March 20, 2014 at 4:30 pm (Life)
My last visit with Dr. D’Ascoli was this week and while I was sitting in the waiting room I thought about my surgeon grandfather talking about how pissed off he would get when he had a patient who he knew would have a bad outcome when they walked into his office. These were generally overweight, sedentary people who for any number of reasons would not fare as well as a fit person post-surgically, and he hated operating on them. It made me constantly aware of how difficult it must be as a doctor to operate on someone who could potentially make you look bad. Dr. D seemed genuinely pleased at my progress and it made me feel like I had held up my end of the doctor-patient bargain: he promised to do a good job and in return I did everything I was told and had an amazing outcome by going into it as fit and as educated as possible.
There are still some numb areas, stairs remind me how weak the surrounding musculature is and the knee joint occasionally gets away from me. There is a tendency to limp when I am tired, but the cane was cast away several days ahead of six weeks and I’m not going back. It is such a miracle to be without the remembered knee pain that I am still startled by it; I had lived with pain for so long and been so conditioned to react to it that it seemed like a miracle to have it disappear.
Now all I want to do is walk! I get up from my desk several times a day and take little movement breaks to keep from getting too stiff; I revel in it every single time. I no longer care in the least about finding a close parking spot and have returned to my customary habit of parking away from the idiots who care little about dinging my doors. Walking feels like a delicious luxury and I have had to watch out for overdoing it which leaves me with a throbbing, achey leg.
I’m incredibly grateful for an amazing doctor and incredible friends and family who were rooting for me…especially Mike who unflinchingly endured my pain and meltdowns with his perpetually positive and gentle nature. He took care of snow removal, litter box cleaning and grocery fetching without a single complaint and I could not have done it without him. Thank you, Mike.
March 10, 2014 at 3:25 pm (Uncategorized)
The last steri-strip fell off my knee yesterday just in time for my return to work for half days today, and after I got home I realized how grateful I was to be able to start slowly. I was tired! I wasn’t even that productive with all my colleagues coming over to welcome me back, but there was plenty to catch up on. My office is easy to navigate without a cane and people were astonished that I was no longer limping. It’s still amazing to me, too.
The knee is still waking me up at least once in the night with its restlessness contributing to my tiredness during the day, but it’s getting better. The goal now is to get it to bend enough to return to spin class; it still will not allow me to complete a revolution on the bike…but I’m close. My walking is getting straighter and my endurance is getting good enough to get some things accomplished. That’s huge for someone who has found the slow recovery frustrating.
March 1, 2014 at 11:18 am (Life)
This morning after my shower I was contemplating what to wear and was dreading the thought of donning yet another pair of “comfy” pants; the yoga pants and stretch pants I had hoarded for post-surgery garb made nice loungewear, but wearing them in public has been a miniature nightmare for me. Nothing says “I give up” quite like wearing loungewear at the grocery store. And don’t get me started on how the average college student comes to class.
Anyway, I decided to give my jeans another try after a crushing defeat the week before which saw me getting my pant leg on about six inches short of what it needed to be. Even my stretchier jeans would have rendered the fabric too tight over the incision to be very comfortable so I put them away in disgust. This morning’s attempt seemed much more promising after Joan’s assertion yesterday that the majority of my swelling was gone, and indeed the pants felt fine after easing them over the few remaining steri-strips that refused to budge. The ten pounds I lost since surgery made things even better and it was just the sort of boost I have desperately needed after a week of frustration.
Once again I am reminded of how recovery is crafted of small victories and milestones, some of them painfully gradual in coming. It has reminded me to slow down, practice patience and be grateful for the dopey little things I previously took for granted.
February 25, 2014 at 5:00 pm (Life)
Now that I can drive my spirits have lifted considerably and I no longer feel so dreadfully dependent upon people; going to the grocery store alone was a minor victory. Bringing the laundry up from the basement is still problematic, but the cleaning of the litter box is now an easily done task; life is slowly returning to normal along with my leg. The deep purple bruising is fading to a strange yellow and more sensation is returning to the parts that were numb; pathways that were cut or disturbed during surgery are now doing their miraculous knitting together and this phenomenon is often accompanied by strange phantom pains and restlessness in the night. The sciatic nonsense has lessened with my increased activity which further cements my theory that movement is the cure.
My in home physical therapy sessions exhausted, I began going to a fantastic woman named Joan for my next six sessions. Her first request was to have me walk away from her and she quickly determined that my right leg is now slightly longer than my left. She immediately fashioned a little cardboard shim for me which she placed in my left sneaker and had me walk away from her again; I was no longer swinging my bad leg around to compensate for the changed length and my gait straightened immediately. Dr. D’Ascoli had warned me that as long as my gait was screwy I was going to experience sciatic issues. This whole mechanical relationship between the different body parts has been fascinating to witness and it is amazing to see the difference small changes make. Joan also warned me that in addition to learning to walk properly again, I would need to retrain some “favoritism” habits such as resting all my weight on my left leg.
This morning I awoke feeling more depressed than usual, so I made a maiden voyage to the gym in spite of the fact that I wasn’t officially cleared to do so. I had this overwhelming need to walk and since the weather was wretched it made a lot more sense to secure a treadmill at my second home. It felt great to walk back in after being away for a few weeks and I got to catch up with some of the gym regulars I have known for years. Sometimes just doing something familiar is enough to calm the spirit.
February 24, 2014 at 5:32 pm (Life)
Today was the last day of in-home physical therapy from Judy who was assigned to my case and it was amazing to see how far I had come. The day after my surgery the thought of bending my gigantic swollen knee at a ninety degree seemed unfathomable but eighty degrees was reachable today with relative ease. It was good to see progress at the end of all the torture in spite of the fact that there is still much more to do.
Dispensing with the walker and using a cane made mobility a hundred times easier and has already helped my gait. I have a love-hate relationship with the cane; giving it up too early will be a huge detriment to the way I walk, but I noticed that the cane makes me completely immune to eye contact of any kind.
The invisibility thing was something I noticed on a recent trip to a restaurant and bar I frequent fairly often. As I was walking the length of the bar using my cane I noticed that people who would normally respond to my smile with a look or a nod were now diverting their eyes as if they were afraid to be caught staring. It took a while for this to sink in; I noticed an oddness as I navigated the crowd but an experimental trip to the bathroom clinched it. People do not want to look at infirmity of any kind or perhaps it is some sort of knee-jerk politeness. In any case, I found it fascinating and made me resolve to work even harder to ditch the cane.
February 17, 2014 at 6:18 pm (Life)
Week two was the week when I finally felt as if I was turning some sort of corner and experienced a lot of the changes that someone healing from this surgery experiences. Sensation was gradually returning to parts of my leg that had been numb and the bruising was slowly disappearing. Physical therapy was bringing back the strength surprisingly quickly so leg management was vastly easier. As of this writing it is still remarkably difficult to get comfortable for long periods of time because of the residual swelling, but it is getting better. In tiny increments. Tiny. This rehabilitation has required every ounce of my patience and focus and there have been a few meltdowns, some of which have been caused by progress that has been frustratingly slow and some by my emotional state before going into surgery. Anesthesia seems to exacerbate these devastating little incidents that leave me drained.
Toward the end of week two the walker is now being handled in much the same way one would handle a very clunky cane, so I am hopeful that my physical therapy session tomorrow will graduate me to an actual cane. Driving is another thing I am really missing and while I cannot think of anywhere I really need to go, it frustrates me to be dependent upon other people.
One landmark event in week two was the follow-up with Dr. D. My gigantic sticky bandage was removed revealing a shiny row of thirty two staples which had not seen daylight since I was at the hospital. They were quickly removed by a woman who had clearly done this sort of thing million times before and covered the eight inch scar with a row of steri-strips. The doctor said I was progressing nicely and gave me a copy of the x-ray of my new prosthesis which made me feel oddly as if some torch had been passed; I had the fleeting memory of the day I took delivery on my pickup truck which made me chuckle.
February 15, 2014 at 10:37 am (Life)
Hospitals are tough places to recover. There is a whole lot of professional staff around and if you fall down someone is bound to notice, but there is a constant hustle and bustle even in the middle of the night that jangled my nerves and exhausted me. When I wasn’t making my slow and painful way to the bathroom or out of my bed for physical therapy I had little foot pumps velcroed to my feet that alternately squeezed each ankle to prevent blood clots. Fortunately my leg was far too clunky and swollen to entertain any thought of rolling over which I desperately wanted to do, so I slept in the intervals brought to me by my pain meds.
After four days my doctor felt I would be able to drag myself the three steps into my house, so Mike came and gathered me up along with my walker for the trip home. There had been a sizeable snow storm the night before, and I knew he had a considerable amount of work to do to get a path cleared so I was especially grateful. I said goodbye to the medical staff who had been taking care of me and was wheeled toward freedom.
Being outdoors for the first time seemed surreal, but all I could think of was getting home to familiar surroundings and my cat who was probably certain her mother was never returning. Using the stair navigation tricks I had learned in physical therapy I made it up the three steps to the refuge of my house and realized I was exhausted. Mike got me installed on the couch with a fresh bottle of water and went off to pick up my numerous prescriptions; a caretaker’s work is never done.
Pain management at home was a bit different since there was no white board and the meds had been reduced from three to one. My fondest hope was that I would have what I needed to navigate at home and complete the rehab sessions. It turned out that I was prescribed 5 mg. of Oxycodone every 4-6 hours, but it was up to me to figure how to make those sixty tiny pills last until until my first follow-up visit eight days away. The effort was mostly successful except for getting cocky the first night and only taking one pill with the reasoning that I would be sleeping anyway. It ended up being a huge mistake and the hour and a half wait until my next dosage was one I never wish to repeat.
There were some new tricks to managing the floor plan of my house. Reluctantly I had gotten a raised toilet seat because of the small amount of clearance my bathroom afforded for a leg that does not bend all that well and ended up being very glad. My high antique bed afforded another challenge to get into with a leg that was less than functional, and I was glad I had done so much leg strengthening before surgery; my good leg became a lever that hooked under my bad leg and hoisted it into bed. The rest of my little postwar ranch ended up being pretty well suited for a walker with the exception of the pantry. When I discovered my walker would only go through the door sideways I burst out laughing at the irony of it and knew it was the universe’s way of telling me not to overtax my new knee by gaining weight. Message received.
February 11, 2014 at 12:37 pm (Life)
One week ago I handed myself over to the competent people at Schenectady Regional Orthopaedics for my long overdue total knee replacement. With much trepidation I showed up at the appointed time and surrendered my clothing and cell phone for a hospital gown, funny hat and an IV line which was to be my constant companion for the next four days. Dr. D’Ascoli visited after I was prepped and autographed the suspect knee; ten minutes later I was off to the frigid operating room and I was grateful to the nurse for covering me with a heated blanket before heading in. I noted with some amusement that my knee was throbbing relentlessly and it occurred to me for the five millionth time that I was making a very good decision.
Awakening in the recovery room I was surprised at how little residual fuzziness I felt in my head; the anesthesiologist must have given me just the right amount of magic to do the trick. Immediately curious about the state of my leg, I peeled back the blanket to see an ace bandage wrapped from mid-thigh to toe and a mass of purple bruises on the exposed thigh above. Lovely. My leg was roughly half again its normal diameter and I was trying to imagine how much was bandage and how much was me. The pain was a dull ache and I knew the local anesthetics he used in place of a femoral block had not yet worn off.
Not long after being transferred to my room, I had my first physical therapy session which seems unthinkable, but I get the logic of it; why not do it before all the anesthesia wears off? This makes the first PT experience relatively pleasant because it is most assuredly less fun as time goes on. Susie did all of the same exercises they prescribed before the surgery and this time I really did feel like the little old person depicted in the booklet. In the space of a few hours my previously useful quadricep had been reduced to mush and I knew there was some serious work ahead of me. I took my first walk with the walker and it took intense concentration to navigate my giant throbbing thigh while coordinating the movement of the walker and dragging an IV drip.
One of my concerns had been pain management, but a white board visible from my bed ended up being the perfect tool for keeping track of a number of things. The three pain meds I was on, Oxycontin, Oxycodone and morphine were listed on the board with their ordered intervals, and every time one of them was administered the nurse would write the time down. This helped me keep track of things and take more ownership of my pain relief which in turn helped the overworked nursing staff. There was a pain scale printed on the board and that became my other tool for managing the daunting amount of discomfort native to this particular surgery and they would tick off the number I was feeling when meds were administered; this gave me a more logical way to assess and convey how much discomfort I was in. Other useful things that were included on the board were the name of the nurse, physical therapist, tech and housekeeper in charge of my room. Genius! There was only one night when a combination of dozing off and a nursing shift change caused me to awaken in unimaginable pain; I have never been so grateful for intravenous opiates in my life.
January 27, 2014 at 5:31 pm (Life)
Exactly a week from now I will be sporting a brand new bionic knee and hopefully astonishing the nurses in the orthopaedic wing with my amazingness. That’s the plan anyway. I’m aware that the reality is probably closer to something else entirely, but I’m doing everything I can within my control to be a good “surgical candidate” as my grandfather used to say and not think about the negatives.
I have been trying to get the body ready by religiously doing my quadricep strengthening exercises; the physical therapist gave me a sheaf of them to do every day, each exercise illustrated by a senior citizen performing ridiculously easy exercises. It reminded me once again that I should be grateful for having maintained a reasonable level of fitness in spite of the knee pain. Because of this I decided to augment these with calf raises, squats and wall sits all of which are no impact but torturous to the legs. Impact of any kind is now out of the question and even my beloved Spin has had to be replaced by the recumbent bike; the knee now had a dull clunk during positions two and three and the swelling after a 55 minute class has, at times, precluded me from wearing jeans. Sigh. At least the recumbent bike provides me with the cardio I need, in spite of the fact that it’s dull.
Mentally preparing myself has been another story altogether, but exercise has gone a long way toward helping me put things in perspective and that little miracle drug continues to reap benefits whenever I go to the gym. It’s hard to watch people go into the workout studio for a class I used to take with abandon, but I have a lot of friends there who are rooting for me and want to see me recover. And a gym membership is kind of like having a PT facility available whenever you want it which I am planning to do as soon as I am able to drive.
Hopefully I can work out until the day before surgery. I want my doctor to have some good musculature to work with, and I’m going to need it for the arduous task of rehab. Bring it on.
January 23, 2014 at 4:45 pm (Life)
Today was the final commitment in the knee replacement surgery countdown; one last meeting with Dr. D’Ascoli before he sees me in a very unflattering hospital gown. It was my last chance to ask questions and address any concerns and while I had been thinking about it for several days my questions were admittedly few. The Joint Class I attended did an excellent job of letting me know what to expect during the entire hospital stay and how to prepare my home for the weeks after discharge; he was curious to know how well I liked the class and asked me if I thought anything should be added.
One thing I did want to bring up with him was my concern about pain interfering with my rehabilitation; every bit of information I had read about this procedure said the same thing: aggressive physical therapy was the surest path to success but in order to put in the work you need to be comfortable enough to do so. He assured me that they have many kinds of medications available, some of which I would be getting automatically and some which will be added as needed, but it was my responsibility to monitor how I was feeling and let the nurses know if I was headed for the weeds. My normal “unobtrusive patient” model may not be a good fit in this case.
Another thing I was curious about was something called a femoral block which I had heard about from the lady on my left in Joint Class. A retired nurse and knee joint recipient, she said it helped her immensely so naturally I was curious about it. Dr. D said he has been using a newer technique which involves injecting areas in the surgical site instead of the nerves in the leg; they discovered that it is preferable to a block which wears off relatively suddenly and can make it more difficult for a patient to get ahead of the pain. A femoral block can also contribute to residual sciatic pain according to my research, which I was definitely not interested in. Since I am all about hitting it hard as soon as I can this made perfect sense to me and I decided to forego the block.
Our meeting concluded and he shook my hand; “I’ll do a good job for you”, he said. I told him I already knew that because I went to the gym with his former secretary Helen and she told me he was the best. That made him smile and I finally felt ready to face things.
I wish I had felt ready to face things a few nights ago when I awoke in the middle of the night in a sheer panic. It was the night of the Joint Class and the facts of the day crowded in on me with a vengeance obliterating reason and logic. It was blessedly brief, and I collected my thoughts by going over the list of things I was no longer doing because of my knee. No more Boot Camp. A cancelled fall trip to the UK. The constant sensation of broken glass in my knee. It was a shitty choice, but it was a choice at least. And there are a whole lot of people out there who are in worse shape than I am.
One thing I have thought about a great deal is the fact that I am extremely lucky to have an employer who gives me liberal time off and great health insurance. I have two sisters who clean houses for a living and have neither health insurance or sick time; they would be completely screwed by a diagnosis like mine. The big picture is that I have it pretty good and that my little middle-of-the-night pity party was largely unwarranted. That doesn’t mean that I won’t have another one; it’s hard for me to imagine what the night before surgery is going to be like. But hopefully I can keep it in perspective.