How A Total Knee Replacement Led to an Emergency Appendectomy

Having just had knee replacement surgery, I was unprepared for another surgery so soon! But life gives us answers we don’t want sometimes, and this past week (birthday week by the way), I spent in the hospital having an emergency appendectomy.

Your pain is not real!

Have you ever had laparoscopic surgery? A lot of women have. But I hadn’t until my appendicitis.

As the surgeon went over the warnings of the surgery, he told me that some people experience a shoulder pain from the carbon dioxide. They pump carbon dioxide into you to inflate the abdomen so they can see better and then they vacuum it out. But they can’t get all of it out and sometimes the CO2 that’s still trapped inside can cause shoulder pain.

As I listened to this in my painful pre-surgery fog, I’m thinking, why does it cause shoulder pain when the surgical site is in your abdomen? I’m also dismissing it because it doesn’t sound like it’s a huge problem.

The surgeon also said the best remedy for this pain is to walk. Okay, I’m not opposed to walking, I love to walk. No problem.

But it was a problem.

I didn’t have surgery until after 3pm the next day after being admitted to hospital. I was back in my room by 5pm and slept.

At midnight I woke up in the most excruciating pain I’ve ever experienced in my life!

As a person with osteoarthritis and sometimes gout-like symptoms, I’ve experienced pain. I’ve given birth to two babies with no drugs! I’ve experienced pain!

But nothing like this. I couldn’t breathe, my blood pressure shot up, I was vomiting. The nurse came in and asked, “have you walked?”

What do you mean have I walked? I just got out of surgery a few hours ago. I have an IV hooked up. I’ve been getting some much-needed sleep. Have I walked? No.

She proceeded to try to get me up walking. Every 5-10 steps I vomited. She put me back in bed. They gave me morphine and hydrocodone and meds to bring the blood pressure down. Nothing was helping.

The amazing thing to me about this pain is they’re not even sure why it happens in about 35%-85% of patients. It’s thought to be caused by irritation of the phrenic nerve from the un-dissipated carbon dioxide. The pain can range from mild to severe and manifests in the clavicle area of the shoulder.

The fact that someone was not stabbing me with a dagger was astonishing to me! How can I be experiencing the worst pain in my life from something that wasn’t even there?

And that, my friends, is pain in a nutshell. It’s still so misunderstood and poorly treated and the pain from osteoarthritis even more so. The research is lacking and the hope for a “cure” for osteoarthritis is nonexistent at this point.

on’t ever, ever let a doctor or anyone else tell you that your pain is not real!

Pain, even phantom pain, is very real as evidenced by my inability to breathe and spiked blood pressure!

Patient Blaming

I have no other words for it.

The surgeon came in on morning rounds and said, “I’ve heard you’ve been in some pain.”

I tried to open my tired swollen eyes but just nodded in agreement.

“I told you, you need to walk!” he chastised.

At the time he said this, still exhausted from the pain, nausea, and lack of sleep, I absorbed all responsibility. Of course, he had told me to walk. And I didn’t. I was guilty as charged.

Now with a clear head, I can look back and say “What?”

In my post-surgery slumber, I was supposed to wake myself up, shake off the nausea, figure out how to disconnect my IV and walk myself down the hallway to prevent this pain from happening?

Now I can see the absurdity of it all. But at the time, I felt sufficiently guilty and shamed that I had not done the right thing.

Maybe the surgeon didn’t mean to blame me for it, but his words conveyed that. Maybe the hospital was just too understaffed for a nurse to be able to take the time to make sure I walked. But patient blaming is all too real and should never happen.

The whole hospital stay I felt patient blamed:

Why didn’t you walk?

Why are you in so much pain?

Why is your blood pressure so high?

Why aren’t you eating your liquid diet?

Why do you keep vomiting?

All these issues were laid to rest on my shoulders. The severely understaffed hospital could not take responsibility for them.

One thing became crystal clear to me. I had to get out of that hospital ASAP!

Now let me make one thing clear: I knew that there was nothing wrong with the surgery itself. I didn’t fear any complications from that, it was the hospital and the drugs that were making me sick. I knew if I could get home and get my head clear of narcotics, that I’d be able to walk and recuperate and start eating again. I knew all that I needed to get back to full health was my own home.

So, on the next morning’s doctor rounds, I summoned all the strength I could to look him in the eyes and tell him I was ready to go home. He examined me and agreed.

As soon as he left the room I vomited. Then I texted the Fixer “how fast can you make it back here, they’re releasing me”!

So how did my knee surgery cause me to have an appendectomy?

I had to google why people even get appendicitis and when I did, it became clear that the opiate induced constipation problems I had post-knee replacement surgery are the cause of this appendix rupture!

According to www.hopkinsmedicine.org appendicitis can be due to a virus……Or it may happen when the tube that joins your large intestine and appendix is blocked or trapped by stool…

As I wrote in my blog post New Year, New Knee, I had such severe constipation that I thought I would have to go to the ER. I was certain that there was a bowel obstruction, and in retrospect, maybe I should’ve gone to get it medically treated. But I believe that those couple of weeks of severe constipation caused a blockage in the appendix that has taken the last 7 months to become infected to the point of perforation.

I’m thankful for so many things under the circumstances, but I’m so grateful that this didn’t happen while we were travelling!

So once again, I implore you:

If you are considering a total knee replacement soon, talk to your doctor about the effects of opiate induced constipation. Ask them how long you will need to be on opiates and what signs of constipation to watch for and how you might proactively protect yourself from it.

Remember, fiber is not necessarily the answer. If the opiates have shut down the systolic action, adding more fiber will make things worse.

Please go into the surgery armed with all the information you need for a healthy recovery and hopefully, your joint replacement surgery won’t turn into an emergency appendectomy!

Happy Gardening!