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Total Knee Replacement
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A Gluten-Free Hospital Stay
by Ronald A. De Cicco
In August 1996 I started having problems with my right knee again. I
had arthroscopic surgery four years before and thought I had solved
the problem. Then in December 1995 I was diagnosed with celiac
disease and I went on the gluten-free (GF) diet. I was feeling a lot
better and thought my troubles were over for awhile and I went back to
work. Between August 1996 and December the X-rays showed complete
loss of all right knee cartilage. The doctor indicated that the pain,
swelling, and stiffness would only get worse and suggested total knee
replacement. Due to some deadlines at work, I postponed surgery until
February 1997.
As our support group had presented a program by hospital dietitians
last fall, I had some idea of how to approach the problem of a celiac
eating in the hospital. Unfortunately, the three hospitals
represented by the three dietitians approached the celiac problem in
different ways, so I wasnt sure how my hospital would respond. I
contacted the medical referral dietitian who had oriented me on the GF
diet for advice. Her assistance was invaluable. (Note: Her office
is concerned with advising patients having various problems with diet;
she doesnt direct the actual food service in the hospital for this
facility.)
One thing I found out was that the doctors admission order is all
powerful, so I contacted his office and explained the problem. This
insured that the appropriate wording was entered into the admission
order. This makes it a specific action and the hospital personnel now
must pick up the ball. This is not to say he will have a direct or
detailed part in treatment (diet), but puts the ball into the game.
(Note: I didnt find a nurse who had ever had a celiac patient,
although one thought it was only a wheat allergy.)
Another thing to arrange beforehand is the autologous blood donation;
in my case I provided two pints which was more than enough. But again
I found that this requires specific direction by the doctor.
Interestingly, since the blood is not tested for transmittable
diseases, if it is not used during the surgery it is destroyed.
As I do most of my own baking, the weekend before I entered for
surgery, I baked two loaves of bread, a pan cake and a blueberry
muffin recipe converted to a 3/4 inch thick flat cake. These could be
packed easily in a flat/tote bag. The flat cake I had previously
found would keep a week in a plastic bag. I froze both cakes and
bread until the morning of surgery. Just in case, the night before I
also packed a box of GF crisp crackers and a box of commercial GF
pecan shortbread cookies as a backup or supplement if needed. I also
packed a box of Erewon GF corn pops (not Kelloggs) for breakfast or
snacking. Note that these supplements did not require any special
handling or preservation except they could not be set where visitors
could sit on them. There wasnt much else I could do at this time. My
wife, who is well versed in my GF diet, accompanied me to the hospital
the morning of surgery.
My own previous experience with trauma and surgery indicated that the
first day or two I am not much interested in eating, especially
anything heavy. This condition was also true this time.
My surgery was scheduled for 10:30 am and by the time I woke up,
eating was next to the last thing I was interested in. In a light
haze I heard my wife discussing the supper menu with someone (an
assistant food service dietitian). They set up meals for supper and
next day's breakfast. The dinner and supper for the following day
would be set up at breakfast time or shortly thereafter. She left a
copy of some sort of master menu in the drawer of my night stand.
Thus for supper that day I had a small baked potato, turkey breast
sans gravy, some plain jello, a piece of my blueberry cake, and
coffee. I really had to force myself to eat most of it.
The next day breakfast was my corn pops cereal, milk, coffee and a
couple of my hard crackers.
By now I was able to get into the menu game on my own for the first
time. (Note: For me as a country boy, dinner is the noon meal and
supper is the evening meal.) For dinner I wanted to try the relish
plate. Wow! This was a ten inch plate with carrots, celery, sliced
red onion, and a slab of sliced pepper on a bed of lettuce--NO
CROUTONS. This was about a meal in itself. This was the time I found
out I had made my first mistake--no salad dressing. I then had my
wife bring in a small amount in a sealed plastic container, about a
two-day supply. There was a refrigerator available but the small
amount would keep for a day or so. She also provided me with ketchup
if needed. As these were from home, I knew they were safe. Thus I
could avoid the problem of hospital brands. For meat items I stayed
with fish and hamburger prepared on aluminum foil, center-cut roast
beef, and turkey breast. I specified that the roast beef not touch or
have any juice or gravy with it. I also had baked or mashed potatoes
and fresh fruit. A couple of times I used my commercial GF cookies
for dessert.
Using these guidelines I found I had plenty to eat without worrying
about getting sicker. I avoided eggs primarily because they dont sit
well with me. The five days of hospitalization passed with no
additional problems.
To summarize:
1. I didn't find food to be a major problem. The hospital staff was
very cooperative. The head dietitian checked in the third day to
see how things were going and to find out if there was anything
more that could be done to help. I was able to say, "No."
2. As with all fellow celiacs, I believe the patient in the long run
is the most responsible to try to avoid problems. It is all
planning and attention to details.
3. Stick to simple GF fundamentals.
4. I found that by planning to have bread and single-serving
containers of soup in the freezer, I was able to avoid having to
do any of my special cooking when I returned home for the first
week when I was still having trouble moving around.
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