The final root canal appointment

To my surprise the dentist indicated that he, too, wasn't completely happy with the way the bridge fit and the hasty decay that was attacking exposed parts of my teeth. I would pay for the root canal, the post and the bridge prep; he would provide a new bridge at no extra charge.

I agreed, no question about it. These teeth -- 28, 29, 30 -- had been bothering and hurting for months. More than a year actually. He finished the root canal, made the bridge impressions and gave me a temporary guaranteed not to break as the one did last Christmas. I'll get the new bridge in January.

PT/INR test #3

This afternoon I got tested again. The score was 2.3. Excellent.

There are lots of food restrictions associated with taking Coumadin, both in getting it to work right and to promote accurate testing. I can't eat green, leafy vegetables or cranberries, among a whole list of forbidden healthy foods. I also have to avoid some prescription drugs and OTC anti-inflamitory medications.

Because of the Coumadin I have been off Mobic, an anti-inflamitory for my joints, for a week now. I have taken it or other drugs like it for about eight years. I hadn't realized how effective it was.

The second PT/INR test result

On Monday I dropped by the doctor's office and they checked my (new and thinner) blood clotting level. It's 2.0. And that is a good thing.

Dermatologist appointment

My doctor wanted me to get the purple, pink and black mole on my right calf looked at. So I went to the dermatologist and her PA cut it all off and sent it to the lab. (A week later I heard it was OK.)

It had been there at least 50 years so I wasn't very worried about it being malignant. But it had alarmed lots of doctors throughout the years.

Coumadin test -- PT/INR

Late last week I called the MD's office and made an appointment for a cortisone shot today. But that's not going to happen.

Meanwhile my MD got back from a conference in Orlando and called me Tuesday night to discuss the test results and medication. I am to take Coumadin, 7.5 mg, once a day. And continue with the Lovenox injections twice a day. I can stop the shots when the Coumadin takes hold. I may be on the latter for six months.

The test for how thin, or thick, your blood is done by a hand-held machine and a finger prick of blood.

When I saw the doctor on Thursday afternoon I had received two doses of Coumadin and six shots of Lovenox since Monday evening. The PT/INR level was 1.1 and it needs to be between 2 or 3.

PT/INR stands for Prothrombin Time/International Normalized Ratio and if you want to know more about it go to Google.

BTW the x-rays taken on 11/11 show advanced arthritis in the right knee. And this morning the dermatologist's PA scooped off most of the mole (from the lower right leg, of course) to send to testing.

I noticed the swelling of my right leg and ankle has gone down a lot. There's almost no difference between the right and the left. I guess there's less inflamation down there and it must be because of the Coumadin and Lovenox thinning my blood.

Root canal: tooth #29 -- part 2

I premedicated with 2 grams Cephalexin an hour before the treatment. It took longer than I expected and he was not satisfied with the first results so lots of x-rays got taken. He still did not finish the procedure and I will return on December 15.

Ultrasound adventure

At 3:15 PM I arrived at the huge local medical center's cardiac testing facility and soon got ready for an ultra sound on my right leg. It was very uncomfortable, all the pressing on sore leg muscles. She tells me I have a blood clot down my leg from upper thigh to my foot. A doctor needs to examine me. Right now. I can sit up and get in a wheel chair. And that's all. No, I cannot go to my car and get a book, cell phone or iPod. I get wheeled to the emergency room at 4:00.

They are very busy. Lots of accidents today. There are no rooms available. At 6:45 I am on a gurney in the ER hallway by the nurse's station.

At 8:00 PM an MD comes by and tells me I have DVT -- Deep Vein Thrombosis. I need to take blood thinners to help disolve the clot and not let bits of it crash around inside my body.

The final result: I can go home if I can give myself a Lovenox injection. Or they will admit me to the hospital for the night while I learn how to do it. With doctor and nurses watching closely I give myself the shot, in the lower belly, and at 9:00 PM I am driving home.

Regular checkup with primary care MD

Prior to this regular checkup I went to the lab for blood tests last Thursday. The results were mostly good. Cholesterol is still up and the bad kind is up more. So I have to take a Simvastatin at bedtime. The A1C was up a little from 5.7 to 6.1 but not bad and not unexpected. He didn't even bother to check my PSA as it has been so low.

The left leg and left knee replacement are doing fine.

I mentioned the problems with my right leg: the knee seems to be arthritic; the heel and foot are always sore and swolen, as is the right ankle; and there's a sore patch the size of my hand on the surface of my inner calf (very sore to the touchbut there's no visible problem). He's worried about the brown and purple mole on my lower right leg. He has seen it many times before. It's been there for 30 years at least.

He had me go for knee x-rays that afternoon, an ultrasound exam next Monday, a biopsy of the leg mole on Thursday; and I'm to come in when I decide to have a cortisone shot in my right knee.

Root canal: tooth #29

I started a 10-day course of amoxocillin five days ago, so there was no need to premedicate an hour before the procedure. I thought this root canal was going to be a simple one but he wanted to pack it and wait a week before finishing.

Nine months after knee surgery

Nine months ago I had my left knee replacement. The left leg is now nearly pain-free. Now and then there's a flash of pain around the knee itself and I expect there's some remaining scar tissue getting pulled. It's not severe and it goes away fast.

The right leg and knee is another story. That side had been compensating for years because of the weakness on the left. And seriously working extra for the past four years or so.

My right foot and ankle are moderately swollen all the time and often my lower leg is as well. The sore heel can stop me in my tracks now and then.

In the past few days I have felt some serious discomfort in my right knee and down to the ankle. Often it is a deep bone pain and nothing helps much. It is particularly bad in the night, waking me around 2:00 AM every morning this week. Sitting up helps a lot, supporting the knee and lower leg on pillows helps some, Tylenol and/or Vicodin gives very little relief.

This reminds me of what I went through seven years ago when my left knee started acting up seriously. I see my MD in two weeks and hope he will refer me to an orthopedic doctor for a cortisone shot. I imagine I'll need a right knee replacement in about 18 months. I hope we still have Medicare then.

Getting the right knee done should be much simpler than the left turned out to be. Right now at least there's no sign of ligament damage on the right.

Dental cleaning

A routine cleaning and nothing serious was discovered. There are future problems probable under the new bridge, but nothing right now. I didn't need to premidicate for this work as I had been on amoxocillin for a week fighting the abcess on #29.

More tooth pain lower right side in the back

Continued dental pain in the usual spot, lower right rear, all weekend. The dentist saw me first thing Monday morning. It's an abcess below tooth # 29. It needs a root canal. He gave me 10-days worth of amoxicillin (through 10/28) and vicodin. I get an appointment for a root canal on November 9. It takes four days for the pain to go away.

This part of my mouth has been uncomfortable for almost a year now.

Flu shots for 2009/2010

Jack and I got our flu shots today at Professional Health Examiners in Pensacola on Old Spanish Trail. These were the 'seasonal' flu shots and not the kind for the H1N1 swine flu (not available yet for our age group).

Still having tooth pain around #30

Lots of tooth and jaw pain around the bridge in the lower right rear. The dentist took xrays and poked around. Told me to come back if it gets worse.

This area of my mouth has been troubling me for 10 months.

Follow up exam with the knee doctor

It has been almost six months since my knee replacement. Today's visit was for x-rays and an exam by the doctor. He said everything was coming along very well and he wanted to see me again in six months.

Pre-medicating for a root canal

I had a root canal today on tooth #20. And he prepped me for a new crown on that tooth.

The dentist had me begain taking Clindamycin last Thursday. He wanted me to start five days before the procedure and keep taking it for five days after. Three per day, a total of 30. It's strange to take a drug when there's no infection because I had a knee operation six months ago.

I had a bad reaction to the drug and called him and the knee surgeon's nurse about the violent diahrrea I was having. Both told me it was the best drug for pre-medicating in this situation and I should keep on with it. And take lots of Imodium and eat plenty of yogurt.

I finish the pills on Saturday and I can't wait.

Pre-medicating for dental work

Today I had my first dentistry since the knee replacement -- a teeth cleaning. And it was way overdue.

Since the cleaning can insert bacteria into the bloodstream, the knee surgeon prescribed Cephalexin to prevent any possibility of infecting the left knee. I had to take 4-500mg capsules one hour before the cleaning. That's a huge dose of a nasty antibiotic.

The cleaning went well but some decay was spotted heading toward the center of a tooth. So I need a root canal and a new crown in a couple of weeks. For this procedure the dentist prescribed a different antibiotic, Clindamycin, and I am to take it three times a day for ten days starting five days before the root canal appointment.

I checked with the knee surgeon's triage nurse and she has no problem with me doing what the dentist advised.

Five months after my left knee replacement surgery

It has been a month since my last report and there has been more improvement in the pain levels and in my gait. My left knee itself rarely has any pain at all. The discomfort is nearly always on my right side (the side that didn't have the surgery) -- I get pains in the lower back, right above the right knee and in my right heel and foot. Riding the bike at the gym is helpful as is swimming. I should go to the gym more often; I swim every day.

I have noticed when I am walking my left knee is making more noise than it did at first. There is a clicking now and then and if I'm sitting and extend the knee there is a "gravelly" sensation. If you lay your hand on the knee you can feel it crackling when the knee flexes. It doesn't hurt at all. I will mention it to the doctor when I see him for a followup appointment in two weeks.

Something else to mention to the doctor are leg cramps at night in the lower left leg. Two or three times a week.

Car trips and sitting too long, like at a play, make me very stiff and it takes a few minutes to stand straight and walk comfortably. This is when I need the cane. And I use it. I can't imagine taking a long plane trip and then needing to rush to another gate. But I guess I could do it if I had to.

Going to the circus in Mobile was difficult -- a long drive, a long walk from the parking lot and many stairs to climb to get to our seats. I was lame the next day. My stamina is very low and is slow to return.

On the good side I am having less pain at night and need fewer prescription painkillers. Tylenol works most of the time.

Four months after knee surgery

Four months after and there's been some progress, but the progress has slowed down -- a lot.

I did some research online about this slow down and discovered that it's not all in my head. For many people who have had total knee replacements there are new aches and pains around the third or fourth month after surgery. Nothing serious but they don't see the progress of earlier months.

My complaints typically were not around the surgery site, the left knee, but on my other side -- my right leg, foot and lower back. At any rate I've been sore much of the time and used it as an excuse to avoid going to the gym. And yet when I did go to the gym, even if to simply ride the bike for a few minutes I felt better. But it is so easy to put it off until tomorrow. I must make going to the gym and doing the knee exercises my top priority.

Much of my physical problem is the lack of balance between my weak left side and my stronger right side. Again, this will improve with more gym visits.

I did stay away from doctors all month. Except for an unrelated exam by my primary care doctor when I developed a big blister from a spider bite.

As for the knee replacement and the area around it, it doesn't slow me down. There's rarely any pain at all. It is swollen a lot of the time, especially after exercise or yard work but other than looking weird it's not a problem. I need to ice it more I guess.

The weather in the early part of the month was quite warm and I got in the pool on May 13 for my first swim of the season. The water was quite cold, but bearable. The rain later in the month made the pool colder still, so we haven't been in again. Usually we are in the pool daily by mid-May.

On May 19 we took a road trip. The longest for me so far. We drove to New Orleans, 200 miles each way, with lots of stops for stretching and changes of drivers. I felt great that night and the next day but on the second evening my right leg was quite lame and my lower back was bothering. Probably it was the long time sitting in the car and too much walking in New Orleans' French quarter. There's a lot of rough pavement and I was leaning on the cane pretty hard.

In the morning it was difficult for me to walk but there was no problem driving. Because of bad weather en route we left for Pensacola mid-morning.

Regardless of my hobbling around the French Quarter, New Orleans was wonderful and their recovery as a tourist destination is coming along very well.

A week later I am better but still lame on my right side.

[Aside from my medical complaints, this month we also lost the old air conditioner and heating unit and had to get a new one; the pool was infected with green algae and has taken most of the month to clear up, with much fussing with filters and adding nasty chemicals; and two days ago the house was struck by lightning, again. It was the second strike in five years. This time the lighting strike fried all the outdoor electrical circuits including the pool pumps, but it spared the new air conditioner compressor. We look forward to a long time without visits from salesmen, estimators and repairmen.]

Joined a Health Club

Yesterday it had been a week since my last physical therapy session and I was feel creaky. I went to the local gym and joined up. The deal was if I paid for a full year they would give me three extra months free, plus no membership fee and they wouldn't charge me the annual $25.00 "Facilities Improvement Addendum."

It came to about $28.50 per month for 15 months. Best of all it's only a mile away from home.

I told my salesman that for the first couple of months I wanted to simply continue my physical therapy exercises. If it turns out I am having a good experience I will add other exercises, but for now it will be my prescribed knee and leg work out. He was pleasant and bright and appeared to understand what I needed and wanted. He also introduced me to one of the trainers. We chatted and he was someone I could work with. Later on. Months from now.

I went there this afternoon to ride the bike and do some gentle knee exercises. At 2:00 P.M. the place was nearly deserted. Good sign.

Before I could begin I had to sit through a long and pointless lecture on the value of exercise by one of their "personal trainers." He was not the person I met yesterday and with whom I was planning to speak today. This guy was going to custom-design my workout. Based not on what I asked for but on what he wanted me to do -- in light of my physical condition and his goals. He refused to listen to anything I told him.

I agree right now I am fat and out of shape: I have been disabled for the past four years and have not done much exercise. But I am not lazy and stupid. And that's how he made me feel.

I told him several times that right now I am not ready for a "total fitness," and massive weight loss, program. However much I may need one. Get serious, in a month I'll be 67 years old and need to get back in the habit of going to the gym three times a week and working up a sweat. To get in the habit I will need to enjoy the sessions at the gym.

Finally I invoked the three-day cancellation clause in the purchase contract. He then angrily said I could do whatever I wanted to. He left the gym, got in his truck and drove off.

The personal trainers apparently are subcontractors and do not work directly for the owner of the gym. Strange.

Three months after knee surgery

Wednesday, April 29, 2009

Three months! I didn't expect this much recovery at this point. There is still minor swelling after exertion and occasional pain that is sometimes beyond what Tylenol can help. Vicodin helps a lot and I take less and less of it as the weeks go by. Mild exercise helps the pain as well. Serious exercise such as physical therapy sessions and yard work sometimes lead to discomfort the next day or two.

Sometimes I start to get a little discouraged but when I look at these notes I see there was a time, just a few weeks ago, that just getting in and out of the car, or the bathtub, was a painful chore. Now it's no problem at all. Progress.

Compared with the knee discomforts of the past six years I am in much better shape. From what I have been told and what I read online, in general, at three months the recovery is just beginning.

One result of my mobility challenge was that I couldn't trim my toenails. One therapist warned that many nail salons have hygiene problems and right now an infection would be a bad thing. She suggested a fancy day spa nearby but I decided it was time to have my regular podiatrist exam and make him trim my nails. Insurance doesn't cover it but you don't have to tip the doctor, so it balances out. Last year I had a toenail fungus so this was also a good time to have him check to see if there were any signs of it coming back. There weren't.

I can take short car trips with no problems as long as there are lots of breaks for stretching. And I can do some of the driving. Many of our favorite lunch places seem to be about 50 miles away -- Atmore, Magnolia Springs, Destin. Good practice for longer trips later in the summer.

On April 15, I had three appointments: physical therapy, my monthly exam by the knee surgeon and my visit to my regular doctor (every six months). All seems well. The surgeon wants to see me again in three months and my G.P. in six months. I seem to be out of urgent medical need.

The therapist sent a report to the surgeon on my progress in bending, and straightening, my knee. When I started with this therapist two weeks ago I could bend the knee back 112 degrees, now I'm at 122 degrees. As for straightening the leg it was -8 degrees and now it's -5 degrees. This is not as good progress as the bending but it's better than it has been in six years.

The P.T. experience remains a good one. The place I use is clean and cheery and everyone there is professional and apparently very effective. It is hard work but I have better mobility now and rarely need even the cane to get around any more. I am glad I chose the facility run by my surgeon's group.

Last Sunday we went to see a play at the university and I climbed some stairs for the first time since the operation. There were just a few steps and I manged them OK, up and down. Going up was easier and faster than coming down. I took my time and used the cane and the hand rails both ways.

What did all this cost? So far, Medicare and my AARP gap coverage policy have covered it all. The only exceptions were for refill prescriptions for painkillers, about $30, and the tub/shower bench, for $95. These are trivial in the light of the actual total billed which is close to $60,000 so far. Of course the amount paid out by the insurance will be a fraction of the amount billed.

The AARP gap coverage is a separate policy that pays the deductibles and co-pays because Medicare pays only 80% of the official Medicare adjusted payment amounts.

I will post a breakdown of all the charges when they are in (and I have figured out how to translate the reports into English).

I had ten P.T. sessions in April and think it's now time to join a gym and (1) continue the knee and leg exercises I learned in P.T. and (2) exercise the rest of me, lose some weight and get in shape. Wish me luck!

The following is out of sequence but I have done some research over the past few weeks and wanted to share what I learned.


Afterthoughts on preventive care in the hospital
I mentioned before that I got a bedsore ("pressure ulcer" as the medical pros call them) on my left heel while I was in the hospital. The link in Wiki tells you all about them. In all honesty I must admit the one I had wasn't nearly as serious or as gruesome looking as the examples they show. Mine was caught before it had time to get very deep.

Now, three months later, the relatively small one I had looks much better but it is still sore at the center of the heel -- where the wound was -- and the skin is still peeling.

My advice to you: if you go to a hospital or a rest home -- don't get a bed sore.

Tell your doctors and nurses from the start that you want them to do whatever they can to prevent you from getting any. And remind them.

My recovery was made much less comfortable because of the bedsore. I had enough bother with the leg brace, also on my left side. Having to "float" my heel on a rolled up towel all the time made the brace more painful and I didn't need the extra bother. Also, it made my early physical therapy less effective because there were exercises I could not do correctly because of the sore.

Knowing what I do now, should the hospital ever ask me to evaluate my stay -- which they have not done -- I would be very vocal in my complaints about the staff procedures that let this happen.

Two months after surgery

Sunday, March 29, 2009

Slowly I began to do more on my own. I shopped at the pool store and convenience stores while Jack waited in the car. And on March 23, I drove alone to a nearby store, shopped and drove home. My first solo drive and shop!

On the 27th I finished at-home therapy and the following week I went to an out-patient rehab facility. It was of course better equipped than at home and the exercises were much more agressive. Ouch!

This rehab place is part of the orthopedic center run by my surgeon's group. The therapists are all very friendly and the place has a great atmosphere. There's lots of personal attention and they appear to be very professional.

I go to rehab twice a week until the end of April. Then I need to join a health club so I can have access to the leg exercise equipment.

While surfing the Internet I found that the Medicare.gov site has links to the charges they have paid on my behalf. If and when I figure it all out I will post a summary of what all this has cost. So far the insurance has covered everything. The replacement knee itself cost $18,020.95, (and that's parts not labor).

Now that I am into a period of steady progress I will post updates only once a month. The next one will be right after April 29.

Seven weeks after surgery

Thursday, March 19, 2009

On Friday the P.T. supervisor visited me and said the progress looked good. The following Monday the original physical therapist came by and told me if the brace is off it is time for me to be more mobile. She called my surgeon's office and spoke with the surgeon's nurse. His nurse checked my file and came back in a few minutes to say I can advance to full weight-bearing on my left leg, stop using the walker and try walking without even the cane. And I can try driving if enough time has passed since the last prescription painkiller (four to six hours).

Tuesday, March 17, St. Patrick's Day, we drove to Commander's Palace in Destin for lunch. It's 55 miles each way. I did some of the driving to give me a chance at driving on city streets, freeways and country roads. I had no problems and getting in and out of the car on the driver's side. It's easier for me than on the passenger's side. It was my first "long" drive and although I was stiff and a little lame when we got there it soon passed as I walked around.

Wednesday I got lots more P.T. than usual and this time I was sore before dark. And more so the next couple of days. Back to the Vicodin for a while.

Six weeks after surgery

Thursday, March 12, 2009

Friday the sixth, was the final visit from the therapist for this round of therapy.

On Wednesday, March 11, I saw the surgeon for my first follow up exam. He says the x-rays look good and I can stop wearing the leg brace. Tomorrow will be six weeks since the surgery so I am well ahead of the 8 to 12 weeks he told me to expect to be wearing it. Later his nurse told me I was off the brace because I had been "compliant" in wearing the thing all the time -- 24/7.

The doctor sent a message to my therapist that now the brace was off the therapy can get more aggressive. And he prescribed two more weeks of at-home therapy to be followed by four or five weeks of out-patient therapy.

A few days after I stopped wearing the brace I decided it was time to take a shower standing up. This was partly because I knew I had enough bend in my knee so I could manage to step into the tub. Also I had noticed there was a chrome grab bar at the back of the tub at shoulder height. I had never noticed it before, but it's right there above the shelf for shampoo.

I managed the shower without falling down. It was, however, a challenge to stand up that long. I have gotten so weak and shaky from the lack of exercise. But it was progress for sure.

Five weeks after surgery

Thursday, March 5, 2009

Got lots of physical therapy at home -- Friday, Monday and Wednesday.

Tuesday, the 3rd, was an active day (for me). We got haircuts and then went to lunch at Madison's Diner. It turns out there is a back elevator for deliveries and the disabled.

I am more active every day and the discomfort is much more from the afereffects of the therapy than from the knee itself. Any pain is largely controlled by some Tylenol. If the pain wakes me up during the night I take something stronger.

Four weeks after surgery

Thursday, February 26, 2009

More physical therapy -- Friday, Monday and Wednesday. She is here for over an hour each time and we are working me hard. The urgent problems are getting my knee to bend more and to get the leg to stretch out straighter. I think I am on a plateau as far as progress is concerned. But the bending gets a degree or two better each visit. Right now I am in the low 80 degrees and we want it to go better than 120 degrees. That will take a while.

She tells me if we don't, or can't, get the knee to bend enough the doctor will do it for me. And apparently that's not pleasant even with a local anesthetic.

Supermarket shopping -- Walmart, Food World, Publix -- has been good physical therapy, even if I ride around in their motorized shopping carts it is more activity than I had been having over the past few weeks. And I get extra practice getting in and out of the car each time we shop.

Three weeks after surgery

Thursday, February 19, 2009

The occupational therapist visited on Friday and Wednesday. We talked about how to take a shower when sitting on the tub bench, how to do the laundry and how to improve the arrangement of the clothes closet. She's finished with me now and I signed her off.

The physical therapist came by on Monday and her boss on Wednesday. They both say I am making decent progress but there isn't much more either they or I can do until I get the brace off. And that may be several more weeks.

On Tuesday we had an outing in the car. Jack drove us down to the bay and we had lunch at the Scenic 90 Cafe. I got in and out of the car ok and managed to get in and out of the restaurant using my walker. It was a nice taste of freedom.

Later in the day I was sore from all the exercise. I am so out of shape! Just getting in and out of the car makes me feel it.

I was supposed to have my teeth cleaned today but I cancelled. I cannot have any dental work for six weeks after the surgery and then I have to take antibiotics either before or after, depending on which medical or dental professional you ask.

This week I had my first (sitting) shower using the tub bench. To get me situated in the tub I had to swing my bad leg up and over the edge of the tub while turning sideways to get to the center of the bench. I wasn't ready to do this with the leg brace off so I used a large black garbage bag tied with a shoelace to keep the brace dry. I also have a open bed sore on the left heel and I need to keep that clean and out of the bath water. The shower went very well. With the hand-held shower head I could get clean all over and it is sure better than a sponge bath. Jack helped me get in and out of the tub safely. I can't wait until I can take a standing shower in a few weeks.

On Wednesday we went to Joan & Billy's for lunch. Southern-style veggies and corn pones. Wonderful. As always.

On Thursday we had breakfast at the Village Inn. It is very accessible for people on walkers.

So I got out of the house three days in a row. I took Friday off and rested.

Thirteen days after surgery

Wednesday, February 11, 2009

The physical therapist came by in the morning. After our regular session I asked her to show me how to get in and out of the car, on the passenger side. I did it several times and she says I am ready to go for a ride.

In the afternoon I went to the surgeon's office for my first followup visit. His nurse removed my staples, all 26 of them. I was not looking forward to this procedure but it was not painful. Slightly annoying, but not painful. The wound had healed a lot and they all told me it looked good. X-rays were taken and the doctor said they also looked good, too. He wants to see me again on March 11.

Shortly after we got home Joan called and said she and Billy would drop by shortly and bring us our supper. Billy had cooked the fish Bill gave us and Joan had made an almondine and lemon topping for it. It was wonderful. And great not to have to cook it ourselves.

Twelve days after surgery

Tuesday, February 10, 2009

I slept soundly but woke up a lot. The complaints: the sore spot on my left foot, the bruise on my right rear gum, a strange numb area on my right thigh, the leg brace. Note that none of the complaints mentions the replaced left knee itself. Go figure.

Speaking of the brace -- it has eight foam pads and they are getting dirty and smelly. I noticed in the docs from the Breg Company that replacements are available so I called and they directed me to the local distributor. He said he could send replacements at no charge and I will have them in a week. Now I can have an extra set washed and ready to go.

Eleven days after surgery

Monday, February 9, 2009

The next morning the physical therapist arrived and put me through my paces. The important exercises are designed to make me bend my knee as far as possible and the others stretch my hamstring and strengthen my quads -- the muscle above the knee. She is friendly and chatty but very strict about doing all the exercises with correct form.

She is very creative in setting up the exercises. The knee bends are done sitting down and dragging the foot back as far as possible. Due to the bed sore on my left foot I can't put much pressure on the foot. So she has me put a piece of wax paper under my foot so it slides easily. She measures flex, bend and extension with a giant foot-long protractor called a goniometer. I have noticed that all the orthopedic folks carry them around with them.

In the afternoon the occupational therapist saw me and inspected the house for safety and disability issues. It seems the house is well laid out for my needs and she had only a few suggestions to make it more useful or safer. We spent a lot of time dealing with the bathroom and how to safely shower and use the raised potty chair that fits over the toilet. It appears that I have enough bend in my bad knee to use the facilities as they are and there's no need for the raised chair (which I really dislike a lot anyway).

The shower bench should wait a day or two so it's sponge baths for me for a while longer.

For dinner I lightly poached the shrimp Bill gave us and made us a shrimp salad.

Ten days after surgery

Sunday, February 8, 2009

It was wonderful to be home and sleep in my own Tempur-pedic bed. I woke up frequently, with many bathroom trips. The swelling in my leg is going down and there's a lot of fluid to get rid of. At one point, a few days after the operation, my left leg was nearly triple the size of my right leg.

I soon learned how to get in and out of bed without hurting at all. And I get quicker every time I do it.

The new knee appears to be working fine. There's no pain around the implant and it's begining to move better. The doctor says it's to be only fifty percent weight bearing right now, so I have to use the walker to get around, but I am getting around.

This morning there was a call from a supervisor at the home care folks and he needed to come over and speak with me today for my initial interview. I saw him at 10:00 A.M. They must make a lot of money from this home care business to call on clients on Sunday.

He told me I would get four weeks of in-home therapy from a combination of occupational and physical therapists -- starting Monday. Somebody will call first.

In the afternoon Joan & Billy stopped by with a wonderful beef and vegetable soup. Just what I needed.

I continue to amaze myself with the injections I have to give me every morning and night. When I heard about this before the surgery I never imagined I could do them at all. Much less with no fuss. The fact they don't hurt at all may have something to do with it.

Nine days after surgery

Saturday, February 7, 2009

The rehab place was very noisy last night. Somebody down the hall kept yelling, "Please help me they are trying to kill me." This got a couple of others yelling to the nurse with their own urgent problems. Finally I heard a nurse tell them all, "You are not at home. There are other people here and they deserve to get some sleep."

This hadn't happened even once the other nights so I asked my nurse if it was a full moon tonight. She said it's always a full moon around here.

Today I can go home as soon as I have transportation. I wasn't sure I could get into the front seat of a compact car so I asked the nurse to get me some special transport to get me home. First the driver was coming at 10:30 then it got later and later. At last he arrived at 1:30 and it was the same guy with a van who brought me here from the hospital. I was able to slide into the wide back seat and sit sideways all the way home.

As I left the nurse gave me the rest of the blood thinner in its syringes (five more days worth) and lots of painkillers.

It was wonderful to be home and Jack had readied it by stocking lots of food and taking up all the area rugs. I managed to get around the house on my walker and easily got in and out of bed. The bathroom wasn't as easy but -- and this is important -- it was possible.

At dinner time Kim came by with pot roast and apple pie and Bill brought some fish he had caught yesterday and some huge Gulf shrimp, too.

Eight days after surgery

Friday, February 6, 2009

It was a quiet night and I got some much needed sleep -- no fire alarms, no roomie, no loud nursing staff. I have gotten used to sleeping with the leg brace on. Early on I learned to lock it in the extended (straight) position, otherwise I get into some uncomfortable positions in my sleep and wake up with a jolt. During the day, for ease of moving around I can unlock it at the knee joint so it can bend.

My morning P.T. session was serious. Between the two of us my knee bent back as far as it could. About 78 degrees if I recall correctly. Afterwards I walked all the way back to my room -- with a walker of course (and with the therapist walking behind me with a wheelchair).

While I was away from my room a new roommate had arrived. He was such a jerk and in such medical agony I had to feel sorry for him. Though it became clear that his being such a jerk contributed a lot to his medical problems. Sometimes you just have to back off and do what the doctor tells you to do.

I spoke with the home care folks by phone and they had spoken with the social worker here at the rehab place. They are ready to send me home tomorrow afternoon. Some of the home care equipment is provided by the insurance. The tub/shower transfer seat isn't provided and I'll have to pay $95 for it, but it sounds essential. It will let me sit upright in the tub and take a shower with the hand-held shower head. All of the equipment will be delivered to the house.

The home care people will call me at home over the weekend to set up initial appointments for Monday and Tuesday. Apparently I need to see a nurse and two different therapists.

One week after surgery

Thursday, February 5, 2009

This all began one week ago today and now I can get out of bed and go to the bathroom unsupervised. Actually I have for the past 3 days but they didn't know about it. Lucky for me I didn't slip and fall. And with all the Vicodin I am taking it's a miracle.

It was very cold in Pensacola last night. The coastal areas, generally the warmest, got down to 27 degrees and it was much colder in the inland parts of the county.

Lots of excitement during the night. At 4:00 A.M. the fire alarms went off and from my room I could see firetrucks and an ambulance arrive at the front entrance. And then at 7:30 it happened again. The first time was for somebody who needed to go to the hospital. The second time was because of frozen pipes that cause low pressure reading in the sprinkler system.

I got up tired from sleeping poorly and the noise from the alarms. Also I was feeling sore from yesterday's P.T.

My roommate left right after breakfast. He's a sad case. Very poor and not very bright. By walking out on this followup care he will probably be refused home care and other post-op benefits. I hope he won't end up in some dreary VA hospital

Early today the therapist gave me another good workout and during it I spoke with a representative of the Medicare-approved home care company assigned to me. They will provide me with nursing and therapy staff for four or five weeks after I get back home. They will also provide me with and/or assist me in purchasing some equipment I'll need for my first days (or maybe weeks?) at home.

By the way, here's a link to Medicare.

I haven't felt up to much of a shower recently and my hair was a mess. So I made an appointment and got a shampoo from the resident beautician -- $4.00 (plus I gave her a $2.00 tip). Wow, I felt a lot better. And I wheeled myself all the way from my room to the other end of this place. What freedom!

Six days after surgery

Wednesday, February 4, 2009

Slept better last night. Also there were fewer interruptions by nurses. All my vital signs have been very normal so I think they have cut back on checking me out so often.

My roommate has been quiet except to complain whenever a nurse comes by. He says he's leaving tomorrow whether or not he gets officially discharged. He's ex-Navy and had his hip surgery at a naval hospital nearby. Then he was sent here for physical therapy -- which he refuses to do. Somebody came by our room today and told him if he doesn't do the therapy at this stage of healing he could end up in a wheelchair forever. He didn't want to hear that and didn't.

Hearing his lecture made me want to do my P.T. and I did, twice today. Both sessions were productive. I have two main things to do -- straighten my leg and bend my knee as far as possible. At the hospital couldn't straighten my leg at all and the bend was about 65 degrees. This is not good. I need to bend it at least 120 degrees when I have recovered. Right now they would like me to reach 90 degrees in the next three weeks.

In addition to physical therapy I get occupational therapy too. I thought O.T. would be somehow job related, but it uses another and quite different meaning of "occupational." The wiki says that "the primary goal of Occupational Therapy is to enable people to participate in the activities of everyday life. For instance they give you helpful tools and show you how to put your socks on when you can't reach your feet. And many other things.

The only time I get to remove the leg brace is for a few minutes when we do the knee range of motion (ROM) exercises. That's when I get to see how swollen my leg and left foot is. The foot is discolored from the betadine and the swelling and looks very much like a giant papaya -- orange, yellow and brown with flecks of green. My knee is swollen but fine and there's little pain. At least when P.T. is over.

Early evening I had a visit from the rehab center's house doctor's P.A. we spoke about medications. She said I could stop taking the blood thinner at the end of the week. I thought I needed to take it for ten days, which would be a week from today. She will check on this for me. I find there is little agreement when it comes to doctors, nurses and dates.

I saw Jack at dinner time and he says it's going to be very cold tonight.

Five days after surgery

Tuesday, February 3, 2009

At night it was quiet and I slept quite well.

So far the food is bad and does not reflect the answers I gave them when they asked me about food preferences. The questions were confusing and something I must have said got me a breakfast today of coffee, juice, two doughnuts and three pancakes. Period. Nothing else.

P.T. this morning was light and not very knee-specific. Or not as knee-specific as I expected and wanted. When the social worker stopped by to speak with me I told her I wanted to go home today or tomorrow at the latest. She said she would see about it and mentioned that we need to get some sickbed supplies delivered to my house.

Jack visited and thinks I should stay at least for the rest of the week. And as he was telling me this the physical therapist and my surgeon walk into my room to say the same thing. At that point I gave up. I'll stay.

The next session of P.T. was much more agressive and we got a lot accomplished. Maybe it was a good thing that I threatened to leave.

That evening Jack brought me more clothes and some magazines. A hard freeze is expected tonight.

Four days after surgery

Monday, February 2, 2009
Slept fairly well and had several episodes of deep sleep. The leg brace dictates my positions in bed and I must stay on my back all the time. When it was time for my morning medicine the night nurse showed me how to give myself the blood thinner injection. So I did it and it didn't hurt at all.

My surgeon came by to visit early -- around 7:30 A.M. -- between surgeries. We discussed rehab places and he had two to recommend. I leave the hospital today and I chose to go to the rehab place the doctor liked best.

Mid-morning I had one last P.T. session at the hospital and walked almost all the way back to the room. The bedsore on my heel is a problem when I do some of the therapy exercises. And there's one more complaint, a new one. My gums around where the tooth was extracted last month is very sore and there's even some dry socket pain. It started bothering a couple days ago. I think it has someting to do with the respirator they stuck down my throat during surgery. The knee happily hardly hurts at all.

I was discharged from the hospital at 1:00 P.M. and at 1:30 I was in a wheelchair, strapped into a van on my way to the rehab facility a couple miles away. It was cold and rainy out. The rehab place was nice, clean and well-staffed. Full of old folks who live there all the time and a handful of us recovering patients.

There was a roommate recovering from a hip replacement. He was old, angry at all the staff and ready to leave. He was also quiet and not very talkative. I liked that a lot.

There was a constant stream for staff coming in the room to ask me questions that I am sure were all answered in my medical records. But it gave them a chance to make me feel welcome.

Late afternoon I was wheeled down to the Physical Therapy room. It was well equipped but the staff had me doing exercises that had little to do with helping my knee's range of motion.

Jack visited during diner and my roommate and I went to bed very early.

Three days after surgery

Sunday, February 1, 2009
Sunday is a quiet day at the hospital. And from the casual amount of attention it's a light day for staffing as well. I had P.T. at 10:00 and it went well. I walked half way back to my room this time. The therapist and I discussed what kind of rehab I should get after I am released from the hospital. The therapist thinks it would be good for me to spend a week in a rehab facility to heal a bit more and to get some concentrated P.T.

By the way, I am getting used to the brace and it is not as uncomfortable as it looks. Also I am happy to report there's very little pain from the operation. The wound is sore of course but the new knee is no problem at all. The brace prevents any lateral movement of leg above and/or below my knee. This allows the Medial Collateral Ligament (MCL) to heal properly. I imagine that without the brace the ligament repair might be a tad touchy.

One of my surgeon's partners dropped by to see how I was doing. We chatted about my knee and he told me how tricky the ligament repair was.

Jack came by to have lunch. He and Billy had already spoken about some post-hospital rehab for me and agree it would be a good idea.

During my second P.T. session I mentioned that there was a sore place on my left heel. The therapist looked at it and told me I had a big bed sore, a "pressure ulcer," and he said the nurses should have been watching my pressure points better. I have noticed a bit of rivalry between the nurses and the physical therapy folks.

Because of the bed sore I now have to "float" my heel. This means putting a rolled up towel under my ankle whenever I'm in bed so the sore doesn't touch anything. Well, it will keep my mind off my knee.

Two days after surgery

Saturday, January 31, 2009
Slept fairly well until somebody woke me at 3:45 for a blood test. Then at 4:20 A.M. the lights came on and the night nurse tells me she needs to change my dressing. There's another nurse on hand to help.

Before they can change the dressing on my knee they have to unwind lots of Ace bandages and break through the rigid foam cast. It breaks apart quite easily and soon they are down to the knee incision. It is surprisingly small -- a single, vertical cut about seven inches long -- and very clean. They count the staples and there are 26 of them. They also remove the drain from the wound and remove my catheter. Why couldn't they have done this at 10:00 A.M. instead of 4:20?

The nurse dresses the wound lightly with gauze pads and then she and her helper install the leg brace. It is much longer than I expected. The photo is my view of the brace. It was taken the day after the staples were removed.

At 11:15 the physical therapist shows me how to get in and out of bed with the brace on. We then go to the P.T. room and I learn to use a walker, how to stand up and sit down and, with the brace off, some range of motion exercises. I was told to take extra painkillers an hour before this one.

Back in the room my surgeon's P.A. stops by and explains the surgery (he was there) and why the ligament repair requires the brace. The knee replacement recovery is generally six weeks. But the ligament recovery is two to three months.

In the afternoon I had another light P.T. session and it went well. On the walker I walked a quarter of the way back to my room.

Lunch and dinner were both from the alternative menu -- deli sandwiches. Kim came by for a visit. I seem to remember I was very talkative from my drugs. Jack brought a Subway sandwich to eat while I had my hospital turkey sandwich.

I went to bed early and my neighbor had beeping problems through the night. The poor man has been in the hospital for something like 28 days. He has multiple problems. He came in after his feet were crushed in a car accident, then several pre-existing conditions got worse and now he has had prostate surgery, a hip replacement, several foot surgeries and a couple additional procedures. He has more surgery on Monday.

I learn all this because he has many family members visit for long periods of time. They are quiet and it's no problem for me but they stay and stay. He must be exhausted by them. At one point this evening there were eight of them in his room. OK, I'm nosy -- when they announced they were leaving I counted as they left.

One day after surgery

Friday, January 30, 2009
I slept fairly well what with the drugs and the busy day I had on Thursday. The cast on my left leg has me pretty much stationary on my back. The trapeze hanging over the bed is very handy and I use it a lot to change my position. And the bed itself changes into 10,000 positions, too.

It's hard to stay asleep because there's a nurse every hour or so to check blood pressure or to take blood. But they need to do it. I also wake up when the man in the next room has various alarms go off. These don't appear to be noticed at the nurses desk and they can go on for many minutes. Last night I listened to one beeper go for 20 minutes before I called the nurse to come and shut it off.

Pain hasn't been a major problem. Once I slept too long and hadn't pressed the magic button for a couple of hours, but I took care of that soon enough. One nurse said I could press it every 20 minutes; another said every five minutes.

At 5:30 A.M., yes, 5:30 A.M., the night nurse and her assistant woke me and said it was their job to get me to sit up, get out of bed and sit in a chair. By the time we were done I was very much awake. The chair was comfortable and had a foot/leg rest in just the right place for me. I stayed in the chair until breakfast at 7:00 A.M. Lots of prunes with breakfast. All this morphine is constipating.

At 7:30 the day nurse came in and he took many of my tubes away. Gone were the IVs for fluids, and the one for antibiotics, and the morphine pump. In the brochure I was given last night it said this would happen 24 hours after surgery but I hadn't read it yet.

Most of the nurses work 12-hour shifts, three per week. There appears to be a separate staff for weekend nurses.

At lunchtime Jack came by and we had lunch. He brought a chicken sandwich from Wendy's, one of the fast food outlets located in the hospital. I had the official hospital lunch. Again the food here is surprisingly good. And if you don't want the meal of the day you can order other items, including deli sandwiches.

After lunch a new physical therapist arrived to take me to my afternoon session. We practiced how to stand up and how to sit down. The session was brief because there's so little I can do with the cast on my leg. It comes off tomorrow.

Back in the room I decided to sit in the chair until dinner. The therapist said this would be a good thing to do. About 30 minutes after physical therapy I was getting some serious pain and the nurse gave me some Vicodin tablets. Half an hour later the pain was worse and he said I would bring me "something to take the edge off the pain." He arrived with a large dose of something in a syringe and the pain was going away before he got it all into me.

A few minutes later the house doctor came by to see if the pain was better. He was the person who authorized the shot.

I don't remember much more that happened that Friday. Except that before bedtime I got my first shot of the blood thinner -- Lovenox, I'm to get it every 12 hours. It's the one I have to inject myself after I get home.

Day 0 -- The Knee Is Replaced, Part 3

Thursday, January 29
About 1:30 Jack came by for a visit. While he was there various people came in the room every few minutes to take blood or check vital signs. I even got a phone call from my "hostess" to find out what I wanted for dinner.

He agreed that the room was very nice and I was getting a lot of attention. A couple of years ago he had a less-than-wonderful experience in this same hospital but a different department was involved.

At 2:45 I got my first visit from the Physical Therapy department -- two people. They said I needed to sit up on the edge of the bed and try to stand. They helped me sit up and turn to the side of the bed. Then they put a wide belt around my waist and told me to stand up. The belt was to catch me when I fell over. Which I did.

I was told to bend my knee a little and I told them I couldn't. They thought I was worried it would hurt. What I meant was I was in a cast and my knee didn't bend right now. One of them tried to bend the knee a little bit and discovered why I couldn't move it. Shouldn't they have known this?

After the therapists left I looked at my left leg. I expected a bulky dressing around the knee. What I saw was a huge, tree trunk sized cast going from my upper thigh to my ankle, wrapped in a wide ace bandage. It is light weight and sounds hollow when you tap it. It's some kind of foam that hardens in place.

Just before 4:00 a lady from the Admission Office came in with a clipboard full of questions for me. These were the same questions I answered last Friday at my Pre-Op interview. While she was there a woman from the surgeon's office dropped off a leg brace "for Saturday."

I was asked my full name and date of birth every time anyone from the staff came in my room. And then they checked my wrist band to see if I was really me. Hospital policy.

My policy, which I decided upon before I checked in, was to be unrelentingly cheerful and full of good attitude. It paid off. The nurses are bored with complaints.

I napped off and on between visits from nurses and aides who kept telling me to breathe better. I got a plastic device to blow into to improve my breathing and oxygen levels. The painkillers were working well for me and my memories of the afternoon and evening are hazy. Dinner seemed very good, turkey, etc. with great pumpkin pie.

The nurse brought me a brochure about the day-by-day recovery from the surgery and valuable tips for knee rehabilitation.

Jack visited in the evening and told me how cold the weather was getting.

Day 0 -- The Knee Is Replaced, Part 2

Thursday, January 29
I am coming to in the recovery room and most of all I am thirsty. And my throat is scratchy from the breathing tube. The nurse says I can have some ice chips in a few minutes. Right now apparently the worry is that I will get an upset stomach if I eat or drink anything. It's a little after 10:00 A.M.

Soon I get a cup of ice chips to eat with a spoon. When I didn't throw up they bring me another cup of ice.

The anesthesiologist visited and said it all went well. Then I saw the surgeon and he said the knee replacement went fine but there was a ligament attached to a bone spur that had to be repaired. I'll be in a cast for a few days then I'll need to wear a brace for a while.

They kept me in the recovery room longer than planned. My room wasn't ready yet in the hip and knee joint wing. Just before noon they took me to my room, very nice, a suite of two private rooms sharing a bathroom.

Once I am settled in my bed I am awake enough to count all the tubes and catheters connected to me. I have an IV for fluids, another for antibiotics, two small hoses connecting the nerve blocker, a drain at the wound, a catheter for urine, a connector for taking blood and a morphine pump. I also have an automatic blood pressure cuff and a red L.E.D. taped to a finger to check my oxygen level. The L.E.D. is on all the time and glows in a very E.T. way.

The room is bright and cheery, on the ground floor with a view of a busy courtyard. My nurse asked if I wanted a special meal for lunch. I told her I didn't need anything special and ten minutes later I got a very nice lunch -- pot roast, veggies and dessert. And endless Cokes all afternoon. And I can press the painkiller pump whenever I need to. Or even want to.

Day 0 -- The Knee Is Replaced, Part 1

Thursday, January 29
Up at 4:20 A.M. and no coffee for me, or even any water. Jack had time for one cup of coffee. We got to the waiting room at 5:00 and sat with other people having surgery today. When I checked in the receptionist said, "Your doctor says you'll need a wheelchair to get to Pre-Op. Be sure to tell the attendant." I told her I could probably make it using my cane but she said it's a long walk. It turns out it's close to a quarter of a mile.

At about 5:20 we all leave the first waiting room and head for the surgery waiting area -- led by me getting pushed in the wheelchair. There are about 9 or 10 patients and another dozen friends and family. The receptionist was right, it's a long walk.

The surgery waiting room is busy and cheery. Lots of nurses and technical people come to me with questions and forms to sign. After I got changed into my gown they paged Jack and he came in to sit with me.

A lady from the chaplain's office appeared to see if I was Catholic and wanted a priest; if not then perhaps a representative from some other religion? The anesthesiologist, an Osteopath, (why are there M.D.s and D.O.s and what's the difference?, that's something to Wiki about someday) stops by to explain what's going to happen. He's the tenth person this morning to ask me when I last had anything to eat or drink.

The anesthesiologist's P.A. came by with a student/intern around 6:45 and they prepped me for the nerve blocker. I would get a light dose of sedation while they found some nerves in the front and back of my upper thigh. These nerves -- serving the area around the knee -- would get flooded with pain killer during surgery and for the next three or four days. This reduces the amount of morphine I'll need after the operation. At this point Jack headed for home and a nap I hope.

As I started to fall asleep somebody told me my surgery was scheduled for 8:00 and I would just stay under after the nerve block installation. When I woke up the surgery was over. I was in the recovery room being told to take deep breaths. I was thirsty, hungry and high as a kite.

A link to my other (non-medical) blog

Click here to see my non-medical blog -- cruise diaries, photos, restaurant reviews, lists and logs.

The Pre-Op Appointment

Last Friday I arrived at the huge, regional, not-for-profit, medical center, known hereafter as "the hospital", for my 10:00 A.M. appointment. They were busy, but that's no surprise. And running late.

The first step began at 10:20 when I was called in to have my blood pressure taken by nurse #1. Then we went into her rather nice office and she said, "Let's see, you're going to come in next Thursday for a left hip replacement."

I was ready to leave. We then looked at all the paperwork and the computer screen. She had mis-read the malady. Yes, all the documents say I'll be having a left knee replacement. She was sorry to have made such a mistake.

She took my medical history. I have done this several times before in recent weeks. When she was finished I asked her about all the things my surgeon said would be explained at this interview. She knew nothing about any of them and asked me, "Weren't these questions all covered in your joint replacement class?" That was the first I had heard of the class.

I am to arrive at the surgery check-in office at 5:00 A.M. on Thursday.

Next I went back to the waiting room to wait. Then nurse #2 took blood (lots of it) and urine and gave me an EKG. I passed that one nicely she said. Then back to the waiting room.

Then nurse #3 explained my anaesthesiology to me and mentioned, for the very first time, that I would have some nerve blocker surgery before my knee operation. I'll be asleep for it but they will wake me up after -- just in time to put me under for the knee surgery. She gave me several sheets of paper telling me what to do and what not to do the day before.

Then I left the Pre-Op waiting area to visit another waiting room for a couple of chest x-rays. I got out of there at 12:00 noon exactly.

Apparently all the things the surgeon said would be explained to me will be explained when I go to physical therapy after the operation. I do have a booklet from the surgeon telling me, along with many other instructions, to scrub the knee area the night before with the special soap provided. But no body gave me any special soap. Or knows anything about the special soap. I'll use Dial.

All I can say right now is, "Just do it."

"Preparing For Joint Replacement Surgery"

Go to this link, for an excellent article by Jonathan Cluett, M.D., from about.com's website. It has some good tips for anyone planning to have total knee replacement surgery.

Follow-up phone call

I got a call from LaQuanna at the hospital. She was checking some of the facts in my file. And making sure I was planning to show up Friday for my appointment for a pre-op interview.

Research Study of Blood Thinners

When I met the orthopedic surgeon last Tuesday he mentioned a double-blind research study of an investigational drug, a blood thinner. He added that this drug is, "not approved by the United States Food and Drug Administration." Not yet, at least. It will be compared to a drug that is approved by the FDA for the prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE) after knee replacement surgery.

He gave me a 14 page contract-like legal document -- an Informed Consent Form -- and asked me to read it and decide, by the time of my pre-op interview at the hospital, if I would take part.

I have decided not to participate. The study appears to require a lot of followup and some tests that sound intrusive and stressful.

Am I expected to participate? I feel awkward turning it down, but I really don't want to be part of it. Deciding on having the knee surgery itself was a huge step for me. Now this question comes up. And by the surgeon himself.

I am sure the surgery and recovery will be quite stressful enough without adding any more stress factors.

Last dentist visit for a while

The bridge is installed and fits fine. What a relief to have the sharp, nasty temporary out of my mouth. My tongue can now finish healing.

It's been nine weeks since the problem there began. That's been a long time. Made longer by the dentist's office being closed now and then because of Christmas and New Year's. I will never have any dental work done just before the holidays again.

Meet the Surgeon

I don't know why I was dreading this appointment so. Maybe I shouldn't have fired the previous specialist? What if I dislike this one as much as the former one? Does this appointment mean I am really going to have the surgery in three weeks?

An hour and fifteen minutes after my appointment time, in walks the doctor. He's friendly, soft-spoken and very reassuring. He immediately answered my first five questions before asking me what questions I had. I didn't have any other questions.

Yes, I need Total Knee Replacement (TKR) surgery of the left knee. Apparently it is the same thing as a Total Knee Arthroplasty (TKA).

The exam confirmed what his assistant had found: my knee needs replacing and soon. Strangely when he was twisting my leg around to see how much play was in the joint (a lot) it didn't hurt at all. For the past several weeks there has been less pain in the left knee. The right heel has been much more painful, especially at night.

Either I have gotten used to the left knee or the pain transmitters have ground away along with my bone and cartilage. Maybe a little of both.

He told me I would be in the hospital three to five days and might need a few more days, perhaps a week, in a rehab facility. Everybody I know who has gone to rehab has had an alcohol problem. If I'm in rehab for knee therapy can I have a drink before dinner?

The next step for me is the pre-op interview at the hospital. Then I'll find out everything I'll have to do before the surgery. And after.

Dental update

The broken temporary crown has smoothed out and isn't as sharp against my tongue (I found a new use for an emery board). The sore spot is less inflamed and doesn't hurt nearly as much. Three more days until the new bridge is installed.

Orthopaedic Surgeon Links

American Academy of Orthopaedic Surgeons
Here are some links to the American Academy of Orthopaedic Surgeons, their information about total knee replacement and some frequently asked questions.

American Association of Hip and Knee Surgeons
The AAHKS also has a lot of information. Start with their Patient Information links.

Pre-Op Appointment

In today's mail came a form from the orthopedic surgeon telling me to be at Sacred Heart Medical Mall Suite 107 for surgery instructions at 10:00 A.M. on Friday, January 23. To reschedule call (850) 416-7830.

I find it strange that yesterday's caller from the orthopedic doctor's office didn't tell me about the pre-op appointment. It was mailed to me from their office on December 31 and must be in my file. Another of their "lost" appointments for me?

Knee Doctor Appointment Confusion

At 3:00 P.M. today I got a call from the orthopedic surgeon's scheduler. She needed to make an appointment for me to see the surgeon.

I told her that the surgeon's nurse had already done that on December 18 -- scheduled me to meet the doctor on January 14. And scheduled me for knee replacement surgery for Thursday, January 29. And told me she would send me a packet of info about the operation and what I need to do to prepare for it. I have received nothing in the mail.

The caller said, "There's no appointment for you to meet the surgeon, just the knee surgery on the 26th." I asked her to check on the date and she corrected it to the 29th.

I now will see the doctor on Tuesday, January 6.

Continued Dental Problem

My tongue very sore again from sharp edges on the broken temporary bridge.