Tuesday, May 31, 2011

Update and Then Some

Not much cooking here so the update will be short and sweet.

On the Joint Replacement - I'm doing okay.  Not great at this point.  The knee is healing but there is still lots of work to do and tons more physical therapy.  More on that in a later blog.  Overall, I can get around but I still have lots of stiffness and pain.  I am trying to wean myself off the pain meds so am not really someone fun to be with at this point.  Yep, there are moments when I ask myself why I did the surgery but I know the answer - I opted for short term pain in lieu of long term pain & disability.  My husband says I traded "intensity" in terms of pain for "duration" in terms of time to heal.  So I traded lifelong pain for short term surgery and pain that was much more intense.  But I am healing and looking forward to less pain and more movement in the next few weeks.  Do wish me luck and keep me in your prayers.

On the hummingbird wars out back:  Well, I think the female (Little Bit) won for the time being.  She seems to be the only hummer feeding at the feeder.  While I wish there were more hummingbirds coming to the feeder, I am happy to have the little sweetie stopping by for a drink of sugar water now and then.  My dear husband has been keeping the feeder full while I recuperate from surgery....along with keeping all the other bird feeders full.  What would I do without him?  I do not know and do not want to find out.

Til next blog - happy trails and see you later.

Friday, May 13, 2011

Joint Replacement Update - Recovery by the Numbers

It's my second time around and I am thinking recovering from joint replacement surgery is a numbers thing.  My corner of the world has gotten smaller and everything in my small world is associated with a number.  So here goes:

0 (zero) --- The degree the surgeon and therapist wants my knee to be when lying on a flat surface - that is the back of the knee touches the surface and can be measured at zero degrees.

1 ---  Times per day to take oxycontin and Celebrex although I reduced that to zero once I had experienced the side effects full on......dizzy is one thing, full blown shivers and itching like I'd been in poison ivy is another.

2 --- Times per week the health nurse comes to draw blood to test the warfarin/coumidin levels and there is a corresponding 2 times per week that the pharmacy calls to advise of the number of pills for the next dose of the medicine....so far, 3 pills 1 time per day.

3 --- Times per week the physical therapist comes to do the official therapy and exercises. This is not to be confused with the 2 times per day that I am supposed to do the exercises on my own.

4 --- Miligrams per dose of dilaudid I can take for pain as needed,  Or, is that 8 MG in up to 4 pills...will have to ask my trusty care-giver on that one.  (I have to say that I would be lost without my wonderful husband who it turns out is an excellent care-giver.  He keeps up with all the details, keeps up with the chores and meals, helps me in/out of bed, and keeps me sane.  I feel nothing but sympathy for those who have to go to a rehabilitation center after surgery or who do not have someone close to them to help with the recovery.  This is a hard thing to go through alone and I am so blessed to have a wonderful husband here to help me. He is, of course, number 1.)

4 --- Four (4) is also the pain number that the doctors say is the pain management thresh hold.  On a scale of 0-10 with 0 being no pain at all and 10 being totally intolerable and excrutiating, they figure 4 is a somewhat tolerable level and the goal is to keep the pain at 4 or below.  Personally, I would prefer to keep the pain at one and below but I am finding that there is no such thing as a pain killer; there are only pain "dullers" that kind of knock the edge off so you don't sit for hours rubbing your knee and moaning, groaning, and asking yourself if the arthritis pain was really so bad that you really needed this surgery.  At a pain point of 4, you might ask the question although you already know the answer - the pain was bad enough and the limping was problematic enough that you needed the surgery...but it is a question that I have asked myself often in this past week. But everyone feels their pain differently - four for me is not good; for others, their four might be barely noticeable.

1 --- Back to 1 as in "one day at a time" which is how I am coping.  I feel a little like this is a 12 Step Program for arthritis sufferers and I am nearing the last steps (no pun intended) with this 2nd knee replacement.  I know that, given enough time, the body heals unless you have a disease or cancer that evolves too quickly for the body to deal with.  But joint replacement, barring an infection or blood clot causing nasty problems, is one of those injuries that will heal over time.  And the therapists tell me that, given enough exercises, the knee will heal very well and I will be walking around good as new (maybe better) before long.  But in these first weeks after surgery, there is no room for too much optimism - just get through another day and I am one day closer to recovery.  And, given the body's propensity to forget the pain and dull the memory of traumatic injuries (even surgical ones), I am looking forward to the day when I will be able to tell all my friends what a great decision it was to get the surgery and all about how I should have done it sooner.  Actually, the decision was "to walk without pain" in the future as opposed to walking with pain or not walking at all...not really a decision at all.

89 -- This is probably my favorite number.  Absolutely everyone I know or have met or talked to about my surgery knows at least one 89 year old woman who was back on her feet in no time and shopping at the Super WalMart within 2 weeks or back to working full-time within 3 weeks after surgery.  It is astounding how many 89 year old women are out there roaming the aisles testing out their new joints and not having any trouble at all.  I imagine that every 89 year old woman I will ever meet will have had a joint replacement and we can share stories around the camp-fire.  I suppose the intent in telling me about this possibly fictitious Super Woman is to encourage me and remind me that I too, being nothing more than a wimpy 58 year old who cries at the drop of a hat, hates physical therapy, and who struggles to push the walker around the living room let alone a distance equal to the Indiananapolis Speedway, will also heal.  But, as you may surmise, it doesn't encourage me at all - it annoys me that I cannot measure up to this Walmart shopping Super Woman (and why particularly the Walmart - don't they ever shop at Super Fresh or Home Depot?)  I will say that mostly I try to smile and offer congratulations and best wishes to all those 80-something year olds who recover so quickly.  Maybe there is something about turning 80 that gives us all super powers to heal...sorry, I couldn't wait to find out - my knees were shot at 50-something. But I am looking forward to experiencing the healing powers that will envelope me on my 80th birthday!

300 - 500  ---  Speaking of walking.  I received a joint replacement handbook from my surgeon that provides all the information you need to know but were afraid (or too ignorant of the whole process) to ask.  It shows all the exercises one should be completing 2 times a day for up to 12 weeks after surgery.  Right now, I am in weeks 1-2 and the exercises are appropriate for me at this stage....more or less.  I actually think this handbook was written by an over-achiever (perhaps 89 years old) or someone who is just mean.  During this period I should be walking (with my trusty walker) 300-500 feet 6-8 times per day at a pain level of 4.  Now, my math is rusty but, let's see, if I carry the naught and cipher on this a bit, that works out to be 1800 to 4000 feet per day (broken up into bite-size chunks, of course).  Now if 5380 feet equals a mile, then I should already be walking almost a mile per day and the staples are not even out yet. At this point, when I am awake enough (since the pain killers also put you to sleep rather nicely), I can maybe get out to the mailbox and back maybe twice.  Then I try to work through the other exercises (leg lifts, quad crunches, and such) and then I try to sleep through the pain all that movement caused.  And by the third week - lo and behold, I will be adding more distance and exercises to the plan and moving from the walker to a cane.  Stick with me, folks, by the end of this program, I might be running marathons.....according to the handbook.

90 -- This is the range of motion number.  The knee should "flatten" to 0 degrees and, in the beginning, bend to 90 degrees.  Ultimately, the goal is 120 degrees.  I learned the hard facts with my first knee replacement.  The numbers seem innocuous enough but you do not want to know what the therapists do to help you achieve these goals.  They put the "pain & tortune" in PT.  I will, no doubt, have another opportunity to experience the thrill of having to do it all over again in future so I will leave that posting for another day.

I am running out of numbers to share so I will end with two final ones -

25 --- the number of staples down the front of my knee holding it all together.  There are inside stitches for the muscles that will dissolve over time and who knows how many but the skin on the outside is held together by the staples that will be removed at my 2 week check up next week.  And, I have to say, that with all the pain otherwise associated with this procees, the staple removal is practically painless - the nurse had about half of them out last time before I even knew it.

AND finally, "As many as possible" - yep, this is the number of naps I try to take during the day (and night).  If I can get comfortable at all during these first two weeks, then I fall asleep.  One must sleep when one can.  And, you guessed it, I feel the timing is right for a pain pill and a good nap coming on.

Wednesday, May 4, 2011

Just a Little Note about a Little Bird

Our hummingbirds are back.  I say "our" because we've had two (boo hoo, only two) hummingbirds to spend the summer with us for the past few summers.  A male we have named "Buster" and a petite female we call "Little Bit".  Unfortunately, they are not the least bit interested in each other and appear to be sworn enemies.  Each has claimed the feeder we hang off the back deck as his/her own.  And each guards it vehemently.  A couple years ago, I hung two feeders on either side of the deck assuming that the fight would end and each would have a feeder to call his/her own.  But that didn't work.  That year, the female laid claim to both of the feeders. She found a perch in the oak tree that allowed her to see both feeders and she attacked any creature, large or small, who dared to taste the sugar water for themselves.  I finally took one feeder down - neither hummingbird seemed to be in a sharing mood.  This year Buster seems to have the edge.  He sits up in the tree and comes zooming down like a bat outta hell if Little Bit so much as flies by the feeder. I have seen her slip in and catch a quick drink but she swiftly flies away at his approach.  Having seen these two birds have at it and dive bomb each other and tussle all the way to the ground, I find myself wondering about their ferocity.  Do you suppose God made hummingbirds fierce because they are so small or did He make them small because they are so fierce?
 Guess that is a question for the hereafter.

Little Bit (top) and Buster (bottom)

Joint Account

Arthritis.  I have it.  I am not sure how one "gets" it but it seems to have affected the daughters in my family and not the sons.  And it seems to prefer our knees.  And knee replacements seem to be the remedy of the day. I had (and continue to have some problems with my neck) but it is the knees that have given me the most problems.  My pain started sometime in 2006 and maybe a little earlier. But in 2007, I really ran into trouble when somehow or another I tore the meniscus in my left knee - both sides.  I had arthroscopy to clean things out a bit and to trim the meniscus.  It gave me relief for the moment.  However, my orthopedic surgeon told me that when he looked inside, things were much worse than he had thought and that I would eventually need replacement surgery.  Well, I wasn't really up for any of that kind of talk...after all, at that moment, I was feeling pretty good and walking just fine.  But it wasn't long before I was feeling the pain of "bone on bone" with every step I took.  It was really hampering my style and my activities.  I love gardening and poking around outside pulling weeds and planting flowers. And I absolutely love birdwatching.  I've gotten so much into birdwatching that we plan our vacations around birding hotspots.  But birds live in the woods and in parks and that involves some walking so the arthritis was more than annoying.  And then there was work. The commute downtown involves waiting on the platform for the train, then changing over to the metro at Union Station, then changing metro trains, and then walking three city blocks to get to the building where I work.  Lots of opportunities for knee pain and stiffness. By evening when I got back home from work, I was seriously limping and hurting.  You can only take so much Advil and all those joint remedies just do not fix the problem.  But I kept putting things off.  I would see the doctor occasionally and he would give me the same ole story - you need a replacement. What I needed was more gumption - guess the pain wasn't bad enough to get me to risk the surgery.   In December of last year, the right knee got involved.  So now I had pain in both knees but hoped that the right knee had not deteriorated so much and could be saved.  Of course, arthritis cannot be cured so much as treated and tolerated.  At the end of January, I had surgery for the left knee.  The surgery is not so much a "replacement" as a "re-surfacing" to add titanium and plastic to the bottom of the femur, the top of the tibia, and the back of the kneecap.  This is not a tutorial on the subject and I am not an expert...you'll have to look it up if you want to know more at this point. There are tons of videos on YouTube that show the procedure very graphically that I dare not watch.  This was, by far, the most traumatic medical procedure I had ever had and it pretty much kicked my butt.  Recovery has been slow at times but I am recovering.  Unfortunately, the surgery and therapy for the left knee has further aggravated the right knee so here I am again heading for replacement surgery.  When I got the left knee replaced, I sent out email updates to my close friends and family.  For the right knee, I will take you with me.  Why have a blog if you cannot share experiences?  The surgery is tomorrow.  I am nervous but not so much as I was the last time.  This time I know what to expect.  That is good and bad.  I know it will be hard and there will be lots of pain.  But I also know that the body heals and I get stronger each day. And I know I will need lots of naps - sleep helps when you're healing. So the surgery is the event; the healing is the journey.  Stay tuned - we're in for a ride.