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.

April Showers

It rained here Friday night and yesterday.  Cold, damp, rainy day.  I treated myself to a day in my PJ’s.  Did a few things around the house, did some reading, watched some sports and the movie Patriot’s Day.  It was better than I expected.  I had read some harsh reviews when it first came out, but I thought it was well done and I shed a few tears.

And tomorrow is Opening Day for Baseball.  I’m excited for a new season and my Red Sox.

My knee?  The new knee is just over six weeks old.  Boy does it feel good.  I get an occassional twinge of pain, but all in all it’s terrific.  I saw the doctor last week and he was very pleased that I could fully straighten and bend the knee.  The only issue was some dissolvable stitches that had not quite dissolved all the way and were poking their way thru the scar.  So he had to gouge in there and clean them up.  OUCH!!  Not pretty.

My primary reason for the visit wasn’t to check on the new knee however, but to talk about the other knee.  The “Old” knee.  The formerly good knee turned very bad knee.  I feared he would tell me that it was too soon to consider replacing the other one, but since I’ve been seeing him for that knee since June of 2009, he was emphatic in his agreement with me that now’s the time.  I am bone on bone and the pain is excrutiating.  Sleep eludes me most nights because it’s too painful and movement wakes me up.  There is no meniscus in that knee and I’d had it glued together with Hyaluronic acid injections for about 6 years, but the injections are no longer covered by my health insurance and the orthopedic wasn’t confident that it was the best choice.

So…. drum roll please…… I will be having the other knee replaced on May 8th.  I wish it was tomorrow.  In the meantime, I will be working very hard for the next 5 weeks to catch up on my clients from being out for the first knee, and I need to get ahead for the upcoming surgery.

So end of the summer I will be back in action, running fitbit weekly challenges and maybe taking in a round of golf.  I wonder how the new knees will impact my golf game?

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.