Chickenminnie’s Weblog

Now that I can drive my spirits have lifted considerably and I no longer feel so dreadfully dependent upon people; going to the grocery store alone was a minor victory.  Bringing the laundry up from the basement is still problematic, but the cleaning of the litter box is now an easily done task; life is slowly returning to normal along with my leg.  The deep purple bruising is fading to a strange yellow and more sensation is returning to the parts that were numb; pathways that were cut or disturbed during surgery are now doing their miraculous knitting together and this phenomenon is often accompanied by strange phantom pains and restlessness in the night. The sciatic nonsense has lessened with my increased activity which further cements my theory that movement is the cure.

My in home physical therapy sessions exhausted, I began going to a fantastic woman named Joan for my next six sessions. Her first request was to have me walk away from her and she quickly determined that my right leg is now slightly longer than my left. She immediately fashioned a little cardboard shim for me which she placed in my left sneaker and had me walk away from her again; I was no longer swinging my bad leg around to compensate for the changed length and my gait straightened immediately. Dr. D’Ascoli had warned me that as long as my gait was screwy I was going to experience sciatic issues. This whole mechanical relationship between the different body parts has been fascinating to witness and it is amazing to see the difference small changes make.  Joan also warned me that in addition to learning to walk properly again, I would need to retrain some “favoritism” habits such as resting all my weight on my left leg.

This morning I awoke feeling more depressed than usual, so I made a maiden voyage to the gym in spite of the fact that I wasn’t officially cleared to do so. I had this overwhelming need to walk and since the weather was wretched it made a lot more sense to secure a treadmill at my second home. It felt great to walk back in after being away for a few weeks and I got to catch up with some of the gym regulars I have known for years. Sometimes just doing something familiar is enough to calm the spirit.

Today was the last day of in-home physical therapy from Judy who was assigned to my case and it was amazing to see how far I had come. The day after my surgery the thought of bending my gigantic swollen knee at a ninety degree seemed unfathomable but eighty degrees was reachable today with relative ease. It was good to see progress at the end of all the torture in spite of the fact that there is still much more to do.

Dispensing with the walker and using a cane made mobility a hundred times easier and has already helped my gait. I have a love-hate relationship with the cane; giving it up too early will be a huge detriment to the way I walk, but I noticed that the cane makes me completely immune to eye contact of any kind.

The invisibility thing was something I noticed on a recent trip to a restaurant and bar I frequent fairly often. As I was walking the length of the bar using my cane I noticed that people who would normally respond to my smile with a look or a nod were now diverting their eyes as if they were afraid to be caught staring. It took a while for this to sink in; I noticed an oddness as I navigated the crowd but an experimental trip to the bathroom clinched it. People do not want to look at infirmity of any kind or perhaps it is some sort of knee-jerk politeness. In any case, I found it fascinating and made me resolve to work even harder to ditch the cane.

Week two was the week when I finally felt as if I was turning some sort of corner and experienced a lot of the changes that someone healing from this surgery experiences. Sensation was gradually returning to parts of my leg that had been numb and the bruising was slowly disappearing. Physical therapy was bringing back the strength surprisingly quickly so leg management was vastly easier. As of this writing it is still remarkably difficult to get comfortable for long periods of time because of the residual swelling, but it is getting better. In tiny increments. Tiny. This rehabilitation has required every ounce of my patience and focus and there have been a few meltdowns, some of which have been caused by progress that has been frustratingly slow and some by my emotional state before going into surgery. Anesthesia seems to exacerbate these devastating little incidents that leave me drained.

Toward the end of week two the walker is now being handled in much the same way one would handle a very clunky cane, so I am hopeful that my physical therapy session tomorrow will graduate me to an actual cane.  Driving is another thing I am really missing and while I cannot think of anywhere I really need to go, it frustrates me to be dependent upon other people.

One landmark event in week two was the follow-up with Dr. D. My gigantic sticky bandage was removed revealing a shiny row of thirty two staples which had not seen daylight since I was at the hospital. They were quickly removed by a woman who had clearly done this sort of thing  million times before and covered the eight inch scar with a row of steri-strips. The doctor said I was progressing nicely and gave me a copy of the x-ray of my new prosthesis which made me feel oddly as if some torch had been passed; I had the fleeting memory of the day I took delivery on my pickup truck which made me chuckle.

Hospitals are tough places to recover. There is a whole lot of professional staff around and if you fall down someone is bound to notice, but there is a constant hustle and bustle even in the middle of the night that jangled my nerves and exhausted me. When I wasn’t making my slow and painful way to the bathroom or out of my bed for physical therapy I had little foot pumps velcroed to my feet that alternately squeezed each ankle to prevent blood clots. Fortunately my leg was far too clunky and swollen to entertain any thought of rolling over which I desperately wanted to do, so I slept in the intervals brought to me by my pain meds.

After four days my doctor felt I would be able to drag myself the three steps into my house, so Mike came and gathered me up along with my walker for the trip home. There had been a sizeable snow storm the night before, and I knew he had a considerable amount of work to do to get a path cleared so I was especially grateful. I said goodbye to the medical staff who had been taking care of me and was wheeled toward freedom.

Being outdoors for the first time seemed surreal, but all I could think of was getting home to familiar surroundings and my cat who was probably certain her mother was never returning. Using the stair navigation tricks I had learned in physical therapy I made it up the three steps to the refuge of my house and realized I was exhausted. Mike got me installed on the couch with a fresh bottle of water and went off to pick up my numerous prescriptions; a caretaker’s work is never done.

Pain management at home was a bit different since there was no white board and the meds had been reduced from three to one. My fondest hope was that I would have what I needed to navigate at home and complete the rehab sessions. It turned out that I was prescribed 5 mg. of Oxycodone every 4-6 hours, but it was up to me to figure how to make those sixty tiny pills last until until my first follow-up visit eight days away. The effort was mostly successful except for getting cocky the first night and only taking one pill with the reasoning that I would be sleeping anyway. It ended up being a huge mistake and the hour and a half wait until my next dosage was one I never wish to repeat.

There were some new tricks to managing the floor plan of my house. Reluctantly I had gotten a raised toilet seat because of the small amount of clearance my bathroom afforded for a leg that does not bend all that well and ended up being very glad. My high antique bed afforded another challenge to get into with a leg that was less than functional, and I was glad I had done so much leg strengthening before surgery; my good leg became a lever that hooked under my bad leg and hoisted it into bed. The rest of my little postwar ranch ended up being pretty well suited for a walker with the exception of the pantry. When I discovered my walker would only go through the door sideways I burst out laughing at the irony of it and knew it was the universe’s way of telling me not to overtax my new knee by gaining weight.  Message received.

One week ago I handed myself over to the competent people at Schenectady Regional Orthopaedics for my long overdue total knee replacement. With much trepidation I showed up at the appointed time and surrendered my clothing and cell phone for a hospital gown, funny hat and an IV line which was to be my constant companion for the next four days. Dr. D’Ascoli visited after I was prepped and autographed the suspect knee; ten minutes later I was off to the frigid operating room and I was grateful to the nurse for covering me with a heated blanket before heading in. I noted with some amusement that my knee was throbbing relentlessly and it occurred to me for the five millionth time that I was making a very good decision.

Awakening in the recovery room I was surprised at how little residual fuzziness I felt in my head; the anesthesiologist must have given me just the right amount of magic to do the trick. Immediately curious about the state of my leg, I peeled back the blanket to see an ace bandage wrapped from mid-thigh to toe and a mass of purple bruises on the exposed thigh above. Lovely. My leg was roughly half again its normal diameter and I was trying to imagine how much was bandage and how much was me. The pain was a dull ache and I knew the local anesthetics he used in place of a femoral block had not yet worn off.

Not long after being transferred to my room, I had my first physical therapy session which seems unthinkable, but I get the logic of it; why not do it before all the anesthesia wears off? This makes the first PT experience relatively pleasant because it is most assuredly less fun as time goes on. Susie did all of the same exercises they prescribed before the surgery and this time I really did feel like the little old person depicted in the booklet. In the space of a few hours my previously useful quadricep had been reduced to mush and I knew there was some serious work ahead of me. I took my first walk with the walker and it took intense concentration to navigate my giant throbbing thigh while coordinating the movement of the walker and dragging an IV drip.

One of my concerns had been pain management, but a white board visible from my bed ended up being the perfect tool for keeping track of a number of things. The three pain meds I was on, Oxycontin, Oxycodone and morphine were listed on the board with their ordered intervals, and every time one of them was administered the nurse would write the time down. This helped me keep track of things and take more ownership of my pain relief which in turn helped the overworked nursing staff. There was a pain scale printed on the board and that became my other tool for managing the daunting amount of discomfort native to this particular surgery and they would tick off the number I was feeling when meds were administered; this gave me a more logical way to assess and convey how much discomfort I was in. Other useful things that were included on the board were the name of the nurse, physical therapist, tech and housekeeper in charge of my room. Genius! There was only one night when a combination of dozing off and a nursing shift change caused me to awaken in unimaginable pain; I have never been so grateful for intravenous opiates in my life.