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.