Weighty Matters

Hi Everyone,

Again, I apologize for letting this blog lapse the last few months. 

Now, here I am, days after Hurricane Irma gave a direct bitch slap to the Florida Keys and went up the state. The aftermath is ugly, my friends. Pure and simple. 

Fortunately, my house did not flood. My roof only lost a few shingles and isn’t leaking. I have minimal inside damage from some wind driven rain at a single window. My cars, which both had to be left behind, are also okay. 

Outside, my fence is destroyed, I’ll need a new shed, and my boat lift is beyond repair. (How happy am I that I didn’t replace my boat last year?)

The oddest thing is that someone’s sailboat snapped its line in the harbor and eventually was tossed up onto my seawall. Thank God, it did not hit my house!

As far as Dolphin Research Center, I can’t describe the extreme joy we felt when the brace stay-behind crew reconnected with us via satellite phone after the storm and told us that they and all of the dolphins and sea lions were fine!

Our facility sustained some damage that we will rebuild. 

Conditions in our city are rough. Essential services are being restored but, as of this writing, power/water/sewer are still inconsistent and the water that is flowing is not potable. 

While I am filled with gratitude that I have a home to return to, I am heartsick for many of my DRC family and other friends in town. Many of them experienced extreme flooding in the houses they own or, mostly, rent. They lost most of their possessions. It is hard enough to find affordable places to rent and, with so much destroyed, this will border on impossible. 

Factor in that our economy is dependent on tourism, and many will be in dire straits. The Florida Keys hopes to reopen for tourists by October 15th and, hopefully, tourists will return. DRC will be closed until then so we do not have that revenue.

We are a nonprofit organization and have already turned to our members and others to ask for donations to sustain us so that we can continue to provide the finest care for our animal family and restore our facility to be ready to reopen. 

I am blessed with so many friends outside the Keys who ask if and how they can help me. Truthfully, the best way that anyone can help me is to help my DRC home and family. If you can spare anything at all, please donate at http://www.dolphins.org/general_donation.

Thank you all for your caring and concern. 

Here’s a picture of that boat on my property. Mother Nature is a powerful force. 

A couple of days ago, I met with my orthopedic surgeon for my three month followup appointment. Technically, we were three months plus a week or so, but no big deal. 🙂

I walked in feeling confident and, admittedly, eager to see what the expert would have to say about my progress and recovery. In a nutshell – he was very pleased! He examined my knee, checked the extension, and we talked about the marks I reached in physical therapy.

At my last couple of P.T. appointments, I’d managed 120 degrees of flexion (bending) with my knee on my own. The doctor said that his minimum goal is 110 degrees and that the average at this point is 117 degrees. So, I surpassed the average. (I hope he wasn’t making that up.) He also said that as I continue to exercise and heal, I may achieve an additional five to ten degrees.

I told him that I’d made it as far as two degrees for extension, not quite zero degrees. I asked me to straighten my leg for him. Then he said what my therapist said, and what I’ve realized. Two degrees won’t make much difference at all and, even that may improve.

We then discussed the difference in strength between the leg with the replaced knee and the other one. He reminded me that my right knee had been compromised and weaker for several years so I needed to be patient and accept that it was going to take time and work to bet it even with my left leg. We both agreed that I’d done myself a lot of good getting as fit as possible before the surgery and that this had no doubt helped me with my recovery.

I then asked the big question on my mind. Could I return to all normal, desired activity including rowing classes and riding my bike on the street? The surgeon looked at me and said he wanted me to forget any restrictions, go out and do whatever I wanted. He was so pleased and happy with my recovery level that he decided he didn’t need to see me again for another follow up until the year anniversary of my surgery!

Then he did something kind of cute. He called up the x-ray that they took of my leg in the operating room after he installed my prosthetic knee. It’s like he was so happy with how good it looked and fit that he wanted to show it off. We spent a moment in mutual admiration before he gave me a hug and said he’d see me in nine months.

I strode out of the office feeling pretty darned good about the whole experience. Considering that as late as last October, I was still resistant to the whole idea of knee replacement and desperately hoping for another alternative, I’ve clearly come a long way – emotionally as well as physically.

So what now? I continue to do exercises at home that were recommended by my physical therapists. I also do foundation exercises from Tai Chi every day. I think the danyus, which look similar to squats, but are actually different, are great for building strength in my legs. Toryus, which I’ve now tried three times to write a description about and failed, are not only good for building strength as a weight bearing exercise, but I can really feel the stretch i my legs. So I figure they might also assist with the straightening and extension.

All of Tai Chi is good for the entire body and I’m rededicated to my practice. I can already feel improved stability because of the replaced knee and I’m gradually regaining and improving my balance on one leg or the other, standing up tall on one leg, and other movements. I had a realization when I started doing Tai Chi standing again. Previously, while learning and practicing the moves, I was always compensating in some way for the bad knee. To some extent, I need to relearn it with my new knee. No doubt I will eventually be better at than I was before. I just need to go through the process. Not only am I willing to do so, but I realize that I will enjoy it. I think it makes me a better student and practitioner to be aware of the change and the new level of ability that I didn’t have before.

Tonight I also booked myself into an early rowing class for tomorrow morning. It will be my first day back. I’m excited and looking forward to seeing crew mates from the months and months that we worked out together. At the same time, I am fully aware that I have not done a lot of cardio exercise in almost four months. I have to remember to pace myself in the morning and work my way back up to the fitness level that I had achieved before my surgery. After that, I can look forward to surpassing that level!

Now that I’m all clear, it’s going to be really fun to discover what life, activity and exercise are like without a bad knee. I’m ready for this journey into a newer, fitter future.

My knee replacement surgery was seven weeks ago. I know I’m improving but the rehab work continues to be hard. Today was my last covered PT session. I’ve decided to continue and pay out of pocket, even while I try to convince my health insurance company to authorize more sessions 

If I stop, I lose the momentum progress and it would be tough to regain with a lengthy break. The therapist and I talked. I’ll go for two sessions a week where a therapist works on me and then an extra session where I can work on the machines they gave me do. 

The treadmill, bike, squat board and weighted plates all are helpful. However, the hands on pushing, pulling and forcing of my leg truly take my leg extension and flexion further than I can get on my own. 

Small wonder that those are the activities that hurt the most. Pain signifies gain, for real. I have two weeks before I am then away for a conference. I am determined to make the most of those weeks. 

This journey has started to wreak havoc with my emotions. I’m starting to roller coaster a bit and noticing that I began to use carbs and sugar in a misguided disease way to balance myself out. 

That’s not the way to handle the situation.  I need to stop eating off plan and ride the feelings. Even when I’m uncomfortable 

I had a two hour PT session today with hard effort. I hurt. I’m also inexplicably sad to the point of weepiness. I hate crying but that’s where I am. So if I need to cry, I will – rather than bury the feelings in chocolate chips. It will be far healthier for me to grab an ice pack and  a book and go to bed. 

Tomorrow is another day to strive for progress. 

Hi, Everyone. I haven’t kept up with my blogging recently. I plead exhaustion. Recovery from knee replacement surgery is hard work and there have been some other issues effecting me too.

All in all things are good. I am able to drive myself again, which is a huge boost. It feels great to have my independence back. It’s also made it easier for me to return to work on site if not for full eight hour days. I can go where I want, when I want and this makes me feel much more efficient and less needy.

I worry less when I can be at work. Even though there are many things I can do remotely from home, it just isn’t the same as being present with my co-workers, able to easily dial an extension or walk down the hall to consult, etc.

The downside is that I am not able to stretch out on a couch anywhere or take a nap when I need to. Oh, those naps are important. For the first four weeks, even with the stronger medications, I could not sleep through the night. Without fail, a couple hours after I fell asleep, pain would wake me up. Then I’d need to ice my leg, sit up for a while, and give my body time to settle down again before I could fall back to sleep.  These interrupted nights really drained my energy during the day. I treasured the ability to nap and restore when I was home every day.

Last weekend, I finally saw a shift where the pain episodes lessened in both intensity and frequency. I got two great nights of sleep in a row! I noticed that I was easing off of the strongest of the pain medications and eventually also reducing the number of times I relied on the second strongest prescription. Most of the time I could get by with the extra strength acetaminophen the surgeon recommended. This made me very happy.

Then something strange happened. This might venture a little into the “too much info” category, so don’t say I didn’t warn you.

The night after my two great nights of sleep, I was woken up about every hour to an hour and a half by the need to pee. Six times a night, no lie! I couldn’t figure it out. I wasn’t drinking gallons of water during the day or having any liquid at all after 7 or 8 at night when I finished a cup of herbal tea. This made no sense and, after four straight nights of it I was so sleep deprived that it made even less than no sense. I was like a zombie yesterday at work.

I Googled the issue very specifically. Don’t laugh but you actually can find suggested pages in answer to the search sentence of “Increased urination at night after knee replacement surgery”. I found a couple of forums where other people who’d had joint replacements complained of the same thing. Nobody had an answer or a reason, but at least I wasn’t alone. I also spotted a couple of references to a connection between increased urination and discontinuing opioid use.

I called my primary care physician and got in the next morning for a urinalysis. I may be one of the few people in history to be disappointed over not having a urinary tract infection. Sadly, after a lengthy discussion, the doctor didn’t have any concrete suggestions either. I was offered a prescription for overactive bladder, even though I wasn’t having the problem during the day. She also suggested an ultrasound just to make sure that structurally nothing was going on. I asked if I could wait a few days to see if the issue resolved and she agreed.

Have I mentioned before that my wonderful sister-in-law is an adult primary care nurse practitioner and has been for more than 30 years? Honestly, there isn’t a medical professional that I trust more than her so I texted her about what was going on. She did some research and sent me a great and thorough article on nocturia. We then talked at length last night. She agreed with my plan to give it a few days and see if it resolved. We talked about the possibility of an opioid connection. She did some more research and texted me today that she saw several references.

So, that is my current theory.  If this is the root of the problem, then the longer I’m off the stronger meds, the more the situation should resolve. Last night was already a little better. I only woke up four times instead of six. It’s now been 48 hours since I’ve had anything other than acetaminophen. Hopefully, this means that I’ll sleep even better tonight!

In the midst of all this, my physical therapy efforts continue. This week’s sessions were brutal. I freely admit that I felt like a big baby on Monday because I yelped a few times when the therapist was manually manipulating my leg, pushing and pulling on it to straighten it even more. I’d like to pretend that I was sweating but, to be honest, those were tears leaking out of my eyes.  I actually felt kind of down about it because I pride myself on not being a wimp. I felt a lot better at Wednesday’s session when the therapist told me that he’d worked my leg extra hard or, in his words, “beat you up pretty hard last time.”

With extreme effort, I can make the knee flexion goal.  It requires some interesting positioning and pushing, but I get there. As far as the straightening, I’m really close to goal as long as the therapist is pushing down on my leg. Unfortunately, I have not yet reached the point where I can straighten it as far as I want to and keep it straight on my own. Close. Oh so close with effort, strain and pain, but not there yet.

Yes, I’m a little frustrated. The female therapist is a little more nurturing than the male practitioner. When he tells me that I’m a little behind schedule, she tells me to focus on the progress and improvement I’ve made since last week. She’s also the one who reminds me that my knee is still healing. At least today he also said that my leg is straighter tha it was and that my knee was bending and performing better when I was on the bike. They both remind me to keep doing exercises at home and to keep pushing myself. All three of us are in agreement on those points.

So, the week ahead is more of the same. Work, therapy, exercises. Keep moving with determination and effort to the eventual goals. At this point, the straightening of my leg is probably “good enough”, but that’s not really good enough for any of us. We want me to be the best that I can be.

I’m a few days shy of the fourth week anniversary of my knee surgery. Yes, I’m seeing improvement. My mobility is pretty good, my pain is reduced most of the time and I’m confident that I can return to driving. I’m not 100% by any means but the improvement definitely increasing.

I still have periodic episodes of pain in other parts of my leg. I believe these episodes are related to how active I might have been in the 12-24 hours prior. Saturday I went to Tai Chi class. Even though I only did Tai Chi from the chair, I then went to friends’ for lunch (up a flight of stairs), then did a little shopping.  That same night, I had a function to go to and I know that I was on my feet walking around for more than an hour before sitting down to dinner. On Sunday, the ache and throbbing in my glute and down the side of my leg were significant. I took it easy all day so last night and today are completely different.  My massage therapist can help with the rest of the leg so I have an appointment scheduled with her tomorrow.

At this point, I think I can reclaim more of my independence. I spoke to my physical therapist about it and he gave me a great suggestion. He said that before I actually drive anywhere I should sit in my car with it not on and practice moving my foot back and forth between the accelerator and the brake to test how it feels and my reaction time. I did that for a few minutes yesterday and it felt pretty good. So, I turned on the car and just drove up and down my quiet street. I even practiced jamming on the brake to see how my knee felt and it was fine.

My final test will be this afternoon. I’m still accepting a ride to P.T. from a neighbor. Then, after I get home from having put my leg through a lot in therapy, I’m going to do the same assessment in my car. If I feel that I can drive even after my leg has worked and is tired, then I will feel confident driving.

My caveat will be that I will not drive if I’ve taken a stronger pain killer. Under the influence of a narcotic pain med, I would be too worried about my cognitive reaction time and reflexes to risk being behind the wheel. If I’m only on acetaminophen, I should be fine. I’m already taking the stronger prescriptions far less frequently than I was in the beginning, which is another sign of my continuing recovery.

I plan to go into work tomorrow, Wednesday and Friday for half days and then again for a couple of hours to take care of a special project on Saturday.  This will help me ease back in so that I can get back to work closer to full time next week.

On other fronts, I’m still doing really well with my food intake. I have definitely noticed that as I cut back on the narcotics, my appetite began to increase. I’m aware of it and alert for it, so that I can be prepared. It doesn’t matter if I get hungrier as long as I don’t start making inappropriate choices. I’m so pleased that I’ve lost weight every week since my surgery which is a longer trend than I’ve experienced in quite some time. I want to build on this trend, keep going and, finally/eventually reach my goal weight.

After my mini-meltdown at the beginning of the week, I’ve had steady improvement in my mood and my physical recovery.  Last night I had the best night of sleep that I’ve had since the surgery. (Monday was the second best sleep.) It’s amazing how good rest can help the other aspects of your life balance out.

After the painful effort of Monday’s therapy, my leg felt looser and more flexible on Tuesday. At Wednesday’s session, we pushed hard again and gained additional improvement. I’m ready to go at it again tomorrow and have been working on my exercises at home.

My emotions evened out and I got over the strong desire to weep and feel sorry for myself. I tried to focus on the positives to help my mindset. I didn’t want to invalidate the things I was feeling, but I didn’t want to wallow in them either.

I also received some great suggestions from readers here and some friends on how to address that other physical issue. Thankfully, efforts in that area are working, too!

Today I had a little pampering with a manicure and pedicure. Right after that, I walked next door to the acupuncturist’s office for a terrific treatment. With that boost, I then went into work for a few hours. I’d told myself all week that I would do so and I am so glad that I was feeling up to it.

It was so good to be on the grounds again to see my work-family and, of course, the dolphins. I was so happy, I got weepy for a few minutes. After visiting a little, I went into my office and dug into some projects. It felt great to be there. Even though I have been doing some work at home, it isn’t the same feeling as being in the office, focusing, with all of the tools and information I need around me.

That said, after four hours when 5 p.m. rolled around, I was ready to leave. Although I didn’t fall into a nap when I got dropped off at home, I knew that my body was ready to take it easy for the rest of the night.

Thank you everyone for your support and encouragement. They helped me get through the rough spot, process, and keep moving forward.

If you don’t want to read a post that mostly includes me whining, I’ll understand.

If you’re still here, well, you were warned. I’m sorry, everyone. I’m doing my best to keep up a good, strong, fighting spirit during my recovery. For the most part, I’m succeeding, I think. Today, however, I’m just not feeling it. Instead I’m feeling the pain, the frustration and the sleep deprivation.

It is all well and good for me to understand that I have to keep pushing myself in physical therapy. If we don’t keep forcing the muscles, tendons and other parts of my leg, I will not achieve the straightness, extension and flexion I desire. These things were compromised from years of a degenerating knee. Improvement is a challenge. I know all of this intellectually but, damn it, in today’s therapy session the pain and effort got to me. I wanted my leg to just. be. better. Right then and there I wanted it to be where I know it will be eventually. I resented every repetition of every exercise, even while I was striving my hardest to push, to press, to straighten, to bend.

I didn’t whine audibly, although I did cry out a couple of times when the therapist was physically manipulating my leg. I refused to give up or ask to stop. Instead I dug deep, told myself to suck it up and kept working, kept pressing, kept going for more. My therapist said that we made progress and that my leg was straighter at the end of the session. I’m glad he could see it because I couldn’t, and I couldn’t feel anything but tired and sore.

After that I went to my massage therapist to see if she could help me with the nightly problem that is creating my sleep deprivation. Every night, I fall asleep and then a couple of hours later a persistent, annoying, powerful ache wakes me up. It starts in my right glute, travels down my leg, often crosses over the quads and can go down into my calf and shin. It doesn’t matter that I take a pain pill before I go to bed and have even been using a sleeping pill on the suggestion of my surgeon. Once the ache wakes me up, I’m then up for two to three hours. I come out into the living room and try shifting lots of positions to find one where I’m more comfortable.  Depending on what temperature I think will feel better, I either warm up the heating pad or use the ice machine cooling contraption.

I’m worried about taking pain pills too close together so I hold off as long as possible to the right time before I take another dose.  That’s all well and good, but it takes a while for the medication to get into my system and help.  Sometimes I just give up on the idea of going back to sleep and just start doing stuff around the house, banking on getting in naps during the day.  Even though I can take those naps, the interrupted sleep really throws me off mentally and emotionally.

I’m tired of it. I want a good night’s sleep. I resent the pain.

Look, I knew to expect a period of pain, intense pain, after surgery. I just honestly thought that I would be experiencing significantly less by this point. Maybe I am.  No, probably I am, but it just doesn’t feel like it today.

The massage therapist worked on me for an hour. She doesn’t just do tissue massage, but instead feels for the nerves, the circulation, the muscles and how everything connects and affects the other parts of my leg. I believe that I started to experience some relief and she confirmed better blood and energy flow so, I am cautiously hopeful that tonight will be better.

She and I are friends and have know each other for several years. Because of that, I felt comfortable discussing another complaint. If you watch television much, you’ve probably see ads with people talking about opioid related constipation. Folks, that’s not something created by pharmaceutical companies. It’s a real thing and it sucks. I do not want to call my doctor and ask for yet another prescription medicine. Instead, I’m trying to correct the problem with a special herbal tea, prunes and, today, my letting my massage therapist work on some of my internal organs too. Please, let’s all be hopeful.

I got home from my appointments and experienced a big, emotional let down.  I’m just tired of hurting, not sleeping, being constipated and everything else. Tonight, it’s all getting to me and I think I may even need to indulge in a good cry to let everything out.

Tomorrow, I’ll pick myself up and get back in the game but tonight, I needed the whine. Thanks for listening.

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.

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.

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!