Wednesday, April 29, 2009

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.

Saturday, April 18, 2009

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.

Friday, April 17, 2009

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.

Wednesday, April 15, 2009

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.

Tuesday, April 14, 2009

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.

GoniometerShe 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.

Monday, April 13, 2009

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.

Sunday, April 12, 2009

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.

Saturday, April 11, 2009

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.