Mid Summer update

View from lunch yesterday in Stonington borough in CTstonington

Tomorrow is 11 weeks since my second knee replacement and 22 weeks since my first.  Feeling good.  I just went on a walk with the dog and realized that I was at a normal walking pace.  It felt good.  I’ve been doing 6000-7000 steps per day and hope to start upping that a bit.  At this point, the most uncomfortable thing I do is stand still.  When I stand still, I feel pins and prickly pinches in both knees.  But otherwise I’m moving along very well.  I went out in public the last 2 days wearing shorts.  I’ve decided I don’t care about the scars.

My RA?  I wish I could say it was better but it’s not.  I’m still very achy every day and mornings are tough.  I saw the rheumatologist this week and he suggested increasing the amount of methotrexate I inject each week.  Today was the first morning I tried that.  We shall see. The dose I was giving myself before wasn’t lasting the week so that I would dose a day or two early, which didn’t thrill my doctor.

The stomach upset that comes with restarting Xeljanz XR has mostly stopped, so I hope that I will soon feel the full effects of the medication.  The doctor said that 2 major surgeries was probably a shock to my system and my immune system is a bit out of whack.  Good point.

I’m not Wonder Woman

I’m done.  Really, that’s how I feel.  I’m totally done with sitting on my couch, being in pain, burning incisions and watching life pass me by.  I expected to rebound from last week’s setback a bit quicker than I have.  I still have major pain and stiffness in the newest knee that was doing so good until the joint filled with blood.  I have taken a couple of longer walks, but the knee is still stiff.  By yesterday I felt like I just wanted to have a good old cry, but I didn’t give in.

My return to my RA meds was delayed by a week due to the setback last week and that hasn’t helped.  I can manage three weeks off the meds, but then after that, the pain is excrutiating and it takes several weeks for the meds to kick back in when I restart them.  I started them Thursday, so they won’t reach full effect for another week and a half at least.  Which means the pain in my joints in the morning is strong.  I thought the knees were the worst of the RA joints, and replacing would rid my body of RA, but that’s not the case at all.  My shoulders, wrists and fingers hurt daily.

The weather hasn’t been conducive to someone with inflamed joints either.  It’s been raining like heck here for 2 weeks.  The morning might be sunny, but then the rain comes.  Today and tomorrow are just rain.  No sun.  I felt better when I saw two friends post on facebook last night about pain in their joints due to the weather.

Yes, I’m whining.  It’s totally not my style.  I promise this is the very last of my whining.

Three week mark

tkrimage of total knee replacement

 

I hit the three week mark from Surgery 2 days ago.  I had a setback over the weekend and wasn’t sure if I wanted to post about it, but decided I would.  Maybe someone else has had a similar issue.

I had the staples removed last Thursday and felt great.  My doctor was impressed with the range of motion and how good the scar looked.  He said I was healing really well and to keep it up – keep moving and walking.  Which I tried to do, but Saturday morning I was a bit lethargic and just didn’t feel right.  I told Mr. Phat that I was going to spend the afternoon on the couch while he spent a couple hours working.  Shortly after he left, the knee stiffened up and the pain started.  And kept coming, and coming.  Very strong pain.  Mr. got home about 90 minutes later and we decided that he would drive me to my surgical hospital.  Unfortunately I couldn’t move at all, the pain was excrutiating.  Instead we called the local town ambulance and they arrived quickly.  They loaded me, screaming in agony into the back of the truck and then before we even left they put in a IV and gave me some pain meds.  They couldn’t take me to the surgical hospital because it’s over state lines, so they took me to the local ER where I got very good care, but they wouldn’t do much beyond Xray and blood tests because they wouldn’t interfere with another doctor’s surgical sight.  The doctor in that ER suggested that it might be infected, in which case the new replacement joint would have to come out immediately.   They conferred with my doctor over the phone on Saturday evening, medicated me again, put me in Mr.’s car and we drove the hour to the other hospital.

Naturally I focused on infection because I had started back on the RA meds that week – one injection of methotrexate and 2 Xeljanz XR pills.  Could that little bit have brought on an infection?  I had taken my temp each day and never had a temperature, so I tried to think positive.  The thought of a third knee replacement surgery in 15 weeks was more than I could handle.

My surgeon saw us by 9:30pm, aspirated some of the fluid, discovered it was mostly blood and said it was most likely a hemarthrosis, which is bleeding into joint spaces.  My surgeon had requested that I take 2 baby aspirin daily from the day of surgery until the day the staples came out.  I’ve taken 1 aspirin for many years on advice of my Primary doctor, but 2 proved to be too much and it thinned my blood too much, causing the bleeding into the joint.

I spent the night in the hospital for observation while waiting for the test results on the aspirated fluids, to be sure there was no infection present.  Thankfully, tests showed no infection.  No surgery necessary, just some ice and rest.

I’ve been home since Sunday afternoon, back on my perch in the living room on the sofa.  I’m tired of being here, but thankful that this will resolve on it’s own with time, rest, and ice.

Monday, Monday

Good morning friends.  I’m doing fine except for the itching!!! It’s driving me nuts!! I have been itchy since the second day in the hospital, right on the incision, around the incision and all over my body.  Benadryl doesn’t really help, half a pain pill helps when it’s really bad, and mindfulness works only to a point.  Naturally it’s at it’s worst when I lay down, so sleep has been elusive of late.  My fitbit says I’m sleeping about 4 hours a night.  No wonder I’m tired during the days.

Three more days and the staples come out and I cannot wait!!

Good Evening

Happy Mother’s Day.  It was a low key day here, as the week has been.  Had Total Knee Replacement of my right knee last Monday, came home from the hospital on Wednesday and have been working on healing since.

From the very beginning, the procedure and the interaction with the hospital was far better than 11 weeks ago when I had the left knee replaced.  The hospital had completed their transition to the new computer system so I could tell that everyone on the staff was less stressed.  My ortho and the  Anesthesiology team was on alert to be sure not to repeat the painful visit to the recovery room that I had last time.  They were so good with the concoction that they gave me as I left the OR, that I slept soundly for almost three hours in recovery.  And the nurses on staff made sure to medicate me before I went up to the floor.  I was in my room by 3:30pm and the PT and OT were there at 4:30 to get me up. And I got up, went to the toilet and sat in my chair for dinner.

What a difference.  One of the physical therapists said to me that all joint replacements are different and I certainly believe it.  This new replacement has had a few episodes of pain, but nothing like the prior one.  I have pretty good mobility as well, and was at about 93 degrees bend the first day.  I used the walker at home for a day and then switched to the cane.  You can’t carry a cup of coffee when you’re using a walker.

Another big difference is the bruising.  My first knee had almost no bruising.  This one has varying shades of purple, brown and yellow from my groin to my ankle, both front and back.  So while it’s fairly ugly to look at, the pain level is minimal.

I’m off all my RA meds except for one celebrex per day and unlike the prior surgery, I’m having NO RA symptoms, which I find amazing.  I’m barely taking pain meds so that’s not mitigating the RA symptoms.  I just feel pretty good.

Admittedly, I’m a little tired of my couch, and my icing machine and my pj’s.  I’m looking forward to getting a few steps beyond rehab and back to living.  I can see the weeds growing as I write this.

T minus 9

One week and 2 days before the other knee gets replaced.  I am so glad.  It’s so painful all the time.  Every movement hurts.  I saw the doctor this week for my pre surgical appointment and he took xrays that I’m not going to share here, but just rest assured that it was ugly.  Bone on bone throughout the entire knee.  I’m sure it’s my imagination but the pain seems worse since I saw the xray.

We talked about this surgery and you might recall that the last surgery had a little glitch in the recovery room where my body had metabolized the epidural, and the pain was increasing and my room wasn’t ready and they said they couldn’t give me pain meds in recovery and they needed my doctor’s permission.  I’m sure the doc was back in surgery, and I never believed the bit about not giving pain meds in recovery.  Isn’t that what recovery is all about????

At any rate, my surgeon acknowledged that people do metabolize medication at different rates and that when I was coming out of the OR into the recovery room he would make sure that they gave me some pain mediation right at that time.  I was much relieved to hear that – it was the only thing that I was really reticent with having another surgery.  Other than that, I am ready to face this head on and I look forward to when I will not limp when I walk and when I can actually set out with my dog on a 2 mile walk.

That comes closer with each day that passes.

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.