The Four “P’s”

Two weeks have passed since I had my knee replacement surgery. Up to this point I was not quite ready to write about the experience. This reluctance has been due to multiple reasons not least of which was the inability to focus on something other than the pain. Additionally, I felt that until I could regain perspective, the dialog would be too negative.

The knee is an incredibly complex joint and to have it removed and replaced requires a great deal of tolerance and motivation to even begin to approach the rehab required to not only heal but to regain the functionality. That journey has taken me all of these first two weeks and I have a lot more work ahead. The good news, each day restores a little more strength and a little more flexibility and that makes the journey a little more bearable.

Lying in the hospital, trying to justify what you have done, considering the possibility that you could have just accepted your condition and continued to limp along, you get the warning of the four P’s; Pain, Pee, Poop and Patience.
Pain is inevitable and the gate I must go through to get to a pain free knee going forward. The doctors and nurses explain that it will be the management of pain that will help spell success. And thus begins a carefully balanced approach to just how much medication will leave me lucid enough to function while still knocking back enough of the pain to allow me to begin the regiment of exercises. I am happy to say that though rough for awhile, the program is working and each day is a little less uncomfortable with longer periods of both sleep and almost pain free periods.

The second P stands for pee. From the moment the surgery is over, the simple act of peeing becomes your first hurdle. It is explained that until I can pee, I can’t go home. It is funny how a topic you would not generally bring up at a gathering, “I think I will go for a nice pee. Be back in a minute”, is now seemingly all they want to talk about. Good news, I conquered the act within the first twenty four hours. And with that, at least I was cleared to start planning on going home. A little rehab would await before I was completely cleared, but this had been an important step. Once I could show some motion and independence, I would be on my way. Not to skip a very important step, they needed to guarantee I wasn’t going home alone. My coach, Deb, would take over the nurses’ role in the next stage of my recovery. There is no way to diminish the role she has played in all of this. She assists, she monitors and she encourages me at every step of my journey. She loads me into the car and delvers me home.

Poop, like pee now becomes the goal. Where peeing was not so difficult, pooping is another task all together. It seems the opiods, designed to hold back the pain, hold back appetite, and yes, pooping as well. I get introduced to my new favorite cocktail, apple juice and Miralax. Each new trip down the hallway is followed up with “Any luck in the poop department?” Like peeing, this just seems like everyday conversation. “Had a good bowel movement today?” As with the first two P’s, pooping finally resumed sometime around day four of returning home. I must say, a real relief both figuratively and literally. I think I announced it as a lumberjack would, “Log jam cleared,river traffic flowing again.”

That just leaves patience. Pain management, peeing and pooping were all important steps, but patience is the real trick. Somewhere along the way I had made the decision to stop living with the limitations of my increasingly arthritic knee and crossed the decision threshold to agree with the knee replacement. Now, rehabbing my new knee and dealing with the associated pain, it was too easy to question my decision. How long would this take? Would I ever completely recover? It becomes so easy to dismiss everyone’s judgement of my progress in favor of my anxiety driven over analytical self analysis. It is only through good analogies from my physical therapists and a daily dose of comparisons to yesterday, that the timeline begins to take shape. As slow as it might seem, I start to mark progress.

My journey is only two weeks old. Driving is still four weeks off. Simply climbing stairs another week away. I am told that at three months, I will feel well enough to stop questioning my decision and at six months will dance into my surgeons office for my checkup. In the meantime, I’ve accomplished those first three P’s and have a better handle on the patience.

My final goal, become a more patient patient.