask “does that hurt?” Ask me how I know this.
For us, the significant “turning the corner” came at about 4 weeks. By 5 weeks, she was off prescription painkiller completely. By the time we left Spokane at the 8 week mark, there was no doubt that she would be able to handle the trip, although we did make provision for more stops and gentler travel.
Lesson Five: If You Like Your PT After 3 Weeks, Fire Him
This was the advice at the hospital pre-op class, and we found it to be true. The point is that PT is painful work, one of those “no pain, no gain” points in your life.
Without belaboring the point, we came to understand what the surgeon told us when he said, “I have the easy part, you have the work.” In all, we scheduled 16 PT visits over 8 weeks. And the real gain comes from doing the exercises they give you to do between visits.
Frankly, we did like the PT very much, and called him a friend when we left. But you won’t like what he or she does to you, nor the exercises they prescribe. But if you work at it, you can be essentially at the goal (full extension to zero degrees, and flexion to 120 degrees) within the 8 week period that we had.
As a side note, we chose a PT place that does pool therapy for part of the rehab (recommendation from a friend). Ellen found it helpful and somewhat more pleasant.
Lesson Six: It Was Worth It
For me, the key moment of this whole process came just a few days after surgery. Ellen ventured outside for the first time with a walker. She was moving slowly, and I was walking alongside her. After just a few feet of walking, she stopped and began to cry. I thought it was pain, but she shook her head. She explained that for the first time in years, she was actually waking on her knee without pain. They were tears of joy. I knew then that we were going to be OK.
Based on our experience, I have several summary thoughts about knee surgery.
- Find a surgeon you trust. Do everything he says and don’t be afraid to ask questions.
- Do it when you need to. The surgeon said, “you will know better than me when it is time.” He was right.
- Make sure you have a good support system. Can’t stress this enough. You need cheerleaders.
- Ice early and often.
- Give yourself time to prep and to recover.
- The therapy is the real work. Do everything they say.
- Use pain meds early, because your body doesn’t recover when overcome with pain. But work to get off them.
- Know that it is well worth the effort.