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Tuesday, May 31, 2011

Contemplating the Night

A week or so ago it occurred to me that if I were more active I might sleep better. That has usually been the case. Last Wednesday I returned to the gym, taking an Aqua class, and I have gone there every day since, except Sunday. I either do Aqua or I do a set of exercises upstairs, using the equipment. In addition, I am going to physical therapy three days a week, and these sessions tend to last about an hour and ten minutes, a workout in themselves in a different way.

By night, my leg feels stiff and I am not walking smoothly. I have to talk myself into standing tall, placing one foot down and then the other, putting my weight on the inside of my feet, pulling my stomach in. I don't always do all of this because I feel achey.

So off to the shower I go. It feels nice while it lasts, and I am for sure racking up the therms on the gas meter. But the calm does not last, not in my leg anyway.

And so I lay in bed, my leg occasionally seizing up or going into a spasm or just plain aching. The theory isn't working; more activity is not helping.

I have also started taking melatonin, two three-mg tablets at night. It hasn't hurt anything that I can tell and it might be helping. I am not taking tylenol pm but I seem to get about the same amount of sleep, fitful and interrupted though it is.  I also take Vicodin, but that supply has now run out, so I'll go back to Percocet. Hard to tell any difference between the two.

I'll admit it: I'm writing this as another means to divert my attention from sleep and my wanting it.

Monday, May 30, 2011

Off to the Theatre

This afternoon I went to see a movie. I had gone to Aqua class and then enjoyed a potluck at the gym, and I thought it would be good to see if I could actually sit through a movie.

I could. Yes, I was stiff, damn it, and I had to set everything down before I could help myself get up, but it was okay. The film? The Greatest Movie Ever Sold, by Morgan Spurlock. See it! It's very funny and alarmingly true. Spurlock seems to have recovered fully from being supersized, too. He looks good.

I was wearing a jacket in the theater yet I was still cold. It seems like I am cold a lot. Could be because it's been cold this spring. I hope that's the reason and it isn't because some meter in me has stopped working correctly.

Sunday, May 29, 2011

Revenge of the Right

Today I went to the Strawberry Festival in Arroyo Grande, about 13 miles from home. This is a giant street fair, covering many streets up and down and back and forth in the "Village", which is the older commercial part of town. I parked on a dirt lot some distance away and took the shuttle to the festival. I spent about an hour walking up and down and around and finally back to the bus pick-up spot so I could return to my car, carrying strawberries of course.

Lately, and especially today, my right leg has started to complain when I walk. My hip hurts, my knee hurts, I feel twinges in different parts of my leg. My last therapist warned me that this would happen, that the change in alignment of my body would start to aggravate the pain in that leg. The ultimate solution is the right knee replacement, but for now I have one straight and one crooked leg and I have to figure out how to deal.

I thought maybe if I just walk longer it will ease up. It did seem to ease, just a little, but not much. I'm fretting about this a bit because I don't want to be limping on that side, I don't want to be just as gimpy as I was before surgery. I want to walk as normally as I can and feel as good as I can. So I will continue to work it very slowly and carefully, and when I see Paul on Tuesday I will ask about it.

Saturday, May 28, 2011

And at Night

I occupy myself as long as I can manage, which often isn't long, before I head for the bathroom to take some acetaminophen p.m.. I have tried different combinations of drugs at different times. Mostly, now, I take the sleep pills at eight or eight-thirty at night, and wait, if I can, for at least an hour before I head for bed. Sometimes I take Vicodin at the same time. Sometimes I wait. Always I am wanting to not take any pain pills at all, and so far always I have failed. I always take some, lately two earlier, two later, total four.

I try to find a comfortable position in bed, and sometimes I can do so right away. I read but am not sleepy. Finally, after reading a while and adjusting my position several times, I do start feeling a little sleepy. I put the book on the table and switch off the light.

The demons in my leg will often surface at this time. It's something like "restless legs", a discomfort that I cannot ignore. I try different positions again, slow down my breathing, try to let go of thoughts. It doesn't work. I switch on the light and sit up, turning my body to the edge of the bed, letting my legs fall over the side, hang there a while. I may just sit there a while or I may pick up a book again, read some. Then I may try to find a good position to sleep again, may turn off the light again, but more likely I will pull my leg up onto the bed and stretch it, pushing the knee into the soft blankets and sheet beneath it.

I look at the clock. It might be ten now, it might even be eleven or a little later. I may take more Vicodin, two more tablets. Deep breathing. A shower. Most nights I eventually get up and take a hot shower, letting the hot water cascade over my knee, over my shoulders, onto my back, then over my front, back to the leg. Sometimes I will sit and let it pour down over me, a waterfall of heat.  When I leave the shower I quickly dry off and put my nightgown back on. It is usually not too cold and I do feel some relief from the discomfort.

I sit on the edge of the bed again. I pick up a book and read some. I try getting under the covers again, place a pillow there between my legs or under the left leg. I turn to the opposite side, adjust the pillow again. I pull out the pillow and put one leg, bent, ahead of the other, both on the sheet. Then the other side, same thing. I take deep breaths, sit up again on the side of the bed, read more. Lie down, read on my side, read on my back, read on the other side.

Sometimes I am able to doze for a little while. Next thing I know it is one o'clock. Then one-fifteen. If I did not take some before I may now take more Vicodin because my legs are calling to me again, my left leg, not the right. Some time around two or later I will fall, unaware, into sleep, and not wake again until it is almost five in the morning.

The cats are bothering me. Knowing that one of them in particular will not let up, I finally get up and stumble down the hall, trying to hold myself upright, pull in my stomach, walk on the inside of my feet: in other words, trying to maintain alignment and proper posture. Rarely do I achieve it at this early time. I  dig into the cat food container with the cup measure, filling it, and then pour a third of a cup into each of three cat food dishes, each in its own special location. I return the cup to the cat food bin, close it, return to bed, turning out the lights on the way and shutting my bedroom door to prevent any further cat interruptions.

Again, more arranging under the covers. Sometimes I am able to get back to sleep after a while. Other times I lie there restlessly until the hour is more decent, and then I pull myself up, slide my feet over the edge, sit there a while, finally get up.  I pull the covers up, roughly making the bed. Go to my closet to grab some clothes, lay them on the bed.  I might take another shower or I might just get dressed. Before dressing, though, I sit on the end of the bed and massage the knee scar, then work the patella back and forth, and up and down, trying to loosen it. I may do some of my regular exercises then, or not. Once I am dressed I open the bedroom door and head for the office to check email.

It should not be surprising that I will sometimes feel an overwhelming sleepiness once, twice, even three times during the day. I know that if I ignore it and try not to nap I may have a better chance at night. But I rarely can ignore it, and I often will take short naps, on the couch or on my bed, trying to get warm, and again trying to get comfortable. It seems like I can get comfortable more easily at these times than I could earlier.  Yet in the in-between times I feel awake, not deprived of sleep. I manage to take my little walk, go to the gym, do various errands. Some days I go for physical therapy in the afternoon. I hope to wear myself out enough to fall dead asleep right away and stay there. So far it has not happened.

Friday, May 27, 2011

Getting There is Half the Fun

I went to Aqua again this morning and to therapy in the afternoon. In therapy, the intern worked on the capsule a bit, then we worked on straightening again, to little effect. Paul then brought in a blood pressure cuff, pumped it up, and put it under my leg. When I pressed down we could see the amount of pressure I applied. I got up to six pounds of pressure. Then he used it on the right ("good") leg and I did ten pounds on there. When it got back to the left knee I was pressing about eight, as I recall. Later, at the end of my time there, I got the stim machine on again and was again pressing ten seconds, resting ten seconds, for however long it was set.

Work on the flex showed that I am clearly up to 120 degrees, which compares to 125 degrees on the right leg, and is a functional number. I may not get much past that - but I'd like to.

I then did some step-ups, which were similar to what I do on the stairs outside every day, but which did not require that I use my left leg entirely to raise my right leg. I could let my right leg do part of the work, spring off some. The intern noticed that I was working on perfecting the move, that I was actually "enjoying" it. I guess I was. I then did leg extensions, using a machine, and leg curls on another. All strengthening work. From there to the bike for 15 minutes, then some calf stretches, and finally the stim machine.

I have come to expect a couple of things from therapy: one is at least a portion of the time I will be dealing with fairly intense pain. Another is I expect to be corrected on form and alignment. I didn't get as much pain this time and I was focusing on alignment myself so perhaps I was doing a decent job. In any case, I have to take full responsibility for form and alignment all the time now. I do not want to slip. I find myself looking for my reflection when I can to see if I am doing things correctly.  More and more it's on me to do this right.

I honestly don't look forward to being set entirely free. I believe I have three more weeks with Paul and that's going to be that. However, I can extend the work on my own if I learn what I can do at the gym. I really want to have a good plan for afterwards, working with Clara at the gym.  I have not had a chance to discuss this with Paul, but I started to bring it up with his intern. I'll try to remember to bring it up at the start of the next session.

Thursday, May 26, 2011

I Feel Good! Like I Knew I Would!

Life for me is a series of ups and downs. I expect it's that way for most people. Today I'm on a high and I did not want to miss reporting it.

I went to the gym this morning and did 20 minutes on the bike, working the resistance up to where I was getting a heart rate of 125 beats per minute. At the physical therapy office yesterday the goal was to reach the level of work that would get me to 120 beats per minute and I wasn't entirely sure what that felt like. I think I've got it now. My knee felt a slight strain with every turn on the bike, which suggests to me that it was working the flex just a bit, which is a good thing.

After the bike I did two sets of ten on the leg press, with 140 pounds. I think I can start to bend my knees more on the leg press. Trouble is, with the Nautilus machine I have to bend to the max when I first get on it. I'd like a different design, please.
The leg press at the gym is similar to this.

After the leg press I moved to the hip abductor-adductor machine, to do abductor work. This is similar to the clamshells I am supposed to do at home but with both knees at once so I don't think I can eliminate the clams, unfortunately. Still, I like this machine so I use it.

And that was it for the gym today. Light workout. Which is good. We need to work up to some things. After spending a few minutes in the steam room and taking a shower and getting dressed, I headed over to Trader Joe's for a few groceries, and then to Roxanne's Birkenstocks in the hopes of finding yet another identical pair of shoes to the Earth shoes I wear all the time. Well. Earth shoes no longer makes exactly that pair and what they do make that is similar was not in stock. Poor me. I ordered the replacement shoes. Also admired some new sandals that are built to be easier on your feet and look good. But they did not have any in my size, of course. 

Back home then, to put the groceries away. And to revel in this feeling of Good. When I get in and out of the car now I no longer feel any pain in my knee because I have achieved a high enough level of flex. I can now walk down stairs one foot at a time (no two-stepping).  I was able to go from the gym to Trader Joe's to downtown without feeling worn out. These things are terrific achievements for me. Finally I am seeing real change and loving it. 

I worked hard at achieving change without getting knee surgery and I was only able to get to a certain point and stay pretty much level after that. I am now making noticeable changes week by week and it is just wonderful. At least that's how it feels right now.

Wednesday, May 25, 2011

Feeling Good about Feeling Not So Good

Today I went back to Aqua class for the first time since before the surgery. I was welcomed back by those who remembered where I had gone, and encouraged to do what I could but not push it. I went ahead and did everything. There were some things that I did not do as well as before but I suspect I did some other things better.  Throughout I felt the knee and its stiffness. It felt great being able to handle the class, to answer that question.

A few hours later I went in for my second PT appt with Paul T. This one was quite different from the last which was mostly measuring. At the beginning I sat on one of the soft tables while Paul pressed my knee down. Straightened it, in other words. This move is never pleasant for me (Wade did it too, of course) but I know it's necessary to get that movement eventually. To get it straight. So I managed to take deep breaths and hang on as long as I could, and managed to joke a little through the pain. I know what needs to be done. After the straightening he then had me bend it, and as usual I found it a little painful to move from one extreme to the other. But I managed, did okay in that area. Flex is easier to get because there is wiggle room in the knee to get more bending, even when it is somewhat inflamed. Straight is harder to get, particularly for me, because for years the knee was not straight. So we are breaking new ground in a very real sense.

Then I was off to a bike. I got it going well enough, feeling good that I could do a bike, but when Paul asked how it was I had to admit it was not difficult enough, I was not reaching the level he wanted, which was "moderate difficulty". I pushed it harder, faster, brought it up to a new level, and started to feel like I was working. Did this for ten minutes, felt pretty good about it. From here I got to use a machine I forget the name of - I lay on it on the diagonal and bent my knees until I couldn't any more, until I reached a stop point, and then slowly raised myself again. Because of the diagonal I wasn't putting all my weight on my legs and I was able to manage this rather well, got some good bending in. Up to 120 degrees, in fact, which is 10 degrees greater than was measured last Monday. I don't think I need to worry about this part, the bending.

Finally, I got to work on straightening my leg. The leg got hooked up to a stim machine, which stimulated the muscle for ten seconds, then laid off for ten seconds. Every time it went on I had to straighten the knee. Kept it up for fifteen minutes. This was one of the longest fifteen minutes in my life.

Before I left I asked Paul what I could do at the gym. He said the bike and the leg press, but that is all, and don't put too much weight on it.  Tomorrow I will do that. Along with the regular at-home exercises.

After leaving the PT office I went to a market and picked up a few things. Although my knee felt like it had been through a wringer I still managed to focus on walking and standing correctly as best as I could. I drove home and unloaded my groceries and sat on the couch, satisfied. I feel well used. The real test will be how well I sleep tonight. I'm looking for some relief.

Monday, May 23, 2011

Out and About

This morning I met friend Devra at Panera Bread, had tea. We had a nice chat. It feels so good to be doing ordinary things. A bit later I did my usual little walk around the block, encountering a neighbor who cheered me on and I met a heckuva lot of cold wind. Worked on the walk, the alignment, the posture, then used the stairs for additional exercises on the way into the house.

This afternoon I arrived at my appointment with Paul, the physical therapist, a bit early. He was running a little behind so I waited. When he came out he introduced himself to me. I told him I'd seen him twice before and I hoped those records were in the file. But they weren't. Nothing from the past. I was flattered that he didn't remember me, either. Thought I was a little bit memorable, but maybe not!

He had his intern do the measurements of me while he watched. Some things looked good and others not so good. The flex is good, is functional for most purposes. The extension, of course, needs work. The leg needs to get straight at the end of each step so I have a slight limp when I walk. I hated hearing that.

After getting all the measurements Paul had the intern pull out some exercises for me to do, and I did what I could. Some had to be modified for now, until I can build up strength to do them as originally designed. I forgot to ask about doing these in the gym, unfortunately. I think it will be easier for me if I can do that. But I have my next appointment on Wednesday. I'll remember then. And in the meantime I will do the exercises at home.

As for the other leg, Paul said I need to get the first leg as strong as I can as fast as I can. Then get the second knee done. He seemed to think my goal of October is a good one. One baby step at a time, is what this looks like.

Sunday, May 22, 2011

Neural Tension

Last Friday I was on my bed, as usual, breathing deeply while the physical therapist stretched my leg by pushing the knee into the mattress. After doing this particular stretch, he raised the leg and started to stretch it that way. ALERT! A different kind of pain enters whenever I have that leg raised like that. I asked him why it always hurts more when in that position.

That stopped him. He tried different moves - pointing my toes, not pointing them, lowering the leg about halfway (relief), asking about the pain in each change. Then he said it may be "neural tension".

According to Brent Anderson, PhD, PT, OCS,
NT is thought to be caused by restriction on the sheath that surrounds the nerve. The nerve should glide smoothly through the sheath like a bicycle brake cable gliding through its casing. But sometimes the nerve does not glide through the sheath well and this can cause restriction.

This is pretty close to how Wade described it. He said the nerve goes all the way from my brain to the bottom of my foot, one continuous nerve, and if it gets stuck along the way it can't move as it should. He then had me lie on my back and when he moved my foot I was to move my head - bring my chin to my chest. This is one of the exercises for loosening up the nerve. When we had done it several times he tested me again and the pain was not as great. So I may indeed have a nerve issue there. He suggested that I ask the next physical therapist (Paul) to do a neural tension test.

I got interested in this topic and looked around a bit online. It appears that this is a relatively new area and there isn't always agreement about what is going on and how to deal with it. There is a book, written in 2005, that offers many illustrations and explanations, and that gets good reviews. Just for yucks, I went to to see if they had it, and they did. But new it costs almost $115, and used it is over $80. I guess I'll not be satisfying that part of my curiosity just yet.

Saturday, May 21, 2011

It hurts

My first full day out in the open. I decided that a good way to celebrate would be to get a pedicure. However, there was a park-wide yard sale this morning so I extended my daily short walk to take in the whole park and to stop at a few places and chat. I talked to one of the yard-salers for several minutes, and I could feel my leg hurting while I stood there. She was enthusiastic about my knee surgery because she herself had had it done a few years back and is very happy with it. She had other medical tales to tell as well, so the standing kept on. Finally I broke away and headed home.

I keep wondering about this walking. It seemed that I was walking well and generally without pain at the transitional care center, but each day when I set out now I am not all that comfortable. Of course I am working on how I walk, how I hold myself, how I step, how I breathe. I am also not on any drugs during the day. A few more weeks, perhaps another six weeks, and I should be walking longer in comfort.
So many different types of women come here.

I headed for the pedicure at about one in the afternoon. When I walked into the nail place the woman asked me to come back in a half hour. The chairs were almost all full.  Both manis and pedis. I think Saturday is a very popular day for nail work. So I left the building and decided I'd walk to Vons, which is in the same center, and pick up a few groceries. I made my way over there and, relying on the grocery basket for some support, I picked up several things and headed back to my car. I put the bags in the car, then went into a coffee shop for a cup of tea. Finally it was time to go back for my toes.

That's a little fan aimed at my toes.
The pedicure went without incident. No issues with my knee, I'm happy to say. And my toenails are blue! I returned to my car and drove home from there. It wasn't really a big day but my knee hurts. I think I may have given it a little too much to do today overall. Reality bites.


Yesterday afternoon, almost as soon as I was cleared for takeoff I did take off. I went to a gathering of the Central Coast Vegetarian Network at a local restaurant-deli, Petra.  With nine other people I enjoyed a falafel sandwich - really good - and chatted with some of them. As usual, I pulled out my camera and asked Erika to find someone to take a pic of us all, which she did, and then she took some of smaller clusters of us.

Later, I uploaded those photos to the ccvegnet website and had a look. In the pics of me I saw that I had slipped into my old slumpy habit. I have gotten much better about focusing on how I stand, how I walk, but I also need to focus on how I sit. It's all part of the same package. Eternal vigilance is not only the price of freedom. It is the price of a stronger me.

It felt good to get out in this official capacity, in a small group. I may go to another gathering tonight, a larger one, just to stop in and say hi to those I know. Also on the agenda for today is a pedicure. The last time I had one was two days before my surgery. That time it was a celebration of the surgery. This time it will be a celebration of my new freedom.

Friday, May 20, 2011

Graduation Day

Today ended my home care physical therapy. My physical therapist shook my hand and congratulated me and said it was a pleasure to work with me, that I'm doing very well, and when I get the next knee done call again. I certainly will. I am now officially out on the streets, so to speak. Let loose on the population again. With my -4 degree extension and 112 degree flex.

I wish I could be completely happy about this. Of course I look forward to getting into a physical therapy office with equipment that will make some of this work easier. But there is that tiny part of me that feels a little sad at ending another relationship, short though it was, and medically necessary though it was. I felt a loss when I left the transitional care center, too, leaving behind the caring therapists I worked with there.  I think the nature of this work makes the forming of some kind of bond automatic if the therapist is any good.  And my life isn't exactly full of relationships that really cut to the bone, in a way.

So I will mourn a little bit even as I contemplate the world opening in front of me.

Wednesday, May 18, 2011

Soon to a New Phase

Friday will be my last day with my in-home physical therapist, Wade. Monday I start outpatient therapy with the therapist, Paul, whom I saw a couple of times before I had decided on knee surgery. Paul will have notes about what my knee was like then, I hope, which may be a kind of benefit. Not to mention I liked him. I have liked all of the therapists I have worked with, and each has had a different approach, which I think has been beneficial overall.

Wade said I'm doing very well for this many weeks from surgery (just over five), and that I can take that as a guide for the next knee surgery, which he suggests I might want to fit in as soon as I can. I need to look at the calendar and see if I can work in that knee in between various events of the John Lautner Foundation. (This is a big year for us because my father would have turned 100 this year.) Based on how I am doing now, Wade says I can probably figure on being able to attend events two months after the right knee surgery. It's got me thinking. On the one hand, it is smart to get the other knee done before I start experiencing arthritic difficulties because of the change in alignment caused by the new left knee. On the other hand, it seems like it would be good to take a break...! I am leaning toward fitting it in somehow, sooner.

For now, though, my focus is on getting out of the house next week. Yes, I do take the car for short trips but this is the official date, the return to civilization. The next phase.

Tuesday, May 17, 2011

It's Paying Off

I had a three-day break from physical therapy. Frankly, I don't like that. I want as few days as possible between these visits so I don't slip.

Nevertheless, I do try to use the time reasonably well and to focus on every move I make. Thus my little walks around the small block I live on and to the mailbox take a bit of time because I am telling myself lift heel and toe, watch alignment, stomach in, stay tall - with every step. And take small steps. Moving is not a problem for me. Moving correctly is.

Inside the house, too, every time I get up I think of alignment, stomach, weight on inside of foot...walking down the hall has become a regular journey, a challenging journey, every time. I have to stop myself from just "going" and go deliberately wherever I go.

In addition to the focus on walking I am of course continuing stretch exercises and doing some specific leg lifting efforts whenever I go into the bathroom. I have a whole repertoire now and I am doing one thing or another in between whatever other business or home activity I need to do. I know that I could do more. I have to give myself credit for doing, though.

The physical therapist finally arrived this afternoon and, among other things, he wanted to see me walk with and without my cane. And he said I am moving much much better than I was last week. When we got to the extension work I had not gained any degrees, sad to say (actually lost, because the goal is zero), but my leg seems straighter in general than it has been. The work is paying off.

Monday, May 16, 2011

Goodby Brace

I planned to make a ceremony of it. When it was time to get up this morning, I'd sit up, carefully take off the brace for the last time, and dump it in the wastebasket. All right, that isn't much of a ceremony but I was envisioning it and seeing myself head for the shower, where I could stand under the water for the first time in five weeks.  It didn't work exactly like that.

Last night I had difficulty getting comfortable enough to get to sleep. I have had this problem from the start, and have gotten to sleep with varying degrees of difficulty. It seems like the past few days were the worst, perhaps in part because I anticipated today and my body had less patience than ever. I admit I resorted to drugs. During these five weeks I have not yet made it through a night without them. Yet they did not do the full job, and I kept waking up, jerking up to sit on the side of the bed, sometimes to get up and walk a little, and always to stretch as much as I could. I thought stretching would reduce the "restless leg" kind of jerky spasms I was having. I took another hot shower in the middle of the night, and that helped relax me for a little while.  But I kept waking. Finally, when the clock said four a.m., I sat up and took the damned brace off. Threw it down on the floor. Pulled my leg back under the covers.

It helped! The spasms were diminished, I was more comfortable, my leg felt less like a lumbering whale attached to my body and more like a living part of me. I managed to grab a few more winks this way, adjusting as needed. Definitely an improvement. I think, too, that letting my leg relax under the covers for a bit was not a bad way to adjust to the coming bigger change: standing on it without any support.

The time finally came to get up. I sat on the side of the bed, a wee bit worried, and went for it. I grabbed the cane and stood up. To my surprise, it felt shaky but stable. When I walk I can feel the muscles and ligaments adjusting to being given the whole load, causing a shimmering kind of shakiness. It's okay. I think a few days of walking on it will reduce the shaking and give me back my leg. I also think it will be easier to get more from my exercises, even though it will feel a little scarier at times. 

I took my standing shower and dressed in long pants. I will still wear shorts or short pants most of the time while I am working on the knee, for access, but from time to time it will be nice to have this option. The end of this tunnel looks just a wee bit closer now.

Tuesday, May 10, 2011

When Three Degrees Can Mean So Much

The two main areas that the physical therapists have focused on are knee flexion and knee extension. The picture above is an example of a knee extension exercise: you place the heel of your foot on a surface like another chair or a table and then relax the knee, let it hang there. Then push it down even farther, using your hamstrings. The aim is to get the leg to zero degrees - straight.

I have no idea when either of my legs was ever straight. I am guessing it's been 20 or 30 years at this point. Now I have a chance to get it there and keep it there. But it's been hell, the getting there. When I left the transitional care center I was at -8 degrees - eight degrees from zero. By the time I met with the at-home physical therapist, Wade, I had gone up to -12 degrees. That's the wrong direction. We worked on it and worked on it and last Friday it was back to -8 degrees. Over the long weekend I have been working it and it simply does not seem to get straighter. I admitted a feeling of lack of progress to Wade when he arrived this afternoon.

You do know that "physical therapist" is another name for "torturer"? Just so you know.

As Wade put it, his friends said, "you're in physical therapy school? I bet you give great massages!". He said they never asked a second time, because "we accomplish something". When he pushes on a muscle you know it, and it makes a difference.

So today we worked on various techniques to loosen the joint: moving the patella back and forth, up and down, and wiggling it when it got to each place; pulling on different parts of the joint (this was Wade's action); massaging the leg to loosen up the edema, massaging the wound, and then lying on my back and pressing my knee into the mattress to a count of five breaths, working harder with each breath (then letting it relax and doing it again, ten times, 11 times, I forget how many). The first time I pushed into the mattress Wade pushed it further and I gained another three degrees - for a measurement of five degrees from zero. After that, I had to keep doing it to maintain those extra degrees.

It feels so good to get that little bit of extra movement! I'm newly energized.  And did I mention - no pain meds today??

Monday, May 9, 2011

I Can Drive! I Can Drive!

But don't be calling on me to pick you up any time soon. This driving thing, even with an automatic, takes it out of me right now. I am not in a hurry to drive around just yet.

Daughter Elaine left for home at about noon today. She helped me a LOT while she was here. I could get used to this invalid situation, almost. It is really nice not being expected to dive in and do this and do that, but instead just to sit back. Elaine took off with my car, a manual shift, and left me their automatic Toyota Corolla.

I had to fill a prescription for Percocet, because mine ran out. I decided to go to CVS because it's closer and smaller than Costco, even though I knew it would cost more. It took just as long, about 20 minutes.  Getting in and out of the car was a little hard on my knee but not bad. What's clear is that I won't do any long drives soon because my leg would stiffen up soon and be that much harder to get out of the car.

I'm not sure where the energy went but it may have something to do with the difficult nights. One more week of this brace and there should be at least some relief in that department. As for now, nap time.

Saturday, May 7, 2011

Bella Bella and More

My daughter arrived Wednesday evening, with dog Bella (see above). Bella is the type dog that has a lot of energy and needs to get out and use it every day. If she doesn't, she goes a little crazy. So Elaine brought her along so she could be company when Elaine hikes or walks and to make it a good time for both of them.

What neither of us expected is that scaredy-cat Peanut (also see above) would not freak out with Bella around. I'm not saying he has gone all lovey-dovey with Bella, but he is not much bothered by her, either. Usually, when faced with another person or animal, Peanut takes off as fast as a speeding bullet, far faster than his heft would suggest he could do. 

Thus the Bella visit has satisfied yet another need: to see how Peanut would react to having a dog in the house. And everyone is getting along with harmony, at least as well as one can imagine. 

Yesterday was another physical therapy day. Toonces loves these visits. He tried very hard to help, too. When Wade was massaging the "ropy" threads in the back of my knees (that should not be there, that need to be broken up), Toonces naturally wanted to do some kneading of his own. But of course he did not retract his claws sufficiently. He means well.

There is much to do yet, to get this knee to bend both directions as much as it should. It feels discouraging at times. But I have had a couple of nights of decent sleep without the intense pain (mainly because I took the nurse's advice and took Ambien plus two Percocet tablets before going to bed) and I think this helps my outlook a bit. I still have a fentanyl patch on my shoulder, but when it comes off tomorrow evening that will be the end of that, and I am thinking I will be fine without it. Being able to do the exercises during the day, without having to add extra pain relief, is a great thing. 

Wednesday, May 4, 2011

Quality, Not Quantity

Yesterday I worked with a professional organizer for four hours, met with the home health nurse for about an hour, and then with a physical therapist for an hour. In between I honestly had difficulty getting any food in me, and I felt a little stressed.

The organizer and I got a lot done but there is a lot yet to do. I like her approach: it makes a lot of sense to work from broad strokes to finer ones. So we organized one file drawer and several parts of the office in a more general way that can be refined over time. Later I took out a waste basket full of trash and another full of recyclables, and several items ended up in the donation pile, which is currently behind the door into the office. I made an appointment with her to continue next month. By then I hope to have solved at least one of the spacial problems that remain in the office.

The nurse said I was no fun. Nothing much for her to watch, frankly. The wound is healed and looks great; I don't have other health issues, like diabetes or heart trouble, and I am managing the meds well for now. I told her I do have difficulty with pain at night. She had no magic solution. I will keep trying to find some way to get through it.  She will come back Thursday and very likely will take my blood to check the Coumadin effects. Gradually I will be off that blood thinner altogether, which is good news to me.

The physical therapist, Wade, mostly did paperwork (as did the nurse, actually), saying that of all the different places he has worked, the home health agency requires the most. It really seemed endless. Finally he watched me walk, watched my simulate using the toilet (I really do need a 3-in-1 commode to fit over the toilet, but not for long), and watched me get on and off my bed. When on my bed he checked the range of motion and extension of my knee. He showed me an exercise to help the extension (straightness) of the leg, to use in addition to those I already know, and said to group my exercises into those that deal with extension and those that deal with range of motion, and do one of those sets in the morning and the other in the afternoon. This seemed contrary to usual exercise practice to me, so I asked why. The reason is that working different ways on one goal does help stretch it out and warm it up. Makes sense.

He said he really likes to take this opportunity to get rid of the bad habits we develop when we have knee problems, so that we walk well, not just "good for having a knee replacement". To that end he suggested yet one more thing to think about when I walk around. I am thinking about exaggerating the heel-to-toe movement, lifting my leg consciously,  aiming for the inside of my foot when I step (to put the weight on) instead of the outside (as I have done all my life) and now I am to push the leg back to get it as straight as I can on each step.  This is a lot to think about as I walk. And on that note, he said, "Think quality, not quantity". "We know you can move," he said, so the aim is to move really well. I can agree with this goal wholeheartedly. I don't want to be limping for the rest of my life, but instead walking gracefully and with good balance. Again, yay physical therapists! You creators of better lives.

Interestingly, the nurse is almost-vegetarian and the physical therapist is vegetarian. So neither had any quarrel with my being vegan, even commended me for it.

Today I am following up on some of the work we did organizing, and doing the exercises as recommended by the therapist.  It's slow going as I am not exactly full of energy. These nights, even though I do sleep, do take it out of me and I find myself collapsing into naps now and then. If I could put off taking naps I might do better at night, but lordy, that is hard!

Monday, May 2, 2011

The Good News Just Keeps Coming

I had an appointment with the surgeon this afternoon. First a tech took an x-ray of the knee face-forward and one from the side. Then Dr. W came in. He said the x-rays look great, everything is as it should be. He then looked at my knee scar and asked about how much movement I had gotten. I told him 98 degree bend and -8 degrees on the knee extension. He said that was great.

I asked if there were another, perhaps smaller, brace that I could change into. He said unfortunately no, this is about all there is for this situation. BUT I can take it off in two weeks, not three!  Everything is healing so well.

I asked about driving. I said I have a manual shift car but my daughter has offered to trade cars with her automatic. So when can I drive? "When you make that trade...and when you're off the narcotics". So that's good news! Not so wonderful news for Elaine, who offered this trade: she is going to drive eight hours each way for me. Otherwise she would have flown. This is very generous of her!

Finally, I asked when I could get the other knee done. Eight to ten weeks, he said. Wow. We'll decide whether I want to do this when I have my next appointment in about two weeks.  It seems like a good idea to go ahead about as soon as I can.  Anyway, I already miss those guys at the transitional care center.

Afterwards, dear Maryann gave me a ride to Costco to pick up a prescription for coumadin, and then to Vons to get some groceries.  I'm set for several days now, if not more.  Right now simple is my watchword.  Brown rice, potatoes, veggies, nothing that takes much time or effort to make, just yet. Gotta save the energy for other things.

Sunday, May 1, 2011

Home Again...or is that Home Alone?

I'm both, of course, home again alone. Home alone again. Something like that. It is quiet except for the occasional excited chatter by cat Toonces, who has been trying to catch me up on what's been happening here.

I have taken a couple of naps and watched some recorded television shows. I have adjusted my brace about 50 times, which is average, and arranged my leg different ways. I have iced the knee, and I have walked around the house with my cane. I can see why the cane, I must admit. Although I can get around without it, I am able to maintain better posture and leg work with it.

I can manage everything in my house. No, I am not going to reorganize a lower cupboard in the kitchen, but other than that it is all as I expected, achievable.

Tomorrow I see the doc in the afternoon, and if I am up for it, I'll do a little grocery shopping, courtesy of driver Maryann of course. The following day, Tuesday, the professional organizer comes in to help me organize my office! One four-hour block mostly morning. I am going to have to be getting up and down during that time but I think that's fine. My main challenge before Tuesday is to move the four-drawer file cabinet to a different location. If I take one thing at a time I think I can do it.

Back to my book and a little television...

Rehab This!

Over the years I have developed ways of using my body that are not all
excellent. For example, I have walked on the outside of my feet since I
was a little girl. I don't have the best balance, and I am sure that
this is part of the reason, along with the disintegration of the knee
joints so that my knees met in the middle.

As I have worked with the physical therapists here, some of these
lifelong habits have come out, and the therapists have given me
exercises to help correct them. When I think about the future I see it
brighter in a way I did not previously conceive. I see my feet walking
straight and firmly, my ankles strong, and I see myself standing tall
and being balanced. And I wonder, why didn't I do this sooner? Or, more
correctly really, why don't we think about getting body checkups?
Whether or not we have knee problems? Wouldn't that be a good kind of
regular checkup,something that would be of real value?

The first time I saw a physical therapy department my impression was one
of wonder: this is where people do good things. I am even more convinced
that this is an area that needs to be brought out from the basement and
given greater exposure. We could all benefit.