One month post surgery

One month out.  I’m finally feeling human again.  I guess that’s a pretty good timeline and I suppose that I’m impatient and expected to feel good and be back in action in half that time.  My new knee feels very strong and sturdy.  Yes, there is still pain, but it’s tolerable.  I took a long walk 2 days ago as part of rehab and it felt therapeutic.  I can’t wait to be back walking on a regular basis.  Abbie the jack russell can’t wait either.

The most surprising part of the surgery was how violently my RA acted up.  I really wasn’t expecting that.  I control that damn disease and it does what I tell it!! Usually.  Not so post surgery.  Of course the biologic that I am on, Xeljanz ER (or is it XR) is a daily pill.  Which means that it leaves your system each day, unlike Enbrel which stays in your system for a bit.  Once I stopped taking it prior to surgery, without any residual in my system, the RA flared.  Post surgery the RA continued to rage through my system and was the worst part of recovery.  The pain of the new knee was nothing compared to the pain of  RA.  Interesting to have a point of reference.

I have found a bit of success by upping my daily dose of prednisone, but that means I don’t sleep until 3am.  My time table is a bit off.  However, I backed down a bit this morning on the prednisone and I’m trying to return to my “normal” life.  Which is funny because my friend said to me this morning that if I became normal, she wouldn’t recognize me.  But I’m back sleeping up a flight of stairs in my bedroom, and no more riser on the toilet.  I’ve been working from home, but am going to head to the office tomorrow.  Life is waiting for me to resume.

RA flare from hell

So I know that trauma to your system can trigger an RA Flare.  A friend of mine recently had a total knee replacement and several weeks later had a painful episode of gout.  I read about that on line and told him that it was due to his surgery – it triggered the gout.

Not sure why it took me so long to look inward and recognize that the trauma of surgery was causing my flare.  I kept thinking I would be better tomorrow.  I did stop the RA meds for almost a month and have been back on them for 2 weeks, but the pain and inflammation seems to get worse every day.  Yesterday afternoon and evening I cried more than I want to admit I did.  I couldn’t get comfortable.  Sleep?  Barely a wink.  My restless legs were all over the place in bed last night.

This morning I cried again and could see how swollen the non surgical knee was.  I thought about my friend with the gout.  I thought about last summer when I was changing biologics, and took a couple prednisone tapers which honestly helped.  I’d been taking 2.5 mg of prednisone per day which is obviously not enough to beat the rheumatoid back.  My brain was thinking I should call my rheumatologist, but I don’t want to whine.  Besides, he’s going to suggest a prednisone taper.  So as much as I hated doing it, I took another dose to bring today’s daily total to 10mg.

It’s been about 3 hours and I definitely feel better already.  I have more mobility in the knee and much less pain.  Most likely I won’t sleep much again last night, but it’s a trade off I’m willing to try.  Besides, we turn the clock ahead tonite, so there’s one less hour to toss and turn.

 

 

Staples out, rehab continues

tkn

You can see the metal parts that were put into my knee 2 weeks ago during a total knee replacement.  To me, it seems pretty clean and neat.   I saw the surgeon yesterday and the staples came out of the incision.  I have to admit that the incision is very ugly but I’m told it will recede and I’ve sent Mr. phat to the pharmacy for some oil or cocoa butter to soften it and help healing.  The doctor said that my movement is very good.  I really have to work on straightening the knee.  Bending is great, but straightening it hurts.  Unfortunately the other knee is very painful of late.  Obviously overuse has worn it out.  It has no meniscus, so will need replacing at some point down the road, but I was hoping a bit later as opposed to sooner.

I have several options at this point with the non surgical knee.  I can try another injection of Synvisc, which acts as a cushioning agent.  I’ve done that two times over the past 6 years with good success.  Sadly my health insurance doesn’t cover it and it’s expensive but I will check with my pharmacist and determine the out of pocket cost.  I can also have a cortisone shot, but that’s a real bandaid and very temporary.  Lastly, I can sign up and have another replacement.  The latter option I have a lot of reasons why it’s a good idea, but the honest truth is that I wanted to be able to wait a year or two before going thru this again.  Time will tell.  We shall see how the non surgically repaired knee responds to being back on my RA meds and sleep on it and make a decision down the road.

The surgeon said to walk as much as possible.  So I’ve just done a little much needed housework to loosen up my legs and done some stretching.  He said to continue the home rehab exercises and see how I do.

Each day gets better.  I’m sure that will continue.  Thanks to all of my readers for all your support and good wishes.  It means more to me than you know.

Almost 2 weeks post op

Tomorrow will be 2 weeks post op for me.  It’s gone by quickly even though at times the minutes seem to be like hours.  Overall I’m doing well.  Progressing.  The surgically repaired knee is now my Good Knee.  My Strong Knee.  It’s stable and sturdy and feels good to walk on.  To that end, I walk mostly unaided these days.  I’ll use my cane overnight or for the first few steps in the morning, but otherwise it is not necessary.

My hurdle has been the other knee which no doubt will be replaced in the future.  Being off the RA meds since the beginning of February has caused the expected flare.  In my hands, wrists and the other knee.  The other knee formerly known as my good knee.  The pain has caused me to cry for a few moments most days.  I get overwhelmed, tired, behind on pain meds or just feel a bit sorry for myself.  I sob for a few moments and then rally.  Because that’s what RA has taught me to do.

I was supposed to stay off the RA meds until after the staples were removed, but I will confess to starting the methotrexate 4 days ago, and the Xeljanz 2 days ago.  The swelling in the new knee has diminished, my physical therapist says I’m doing great – I did climb a set of stairs yesterday and walked down the street and back up (it’s a hill).  Today is the first morning I’ve not cried since surgery.  Yes, I was stiff and sore, but the pain seems manageable and the RA flare is being extinguished.

I’ve had incredible support from Mr. Phat.  I couldn’t have gone through this without him.  He’s held my hand, cooked meals for me, and most importantly is my Iceman.  He keeps my icing mechanism full – he says I have a $4 a day ice habit and we’re not even making margueritas.  My parents drove down over the weekend for a visit which proves that you can be 55, but you’re still a daughter.  Mom needed to see for her own eyes that I was doing well.  I’ve had tremendous support from my friends and colleagues at work, which has helped me go through this challenge.  And my ski group, Team Cannon, left for the annual trip to Switzerland over the weekend.  I know that my spirit went with them.

Stay tuned for more updates.

Home

Last night, I came home from the hospital.  My new knee came home with me.  Overall the surgical procedure was fine.  The thing I was most nervous about was the epidural, which was a very insignificant part of the process.  No pain or discomfort and I was numb for 3 hours after surgery in recovery.  Sadly, the block wore off sooner and more completely than they expected, my room wasn’t ready, and they didn’t have pain meds in the recovery room.  Which I had trouble understanding.  That, and the recovery room wasn’t too busy that day.

They finally put some dilaudid in the IV, but it was too late and I was way behind on the pain.  When I got to the room I was in such distress, I cried for 3 hours. Mr Phat kept trying to encourage me to breathe deeply in and out.  Ultimately they got enough pain meds in me to get ahead of it and I’ve been doing fine since then.

The day after surgery I was getting in and out of bed fairly easily, and did the long “loop” on the ortho floor.  My doctor visited and said that the old knee had a lot of erosion, which is typical of what they see with Rheumatoid patients.  Not surprising.

I’ve already had my first Physical Therapy session this morning.  He thought I was moving along on my walker pretty well, and he showed me some exercises to do, interspersed with walking and icing.  That’s what I will be doing for the next few days – walking, icing, exercising and resting.  I will keep you posted on my progress.

T minus 6

Snow day!!  The state is closed down because of an all day snow event that will bring  8 – 16 inches.  We are also getting Thunder too, which is eerie.  Amazing when it snows and thunders.

So 6 days until total knee replacement surgery.  I’ve been off my Xeljanz for a week and took my last methotrexate shot Sunday night.  I won’t lie to you.  I hurt.  The Rheumatoid Pain is very strong.  More than I expected.  I had actually told Mr. Phat that I was going to consider not going back on the Xeljanz after surgery because it didn’t seem to do anything.  Boy was I fooled!!  Mornings are the worst – the pain and stiffness makes movement slow.  It takes a few hours to loosen up the joints.

That’s why I’m appreciating the snow day today.  I was able to stay in bed until almost 9 and catch up on the sleep I lost while in pain overnight.  I will actually hook up my laptop this afternoon and do some work. I’ve been working ahead and am in good shape, but I want to stay ahead and I’m not sure I’ll be able to work much the 2 days before surgery – if this is any indication of how I’m going to feel.

I’m reminded of my early days with RA – before biologics and metho.  I would have to take pain meds while still in bed and I remember sitting in my living in the morning crying due to the pain.  Also, thoughts of my grandmother with RA fill my brain.  She didn’t have any fancy medications to relieve her inflammation and pain.  And she never complained. My role model for sure.  We called her Memere and when I became a grandmother, That’s what my grandchildren call me.

Blessed indeed that I can have a total knee replacement, then ultimately go back on my RA meds and hopefully resume my active and busy lifestyle.  I’m also especially blessed to have Mr. Phat who takes care of me both physically and emotionally.

Speaking of Blessed – How about those New England Patriots?

Saturday 8:20 am

cannon-mountain

 

Damn.  I missed first tram.  Again.  It leaves the station on weekends at Cannon Mountain in Franconia, NH at 8:15 am and for the past decade I’ve been on it.  This morning there’s a little layer of new snow.  “Freshies” we call it.  I love skiing freshies from first tram – there’s no real sound but the skis moving through the snow, pushing it out of your path.  The cold crisp air feels great on your smiling face.  These are my favorite ski mornings.

Since I can’t rush to first tram this morning, I can sit here and enjoy the Freshies out my window.  The flakes are still falling down and the quiet pierces the air.  I’m trying to find the silver lining in the cloud that is my season of not skiing.  Knowing I’ll be stronger and pain free next year.

2 1/2 weeks until Total Knee replacement surgery.  I won’t lie – it hurts.  Rolling over in bed hurts, getting in and out of the car hurts.  Walking hurts.  Finally it seems that the RA flare that has been with me for 6+ months has moderated a bit.  I can open jars again, and cut food without wincing.  Of course starting in 5 days I have to start weaning myself off my meds prior to surgery.  That will be challenging as well.  But I’m  willing to take it if it means “freshies” next ski season.