Post Surgery Week 10: Grumpy McPouty Face

Wednesday, July 31, 2019

Today marks the end of week 10 after my Total Knee Replacement surgery.

I should be grateful that I’m finally making progress.

I’m walking - as much as a couple of miles in a day.

I’m stationary biking up to 18 minutes at a time, soon to be 20 minutes and more.  One of these days I will get on a real bike and ride somewhere real, as opposed to just spinning in place.

I have a new PT who is keeping me honest in my exercises, pushing me to keep my extension straight, and helping me to walk without a limp.  She’s also allowing me to start doing some Pilates exercises, and soon - I hope, maybe even within weeks - I’ll be able to join my Pilates class again.

Speaking of my Pilates class, my last PT appointment butted up against my old class time, and I got to see all of my old classmates.  They were all smiling and welcoming and curious about my progress post-surgery.  It was grand to see them.

But.

In the face of all that is good, I feel like Grumpy McPouty Face to point out what is not good.

And what is not good is the freaking pain.

The pain seems to have a life of its own.  The current incarnation of the pain-that-won’t-allow-me-to-sleep is the screwdriver that is being driven into my knee on a constant, non-stop basis.  It’s on the inside facet of my knee, down below the bend.

Somebody has apparently stripped out the threads on the screw, and they keep turning the screw, and it hurts.  

It. Just. Plain. Hurts.  

All. The. Freaking. Time.

People keep greeting me with stuff like “it’s so good to see you walking pain-free again!”  It feels rude and a major downer to point out that while I am walking, it’s still pretty far from being pain-free.  I mean, really:  what use it is to keep complaining?  

I have had moments when I’ve thought that I was past the worst of the pain, but then, this.  Many nights - again - of a completely achy knee.  Many nights - again - of the screwdriver-in-the-side-of-the-knee.  Many nights - again - of not sleeping.

Dammit.  I did not sign up for this.  Crap.  Damn. F*&^.

Here’s praying that when my doctor’s office calls back today or tomorrow, they’ll have yet another trick up their sleeve.  Until then, I’ll just go sit in my corner and pray that the next ice pack brings some relief. 

Damn.

Post Surgery Week 10: Abyssinia, Lindsey

Friday, July 26

Among our guilty pleasures is binge watching shows on Netflix and Hulu and PBS, and well, anywhere we have a subscription, something that we’ve indulged in a big way during this recovery period.  A while back, we finished watching all ten seasons of “Friends”;  neither of us had watched it when it ran in prime time on network TV.  Both of us were snobs when we started watching it (what the heck is all the fuss about, already?), but as we got further and further along in the timeline, we fell in love with the characters, and it was devastating to reach the end.

We searched around a bit for a replacement, and finally settled on M*A*S*H.  Both of us had watched this show when it originally aired (1972-1983), but that’s a long, long time ago, and we’ve both been loving seeing it again now.  It packs in the laughs, but it’s much more serious, and packs a much more emotional punch, too.  The other night, we watched the final episode of Season 3.  The episode is titled, “Abyssinia, Henry”, and in the episode, Colonel Henry Blake gets his discharge papers, and leaves the 4077th.  (Wikipedia tells me that “Abyssinia” was slang for “I’ll be seeing you”.)  The gut-punch (spoiler alert if you haven’t seen it) is that in the closing moments of the show, we learn that Colonel Blake’s plane home was shot down, and there were no survivors.

I don’t much care for goodbyes, real or fictional.  I know that this is a fictional character from a TV show from nearly fifty years ago, about a war that took place twenty years before that.  But still.  Still, that ending was not something I remembered from my teenage years of watching this with my family, and the permanency of that loss has haunted me for the last couple of days.

In my real life, when I haven’t been thinking about the loss of Colonel Blake, I’ve been marveling at how far it seems I’ve come in this last week.  I’ve engaged with Karen at Blue Sky, and my recovery has amped up.  I’m doing PT with her, and a tiny bit of Pilates, and the outlook is all good.  The anti-inflammatory is working its magic - I manage to stave off the worst of my recovery pain with just one dose a day, with the occasional second dose if things start to feel too painful.  (I’m terrified of letting the inflammation flare up again.)  The TENS unit is providing me with a tingly knee several times a day.  I’ve been walking more - Ed says that our walk the other evening was a mile in length - and cycling more, too (up to 17 minutes of spinning on the trainer, soon to be 18 and more). 

136 degrees of flexion!

It feels like I’ve finally turned that proverbial corner.  That doesn’t mean I’m not scared to death that I’ll hit a dead-end or a U-turn at any moment, but I’m enjoying this for what it is.  Progress.  Moments of not thinking about my knee.  The hint of actually being able to get my life back again.

And so as part of that “getting my life back again campaign", this morning seemed the right time to call my PT with Lindsey complete.   We agreed that the best approach would be to let Lindsey know at the start of the appointment this morning that this would be my last visit. Ed has been with me every step of the way in this recovery, and always a part of my PT appointments, so the two of us approached this goodbye together.

Her reaction was super:  agreement, congrats, a review of the exercises she advises I continue to do for the - gulp - next year.  One last check of my range of motion was in order, and the results were good for high-fives all around.  My extension today - after much work this week - was all the way down to 2 degrees.  And my flexion?  A whopping 136 degrees.  Lindsey made my day by telling me this is a record for her:  she’s never seen anyone with a TKR get that much flexion post-surgery.  Now, how or why that matters is another question altogether, but, well, when you have a competitive nature, that’s just the way it works

Flanked by my PT team of Ed and Lindsey

And so it turns out that, after nine weeks and twenty visits, my honorable discharge papers are in hand, and I’m leaving the M*A*S*H unit that is the Centura Therapy Center, and going home. Home in this case is Blue Sky Pilates and PT, where Karen tells me I’ll be able to join my old Pilates class in a couple of weeks, after just a little more one on one work with her.  Home is also hanging out here at home with Coach Ed;  he promised Lindsey that he’ll make sure that I pay attention to my PT and my walking and my stance, always keeping my knee over my second toe, like I’ve been taught.

And it means I had to say Abyssinia, Lindsey.  It’s been good!  I got hugely frustrated with you during my setback, but you always had my best interests at heart.  Thanks for the memories.  And the pain.  And the care.  And the cheerleading.  And - while I’d love to stay and chat - I have places to go and people to see, and I hope won’t be coming back this way again any time soon.

Post Surgery Week 9: It Hurts So Good

Wednesday, July 24

When I was a kid, they didn’t have organized sports for girls until you hit junior high.  That’s how my first introduction to the concept of “getting in shape” didn’t occur until I was in seventh grade, and I went out for the basketball team.  This was something I had wanted to do ever since I learned that my mom was an all-state basketball player in her day.  I’m not sure I ever thought about a possibility that didn’t include playing basketball;  I wanted to match what she had done.

That first year must have been brutal;  I think I’m kinda glad that I don’t remember the pain that came with getting in shape that first time.  I know that we did the fun stuff of basketball practice:  shooting hoops, dribbling the ball, practicing passes.  But I also know that we did the hard stuff:  running laps, doing pushups and situps, and - oh the pain of it all - running line drills.  Line drills were the things where you started at the baseline of the basketball court, ran to the free throw line, then back to baseline, then to the half court line, and so on, until you had run the entire length of the court, all as fast as you could.  They were killers.  And we all had a love/hate relationship with them.  We all raced each other to be the fastest.  We all complained about them before and after (we were too out of breath during to complain then).  We all knew that the good practices were the ones where we ran line drills, because we knew they were helping to keep us in shape.

Those first few weeks of basketball practice were, I came to learn, always killers.  It all hurt.  In the days after basketball practice started, we were all sore and stiff, nursing muscles that we didn’t know we had.  We hobbled around.  We wore the pain as a badge of honor. 

But then after a few weeks, we were well on our way there.  We felt our muscles get hard and lean, it took longer to run out of breath.  Sure, when we had a really hard practice, we all might be moaning and groaning again the next day.  But nothing like those first few weeks.

I came to love that feeling.  The feeling of getting into shape, of being in shape.  Of strength.  Of fitness.  Of health.  This sequence of events happened every fall, and then again in the spring when track season started.  Spring soreness was never as bad as fall soreness, since we were usually coming off basketball season, and didn’t start from so far back.  We became perpetually fit during the school year.  We were defined by the seasons of fitness all through junior high and high school.

When I went to college, I lost that.  And missed it immensely.  I gained my Freshman Fifteen, and felt miserable.  By my third and last year of college (I did the fast track thing), I was ready to do something about it, and enrolled in a Personal Fitness class.  It may just have been the favorite class of my college career.

In Personal Fitness class, I learned about fitness.  About nutrition.  About aerobic exercise.  About weight-bearing exercises.  I started running - just a little at first, and then longer and longer, until I was stringing together a mile, then a couple of miles, then three miles.  I went through the “getting in shape” phase, and oh, how I had missed that soreness, that proof that I was actually getting strong and lean.  

In the intervening years, I’ve pretty much perpetually stayed “in shape”, at least in some small way.  There have been times when I’ve had to take time off (other surgeries, other illnesses, a few broken bones), or times when I ramped things up (like doing marathon training), or times when I’ve done new things that exercise muscles that haven’t been getting used in other ways (like weight-lifting or Pilates or my-very-limited-attempts at yoga).  I’ve always welcomed the chance to feel like I’m getting in shape again.  The soreness - that bit of pain - has always been the confirmation that I’m working hard enough, that I’ll get back to some level of fitness.

This knee thing changed all of that.

Before surgery, my running had come to a stop.  My knee just wouldn’t allow it.  So I was walking, but even then, my knee sometimes rebelled.  I kept up with Pilates classes until the bitter end (my last Pilates class was two days before surgery), and I did some easy weight-lifting to try to stay in shape as best I could given the circumstances.  But I knew that going through recovery was going to feel a lot like starting from scratch.  Just like that first day of basketball practice.

I was down with all that.  Really.  Remember, I love the feeling of getting into shape?  I was ready, eager, and willing, just as soon as my new knee could take it, I was going to be on it.  That pretty much describes my first three weeks of recovery.

But then my setback - that damned tendonitis - changed everything.  When the PT advice was “do nothing”, it was probably the worst prescription I could ever be given.  I almost forgot that I would ever be able to get in shape again.

But then, this happened.  A bunch of doing-nothing time.  A new anti-inflammatory drug.  A cool little TENS unit.  A new PT who gave me new exercises.  A surgeon who said “I want you to walk!  I want you to ride a bike!”.  More icing.  Fewer and fewer pain meds.  Building up some walking distance again, block by block, day by day.  Building up my cycling time, one minute more each day on the stationary bike.

Which is how it came to be that yesterday at lunch time, I decided to go for a walk around the block.  Ed was out, so I went solo.  I walked up the block, going south - it’s a tiny incline, you can’t really call it a hill - then turned east, then turned back north again.  I had the weirdest sensation, and I just couldn’t put my finger on what it was.  After all, I concentrate hard when I walk these days, trying to get my leg extended as far as I can, trying to remember to go heel-toe in my foot strike, trying to remember to let my arms swing naturally.  It’s a lot to think about, which seems very weird for something that is such an every-day, matter-of-fact act for most people.

Then I figured it out.  It was my leg muscles:  they were complaining.  They were not complaining about surgical pain.  They were not complaining about soft tissue inflammation.  They were simply complaining because I was using them again.  They were giving me that old “hey, you’re making us get in shape, and well, it’s a bit of a pain” message.

Nothing has ever hurt so good before.  If I could run or skip or jump the rest of the way home, I would have.  But I’m still working on walking, so I did just that:  I walked the rest of the way home.  With each step, I couldn’t help but think how good it feels to be getting back in shape again.  Even if it is a bit of a pain.

Post Surgery Week 9: This is Just To Say

Monday, July 22

This is just to say that sometimes, it’s not so bad.

The new anti-inflammatory drug seems to be working.  The new TENS/IFC unit seems to be working.  Who actually knows which one is working?  Or are both working?  I really don’t care.  I can almost sleep through the night.  I can almost imagine going to sleep and not having pain wake me up.

Did I mention that yesterday was National Ice Cream Day?  We had our 5th Annual Ice Cream Social out on Mayberry, our front porch.  Ed and I started this tradition the first summer that we had this house, and what a grand event.  We started out with an intention that the Social would be an event just for our block, but in the intervening years, we’ve adopted the big tent approach.  So now we formally invite all of the folks on our block, as well as other friends and neighbors.  Yesterday we had roughly 40 people.  And what an easy and delightful event to put on - we get a few gallons of ice cream, set out a bunch of toppings, and let people make their own sundaes.  Sam, our 8-year old honorary grandson, has a tradition of being first in line (when he lived across the street, he started stalking us from his front yard as we started our setup, slinking into our yard, trying to hurry up the clock), and even though he now lives a mile or so away, he was here to lead off the festivities.  The day turned out to be perfect:  sunny and warm, but not too hot.  We ended up with some ice cream soup by the time we put everything away, but who’s to say there’s anything wrong with that?

Did I mention that the anti-inflammatory seems to be working?  And that the TENS thingy is also doing good stuff?

This is just to say:  sometimes it’s not all bad.

I rode the stationary bike this afternoon for 15 minutes.  15 minutes!  That’s a new world record!

Ed and I went out for a walk later, and we circled DeBoer Park at the end of the street, adding little by little to the distance I can cover before my knee gets cranky.   As we were heading back home, we met our neighbors on their way to the playground.  Josie is around five years old, and the last time we talked to her, she thought my knee looked pretty gross.  Today, she didn’t even look at my knee.  She looked at me and said, “I like your shoes!”  Now, coming from a five year old girl, that’s a pretty sweet compliment.  Does it get any better than that?

Well, yes, yes it does.  Ed and I made a quick trip to Whole Foods, and when we got home he disappeared into his office to finish up a bit of work.  That left me the task of putting stuff away, and doing some of the very minimal kitchen work that I do.  My watch started to buzz, and I looked at it, thinking it was probably just alerting me that I had yet another junk call.  But no, it was my Garmin telling me that I had hit my daily steps goal.  Now, I have no idea how low that goal is just now - it calibrates the goal based on how many steps I actually take - but that doesn’t matter.  Not one bit.  The important thing is this:  I’m pretty damned sure that it’s the first time since surgery that I’ve even come close to hitting my steps goal.

And that, my friends, is just to say:  sometimes it’s not all bad.

Post Surgery Week 9: Everything But the Kitchen Sink

Saturday, July 20

The eight week anniversary of my surgery came and went last Thursday.  I was hoping to write a celebratory blog post about getting to eight weeks and turning the proverbial corner, but my entire left leg had other thoughts.  Instead of sticking with the roller coaster trajectory - some ups, some downs - the leg went on a downward spiral and I was back in super-depressed mode.  Multiple nights of increasing pain and decreasing sleep had me on the verge of tears.  Again.  It’s not like I’ve ever been all that stoic - heck, I tear up when I hear that someone somewhere is getting married - but I’ve never before felt like such a huge crybaby.

So then instead of a celebratory post, I started a super-depressed downer of a post.  I mean, really:  what is up with pain that just won’t end?  But I depressed myself so much that I couldn’t bear to finish it.  Some things are better left unpublished.

And so, pretty much out of desperation, I started into Everything But the Kitchen Sink (EBTKS) mode.  After eight weeks, I’m just no longer going to take this pain crap lying down.  And, oh, did I mention that my cheerleader/coach/drill sergeant of a husband started prodding me hard to do something instead of just feeling sorry for myself, and like the world was against me?

The first stop on the EBTKS train was a call to Heather, the Friendliest-and-Most-Upbeat PA in the world.  No, what I’m going through is not normal.  No, having this much pain this far out is not the expected outcome. No, I shouldn’t expect to be in pain like this.  But, it happens. 

Heather’s addition to the EBTKS quest was a new anti-inflammatory, Diclofenac Sodium.  Heather says this is the strongest anti-inflammatory she can prescribe, so off we went to Walgreen’s to pick up yet another prescription.  I’ve tried to stop reading the warnings that come with prescriptions;  if you read them in detail, you’d never take another dose of any medicine again in your life.  I glanced at the flyer and then filed it away.  Who says that knowledge is a good thing in all instances?

Heather had a bunch of other thoughts for the EBTKS.  Don’t do any of the PT exercises after 4 pm.  Ice.  (Duh.  If nothing else, I’m an icing machine.)  Keep going to PT, and yes, seeing a new PT at this point (aka Karen) may just help shake things up.   Another new idea:  use a compression knee brace or ACE bandage to give the knee some support and to help keep down the swelling.  I’ll spare you the details of how the knee brace I bought a few months ago has disappeared into the ether despite tearing the house apart looking for it;  suffice to say that the trip to Walgreen’s was not wasted on prescription drug retrieval only.

My first dose of Diclofenac was Thursday night, and I slept marginally better, with at least a bit less pain.  Friday morning was definitely less pain, but on the down side, the new drug put me in loopy mode.  Well, then.  No driving me for again while on this drug.  

But never mind, Ed took me to my PT appointment with Lindsey.  Remember Lindsey?  She’s my on-again, off-again PT.  The EBTKS policy means that we take on new but don’t necessarily throw out the old.  My biggest concern about Lindsey is her ultra-conservatism.  She is so insanely afraid of doing (or approving) anything that she thinks might spike the inflammation that I end up feeling like I’m in a cage.  Dr. Miner and Heather had suggested that PT massage might help, but Lindsey was afraid of making things worse, so no massage.  While we were talking about this during the Friday morning appointment, Ed asked about TENS, and you could see the light bulb go off in Lindsey’s mind.  “That’s a great idea!”  So just like that, I got an introduction to TENS, and was on my way to getting my own at-home unit.

The person who handles getting the units, Ariane (I may have butchered the spelling of her name), was on it.  She got the prescription processed, contacted the vendor who supplies the machines, and had it ordered and ready for delivery.  But since it wouldn’t get here until next week, she magically pulled a unit out of her hat and personally delivered it this morning, describing how it works and how it will benefit me.  She showed me how to set it up, and then gave me a primer on how to use it. 

Even more, she’s also a therapist, and when I described how my recovery had gone haywire, she got it.  She said, yep, that makes sense - as you ramped up your activity, you were no doubt walking oddly, and your IT Band and outer quad muscles got inflamed.  They are like playground bullies, and they pretty much took over everything, and the VMO (inside quad muscle) - the thing you need to stabilize your knee - just shut down.  She pointed out how you can see how much my quad muscles have all atrophied. 

So the cool new tool that came is a NexWave:  based on the manual for the thing, it’s a multiple-mode stimulator that allows IFC (interferential current), TENS (transcutaneous electrical nerve stimulation, and NMES (neuromuscular electrical stimulation).  In essence, it uses electrical stimulation to promote healing by reducing inflammation and swelling.  It works on releasing endorphins and somehow messing with pain messages to the brain.  Ariane explained all the stuff, and there’s a booklet that explains some of it;  the important thing is that it’s just one more thing I can use from the EBTKS arsenal of things.  And the tingly feeling it gives my knee:  far better than any of the pain feelings.  It’s worth a try.

Onward and upward with EBTKS.  If these new things don’t get me completely around that next corner, then I am making a mental list of where to go next.  Acupuncture?  It has helped me for other stuff in the past.  More laser?  Sure, why not.  Massage?  Sign me up!  Meditation?  Time to get going with that.  I have contact info for a medical intuitive in case all these more physical-level things don’t work, maybe metaphysics will.  As Ed keeps telling me when I get cranky and whiny and teary, I’m actually getting better, day by day, even though it doesn’t seem that way to me when the pain takes center stage.  Really.  And with my new EBTKS mantra, I’ll get there.

Post Surgery Week 8: Roller Coasters and Blue Skies

Wednesday, July 17, 2019

What a night that was.  Miserable as they come.  I feel like I’m starting to sound like a broken record, but, holy hell, this is getting old.  Lately it seems that I’m on a roller coaster when it comes to pain and sleep.  One night (like Monday night), I’ll only wake up a couple of times, and then a quick walk and maybe some CBD lotion will dull the pain enough that I can get back to sleep.  The next night (like last night), the pain is just this side of unbearable.  I sleep very little, and wake up often, and it takes everything I can think of to dull the pain (walking, stretching, bending, CBD lotion slathered on, fresh ice packs, more Tylenol) just enough so that I don’t scream.  Or cry.

I know that yesterday I vowed to adopt a new attitude, but, well, nights like last night sure make that a bugger of a challenge.

Last night, the pain was so bad that I thought seriously about going back to the narcotics that I kicked a few weeks ago.  The only thing that stopped me from going down that path was the fact that I had an early appointment this morning with a new physical therapist, and I needed to drive there, and I really didn’t think it would be a good idea to drive if I had just taken a Tramadol a few hours earlier.

Actually, the physical therapist was not really new.  Karen, at Blue Sky Physical Therapy, was my first choice for a PT when I was working on my post-surgery PT plan.  I have known Karen for at least ten years;  she (and a couple of her partners at Blue Sky) has been my go-to PT whenever I’ve had injuries in the past; she’s also my Pilates teacher; and as a result she knows my body and my physical quirks and bad habits exceedingly well.  So it was only natural that I would schedule my post-op PT with Karen.  But it turns out that Blue Sky is not in-network for my insurance plan, and that meant - with months of PT to be worked through - the out of pocket was just going to be too rich for my budget.  That’s how I ended up with the hospital PT practice and Lindsey:  all one easy package, especially from a financial standpoint.  And - to be completely transparent - the hospital is a four minute drive from our house, and Blue Sky is close to half an hour.  It was just that much more convenient.

When I saw Dr. Miner last week, he told me I could go back to Pilates classes.  Yay!  I was thrilled that he okayed the activity, but I was also very nervous about getting back to the classes.  I’m in pretty crappy shape after laying around on the couch for weeks on end, and, plus, I wanted to make sure that Karen agreed that I could join the classes again.  So we talked late last week, and set up some appointments so she could assess where I am, and what it would take to get me to a point where I could do Pilates again.

That’s why I needed to drive to an early morning PT appointment at Blue Sky today.   Yes - did you notice?  I drove!  Now, that’s a milestone to celebrate!  This was my first outing behind the wheel since pre-surgery.  I did borrow Ed’s Prius, since we were both worried about my ability to operate the clutch in my own car.  It felt, well, really, really weird to be going to an appointment without Ed.  He’s been with me, quite literally, every step of the way in this recovery process.  The comforting thought was that I already knew Karen and the other folks at Blue Sky, and in a sense, I felt like I was going home.

Karen spent a full hour with me, doing a full PT intake.  As we walked from the front desk to the treatment room, she took one look at my gait and said, “we need to do some work on extension, don’t we?”  When she measured it a few minutes later, it turned out she was completely right:  it was at a lousy 7 degrees this morning (ultimate goal is to be at zero).  Karen explained that extension is really important in being able to walk normally;  without full extension, I would be continuing to put bad pressure on the IT Band and the new knee.  I had already filled her in on details of my post-surgery experience, and the IT Band tendinitis.  She did some basic evaluation, and noticed immediately that my quad wasn’t firing the way it should.  What had seemed like a big mystery to my now-truly-former PT was incredibly apparent to my new-and-forever PT:  my soft tissue got pissed off because my quad wasn’t doing its fair share of the work, and as a result, the IT Band was working overtime, and getting stretched in a way that it’s not supposed to be stretched.

Karen worked on helping me get the quad muscles to fire, and she manually worked on the tissue there, and she gave me a few new exercises to do.  She talked about using e-stim if my quad doesn’t respond to these efforts to get it to do its job. 

Then she spent a bunch of time working on teaching me how to walk again.  Really.  We walked up and down the PT office, over and over and over again.  Since I quit walking with any help (cane, crutches, walker), I’ve felt that walking feels just plain weird.  I’m always working hard to not limp.  Karen demonstrated to me what that looks like, and, well, yeah.  That sure looked weird, and it’s what I’ve been doing for weeks now.  

When I saw my chiropractor (another Karin, just spelled differently) a few weeks ago for laser treatments, she asked, “is your PT teaching you to walk again?”, and when I said no, she seemed aghast.  “I don’t understand how you can not go through true gait coaching when your leg has been changed so much.”

Well, it turns out that Karen and Karin both agree.  I need to relearn how to walk.  And I have hope now that Karen will help me get it right.

And so, just like that, after a totally lousy night, and after waking up feeling extremely despondent, and after fearing that I’d never get past this roller coaster:  there’s hope.  There’s a glimmer of something.  There’s a bit of Blue Sky.

Blue skies smiling at me

Nothing but blue skies do i see

Blue birds singing a song

Nothing but blue skies from now on

Never saw the sun shining so bright

Never saw things going so right

Blue days, all of them gone

Nothing but blue skies from now on

Blue skies smiling at me

Nothing but blue skies do i see

Post Surgery Week 8: Great Expectations and Other Good Rubbish

Tuesday, July 16

In the weeks leading up to my knee surgery, I spent a lot of time with Dr. Google.  My friend Melissa, who is going through cancer treatment, says that Google is not your friend when going through something like she’s going through.  It can feed your worst fears, and raise possibilities of horrors that you’d never otherwise imagine.  So Melissa mostly stays away from the internet these days.  I don’t blame her, not at all.

But my experience with Dr. Google came early on, and it didn’t scare me quite as much as it might have.  I was forewarned about watching the actual surgery itself, as there are, apparently, videos of the full procedure. I’m not sure I’ll ever be tough enough to sit through that.  But I did find a YouTube by a couple of guys who style themselves as the “Most Famous Physical Therapists on the Internet”.  The entry of theirs that came up in one of my searches was “Knee Replacement Rehab:  Top 5 Mistakes People Make”.

Their list included an admonition to keep pain under control;  their argument for this is that you can’t progress with therapy if you can’t work through the pain of getting mobility back.  True dat.  A little self-serving was their item (#5 on their list) warning people not to stop therapy too soon, but I’ll spot them that one.  Even with my setback (which was, by the way, deemed to be “iliotibial band tendinitis” by Dr. Miner when I saw him last week), I’m pretty sure that my therapy has helped immensely.  If nothing else, it’s definitely given my recovery a form and direction that I would have had to work hard to come up with on my own.  

Another of their five mistakes deals with range of motion:  that people tend to focus on the wrong thing, for instance, trying to build up activities like walking, when the real number one focus post-surgery should be on range of motion.  This is one that I think I have in hand.   My surgeon’s 6-week goal for me post surgery was to be at flexion of 120.  I was at 108 immediately after surgery, and at 128 last week when I saw him for my checkup.  And still improving.  Lindsey, my not-really-fired physical therapist, said last Friday:  “I can count on one hand the number of people I’ve seen who have gotten better flexion than 130 with knee replacement”.  My extension has yet to reach the perfect goal of zero, but I’ve gotten darn close:  Dr. Miner clocked me at 1 degree in that same checkup. 

Another item is about not replacing the walker too soon with a cane.  That one is water under the bridge, and was not really an issue for me.  I used a walker for the first few weeks, then when I had my two-week post-op checkup, the wonderful PA Heather told me I could ditch the walker entirely.  Which I did, very happily.

So, as far as the five mistakes go, I did okay.  For four of them.  That other item?  “Don’t compare yourself to others”.  Oh dear.  That’s the hard one.  Especially with the setback.

My first few days - no, first couple of weeks - post-surgery were right on schedule.  I was making great progress.  My PT told me I was ahead of the curve, and I loved loved loved that.  All the fitness I had going into surgery was paying off.  I hadn’t been able to run for a while, but I had stayed in pretty decent shape by walking briskly every day, and putting a lot of time on the stationary bike, as well as Pilates classes.  That’s how I got okayed by PT, early on, for increasing activities.  I started to walk further at the end of week 2, and started some stationary biking around the same time, and started walking upstairs without much help, and was just starting to be able to walk downstairs normally, too.

My only real comparison at this time was with my own expectations.  I just thought I was going to be ahead of the curve, in every way:  mobility, range of motion, ability to get back to work.  Call it vanity.  Call it hubris.  Call it years of running and thinking that the running gave me a level of fitness that would have a payoff in this - or almost any -  case.  Call it just plain being wrong.

During my first few weeks of PT, I developed another basis of comparison.  Another woman, someone I judged to be about ten years older than me, had PT appointments at the same time as mine;  she had had her knee replacement surgery three days before mine, so she was a few days ahead of me the first time I saw her in the PT office.  But I passed her in progress within the first week, and I privately took some pride in that.  She was exceptionally friendly;  she always had a big smile on her face.  She was in the office the morning I came in after my setback, and when she asked how I was doing, one of the hardest things for me was being unable to match her smile.  Later that week - when I was still suffering and very teary - I saw her one last time.  Lorraine (I finally learned her name), came up and gave me a big hug, and told me she was done with PT.  I almost cried:  partly because I truly would miss her happy smile and vibe, and partly because I felt so far behind.  (By the way, the Most Famous Physical Therapists say that when they have more than one TKR patient at the same time, they try to schedule their appointments far enough apart so that they won’t end up comparing themselves to each other.  Good advice, that.)  But for all that, I’m still glad I got to know Lorraine, even just for a little bit.

So it turns out that I’ve wasted a good deal of time and mental and emotional energy this last month on doing exactly what the Most Famous Physical Therapists on the Internet warned me about:  comparing myself to others, and coming up short. I even started to beat myself up the other day after another Dr. Google search brought me to a YouTube of Al Roker after his total knee replacement.  WTF, I wanted to scream at the computer.  Al Freaking Roker had a TKR and was back at work in two weeks, looking completely put together.  How does that work?  How is that fair?  How did I go wrong?

But my caregiver, nurse, coach, cook, and chauffeur Ed just happens to be my biggest cheerleader, too.  It makes him crazy to hear me compare myself and come up short, so I’m working very, very hard on a better outlook.  Melissa, going through cancer treatments, also tells me that she’s getting through her ordeal by practicing positive imaging and meditations.  It’s all about positive vibes, and positive attitude.  

So today’s thoughts about healing are positive ones.  I’ve got great range of motion.  I’m walking a little more every day.  I’m (mostly) sleeping better with (mostly) fewer pharmaceutical aids and (mostly) less pain.  I’m riding just a little bit more on the stationary bike every day;  yesterday I got up to 9 minutes, and today, by gum, I’m going 10 minutes.  I can walk upstairs pretty easily, and downstairs, too - just not with much grace yet.  I’m starting to get antsy to do things….travel, vacation, whatever.  I'm starting to actually live again.

I’m on my way.  Maybe not as fast as I thought I would be, but after all, who cares?  Great expectations are highly overrated.  At least sometimes.  This other way of being - taking just a little longer than I planned for recovery, being kind to myself, giving myself a break - could hardly be better timed.  Now I have a great excuse to sit on the couch with the ice machine running, watching the Tour de France.

Post Surgery Week 8: What a Pain

Friday, July 12

It’s been seven weeks and a day since my surgery, and the one constant throughout the entire recovery process has been pain.  And thoughts about pain.  And questions about pain.  And efforts to reduce pain.  All this attention on pain is, well, a pain in itself.

My knee pain started at least twenty-five years ago.  Twenty-five years!  It’s impossible to think of a time when I wasn’t at least a little aware of pain in my left knee.  The problem wasn’t anything mysterious or out of the ordinary or hard to diagnose.  Being knock-kneed (or, as I’m learning more of the medical terms for it, having a “valgus deformity”) combined with arthritis meant that the cartilage on the outside of my knee wore away, and I was left in a bone-on-bone situation.  And bone-on-bone is just plain not good.  

I have been knock-kneed for as long as I can remember;  one of the first docs I saw when my knee was hurting before my second or third marathon took one look at my stance and said, “you have really bad bio-mechanics for running”.  He recommended shoe inserts and lots and lots of Advil.  I learned to live with the pain.  I saw other docs, and I went to lots of physical therapists, and had acupuncture, and I searched like crazy for a magic pill to solve the pain-in-the-knee situation.  I got a foam roller.  I got a different rolling stick thingy.  I did some stretching.  (Okay, I didn’t do all that much stretching.  I had good intentions.)  I sat in ice baths.  (Okay, I’m stretching on that one, too.  I had good intentions of sitting in ice baths, but was maybe just not stalwart enough. A few ice baths went a long way to convincing me I didn’t really like ice baths so much.)  I iced my knee with ice packs.  Sporadically.  When it hurt a lot, I iced a lot.  When it didn’t hurt so much, the ice packs were safe in the freezer.  (Mick, my long time boyfriend back many years ago, was a huge proponent of icing, and he was very persuasive in getting me to ice even when I really didn’t want to.  Heck, he probably gave my knee an extra year or two.)  I made sure to replace my running shoes frequently;  at the height of my marathon running years, I would easily go through eight pairs of running shoes a year.

The pain was all - 100% - on the outside of my left knee.  It became a regular part of me, just another thing like having blue eyes or being right-handed.  Some knee docs said I should stop running, but that option seemed like poking out one of my eyes, so I just accepted the pain.  After all, it was never that bad.  At least not on a regular basis.  The pain would come and go, and between the ice and the Advil and the denial, I could handle it.  I got cortisone shots as often as the knee doc would allow.  I did hyaluronic acid treatments.  I had the knee scoped.  I did one round of PRP (Platelet Rich Plasma).  I got relief.  The relief wore off over time.  I looked for more ways to get relief.

I finally started to run less - a lot less.  I stopped running marathons.  I stopped running races of any kind.  Fourteen years of living in downtown Denver and running almost exclusively on concrete caught up to me;   I found softer surfaces to run on. Even then I might be running, and the pain would just overtake me.  I’d stop and walk for a bit, then start running again when my knee allowed. The pain never went away;  it got more intense over time, but at some point it was just there.  A part of me that I could accept, just like you accept the crazy aunt in your family.

In February of this year, things changed.  My knee had, apparently, reached its limit, and it started to hurt for real.  It. Hurt. Like. Hell.  Seemingly out of nowhere, my knee started talking to me.  Or, as my friend Leann says, it started asking why I was so hard of hearing.  It had been talking to me for years, and I’d ignored it, so now it was pumping up the volume.  It was screaming.

When you talk to the medical folks, they like to ask you, how bad, on a scale from 1 to 10, is your pain?  I’d never really known how to answer that.  The pain was never one number;  it was a range of numbers too varied to choose just one.  But when my knee started talking to me in February, there was no longer any question.  It was at a 15.  That was when I knew that it was time for a new knee.

Now, seven weeks and a day after the surgery, my knee still hurts.  And I’m still getting questions from medical folks.  What level is your pain?

Well, that depends.  If I’m sitting here on the couch with the ice machine running, it’s maybe at a 1 or 2.  But then I might take off the ice and stand up, and it may just yell at me with a 7 or 8.  It doesn’t like being in one position for long right now, but it really doesn’t like the transition from being in a fixed position to a different position.  This week, I have been working part-time, and my knee really doesn’t like that.  Sitting at a desk for any length of time is pretty much pissing it off.  I get up, walk around, and it calms down a little.  I try to keep it propped up: on a basket, on a  pile of pillows, on a big rubber ball. Nothing works very well.  I don’t think it’s gonna be happy with me when I am back at work full time.

The pain that took me backwards about four weeks ago was a MoFo.  It was a big chef’s knife stabbing me in the outside of the knee.  And stabbing.  And stabbing.  What level is that pain?  What does a number matter?  The level of that pain when I tried to move my leg with that knife sticking in the side of the knee was horrendous.  I tried to move my leg - to get up off the couch to walk, since walking usually helped bring down the pain level - but the message from my brain to my leg muscles got interrupted.  There was a circuit breaker, it seems, and that circuit breaker was saying “Nope.  No way are we moving that leg.  We know it’s gonna hurt more than we can handle.  Just. Not. Gonna.  Do. It.”  Those were the instances where I had to get Ed to come move the leg for me.  

You assign the number for that level of pain.  I can’t do it.

But things are getting better.  The pain comes and goes.  On Wednesday, I had a scaled down version of the chef’s knife pain;  this time it was a screwdriver sticking me in the outside of my left knee, and at a rate that wasn’t quite as severe as the earlier pain - but not so far behind, either.  Ed and I had plans to go out for lunch, and I was in enough pain that he suggested we stay home.  But I know that moving helps.  Changing environments sometimes helps.  Being around people - like our good friends at our local breakfast/lunch place - helps.  Anything to get my mind off the pain helps.  I iced the painful spot.  A bunch.  And I slathered CBD lotion on it.  A lot.  And I massaged it.  And talked nicely to it. Took a couple more Tylenol.  By mid-afternoon, the nearly-off-the-scale pain was gone.

The pain still wakes me up in the middle of the night.  Every night.  Sometimes multiple times.  That bit is getting old.  The pain that wakes me up can be acute, or it can be just one great big ache.  Sometimes I can get it under control just by massaging it, and moving it around, trying hard not to wake up Ed.  Sometimes I get up and walk around a little, and that helps.  Sometimes I go downstairs and get a fresh ice pack.  The other night I resorted to more Tylenol at 3 a.m.  But at least I didn’t need the Tramadol.  Or the Diazepam.  So that seems like progress.  I’m praying for the morning when I wake up, and realize that I’ve slept through the night.

I know that the pain will eventually go away.  Or - more honestly - I pray that the pain will eventually go away.  One of the very weird things is that the most frequent pain I have in my left knee right now is almost identical to the pain before the surgery, and before it all got really bad.  How do ya like that?  Major surgery and trauma to get back to the same place you were a year - or less - ago.  One of my friends who has had knee replacement surgery told me that it was a year before he had a day when he didn’t think about his new knee.  He didn’t mention the pain, but this conversation was before my surgery, and I suspect he was saving me from a dread that I didn’t need when I was already a little more than nervous.

One day, I’ll walk down the street without pain.  Really.  I’m holding on to that thought.  But I’ve gotten so used to having the pain, I can’t really imagine how that will feel.  This pain - oh, so much pain over the years, almost all on the outside of my left knee - has become a part of who I am.  Who will I be without it?  I’m looking forward to figuring that out.

Post Surgery Week 7: Unintended Side Effects

Wednesday, July 10

It turns out that my wonderful “Short Term Disability” benefit truly believes in the “short” in its name, and so, reluctantly, I had to return to work this week.  That’s the bad news.  I would much rather keep spending time on the couch with the ice machine keeping my knee from overheating and swelling, working crossword puzzles, rubbing CBD oil on the painful parts of my leg, reading books, and, of course, watching The Great British Baking Show.  And, well, also, going for walks, and spending a few minutes a day on my stationary bike, and starting up my PT exercises again, and generally finishing the job of healing and recuperating and getting back up to full strength again.

The good news is that my first two weeks back to work are at 50%, so at least I can ease into things.   But, oh, what a roller-coaster ride this returning to work thing has already been.   And it’s only Wednesday afternoon.

My work is all project-based, and that suits me fine.  I’ve had staff positions in the past where I’ve been bored out of my skull.  Working in a project environment feeds the part of my soul that needs new:  new challenges, new environments, new people, new schedules and budgets, new scenery.  My work is also very matrixed:  working for a company of somewhere around a hundred thousand employees all around the globe means that the company is sliced and diced and divided into all kinds of organizations.  And that means lots of politics, and oftentimes your fate is in the hands of people in different parts of the world who know little or nothing about you.

In such a matrixed environment, it’s often a challenge to keep assigned to a project (or projects), but that’s the name of the game.  You need to have a billable charge code at all times;  when you don’t, you’re always at risk.  Not having a project is referred to as “being on the bench” - or is it “on the beach”?  Being on “the beach” implies that you’re vacationing, enjoying downtime, and having some nice colorful icy drinks with little umbrellas.  The reality is actually more of being on the bench.  Put me in, Coach!  Too much bench time means you may not have a job when the next round of layoffs comes around.

The last few years have been challenging for me:  way too much bench time for my comfort level.  I’ve had a variety of projects, but none have been full time (or at least not full time for very long), and none has been long term.  I envy my colleagues who are on multi-year projects, who never have to worry about what charge code they’ll use this week, or what they’ll be doing next week.  But over time, I’ve cobbled together a number of contacts at a number of customers, and managed to stay mostly busy - or at least busy enough to keep me off the layoff list.

Earlier this year, I picked up a nice little project for a customer in Seattle.  It was not a long term project - scheduled to complete in September, or perhaps October, of this year - but it was a good one.  Big enough to be a challenge, including a product that was new to me, so a good learning experience.  The team was already in place when I picked up the project, and how lucky I was to get a strong team.  One of the technical leads is a guy that I first worked with at least a dozen years ago.  He was a great resource then, and an even more valuable one now - and it was a treat to finally, after all these years, get to meet him in person.  The other tech leads were also great:  skilled, experienced, and very responsible.  And every bit as important:  all really nice guys.

When I knew I was going to be out several weeks for the surgery and recovery, I approached my boss, and we talked about getting coverage while I was out.  Ultimately, the decision of who would cover for me was in the hands of the guy who was my superior on the project, a guy I'll call "Mr. Matrix".  We pitched my colleague Drew, who was, to our way of thinking, a perfect fit, to Mr. Matrix.  Sadly, Mr. Matrix rejected Drew without even seeing his CV or talking with him, and chose to put in, as he said, “my own guy” for the short term that I would be out.  The plan was still for me to step back into my role once I got back on the job.

Monday was my re-entry day, and I spent my four hours doing email triage and feeling exhausted and wishing I didn’t have to be back at work yet.  But Tuesday morning was my first team meeting, and, oh, what a nice welcome back.  I had forgotten how much I liked this team, and how good they all are - beyond competent, beyond intelligent, beyond professional.  They started the process of bringing me back up to speed, and we spent some quality time putting together our weekly status report for the customer for our weekly Wednesday meeting.  By late afternoon - well beyond my four hour time limit for the day - I was feeling really positive about being back at work, and back on this project.

Only then did Mr. Matrix send me a “welcome back” message, telling me he was replacing me with "my own guy", immediately.  It was a risk that my boss and I knew existed when I announced that I would be out for so many weeks, but it was still a shock.  And a disappointment.  I was in the middle of a conference call with the team when I got this message - a message that came via email, not even the courtesy of a phone call - and I felt tears start to burn in my eyes.  These guys were my work family, if even for just a few months.  I spent the remainder of the afternoon trying to work whatever angle I could to save my role on the project, but Mr. Matrix had made up his mind, and he’s in charge, and, well, that’s that.

So today was a sad day.  I had to tell my team that I was out, and then I had to tell the customer that I was out.  My consolation prize was having the guys all say nice things about me, in a lovely heart-felt way.  The customer contact - a guy I thought was incredibly tough when I first met him - brought tears to my eyes when he said nice things, too, telling my replacement, who was on the call, “you have big shoes to fill”.  A person could have a much worse sendoff.

It’s all part of the work world, and all part of this project world I’ve chosen as my career.  By mid-morning I had already been in touch with my boss, and was already talking with other people involved in other customers and other projects about what I might do next.  In a week or two, this project will be just another entry on my resume.  In a week or two, I’ll be asking someone else for a charge code, and setting up other meetings, and working on other project plans.  But right now, as I sit on the couch with an ice pack on my knee, I can't help but spill a couple more tears from just one more unintended side effect of this surgery.