Weighty Matters

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!

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.

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. 

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!

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!

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.

I’ve been away for eight days. I left a week ago yesterday for a business trip. I prepared as best I can and psyched myself into doing well with my food plan – but I bombed.

Okay, maybe bombed is too strong a description, but I wasn’t clean in my eating. I let stress and tiredness get to me and I ate too many carbs and also sugar.  I’m annoyed with myself and dreading the weekly weigh-in tomorrow. However, I am going to hold myself accountable for my actions and choices and get on the scale anyway.

It is what it is. I can be annoyed and continue to eat wrong, or I can pick myself up, dust myself off yet again, and get back on track.  I will recommit to doing the best that I can each day. I will follow a more restricted plan for the next two weeks so that I can lose as much weight as possible in time for my knee surgery.

Yes, my knee replacement is now sixteen days away. I am so ready to get it done. I am not looking forward to the surgery itself, or the immediate pain in the first couple of days, but afterward? Bring it! The sooner I get it done, the sooner I am on my way to recovery and an improved knee.

i was in Miami today for my pre-surgery appointments, including the rehabilitation orientation so I know what expect as soon as I’m out of the recovery room. There were three other people in the class and they’re all also having knee replacement. I was the youngest one there by 15 years, maybe by 20 years. I know from watching the other folks walk and hearing them talk that they are experiencing even more pain and problems than I am at this point. It was a clear look at what my future would be like if I had continued to resist getting this done. I know that my “youth” and the fact that I have worked so hard on my fitness will also help me to recovery more quickly.

I’m so grateful to my brother and sister-in-law for their counsel and how they helped me work through my resistance and fear. I’m grateful to everyone who has encouraged me since.

Lest you think that I went right from an intense five days of business meetings to a full day of medical classes and exams, without any fun — I also squeezed in a quick trip to Orlando. Friends of mine drove down from Virginia so that one could run her first half-marathon (The Disney Princess Race.) I haven’t seen them in two years so it was worth the extra effort for me to drive up to see them. We spent all day Saturday together, including lunch at the Animal Kingdom Lodge overlooking zebras, giraffes, wildebeests and cool birds. A little shopping, and then dinner out and a horse-drawn carriage ride on a lovely evening. Yesterday morning, we went to Disney to cheer on our running princess.  She did great!

It was inspiring to see her accomplish this goal. Two years ago, she had to have a few major surgeries. It took a while for her to recover and then she was determined to start running again. She’s increased her endurance and distance over time and now look at her. 13.1 miles!

I have to admit that I started wondering if jogging is something that I will be able to try once I recover completely and am used to my new knee. Maybe it’s too early to even think about it, but I can find out in the future, right?

A local newspaper article included the suggestion to check out a Ted Talk by Jordan Brewer. I went to http://www.ted.com and found the talk, which focuses on using mindfulness to break bad habits like overeating, smoking, even texting while driving.

Here’s what the description on the site says:

Can we break bad habits by being more curious about them? Psychiatrist Judson Brewer studies the relationship between mindfulness and addiction — from smoking to overeating to all those other things we do even though we know they’re bad for us. Learn more about the mechanism of habit development and discover a simple but profound tactic that might help you beat your next urge to smoke, snack or check a text while driving.

Among other things, Dr. Brewer is Director of Research of the Center for Mindfulness at University of Massachusetts School of Medicine.

If you want to watch the talk, here’s the link: https://www.ted.com/talks/judson_brewer_a_simple_way_to_break_a_bad_habit

For the last couple of weeks, I’ve been sticking to a more strict food plan from Sunday through Friday and then giving myself permission to have a special treat on Saturday. It’s been working for me. The weight loss isn’t in big chunks but it’s been steady. By the time of my knee replacement surgery in mid-March, I’m confident that I will have lost 20 pounds since I saw the doctor last December.  I’d hoped to lose more but when all is said and done, I am grateful to have lost at all.

Tomorrow morning, I leave for a business trip and will be away from home for more than a week. (Tacking on a weekend of fun with friends.)  Being away from home and living at a hotel means that I will not be able to prepare my meals the way that I’m used to, the way that’s been working for me. I’m a little apprehensive. Okay, I’m a lot apprehensive.

Traditionally, when I go to these things, I tend to carb overload because that’s what’s usually the  most available food in the mornings with the bagel/pastry/fruit arrays that are normally provided as part of the meetings.  It’s just so easy because those foods are just there! Even if the platters do include yogurt, it’s usually the low fat stuff that has more sugar and carbs.

I also get a little anxious because the meals are on the meeting’s time schedule, not on mine. That messes with my head.  Then, on top of everything else, I tend to over-caffeinate too.

Add to all this is the fact that I will not have my rowing and Tai Chi classes for exercise, or my fitness DVDs.

In case it wasn’t obvious, I’ve spent a lot of time analyzing my past behavior at this meeting. I want to do things differently this time. I’m so afraid that I will eat inappropriately to my needs and goals and end up gaining back some of the weight that I’ve worked so hard to lose. So, analyzing the past means that I can strategize how to succeed this time out.

I’ve planned some things that will help. I’m taking a shaker cup and some individual protein powder packets so I can shake up a protein drink in the morning before I go downstairs to the meeting. The protein will definitely be a better choice for me than white flour products and sugar.

I’ve also packed some cheese wedges that don’t need to be refrigerated and some jerky sticks. Again – good protein choices that are easy and to take to the meeting with me and consume when I need to.

For the caffeine kick, I know perfectly well that I don’t need four cups of black tea. I do, however, need to keep up with my water intake. So, I will commit to no more than two cups of black tea in the morning and then make sure to sip, sip, sip my water throughout the day. Not hard to do when there will be pitchers and glasses on the tables.

For lunches and dinners, I am reinforcing a positive mindset that I can make healthy choices from whatever is on the menu. Protein and produce are the key things on which I want to focus. I’m sure I can find some at the other meals.

As far as exercise, the hotel has a fitness center. My boss is in training for a bridge run in April. In addition to going to rowing classes, she also runs a few times a week. Neither one of us wants to take a week off from our exercise routines, so we’re packing some workout clothes and planning to get up early enough to hit that fitness center at least a couple of times while we’re there.

So… I’ve pre-planned and packed what I could so that I’ll have food available. I’m working on my mindset. In the end, that’s really the key to whether I do great with my food plan this week or crash, burn and compulsively consume unnecessary, unwanted calories and carbs.  I will do my best to be mindful and thoughtful whenever I am around food. Staying conscious and “in the moment” are vitally important.

Maybe instead of worrying that I’ll be “out of my routine”, I should just start cultivating the idea that I’ve developed a new routine for whenever I am out of town.