Day Thirty-Four

Today was my first out-patient physical therapy visit that wasn't in the pool and the physical therapy that my recovered knee replacement comrades still talk about.  The physical therapy for which surgeons prescribe the pain killers.  Up until today, I've pretty much had control over my stretching, bending, pulling...basically, how much I've wanted to hurt...but therapist Vinny (no relation) showed me there is a whole other level of discomfort I was subconsciously avoiding.

He started out by having me sit on the table with my legs straight out in front of me while, from the top, he pushed the back of my knees into the table, one at a time, with what I could have sworn was all his weight.  It's called working on the extension which the PA told me last week couldn't be any better? 

When I came to, he was trying to sneak my heel back to my butt a little at a time.  I was still lying on the table but my this time my knees were bent like I was doing girl-sit-ups. 
"How does that feel?"
"Great," I grunted while clutching the sides of the table to keep from slapping him.
Once he got my heel as close to my butt as it was going to go, he held my foot in place with his hip while he took way too long to measure the flexion.  115 on the right and he guessed 120 on the left after dropping the calipers just before he got a good look at the numbers but knew better than to mention trying it again.   Just getting it to 115 or 120 isn't bad, it's the holding it there that makes me nauseous.

After the hour of torture he told me that my progress was "right about here" with a shoulder height, horizontal hand signal  across an imaginary vertical scale that I took to mean 'about average'.   What happened to the top 80% Dr. Huber?  Then he said that the only thing that was really bad...I don't think he actually said 'really bad' but that's what I heard....was my gait.  How can something I've been doing since I was one be so difficult?

I asked him what I should do for my PT at home this afternoon.  He said to play it by ear and that I may not be able to do much of anything given what I'd done with him this morning.    Of course I knew that would never be the case....but it was.

Day Seven

That's my leg in a contraption that flexes my knee while I just lie there.  You know how I feel about exercise equipment that does the work for you?

Tim, my smart-thorough nurse came and took out my staples.  I think that was the most painful thing about the surgery for which I've been awake and the first time I'd regretted having both knees done at the same time.  One staple wouldn't have been bad but forty seemed to go on forever.  Some stuck and pulled but most of them didn't so that was good.  I tried to keep screaming to a minimum even though Tim said I could scream as much as I wanted. It felt like 200 degrees in the house.  I signaled for Tim to 'hold off for a second' while I scrolled through our CD collection until I found "Run Around" by Blues Traveler, turned it up until the windows rattled and gave him the 'GO' signal.  That worked.
 
Physical therapy came.  She told me to keep my movements slow whether it was exercise or household routine....no problem there.  Added standing-at-the-kitchen-counter exercises and up an down the stairs to my laying-down routine.  My right leg flexed at 96 and my left leg flexed at 95 so I'd progressed when I was positive I hadn't.  I crutched around the outside of the house five times.


I ate more than my maintenance calories.

Pain and fever are still monkeys on my back.

My blood is still too thick (clotting risk) so I increased my Coumadin level again. 

Picked up the neighbor's rocking chair (another knee replacement survivor).  Vin glued it in a few places and now I can work on flexion without thinking about it.

Thirty-Six Days

Weird.  I skied 2:10 on the flats, did 10 minutes of upper body rowing and have pretty much no pain.  I think skiing on powder is good and skiing on frozen granular is bad.  Whatever it is, I'm not complaining.  Skiing on the flats like I've been doing won't increase my fitness.  I doubt I'm even maintaining but being out does wonders for me mentally and since I'm sentenced to the couch most of the time, getting out is HUGE.

Even with a pill, it was hard to get comfortable enough to sleep last night.  Although I have very little pain right now, I'll probably take one before I hit the sack tonight since the pain is more obvious when I'm in bed.

I find myself getting cocky and walking without crutches when the pain isn't bad and it ALWAYS sets me back.  It's usually the next day or later in the day when I ski that I am kicking myself.   I should always use my crutches to keep weight off my right leg/knee.  The knee is always swollen and even when it isn't hurting, it is too swollen to straighten...another reason it's hard to walk and crutches are good.  It's swollen hard.  It used to be swollen and more liquidy soft and spongy.  The baker cyst isn't bothering as much as earlier in the winter. 

I'm babbling.

Forty-One Days

Less than 6 weeks !  yay.   Six more weeks of my legs continuing to atrophy.

There used to me a muscle there on the outside.

So Saturday I got rescued by a snowmobile and today I skied 2:20...most of it, north of here in the hills.  I was never anywhere I could've gotten stranded.

No pain to speak of and just 1/2 of a meloxicam.  Who knows?  I have a theory.  My knee has been swollen so long and so hard that it seems like things are getting used to being stretched...therefore it's not as painful.

Got a hydrocodone refill (5/325s).  Think I'll try just taking one before bed if I need it....none during the day unless I have an explosion.  I seem to be able to ski with the meloxicam.  I dread going to bed.  Tossing and turning like I do makes the nights so long.

My rented Ford Focus got stuck at the end of the driveway  today with me in it.  I put all of the groceries in my backpack and crutched up the driveway, traded one crutch for a snow shovel, got some ashes and crutched/snowshoveled back to the car.  A few ashes and what seemed like enough shoveling did nothing.  I was sure I'd drive right out.  Finally the neighbors that were watching through their window 10 feet away came out to help and a half hour later I was driving out of the hole we'd dug.  (Thank you neighbors!)  

THEN my knee hurt.

Forty-Two Days

A more cheerful sitting situation there could not be.

I sit on that pink couch all day.  Ignore the wires and it's a pretty happy spot.

I do best if I can stay off my knee other than getting a little exercise.  As much as I hate sitting all day, I know I'm lucky to be in a situation where that is possible.

I have to say I have been pain free all day.  That's before, during and after a 2 hour ski along the river.
Plus 11 minutes of one legged upper body on the rowing machine.

Ice and 1/2 meloxicam.

I'm trying to get up enough courage to post a photo of my muscle-less thighs.  I caught site my right thigh the other day and thought it belonged to someone else.  Like to someone from Biafra.

Forty-Seven Days

Did 35 minutes of upper body rowing while watching some 'Reno 911'.  Skied 1:35 in 35 degrees after a night of rain.  Took 1/2 of a vike before I went out but not even sure I had to.  The knee is still very swollen, firm and ugly.  Because the general knee swelling and huge baker cyst,  it is impossible to straighten my leg. I have to walk slowly and with a limp.  Nice.

It was very damp last night and this morning but I had very little pain.  Even though my knee is firm (it USED TO jiggle when I tapped it but now it doesn't really move), it seems to be less swollen.  I did ice and took a half of meloxicam today.


Somedays I feel like something as specific as a knee replacement couldn't possibly fix all of the wacky knee things I have going on (firmness, baker cyst, limping) and today was one of those days.

Forty-Eight Days

Did my pain management and skied 1:20 south along the river.  Heaven.  Do I sound like a broken record?  I was actually hoping to get to the point where I sounded like a broken record....i.e. find a routine that worked.  So now I know how I can get away with a little ski, I rented a car so I'm not stranded here on the couch while Vince is in school 9 hours a day and my couch nest is right where I want it...filled with good books, a writing pad and knitting.  Life is good.

I still have pain but it is tolerable.  A week ago I didn't know how I would make it to March 12.
The knee is still very swollen.  I googled 'swollen knee + coagulated blood' and got a couple articles.  One where the guy died and the other where they amputated the leg.   Then I notice the articles were from 1880.

Forty-Nine Days (and some Fifty)

I hope it's not bad luck to miss the post with 50 days to go.  I'm down with the pain management.  Pre-ski vike and 1/2 meloxicam.  Skied 2 hours today and 2:15 yesterday.  Both days started out south along the river.  Yesterday I climbed up out of the valley toward Greensboro which felt fine but coming down, which is generally pretty close to the most fun thing ever possible, was sort of scary.   I've never been aware of my knee in a snowplow and this time it was all I could think about.  The doc says I can't do anything to make the knee worse but what I'm worried about is short-term....having it explode and getting stranded.
You're wondering why I take, what sound like, chances.  I want to be fit for the surgery and I love being out so it's worth the little bit of risk I am taking. 
My knee is swollen as usual. Instead of being mailable, liquidy and loose, it's a bit spongy and sort of hard.  NOT liquidy.  I'm going to do a little research of my own because it's different than it used to be.  The PA and doc aren't concerned. 

Fifty-One Days

Took a 1/2 vicoden** and 1/2 meloxicam an hour before I went out for a ski*.  I headed north from the house which meant there would be a few steep-ish downhills on the way back home.   I'd been avoiding this route due to fairly shitty conditions but the new snow last night should make it more-than-likely doable.  Half way around the loop I was not totally surprised when I felt my knee swelling so I headed home which was the same distance either way. :)  I was out 1:50.  It was delicious.  Sunny, 15 degrees and new snow.  Yum.
I iced when I got home and was very comfortable.  Comfortable enough to do 20 minutes of upper body on the rowing machine and go out again flat along the river for 1:10... with no more medication.  Now, showered and reclined on the couch, I am pretty much pain free.  High pressure*** again but I think the meloxicam may be working for me.
I've 'always' been passionate about getting some exercise everyday and having the surgery coming up, in the spirit of a quicker recovery, I'm even more determined to get out everyday.
*when I mention skiing, it is always Nordic skiing.
**all the books say that after surgery, for PT, the patient should take a pain killer in order to get the most out of the PT session.  Seemed like that same protocol should work for skiing and I want to go into the surgery being as fit as possible.
***I like to think weather has an effect on my arthritis even though I know it probably doesn't.

Fifty-Two Days

I think I'm getting the hang of the pain management.  Took a half of vicoden and half of meloxicam after I skied 1:20 so I could sit without moaning.  I really think the meloxicam works.  Is it possible that I have come across an anti-inflammatory that works for me?  And then there was high atmospheric pressure today too...that never seems to hurt.

All in all...pretty darn comfortable today.   The pain is thankfully at a level I could tolerate until March 12.  I'm thinking I may do a slightly more ambitious ski tomorrow. 

For the record....this is my personal knee journal and probably wouldn't be interesting to anyone with good knees.  In fact there is a good chance it wouldn't be interesting to anyone but me....IF it's even interesting to me.  In my defense, I would love to read someone else's pre and post-op knee journal as I'm waiting for surgery just to compare notes.

Fifty-Four Days

I carefully stepped out of bed and just stood for a minute until I was sure I wouldn't have a knee explosion.  Good to go.
Downstairs, I was on my leg (with crutches) as little as possible.  A minimal amount of personal grooming, tea and just enough oatmeal for me to feel safe taking a multi-vitamin.  Oh, and I washed a couple of windows so when someone asked me what I did today I wouldn't have to say I JUST sat on the couch.
About 8:30 I went to my pink perch (couch).
It was about 10 AM and I usually don't feel like I've wasted the day until around 2 so I was feeling pretty good.  What the hell?  Now my left knee was swelling.  Of course my right knee was swollen...just go ahead and assume that is the case unless I tell you differently.  The pain wasn't horrible (a 6 or 7?)...'ambulance' hadn't even entered my mind....but I was having a really hard time moving.  Rain was in the forecast (always my first thought).  I had to get some fresh air.  Vince says even though we don't get a signal here, 911 would still work.  Slap me, but I put some special blue on my skis and headed out along the river with the phone.  I managed to propel myself to King Farm Road and back in 1:10.  A record for slow.  I stopped and sat a minute on a rock at the side of the trail.  The trip back was a little easier.  The day was mild, windless and overcast.  Very therapeutic.
When I got to within 50 feet of the house the pain started talking to me....still not a 10 but similar enough to the pain on it's way to a 10.  Without even taking my boots off I was breaking a vicodin in half until I remembered not 'staying ahead of the pain' nightmares and took the whole thing.  It's scary being here by myself not knowing what causes the spontaneous explosions.
Anyway.  No ill consequences with the ski.
Did 20 minutes of upper body only on the rowing machine.  I'll bet the left knee was reacting to the last few days of the one-legged indoor exercising.  None of that today...couldn't if I wanted to anyway.

Fifty-Five Days

Another day in a row that I was able to get up without excessive pain.  I was leery but for no reason.  I had an abysmally unproductive couch day except for finishing the xmas card.   I was here alone....Vin's first day of school.  Very strange.  Did 15 minutes each of one legged bike trainer and rowing machine.  Skied to the hill above town and back (1:10).  Took a pill when I got back because the knee felt tight and I was worried there might be another explosion fiasco. 

Doesn't even look like a body part

The egg is almost gone except for a little bruising.

Guy from the ortho clinic called to give me an appointment time with the rheumatologist at Fletcher Alan for tomorrow.  Vin has school and we have one car so that didn't work.  Rescheduled for April.  Doesn't sound like an emergency and I think it would be sort of a wild goose-chase anyway.  I'll go in April and do a little research in the meantime.  The reason for the alarm is that the ANA level is elevated to 160.
I have to come up with a name for the right knee.  That will be my project for tomorrow.
And that's about it.

Fifty-Six Days

For a minute there I forgot what I was counting.
So far....a good day.  Got up, albeit a bit nervous, and my knee was OK.  I was careful around the house.  Mostly sat while painting a cabinet.  Iced a couple times.  Couched some.  Skied 1:10 along the river to the hill before Craftsbury Village.  Good tracks pretty much.  Did 30 minutes of one-legged rowing.  Icing now and still OK.  Skiing pain seems to hoover in the 7 to 8 range but is tolerable and stops when I stop.

Baker cyst with compression sleeve indentations.

Most of the pain seems to be radiating from the baker cyst.

Fifty -Seven Days

The knee was tight when I woke up making me worried I'd have a knee explosion so I stayed in bed and read for a half hour as a transition from in bed to out of bed.  Don't know if that was the reason (probably not) my knee was pretty OK all day.   Iced a couple times.  Couch surfed except for 30 minutes of one-legged bike trainer and 30 minutes of one-legged rowing machine.  Skied for an hour along the river with no tracks.  3 degrees, no wind, sunny.  New sparkling snow. Yum.  I don't know if it was a good idea to be out (doh) but it was so beautiful I couldn't help myself.  It's really not clear what causes the 'episodes'.
I want to be as fit as possible going into surgery so recovery is faster....that's what they say.  I am relatively so unfit now.  Any exercise I try to do right now is just going through the motions but I'm guessing it's better than nothing?

Sixty Days

I'm not sure I can wait sixty days.

I woke up with half of a vicodon next to the bed and, as planned, I was going to stay ahead of the pain today.  I took the pill and got up.  As it turned out, half of a vicodon was too small of a quantity and too late because within minutes my pain was unbearable AGAIN.  Vin was working in the living room where his concern was surfacing in anger.  I was able to sneak upstairs where I figured I could be out of his way while I waited for the pain meds to kick in.  They weren't kicking in and soon the pain was off the charts.  I didn't know what to do.   The pain was indescribable and there was no way I could make it downstairs and then to the car to get to the ER.  It was 9:30 and I couldn't wait until my 2:30 knee draining appointment with Leah.  I had to have it drained in the ER.  Vince called 911.  An ambulance came.  The lights were flashing as they loaded me onto a chair thing that got me down the stairs.  The meds were starting to kick in and, although barely, the trip to the ER was tolerable.  Yada yada.  I ended up waiting for Leah at 2:30.  She attempted to drain the knee as usual but the blood/fluid was so viscous she was only able to extract 28 ccs.  She pulled on the syringe for about 5 minutes.  Guy helped by 'milking' the fluid toward the needle.  At one point we all jumped because something 'let go' and Guy said a large amount of the fluid shot out.  Usually in a minute and with no apparent effort she is able to extract 75 to 100 ccs.  She band-aided the needle hole.  I didn't experience the relief I normally do.  When I got home the compression sleeve was soaked with blood and the 'wound' was still bleeding.  Surrounding the 'wound' was a bruised swelling the size of an egg.  Leah has drained my knee at least 20 times and nothing like this had ever happened.  I called the office.  Lisa answered and I explained this unusual (for me) series of events.  She said Leah was with a patient but she would have her call me.  A half hour later Lisa called back telling me to 'take two aspirin and call me in the morning' (except 'don't call me in the morning').  I asked Lisa several questions, none of which she was able to answer except when I asked her what her position there was and she told me she was a scheduler.

Anyway, the knee is still embellished with a bruised egg that is bleeding.  What's going on?

My big worry is....since draining offers no relief....what do I do if (and I know it will) the knee does that pain thing again.  I feel like the only thing I can do is be medicated ALL THE TIME.

Sixty-One Days

I think I toss and turn because of the knee pain and then the pain get worse.  So a double whammy.  How else can I explain this?  I was completely awake this morning and could feel my knee hard with swelling.  I knew when I got up it would probably really swell and be unbearable like yesterday.   Everything I read about pain is to stay ahead of it but my pain meds were downstairs and I was upstairs.  I inhaled and ran...or let's say moved as fast as I could which wasn't very fast...straight to the meds in the pantry with a really full bladder.  Too late (for the meds I got lucky with the bladder).  Within minutes the pain was a 9.5 but the timing was better than yesterday.  I think I may have gotten a little jump on it.  Tonight I'll have the meds near the bed and take them before I get up if need be.  I'll get it figured out.

Even hating needles as much as I do, I couldn't wait to get to the doc to get my knee drained today.  When I got there they told me my appointment was tomorrow.  :( For a change, I wasn't the one that made the error, it was the desk person, but evenso, the knee drainer was out and I was out...of luck.