A Day in the Life

I wake up after a series of waking-ups, not quite ready to meet the world. More often than not, my left arm is pinned down and my right leg stiff and in pain. I don't want to get up but I do. I kick off the covers, best as I can, and slide my feet over the edge of my bed, where I let them swing a little before placing them on the ground.

I stand by pushing my fists into the mattress, pushing myself up on my stiff, still-swollen right leg, and I realize that my left leg feels fine. I anticipate searing pain when I stand but that doesn't happen. It's more a deep soreness that does not want to go anywhere. I know that lying down again will not help anything, so I grab my cane and lean my way into the bathroom. By the time I have finished my shower I am still stiff but moving better. I get dressed. Often at this time I lie back down again on the bed and raise my right leg, placing it on an upside-down laundry basket, the oblong type, which is covered by a soft pillow. I elevate the leg for twenty minutes, reading to keep my mind off it.

Finally I get dressed and make my way into the office, kitchen, living room. I check email and Facebook, sometimes get involved in writing a book review or reading something, until I realize i have been sitting too long. Getting up brings back the discomfort.

There are two points on my knee that are especially painful. On the right side there is a small lump that is very sensitive. On the right is a wider area that feels sore. If I massage my calf area I'll discover pain there, too, an indication of edema. The swelling has gone down considerably but there is still enough there. I try massaging the left leg and find no pain there. Good job left leg!

If I'm up for it I put on my shoes. I must walk. A short walk around the small block on which my house sits. It is usually not too uncomfortable, but most of the time I don't feel up for more than this short distance.  On PT days the therapist shows up and we do some things, and sometimes it helps. I feel inspired to work harder on my own. I just recently made a chart, listing each exercise, the reps and set lengths, and what the exercise works. Each day now I mark the chart every time I do that exercise, aiming to meet the goal number of sets.

It feels like I've lost ground. I was able to walk rather comfortably not that long ago, a few weeks ago. I don't know why it has become not as easy. Part of me wants to push it but when I do I invite inflammation and that makes things worse. I tend to take the easy way: I sit on the couch or chair, reading or watching television, and get up to fix food or do an exercise or two. I will eat, take naps, sometimes on the couch, sometimes on my bed, do some exercises. Take drugs. The drugs I am taking for pain now are somewhat helpful. IF I could take two at a time they would be more helpful, but two makes me queasy, and the quease lasts for hours.  And before I know it the cats are asking for their afternoon meal, then it's dinner time, and finally I am just waiting for time to go to bed.

I think I will feel much better about myself when I am able to go back out into the world and especially when I go back to the gym. Going to the gym will help me feel better physically and mentally. It is easier for me to maintain a regular set of exercises if I do them at the gym, where others are doing the same thing. Even those that can be done at home. I can't drive yet, and I'm not sure I am up for a full set of gym exercises, but I could work up to that.

Time for me to take a walk.

A Short Drive

This afternoon I decided to try driving. I drove to a nearby shopping center to buy a few things at the drugstore. Here is how it went:

First, it was a little painful getting into the car. Not too bad, though.

Then, when I got on the road I found that switching from the accelerator to the brake called for a bit of a twist of my foot, which was painful. Pressing the accelerator was not too bad but a bit uncomfortable.

My conclusion: not yet ready. Need more flex, less pain. Perhaps in a week?

Moving on

Last week was Roberto. This week I have Wade again. I had Wade for my three weeks of in-home therapy for my left knee, so I got to know him well, and like him very much. Wade does not see me simply as a knee. He came for the first time today. We expect I'll have him just this one week.

I told him about my difficulties controlling the pain. He said I should tell the nurse and see if the surgeon can come up with a better solution - perhaps back to the patch, for example. To both help with knee movement and the pain, he did some "mobes" (joint mobilizations) on my knee today, working to get the upper and lower parts of the knee to slide back and forth more easily. This should help in loosening the joint. I felt less pain when he was done with that. He said to work on one exercise especially:

While sitting watching television or reading, slide my heel back and forth a few times, then stop it at a bent point and pull in toward me and stop it there, foot flat on the ground. I should feel a stretch that hurts a little but is bearable. Hold it there to let it get used to the stretch, until it feels ready to stretch more. Then slide my butt forward a little to increase the bend and let that sit for a while. This way I gradually yet gently increase the flexibility.

In addition, he said to keep going on little walks and icing and elevating as needed. When I have a bad day don't push it, but when I feel good give it some more time. It all seems like common sense, yet I have been feeling I had to push through everything and work on everything until it hurts majorly. I feel encouraged. The last few days have not been wonderful and I am going to get past it.

Too Soon

My physical therapist for last week, Roberto, reminded me that I need to make working on my knee my job right now. It is tempting, though, to jump out into the world, celebrating the progress I have made and stretching myself. Today I did just that, by going to a one-day sewing class. The class was led by Linda, who has taught sewing classes for years, and I have been in many in the past few years. The cool part is that our class has formed bonds with each other, so it is a pleasure just to be there, among friends.

Today's class was "holiday aprons". We all made aprons from the same pattern, with our own material. It went from ten a.m. to two p.m., with a break for lunch, provided by Linda. During that time I was mostly sitting but got up frequently, mainly to use the iron. I did not elevate my foot (where was I to do that?), did not ice my knee (again, where?) and I only did one exercise, one I was able to do while standing at the ironing board. I felt that it was a little exhausting but I did all right.

Until I got home. Then the pain started. I tried lying down with my leg up, but could not get rid of the pain. I took more pain relievers, iced the knee, tried different positions, simply could not get any relief. It was hours before I could get myself anywhere near comfortable, and now I sit here looking at my puffy leg and foot and sighing.

It was too soon. I need to focus on my knee, make sure I elevate, ice, get up and move around short distances. I need to stay on track and leave the excursions for later.

Hurting

Yesterday, when the physical therapist was here, I told him about the pain I have in the mornings, in bed. He asked if it were getting worse or staying the same. I said it seems to be staying the same. He said that with the work I am doing that staying the same would indicate an improvement, in a way.

Today I woke again with excruciating pain. The pain is in my knee itself, mostly on the sides - where the drain was and on the opposite side. I tried and tried to get comfortable and found myself just bawling out loud (good thing I live alone) for several minutes.

I just looked back in this journal to my pain with my left knee at about three weeks. I was dealing with restless leg pain mostly, at night, and nothing like this morning's pain. I don't know what this means, especially given that I had a leg brace on at the time. That brace may have actually helped with the pain in some ways. I noticed that my flex was about the same at this point as it is now, so I am less worried about that than I was. I thought that maybe I sacrificed some flexibility by leaving SLTC so soon. The bicycle wheels in particular were really helpful in stretching, improving the bend. I wish I had one of those here.

Today Maryann is picking me up to go to an apron-sewing class! It is the same teacher as we have for our regular sewing class so I know I can manage somehow. I will get up and move around and do what exercises I can during the class. No good to be freezing up. I thought it would be a good thing overall, to go to this one class, start getting a little bit social again.

How it's Going

I have been out of transitional care since last Saturday, five days. It's been a busy time for a couch potato like me. Daughter Elaine was here until yesterday, when she flew home again. She stocked up on groceries, vacuumed, washed clothes, sent spiders off on new journeys.  She took me to my appointment with my surgeon Tuesday and sat in on it (everything looks terrific). So her time was another kind of transition for me, a way for me to break slowly back into my old home routine.

Saturday I attended a wedding! But wait. It was a low-key affair and I left after the ceremony, did not wait for the food, much as I am sure I would have enjoyed it (daughter Elaine dropped me off and picked me up). I am happy to report that I have had very little nausea or other food discomfort, compared to last time. When I had surgery on my left knee I did not actually lose my appetite or my taste but food was simply not interesting for several weeks. I ate just as much but did not enjoy it. Not so this time. I have been enjoying it from the first bite of - what did they give us that first day? applesauce? Something like that.

Sunday I mostly vegged, watched Breaking Bad with Elaine. I think I took a small walk. Monday I met with the home-care nurse, Sandy, for the first time. She was impressed by my progress and my overall good health, surprised at the small number of meds I am taking.

Over the weekend and into Monday I did not do much in the way of exercise. I had the packet of exercises from SLTC (San Luis Transitional Care) and I knew others I could do, but I just relaxed instead. I was not surprised when the physical therapist, Roberto, measured my flex and extension on Tuesday and found that I had lost a little of what I gained at SLTC. Neither of us was worried about it, though. Roberto went through the SLTC packet of exercises and circled those he thought I should focus on, and filled in the number of sets and reps for each. He said, though, that he is pleased when his patients do any exercises at all on their own. I have heard this a lot. I am not so gung-ho that I do everything every day but I believe I am more conscientious than many others. He echoed Sandy's comments that I am doing very well and he anticipated that I would move to outpatient therapy in two weeks.

Roberto emphasized the need for elevating my foot and was happy to hear that I am big on reading. It is easier to get patients to elevate when they have something like reading to do.  He suggested that I lie on the floor and put my leg on the couch to get the right height. Later, I tried this, and had a helluva time getting back up again. I moved myself over to my knees, and my right knee is so very much not ready to kneel. Getting up was too painful.

Wednesday I saw Roberto again. We went through all of the recommended exercises and I went up and down the front steps as well. I told him my trouble getting up from the floor and he showed me another way to do it, which works much better. I have done it a few times since then.

The pain. It seems like a lot. I wake up in pain and have trouble loosening up enough to calm it down. This morning it took over an hour to feel relief, even after I took some pain relievers. I think most of this difficulty is from the swelling - the edema. It is going down but has a ways to go yet. I don't remember feeling this much pain the last time but on the other hand I do have a vague recollection of having some concerns about it. I was so happy when I could go off pain relievers altogether, which happened somewhere around six weeks after surgery, as I recall (I was still using something at night).

I need to get up and move around and do a few more exercises. This is the best path to pain relief and flexibility. I will do that in just a few minutes.

Sandy came for the second time this morning. She said I was healing so well that she figures one more visit will do it. I do not need nursing. Most of her patients are much sicker than I am.

I am loving all these positive reports from all the health care professionals. There is no doubt in my mind that the time I spent in the gym paid off, as did my plant-based diet.

Going Home

My checkout time is 11:00 this morning. Elaine plans to arrive at about 10:30 to help me load my stuff into the car and to take me home when all the paperwork is done. She arrived yesterday morning and spent time with me here twice yesterday, even having dinner with me last night (the center will prepare an extra meal for $5. Quite a bargain). I am excited about going home. There is a lot to like about the San Luis Transitional Care Center, but seriously, any care center worth its salt is going to want its residents to get antsy eventually. In my case it may have happened sooner than typically simply because I am not the best fit for this center. I suspect that most people who like their independence as much as I do never go to a rehab center in the first place. They take their chances at home, with the in-home therapists and nurses and occupational therapists (as needed). I knew from the outset that my knees would really benefit from a lot of physical therapy and I knew, as well, that if left to my own devices I could never provide as much on my own as I could get here. Three times a week does not compare with twice a day. So I do have mixed feelings. I am now going to be more on my own, having to remind myself to get up and work on my knee at various times during the day. I tend not to push myself as much as a PT will, either. I do believe, though, that I have gotten enough of a good start here that I will continue to improve, even with my less-intense home workouts. Not only that, but I will be able to take little walks around the park, paying close attention to every step, as I did for the other knee. I will also enjoy being able to spend time with Elaine, just the two of us and my four cats. For now, though, I am suddenly sleepy! Time for a little nap.

Visitors!

Yesterday I had two visitors and two again today. Both times my visitors were able to watch some of my physical therapy. I really appreciate that SLTCC recognizes residents' needs for wide-open visits. Meaning our dogs can come to see us. Meaning our friends can watch our physical therapy. This way they get to see what I am up to and for some of them to imagine what might be in their own futures as well. Visitors can also have coffee or tea if they like, all of which makes me look like a good host. If you think this means you are welcome to come see me in the short time I have left here, you're right! Barb, one of today's visitors, brought a get-well card from my sewing class. This sewing class is way more than a class. It is a support group, a potluck club, a group where no topic is off-limits (well, almost). When I first joined I thought I was going to be learning more about sewing. For a hermit like me, it has turned out to be so much more. And yes, we do learn more about sewing. Physical therapy has ranged all over the rehab room and outside grounds lately. My many therapists have different approaches but keep some things the same, and all are helping me reach that zero-degree extension (as well as, of course, a decent flex). I don't see that happening while I am here because it takes a lot just to get one degree of extension, but I believe I have made enough progress to suggest that success is in my future. For the record my flex reached 105 degrees and my extension about a -7 or -8 degrees today. In comparison, when I left physical therapy for my left leg I had been stuck at about -12 degrees for several visits. Tomorrow will be my last day of occupational therapy. I will take another shower. There just has been no good reason to continue considering I've been down this road already and I know the tricks.

Getting Out

All these physical therapy, occupational therapy, food service, and other activity interruptions are getting into the way of my life! Seriously, it did seem that way this morning but here's why: I got up latish because I had a stomach ache. I got dressed, finally, and got my pain killers, and got into physical therapy first thing. No time for email checks or writing here. When I was done with PT I lay down with my leg elevated, with ice on it, for fifteen minutes. When I was done with that I went out to the living area and sat on the couch to read a bit. I had very little time to read before the occupational therapist showed up. We did that but before I was even done one of the physical therapists, who was having a hellish scheduling time, asked if I would be willing to go for PT then with her and not wait for Tim later. I said I wanted a break! So I got one. The stomach pain did go away. I have no idea what it was. I just don't want it to come back. I have been lucky this time in that Ive had very little nausea or any other type of stomach pain. I am now debating the pain killer question once again: I do not know when Tim will be by for my second session of PT and I would like to be revved up for it, which is to say I want the pain killers to be working. There really is no answer for this because even Tim won't know when he will come by for me. Another interruption was the person who arranges for discharges. She said she noticed how well I am doing and thought we should talk about when I go home. We decided on this Saturday. That way I get both PT sessions Friday and can start home PT Monday, and I get to go to the wedding of a friend Sat afternoon. So you heard it here first: I am going home this Saturday.

Comparisons

All of the physical therapists I asked told me that their patients who had one knee replacement after the other said that the second one was easier. Not because it was necessarily physically easier but mainly because they knew what to expect and were therefore calmer. I fully expected this second surgery to go more easily. It has, for the most part. But there are aspects that are harder. A comparison: Pain level and sleeping: Out of the box the second surgery was more painful. But over time it is less so, or I am tolerating it better. When I woke from surgery the pain of the first surgery was less than that of the second. I was shocked at how sharp and intense the pain was. But, possibly because of the three-hour interval for Percocet, I have found it easier to bear the pain over time, and to sleep better. I have meds for the rash (and I know what it is) and for the restless leg syndrome, so getting to sleep is easier than it was the first time around. Moving the leg: It seems that walking and generally moving around is similar the second time to the first. However, I believe that the pain and difficulty of moving my surgical leg on the bed is worse the second time around. I wonder if the brace helped with movement by stabilizing the whole leg the first time. Swelling: It seems like the swelling of the leg is about the same for both times. I was unable to see the naked leg often the first time around, though, so my impression is that the knee swelling was smaller the first time - but that may not be the case. It probably is about the same. Overall, because I am sleeping better and tolerating the pain better, I feel the experience is much better the second time around.

Who'da Thunk it?

There was no physical therapy for me today but that does not mean my Sunday was without adventure. I took a long nap in the morning...no, that's not one of the adventures. AFter lunch this afternoon I was visited by a young man from the kitchen. He said he didn't know anything about vegan cooking but he wants to know more. He said we're having sloppy joes for dinner and he knows I could not have that. I said but yes, I could - just replace the meat with chili beans or corn or rice or whatever looks like a good texture for it. He said he had never thought of that, and that he wants to be sure I get enough protein. I said fruit is about the only thing that doesn't have protein in it. He was surprised by that. So, I said, don't worry about it. He was surprised and pleased and headed back to the kitchen. Not much later he returned, saying he had come up with a dish with brown rice and mixed vegetables and it is simmering on the stove and he thinks it is going to be good! So that was a real pleasure. It is so rare for a cook in an institution to be curious. Mostly they just want to be rid of me. I understand that, but frankly, with all of the versions of diets these days it is a lot easier, I think, to go the curious route than the woe is me. Later I was surprised by a visit from Kristen! Carrying a decaf soy mocha! My wish!! She also brought a vegan cookie, which I am saving for a little later, after dinner if I can resist that long. We had a nice little chat and she went on her way. As if my heart could stand all the adventure, I went into the living area, where the rec person was showing a man named Wally how to use the Wii. I stepped in to offer myself as another player and the rec person took this as an opportunity to turn it over to me. So I bowled with Wally while she went on walks with other residents, checking in from time to time, and while some other residents watched us from the sidelines. Nobody else wanted to play, but maybe they will next week. I won one game and Wally won the next. Kris also brought some magazines. One is Veg News, to which I subscribe. I might offer it to the person from the kitchen - or not. The recipes are often aimed at people like me, who really enjoy cooking. In any case, it's a good one to have around here for others to read. And that's just how it is here at the ever-exciting SLO Transitional Care Center.

Sunday

It's Sunday at the rehab center. I am sitting on the edge of my bed, still in my long comfy nightgown. This morning I have had my vitals taken, my weight measured, meds given, and breakfast brought to me. I asked for peanut butter for the toast because the meal was a wee bit skimpy (toast, sliced tomatoes, small fruit bowl, juice, tea). We are all hanging around like the rich, waiting to be taken care of. It seems funny to have this day. Of course wounds continue to heal and we do our little bits of exercise in our beds, but in general not a lot of effort goes to the main goal. The staff works just as hard nevertheless. Maybe harder. In a little while I will choose some clothes and go brush my teeth, wash my face, do a quick-clean of my bod, and get dressed. Then perhaps I will wander around the center. Outside and inside. Only thing to complete the morning would be a fresh soy decaf mocha. That isn't going to happen. For some reason, SLO TCC does not offer fancy coffee drinks. Yet.

Alarming

There are many sounds here at the Transitional Care Center - hereinafter called the Rehab center, maybe. Whenever one of us "residents" wants assistance, we press our little red button and somebody magically appears. There is a blinking light on top of our door indicating this is the one, and a beep beep sound. Some residents need a little more monitoring. They get a sensor clipped on their bodies somewhere. When the resident falls or otherwise causes a disruption to that sensor, an alarm goes off, a rather more serious siren-sounding alarm. People really jump at that one. Just recently a new system has been installed, an alarm system for the building. Since I have been here - since last Thursday afternoon - it has gone off several times. On at least one of those times a sliding door closed off our side of the building. That is more of the "get out" type alarms that we hear in schools, and we usually look around to see if it's the real deal and if we all need to hobble on out of here. So far it's all been testing or mistakes. Televisions play a pretty big part of life here. There is a large-screen tv in each living room, and in the afternoons (sometimes mornings too, but that is usually for some kind of game) the set goes on and one or more people sit around watching it. And it tends to be quite loud. If we are watching our own sets it is sometimes necessary to shut our doors to hear them. And yet, as I mentioned in a post some months ago, no piped in music. So I continue to be very happy at the choice of noises offered here. IF one of them gets to me (and usually that's going to be some other resident talking too much) I do have a couple of ear plugs.

I know it's corporate, but...

It's almost like coming home here at SLO Transitional Care Center. There is no escaping the genuine caring, genuine smiles, genuine encouragement. I feel lifted. This morning I worked with the occupational therapist - Tracy? I forgot already! - to take a shower. We just used the standup shower in the bathroom attached to my room, so there was less complication. The wound is "sealed" so there was no need for plastic wrap. This is apparently a new thing just since I had the first op. It's rather like that spray-on bandage, in fact that may be what it is, sealing the wound, protecting it from water and other invasions. Made it so I could have a shower right away. After I rested up from the shower (!) Tim took me to the PT room, where I did a number of small things: * pressed a ball between my knees * pulled outward against a rubber band tied around my knees * Walked forward and backward with the parallel bars * stood up on my toes, then rocked by to my heels * While standing, raised my leg up, then returned to the floor (short distance) * "kicked" backward, similar to above * touched the ball of my foot to a short stool, then returned to floor * sat in chair, worked the bicycle wheels back and forth (but not all the way around) * took short walk with Tim, outside, and climbed steps up and down and more I can't remember Tim says he is really impressed by how well I am doing, that the swelling is about the only thing holding me back now. To that end, he layered my leg with ice when I got back to my room and on my bed. I have been meeting staff people I remember from before. I saw Gary in the hall today. Gary was the nurse I liked so much last time. He is now working in the office most of the time, but still has the floor one day a week, so I may see him again before I leave. I joked with Doug last night and was happy to see several of the same physical therapists. I will be working with one of the "hands-on" ones this afternoon - Laurie. She makes one work for it but she's kind and thoughtful, albeit a little of a renegade, it seems. A nice image: on a coffee table in the living room is a tray with coffee, hot water, tea bags, and several brightly-colored coffee cups. There is also a glass urn of lemon-water for the taking. As I was fixing myself some tea there, another resident (we are residents, not patients, remember) stopped by to say how beautiful it all was and how it makes such a difference (her words were better than that but I don't remember them). I had to agree. Honestly, somebody is doing something right here.

First Friday

I woke a couple of times to go to the bathroom. Then I was awoken at 6:30 for the daily blood-letting. 6:30, not 4:30. And the person was from the French hospital lab. Somehow I do not think they needed to take my blood at 4:30 for my benefit. It was for theirs. I had called for percocet about two hours ago, so I decided to loosen up my leg here in bed before getting up. I did some leg lifts, some knee presses, butt crunches and pulley knee lifts. I think these are good to warm my leg up enough so that when I do get up I will be in less pain and be less stiff. I have found, from the months of doing fairly simple exercises in the gym, that it all adds up. The bed is comfortable. I did sleep well. Admittedly I had hydroxyzine, Requip, and Ambien to help me along. I did not take any Ambien in the hospital. If I take it here will I be less able to sleep on my own? Worth looking into. I haven't felt anything like restless legs since the op I don't know if that means the Requip is working or that I simply am not having any episodes now. The combo of iPad and keyboard is working well now. However, editing on the iPad can be a pain. I have to put my finger where I want the cursor to go and it just doesn't always go where I want, so I end up erasing more than I intended, then rewriting. At home I have a little stylus - I forgot to bring it. That is a little more helpful. My challenge for the day: to get dressed. I would like to take a shower but I have to arrange that ahead of time (or pick a time when the bathroom is not in hig demand). I can get everything else on, but my right sock and shoe is a challenge. I discussed this with the occupatioal therapist and she brought out a grabber and long shoehorn. This combination does work. I could use another grabber, so may ask Maryann to pick one up. In any case, I doubt I will need it more than a week - for the knee. I will still find it useful at home for other purposes, though. I think there may be a window here for me to hit the bathroom with my bucket of supplies.

It's as if I never left

I am sitting in my room at the SLO Transitional Care Center. I am tired but see no real hope to get any rest just yet. My roomie, Bernice, is a confessed television addict and the television in the sitting room is on some kind of game, loudly. My space is nicer than the hospital room I left this morning. It's funny how we expect that, yet the hospital will charge so much more. Seems like they could provide, say, a bathroom equipped for the disabled. The bathroom is sort of equipped but far too small to accommodate anything beyond a walker. tHe bed here is also far better than the one in the hospital. I can sit on it comfortably, and that is what I am doing now. It's a good setup for me with my iPad. I am again dealing with the many blocked websites, though. But I've got that covered this time: my phone has "wifi hotspot" enabled. So neener neener. But perhaps we should go back to this morning, or even last night. I slept all right last night, with the usual interruptions, both from my wanting to go to the bathroom and from hospital folks traipsing in. My favorite was the young woman who came at 4:30 every morning to take my blood. I asked her "why 4:30 am?" and she said that they can get the results to the doc before he comes to see me, in case some change needs to be made in blood thinner. She laughed then, and said she shows up at her other location at 2:30 am. I guess I should have felt better. Every morning I have to work out when to ask for pain meds. If I take them too soon, I may not be fully protected by the time I get into physical therapy. Ideally I should have taken the drugs about an hour before PT. This morning I called for drugs at about 5:45 but got no response. I called again and again and finally got the drugs at 6:15. I knew this could be a problem. And yes, the physical therapist showed at 9:15, right when I was due to take the drugs again. I toughed it out, and it really wasn't that difficult, fortunately. Today was the day to go to my new residence. At first I was told to show up there (here, SLO transitional care) at 12:30. Then, after I had arranged with Maryann to pick me up at 12 noon, they told me no, ten o'clock. I changed arrangements with Maryann and then was told 11:00. I said forget it, I'll just have to ask Maryann to wait. So that's what happened. We sat and chatted and talked a bit with my roommate Natalie. Natalie had a hip replacement and yesterday had some sharp pains and felt a "pop" on the side of her new hip. She screamed each time. When her doc came to see her he said it was nothing, it was "almost impossible" for the hip to be popped out of its socket. But then it happened again and he said let's get an x-ray and Natalie stays another night. And here at SLO TC? It's good. It's very much as I remembered it, and several of the staff members remember me and have been complimentary about how well I am getting around and how good I look. I thought that, because they did remember me, we might have a shorter initiation. NOt to be. The food people asked many questions, the PT person talked forever about his views on therapy (and he explained all of the exercises in his booklet, which I had already gotten and actually used since the last time), the nurse asked more questions and did a "skin check" and got me to sign millions of pages of legal documents. I guess I have given away my home and my first-born. I was finally set free, somewhat, and I made my way to the gathering area outside my room. This is a kind of living room, with tables and chairs and television and a snack table. I was cold, so I brought my book to the couch out there and read for a while. A younger woman came in with a chubby chihuahua. I asked if I could say hi and we got into a long and interesting conversation. She is 40 and a runner and is visiting her father, who has congestive heart failure. She now lives in New York and is returning there Saturday, but is very worried about her father. We talked about New York and heart trouble and a number of other things. The dog is her father's, and was visiting too. That's one of the nice things here: you can bring a dog to visit a patient. There is one woman here, though, who comes with her own assistance dog. It appears that she is there for some sort of respiratory therapy. She walks well enough, gets around easily, and has this dog with her, with his therapy dog vest. It is perhaps a kind of Golden Retriever, very dark though. Very nice dog. BUT. When the chichuahua came in and yipped at the larger dog, this woman pulled the assistance dog away and yelled at him, hit him, and told him unkindly to lie down. I could then understand why this beautiful dog walks the way she does - submissively. Later Maryann noticed that he (or she) is wearing some sort of choke collar as well. Assistance dogs are so well trained that I cannot think of any excuse for this collar other than the pure ignorance of this woman. It makes me upset every time I see her now. ANd I, without any dogs of my own and with no training degrees, can hardly step in and demand that she not do these things. I could, but it would do no good. As for getting any work done here: the occupational therapist talked a whole lot about what she does (and she knows that I know what she does) and kept telling me about how we'd be doing things that, frankly, I have been doing forever. She did not seem to understand that I really do not need her at all. I have dealt with knee pain for years. I have worked things out. I am hoping she bows out very quickly so I can catch up on my reading. But seriously. I've been reading quite a lot, in spite of interruptions. I released a book at the book cart in French Hospital, and got a very big thank you from the woman who manages the cart. Embarrassing. Just think if I'd given her two or three! I walked into SLO TC using my cane, and by doing so I have set the stage. I think I will move quickly. I really am hoping for some greater reduction in swelling, almost more than anything else. Oh, did I mention my flex is up to 100 degrees? Wooo!!!

As I lay thinking. . .

When I was through surgery on Monday, I awoke connected to many tubes. Each had a different purpose,shape, and length. And movement was difficult because I kept tangling them up. The gowns are now made so every kind of tube can be attached to a body, through,over, under the gown. I wonder how it would be if somebody like Steve jobs thought about this issue and designed ways to plug patients in without threatening them with strangulation. Sometimes I think apple products are a little too "elegant" and would like just a little more instruction and less reliance on intuition (our intuitions do not always see things the same way). Nevertheless, I think an apple-designed hospital could revolutionize healthcare.

Omg

I went a whole day there without posting! Or did I? The doc took out the drainage Thing in the morning, freeing me from all tethers. one of the first things I did after that was change into my own night shirt, a pretty blue patterned simple flannel gown, same length as the dread hospital gowns. Of course the hospital gowns afford us all opportunities to loosen up with roomies and nurses, but hey, I can live without that. I took more walks, of course, and it is getting easier and easier. The one thing that seems worse this second time around is that it is very hard to lift my leg. Hurts a whole lot, even with pain meds. I wonder if the full-leg brace somehow helped in that department. I would never have guessed it. Sleeping is both better and worse. It is easier to fall asleep and get back to sleep after waking up. But I am unable to sleep on My side. So i sleep on my back, which causes lower back pain after a while. Getting up not easy. Today I go to transitional care, at about noon.there will be a bit more freedom there and I look forward to getting this leg working well. So far the results are promising.

Soon to move again

Early days mean faster improvement, I think. Today I made more strides, literally and figuratively. In the morning I walked to the entrance to the "garden walk", just so I could look out at the rain. For the most part, being in the hospital has isolated us from the weather, which is unfortunate. When I wanted to make a larger circuit the physical therapist said better not, or might not be allowed into the transitional care home. I don't think he was joking This aft the therapist - yet another one - emphasized how to walk. Heel to toe, stretching in the right places and flexing in the right places. I think one reason the therapists always emphasize walking is that this mo ement uses all of the flex and extension that I am working on. Of course, walking became more difficult while I tried to remember everything. The extension is at about ten degrees from zero and the flex is already at 95 degrees. So I am progressing at a faster pace than I did with the left leg. I just noticed that our nurses for today are named breanna and lynaia. Spelling!

Freedom beckons

Today I took myself to the bathroom twice. Had to call a nurse to haul iv stand behind me. So the second time I said I couldn't wait until that bag was empty. One of the nurses had said that would be the last bag. Fortunately, the nurse with me this aft said he could make a case for undoing it early. I thus down to just one cable - the drainage bag from my knee. That goes tomorrow. I would not do well as a longterm patient, hooked up all the time. I break the rules, escape when I can, and generally am a problem patient. Of course, I am always reminded how important it is to move so the caretakers usually applaud my efforts. In pain again...still.

No pain no gain

I think I have to accept that old saw when it comes to the knee therapy. Again and again nurses and others say one has to keep pain meds in the system so that therapy will not be very painful and therefore make progress. I used to want the pain to be blocked altogether and would be impatient when it did not happen. Of course, in a perfect world, I would get that. I have personally observed four people who have had knee or hip replacements and all of them have had trouble finding pain meds that worked for them. The first days are usually the worst but in my own case I struggled nearly until I went off the meds altogether. I am trying to take more deep breaths and reduce my expectations in this department. Today the therapist - Ron this time - had me do some tiny leg lifts, then ankle bends and the pulley lift, and finally he struggled to get all the cables put aside soi could get up with the walker and walk down the hall and back. It got easier and much better than yesterday. Yesterday my knee buckled whe I tried to stand straight up. I stopped at the bathroom on the way back, to my great relief. My one attempt to use a bedpan this morning was not encouraging. Little by little I am regaining independence. Perhaps it is a good thing that I am so impatient.

No walk in the park

Oh the misconceptions. This knee was going to be easier than the last. I was going to power through the pain. Let's just admit up front that I am as much of a wimp as ever. I lost count of the different pain meds I have been on so far. Celebrex to start,along with oxycontin. A spinal anesthesia along with some sleepy stuff, a tranquilizer? Later two or three of something I do not remember,then an injection of Demerol. Which I got to repeat last night. Finished up with two percocets. My knee is hard to move. I am managing to wiggle toes both ways now and flex my foot, sort of. I have done the pulley exercises five or six times, last night. Need to rig that up again. The nurse was in here maybe a dozen times last night. Replacing iv bags, checking meds, and so on. It is a miracle i slept at all, even given all the drugs. One day at a time is my motto for now. I know that improvement will come, that I will celebrate small victories.

Understaffed or something else?

It is after7:30 and my dinner tray is still here. And the things that go around my legs to keep the circulation going and mi imize edema are still sitting on the end of the bed. And I don't know if I am going to get my usual reqip and hydroxyzine. I asked about it some time ago. These things don't surprise me. I have become used to waiting in this hospital. I have noticed tha this for-profit hospital uses a lot of volunteers,too. It is hard to figure it out except that these are cost-cutting measures to maximize profits. AM I just cynical? Edit oct 6: I have since discovered that French hospital is "not-for-profit". I don't know if it has always been. And of course that does not mean "non-profit" technically. I should look that up.

P t and the pursuit of happiness

The pain persisted so the nurse - brad - said he'd get me an injection in between physical therapy. I like this physical therapist. He s very thorough and thoughtful. The goal for today was to get up and into a wheelchair and to hang there for a while And I did it. Also I am hooked up to the pulley apparatus and am pulling my leg up to bend it every now and then. I got to 75 degrees when I did it for the PT, so that was good. I feel hopeful because I know it will get better.And maybe this last drug - injected - will be the answer for the pain. Frankly, I'm willing to go with injections if it works. Lunch was liquid. Heavy liquid, including a blended vegetable soup. And the infamous artificially sweetened and flavored sorbet. As for using my iPad for these journal entries - both good and bad. I prefer to use my iMac keyboard but arranging everything so I can see is a little challenge. A small laptop would be better, to be honest. However, the iPad is small and I can use it alone, without the keyboard, particularly for short answers to emails.

In the grip

The surgery went well. I woke,however, in a lot of pain. The nurses gave me all that they could over the period of time that I was in the recovery room, and then when I went into my regular room I got still more. I woke up at about 9:30 am and it is now 2:10 and I am embarrassed at how much pain relief I have been given. It's better but far from comfortable. I had some trouble adjusting pain meds the last time but I do not recall waking up in such pain and having it continue as it has. This is not entirely unusual, of course. People have different experiences, even the same person at different time. I am in a room with a woman I met in the waiting room, just like last time. Only this time she had hip surgery and she will not be going to Transitional Care. She has a husband and daughter to help her at home. I was right when I remembered how dark these rooms are. Finally I have some light. I could not figure out where the light was until the nurse showed me and hooked it to the pillow like last time. Between the two of us and our machines there is some kind of beeping going off practically every few minutes. IV bag empty. Malfunction of something or other. There is also room for a third patient in between us, so I'd say the room is spacious. I wish I could get up right now and walk around it, but the pain makes that seem impossible. When the physical therapist arrives I hope I will be able to stand up. That might even help, once I get past the initial pain of moving off the bed. Oh, yes. The good news is that there is no full-length brace on my leg this time! I hope this means everything will proceed a little bit more easily.

The Day Of

And so here I am, 4:30 in the morning or so, on the day of my second surgery.

I got so worried last night that I would not be ready and that I would not wake up that I got pretty much everything done, except pack a second suitcase. I have also left some domestic chores for...whenever. As I sit here, though, I remember a couple of things I need to bring, so I am going to go get them and put them in my bag.

All right. That's done. But the new kitty litter is not yet where it should be. I like to mix two kinds so I keep a covered wastebasket near one of the litter boxes and I layer it in there, ready to scoop for freshening the boxes. I need to at least have the litter near that wastebasket. Gonna do that now.

All right. Did that. I'm feeling better, ready to go. In spite of hardly sleeping at all last night. Good thing I don't have to drive anywhere. Or be alert. Just alert enough to tell them which knee to mark.

As Usual, Far From Ready

I am not fully packed yet for my surgical and transitional stays. I am bringing one smaller bag to the hospital, with just a few things in it plus my iPad. Then I am leaving one packed bag for Transitional Care in my car, so friend Maryann can come drive me there and we'll take the fresh suitcase. If I get it together I will fix yet a third bag, which Maryann can trade for my dirty laundry down the line...we'll see!

The hospital now requires a "ticket" when I arrive. This is an 8-1/2X11 colored sheet of paper with a large checklist on it. I am supposed to check that I have had nothing to eat or drink after midnight tonight, that I brushed my teeth in the morning, that I have had all of my pre-op appointments, and so on. Cute. Not really. But I can see why they do it. I have often wondered how many people fail to follow all of the directions before surgery and before pre-op appointments. It isn't as if anyone is calling to remind us.

In another way I am more than ready. I have had a lot of pain in my right leg for a long time. I really hope this new knee goes a LONG way to taking that away, that I do not have to wait for a new hip.  I won't know, really, until I am off pain meds, though, more than likely.