Post Surgery: This is what TKR looks like 3 months out

Sunday, August 25

Friday was a milestone day:  three months to the day from my Total Knee Replacement surgery.  May 23 to August 23.  Only three months, and yet, it seems, a lifetime.  And a good time to reflect on where I’ve been and where I’m going.

Here’s the short story:  I am on the mend, getting better, if not every day, certainly every week. 

For the longer version, we’ll start here.  The first order of business post-surgery was to get into physical therapy and get my range of motion back.  In fact, just hours after surgery, a PT visited me in the hospital and gave me some basic exercises to do.  Heel slides for flexion.  Quad sets for extension.  Leg raises.  Ankle pumps.  The goal was to get to 0 degrees of extension (a leg completely straight) and 120 degrees of flexion.  Sure, walking was a goal too:  they had me up and walking with a walker just three hours after my surgery ended.  But there was also an admonition:  don’t get overzealous in racking up distance walking;  the range of motion is more important to start out with.

So today, I have flexion well under control:  I hit 136 degrees the last time I was measured, which is more than my first PT has ever seen in someone with TKR.  That may not be an entirely good thing, though.  The prosthetic knee isn’t really meant to go much beyond 130 degrees, and a likely reason that I ended up with bursitis may have been because I overworked the flexion and strained ligaments, inflaming the bursa where a ligament (or is it tendon) attaches. 

Extension:  well, that’s been more of a struggle for me.  I’m still fighting to get that knee completely straight, and I’m still going to PT with Karen twice a week to work on that. Now is the time;  I don’t want to give up on this now only to find myself with limited mobility in the future because I wasn’t willing to put in the hard work.  With lots of massage and pressure from Karen (this is painful - not your feel good massage!), plus some Pilates machine stretching, and the PT exercises I do at home, alone, I’m getting there - just really, really slowly.  A few days ago, Karen measured my extension at “almost 1 degree” after she had spent thirty minutes really working it.  When my friend Clay told me that he was in PT for 3+ months after his knee replacement, it sounded like a long time to me.  Now I’m scheduled out for at least another month.  It doesn’t feel so long when you’re on this side of the fence.

Progress is good on many fronts:  I’m walking now - up to three miles in one flat “hike” last weekend, and lots of daily walks that are more like one and a half miles.  (Our friend Doug, who has had his knee replaced, cautions me against doing too much walking too soon.  A few years after his TKR, he had to have a revision, and he thinks it was because nobody cautioned him properly against doing too much too soon.)  I’m on my stationary bike for up to 35 minutes now, and am working - very slowly, just to stay safe - on short little rides on the street as well.  I’m walking up and down stairs almost normally, although Ed sometimes points out to me that I’m not doing so evenly.  I’m back in Pilates class once a week:  Karen, my PT, watches out for me, making sure I don’t do anything stupid.  I’ve finally started to drive my own car again:  because I was afraid of my surgical leg’s ability to hold the clutch in traffic, when I first started driving, I drove Ed’s Prius.  Getting back to my own car felt like yet one more step in getting my life back.  And The Rolling Stones?  Making it to the concert and enjoying it, finicky knee notwithstanding:  well, that was just the cherry on top of all the other good stuff.

My knee on the left, Doug's on the right

So, all in all, after a good start and then a couple of scary and frustrating setbacks, it feels really good to be making solid forward progress.  In fact, Ed and I had not taken any vacation time this year because my knee was such an uncertainty.  But in the last few weeks, we’ve gained enough confidence in my mobility - and promises of increasing mobility - that we’ve put together plans to use up my vacation by the end of the year (my work vacation is “use it or lose it” within a calendar year) with lots of travel.  Life is looking up.

Back in mid-March, I had my last appointment with Dr. Thomas Noonan, who had taken care of my knee for ten or twelve years.  He had been telling me, since the first time I saw him, that I would need a total knee replacement someday down the road.  Now, in March 2019, we agreed that I had exhausted all of the more conservative treatment options, and now was the time.  I had lots of questions for him, including, “how long will recovery take?”  I almost fell off the exam table when he said, “one year”.

One year?!?  Really, a full year???  I couldn’t quite wrap my head around it.  So I chose denial, figuring that a year was what it would take for someone who wasn’t active, and who wasn’t really motivated to get back to an active life.  It was only in the weeks leading up to my surgery that I started to get worried that maybe a year was the actual time needed for recovery.  I reached out to several people for advice and counsel.  One person who had had TKR told me that it took a full year before they woke up one day and realized that they weren’t thinking about their knee most of the time.

The booklet from the hospital with
info on all things TKR.
I'm retiring this from the coffee table;
happy not to need it much any more.

Now, I’m finally starting to get it, and to accept that this is just a long, long recovery.  Although I’m sleeping through the night (most of the time) these days, I still wake up pretty much every morning with my first thought:  my knee hurts.  Some days it’s the whole knee, just achy throughout.  Some days it’s a stabbing pain, something that moves around.  This knee still tells me regularly that it’s not happy.  I can’t be in one position for very long before it starts getting cranky, and forces me to get up and move.  I still ice my knee, multiple times every day.  I still have Doug’s ice machine, and I use that almost every night - although I have to return it soon, since he has another friend going in for TKR in September, and she’ll need the machine more than I do.  

I still have lots of milestones to hit on this recovery.  I’m going to hike again, and not just on flat surfaces.  I’m going to cycle outside more and more and more;  maybe next summer I’ll do the Triple Bypass.  That’s a classic bike ride here in Colorado that is 120 miles and goes over 3 mountain passes.  I’ve ridden that event three times in the past, and had signed up to ride it this summer way back before my knee wigged out.  (Good thing I bought the cancellation insurance!)  I’m definitely going to ski again:  and yes, I’m going to do some bumps, even if I have to back way off.  I’m going to run, too:  who knows how much and for how long and whether I’ll do any races, but it’s just a part of my DNA that I’m not ready to give up on yet.

For today, though:  we walked to Keith’s Coffee Bar for our Sunday church of homegrown music, and I’m sitting on our front porch with blustery winds.  There are Blue Jays noisily calling and grabbing peanuts off the tray feeder.  A hummingbird - a female Broad-tailed, I think - just stopped by a feeder, sat for a minute or so to drink the sugar-water, and then dashed off.  Chickadees are chirping in our neighbor’s front yard juniper tree.  I think it’s time to take off my ice pack, since it’s not really cold any longer, walk inside, and do a few PT exercises before I tackle the NY Times Sunday crossword.  Life could be much worse.

My bionic knee, three months after surgery

Post Surgery Week 13: Vine Street Criterium

Thursday, August 22

When I was 8 years old, I got my first bike.  It was a blue beauty, and special because it was brand new and a girl’s bike.  No hand-me-downs for me!  I had watched my big brother learn to ride, so I had a head start.  I used training wheels for just a short time, and then I was off, riding like the wind.

Well, as much like the wind as an 8 year old can ride.  The truth was, I rode all over town.  All. Over. Town.  Of course, you have to remember that these were different times, and the town where I lived until age 9 only had a population of about 200 souls.  Still, it was grand to be so free.

Something happened early in my biking career, and I fell in with a bunch of kids who liked to race.  The course was the block that was home to the town’s two churches:  one Methodist, and the other Christian.  The streets were crumbling asphalt, which meant that the corners were particularly treacherous with loose pebbles and sand and rocks.  We raced around and around that one block, and, inevitably, someone would spin out on the loose stuff, and there would be a wreck.  It never failed to happen.

Methodist Church, Henderson, Iowa

My first wreck netted me skinned knees and elbows, but nothing terrible.  What was terrible was my mom’s reaction.  She read me the riot act, lectured me on the dangers of racing, and forbade me from ever racing again.  I was sufficiently scared that I didn’t head right back out to play with the racers.

But then, time elapsed, and somehow I was out on my bike again, and somehow I ended up racing that same block with those same kids again, and pow!  I got into a bang-up of a wreck.  This time my knees and elbows were much further gone than mere road rash.  I was a mess.  I was scraped and bloodied and bruised.  I had pebbles embedded deeply in both knees.  My elbows were, well, don’t ask.  My friend Ann Phillips was there, and she lived just a block away, and her mom was a nurse, so that’s where I ended up.  Mrs. Phillips worked on cleaning me up with mercurochrome in their brightly lit kitchen.  I cried as she worked on me, and she tried to reassure me that it would all be okay, and she was going to call my mom to come get me.  That was when I blubbered:  “But my mom is going to kill me!”  Sure, it hurt like anything, but I was more scared of my mom than I was of the skinned up body parts.

Mom, baby brother Dave, me, Ann Phillips

But Mom was great, and kind.  I think she knew that I wouldn’t be racing anytime soon again.

And I didn’t race again on a bike.  For a long, long time.  I had no interest in it whatsoever.

But then, many years later, I moved to downtown Denver in 2000, and woke up one Sunday morning to find there was a bike race going on right outside my window.  I mean: Right. Outside. My. Window!  It was the Bannock Street Criterium, a race that has been held annually since the early 1990s.  A criterium, or “crit”, is a bike race of multiple laps on a closed course.  The Bannock Street Criterium course is a figure 8 configuration through what used to be my neighborhood.  I was a total newbie to bike racing of any kind in the early 2000s, so this was all virgin territory to me.  I went out on the street and watched as different groups - fast, powerful men;  kids;  women looking just as fierce as the guys; - flew by in different waves.  It was fascinating to see the changeup in position each time each different group went by.  It made me think of racing around the church block in Henderson, Iowa, in the 1960s.

It was shortly after that that I met Mick, the guy I would go on to spend eight years of my life with.  Mick was big into cycling, and into bike racing.  It took a few years before he convinced me to join him in a bike race or two, but they were all uphill races in the mountains that were too vertical to build up much speed.  I was never really frightened of speed on those uphill races because, well, even while I was racing, I was going at slightly more than a snail’s pace.

But in the summer of 2005, we happened to be spending the weekend at my place on the Sunday of the Bannock Street Criterium.  On a whim, he and I both decided to enter the race.  Now, I didn’t know a darn thing about racing a crit, but I figured that I would be just riding for fun, not actually competing.  I still don’t understand the ins and outs of competitive bike racing and all the “Cats” and ranking algorithms, and how you end up racing in which category.  But it turned out that there was a Citizen’s category for women, and so there I was, lined up at the start with 6 other women in my age group, and the horn sounded, and we were off.  Our race was 5 laps on the 1.5km course.  Not terribly long, but with that figure 8 configuration and all of the hazards of racing on city streets - manhole covers, cracks and potholes, etc. - it was a real challenge.

There are few details from that day that stick in my mind as firmly as the feeling that I got as I engaged in the competition.  Once I noticed that I wasn’t getting dropped from the outset, I just went into autopilot, and didn’t even notice that I was getting into the race.  About halfway through the race, though, we went flying around one corner, and I realized that I was on the edge of my ability to stay upright.  Whew!  I was 8 years old again, back in Henderson, and I was racing around the church block.

Something about that visceral memory of the wreck and being scraped up and ouch:  well, the speed on the corners pretty well scared me, and I backed off a little.  I didn’t fade entirely;  in fact, I kept with the group enough to finish third out of the seven of us.  But, oh, how that race brought up memories!  It was fun, and it was exhilarating, but at the end of the day, I found I really didn’t have enough confidence in my skills to want to race another criterium, and I didn’t want to invest in the road rash that I figured would come with trying to get up to speed in that realm.  My criterium racing days were pretty much over after that one race.

What does any of this have to do with my knee surgery and my recovery?  Well, last Friday at PT, I asked Karen what she thought about me going for a bike ride out on the streets rather than on my trusty trainer.  She turned this right back on me:  “How do you feel about it?”  Well, the answer was:  I wanted to do it, but I was really, really nervous.

Which is how it came to be that early Sunday afternoon, Ed and I went out to the garage and pulled my town bike down off the wall.  I just bought this bike last fall, and between weather and work and travel and other distractions - like knee surgery - I had only ridden the bike home from the store and then parked it.  It’s a sweet hybrid bike, a beautiful blue baby.  It was brand spanking new, and it’s a women’s specific designed bike.  When I rode it home from the store, I thought I was on my original blue beauty.

Ed made sure that my tires had good air pressure, and I donned a helmet and gloves.  It was finally show time.  I sat on the bike and started to roll down the alley.  

Oh. My.  

I had forgotten how wonderful it is to roll along on a bike, just floating along.  This hybrid bike is built out of steel, so it’s pretty heavy, and that means it has a lovely smooth ride.  

We got to the end of the alley - Ed was riding alongside me - and turned east.  This was still going slightly downhill.  At the corner, we turned right onto Gaylord where it’s slightly uphill, just enough that I had to shift and actually put some (nascent) muscle into the machine.  We turned right at Vasser, then right again on Vine, going slightly downhill again, right in front of our house.  When it came time to the turn in to the alley, I kept going straight, and caught Ed by surprise.  “So you’re going further???” he asked.  Damn straight!  Around the block I went again, and then again.  Ed finally reined me in:  he was afraid, rationally, of me overdoing it, and having yet another setback.

So we ended the great Vine Street Criterium of 2019 at just 3 laps.  But, good heavens, did that feel fantastic.  My legs had to work more than they had worked in weeks - no, months.  It was good to feel them offer up that effort.  It was, no doubt, smart to limit the ride to just a few laps around the block.  But, trust me:  this criterium is going again soon, and longer and, well, maybe, just a little bit faster.

At the end of the Vine Street Criterium of 2019

Post Surgery Week 13: Every Step You Take

Saturday, August 17

One of the most amazing things about my post-surgery experience was the fact that a mere three hours after my surgery ended, I was up and walking in the hospital.  Sure, I was still under the influence of the good drugs.  Sure, the parts of my leg that had been ravaged were still mostly numb from the nerve block.  Sure, I was holding on to a walker, and I had a physical therapist helping to hold me up.

But still, just three hours later, I was walking.

I didn’t really understand in those early days that in the coming months, I would need to completely relearn how to walk.

I remember talking with the surgeon in the pre-op appointment about this;  if you totally rebuild my knee, how will it affect how I walk?  Well, sure, but I didn’t fully get the impact of it.  Then when I had tendonitis, and went to see my chiropractor Karin, trying anything - everything - to deal with the pain, she brought up the topic of relearning how to walk.  “Isn’t your PT teaching you how to walk again?” asked Karin.  She was pretty much aghast that it wasn’t the number one focus of every PT session.

That’s all changed now that I’m working with Blue Sky Karen, both in PT and in Pilates.

My valgus deformity, pre-surgery.
My left knee is on the right of the image,
and you can see how slanted inwards it is
in relation to the right one.

I have, as long as I can remember, been terribly knock-kneed.  The medical term for this is a “valgus deformity”.  I may have had a bad case of arthritis in my knee in any case, but the valgus deformity was the thing that caused my left knee to get to bone-on-bone on the outer surface, with all the nasty pain that goes with the whole bone-on-bone thing.  This was something that every ortho and every PT I’ve seen since my knee first started hurting told me.  It was always something that the PTs - and the Pilates teachers - pointed out that I could fix - at least in some degree - by paying attention to how my knees move in relation to my hips and ankles and feet.  They would point out to me - more often than I liked - how my knees would collapse inward in almost any exercise we did.  Too bad for me that I didn’t pay nearly enough attention to fixing this.

But now, it’s a requirement.  Dr. Miner and his team changed the entire geometry of my left leg.  Is it 100% straight?  I don’t know, but I do know that it’s a heckuva lot straighter than it was pre-surgery.  (I wonder if perhaps I have grown taller as a result?  Wouldn’t that be nice? I must measure my height one of these days.)

And my right leg?  Well, so far (knock on wood), I’ve had no issues with arthritis in that knee like I had in my left knee.  (Full disclosure:  I banged my right knee up about six or so years ago when I fell while out for a run, and had it scoped to fix the torn meniscus.  But it’s never hurt outside that experience.)  But the reality is that both knees suffered from the valgus deformity;  it was just that the left one was worse.

So one of the things that I am paying very close attention to now is making sure that neither of my knees turns in when they are supposed to point straightforward.  This is maddeningly difficult.  Oddly enough, it’s tougher for my right knee;  I guess the rearchitecting of my left knee has made it easier for that one to behave.  It is amazing how that reflex for my knees to both turn inwards at every movement is deeply ingrained.  60+ years of walking, standing, sitting, standing up from sitting, going upstairs, going downstairs while not paying attention to this one seemingly little thing:  well, there are some bad habits that stubbornly hang on, and resist breaking.

Which means that I am, every day, every movement of every day, relearning all those movements.  I stand up slowly to make sure my knees don’t collapse inwards.  I walk down stairs very, very slowly, because if I go any faster than turtle speed, my knees turn inward.  I go upstairs slowly for the same reason.

Working at having straight,
non-knock-kneed knees.

The other day at PT, Karen had me stand up from a sitting position on a bench - with no help from my hands and arms. It was harder than I thought it would be, and boing! There went my right knee, collapsing like a cheap cardboard box.  She had me repeat this multiple times, and then she lowered the bench, making it that much harder, and it was back to the drawing board.

Likewise, Ed is on board with the vigilance to make sure my knees don’t drift in towards each other, and now he’ll watch me coming down the stairs.  Just when I think I’m nailing it, he’ll start shaking his head, and then demonstrate back to me exactly how poorly I’m doing at this exercise.  This walking business is much harder than I ever expected it to be.

Late yesterday afternoon, I went for a walk by myself, just a mile and a half on the local bike path.  I wore running shoes because I’m learning that they offer the best support.  Flip flops are not part of the equation for me this summer:  I tried them weeks ago, and it just didn’t work very well.  My extension is still not up to 0 degrees  - I did hit 1 degree with Karen in my PT appointment earlier Friday - so I keep my mind on extending my leg and exaggerating the heel-toe motion.  And then I concentrate on making sure that my knees stay over the second toe, working hard  not to let those knees kiss each other like they have done since I don’t know how long ago.

One day I’ll worry about walking without pain;  this poor knee that was badly abused over so many years, and then seriously set upon almost three months ago still likes to hurt much - well, no - most of the time.  Right now, though, the pain is in the back seat, mostly under control.  But the instinct for both my knees to go all knock-kneed on me is the biggie.  It’s a bear to break. With every step I take, I’m working to break bad old habits.  With every step I take, I’m learning to walk again.

Post Surgery Week 12: Something Happened

Sunday, August 11

First, this happened.  On Tuesday, late afternoon, I went to PT with Karen at Blue Sky, and then to Pilates class.  Pilates!  Karen was careful to make sure that I wasn’t tweaking my knee in a bad way, and yet, for the most part, I was able to do everything that the class did.  What a joy!  What a workout!  I finished the class with visions of that very wonderful muscle soreness that I expected to hit Wednesday afternoon.

But Wednesday afternoon brought only a small amount of aching muscles.  What luck!  Maybe I have not lost as much fitness as I thought.  Then on Wednesday night, we had dinner and drinks with our friends Debbie and Tom.  They came to our house;  we had champagne on Mayberry, our front porch;  we walked over to the Pioneer, our local college Mexican food go-to place.  This get together was a very late celebration of their wedding, which happened more than a year ago.  (Why rush things?)  It was a lovely evening:  nice enough to sit outside, not so hot that you needed to be under a mister.  We walked back home.  And here’s what happened:  I walked both ways, no big deal.  And from moment to moment, I thought about things that were not related to my bionic knee.  

And - wonder of wonders:  I slept.  I mean, slept all night long, something that had not happened since sometime back in May.  It was glorious.  It was ever so odd, waking up Thursday morning, well rested, and without thoughts of how much my knee hurt.  Well, of course it hurt:  it always does, at least a little.  But there are moments - and now an entire night! - when other things enter my brain before the pain signals.

And then this happened:  on Thursday night, my niece Annie and her friend Jess arrived from Iowa for their own little getaway.  On Friday morning, bright and early, we walked to Jelly’s, our favorite local breakfast place.  And here’s the thing:  we walked at a brisk pace (for me, anyway, in my go-slow phase), had breakfast, and then we walked back home.  Both ways.  Not always thinking about my bionic knee.  Talking about things that are not my bionic knee.

And then this happened:  The Rolling Stones at Mile High Stadium on Saturday night.  Back when the Stones announced this tour, Ed and I had a chat about it.  He said, “well, wouldn’t that be cool to see the Stones, but the tickets must be outrageous.  We’re not doing that.”  To which I responded:  “What you mean ‘we’, Kemosabe?”  I told him that this might well be the last chance ever to see this band, and well, I was going at any cost.  Ed said, “you’re not going without me!”, which explains how we (along with my concert-buddy Denise) ended up with tickets for the Stones for their May 25 date in Denver.

We bought these tickets in November 2018, long before my knee completely went whacko back at the beginning of February this year.  On February 22, I had a cortisone shot in my knee, never thinking it would have anything at all to do with the upcoming concert.  But when that shot didn’t magically make my knee better (as cortisone shots had done in the past), we started down the path to the Total Knee Replacement.  One of the first caveats we learned while going through the process of choosing a surgeon and scheduling the procedure was that most surgeons advocate against having the TKR within three months of any cortisone shots.  That all meant that the earliest I could schedule the surgery would have been May 22.  Despite the fact that once I decided to have the surgery I wanted to get it done as quickly as possible, there was no way I was going to forfeit those Stones tickets and that experience.  We decided that when it came time to schedule the procedure with a surgeon, we would target later in May, and just pray that I would be able to walk well enough pre-surgery to enjoy the concert.

Then Mick Jagger went in for heart valve replacement surgery in April, and the concert was postponed.  I was bummed about that - mostly due to fear that the concert might never actually happen.  But on the other hand, it freed me up to schedule my surgery as soon as the medical folks would allow.  That meant I chose the very first available day, May 23.

On May 16, the Stones announced the new concert date:  August 10.  By my calculations, that meant just over eleven weeks post-surgery.  Easy-peasy!  This was working out to be ideal.

Until.  Until the tendonitis.  And the doing-abso-freaking-lutely-nothing for three weeks.  And starting recovery from scratch six weeks after surgery.  Then the bursitis.  And the spiral down the rabbit hole from all that malarkey.  When I could manage to think about the future at all, it was hard to picture a time when I would ever be mobile again.  I started to doubt ever being able to do anything again - let it be biking, or hiking, or skiing, or running, or something so seemingly simple as going to a concert.

But then, something happened.  There was a curve in the road, a corner, a bend.  Somehow, magically, slowly, bit by bit, this knee - no, this entire leg - has started to heal.  And with it, my psyche, too.  Which means that when it came time to head out to see the Stones, there was no question of whether I could handle the travel, the walking, the being on my feet for hours.  Because:  healing.  Because:  becoming whole again.  Because:  something happened, and there I was, taking the light rail to Mile High Stadium, finding our seats - right there! - and stashing our blanket there, finding the vendor to buy a t-shirt, and then finding a vendor to buy our beers.  And there I was, standing and singing and yelling and dancing and maybe not exactly jumping up and down, but there I was.  Moments in time when my bionic knee was not my focus, not the entirety of my attention.  My mind was elsewhere, on more important things, on the music that defines my generation, that makes me smile and want to dance and want to move.  Moments of watching these septuagenarians - Mick and Keith and Ronnie and Charlie - on stage, rock-and-rollers until they drop, making me aware of how precious - and how joyful - it is to do what you love in life.  

Moments when I thought about the things I love in life.  Moments when I didn’t think about my knee at all.

Post Surgery Week 11: This Is Not A Rant

Tuesday., August 6

This is not a rant, not really.  Because, really:  who am I to complain?

In the world of health care in the grand old United States of America in the year 2019, I have it pretty darn good.  I happen to work for a Swedish company, and coincident with the Swedish values, we have exceptional health insurance.  I knew the deal was great back when we got absorbed by this company in an acquisition several years ago, and I learned that my portion of my health insurance bill would be zero.  That’s right:  a goose egg.  A big fat donut.  Zilch.  Nada.  Health insurance for free?  Who doesn’t love that?

And then a few years later, when Ed and I were planning to get married, I suggested that we put him on my plan at work.  Ed has been free-lance for pretty much his entire career, so he has always had to provide his own health insurance.  He loved, loved, loved the early years of Obamacare.  He loved his health insurance, and the premiums were finally reasonable.  So he said he wouldn’t switch over to my insurance unless the premiums were a lot cheaper.  It took me some digging to find the answer to “how much will it cost to add a spouse to my insurance”, and when I found out, we both fell off our chairs.  The answer was, again:  zero.  Nada.  Nil.  Zilch.

Who ever heard of that?  Health insurance for your entire family, and no premiums?

So, really, who am I to complain?  I have great coverage for my knee surgery.  The downside of the free premium is that there’s a high deductible and high out of pocket limit, but in the big picture, what is seven grand for a new knee?

I looked at the hospital bill the other day, and decided I really should not complain.  Between the hospital and the surgeon and the anesthesia and all the attendant charges, this bionic knee carries a price tag of somewhere around $84,000.  The knee itself, listed as “other supplies”, was $32,000.  My part of all that is done, paid, complete.  When I find myself grousing about the fact that I’m paying for my PT now out of pocket, well, big deal.  In the grand scheme of things, it’s really not so much, especially when you consider the people who lose their life savings, and their homes, and their jobs because they don’t have health insurance.

And speaking of people losing their jobs, well, why don’t I just shut my trap right now?  I have incredibly good disability insurance, and the company pays for that, too.  I moaned and bitched (a little) (well, maybe more than a little) about the process of getting my short term disability claim filed, but once it was in motion:  wow.  The STD coordinator checked in with me once a week or so, and kept approving the time I was out of work.  My doc’s office was great about responding to the insurance, also, so I didn’t miss any pay at all.  In fact, I was out of work for six weeks full time, and then two more weeks at half time, and I could have stayed out much longer if I had needed to.  I may moan and bitch (a little) (well, maybe a bit more than a little) about my job from time to time, but holy gee-whizzakers.  Unless you’re in the CEO racket, it doesn’t get much better than getting paid to heal.

So, really, who am I to complain?

I mean, really:  I had a surgery that will, hopefully, at some time in the next year, allow me to return to all my activities, and to do so pain free.  So what if my freaking knee hurts.  A little sometimes.  A lot at other times.  It’s getting better, little by little, even if I am slow to admit that because I become Debbie Downer and complain all the time.  So what if I miss a little sleep?  I have a doctor and all of his staff who are intent on getting me through this, and they will keep prescribing treatments and drugs until I can get through the night.  And slowly, slowly, day by day, and week by week, I will have less pain and walk more normally and eventually ride a bike outside again.  I’m learning to shelve the expectation that I’ll run again.   Who knows?  Maybe I will, maybe I won’t.  But there’s no use complaining about any of that just now.

I mean, why should I complain when one of my best friends is going through treatment for Stage 2 breast cancer?  I still have all my hair, and none of the scare of all those nasty chemo drugs.  My surgery is behind me, and hers is yet to come, and then there is still radiation and immunotherapy, and, you know what?  She is handling this with such grace that I am humbled every day.  Why should I complain when my sister-in-law’s brother is in a hospital today, awaiting double bypass and lung transplant surgery?  His lung has been deteriorating fast;  he’s been turned down twice already for transplants;  now he’s just waiting for an available lung.  Why should I complain?  Why should I complain when a good friend is dealing with the scare of a return of prostate cancer?  Strike that:  I have TWO good friends going through this scare right now.  And another friend just wrote to tell me that her dad - early 80s - just died, suddenly, unexpectedly, in the richness of a full and active life.  And this same friend’s mum has early Alzheimer’s, and what do they all do now?

I mean, really:  today I got up for an early morning meeting, and was able to sit outside later while it was still deliciously cool out and have breakfast with my husband (his yummy French toast, with fresh berries, and real maple syrup that a friend brought us from the family trees in upstate New York).  I had some meetings, filed some emails, ran some reports, created some spreadsheets and updated others.  Then I went for a walk outside, being careful not to limp.  I took some mild drugs, and iced my knee, and hooked it up to the TENS machine.  I’ll finish up some other work, and then I’ll be off.  Off to PT, with a therapist I like and trust.  And then to Pilates!  Yes, yes, yes - approved for Pilates and looking forward to the soreness I am sure to have in my abs, my arms, my whatever tomorrow morning.  Then Ed and I will struggle with the decision of where we go for our vacation later this year:  both of us praying that I’ll be mobile enough to have at least something of the adventure we’ve come to love.

And then we’ll sit down with a glass of wine and an old episode of M*A*S*H on TV.  I’ll hook up the ice machine, and take a gabapentin so I can sleep through the night.  And I promise - for this one moment in time - that I will have absolutely nothing to complain about.

Post Surgery Week 11: Anatomy of a Sleepless Night

Sunday., August 4

It’s 1 a.m., and I am wide awake.  My knee hurts, and my entire left leg aches.  I can’t get comfortable;  I turn this way and that, but it seems that every position I try results in painful pressure on my knee, no matter what I do with the pillows that I use to cushion my knee.  Ed is sleeping soundly as I go downstairs to get an ice pack.  It helps, but just a little.  I doze a little, but then I’m wide awake again.  I get up, go into the bathroom, take the ice pack off, slather my knee with CBD lotion, and start to cry.  I’m thinking that I don’t know how to handle this.  I don't know if I can get through this:  all this pain, all these sleepless nights.  When will it end?  I climb back into bed, and my crying wakes Ed enough that he hugs me, then he’s back asleep.  And I’m back wide awake, not knowing what else to do.

It’s 2:02 a.m., and I decide to take a Tramadol.  I haven’t taken one of these in weeks;  it was a mother getting it out of my system, but what else can I do?  I try to reassure myself that I’m only ten weeks post-surgery, and it’s okay to take pain meds. 

On Thursday, Heather gave me a new prescription for a painkiller called gabapentin.  She had diagnosed the screwdriver-in-the-side-of-my-knee as bursitis in a phone call late Wednesday afternoon.  She told me that there are several small bursa in the knee, and one exactly in the spot (inside face of the knee, below the joint) where I described my pain.  Heather said that the bursitis is very common, and she teased me with the promise of a cortisone shot - something she said she could do as soon as I came in to see her.

But when I went to see her Thursday morning, she had consulted with Dr. Miner, and they decided against the cortisone shot.  Cortisone can thin tissue, and since my tissue around that particular bursa is already very thin, it just didn’t seem like the best idea.  Instead, she wrote me a prescription for gabapentin.  She told me that it should help me sleep, but that it might make me loopy and hungover.  I picked up the new drug at the pharmacy later that day, and read the list of side effects.  Dang.  Not a good thing to do if you actually want to take the drug.

Because I had an early PT session at Blue Sky Friday morning, I decided against taking the gabapentin Thursday night.  I wanted to be able to drive safely - drug free - to the appointment.  Somehow I made it through that night, and got to my PT appointment a few minutes early.  There were several other people waiting in the reception area when Karen came to take me back to the treatment rooms.  “How are you doing?” she asked.  My answer:  “I’m ready for this knee to stop hurting is how I am”.  The people waiting in the reception area all laughed.  I wished that I found it as funny as they did.

Karen worked on my extension, and gave me some new stretches to do.  She found a tight muscle (my adducter) that she thought might be contributing to the bursitis, and worked on it.  The stretching is intended to lengthen the muscle in order to take the pressure off the tendon that attaches near that bursa.  Then she gave me time on the reformer, and we spent most of that time doing more stretches. I left the PT session feeling good about the progress I’m making.

But by Friday afternoon, the stabbing pain returned.  By 8 p.m. Friday night, I gave in and tried one of the new pills.

It dulled the pain, and helped with sleep, but oh, my, I had weird dreams.  Elton John showed up at a company meeting, and he and I ended up sitting next to each other on the floor at the back of a conference room when there weren’t enough chairs for everyone.  He and I had a nice chat about how much fun it is to sit at a piano and noodle out sounds until you find something that works.  And then I was late for a meeting, and I took off running down a hall until I remembered that I couldn’t run because of the knee surgery.  So they weren’t horrible dreams.  But, as promised, I woke up woozy and feeling hungover.  Ed was alarmed at how cranky I was, and how I was even more grumpy than before.  I decided that maybe this wasn’t the drug for me.

Which is how I decided, at 2 a.m. Sunday morning, to try going back to the Tramadol.  But now it’s 2:32 a.m., and I’m back in bed, still not sleeping, still with the aching knee.  And now I’m dealing with an upset stomach.  I had forgotten that you need to take Tramadol with food.  We had an early dinner, so my 2 a.m. Tramadol dose was on an empty stomach, and I’m thinking I might throw up if I don’t get some food in my gut quickly.  So I go back to the kitchen and have a few bites of the last of the banana bread that Ed made this past week.  I’m afraid to lay back down until the nausea has passed, so I try to do a blog post, but the Tramadol is doing its thing, and I’m getting fuzzy around the edges.

At 3 a.m., I shut down my laptop, stumble up the stairs once again, and crawl back into bed.  Pain is a night stalker, and even with the Tramadol, my knee is still hurting.  My head feels off because of the drug, and my entire left leg still aches.  I watch the clock slowly tick by the minutes.  Now it’s 4 a.m., and now it’s 5, and it’s going on 6.  Will this night never end?

At 7:30 a.m., the sun and the birds wake me.  My head is woozy from the Tramadol, but at least my knee pain is manageable.  It still hurts, but tiredness wins out, and I close my eyes to try to squeeze another hour or so of sleep before we get up and go to what serves as Sunday morning church for us:  the live music at Keith’s Coffee Bar.  

Shortly after 10 a.m., we walk into Keith’s.  This is only the second week that I’ve been able to make the walk - roughly 7/10ths of a mile - since surgery.  I try to remember that this is still a big win, to be able to get here on foot, even if my knee does hurt walking today, and even if I feel loopy and fuzzy.  We have lots of friends in the crowd of regulars, and they all greet us, and ask after the state of my knee.  What can you do?  Complain ad nauseam?  That doesn’t seem to do much to help things improve, so instead, I just try to smile and say “it’s getting better, little by little, with some ups and downs”.  What’s the saying?  Fake it until you make it, or something like that?  Somebody comes up and tells me that they were happy to see me walk in without limping.  Really?  I thought for sure that I was gimping along, so maybe things are really getting better.

Ed and I leave Keith’s early so we can walk home in the bright sunlight, and we can do some maintenance on the ice machine, and then I’m back on the couch, loving the feel of the ice water wrapping my knee, waiting for the fuzziness to pass, wishing I could nap.   When sleep doesn’t come, I grab my laptop and work to finish this post.  I’ll try to hold on to all the positive thoughts that I can, even as I dread the next night, when the pain monsters come crawling out of the dark again.