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Things Knee Replacement Surgery is Teaching Me

It’s now two weeks and two days since my knee replacement surgery. I continue to make progress in my rehabilitation. Although I still have periods of significant pain and discomfort, those periods don’t last as long and the pain isn’t acute.

This experience is teaching me a few things about myself, or at least reinforcing some things that I might know but don’t necessarily always acknowledge.

I’ve learned that my stubborn determination serves me well when it comes to doing physical therapy. Remember that in order for my leg extension and ability to flex/bend my knee to improve, we have to push the muscles. We can’t stop at the first twinge of discomfort. I refuse to wimp out during P.T. When the therapist encourages me to push, stretch or bend more, I keep trying, even if it hurts. I have a goal to achieve as good a range of motion as absolutely possible and I won’t let anything – not even myself, block me from reaching that goal.

I’ve also learned that my stubborn determination can be a detriment when I want to force myself to do other things that my body just isn’t ready for quite yet. I think I mentioned before that I had it in my head that I would go back to work part-time next week. Nobody else was pushing me to do this. It was all in my own brain. I realized a few days ago that this is an unrealistic expectation. I need to have the ability to shift position, stretch out on the couch sometimes, and take a nap from time to time. I can’t do that at the office. Once I accepted that going back onsite at the three-week-post surgery mark would not serve me well, I was actually more at ease. I also saw that there is a significant amount of work that I can accomplish from home so I’m still getting things done.

See, that’s something else that has been reinforced. While I can revel in the occasional lazy day, or enjoy a glorious two week vacation, I am not wired to be at home and be unproductive for a long stretch of time. It is better for me mentally and emotionally to check in on work and do what I can from here.

Finally, I’ve learned that it really is okay to ask for help and that my discomfort with doing so eases with practice. My neighbors and friends have been super about transporting me to therapy or offering to get me what I need from the store. I will never be one of those people who takes advantage of the helpful offers, but I no longer need to feel guilty or uncomfortable with accepting the sincere assistance from people who care about me.

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Surgery FollowUp

Yesterday, I did physical therapy in the morning then came home and changed before a friend picked me up to go to Miami for a follow up appointment with my surgeon. Normally the doctor wants to see patients after three weeks, but he’s going to be away so scheduled me earlier.

My physical therapist took new measurements for my range of motion and announced that I continue to improve. I’m so glad because the exercises are challenging and not without a degree of discomfort. I can tolerate anything as long as I know I’m achieving the desired results.

After the two hour drive, we parked and I had a longer walk than I’m used to through the parking garage and the medical arts building to the doctor’s office. I have to say that I’m pretty darned impressed with my own mobility and strength. This was really brought home to me when I saw a woman in the waiting room who was not doing anywhere nearly as well. Granted, she was about 12-15 years older but she had her surgery a week earlier than I did, yet she was hunched over her walker, leaning on it with most of her weight while she shuffled her feet forward. My heart went out to her.

The surgeon was very pleased. In fact, he beamed and hugged me. He said I’m a rock star and ahead of the marks on my mobility! He thinks the incision is healing great, too.  (I agree!)  We talked at length about the issues I have with severe pain in the middle of the night and how it is interrupting my sleep for two to three hours every night.  He suggested I try a sleep aid at night to see if a deeper sleep would help me sleep through the pain. I’m not crazy about sleeping pills but I’m willing to try anything for a few days to see if it helps.

I know that the pain will decrease as the days go on. Last night was particularly hellish which is probably because I did a lot between PT, travel, and walking.  I need to be patient, listen to my body, and take naps as needed.

All in all, however, it was a great progress report. I’m on my way, day by day.

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Managing Food During Recovery

In the past, days that I spend hanging around the house are usually days when I find it more challenging to stay on my food plan and not make compulsive eating choices.  I was concerned about how I would do with maintaining my abstinence and not overeating these weeks that I am recovering at home. Even grazing with a couple extra bites here, a couple extra there means that I’m giving in to the compulsion. The behavior can also add up to a lot of calories. Given that I’m also not able to do good calorie-burning cardio, I’ve been fearful that I would gain weight.

So far, so good. Right away after surgery I had a false-water retention gain of ten pounds. I was filled with fluid and my sister-in-law cautioned me to not even get on the scale for a few days. They weighed me in the hospital and, of course, I weighed myself as soon as I got home. Then, knowing that this gain would gradually go away as the fluids flushed from my body, I stayed away from the scale for most of the week. When I weighed again this morning, I was quite happy to see that not only had the gain gone away but I was also a couple of pounds down from my pre-surgery weight.

I was also surprised because my diet since home has included more carbs than I usually eat. I started to really think about it and note exactly what I was eating and when. I believe the weight loss is due to a combination of behavioral adjustment and overall quantity of foods.

I am not indulging in unplanned snacking as I feared I might. I am also eating smaller portions at meals. I feel fuller on less food and have less appetite overall. The appetite  reduction could be a side effect of the pain meds. However, I think reaching satiety with less food indicates an overall reset in my body and habits. This is something that I’ve been working toward off and on for several months.

I definitely want to make the most of this and build on it moving forward. There are a couple of guidelines that I’m following. I make sure that I have protein and produce at lunch and dinner. Even if I also have a little bread or potato or beans that add carbs, I focus on the protein and produce first so that those important nutritional components are in my body before I reach satiety. I continue to pre-plan my meals. This is particularly useful since I’m dependent on rides to get to the supermarket.

It’s also important that I continue to work on drinking enough water each day. I’m aiming for 64 ounces of plain water and green tea a day, with the majority of the fluids coming from water.

I’m not fixing a weight loss number in my head during my recovery weeks at home. I’m happy just to lose any pounds at all. It’s a good way to maintain a goal and be pleased with positive results.

In other news, I had my third PT appointment today and also continue to do my home exercises. We’re seeing improvement in my extension, flexion and leg straightness! I believe that overall level of pain is dropping along with the duration of the painful periods. Although I’m still not able to sleep through the night, I compensate by taking naps whenever I need to do so.

Recovery – both physically with my knee and emotionally/mentally/physically with my eating disorder – is on a good, positive trend!

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Asking for Help – Being Willing

Hard to believe that a week has gone by since my knee replacement. All things considered, I’m doing pretty well. My fitness activities of rowing and Tai Chi have paid off. I am already strong enough to not use the walker, at least at home.  This was okayed by my physical therapist. I still take the walker out with me for short walks just in case I get tired, but I’m also careful to find the right balance between pushing myself to recover and overdoing.

Pain comes and goes. It’s odd because the site of the pain moves. Sometimes I feel it right in my knee but other times it’s located in my upper thigh or the side of my leg, even down on my shin. I still have a fair amount of bruising and swelling from the procedure which contribute to the soreness. The worst time for me is in the middle of the night. I believe this is because my leg stiffens from inactivity and that just aggravates the different parts. So, I’m not getting good sleep. As a result, I’ve been taking naps a few times during the day. All in all, things are manageable with medication, massage, rest and icing.

I can tell you that I’ve learned this procedure and recovery process isn’t for sissies. I had my first physical therapy session on Monday. The goals are to increase my extension and flexion. In order to do this, we need to challenge my leg and muscles and that requires me to keep pushing, even when it hurts. Pushing through the pain leads to improvement. I know this. I can feel it after. However, it does not make for a pleasant process. On Monday during the session I was extremely grateful that I was able to keep from verbalizing the colorful language that was rocketing around in my brain.

I left with instructions to do at least four sets of four specific exercises every day at home. I space them out throughout the day. Yesterday, the first two sets were torturous, but I am tough and determined, so I didn’t wimp out. I continued to push through the pain, following the therapist’s instructions to not go past a 6 or 7 on the pain level. By the time I did the first set in the afternoon, I noticed that the exercises weren’t quite as painful, so I know that continuing to work my leg, even when uncomfortable, reaps benefits. I hold onto that thought when my inner child wants to whine.

So, that’s where I am so far, a week out from the operation. My brother and sister-in-law left on Monday so I’m on my own at home. My family could not have been better caregivers and I am eternally grateful that they interrupted their lives to fly down and help me. They were physically helpful, of course. My sister-in-law carefully wrapped my leg so that I could shower and then checked and re-bandaged my incision. However, she also went to the supermarket and cooked for us and did my laundry. My brother found some fix-it jobs around the house and took care of them, like fixing my sliding screen. Everything they did made my life easier.

Good friends prepared a meal for us for Friday night. The husband transported me to and from my PT appointment. The wife is doing that for me today. Friends have texted and called to see if I need anything. My neighbors check in on me.

I am surrounded by people who care about me and are ready, willing and able to help.  I am, indeed, a very fortunate woman. This situation is teaching me an important lesson. It is okay for me to ask for help when I need it. Recognizing that I can’t do everything by myself right now and being willing to reach out to the helping hands that are ready does not compromise my security or my standing as a strong woman. Accepting assistance doesn’t mean I’m weak.

For some reason, this has always been hard for me. I’m not sure why. I know when I was  younger I liked that people considered me strong, dependable and someone on whom they could rely. That became my reputation so perhaps I thought that I needed to protect that image. Maybe it was a subset of my issues with low self-esteem and I was over-compensating. So, always being strong became massively important. It’s really interesting for me to look at these things now from my more adult, better adjusted perspective.

Today, I’m looking at my willingness to ask for and accept help as positive indication of a healthier self-esteem. I can ask for assistance because I believe that I am worthy to receive it.

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Self-Advocacy

I have a mega-ton of respect for medical professionals. Doctors, nurses, therapists, et al work very hard. They devoted years to their education and training and put in long hours in dedication to their patients. 

I will admit that I also have high standards to the level of care and professionalism that I expect from doctors and nurses. What can I say? My parents, brother and sister-in-law set a high bar. 

Here’s what I believe to be a core truth in medical care. Yes, the hours are long and hard and even so, there are expectations that need to be met. When they aren’t the patient or someone with them must advocate and get the care they deserve. 

There were a few snafus and problems post-surgery. Some miscommunications and omissions happened that shouldn’t. Nothing that put me at harm, but that messed with my pain management a few times. That is not something you want to experience after knee surgery. 

So, there were a few times when my sister-in-law or I had to get things straightened out. That’s the lesson. In medical care as well as life in general, we need to empower ourselves to speak up. 

This doesn’t mean turning into screaming harridans. There are ways to be firm, direct and forceful without bitchiness. The goal is not to make the other people feel like shit, but to resolve the problems. 

Thankfully, I have learned to self-advocate and I also had the support and leadership of my S-I-L. We got the issues corrected and that raised the level of care to where it needed to be. 

Don’t get me wrong. The problems were not across the board. Overall, the care at this hospital is great. There were just a few areas or situations that needed adjusting and when they were brought to the attention of the people, they corrected. 

Just take the lesson that speaking up for yourself is a good and necessary thing. 

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Surgery Success

Just popping on to let you know that my knee replacement surgery was successful. Eighteen hours later, I feel pretty good. (The nerve blocker is starting to wear off so that could change. I took prescription strength Tylenol as a pre-emptive strike.)

I’ve been out of bed a few times and took a lap around the floor I’m on. The knee flexibility is pretty good. 

Thanks for your support and kind words!

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Counting Down

I’m about 36 hours out from having my knee replacement surgery. The little challenges and glitches keep cropping up and I keep stomping them out and moving forward.

At this point, I sort of shrug when something happens, shake my head, and get down to doing whatever needs to be done to fix the problem. Today was the counter guy calling to run down the prices and get my okay to order the half slab of recycled glass that I want.

The half slab of recycled glass that his shop assistant told me he ordered last week so it would be cut and installed this week. Now it won’t get here until next week which means that my bathroom won’t be as functional as I thought. My hope is that I will at least be able to use the shower and toilet when I get home from the hospital. If not, well at least I have another bathroom.

Most of us have endured construction and/or remodeling projects at some point, so we all know how much dust infiltrates not only the room that’s being remodeled but pretty much the whole house, or at least the entire floor that the room is on. I have a one story house so, yeah, it’s all over the place. It also doesn’t help that I am a casual house cleaner at best. At worst, I’m good at ignoring what I can’t see, or not seeing what I’d like to ignore. Oh hell, more a combination of both. Anyway, there are places that I haven’t visited with a dust cloth, broom or mop in a while – like behind the refrigerator.

In preparation for my recovery period at home and the initial stay by my brother and sister-in-law to help me over the first several days, I splurged and arranged for a cleaning service to come do a deep cleaning. That was today and I would recommend these people to anyone. (I probably will, actually.) They weren’t kidding that they go deep. It’s a husband and wife team and I believe that she scrubbed the kitchen floor by hand. Between my own less than stellar cleaning and the construction, they have even more work than they expected and actually ran out of time today so they’re going to return tomorrow and finish up. However, whatever they cleaned is absolutely gleaming! I am amazed.

I’d checked in with them mid-day and they said things were going well but that they were currently working without water because of the plumber. The plumber? I wasn’t expecting the plumber to return today, but on Wednesday. Well, how the heck are cleaners supposed to clean without water? I made a quick executive decision and authorized them to please let the plumber know that he had to turn the water back on for them.

I know that it’s a little thing and it was easily fixed but this happened right after the counter guy told me about his delay. It was just one more thing that I had to handle on a day when I was already spinning too many plates. When I got off the phone with the cleaners, I shut the door to my office and indulged in a short cry. Letting it out, even through tears, released the stress and let me move on.

After work, I went for a treatment with my massage therapist. Among other things, she does manual lymph drainage. I heard from several people that flushing out the lymphatic system of toxins before having a surgical procedure helps the body with the healing process. She worked on my lymph system for a good half an hour and then finished up with releasing tightness in my back, neck and shoulders. I got off that table and my body felt great!

I’m now winding down for the night. I have a couple of things to pack into my overnight bag to go with the clothes and other items that I’ll need over the next few days. Mostly I’m set, but I made a list and will check it twice before leaving tomorrow.

I committed to this surgery in mid-December. I’ve done everything I can to prepare myself for the actual procedure and for the immediate days after. I’m as ready as I can be.

Wish me luck! I’ll see you afterward. Thank you for the kind words and support!

 

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Pre-Op, Prepping, Dealing With Stress

If there was ever a time when I needed the Serenity Prayer and to re-study the ideas of acceptance and turning over my problems to a Higher Power, it’s now. This is the last full week before my total knee replacement. I have worked hard to have everything properly planned. I scrupulously followed the instructions and made a list of all the tests, exams and appointments I had to accomplish in the last couple of weeks.

I have complete other lists at work and at home. Work projects that need to be completed or at least to a certain point before I go out on leave for a few weeks are in good shape. My master bathroom remodel is almost done and the room could be mostly functional by the time I get back from the hospital.

I was positive that I had everything under control, even though it was stressful and a lot of work and effort to make it so. This week presented a series of challenges on all fronts that have severely impacted my ability to remain serene.

On the 28th I met with the surgery center to pre-register, get a blood test for match/type, have a chest x-ray, meet with the anesthesiology representative, and go to the rehabilitation orientation. A few days before they’d called me to tell me that my surgical team was now doing the procedures in a newer way that would not require general anesthesia and would provide for me to be released from the hospital the day after my operation instead of two days later.

That was surprising and a little alarming, but I rolled with it. I told the anesthesiologist assistant that I needed assurance that I would not be aware of, or feel, anything that was happening during the operation. To be blunt, I said, “Promise me that I won’t see, hear, feel or smell the saw or what it’s doing to my knee.”

Three days later I went to my primary care physician’s office to have blood taken for the full labs.  This past Monday, I went back to my doctor for the exam, an EKG, and so she could clear me for the surgery.  All was good! My cholesterol, blood glucose and Ac1 are all good. My blood pressure and EKG showed normal. The doctor signed off on my clearance. Check that off the list!

Then on Wednesday I get a call from the surgeon’s coordinator. The surgeon thought my blood work was abnormal and wanted me to see a hematologist. Say what? I had no time to get up to Miami to see anyone and didn’t understand why it was necessary and what they thought was abnormal.

Well, it turns out that something that is normal for me sent up a flag for him. I have Thalassemia trait with red blood cells that are smaller than normal. That’s often seen in people of Mediterranean heritage. I’ve known about it all of my life and it’s never been an issue. My blood tests show up as if I’m slightly anemic but as long as the tests show the same thing year after year, we know it’s stable.

My doctor noted about my stable Thalassemia trait on the lab reports but that page didn’t get sent to my surgeon. Hence, his desire for it to be investigated.

I have a standard response when I’m under a lot of stress. Something happens and I have a short period where I freak out and get upset, then I put it aside, dig in, and get it handled. So, after my initial freak out, I got on the phone to my doctor, got another copy of the note faxed, wrote a long email to the surgical coordinator explaining the situation and how important it was for there to be no delay in my surgery date. Yesterday, I got the response that the surgeon reviewed everything again and I was good to go.  WHEW!

Then today I get a call from my primary care physician’s office. Turns out that there was now another issue. My doctor missed the original request for another fairly important blood test that indicates the rate at which my blood clots when I’m bleeding. Sooo, I needed to leave work and run down to the hospital to get more blood drawn for the test so that the results could get to the surgeon.

Ok, got that done and back to work in 90 minutes to go back to tackling the projects on my list. I felt fairly confident that this was the last stumbling block. I knew I could stop worrying about that aspect of my life and concentrate on the list of tasks I need to accomplish this weekend to prepare myself and to prep my house for my post-surgical return when my brother and sister-in-law will be here for a few days.

Remember that I’m remodeling my master bathroom. So, I’ve been living with plastic sheeting between the bathroom/closet area and my bedroom. It’s okay – just a little hard to get to my clothes. Things are moving along for the most part and it’s beautiful. That said, it has not been without challenges this week, too. Lighting was supposed to arrive Tuesday. When it wasn’t here, I checked. The company had cancelled the order because they were no longer carrying those lights. Whoops. They forgot to email me! I found the same lights at another company and ordered them through Amazon. The order said they’d arrive yesterday but, again, no lights! The order confirmation changed the arrival day to this Monday. Argh. I arrived home today and found one of the lights had arrived. Why they packed them in two different boxes, I have no idea, but the other box will get here Monday.

On the other hand, the cabinets arrived a day early and are assembled. The cabinet guy just has to finish the vanity and put it in place. Yay. After that, I can take down the plastic sheeting to reaccess the closets. I will also be able to move stuff out of the guest bedroom and into the bathroom cabinets which will, in turn, allow me to straighten up the room in which my family will be sleeping. I have even arranged for a cleaning service to come on Monday and do a much-needed deep cleaning of the living room, dining room, kitchen, bedrooms and the other bathroom. So, we’ll return home from the hospital to a clean home.

I relaxed and had a nice dinner, secure in the knowledge that, again, despite the blood test glitches and missing lights, I had everything. under. control. My ship was on course with smooth sailing ahead to next Wednesday. I should have known better.

My sister-in-law called a couple of hours ago. She was scheduled to fly down the night before my surgery to be with me at the hospital and the next day. My brother flies down the day after. Well… it turns out that a huge snowstorm is scheduled to hit their area on Tuesday! She received notice from the airline about changing her flight. Unfortunately, she can’t switch to Monday and come in a night early, so she had to change to Wednesday morning.

This means that she won’t be with me at the hospital before my operation or while I’m there. I will be 100% honest that when I got off the phone with her, I had a complete stress overload reaction and burst into tears. The melt down lasted about 20 minutes and then I reeled it in and started thinking about what to do. I know that for my own peace of mind, I need someone to be at the hospital as my companion that morning. The surgical center was adamant about needing a support person present.

It is extremely difficult for me to call and ask for help when I perceive it to be a major favor. I overcame that resistance tonight and reached out to a friend who lives in Miami near the hospital. I explained the situation and she agreed without hesitation. I am blessed! She’ll meet me at the hospital in the morning and be there until I’m either in my room post-recovery room or my sister-in-law arrives, whichever comes first. This relieved my mind more than you know.

I’m not going to get overconfident, but I think at this point it’s safe to say that I’m not going to get hit with another stressful situation tonight.

When I wake up tomorrow, I will begin to methodically and calmly go down my list of tasks to accomplish this weekend and start checking them off on by one. I can do this, even if life stuff manages to throw additional challenges my way.

 

 

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