What I didn’t anticipate about surgery

When you’re facing major surgery, your surgeon will load you down with information. At the first meeting with the Midwest Orthopedics surgeon who would replace my right knee, she gave me a folder with two dozen pages about the procedure, medication, exercises, and frequently asked questions; a preparation checklist; and a postoperation guide. I went home from surgery with another folder. But all the information still didn’t forestall surprises, including these.

That I would second-guess whether I was taking pain medication properly. 

A chart from the surgeon’s office listed three pain medications and how frequently to take them: oxycodone, a prescription opioid for severe pain; tramadol, a moderate-pain opioid; and over-the-counter acetaminophen for mild pain. It’s a common regimen for knee replacement and many other major surgeries.

During a phone conversation, I asked a nurse practitioner to confirm how to take the drugs.

“Take oxycodone the first two or three days,” she said. “If severe pain is gone, you can space out oxycodone and introduce tramadol, or just take tramadol.” As pain continues to decrease, I could take less tramadol, then rely on only acetaminophen until there is no pain. 

Two days after the surgery, a visiting nurse attributed my considerable pain to improper medicating. She said that I should have been taking all three drugs from the start, one every couple of hours. She wrote a schedule: oxycodone at 6 a.m., acetaminophen at 8 a.m., tramadol at 10 a.m, repeating the cycle throughout the day. 

A week after the surgery, another visiting nurse said that medicating varies because everyone is different. She said that I should judge the severity of my pain about every six hours and take the appropriate drug, if any. Acetaminophen can be taken as long as there is pain, with tramadol and oxycodone used for “breakthrough” intense pain. 

So was the nurse with the schedule wrong? Not for me; her protocol decreased my pain. 

I wish healthcare providers were more consistent with instructions, however. It would have helped to hear from the start that there aren’t strict rules about medication. I wouldn’t have worried that I was doing something wrong.

I’m off oxycodone now and alternate tramadol and acetaminophen, not on a strict schedule. If there’s ever a next time, I’ll know that pain medicating can be flexible as long as I don’t overdose on any drug. I can take acetaminophen continuously and oxycodone or tramadol, or both, as needed. I’d wean off the opioids asap, oxycodone first. 

I’ll spare you details of what opioids do to the digestive system, another shock.

How much my whole body would be affected. 

Expecting to spend a lot of time sitting, I had made lists of books to read, possible online courses to take, and educational shows to watch on PBS Passport. So far, I’ve had the energy only to do physical therapy and watch television dramas. (I did manage to write this post.) The first time I resumed online Scrabble, I nodded off.

All of my attention before surgery was on how my knee would be affected. Now I’m learning about what knee replacement surgery does not only to that joint but to the rest of the body. Surgery triggers pain, inflammation, possibly nausea and depression. Any major surgery stresses the whole body, which works hard to heal and consequently feels tired. Narcotic pain medications taken after surgery cause more fatigue. I’ve also found that I feel full quickly, so my body may be weak from eating less than usual.

I’ve accepted that feeling groggy and sleeping a lot are normal responses to surgery. In the long run, rest will serve me better than studying Victorian novels. What better time to be self-indulgent without guilt?

How much time I’d spend lying on my back.

“Toes above nose” is a popular slogan in the orthopedic world. It’s a reminder to people who have had knee replacement surgery to lie down and elevate the affected leg on a pillow so that the knee is higher than the chest. (The slogan uses nose instead of chest because it rhymes with toes.) The position helps blood to flow back to the heart, reducing swelling around the knee. 

Toes above nose rules out a footstool or the sitting position on a recliner. Unless I were to stand on my head, the only way to get my feet higher than my chest is to lie flat on my back. To answer emails from friends, and to write this post, I’m propping up the laptop on my bent left leg. It’s awkward. 

If you have had major surgery, you could add to this post. If you have been fortunate to avoid it, as I was until now, this information may be useful some day. I hope your luck will continue, though, and you’ll never need to learn what recovery is like.