New Knee, Five-Day Diary (Was supposed to post Jan 24!)

SUMMARY: Another adventure in artificial human parts.

FYI Some of what follows might have been posted on Facebook first.


Saturday Jan 18: I will be stuck upstairs in my house for probably a couple of weeks. That means: Bedroom, bathroom, hallway.  Then mostly to the house for another couple of weeks. Then slowly more activity outdoors.  On a walker for some number of weeks; then walking with a cane for more numbers of weeks.

Morning before surgery. Standing on a ladder in the corner of my yard.
To my left, Martial Cottle Park. To my right, looking up my yard to my house.
That window below the chimney? That's where I'll be looking out for the next few weeks.
No ladder climbing!

So I need to make sure that my room is ready for me, that my house contains all that I'll need and that my stay-in caretakers will need (food? entertainment? Clean rooms? Clean linens? Etc.).

Bedside table with the necessities;
I'll use the large receptacle for constant ice water.
I'll drink a lot. 
Also Kindle is there; also styrofoam thingie on dresser for PT.

I have 4 days to get it all ready: Go.



P.S. I have already arranged with various relatives to stay with me to cover me 24-7 for 2 weeks, except for one night towards the end. TBD.

Tuesday a.m.: I had decided that I wouldn't board the dogs for the first couple of nights like I did for my hip replacement last year. Turns out that worrying about that kept me up a good portion of last night--because it was very useful to have them out of the way while getting things figured out and recovering initially from the surgery.  Called my agility instructors, who also do boarding, and ask whether they could manage it at the last minute. Oh, and Chip needs eye ointment and pills.  They say, sure, if I can bring them up Wed. morning. I say, sure, 9:00, see you then.

Partial list. VERY partial list.

6 p.m.  I get home from shopping and errands and discover that Kaiser has rescheduled my arrival time for tomorrow to 9 AM instead of 11. I call boarding back and say, uh, how about this evening? They very generously agree, although it means they have to do some prep work in the dark.  And fortunately my morning ride to the hospital is able to manage the 2 hour change, also.


Tuesday evening: Made a lot of progress on my list. I think it's sufficient. It's not ideal; never did sweep the stairs or kitchen or vacuum the guest room, for example.  Didn't help taking 2 hours out of the plan to take the dogs up to boarding.

Wed. a.m.  Didn't sleep all that well again.  I'm fine with the surgery: Can't wait to have the new knee. It's everythng else...

Arrive at 9 a.m.  There's a delay; surgeon had higher priority things come up, etc.

They give me an epidural to numb my right leg--but it turns out to be a challenge. Because of my recently acquired extreme lower-back scoliosis, it appears to have twisted so that injecting into the right side numbs the left leg! After several attempts, the solution is to roll me onto my right side instead of left, and then although left leg numbs first, the numbing agent moves into my right side because of gravity.  Clever.

I get an IV sedative.

Wake up a while later with a new knee.

Post-surgery. Tubes still attached to left arm (I think).
There's this cool thing in the recovery room--every bed has a "skylight"
with some photo looking up. Nice, because we're in the basement.

Physical Therapist wheels in her own step for testing.
(It folds down.) Tricky!

With delays and everything, and with my right leg not wanting to come un-numb, it's not until nearly 6 that the physical therapist can check whether I can stand and walk (with a walker) and go up and down a step. I can. Off home.

Sister #1, who took me to the place in the morning and stuck around nearby
until they released me around 6 that evening.
She came prepared with electronic gadgets for "working" (so she claims).

Mr Fox No. 12 examines the knee brace and the foam elevating wedge
while Human Mom consumes breakfast.

Thurs. a.m. I have a very sturdy velcro brace wrapped around my knee and at least a foot above and below. Expecting to wear it for several days at least to support the knee.  When I took it off midday for a nap, discovered that my initial dressing over the surgery site had filled with blood and was leaking through. Instructions said to replace with sterile gauze if that happened. Taking it off, looked like it was old blood and not still oozing, so no worries.

They sent me home with an ice machine, so I'm icing and elevating and taking pain meds and being subdued, dozy, generally happy.  Home  Physical Therapist calls to set up an appointment for  tomorrow and, wow, it's the same excellent one I had for my hip last year! Yay!

This is the wrap that *I* use over the dressing.

Friday: 

Therapist comes, goes through the first simple set of exercises with me. After the last one, she says, well, that was not just an exercise; it was a test. So your muscles are strong enough that you don't need to wear the brace! Yay!

She replaces the dressing, and there was a small bit of oozing between yesterday and today, but not much. Lookin' good.

Sister #2 and I investigate my emergency supply of tape and dressing.
Apparently for some reason I kept this tape roll. Possible to remember Jake by--
I've always played with my dogs with empty TP and paper towel cardboard tubes.
Then Jake figured out that there were cardboard tubes EVERYwhere if one looked around!

Knee Status 6 Weeks Out

SUMMARY: The new one is very good. But the technology isn't perfect.

From a Facebook post March 9.

!!! TO DO: UPLOAD PHOTOS !!!

Went in for my 6 1/2 week check-up today (March 9) with the surgery department. I'm happy happy happy with my new knee!

Per them: X-rays look perfect. Surgery scar looks perfect. Pain is very minor today. 

Side note: About 3 days ago, the knee started into constant low-level pain.
Icing didn't help, even though it always did til now.
(Multiple tries.) Acetaminophen and NSAID didn't help.
After a day and a half, finally gave up after bedtime and took
one remaining reserved heavy-duty pain pill. Knee has been pretty good since.
That has been the first time in all these weeks that I've had a problem with pain.

Takeaways:

• Walk as much as I want, let pain be my guide. 
• Don’t expect to ever do much running on it. (As in: dog agility..., hmm, we'll see... . Certainly not jogging. But I didn't anyway, so that's OK.)
• Don’t expect to ever be getting down on my knee; maybe briefly if it’s absolutely necessary, but not on a regular basis and not for very long.
  (As in: Gardening. Pulling weeds. Laying brick pathways for which I  have bricks stored up. Getting under desk to where wiring for everything goes. Scrubbing textured kitchen/hallway floors. Cleaning spots on the carpet. Many varieties of household tasks (e.g., I replaced the slide-out drawer in a kitchen cabinet last year. HAD to be on my knees.) Cleaning dog vomit from the back of a large soft crate. So many things I'm used to doing on my knees!)
• Expect that everything should be about as healed and healthy as it’s going to get after a year or so. (A *YEAR* or so?!)

Front of knee. They replaced the ends of my bones with surfaces made of chrome, titanium, and something, cemented in place, then put a pad in between to replace the cartilage that hasn’t been there for a very long time.
Some kind of plasticky stuff.

Side: and, yes, that’s my original patella hanging out at the front of my knee.

And I’m apparently in good hands: Team physicians of the San Jose Sharks? Here at this facility or at a different Kaiser? Those men take a beating, so if they can fix them, they can fix me, is the message.

About My Back

SUMMARY: Bringing my blog up to date on this topic.

I had not expected my body and life to take a turn in this direction, but they have, so here we go.

I've mentioned my recent back pain over the last year a few times.



I have a bit of history of back issues related to spine problems--bad one back in 2000/2001, when I was on disability and couldn't do much of anything, then using a lot of caution since then or risk sciatic pain creeping quickly in, then the current bout that started early last year, got a bit worse, got a bit better so that I could start doing longer walks again, but up until 3 or 4 months ago it did not interfere with actually doing agility. Got slowly worse again to where I couldn't actually do agility, more than maybe one run a day.

Then abruptly one morning I couldn't stand up, I was in so much pain.

The short story is that my lumbar (lower) spine is suffering the effects from degenerative disk disease and arthritis and probably bad luck and is now so contorted that nerve pain is constant. I have discovered gradually that hobbling downstairs and using the exercycle for 5-10 minutes followed by basic core exercises and stretching allows me to operate in an upright position per my design specs, but the individual parts are wearing out and I can't get replacements. Icing helps temporarily. Heating helps temporarily. Stretching helps temporarily, but only to ease the pain, not make it go away.

I'm out on short-term disability again while investigating whether very serious surgery is my only solution and meanwhile trying to ease the pain a bit. Just being out from work I think helps a bit--not so stressful, no requirement to be on the computer any longer than I feel comfortable doing, and so on. However, I was enjoying my current long-term assignment and it was sad to clear out my cubicle and leave it behind for now. Hoping that's not long term, but still TBD.

There's no way I can do agility at this time. Any kind of training at all is hard when trying to avoid any kind of bending, and sitting hurts, and standing up hurts. Bah, I say.

I'm not trapped at home: Driving is comfortable. Places where I can sit immobile for a while (e.g., movie theaters with good seats) are OK, as are places where I can lean forward onto a table to take the weight off my spine/backside are OK. Hard to work under such restraints.

Also on assorted meds trying to ease the pain, so I spend a lot of time just sleeping.

But I've been in a good state emotionally all spring and into summer, and despite the challenges, I'm still there, just occasionally whining to myself and having a brief self-pity party. Then I'm off and running (figuratively) again, setting up appointments, doing research, gathering data, and so on.

People have been very helpful and understanding. It's amazing how many of my friends have had some kind of back surgery or have avoided it but still have problems.

I might need that deeply involved and complex surgery. We'll see--but if I do, it'll probably be sooner rather than later. Oh, boy, something to look forward to: Being out on disability and in a lot of pain for up to a year. But if it fixes the problem...

Yeah.

Hope all of your backs are doing well.

Knee Surgery Is Done

SUMMARY: The last 24 hours--or less--

Tuesday evening, 7:00: Meet with my friend Karey, who is quite the knee-surgery veteran, to borrow her automated knee-icing machine (some inventions are truly mahvelous--and simple--and I'd have never imagined such a thing if she hadn't mentioned it earlier and offered to let me borrow it). She throws in a dinner of Thanksgiving "leftovers", which turn out to be a really lovely casserole made with layers of turkey and broccoli and potatos, smothered in cheese and baked. VERY tasty. Would never have known they were leftovers (which are supposed to be eaten out of tupperware containers and barely warmed over). Karey and Dan have lots of helpful hints.

My three dogs mingle with their three dogs with various levels of enthusiasm or antipathy. Inyo the retired Terv (well,OK, he hasn't retired from Tervhood) mostly hung out in the background, except when he came by periodically to show that he still remembers how to do the Shake and High 5 that I started teaching him while waiting for agility class Lo those many years ago. I just happen to have treats in my pocket for just such dog-behavior emergencies. He's not entirely convinced at first that a piece of puppy kibble is really what one would call a treat, but he eventually accepts it and periodically comes back for more.

The other dogs think this is a good idea and pretty soon I have thousands of dogs doing rights and lefts upon various commands (mostly rights and lefts but not guaranteed to match with what action the dogs actually take).

I am very stressed about the surgery although I know that there's no real reason to be. My knee, contrarily, is feeling absolutely wonderful and isn't swollen at all. Except for that catching thing that it started last week, which is happening more and more and more, to the point where I think that I don't even really want to walk, to avoid the chance that I might have to endure another of those sharp sudden spikes of pain. I will be very happy if the doctor can fix that. And whatever else needs fixing.

I head home after 10:00, picking up tons of ice for the ice machine on the way home. I decide that I'm too tired to start getting everything prepped for Surgery Day and crawl into bed with my security electric mattress pad (like a security blanket, only warmer) and then read for a while--everyone dies, makes me feel particularly encouraged), then fall asleep sometime after midnight.

Wednesday, 6:00 a.m.: I'm awake. Why why why? I lie in bed quietly for a while, checking to see whether maybe I have some sleep molecules left to take me away again. No such luck. Get up around 6:30.

I've had Boost back in her crate the last 2 nights, after not bothering most of the time for a few weeks. Of course she likes being on the bed because the other dogs are there, but she has to take the middle position to avoid the other 2 dogs, who hold down the two far corners of the bed. Which means that, as she adjusts her position or rolls over during the night, she always rolls over in my direction rather than towards the other dogs, which means that when *I* roll over, suddenly there's a dog where I want to be. So I jab my knees into where I want to put them, which makes Boost jump up, and then usually she jumps off the bed and wanders aimlessly around the room, which makes me nervous, so then I have to insist that she come back onto the bed and get her settled into position again in the middle of the bed. Repeat a couple of hours later.

So two nights ago I was just too tired and stressy to deal with that, so I suggested that she get into her crate (where she has slept most of the previous 18 months) and zipped her in. I think we both slept much better that way.

Wednesday, 7:00 a.m.: Boost fetches the newspaper for me from the end of the driveway. But--dang--I'm not allowed to have any food or drink, not even sips of water or mints or anything--after midnight before the surgery, so no reading the paper with breakfast! What ever shall I do?

I shall go through my to-do list to prep for my anticipated restrictions after surgery:

• Finish laundry and haul most of it back upstairs to my bedroom.
• Clear the boxes of xmas ornaments out of the hallway and off to one side in the living room. At least the tree is set up and has lights on it.
• Put away all the random stuff sitting around in the kitchen and various other places that might be in the way.
• Set up a "nest" in the living room, which is on the same level as the kitchen (bathroom & office are down 5 steps; bedroom is up 12), with laptop computer, books, crossword puzzles, lightweight down comforter, extra pillow, stuff like that.
• Make sure I've moved plenty of cold drinks from the garage (down 5 steps) into the fridge.

Also assembled everything I need to take with me, or imagine I might need, if I end up having to wait a long time ahead of time in the waiting room or a long time afterwards in the recovery room. Plus I want to be prepared for blogging!

• Notepad and paper, pens, digital snapshot camera.
• Novel I'm in the process of reading; crossword puzzle book.
• Kaiser card and photo ID, and $20 just in case--I don't know, but just in case anyway.
• Glasses case for my glasses and inhaler for my occasional lightweight asthma, requested by Kaiser that I bring with me.
• Crutches.
• Icing machine.

Mom and Dad's Chauffeur Service dropping me off in the morning.

I'm now fully IDed.

Self-portrait with cute little surgical cap and gown.

9:15 a.m.: I am showered, packed, dressed "in loose-fitting, comfortable clothing, no jewelery", and parents are here to pick me up right on the dot. My check-in time is 9:45 and it's only a 15 minute drive there, usually.

9:30 a.m.: Mom and I go in while Dad parks the car. No line at the check-in, so I register and sit down. They call me in to get started before Dad has even reappeared from the parking lot. They go over a lot of the same questions that they asked me in pre-Op (hearing aid? diabetes? allergies to meds? screaming panic attacks at the sight of doctors in cute little surgical caps? etc.).

10:00 a.m. (est; I'm not wearing my watch): I'm on a bed in the pre-op area, dressed only in my undies, one of those nice cloth gowns that tie in back, a cute little surgical cap for my hair, two disposable surgical booties, and one sock. They bring in all my stuff and send my parents home. They guess that I'll be done and ready to go home probably before 1:00.

Nurse has trouble getting the vein in the back of my hand to straighten out for the IV connector. She explains kindly what she's doing and why, apologizing repeatedly for the pain. I ask her whether most patients eventually give in to the torture and tell where the treasure is buried. She laughs and says she's never heard that line before. Maybe she's just being polite.

My doctor, Mr. Automata in our intial meeting, breezes in with a cheery and human-looking smile. We converse briefly about the right knee being the right knee, or the correct knee being the correct knee. He sent me email yesterday in response to a question of mine, saying "I'm looking forward to tomorrow." All of this is confirming that people go to medical school primarily for the joy of being able to legally poke other people repeatedly with sharp objects. When I mention his message, he says he always looks forward to the chance to make people's pain go away. It's a good line. Would probably hold up in court.

The nurse finishes pinning both the back and the front of my left handage and brisks herself away in search of substances to inject into the tubes and thereby into my circulatory system.

The anaesthesiologist, a very nice man, comes by and we have a brief discussion about the right leg being the right leg, etc., and then progress to a longer discussion about epidural (spinal) numbing or general anaesthesia. I really don't want to do the latter. It's scary, because you lose control of your body and your ability to respond to what it's telling you and so on. The doctor tells me that he has the same reaction, hates losing that mental control, but when he's had surgery, he had general, and he strongly recommends that for a variety of reasons. Epidural has small but slight risk of damaging nerves. More painful before and after. Recovery can take hours. More side effects likely. Sure, it's a commonly used procedure where they want the patient to be aware, as in birth deliveries, but they don't often use it there for knee surgery. General has its risks, too, but I'm a very low risk patient and he has no reservations at all about recommending the general for me. He gradually convinces me. He says that it's a bit of a phobia, wanting to avoid that general anaesthesia, and he'll give me something nice IV (valium-equivalent) to help me feel better about the decision. And about the surgery. And about life, the universe, and everything.

They are kind enough to have me read and sign all the various releases and disclaimers BEFORE they give me the "what-the-heck-life-is-beautiful" drug. I've had no time at all in which I needed to have novels or crossword puzzle books, although I do manage to snap a couple of photos (and nurse takes photo of me in the bed).

10:30 a.m., more or less: I feel great! A little distanced from the world, but just hunky-dory happy, calm, and peaceful. Everything's going to be just fine, yessirree. They wheel me into the operating room and I wiggle myself from the card onto the table with a little guidance. Dozens of people are bustling around doing whatever it is that people bustle around doing in operating rooms. Maybe if I ever watched TV (ER?) I'd know.

In the recovery room. With cap off.

Recovery room. Is it me or the camera that's a little wee bit skewed at the moment?

Apparently one of the things they do while bustling around is wrap my leg in surgical gauze and ace bandages, because I'm now lying there in the recovery room, opening my eyes (when did they close?), with my knee all bundled up. I suppose that some of the bustling also involved surgery, but you couldn't tell by me. I feel just the same as I did 30 subjective seconds ago while I was moving onto the table in the operating room--awake, comfortable, calm. The clock says, I think--

Blood-oxygen monitor. No sharp pointy things involved.

Post-surgery meal: Bread and water.

Noon-ish? Various very nice people ask how I'm doing, feed me some Vicodin, water, and graham crackers, call my parents, check my various status indicators, read me my instructions for the next few days, have me sign a release stating that I acknowledge still being alive after the surgery, and so on. Dad is there before they're even done with all that, and I get into my clothing and take a couple of steps into the wheelchair (so I didn't need the snacks I packed, the novel, the crutches, or the ice machine--I'll put that on at home). They wheel me out to the curb, dad drives me home and settles me in.

At home now--my view from my sofa nest. Finished putting lights on yesterday. Decorations are still in boxes.

You can see my three loving guard dogs hanging around my sofa nest (Jake left, Tika bottom, Boost by tree), and some boxes of tree decor, just waiting.

The icing machine. Looks like a cooler--well, I guess it is, with a motor and a hose and a thing that wraps around my leg and conveys ice-cold water automagically.

My sofa nest.

1:45ish Dad is gone, I'm here in my couch nest, the ice machine running. The surgical dressing is so thick that I can barely feel any coolness, but I'll just leave it on, letting it do its job. Leg feels fine, but the instruction sheet says "marcaine (a type of pain medication) was placed in your knee after the surgery, which will significantly reduce your discomfort during he first night. When this wears off, you may feel increased discomfort." Something to look forward to. And to discover whether "increased discomfort" is a euphemism for "bring on the morphine now, by the truckload please."

I feel no nausea, maybe a teeny bit of light headedness when standing (but that could've been from lack of food, too), and right now I'm feeling a teeny bit headachey (could be from lack of food, lack of sleep, aftereffects of anaesthesia, or just random headachability.

I think I'll have more food, see whether I can xfer this to my real computer to post on my blog, and maybe take a nap.