Another ten years, another hip

 I am eight days away from an operation on my left hip. Same operation as the left, a total replacement, anterior. It has been a long and often painful journey (and boring too) but finally I got into that operating room and here I am, eight days later.

Lately I have perused my notes from my first hip replacement, to remind me how it went. It was not a case of immediate pain relief. I did not expect that it was, but my memory was that it was so much easier than the hip replacements that it seemed instant. 

Today I drove for the first time since the op. I had been taking some narcotics (oxy) so could not drive even if I felt up to it, and I did not feel up to it. I stopped the oxy yesterday afternoon and today I felt ready.  In fact, there was quite a change between yesterday and today, both in the level of swelling I see and in the pain I am experiencing. 

Here are my feet yesterday. Notice that the left foot is very puffy. My leg was similarly puffy.

And here are my feet today. They look almost identical. You can't see my thigh, where the swelling from the operation is most noticeable. But the difference in my feet is reflected in how much better I feel.

I had the hip operation because the hip is worn out. The doctor thinks that the hip was causing the knee pain I had in my left knee for the last few years. I have been cautiously optimistic. It is still too early to tell for sure because I still do have pain and swelling to work on, but I am gaining in hope. I met with the physical therapist today and he had me climb some stairs. He said just to try stepping up with the left foot, just see if it hurts too much. He didn't want to pursue it if it did hurt too much. But it didn't. In fact, I think it may have been less painful than it was before the operation. That's what is giving me hope.

Checking in and checking up

It has been way too long since I have written here. Much has happened or changed, even though right now I feel like I'm treading water.

Leading with the hips was good advice. I still follow it. I still have to tell myself, though, consciously. My physical therapist says I am walking much better, my back is straighter, and my knees are "softening". He says they no longer bounce back when he presses down on them. It's been a long time, this straightening. Most people do not have to spend so much time doing this. On the other hand, my therapist told me of another woman who has not put the time in as I have and who is now bent over and whose knees are bent more than before. He compliments me on my persistence.

Hip pain is a distant memory. I never have it any more, either during the day or the night. My experience is much like others who have had this surgery. Easy and done.

My main complaint when I walk is lower back pain. This is largely because I still don't have the best posture, and I know my weight makes it worse as well. Nevertheless, I have walked across the Mackinac Bridge in Michigan two years running - that's five miles across, and last September was cold and windy - and while I did feel back pain it was not enough to deter me or even cause significant discomfort. I felt like I managed it better in 2014 than in 2013. Not as tired, not as hurt, even though I had not done much to get ready for it.

Still in therapy. Still working on getting my knees straight, but also working on my right shoulder. I developed a constant ache in my arm and finally went in to see what was up, got referred to the physical therapist again. Actually, this turned out to be a good thing, because Medicare was no longer paying for my leg therapy. The therapist was "carrying" me. I didn't want that to keep happening so now I go in for rotator cuff damage and the knees get thrown in, so to speak. The tendon is not torn, I am happy to say. At this point much of the pain has gone away. The therapy is working. It's a delicate area, though, and one must be careful not to put too much weight or strain on it too soon. I also am working on elbow damage, different from the rotator cuff.

What with the shoulder, knee, elbow, and hip work I am in the therapy office for 1-3/4 hours each time now, three times a week. I use weights, a roller thing, and eight machines and do a total of 23 different exercises.  I have a rubber band to use for shoulder exercises when I travel. I tell people I am working my way through all my joints. I sure hope that isn't actually true. I look forward to getting out of physical therapy.

I did it!

Today another milestone. I did my first hike since the first knee surgery last April. In fact, it was probably well before April when I last hiked. I was hurting so much that hikes were far from appealing at the time I first went under the knife.

I chose the Elfin Forest in Los Osos for my first foray. The walk is almost entirely boardwalk, with many benches, and is only 4/5 mile long. It is not flat but the ascent is not steep, as it is very near the bay. Next to it, in fact. The picture above shows how it got its name. It really looks magical inside the tree cover. A separate little boardwalk enters the forest in specific locations so we can look but not touch. You could walk the whole way on the boardwalk and not know the wonders inside. But there is much to enjoy outside of the forest itself, in the views of Morro Rock and several of the "Seven Sisters" - ancient volcanos that line up, marching from Morro Bay to San Luis Obispo and actually into a part of San Luis Obispo.

But I digress. I went without a cane. I remember the last time I visited this little walk. It was well before my knee surgery. I grabbed at almost every chance to sit on one of the benches, to relieve the pain. This time I did not sit down once. I did not feel I had to. I did feel a bit of a strain toward the end but it seemed mostly because my body is not used to walking any more, not because of pain. My left knee did get a bit sensitive but it recovered all right. For a bit I thought I might need to ice my knees when I got home but I was fine by then, and am still fine now.

I could feel the pressure I was putting on my knees. It was a bit uncomfortable but not painful. I feel like I pushed them as far as they want to go right now, but I could go a bit farther next time out. I did not experience any hip pain.

This post does not reflect well how great I felt when I finished. Just yesterday I was making my way around Costco and finding it quite uncomfortable, both inside and out. I did not see how I could do a hike comfortably. Now I know that I can, and it's exhilarating.

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.

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.

No Longer a Matter of If, but When

I met with a surgeon Feb. 23. He took more x-rays and told me that my left knee is plumb wore out (not in exactly those words). He said surgery should have been done several years ago. Not only is the cartilage gone but there are bone spurs all over the joint. When I asked if there were specific exercises I could do before surgery he said not really, ride a stationary bike if you can, do some leg lifts, but until those bone spurs are gone there is not much to be done.

He asked when I wanted it done and I said as soon as possible. But when I got home and started thinking about it I realized that I had not taken all things Medicare into account. I learned that hospital coverage ("part B") does not cover the doctor's costs - or, in fact, the anesthesiologist's. I would have to pay 20% of those costs in addition to a "hospital deductible". There is a difference between in-patient and out-patient status as well, so the transitional care might also require a 20% co-payment. I got to thinking that maybe I need a Medicare supplement after all.

I hunted around and found a supplement that looks right for me and signed up. As I understood what I read, this first surgery would not be covered if I have it done right away. I will probably have to wait a few months. I am going to call the agency tomorrow to find out if I read that right.

I am definitely having this surgery. My knees are too far gone for any other program to help them now. The surgery will be "minimally invasive" so I should be on my feet the day of the surgery, which is a relief.

Obviously this changes this blog. I really wanted to manage this arthritis without surgery but it has become so disabling that I am accepting the need. I am continuing to go to the gym because I am sure that the more flexible and strong I am the better.

Changes ahead

Two days ago I had an appointment with my regular doctor, to discuss options for my arthritis. I told him that I am living about 1/3 of the life I would be without arthritis, that I am in pain when I walk and when I stand, that this pain prevents me from doing many things alone and with my children. I told him about my efforts at the gym and beyond, and said I don't normally take pain relievers because of the effects on my stomach.

He said the only solution that makes sense for me is knee surgery. It's a "no-brainer", he said, and then sent me to get some x-rays of my left knee. When he came back in the room he said it hurt just to look at the x-rays, and he prescribed some Tramadol, a narcotic, for the short-term, and made a referral to an orthopedic surgeon. The appointment will be made when I get approval from Medicare.

In the meantime I went to get the Tramadol. I started taking it at about noon yesterday. It makes me fuzzy, as narcotics usually do. I do feel some relief from the pain, though, so I am going to keep taking it, to see if the fuzzy effects go away and the pain relief remains.  Right now I just feel like lying down.

The Left Leg, the Right Hip

Sometimes, out of the blue, I feel a sharp twinge in the area just below my left knee. It is pain combined with a stiffness, that odd kind of arthritic stiffness that I associate with an arthritic "flareup".  It usually eases off a bit but not always.  It has happened a couple of times lately when I was in the middle of doing leg presses, and continued through the rest of my gym routines.

Sometimes I wake with right hip pain. Sometimes it eases off soon, but other times it just won't. Today, for example, it caused me difficulty getting around the house. I hoped that the Aqua class might actually help it but it didn't. In fact, the frantic water-walking we did today had me almost biting my tongue as I kept hoping it would ease up. It never did and it still hasn't.

These are the two pain issues that most affect me right now. Even when I start off feeling good, going to the market for example, in no pain, one or another of the two will often slip in and make my feel-good time not so feel-good.