Knee replacement part 2 - start of recovery

(STILL) AT LAPEYRONIE

I'm nearing the end of a week in hospital and tomorrow I transfer to a clinic for 3 weeks' rééducation.  More of that soon, but 2 of my good friends have already been there for similar post-operative treatment and both recommend it warmly.  They also say I'll be worked hard, and it is becoming apparent that I'll need it.

The system in France is very different from the usual approach in England.  One friend (an ex- nurse/midwife) wrote that her father in law "was sent out two days post op with an instruction leaflet for exercise...and a physio appointment for six weeks. The wonderful nhs." while another friend has just had a similar operation, was happy to be sent home on crutches and presumably with the said instructions after only 3 days in hospital, and was quite happy to be home and conducting her own rehab, but presumably with adequate physiotherapy supervision.  I guess it all comes down to personality - I am very happy to have quite close supervision, because I don't think on my own I would get to 30 straight leg lifts a day when the quadriceps and calves are screaming after 20.  I am definitely not cut out to be an elite athlete!!

The young trainee physio (kiné or, in long, kinésithérapeute) who looks after me daily and puts me on the knee bending machine 3 hours a day is in her final year of training, her last placement before exams, and she loves the work.  We have had discussions about the differences in aftercare and of course associated cost - she says in France they pay a lot of attention to rehab after knee replacements because they are quite delicate mechanisms and so the muscles have to be in good shape.  Anyway, apart from the machine and the leg lifts there are ankle flexing and knee straightening exercises all of which make some muscles scream.  And lots of ice which will take down swelling but is difficult to keep in place.

Systems here are a mixture of high-tech and low-tech.  The bed does all but fly with remote control buttons, though since the mattress is covered in stout plastic it is uncomfortable and sweaty unless there is plenty of air.  Luckily here it is a mild spring, so I can have the window open and some air around.  A raised loo seat arrived after 3 days, smuggled in by an auxiliary who pointed out that the store had none of the relevant clips to hold it to the loo so be careful (implication it would be her head on teh block if I fell off).  Hygiene and dressings are incredibly sterile-conscious, with all manner of gloves, masks, hand scrubs and tweezers, but when the Chinese plastic tweezers don't meet in the middle the whole sterile pack is wasted.  When I have a shower my leg is taped over with a bin bag which works fine to keep the water off the dressing, but you have to watch out for the little plastic tie floating at the bottom, or you could trip up.  Ice cubes are in plastic bags tied at the neck which are put in pillow cases and slither anywhere but where they are needed.  None has leaked yet!

Food is OK, all in sealed microwaved trays which are usually well heated.  Varied menus, often too light on sauces and seasoning, and usually too much.  Plenty of fruit and salad in among.  Remember this is me  talking, not a bird-like eater, and I know I need my healing calories.  I really have not missed the daily wine, though I can't say I'll be sorry if and when some appears in the weeks to come.  The coffee is atrocious - I really think the AOC system should be applied to forbid the word café in the phrase 'café en poudre' (instant coffee), but I drink it anyway.  When a visitor brings me an espresso from the foyer it is a red letter day.

People are generally kind and attentive, and messages usually get passed round the nursing team, just slip through the gaps when there is a rush on.  I have been highly impressed by Prof Canovas, the top man and my surgeon - he has called in every day as well as sending the usual bevy of flunkeys round regularly, and even appeared on Sunday evening to check all was progressing well.  But I lave little idea beyond murmurs and occasional buzzes of voices in the corridor what is going on in the 'ward' of about 50 rooms, therefore I guess 70+ people - I am so glad to have my own room.  

I never sleep well, and here it's worse despite some pills from time to time, so I am very pleased to be able to do as I please behind my closed door, read in the middle of the night and so on.  It's quiet, though I do keep the wax earplugs at hand against the chatter of the A&E night staff off duty next door and under my window.  Helicopters land nearby in batches, but the view beyond is of trees, houses and sky, not at all urban.

I find myself reflecting on the whole project - looking forward to operation and then rehab is like standing on a valley edge looking down at the pleasant valley.  The hills on the other side look very near and not difficult to get to.  Down into the green valley, operation well-completed, and now the reality of getting back into shape is only too obvious - from the bottom the climb back up to the heights above seems daunting.  But of course I know the views will the great once I get there.