Week Two

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.

Being Home

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.

The First Week

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.

 

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Preparing the Body

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.

Fears

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.

Countdown

Nothing drives home the fact that you are single and living alone quite like major surgery. Suddenly being an Independent Woman seems like a burden when you have to plan for such things that were previously commonplace like laundry, cat care and getting the driveway shoveled. Married women never have to fret about things like that, since it’s buried in the marriage contract fine print that hubby will pick up prescriptions and clean the litter box; there is no “given” with being a single girl. In preparation for the big day I have been trying to think about every eventuality so as not to burden my daughter and friends too much and I have been trying to stock up on staples such as coffee and toilet paper. I’m incredibly grateful to have a big family and some amazing friends and colleagues but those questions they ask during Pre-Admission testing are haunting. “Do you live alone?”. “Have you arranged for someone to look after you when you get home?” The person asking the question looks mildly alarmed when they find out the only person in residence is a cat named Violet, as if I will require some sort of Social Service intervention. What do they know that I don’t? It’s times like this that I am entirely too sensitive for my own good.  Fortunately my best friend Mike is on board to help out as much as possible and Violet thinks he is absolutely wonderful, so my concerns about the kitty are resolved. He will cheerily clean a litterbox, grab a prescription and shovel a driveway so I am in very good hands when it comes to having extra help. My daughter is at the ready as well and I am hoping she will come and cook me something amazing and help me forget how crappy I feel.

One of the things that scares me is the amount of pain inherent in knee replacement surgery and the job of managing that pain. The people I have spoken with who have been through the procedure pull no punches about the magnitude of the discomfort; knees are complex structures with millions of nerve endings and they are bound to complain when so mightily disturbed. The fact that physical therapy begins on the day of surgery is both a blessing and a curse; movement of course is the cure for all that ails mankind but the thought of doing it hours from surgery boggles the mind. Do it I must, though and I am trying to mentally prepare myself for it. A gym buddy who happens to be a physical therapist has had the procedure recently and told me not to be a hero; she advised me to take as much medication as I could tolerate in order to complete the arduous task of rehabilitation and to do everything I was told.

To that end I have been trying to physically prepare for it. Knee replacement surgery is most successful with strong quadriceps and surrounding musculature so I have been doing quad strengthening exercises several times a day.  My colleagues are used to me doing wall sits and leg lifts at my desk, and in a show of solidarity have even joined in. Everyone is tired of seeing me limp around the office and can’t wait to see me get better so I feel like I have something of a cheering squad. I feel incredibly lucky to have a job where I have four to six weeks of sick time accrued and can worry about getting better instead of drawing a paycheck. And having medical insurance in this era of healthcare uncertainty has been an amazing stress reducer; no one should have to worry about losing their home because of necessary surgery. At the end of the day I am really lucky in spite of the fact that I fall into that weird spectrum of people who don’t have a significant other. And I’m grateful.

The Knee From Hell

“You need a knee replacement”, said Dr. Cooley in a particularly unemotional way as if he had been dispensing this sort of commentary for years. He was in his sixties, a slender, wizened man who looked as if he had done this sort of thing before and rather pitied people for the condition of having a bum knee; I read his bio online and knew he had hiked all the Adirondack high peaks so I knew he was accustomed to having all his parts work well. I sat there looking at him with tears streaming down my face and knew that he was right; my general practitioner uncle had warned me that my knees would wear out prematurely and apparently they had. Too many nights of dancing, extreme gardening and plyometric lunges during Boot Camp had taken their toll on a knee that had been compromised by a horse-related injury years ago. Back then my mother told us to ice pack it and get back to the barn; in those days there was no such thing as seeing an orthopaedic surgeon which was reserved for professional athletes and people with broken bones.  Somehow I had known my knee was in trouble when I ran my last 5K wearing an ace bandage so tight I could barely feel my leg but I had been in denial about doing anything about it.

A hyperextension while trying to reach into my pickup truck for something nearly leveled me with the pain and became the impetus for this latest round of visits to the specialists. Dr. Cooley was no longer performing surgery, but a Dr. D’Ascoli was and he was a doctor I was familiar with at least having operated on the professor’s knee several years earlier. He had a good reputation, so we began the discussion about what a knee replacement would entail and the risks involved. An x-ray showed a complete loss of cartilage on the anterior side of the knee and he concurred with Cooley’s findings but was very concerned about my age; knee replacements last between 15 and 30 years so there was a good chance I would need another in my lifetime. He wanted me to try a round of Celebrex which was more of an exercise in getting me to really think about the surgery and a non-invasive stab at making me more comfortable. Cortisone shots were out if I was considering surgery within three months so I decided to give the Celebrex a try and forego the cortisone so as not to paint myself into a corner. He gave me a three week supply and told me to let him know.

The sample boxes exhausted, I wasn’t noticing much of a difference except for a slightly better time sleeping. By the time I decided to try a course of anti-inflammatory the knee pain was waking me up in the middle of the night , so having the inflammation subside during the night was nice. But it wasn’t enough to weather the potential liver damage that usually accompanies such a drug and I began researching knee replacement surgery in earnest. My first resource was our receptionist Jeane, and amazing woman who walks forty to fifty miles a week on her knee replacements; she has had both knees replaced and one of them was done by Dr. D’Ascoli. She spoke very highly of him and I was grateful to her for all the nuggets of information she passed along. Jeane pulled no punches when describing the pain and I have been grateful for her honesty. I can vividly recall my grandmother telling me it was the most painful surgery she ever had, and she had undergone several including open heart surgery. I knew it was going to hurt, but a few weeks of Big Hurt balanced precariously against years of nagging pain became a relatively easy trade. As my colleagues heard about my knee replacement research (and watched me limp around the office) I began to hear other success stories of people who said it was the best thing they had ever done for themselves; somehow they had gotten past the pain and emerged to the other side in much better shape. I wanted that. And I wanted it on this side of my life, not on some un-promised time down the road.

Joint Class

Deciding to go ahead with the surgery set in motion a series of doctor’s appointments and consultations that made me really realize the gravity of the surgery I was about to undergo. The hospital where the surgery was taking place scheduled a Joint Class which was to give me a good overview of what to expect when undergoing joint replacement surgery; their logic was that it was better to impart this information when a patient was lucid and I was grateful. There were nine people in the class and they were all quite a bit older than I was. The woman on my left was a retired nurse who had the surgery three years prior and said it went extremely well; she was transporting a friend who didn’t drive. She counseled me to ask the anesthesiologist for “the block” which I was to discover later may buy me a few hours of physical therapy with less pain. The woman on my right was getting ready to have her second knee replacement and said her first knee was well worth the rehab and she was looking forward to getting on with her life. I appreciated her no-nonsense manner and the fact that she walked three dogs each day.

The class consisted of three medical professionals: a physical therapist, an occupational therapist and an RN who works exclusively with joint replacements. They outlined the expectations they had of the patients on the floor and the OT went over things that would be helpful once you are home. Of particular fascination was an actual joint prosthesis which was passed around; the titanium part was surprisingly weighty and it was not hard to see why it can be a problem at airports. The medical personnel were frank about the kind of pain I could expect and stressed the importance of taking meds at the right intervals so the pain does not get ahead of you. Clearly pain management is the key to successful rehabilitation, since it’s impossible to do the required exercises without it; pain medications scare me to death, but I was beginning to realize what a valuable tool they could be in getting better and I knew I was going to need to make my peace with them.

The Cat Mother

Her name was Violet, and she peered out at me from her erstwhile mother’s arms in a Facebook post; four nearly identical little kitten faces, who I was to learn later had been discovered abandoned in a garage about two weeks shy of being ready to leave their mother. Her foster mom Suzy was a friend of mine and when I saw those little faces on social media some magic they contained made me inquire if one of them was a little girl. The partially formulated idea in the back of my head sort of blossomed into reality as I seriously considered the idea of owning a critter and (gasp!) being responsible for one.

Having always considered myself a dog person, no one is more surprised than I am at suddenly being thoroughly owned by a cat; not even my family who has always been under the assumption that I hated felines. How did I know cats didn’t like to live in mailboxes? Growing up on the farm cats were relegated to mouse duty and were rarely given names. Never allowed in the house, they still had to follow the rigid barn behavior protocols of the other animals and mind their manners around milking time. They knew they would be rewarded with strip milk when the chores were over, so they waited patiently around the big shallow milk pan as soon as they heard the compressor start. In contrast, the farm dogs were allowed into the house and were members of the family so I was much more familiar with the rudiments of dog ownership, but my suburban lifestyle and the fact that I liked to travel at a moment’s notice made having a dog impractical.

After inquiring about the adoptability of the kittens and being told they would be ready in a couple of weeks I decided to visit them; it did not take long for the little girl kitten to latch herself firmly to me like a cockleburr and I knew I had to take her home. She was a little gray shorthaired tabby with bright green eyes and beautiful bullseye markings on her sides; I was completely smitten. After waiting a couple of weeks for her to be cleared with the vet, chipped and neutered I was able to bring her home.

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It has been fun to watch her develop from a wobbly kitten into a young adult cat and she has been instrumental in reminding me to find the curiosity in everything; nearly anything can become a toy or a game when you’re a kitten and her joie de vivre is infectious. Somehow Violet ended up being one of those loving and affectionate kitties who worship their owner, so my fears of ending up with an aloof and elusive house cat were unfounded. She follows me around the house like a dog and curls up next to me at every opportunity. It is amazing how much personality can be contained in that little eight pound body and she makes me laugh every single day even through some very dark times. In spite of the litter box duty, the cat hair and the vet bills I am very fortunate to have adopted such a delightful little creature and I hope we have many years of snuggling, purring and tuna breath ahead.

Farewell 2013

Well, it’s January 1 and in true new year fashion I have been doing a sort of personal retrospective of the year’s events. Maybe it’s all the resolution media hype working on my subconscious, but I thought perhaps it was as good a time as any to take stock of what has worked….and what hasn’t.

When I consider the events of the past year the first thing that comes to mind is the victory of finally graduating from Sage after more than ten years of textbook hassles, late nights of evening class commutes after working a full day, and the never ending homework which consumed endless weekends. It had been such a long time coming that I was in near disbelief when I finally picked up my regalia at the college bookstore, and I remember kissing my diploma when the college president handed it to me eliciting a chuckle from her. I stood there among the capped and gowned graduates and was grateful to have finally been strong enough to right a regret I had been harboring for years….the regret of not going to college. Very few people ever get to do such a thing and I felt as if I had been given some sort of special dispensation which was incredibly liberating. In spite of the grind, it was worth finally joining the ranks of those with a four year degree.

The same kind of strength came in handy a few months ago when I had to find the fortitude to walk out of an intellectually stimulating but psychologically dangerous relationship with a man I was absolutely crazy about. It had been many years since I had had a front row seat for that kind of predatory exploitation of my naivete´ and I was caught completely and totally off guard. I’m grateful to therapy and friends for keeping me sane, and for my own sense of discernment which finally told me that the bad really outweighed the good. A lot. There really are sociopaths and narcissists out there, and I am not exempt from being hurt by them as my Piscean soul has learned.

Having the bad outweigh the good was instrumental in finally helping me to make the decision to get my knee replaced next month. What started as a childhood horse injury had been plaguing me for years, and I vividly remember my general practitioner uncle listening to it with his stethoscope twenty years ago and telling me it wasn’t going to last. His prophesies were correct, and after much thought and deciding that I would rather have the quality of life on this side of my life rather than on some unpromised time years from now, I decided to do it. I know it is going to hurt like hell and the rehab is going to test everything I know about my own limits, but frankly it will be nice to focus on the project of rehabilitation while my heart heals. Hard work infallibly ends up being positive in some way, and it will give me blogging material. Stay tuned.

Resurrection

In spite of the fact that I am decidedly non-religious, Easter is by far my favorite holiday. It’s not because it’s a lower pressure holiday than Christmas or because those little candy covered chocolate eggs are so darn good; it’s because it’s a time of renewal and of promise. When Christmas rolls around I’m preparing to hunker down for the long winter ahead and bracing myself for captivity. In stark contrast, Easter represents a lightening, a freeing….a release. The longer days ahead are like a banquet I have not yet arrived at and it fills me with a sense of buoyant anticipation as I look forward to the light and warmth of spring.

This Easter is especially significant for me because for the first time in ten years I am single. The professor and I decided to call it quits, amicably of course, last fall and I spent the winter in my cocoon reinventing myself as a single girl and thinking about this next stage of my life. After all those years of being someone’s significant other my psyche feels unbound as I prepare myself for new experiences, and rather than feeling frightened I feel more alive than I have in years. The chrysalis metaphor comes to mind here and I am reminded once again that hope does, indeed, spring eternal.

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