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.

 

 

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.

Snow Day

Traditionally the first weekend after New Years has always been my favorite weekend to ski.  The hard core regulars are there but the casual skiers are home.  It’s not so crowded, and always an enjoyable weekend to ski.

Alas, this year that’s not to be as I wait for my surgery on a total knee replacement.  But there’s a silver lining to my cloud.  It’s a snowday and I am happier than anything to be snowbound with Mr. Phat with our brand new kitchen a little post holiday organizing and football later this afternoon.  We made breakfast together and the whole house smelled wonderful.  Later we will roast a chicken with some vegetables for dinner.  Yum.  What more could a gal want on a snowy Saturday?  Oh right, a nice cozy great room with a roaring wood stove. Life is truly good my friends, no matter what the circumstances are.  My silver lining is being in my comfy home surrounding by warmth, good smells, the man I love and our dog.

My other silver lining this week?  My eating.  This is a diet blog, right?  I did a lot of reading last week about food and the immune system.  My immune system has definitely been out of whack since summer.  Changing RA meds hasn’t helped my immune system.  Being sick and stopping my RA meds intermittently most likely has contributed to this yoyo effect.

So this week I eliminated all the inflammatory foods from my diet – dairy, grains, sugar, alcohol and legumes.  The latter is no biggie as Legumes aren’t my favorite food.  I also fasted during the day on Tuesday and Wednesday and had coffee, tea, water and bouillon during the day and salad or eggs with protein for dinner those nights.

I have already been able to cut my prednisone does in half and my goal is to be off of it shortly.  At some point in the near future for several weeks prior to my February 15 surgery date I’m going to need to be off all RA meds.  I’d like to have the inflammation as minimal as possible prior to that date.  I will keep you posted.

In the meantime, if you’re in a snow zone, relax and enjoy.