One Step at a Time

Wednesday, July 17 - After escaping the fiery pits of Mordor yesterday, I took it very easy today.  The home health nurse came by and set up everything for my in home therapy.  The therapist might get by today, but if not, would definitely be here tomorrow. I iced, elevated and slept a lot.  The swelling in my leg had definitely gotten worse after Tuesday's trip to Hell, but all day of RIES, and things were back on schedule.


Thursday, July 18 –Slept fairly well on recliner again only waking for bathroom and pill popping.  Nice long, hard sleeps.  About 4 a.m. however, I woke and knew I wasn’t going back right away.  Messed around with the computer a little, contemplated going to the bedroom but didn’t want to wake the puppy too early. Once she gets up, everyone's up!  Finally did what I did the night before and stretched out on the sofa with pillows propping up surgery leg, and slept on my left side.  Heaven!  Didn’t awake til puppy came through close to 6 a.m.
Supposed to have therapy today since he didn’t come yesterday.  Anxiously awaiting this as one hears of so many different kinds of therapists.
Therapy was exhausting, but not too bad.  Lots of gentle stretching.  My extension is the worst right now, so anything pushing that was "ouchy."  However, once the stretching was through, I felt a lot better walking.  It really does loosen up my leg.  The therapist wants me to use my walker more than the cane, so I've decided to use the walker every time I take the hall trip to the "necessary" room.  Then, I walk backwards, stretching that hamstring some more.

Sunday, July 21 After my harrowing day in the ER, I have slipped into a routine. I sleep on the recliner sofa each night. With all the pillows, the ice machine, and pain meds, I actually get a fairly good night's sleep. Last night I was awakened before pain pill time with my newest pain - a sharp spasm which hurts like the dickens, but only lasted seconds. It was only about 15 minutes before pain pill time, so I took it and went back to sleep. Slept through the next pain pill time by over an hour, and then for the first time, had to make a bathroom trip. So almost a whole night!

My wonderful husband refills the ice machine and hands me my morning coffee, and I surf the internet for a bit, taking the empty stomach meds. Then breakfast, and some therapy on my own. I'm doing stretches, leg movements, walking and walking backwards. In home therapy is Tuesdays and Thursdays. So far, the PT is doing well. No massages yet. I envy the guys with the massages that I read about on Bonesmart.org, but he's pushing me without major pain. My biggest weakness is extension. The hamstring is tight, so I'm trying to stretch that whenever I think about it. My ROM was 90 in the hospital, and they told me not to push past that until staples are out. My therapist did measure close to 100 the first day he came, but he said I was cheating (?), so it didn't count. He didn't even measure last visit.

I find that a nap during the day is inevitable. If I stay awake through the sleep promptings in the a.m., I'm down for the count in the p.m. This is from someone who could NEVER sleep in the daytime unless ill.

My appetite has returned although I can't eat as much as before (which is a good thing!) Part of this I believe is because I froze so many meals prior to my surgery, so I know the stuff I'm eating will taste good, and it is all on my Weight Watcher diet as well. I have actually gained a couple of pounds since I returned from the hospital, but I had also lost seven pounds in 5 days, so I knew that wasn't going to stay put.

Overall, I'm very pleased with where I am currently. Wednesday will be staple removal day, and the two week anniversary. I'm quite mobile using walker and cane to get around. I still take pain meds around the clock and ice and elevate whenever sitting. The newest spasm pain that started yesterday is the worst pain I've experienced, but it comes and goes so quickly, I can't complain.

I've had one experience that lets me know that I have a totally new knee, and that things will be very different once I get past this rehab. On the last day in the hospital, the PT wanted me to put my foot on a step and lunge forward for a stretch. I looked at her and said, "Do you know how long it's been since I could lunge?" The grinding, popping, and pain that would occur had I tried that previously would have been mind boggling. I did it for the PT, and HAD NO PAIN! The future is NOW!

Tues., July 23  Had my 3rd PT today. Feel stronger and can move more without pain every time. After PT this time however, I had what seemed like deep bone pain on the outside of my leg below my knee. My husband has this little vibrator he was given when he was having nerve pain after a botched carpal tunnel. He held that vibrator over the area and just lightly ran it up and down. It was amazing how much better it felt.

Tomorrow I get the staples out.

Weds., July 24 - Staples removed today with very little discomfort.  What was discomforting was seeing the flesh gape open in a couple of places.  My OS and P.A. didn't seem to think this was a problem.  I now have a series of "steri-strips" down my incision and no longer have to have any kind of dressing on it.  They said after a couple of days, I can shower without anything over the incision (except the steri-strips) as long as I don't scrub the area (not to worry.)  The strips stay on til they fall off naturally.  They just asked me to show my flex and extension and were quite impressed.  My P.A. thought the ROM was about 100, but no one measured.  He said I will probably be taking pain meds about another 6 weeks and won't be driving at least that long.  I have to keep wearing the TEDS until I don't have a problem with swelling which was not today.  I made the mistake of riding in the front seat on the way up to the hospital.  I'm still paying for that even though I'm at home now and elevating and icing.  I got in the back seat and elevated and iced in the car, but the 90 minutes of leg hanging down had already done its dirty business.

One Does Not Simply Walk into Mordor

I had a really great night at home.  Although I tried to sleep in my bed, I could not, but had really hard sleep in the sofa recliner.  I awoke to the glorious scent of real coffee brewing (not de-caff!)  How wonderful it was to go down my own hall to the bathroom, sit in my own sofa and reach for my own computer.  We’ve rigged up a table next to the sofa for the computer, and then a bed tray to put over my lap to keep the laptop off my knee.  I was able to hug my puppy and give her a good rub-down, until she decided that my ice machine was just too tempting not to be tasted.  That’s why we have the portable fence – invalid on the inside, puppies on the outside.  All in all, a stellar first morning until . . .

I was sipping my coffee, surfing through mounds of email etc., and waiting for time for breakfast when that same awful feeling came over me.  The dizziness, cold sweat, trembling hands – only this time I had not taken a pain pill since about 2 a.m., and was waiting to eat until I took one.  I remembered what the Dr. said, and hastily googled heart attack symptoms in women.  Good night, I had three of six!  Reluctantly, I told Jeff we needed to go to the ER.  Just for drill, because I had wondered if my “incident” yesterday was a low blood sugar, we decide to test it with Jeff’s glucometer.  I have a 70.  I know that my fasting blood glucose is usually in the mid-eighties.  We decided to go to the ER here in Homewood rather than risk a 70 mile drive.  I wish we had driven the 70 miles.

Anyway, we stowed the puppy in her crate and took off to the ER.  Jeff went inside and told the security guard who came out with a wheelchair.  I’m still very shaky and understandably scared.  He wheels me up to the clerk, and I try to tell him that I’m six day post-op total knee replacement with symptoms of a heart attack.  I say try, because a custodian was loudly vacuuming the rug right next to me, and I could barely hear what I was saying much less the clerk. Turning off the vacuum when a patient comes in should be standard protocol, one would think.

I do get taken into triage right away where they ask the usual questions, and I tell them about the Dr. at the Navy Hospital which is mainly why I’m here.  I also tell them about the 70 blood glucose taken at home, but they are not impressed.  They think  a 70 will not have any of the symptoms as I described.  I’m wheeled into a room with another doorknob bed, covered with electrodes and stabbed with knives.  Seriously, they got right to running the EKG, setting up the most uncomfortable IV I’ve ever had, and taking blood.  Then I sit.  And I sit. And I sit.  Occasionally the blood pressure cuff goes off, but other than the occasional blip of the screen.  Nothing happens.

I ask for something to elevate my leg, and am given a pathetic thin pillow.  I’ve had no pain meds since 2 a.m., and I have no ice.  One of the nurse technicians seems anxious to help and tells us they’re still backed up from yesterday when it was a seven hour wait.  I have a very dry mouth and haven’t eaten since a milk and cookie snack the night before.  She brings me some apple juice and graham crackers which I gratefully eat. 

I checked in at 7:40 a.m.  Around 10 a.m., a lady who identifies herself as the nurse tells me the Dr. will be in as soon as he can.  I understand the problem with ER's,  and ask about some pain medication.  She brings me back some Norco.  I can only assume that since nothing has been done to me since the original triage, that the EKG didn’t show anything. I'm obviously on the low end of the totem pole for care.  In fact, the longer I lie there, the more I begin to believe that it was a low blood sugar event even though I don’t have diabetes.  I have felt much better since the juice and graham cracker.

Around 11:30 a.m., the Dr. comes in.  He seems really nice, asks the usual questions and in response to mine says that the EKG was normal, but they want to run an enzyme check and a urine test just to make sure everything’s OK.  I know this is standard procedure, so nod my head, and he leaves. 

Now it begins to get strange.  Nothing happens.  No one comes in to take more blood.  No one asks me if I can do a urine sample.  Nothing.  Jeff goes home to take care of the puppy and himself since he has had no breakfast.  The nurse come in when the monitor goes off for some reason, and I ask her about the tests and she says something to the effect that” if people didn’t come into the ER when it wasn’t an emergency, they wouldn’t have this back –up.”  I thought this was pretty inappropriate since I had been told to go to the ER and said as much.  This also did not answer my question about the ensuing tests.  She did, upon prompting, get me some more pillows and some ice for my knee. 
I continue to wait.  Hours pass.  The nurse technician feels sorry for how uncomfortable I am, and changes the doorknob bed for another in better shape.  It does feel a lot better.  I have the urge to go to the bathroom and knowing that the Dr. was going to order a urine sample, mention that that could be taken before I evacuate my bladder completely.  This does get me a specimen bottle which I fill and turn in.  I go back to the room and wait.

During this time, I do get in touch with my primary care Dr’s nurse, and explain all that is going on.  I’ll tell her I think it’s just a low blood sugar event, and she agrees that a 70 would give me all those symptoms. 

Sometime around 3 p.m., I think, the nurse technician come in to take my blood.  I’ve only had a couple of juice packets and I tell her good luck on finding a vein.  She digs around in my arm, I see the single vial that she has filled, and then she leaves.  I never see her again. At some point, the Dr. comes in and apologizes for the wait but says there is some confusion in the lab about the second enzyme test, but that he hopes it is cleared up, and I’ll be leaving soon.  This is the first I’ve heard about a second enzyme test.

Sometime after that, the nurse comes in with all the blood paraphernalia to take my blood again.  She says someone lost the second blood sample.  I show her on my arm where it was taken.  She takes about three vials of blood.  She also responds to my dehydration and hunger by bringing me a turkey sandwich and some more juice.  My husband asks her how long this might take.  She says it’s about a 20 minute test.

We wait forty minutes.  Still nothing.  My husband goes out to ask about the test.  Someone flippantly tells him there’s no such thing as a 20 minute blood test.  Every time anyone comes close we ask how long, what’s happening etc.  We are given no answers, no explanations.

Finally sometime after 5 p.m., a new nurse comes in and brusquely begins to explain about how long all the tests take and why I needed them etc.  It seems that the second enzyme test has to be done several hours apart.  I’ve already been here over nine hours; I tell her I just want out of there.  The Dr. said negative on the heart tests, and I just want to go home.  She is much more informative that almost anyone has been all day, but treats me as if I’m the whiney butt who has to be tolerated while they’re saving my life.  It’s pretty obvious that she’s the closer who’s trying salvage a very poorly done job. 

Suddenly, blood tests are done (BTW, 2^nd enzyme test completed at 4:20 p.m. – it is now 5:40 p.m.) paper work appears, and ONLY ten hours after I originally checked in, I’m out of there.

I felt like I had escaped prison.  It was the most horrible day of my life.  If the Navy Dr. hadn’t been so insistent the day before, I probably would have just gotten a glass of orange juice at home and felt better.  At least I know where NOT to go in an emergency situation in the future. 

The Cutting Edge or Adventures After Surgery

Wednesday, July 10th - Day of Surgery - I had a general and no nerve block. My anesthesiologist told me she would introduce me to everyone in the OR, and she did. I had a glance in front of me while she was accomplishing this where I saw a vast array of shiny steel hardware and was able to think, "OMG, some of that is going in me!" That was my last conscious thought til recovery. The surgery took almost exactly two hours. I woke quickly and was amazed it was over. Not too long afterward, and I really have no idea how long, I was moved to my room which was private (surprise!) and huge. I had a PCA morphine pump, and the pain was minimal. I usually was able to adjust my hip or leg slightly to change the amount of pain. I also had fluids and antibiotic through the IV. I did not have a Foley during or after surgery. I had TED hose on my non-surgery leg which I had put on pre-surgery, plus a wrap around pump like contraption on top of the hose which would inflate and deflate randomly. The Iceman Cold Therapy machine was kept running constantly. Wednesday night was long, and I seemed to wake every hour needing to empty my bladder. The bedpan and I were not friends. So hard to release in bed, yet I had such a full bladder. Hard to have to ask people to help you go to the bathroom particularly when it was so often. My mouth was exceedingly dry, so I was using ice chips at first, and then water in copious amounts which did not help the bedpan relationship.
Thursday, one day post-op - still feeling pretty good. Still dealing with dry mouth. Wasn't hungry at all for breakfast, but ordered some toast. Could barely get some down. Dry toast and dry mouth are incompatible. Starting to have acid reflux pain. I take omneprazole (prilosec) daily (thank you years of NSAIDS,) but missed it on the day of surgery. They gave me one this a.m., but it takes a while to get back into your body. I kept asking someone for a Tums or Rolaid. Nothing. When my surgeon came in, I asked him about something for the reflux, and told him that if I had my purse, I would have taken some already. He told me to have my husband go get my purse since he didn't think they were in the formulary.
They constantly ask you what your pain level is on a scale of 1-10. I find that very hard to quantify. I think most of the time I was telling them it was in the 2-3 range, but it wasn't painful all the time, twinges or cramps would ramp it up.
I was finally able to go to a real toilet!!!! They moved me to the bathroom in a wheelchair where I had to transfer to the toilet. It felt so strange to stand and wasn't as painful as I had imagined. Emptying bladder is still hard though better than before. I have to really concentrate and push almost like a BM (which also hasn't happened yet.)
I had an 8 a.m. PT appointment where I taken by wheelchair. The PT told me to take things very easy (that was good to hear,) and not to bend past 90 degrees on anything. I first had to walk the parallel bars backwards several times, then actually went up and down a small riser height set of stairs and did some relevés (lifting up to toes) I felt shaky, weak, and especially the pull at the back of my leg. After a couple of rounds on the stairs, the therapist got me on the table for heat on my thigh to drain my lymph, ice on the knee and elevation. She told me to trace the alphabet with my ankles while I was doing the ice/heat thing, but I kept falling asleep between letters.
Back to my room, dry mouth is still a problem. Hard to talk. Acid Reflux is worse. I have no appetite. Ordered a tuna sandwich which tasted like sawdust and I could only eat a small amount.  Husband brings me much needed Tums - relief is just a swallow away.
After lunch I had second therapy.  Walked a few more rounds on the parallel bars, and did 10 minutes on the NuStep without the arms.  I was given my walker, so now it will be easier to motabulate to the bathroom without having to get the nurses out each time.  The PT also has me lifting my foot to the back while using the walker, and putting as much weight as possible on right knee.
When my OS came by today, he asked me if I could lift my leg.  I looked at it, and said, "Lift!"  A slight shaking was about all that happened.  Guess that will happen when it happens.
I'm still hooked up to IV, so I have to drag that around, so I do still have to get nurse help.  Which, BTW, my nursing staff is excellent!  Couldn't ask for better.  Starting to notice that pain upon bladder evacuation has not gone away even though I don't get my bladder as full.  Also I am very sensitive to temperature - sometimes have the shakes as if I am running a fever.  This has the earmarks of bladder infection – Yuck!
Still no appetite.  I ordered the fruit plate for dinner and was able to eat a little, but not much.  I’m trying to eat enough to stay healthy, but really, is losing some appetite such a bad thing?
Thursday evening was somewhat better, only got up every two hours to go to bathroom, plus actually being able to go to the bathroom (as opposed to being in bed) helped.  Still having pain and low grade fever.  The thot plickens.
Friday a.m. I discover today that I have to give myself a shot in the stomach area for the blood thinner required.  The nurse does the first one, but after that, it will be me.  It’s given much the same as an insulin shot which I am familiar with, although since my husband has an insulin pump, he hasn’t had to do that in years.  They’ll send me home with prefilled syringes to use for about the first two weeks.
I feel really rotten.  I tell my nurse that I think I have a bladder infection and also report to my surgeon.  He says he’ll order a sample done and see me in therapy where his P.A. is going to remove my big bandage, so I’ll get to see the Bride of Frankenstein’s leg for the first time.  It doesn’t look too bad for 8-10 inches of staples down the front of your leg.  They put some gauze and plastic wrap over it, and I’m cleared for showers which I hope will be today at home.  Jury is still out on my leaving today with possible bladder infection, and the fact that the in home therapy has not been scheduled.  The P.A. is working on it.
The TED stocking for the right leg is gingerly put on.  If they’re going to make me wear these thigh high stockings, they should at least have some sexy garters.  I do some parallel bar walking, but the PT can tell that I am wasted.  She ices me and sends me back to my room.
Back in my room and the PCA is removed and I am now officially on Norco every four hours.  What a pleasure to crank up the walker and go to the bathroom unaided.  I may take a while, and I may be out of breath when I finish, but by golly, I’m doing it.  I’m using an extra TED stocking to loop around my foot to get it off the bed.  I can raise my leg slightly now, but it takes a lot out of me.
Urine sample is taken, but comes back negative for bacteria.  I’m still having burning, so (due to my vast medical knowledge,) I decide it must be from trying too vigorously to pee after surgery.  I try to relax more when evacuating.
Dry mouth has eased, appetite is still gone.  Somehow I got put on a cardiac diet, so the food has little seasoning.  Combined with my lack of appetite, not many calories going in.
Getting in and out of bed is slow, but not too painful, as long as I take it slow.  Walking is getting more confident.  There is still a strong pull on the back of my leg that needs to be worked through.  No therapy this afternoon, so I practice ankle pumps and quad stretches as much as possible.
P.A. tells me I have to stay through the weekend since the snag with in home therapy has intensified.  My insurance wouldn’t approve it.  Don’t know why yet.  They’re looking for outpatient PT close to my home.  I’d give a lot for a computer and internet right now to do some research on this, but I’ll have to wait. Hubby goes home as he and the puppy have been staying in a hotel on base hoping that I would get to come home today.
During my numerous trips to the bathroom, someone has been coming into my room and replacing the filling in my mattress with doorknobs.  Every day it becomes harder to find a soft spot around the doorknobs.  And I have to be here three more nights!  AARRRGGHHH!
Saturday, July 13 The food service has been pretty decent until now.  They have a Room Service menu, you call Room Service, and they bring you what you’ve ordered.  Except for the fact that I’m on a cardiac diet and have no flavor, the food is OK.  Today, that changed.  I called and called the number for room service and no answer.  Evidently something is wrong with the phone system.  About two hours after I had taken my pain med, I still had no breakfast and started to feel a little nauseous.  The nurse gave me some juice and crackers, and I felt much better.  I had been going to wait till after breakfast, but Room Service called me for my order, and it was going to be 45 minutes so, I finally took a shower!  Zing, what a feeling!  By the time I had finished, dressed, and gotten back into bed, my breakfast and therapist showed up.  I was so exhausted by the physicality of getting clean, that I asked the therapist if she could come back later, and tackled breakfast. I’m not a huge cereal fan, but had ordered Cheerios with a banana, and they left the banana off.  I just couldn’t eat naked Cheerios; so I just had toast and yogurt.
I am giving myself my belly shot with aplomb now.  The urinary burning is definitely subsiding, but other areas have yet to make an appearance, so still taking Miralax and stool softener
The therapist came back and we did some simple walking around the room and holding my leg up etc. The stretch at the back (hamstring?) is still tough.  My OS came in for his check and asked me about pain now that I’ve been on the Norco about 24 hours.  I told him the Norco was certainly not as comprehensive as the morphine, but I still only had twinges of pain that would travel over the 3-4 range.  That was then.
The problems began with my inability to get in a comfortable spot.  Before, I could always adjust something, and the pain would go away, but not today.  I am beginning to think that a shower and therapy was just too much.  I get a little depressed thinking that maybe this surgery was not such a good idea.  My afternoon is not made better by the fact that Room Service is totally shot.  They finally bring me a lunch similar to the old hospital types of lunches. – “You vill eat this and you vill ENJOY it!” It has fat free milk which I cannot stomach -  One per cent fine – fat free – NO!  I’m able to get some of the sandwich and the fruit down.  Same thing at dinner – salad with fat free Italian dressing, broccoli with Mrs. Dash, sliced turkey and mashed potatoes with gravy – “Can I have a side of flavor, please?”
OK, I know I’m just in a crummy mood, but sometime after dinner, everything changed.  Suddenly, I was able to get in a comfortable position, the depression hammer was lifted, and I felt pretty good.  It was almost like turning a corner from a gloomy, shadowed side street to a bright, cheerful flowered boulevard with.  Glad that’s over with.
Sunday, July 14 
Today I feel like singing the Act I closer to Les Misérables – One More Day!  I have truly enjoyed this as much as I can stand and despite the really good nursing, I am ready to break out.  After all, how can they miss me if I don’t go away?
All body systems are now go (no more Miralax,) but Room Service is broken.  Today they brought me oatmeal for breakfast.  I have a love/hate relationship with oatmeal.  I would love to like it, but I hate it.  Can’t stand the texture mostly, and I blame my younger brother for this.  He loves oatmeal and used to make a big pot of it.  This is WAY before those little microwave packets.  He would eat most of it, and would put the pan into the sink to soak when he was through.    As the female (remember this is the 50’s and early 60’s,) I was expected to wash the dishes.  The sliminess of a cooked oatmeal pan is beyond belief.  So I managed to eat half of a bagel, and some fruit.
It’s amazing how much better I feel today.  The dark cloud has lifted, and I’m ready to get on with my life.  There’s no therapy today, but the nurse and I walk down the halls with my walker.  This is when I find out that all the other rooms are regular hospital type rooms; I’m the only one who lucked out with a suite because it’s usually used for pediatrics.
The word is out that the Room Service system will be fixed by dinner.  Callooh! Callay!  I ordered a grilled pork chop with mashed potatoes, gravy and corn.  I can’t eat it all, but even without salt, it tastes so much better than the stuff they’ve been choosing on their own.
I’m really happy, and settle in for what I hope is a good sleep in spite of the doorknobs
Monday, July 15 Well, a good night’s sleep was not in the cards.  I slept for a little bit, then was wide awake.  I was taking my pain meds which usually made me sleepy, but for whatever reason, I could not fall asleep.  I finally turned on the TV and watched lots of mindless television hoping to bore myself to sleep.  I’d drift off for a moment, and then be back awake.  Maybe it’s because I’m so ready to get out of here.  Maybe it’s because my bed seems to be made entirely of doorknobs.  At any rate, not a good night.
Therapy scheduled for 8 a.m., so I wanted to take my pain pill about 7ish; however, breakfast had not shown up, so I took the pain pill at 7:15.  Breakfast finally shows up about 7:40.  I can eat about a third of it, when my appetite just shuts down, so I decide to get ready for morning PT.
I get up on my own using the walker, deal with the toilet area, and I remember just feeling so tired that I rested my head on the walker arms.  I moved over to the sink for teeth brushing etc., and it hit me like a wall.  I felt dizzy, nauseous, cold sweat, trembly – you name it, it was not a pretty sight.  I managed to make it to the chair in my room and called the nurse.  After describing my symptoms, she put a call in for the doctor, and the technician gave me a cold compress and some ice chips which helped.  We decided that it might be taking the pain meds before breakfast since I had had a problem with that when my breakfast was delayed on Saturday.  I did ask her if it could be a low blood sugar since I had not been eating well, and I’m pretty familiar with hypoglycemia as my husband has been a Type I diabetic for almost 42 years.  The nurse didn’t seem to think so since I had eaten some breakfast.
The longer I sat, the better I felt, although my hands still trembled.  I continued to sit in the chair, elevating and icing. I felt that if I returned to the Throne of DoorKnobs, I would not be responsible for my actions.
After about an hour, I felt in control enough to finish my morning ablutions.  Just that simple act, wore me out however, and I returned to my chair (which also happened to be a recliner.)   My husband was supposed to head out today to bring me home, so I called him and filled him in on the latest wrinkle. I told him I wanted him to go ahead and come out, proceeding as if I was still being discharged.  I was so depressed by the turn of events that I couldn’t help crying as I rung off.
The Social Worker appears as I’m in the throes of the crying jag and is appropriately sympathetic.  She’s still working on the home therapy, and I ask her why it was denied since practically every other insurance company approves this.  They told her it was because I wasn’t “Home bound.”  Well, the depression left immediately and anger took its place.  “Excuse me,” I said.  “Not home bound?   I can’t drive.  My husband is 100% disabled and can only drive short distances.  Let me at ‘em.”  She was unaware of my husband’s situation, so she said she’d take it on from there.
My surgeon comes in and is apprised of the new wrinkle in my health.  He seems disappointed that I was unable to make it to therapy, as they wanted me to have two more therapy sessions before discharging.  His disappointment does not equal mine.
The day moves on with positive breakthroughs in the insurance covered therapy. Evidently the person who denied the coverage on Friday should not have even been answering the phone, much less denying coverage.  Coverage is on, now they just need to find a therapy company who accepts my insurance.  I have something called ChampVA which comes from my husband’s 100% service connected VA disability.  It’s not as well-known as Medicare or Tri-Care, so a little harder to find facilities with a contract.
I’m feeling much better, making sure that I eat before pain meds.  I still feel somewhat wiped out by getting up and moving around, but no dizziness, cold sweat etc.  My PA comes in and wants me to stay another night.  NOOOOOOOO! I tell him I must go home today.  Finally I convince him that if I have a good therapy session, he’ll let me go.
Therapy comes and I work on the Nu-Step, do some stretches, walk with a cane instead of my walker, and my therapist says I’m great.  I’ve got 90 degree ROM (range of movement.) My PA comes down, but still is not convinced to let me go without my therapy being sewn up.  I beg and plead, was close to bribery, and he relents.  He goes off to fax paperwork and order meds, and I go up to my room to wait.
The discharge nurse appears and begins having me sign papers.  All looks wonderful until a doctor whom I have not seen before, but is identified as the Chief of Medicine comes in.  He is most upset that he had not heard about my little incident this morning.  He is convinced it could have come from a cardiac problem and wants to run all sorts of test etc.  If I could have gotten down on my knees, I would have.  I try to tell him that I truly do not believe it is cardiac.  At length, he tells me that if it happens again, I’m not to think twice, but immediately got to an Emergency Room.  I promise faithfully.  Everyone leaves, the discharge nurse comes back and says the pharmacy is really backed up, could be another hour before we can leave, so I better order dinner.  I’m so excited (insert sarcastic font here) to have another cardiac diet meal before I leave.
Hundreds of years pass, the discharge nurse takes me down to the pharmacy; my husband goes to get the car.  Moments later, I am wheeled to the blessed car, and we head toward home.  Of course by now, the Chicago evening traffic is in full swing, so lots of stop and go.  I made the mistake of getting in the front seat because I knew I could extend my leg; however, I had not counted on the hours of sitting with my leg down previous to the actual escape.  The swelling is palpable.  I ask my husband to exit the Tri-State Tollway at the first oasis, so I can remove to the back seat and have my leg up.
It is close to 7 p.m. before we pull up to our house – even the lumps in the driveway look good.  Our five month old Cocker Spaniel puppy is in her “playpen,” and greets me with abandon.  In no time at all, I’m on our recliner sofa, leg elevated with pillows, Iceman strapped around my knee and totally happy. There is no place like home.

The Waiting Game or Trying to Screw My Courage to the Sticking Post

I made the appointment to discuss TKR with my OS.  He, of course advised me of all the things I would have to go through - hospital days, blood thinners, antibiotics, anesthesia,  the ULTIMATE RISK OF DEATH.  They don't make it easy.  I then had a check list of things given to me which had to be accomplished before they could set a surgery date.
I won't say I drug my feet, but I didn't rush around.  The lab work and chest xray were easy - going to the dentist was not.  I'm a major wuss when it comes to dentists, but I finally pushed myself in, and lucky for me, my teeth were in pretty good condition, so no work needed to be done.  Lastly my visit with my primary care, then on to setting the date.  At first we discussed a date in June, but I had tickets to The Book of Mormon on the July 7th.  My physician's assistant had already seen the show, so he knew that I didn't want to be uncomfortable, so sorting out our priorities, we set the date after the show - July 10th - D Day.
I was given a set of pre-hab exercises to strengthen my leg muscles which I tried to do faithfully.  I wasn't always successful.  I certainly did a lot more than I would have had I not been preparing for surgery.
As the days ticked forward, I began to have this sense of dread in my life.  Several times a day, I would come up with reasons as to why I didn't need to have this surgery done.  I was still walking, wasn't I?  I had some pain, but it wasn't that bad.  Two things kept me from weaseling out.  First:  I had pulled out of my hysterectomy many years ago only to be forced to have it done four years later.  By that time, it was bad enough that I had to have more invasive surgery and a longer recovery.  Second: every time I stood with my legs together (or tried to) I could see how my right leg was growing more and more crooked.  Doggedly, I kept on swimming (that metaphor really doesn't work, does it?)
June 28 - Finally my first pre-op appointment comes.  I have to have more blood work and also pick up the Hibiclens to wash my knee with before surgery.   My P.A.  is great and asks if I have any questions, but I really don't.  I don't know enough to ask questions.
In the week between the 1st and 2nd pre-op visits, I resort to googling knee replacements and reading all I can.  I judiciously avoid any YouTube videos of the surgery.  Talk about TMI!  I find a great website called Bonesmart dedicated to joint replacement surgery.  They have a pre-op and post-op side (or the "other side" as they call it.)  I begin to read voraciously.  Lots of information that I had never thought about.  I jot things down on my phone.
July 5 - I had my second pre-op and boy, did I have a lot of question for my P.A..  I also got a lot of questions answered. My blood was typed, and I'm now wearing two hospital bands which I have to keep on, and I don't even go to the hospital til next Wednesday. Still don't know exactly what kind of anesthesia I will be having since I haven't talked to the anesthesiologist, but I have filled out a questionnaire for him/her. I will have a pain med button to push at the beginning, and I will have an ice machine to take home. I will not have a wedge, so will have to pillow elevate. I will have TED stockings. I will be given Norco for pain, and when I asked if I needed something more, my PA said they would have something. I will be given a stool softener to take all the time I'm on the pain meds, so hopefully that will handle any bowel issues. I asked him about the TENS unit which I already have for my back, and he said not until wound has healed more 2-3 weeks.
I've already cooked and frozen more than two weeks of dinners that my hubby can just pop in microwave and add maybe rice, potatoes and veg to. He can do that. I'm hoping to get dusting done, but if it doesn't get done, it doesn't get done. The rest of the house is in pretty good shape, and my husband has been doing the laundry since we moved here since the W/D are in the basement. I don't do stairs if I can help it. He gets to walk the puppy (5 month old Cocker Spaniel) all the time til I'm up to walking down the stairs and outside.
This week before surgery, I've had to quit taking my ibuprofen, plus the low dose aspirin and a couple of supplements.  I probably say to myself several times a day "This is not that bad, maybe I really don't need this surgery." but today after three days off my ibuprofen, I'm ready to stop this pain!
Now, it's the day before surgery.  It's been a tough day so far. I'm really tired because I got up so early since I couldn't sleep, and all the nervous apprehension got to me a little bit. I got really low this a.m., but I feel better now. We're having dinner tonight with some friends.  She had a partial knee done about two years ago and loves it.  She has been rooting me on for years. They had the servers at the restaurant play Sir Paul's "When I'm 64" with a birthday cake and ice cream brought in since my birthday was yesterday.  Great evening.
OK, first ceremonial washing with Hibiclens done. One more in the morning, then off to the hospital!  Now if I can just sleep. . .

In the Beginning – the True Story of How My Knees Turned Against Me and Joined the Other Side

My knees first began to ache when I was in college.  I was 32 at the time, so I was not your typical college student.  As a theatre arts major, I was taking a dance class which involved hundreds of pliés daily, I was in a production of Fiddler on the Roof and therefore rehearsing the hora dance which involves lots of demi-pliés (thank goodness I wasn't one of the bottle dancers!) and it seemed that all of my classes were on the 3rd floor (no elevators.)  I remember going to the campus clinic complaining about how my knees ached.  I was given Tylenol and sent on my merry way.
Fast forward one year.  Now I'm in a production of Ten Nights in a Barroom where I have to run up and down a small set of stairs multiple times and dance in a kick line.  The aching knees would keep me awake unless I slept in a knee brace.  I did not go to a doctor.
Made it through the next nine years relatively unscathed.  During that time, I traveled to England and walked up and down many stairs while using our BritRail pass, climbed to the head of the Statue of Liberty, hiked all over Disney World and several National Parks with only slight discomfort.  This changed when I went on a cruise  in 1991 where our cabin was in the bowels of the ship, and it was almost impossible to get an elevator without waiting for hours.  I went snorkeling on one of the excursions, and the wave action was so rough on my aching knees, I almost couldn't stand, much less get to the deep water for snorkeling.  By the time the cruise was over, I needed to see my first orthopedic surgeon.
The XRays confirmed that I had osteoarthritis in both my knees with the right considerably worse.  I remember the surgeon asking me, "How's your stomach?"  I'm the original Tex-Mex girl, so I said "Fine, I can eat anything and never have indigestion."  He gave me my first NSAIDS (Nonsteroidal anti-inflammatory drugs.)  I took them for a little bit, knees felt better.  Whenever I had a major twinge, I would take them again, and things got better.
I traveled to England and France with some students, and we walked up and down many a staircase.  Took NSAID, felt better, stopped taking NSAID.  This philosophy lasted for several years, but the time between taking NSAIDS became shorter and shorter.
Finally, in 1996, went to orthopedic surgeon with "this has got to stop."  He scheduled an arthroscopic surgery on my right knee.  They cleaned out underneath my kneecap which was full of lumps and bumps, and did the best they could with the joint.  I iced and elevated until I thought I could walk fairly well.  I remember driving to the store after I thought I was healed, and the knee hurt so badly that I just sat in the car and cried when I got home.  I called the OS, and then only then, did he recommend that I go into physical therapy.  PT hurt like the dickens, but it was the way to a healthier knee.
I did OK for a couple of years.  I was teaching technical theatre which required me to go up stairs and ladders with the occasional crawling around. I also spent a lot of time on the floor in my classes (therefore a lot of time getting up off the floor.)  In 1999, the left knee was not feeling the love, so had the arthroscopic on it.  Demanded physical therapy as soon as possible, so healing was much better this time.
Lost a lot of weight, which helped.  Started exercising regularly which helped and hurt as the knees did not like some of the exercises I wanted to do.  Even did a 5K which I discovered was about 2K too much.  Had a couple of cortisone shots in the next few years which really did nothing.  OS says nothing will help but total knee replacement.  I say that I'll hobble on, thank you very much.  Not ready for TKR at this time.  Taking so much ibuprofen that my stomach is now ruined and have to take Nexium for acid reflux.
In 2006,  my husband who was already retired and I (who took early retirement) sold our house, many of our belongings and took to the road full-time in an Airstream travel trailer.  We had a ball.  I did a lot of walking, knee pain was limited to getting up and down during this period.  Had some bad days, but more good than bad.  Kept taking the ibuprofen and Nexium.
Because I took early retirement, I was unable to get health insurance through my teacher pension.  I kept my COBRA, and figured that I would convert to a private policy before my COBRA ran out.  I filled out the forms, sent them in with my deposit, and imagine my surprise when they declined to cover me because of "pre-existing conditions."  Reason for denial - arthritis.  What person over 50 doesn't have some amount of arthritis?
Now, what do I do.  Can't get insurance unless I pay over $1,000 monthly to a high-risk pool.  That's for a high deductible which only covers me.  I can't afford that, so I decide to be very healthy.  I make sure that I do all the healthy maintenance check-ups and pay cash, always asking for a discount for cash.  I found the range of prices for some services to be amazing.  A mammogram ran from $250 to $750.  Guess which one I got?
Of course the pain in my knees continued to worsen during this time.  I took double the dose of generic naproxen (bought in large quantities at Sam's,) and dealt with it.  Finally in December 2009, my husband who health condition had been worsening over the years, finally received his 100% service-connected disability certification with the Veteran's Administration.  The best thing about this was that I would now be able to get health insurance through the VA, and even better, if we went to a VA hospital that participated in their in house initiative (not all did,) I could be treated there at no cost.
In 2010 after my left knee joined my right knee in the battle against me, I was finally able to go again to an orthopedic surgeon.  I went to one at the VA hospital in North Chicago, Illinois where my husband was already being treated.  I was afraid this was going to be the time that I would have to give in to total knee replacement, but the OS suggested that I try Hyaluronan Injections.  I read up on it, decided to give it a go, and had both knees injected.  What a miracle!  I could rise from a chair without painfully stretching my legs out first.  I could walk without feeling like one or both of my knees might give out without notice.  I was still taking the ibuprofen, but feeling soooo much better.  The shots can be repeated after six months, and about that time, I started feeling the old familiar pains again.  This time we were in Tucson, AZ and I had the second series of shots.  The immediate relief was there, but the staying power was not.  By the time I had the 3rd series In August 2011, I couldn't tell any difference even immediately, so the die was cast.  The only thing left for me was total knee replacement.
My husband was having some difficulty with his eyes as well as his other diabetic related problems, so we faced the fact that skipping around the country, and seeing different doctors was not doing his health any good.  We made the difficult decision to get off the road.  In make the location choice, his health was always upppermost in our minds, so locating close to the VA hospital in North Chicago made sense.  Our son and daughter-in-law had just bought a house in a delightful village south of Chicago which seemed perfect even if we did have a 70 mile one way trip to the doctor. So we bought a small house, sold the RV, and set out to get ourselves as healthy as possible.
My husband's eyes were first.  He was a high risk Type I diabetic with glaucoma and cataracts.  One his eyes were sorted out, then I could start the process for my knees.