Birthday

Dorothy Evelyn Rita Madigan, December 29
Helen Cecelia Donovan, December 30

Dream on.

     Today I saw the woman who is in large part responsible for my having knee surgery.  I first met her exactly one year ago, on Election Day 2012.  She'd had both knees replaced, four months apart, and is ecstatic with the results, as she was a year ago.  She is evidently in love with the surgeon; she refers to him by his first name.  She says she was not only pleased with the surgical results, but was thrilled to have awoken from the anesthesia seeing his face by her bedside.  Story of my life---I miss out on a lot of things.  My memory of waking up from the anesthesia is having the  disembodied voice of a nurse asking if I could move the toes on my right foot.  I tried, but no, I couldn't.  She asked if I could move the toes on my left, unoperated side, but no, I couldn't do that either, at that point.  I didn't care, though.  So I wasn't worried, but where is the romance in that interchange??

Strides

Today I participated in the Making Strides Walk at Washington Park in Albany.  The longest part of the walk, the most strides, was from where the car was parked, in front of Albany Medical Center, to the park, and of course the return trip.  About 15,000 registered for the walk, and the crowd was estimated at 30,000.  A lot of activities and team tents, a whole lot of pink, and a great amount of donations.  It felt good.

Minus the sinus

Since the word sinus refers to a hollow curve or cavity in the body, I asked  how it would be possible----can you lift a hole?  Turns out you can, as Google will attest in graphic detail.  Too graphic; I'd rather watch a TKR on a cadaver.

The Big Question: Ortho Style

The first question asked, or rather the second, after "How/Who are you?" is "Are you glad you had it done?" combined with "Is it better than before?"  When the answer is positive, relaxation sets in. 

Damn the Dentition

Terms to add to my dental vocabulary:  crown lengthening, sinus lift.  And besides dentist, oral surgeon, periodontist, endodontist, add on orthognathicist.

Knee Saga May to October

   Today was my first official visit to the surgeon since the May 24 surgery, though I'd seen him a few times in the hospital and once during a "meet and greet" at a visit to the P.A.  All went well: since I said I had no problems, I didn't need any X-rays, and everything else checked out fine.  The doctor said that the plastic "cushion" part is subject to deteriorate into the bone in from 15 to 20 years, indicating a need for replacement, sometimes of just the plastic cushion and sometimes of the whole knee.   The side of me that aspires  to be a comedian  wanted to ask him what happens when  I return in 20 years, and he's retired; who would I see then.  But instead I just said okay.  (Since he's not yet 40, he'll probably still be there 20 years from now anyway.)  I'm scheduled to pay another visit one year from the surgery, in May 2014, so that's enough of a goal for me.

From certain camera angles.......

......., and probably because it was the middle of the night, but the TV was tuned to the Live Well network, and Food Rush's Chef Ryan Scott had his mother as a guest on the "Desserts with Ryan's Mom"  segment, and when I woke up some time past midnight, I saw Dorothy.  It was mostly the hair, but her profile when she looked down was kind of haunting......

A Bookless Library

  I heard one opened, in San Antonio, Texas, the first library without books.  I suppose it's possible to call it that.  "Liber" means book in Latin, but it could be a place to access what is written in books, minus the actual volume.  I don't plan to transform my home  into a bookless house exactly, but am in the process of trying to bid adieu to a whole lot of books, probably about 700 of them.   I'm getting a headache from them, though;  not only am I developing eyestrain from perusing them once again, but that musty, old book smell attacks me right in the sinuses.  And my margin notes and papers remind me that I once possessed a great depth of knowledge that is foreign to me now.  I used to be smart and now I'm dumb.

In dreams

    Funny how the atmosphere in dreams can seem to be so different from how things look in real life, but somehow the dream  feels so familiar and more natural than your waking state, if only you could just capture that essence that hangs just on the edge, but you can't because the more you try to bring it into focus, the more you feel it slipping away. 
     I dreamt the other night that Dave was away and just on the point of returning when we received a call saying he should pack his bags and head elsewhere. He was shocked when he heard the news, but it was not what we had thought was most likely, not quite.  We were left wondering how he would be able to be back in time for the wedding.  (I do remember the missing part of this dream, but can not name it.  I'm not superstitious, but not morbid either.)

IF....

  If I could, I would recount to my sister a recent visit to a medical office which we had each attended, though at different times.  I would tell her that the "Halloween Lady" receptionist is still there. She still has on her desk and surrounding area  every extant Halloween-oriented tschotske ever put on the market.  Still has the orange hair, and a lot of orange in her wardrobe.  The doctor's children have gone on from being little kids to college age, with the "baby" now in high school.  And my sister would know what I mean when I tell her that the hiring of the office staff is obviously still done by the same person. She would laugh, as we used to........

The End

  Love may be  all there is.  The Beatles, the Bible, Thornton Wilder all thought so.  But so many times it just isn't enough.  I can tell from the love letters that are now in my possession that he loved her, but he was unable to undo what had gone before.  He couldn't bring himself ultimately to do what might have confirmed his love to her.  He continued to proclaim his undying love until......yes, until the time he died, some years ahead of her.    She kept the letters, though, until her death.  Forgotten perhaps, or could have been as a link to one who cared about her. Those links become thinner as time passes, and memories become more precious. 
    What to do with  those letters.  I've already thrown them away, then retrieved them.  I have no link to him except as a casual acquaintance, but through his words to her, I sense her presence.  He wanted to spend the last part of his life with her, to be near her.  It makes me picture her as warm and alive.......

Baby Steps

 For the first time in a long time, about 5 years or so, I had the choice of  the stairway or the elevator, and I opted for the stairs.   Sure, it was only one flight, and yes, I did use the handrail, and it was true there was no one else around to observe any awkward gait, but still I did walk down a flight of stairs in a public building even though the elevator was available.  Only those so afflicted can understand how it felt, sort of a "walker's high."

Date to Remember--or Not

September 26, 1964   The wedding  of Dorothy and Gus
  In the good old days when everybody was alive.  And death not much more than a myth..

Health Check

  Are you sure your Sphincter of Oddi isn't too tight?

Places you don't want to go to:

Number One on the list might be the Ampulla of Vater.  Steer clear.

Je ne comprends rien de la mein eye appt.

   I had three ophthalmology appointments in  two days.  I fully intend at each visit to get a status report so I can keep better tabs.  There are so many tests and retests and the patient can see the computer charts of all eye activity, with lines and graphs of various colors, extending to various angles, but they  mean nothing unless they are interpreted, and they never are.  Those readings are a carefully kept secret between the doctor and the assistant, and they keep it between them by whispering to each other, while the patient sits there, with nothing to do but stare at their shoes.  When they have finished conspiring with each other, the doctor turns his attention to the patient.  "No change," he might say, or "at least no significant change. We'll keep an eye on it.."   Come back in 9 months, says one doctor while the other says to return in 6 months.  I don't understand how they can compartmentalize the different maladies into time units for follow-up visits.  What if one eye condition spills over onto the other; blindness is blindness, after all. 
   A  visual field test is a purely subjective assessment that is treated as if it is objective.  The graphing and color lines support the findings.  There are even 2 different categories of that test, one more specialized than the other.  I have taken the test more than a few times in the past several years, and each time the test has been affected by various factors, including the tester and the conditions of the  machine, in addition to the mood and condition of the test taker.  Is that a spot that I'm supposed to click on, or merely the aura left after the original spot disappears?  Since there is a light showing at the top of the machine  that could be a clickable spot when you are supposed to be staring straight ahead; should you click on it, though it seems too high?  When the test taker tells you not to worry about missing something, because you'll have another chance the next time around, what does that mean?  When the tester forgot to close the slot over the light at the front of the machine, did I click on the wrong spots?  I never feel that I have made a definitive decision, though the computer readings scan all the results into my file.  Done and done. 
   On the Corneal Dystrophy site I belong to, the members all seem to know their numbers  of their BVA, and all their other testing results.  But I can never get further than the basic send-off.  I think by the time you're through with all the eyedrops, tests, dilations and drawn-out time spent  in the different waiting rooms, all you want to do is get out of there.
  "Who cares?  What difference does it make what the tests say as long as you are doing okay?"    No, these are not my comments, but the words of the last eye specialist I visited.  At the time, I agreed with him, because that was what was expected, but really?   I hope to tune in tomorrow's Medical Monday on NPR to see if he reinforces this credo.  The show accepts call-in questions; I hope someone asks, someone else, that is.
  

Symposium

Ever since I joined the Corneal Dystrophy Association, I receive an invitation to their annual Symposium, held  this year in Milwaukee.  Noted ophthalmologists from all over, the country and the world, as well as those afflicted, gather to share knowledge and  research of what is considered a rare disease.  The good news is that this disease has a cure and the process of  the cure is constantly improving, with less and less invasive procedures.  The bad news is that since the disease/ disorder is relatively rare that it is not a payoff for most doctors to invest time and finances into learning the skills necessary to treat it.  So those whose symptoms have accelerated into the need for treatment willingly travel to the comparatively few experts who have practices, notably in Indiana, Oregon,  Florida, Texas and Maryland.  I know of one area ophthalmologist who performs the surgery, and have heard of only one person I know who has had the surgery with him.  She was happy with her results, but the Association website has other members who regret having gone with him.  So if the Fickle Fuchs' ever intrudes significantly into my life, I'll be off to Baltimore for treatment.  Years ago, corneal dystrophy used to be a leading cause of blindness, but as is said, there is now a cure.   For a person  diagnosed, each of that person's children has a 50% chance of inheriting the disease.  Though the disease typically does not show up intil later in life, that is not always the case.  Upstate NY and even the Boston area are notably lagging in knowledge and treatment of the condition, primarily because their practices are devoted to more common and profitable treatments, like laser treatments, which, btw, are very important to avoid if a person has corneal dystrophy.  (But who ever listens to an old person?)

More Medics

     Not the knee this time, but regularly scheduled maintenance on the eyes.  There are  11 eye care professionals at the Ophthalmic Consultants, and I have had appointments with at least 9 of them over the years, plus 2 who have left to set up their own practice, and 2 others who are deceased.  I have been a patient at that practice since it was run by Dr. McCarthy, and that was a long time ago.  I remember that he was a Princeton graduate who rode in a parade with then student Brooke Shields, and that he used to parachute out of airplanes, until he crash landed and messed himself up pretty badly.
     My brother and sister wore eyeglasses since childhood, and while I didn't need corrective lenses until I was in my forties, that doesn't mean my eyes are problem free.  Cataract surgery is pretty much considered an inevitable part of aging, so the need for that didn't come as any great surprise.  But the examinations for that revealed a congenital eye disease that I was completely unaware of.  (It is heredity, so younger relatives should be aware of their risks, but naturally nobody takes that seriously.   I feel  a little like Snowden; he is awaiting September's  solar flares for his justification.)  Additionally, I have had laser surgery for 2 separate retinal tears.  Like applying wallpaper, says the esteemed doctor.  My latest diagnosis, or quasi-diagnosis is as a glaucoma suspect, in danger of what is called normal-tension glaucoma as eye pressure is only 10 and 12, where glaucoma usually has pressure over 20 or so.  Moreover, one of the doctors now tends to prescribe "eye vitamins" to lessen the effects of macular degeneration;  there is no clinical  evidence of that disease, but a lot of older people suffer from it, so taking precautions won't hurt is his philosophy, and he does have a Ph.D., so he should know. 
     The point is that what used to be routine appointments are no longer that exactly; they are follow ups to previous visits that are now problematic in some sense.  I have 3 such appointments in the next week, and none of the news can be really good; the best I can hope for is no further deterioration.  And I'd be the last to know.  At my last visit several months ago, to a new specialist at the practice, he asked how I was doing.  I said fine.  My distance vision is great, and I can read without glasses, all but the smallest print.  "Unfortunately," he said, "that doesn't matter."   I think I'll kill myself.
  

Winding Down, Knee-wise

   I'm finished with Physical Therapy/ Rehab, both 2-week home based and 4 weeks out-patient.  Everything went well, my progress is very good.  I've had 2 visits with the P.A. one at 13 days, and the last at 6 1/2 weeks.  Everything is fine, including the X-rays, and I will see the orthopedic surgeon in 3 months. 
  It's hard to remember when I knew I had a real knee problem. I tend to trace it back about 6 years when I heard a clunk when I was walking down the long entry to a school, and at first thought I must have a stone caught in my boot.  But there were a few warning signs considerably before that time; in 1976, I had a cortisone shot courtesy of the late Dr. Paish.  Nothing showed up then, and I had no more issues until my knee inexplicably swelled shortly before a planned trip to Disneyworld, and an orthopedist drained fluid from the knee, and issued a brace (which I didn't wear.) Again, X-rays showed no damage.  Ahh youth!  I can remember hurting my knee a few times, really painfully, once in an auto accident, once ice skating and another time tobogganing. But once the injury went away, all was forgotten.
     So the real problem sneaked up on me, and on Dorothy also.  I remember sympathizing with her about two-footing down stairs; she'd had arthroscopic surgery before my knee became a real problem.  Not too many years ago, I used to tutor at a school in Troy, for 3 different grade levels. The school had 3 levels, and my tutoring had me go up, down, then back up and down.  I remember getting winded, but had no specific knee problem.  Later, I remember letting students pass me on the stairs, so I could take my time, and still later I would wait until no one was in sight so I could "watch my step."  You know what this means, the dreaded old-lady two-footing each step.  Once in a while, I would have to climb stairs with a guidance counselor or teacher, and I would suck it up, and walk like a normal person, though I knew later, there would be pain.  Finally, I cried uncle and gave up any effort at normalcy, but it was such a gradual process I can't remember how long ago that was. 
  So now I no longer have knee pain.  It seems funny, but it seemed like they both ached, and maybe they did, but after surgery on the more severely afflicted, the other knee is pain-free.  I completed all the therapy with flying colors, but there is one issue that remains, and that is those infernal stairs.  I can ascend stairs like a normal person, but for some reason, I can't bring myself to step down with my "good" leg.  I can't even remember how that leg worked before the surgery, and nothing happened to it, but I am blocked from using it to step down.  The exercises are supposed to strengthen your quads, but it seems they are targeted to the operated leg, not the untouched one.  If I'd kept a record of how I walked before, I guess I might understand, but that's spilt milk.  There must be a lot of truth to the statement that you lose what you don't use.  So here I am, practicing how to walk down stairs like an adult.  Oh, the horror!

Karma in Retrospect

    I had a medical appointment this past Monday scheduled for 11:30.  The doctor walked into the room at exactly 12:30.  When I'd checked to see if  I was forgotten, the staff explained that "He is running a little late."  I was on the verge of being irritated enough to say I would reschedule, but then I remembered:   at my last visit with this doctor, he was concerned about my  scheduled surgery, and that perhaps it should be postponed. He made 3 telephone calls to the surgeon's offices while I was there, and waited each time until he received the information he was looking for.  I don't know if a patient had to wait during this time, but I felt I should extend  the benefit of the doubt.  ***I did  just read online that a patient was very indignant after waiting 3 hours at the Troy Eye Docs only to find that the doctors had all left, forgetting this patient.  So you gotta ask!

Collateral Compliments

In addition to my knee, the internal components anyway, I'm also racking up compliments on my sneakers, the first pair I've bought in at least 15 years.  I didn't think they were anything special----Nike Flex, bought at JCP's.   All physical therapists and Orthopedic Physician's Assistants admire them.  They are quite colorful, gray with turquoise on a white sole, a few discrete touches of chartreuse lettering, and the Nike Swoosh in rose pink.  Huzzah!

More on the Knee

    Today was my 6 week post surgical follow-up visit, a little late because of the holiday. I saw the P.A., Rich, who is very friendly and at the same time professional.  He ordered 3 X-Rays, and asked me if I wanted to view them, which of course I did. He explained each of the views, describing what had been done, and what and where all the titanium, chromium, and plastic pieces are.  Everything  looks great, I'm told.
   Today's  appointment was with him, the P.A., but he  asked me not to leave until Dr. C. stopped in. Though I'm not scheduled to see the surgeon for another 3 months, Rich said that it's Dr. C.'s preference to visit with his patients before that time, so we won't feel abandoned.  So he dropped in, all upbeat and positive, which I thought was a nice touch.  (I must say, he is kind of adorable.)






  

Never ceasing to amaze-----

  ----- No, not me, just my knee. Had return visit with Dr.G. today, last saw him  the day before TKR, when he'd called the surgeon questioning the wisdom of going through with the operation because of potential for infection.  His concerns were put to rest by the surgeon, who was no doubt by then in slice and cut mode.  Anyway, at today's visit,  Dr. G. was "Surprised as hell"  that I had no walker or cane.  He wanted to verify that I'd had a total knee replacement, and asked to see the scar.  He advised me to keep up the rehab.  I do, on my vintage 1980's Sears exercycle, rescued from the cellar where it's rested for many years.   I'm the daft lady pedaling away in  front of the house.

Talkin' It Over

"Have you always been so quick to make decisions?"  asked one of the intake nurses when she learned that I'd scheduled surgery at my initial visit to the orthopedist.  I can't remember just how I answered her question because in truth I can't remember making very many decisions, at least any that anyone would ask about.  At that first visit, the orthopedist did suggest, after he related his findings and the available options, that I go home and talk it over before making a decision.  I couldn't think of who I might discuss what with, so I said I'd forego that, and just schedule surgery, which I did.  I'm fresh out of discussions, discussors, and discussees for that matter. 

Cry in the Night

"Can you tell me what time it is?" I heard her ask from the curtained-off part of the room, where we were invisible to each other.  "It's 4 A.M.," I answered.  She thanked me.  It occurred to me, one aged person to another, to add some innocuous comment, about how that was the time we used to be arriving home, but I  didn't say anything else.  I didn't want to add to her distress or make the  presumption that she would care to relate to me.  She was born June 13, 1920, and her name was Katherine.  She was regularly visited by her involved and caring family, and it was obvious that she'd lived a full and adventurous life, far more interesting than  mine.  I didn't want to burden her with the obligation to respond to an anonymous voice who happened to share her room.  The nurses were invariably courteous and considerate of her needs, which at the time were substantial, her having had surgery after a fall at her home.  The last words I heard her say on the morning I was discharged were "Somebody please help me."  When I looked, she was sitting slumped over and appeared to be almost asleep.  The nurses arrived to help her, but I don't think that's what she meant.
 

The Cutting Edge

     What is it about surgeons that they tend to be either loved or hated?  I belong to a site, vision related, which deals with a specific eye disorder whose only cure is surgery. The people who sponsor the site are of the learned and erudite sort;  the eye disease is quite rare , and only those who pursue a solution to their symptoms are eventually diagnosed, a process which is costly, time-consuming, and not for the faint of heart.  The contributors to the site are in various stages of finding a solution to their eye disorder.  Although many will require surgery, the path to surgery can be distant, or in some cases, unnecessary. There is only a relative handful of qualified surgeons, and fewer still  who are top-rated. Those patients who have had successful transplants at the hands of these select surgeons sing their praises to the heights, lauding every aspect from surgical skills to compassion and caring.  But there are some posters who maintain the opposite about these same doctors; they found them to be dismissive, unconcerned, and downright rude. 
     How can there be such a wide disparity of views about medical care from the same doctor?  Bear in mind that the doctor is a SURGEON, not your ordinary doctor.  If a surgeon determines that you are a candidate for surgery, he will be there for you, ready and willing to share his expertise with you.  If, however, he thinks you are not a candidate for his type of surgery, either because it's too early in your condition, or for some other reason,  he has no interest in  discussing anything with you.  He is out the door, ready to put his skills to use on somebody his surgery will help.  Rude, dismissive, yes, especially considering the price you pay, but he does not want to spend his time talking; he wants to perform surgery.
   A nurse recently told me of a patient who had been scolded by an orthopedic surgeon for asking about advice on medication, saying don't ask him about that.  I personally was told by a urologist that he does not diagnose, that he does surgery.  I guess he prefers to work from the referrals of other doctors.  Out of all the young people I've been in contact with over the years, a few have indicated they wanted to become doctors, and several indeed have done so.  I don't know of any young person who has expressed an interest in becoming a surgeon.  I wish I did, though; it would be interesting to see how surgeons evolve. 

Irony, coincidence, or just plain Fate.....

   How does it happen that only professionals ask personal questions?

Now What?

  I am finished with all the Rehabilitation sessions that were prescribed, 2 weeks of home visits and 4 weeks of out-patient therapy.  My 6 week re-check with the P.A. has been delayed a week because of the holiday: on July 10 I will return to him for the second time.  I'm not sure why because on my first visit to him, which was 13 days post-surgery, he said all was well and he cleared me to drive.  He did say it would be a good idea to practice in a parking lot to get the feel for it, but I live in Valley Falls, which pretty much is a parking lot. 
    The only concern I mentioned to him  was  what I perceived as a discrepancy which I attributed to my now straight right leg.  Which, BTW, brings me to "How could they!"   Just before I went in for surgery, I had pictures taken of my legs:  sitting down where they appeared perfectly straight, and then standing.  I knew my legs were pretty crooked when I was standing up, to the degree that I would no longer consider wearing a skirt or a pair of shorts.  I'd disposed of any pants I owned that had stripes or any vertical seaming because of the distortion, and I tried to avoid looking at or thinking of it.  Not until just the other day did I feel I could look at the pictures taken pre-surgery, which brings me to, "How could they!"  How could my family and those close to me have allowed me to walk around with such a marked deformity without insisting or at least  encouraging me to do something about it?  To my recollection, only one person repeatedly and persistently said I should seek some kind of help, and that was partly because it made him shudder to watch me walk.  I guess there is such a thing as self-denial and just plain denial. 
     So now I will have a return visit to the P.A. who on the previous visit said my issue with the discrepancy in leg length was a natural after-effect of surgery and should work itself out, so we'll see if he's reconsidered that issue. 
     Though no appointment with the surgeon has been set up, I think I'm supposed to see him at some time in the future.  My first, and only, visit with him was last February. Originally the surgery was set for March, but I delayed it until May because I had been asked to tutor a senior who needed to write a term paper in order to graduate.  I'm happy to say he did get the paper written and was able to graduate. Yay.
     I'm having flashbacks to that long-ago visit to the orthopedist last February.  I know he used the term, "bilateral total knee replacement," (as did the first orthopedist I'd consulted 6 years earlier.)  I'm remembering he said he would do the right knee FIRST, because he wanted to straighten the leg.  I recall his saying that although full recovery from a TKR takes up to  a year, it is not necessary to wait that long to have the other knee done.  When I saw him briefly in the hospital after surgery and he asked how I felt, I said I thought my right leg now felt longer than my left, his immediate reply was "Fix the other knee." (Maybe he wasn't joking?)
     So here I sit, sleepless and wondering.  I think I'm doing pretty well as is, and am not anxious to alter my situation.  I have a wedding to go to, and then a new baby to see.  Even though TKR #1 went more smoothly and quickly than I'd expected, I can't assume the same for a repeat procedure.  On the other hand, I don't want to risk jeopardizing my gains by keeping the status quo if doing nothing more could have harmful effects.  
    Dr. C. ended the office visit by saying I would be really mad at him at my next visit to his office, because of all the rigors of rehab he'd prescribed.  While that hasn't happened, I'm not so sure about what lies in store for the future.  Who ever knows anyway.

How are you?

  You know how when you're asked this question, you just answer that you're fine, assuming it's a social phrase and not a query as to your actual state of health.  And you usually reciprocate the civility by turning the question back on the asker.  But how do you answer when the question is asked by a doctor entering the examination room: do you say fine or do you detail your health report?  I  think I usually choose the first option, but I'm not always sure because I tend to suffer from a type of physician's office amnesia: blacking out whole sections of say a physical exam.  Did the doctor look in my ears, or my throat, or palpate my abdomen?  Can't prove it by me---I lull  myself into  a trance-like state; in my mind I'm not really there.  That could be why physical therapy rehab was so uneventful; pain recedes if you're not present for it.  Mostly, I say I'm fine and wait for the doctor to ask more specific questions.  I figure the less said the better.
     But one time, when the doctor asked how I was as she entered the room, after I said I was fine, I asked the doctor how she was.  She answered that she was not doing so well, as she had had a very stressful day up to that point, was very worn out, and was glad to have had the little break that she considered my appointment to be.  I can't recall how I responded, but  am sure I was sympathetic, and maybe even expressed appreciation for her efforts and dedication.  I can only imagine how difficult it is to be a doctor who specializes in breast surgery.
   

P.T.Fini

    Today, July 2, was the final day of my Outpatient Rehabilitation Physical Therapy.  I had 12 sessions of post-surgical PT which started on June 5, after 2 weeks of home based PT which started May 28, on my 3rd day home from the hospital.  The home-based services are acknowledged to be not of a high stress level; they include a lot of education and instruction, and some gentle exercises.  The home visitors  warned  that the Outpatient Services are rigorous, and may bring me to tears. Even the woman who motivated me to seek out the surgeon advised me to avoid Outpatient PT in favor of home-based, saying Outpatient was brutal.   I knew I wouldn't cry; I may have cried  reading "Old Yeller" or "Black Beauty"  (poor Ginger), but that was not in public.  No PDA's for me. 
     Anyway, I didn't find the Rehabilitation difficult at all. At first, I entered a room, with individual cots partitioned off.  That was the place for preliminary exercises and those sessions often included moist heat packs to loosen muscles, very enjoyable, and helped with the leg lifts and stretching and other simple exercises. That didn't last for long, however; the majority of the sessions took place in 2 separate rooms.  I referred to one room  as the Toy Room, because it held all the props: steps, bars, balloon type things, stairs, ankle weights, elastic bands.  All these objects, and more, were aids in  balance exercises (which I stank at), lunges, stretches, sidestepping, and a host of  other devices intended to make you feel as if you belong back in the normal world. None of these exercises were painful in any way, though some were surprisingly tiring.
     The second room, the Machine Room, was my favorite.  There are about 20 pieces of major equipment in the room, a few  duplicates, and I worked out on 6 or so different exercise machines.  For some reason, my favorite was the leg press, even after the weight was increased to 45 pounds. That seemed like a lot, until I noticed the weight on the bottom of the stack was 280 lbs.  That must be some rehabilitation. I usually started or finished the session on the Exercycle, another favorite, even though I found that riding for 10 minutes  got me to just a mile and a half, and only burned 40 calories. That of course was at my speed and resistance.  Oh well, this wasn't intended to be a weight loss venture.  (BTW, part of the reason surgery with Dr. C. appealed to me was that he said my weight was not a factor in my arthritic knees or would be problematic post surgery.)
    Some of the Rehab was tiring, but nothing really painful or even uncomfortable-----except for the what my therapist referred to as "The Zone of Discomfort!"   I call that term the Euphemism of the Century.  The only exercise that I didn't control myself was the one that measured leg extension and degree of  flexion..  This measure involved lying on my back while the therapist assesses how far your knee will bend.  That can be painful.  I didn't mind the strain on the muscles or ligaments, but the pressure on the kneecap was considerable. I could picture a flying patella.  My final measurement was 0 to 124 degrees.  She said 90 degrees was acceptable, that it allows you to do most daily activities, but since mine was 105 degrees when I got there, she felt I could go a little further. She thinks I'm at my present limit because the  skin at my knee is unable to  stretch any further.  I agree--the kneecap could fly right off.
  Sandie, the PT, said Dr. C. is building a real reputation  as a surgeon, and is doing many surgeries, 6 hip and knees at Samaritan just the other day. Even so, she said I was her star patient, that in my case, everything just came together to give a near-perfect result. I know I didn't really have anything to do with it, but I'm glad it worked out that way. 
   Next Post---Now What?
  
    

PT---Down to one more week

The therapist today remarked that my leg extension is 180 degrees, completely flat on table.  Prior to surgery, I couldn't even make my leg touch the table.  She said often in those cases, patients have difficulty, and often need additional therapy or surgery.  I told her the doctor said he wanted to do that leg first so he could straighten it.  She said it's better not to know how that's done.  (I picture a football player with a sledgehammer.) She said that's what surgeons do; a patient she knew some years ago had his knee replaced by the eminent Dr. F. (since retired), and the patient asked him about what kind of medicines might be helpful.  Dr. F. replied, "Damn it!
Don't ask me those questions.  I don't know about medicine; I'm a surgeon; I do carpentry.

Diminishing Descriptors

  I am no longer anyone's granddaughter, daughter, niece, employee, advocate, lector or teacher.  Wife, mother, sister, cousin, grandmother still apply, but the tipping point approaches when these identifiers too become irrelevant, stripping away all but concept of self.  Maybe that's why people go to the gym, or into therapy of one type or another---to avoid being defined by one' s relationship to others. 

Even Therapists Take Vacations

   I learned today that Sandie, my physical therapist, will be away next week on vacation.  So next week,  I'll have a different therapist.  The Government has July 3 as the end date of my therapy, and so I can't skip a week and wait for Sandie to return.  She will be back in time for my 2 last sessions, and to write up my paperwork.  The week after that, I return to the P.A. in East Greenbush office this time; I don't know what to expect from him.  After that, I believe I'll see the surgeon, don't know what to expect there either.  At initial consultation, he was reserved in his suggestions, advising that I may want to go home and think about it and  talk it over before deciding on surgery.  But in the hospital, he blithely said for me to have the other knee replaced also, and Danny said he used the word terrible or awful or such to describe the knee, so who knows what lies ahead.  Everybody has to be somewhere.

Therapy

    Tuesday  marked the 4th week since my TKR, and my third week of physical therapy.  Although the woman who motivated me to seriously consider the surgery warned against out-patient physical therapy,saying it was too rigorous,  I have to say I have found it to be interesting, effective, and not brutal as described.  Today the angle of flexion of my right knee was 122 degrees, which the therapist says is the normal range.  But of course the normal flexion at that range would not be painful, as it definitely is at present.  But the pain will lessen as the knee gets used to bending that far. 
   It seems strange to be receiving comments that my progress is extraordinary, and I have to believe it because everyone from the nurses in the hospital to the home health workers, the P.A. and the physical therapists at the Rehab Center remarks on it constantly.  I have never been particularly athletic or overly motivated, so I have to believe the surgery was a kind of fortunate fluke.  The surgeon who operated on me performed 8 ortho-surgeries last Friday, and he has used the newer Signature implant many times before, and evidently without such striking results.  I've watched several different real-time videos of the procedure, including one on a cadaver, and the only observation I made  that could account for my super range of motion is the way the surgeon manipulates the leg after inserting the implant, to be sure the range of motion is good. It looks like the leg is flailed back and forth like a dead fish.
    And there's something I don't understand about anesthesia; supposedly there is a nerve block to prevent pain, and then the administration of the type of sedation that is not general anesthesia, but rather the kind that just makes you forget what  has happened.  I don't buy that; I'm sure I'd have some memory of the sounds of the cutting and the hammering, but above all if I were even minimally awake, I know I would remember somebody putting that white elastic stocking on my other leg.  How could anybody force your leg into a tight tube without your knowledge if you had any consciousness at all.
    But for me the most interesting part of attending physical therapy is a feeling of independent autonomy.  I'm one of the few people I know who has never  been in a gym, not even Curves, which attracted almost every woman I knew a few years ago.  So it's all new to me, and all I have to do is walk into the room, where I know nobody and they don't know me, or anybody who knows me.  It's all a clean slate, and the therapy is all there is.  It is a simple thing; almost Zen-like.   I find it easy to detach myself and just concentrate on the activities.  Possibly that's why I can work through the discomfort and even the pain.  My patient advocate in the hospital said there would be real pain, the woman skipping around the polling place last November was advocating the surgery, but advising me to say no to the on-site therapy, and even my orthopedic surgeon said I would be hating him at my appointment after rehab was completed.  No exaggeration--I hear the words tough, stoic, amazing, remarkable, unparalleled.   I don't have any explanation, but it is gratifying for me to have a straight-line focus where I am able to do something which is known only to me, and of course to you, Oh Blog.

Birth of a Knee

The revised knee is 3 weeks old today. I have been driving my car since 13 days after surgery.  The scar is healed, the swelling is mostly gone, the physical therapist seems to have run out of exercises for me, and I pretty much forget about the surgery during the day, so what's the big deal about a total knee replacement.  It's more like having a dental crown-like cap placed on the ends of your leg bones with the insertion of a small cushion for separation.  Truthfully, I'd rather have my bones worked on than my teeth anyway.  I still get nightmares over a tooth restoration process called a crown-lengthening which was once proposed but turned out not to be.  I still think about the surgeon I almost went to who has all his patients restricted to a walker for 4 weeks.  Word is he's very good, but 4 weeks with a walker!

Time in Hell

The zone of discomfort, formerly 5 seconds, has been expanded to 10 seconds.  If pain can reach the apex of sublime, does time matter?  If you've lived a wonderful life for many years, but die in a spasm of agony, does the end cancel out all that has gone before?  (As far as you're concerned anyway.)

Rehab #2

Sandie, the therapist, told me that Dr. Marotta, who is one of the top orthopedist docs in Troy, restricts all his TKR patients to 4 weeks in the walker.  I had considered him for surgery, but am so glad that I'm not using a walker.  I think I'd be stir crazy if I had another 2 weeks of "invalidism."

Threshold

I'm stoic, I've been told, that I have a low threshold of pain.  But I think that should be a high threshold of pain, if the threshold is the point at which you begin to feel pain, or at least react to it.  This term is similar to the dreaded double negative;  I'm still working on the line from "The Man Without A Country" :  "He loved his country like no other man has loved her, but no man deserved less at her hands." 

Re-hab #1

Though I've had 4 Home Visits which included light exercises, today was the first visit to the Facility.  The worst part was waiting; the room was cold.  The next downside was watching while the other waiting patients were joined with their therapists.  One by one, I discounted the therapists as unsuitable for me---too goofy, too sullen, too cavalier.  I was already planning to take back my scrip and go elsewhere.  I despise hospital settings anyway.  Matters didn't improve when I dropped the clipboard on my "bad" foot, skinning it slightly,  but they did give me a bandaid.  Then my assigned therapist introduced herself to me, and she seemed like the ideal therapist.  She took all the salient information, measured the affected parts of the knee and entire leg, and then the other leg for comparison purposes. One detriment of having my severely crooked and grotesque right leg straightened with the insertion of the knee implant  is that the right leg is now just under 1/2 inch longer than the left.  So until the left  knee is replaced with the accompanied straightening of that leg, I could benefit by a shoe insert in the left shoe.
   Went through all the usual exercises, and a few new ones.  Only one put pressure on my lower back in area once home to herniated disc, so she agreed to eliminate that exercise.  Another was new to me, and one of the few where the therapist is involved, forcing my knee backward into the "zone of discomfort" and holding it there for 5 seconds.  Okay, no problem, 5 seconds is just that.  She told me later that most people yell out during that maneuver, and for the third time this week, I heard the word tough used in connection to me.  I AM A PIONEER.  
   Sandie, my therapist, told me that I have had the fastest recovery at this point of all the patients she's had, not even adjusting for age.  She said the progress so far was amazing.  Again, I could wish that I was being commended for some other life accomplishment, but at this point, I guess  I'll just have to go with what comes my way.  We ended the session with me on an enormous exercise bike, pedaling away to an Adele song---and even that didn't bring me to tears.

First F.U. Appt.

One day short of 2 weeks from surgery, I receive clearance for everything but soaking my knee or swimming.  I am okay to drive, I'm told.  I know I could have safely driven a week ago, but decided to wait for the official word.  But the naysayers have doubts:  "What if you need to stop really fast and need to stomp your foot on the brake with full force?"  "How can you drive with that horrible looking incision still on your knee?"   "What if......?"
I guess I'll just sit here and have other people haul my carcass around.   And then when I get to Rehab, I'll break into tears because it's so darn hard.  That's me, all right.

Cipro

 After you are prescribed a powerful antibiotic, such as Ciprofloxacin, be sure to roll in the dirt and wallow in the mud.  You do NOT want all of your germs to be dead. 

Fleeting Fame

  Sad to say, of all my life's accomplishments, real or imagined, it seems likely  the closest I'm ever to come to Andy Warhol's iconic 15 minutes has been realized.  The hospital staff was awestricken, the home health care workers were amazed:   my TKR has left me mostly pain-free, and with a remarkable range of motion, almost ideal fresh out of surgery.  I see no possible way I can take credit, at this point anyway.   Precocious results  do not necessarily translate into perfect results, so there is a lot of work ahead, so they lead me to believe.  It would be nice to have been acknowledged for some active pursuit on my part, rather than being a passive entity to a medical process, but it's not the worst possible scenario, I guess. 
     It's far too early for me to take a solid position, but many people say they wish they'd had such surgery years earlier.  Not me;  though I wish it were in the past, I'm glad I waited.  Yes, I would have avoided 6 years of decline, but I think the advances in surgery for knee replacement are well worth the wait.  Why have a surgeon whittle away at your opened knee bones while he figures out how to insert the replacement part when it's possible to pre-determine just how and where the tailoring will be done.  No longer a need to have a metal spike inserted into the shinbone, or to cut all those tendons that can get in the way.  At least that's my take on it, for now......

Weighted Down

  The days in the hopsital, I couldn't eat anything at all, nor the day before I went in, and I really haven't eaten much since.  I weighed myself today, and found I've gained 5 lbs.  I think they filled my right leg with cement: that's what it feels like.  I believe anything is possible.  Today the nurse told me my incision is not closed by staples or stitches of any kind:  it is glued closed.  I have the thought that when they succeed in getting me to move my knee back as far as they are threatening it must go, something will have to give---glue?
    I am committing myself to less truthiness.  I have the feeling that when I downplay the pain, that only feeds their determination  to inflict it.   "You can't recover unless you suffer.  You'll probably cry."  Now if only Pete of the sleeve tattoos did rehab.......

Eschew tattoos no more

  I've never been  a fan of tattoos, not that it matters to those who get them.   My ex-brother-in-law bore the usual USN tattoos as did many men back in the day.  They always looked fine to me, were never a point of criticism or negative opinion.  But in recent times, the acquiring of tattoos has increased dramatically, mostly by young men and women.  They are often done in hastily sprung-up tattoo parlors, and a lot of the young people I know have gone for the cheapest price, sometimes even being inked by street artists.  The themes are the usual cliches plus many monstrous and violent images which reflect the tortured emotions of the youths who get them.  They are invariably gaudy, oversized, and added to or subtracted from as the mood and finances evolve.  One young man I knew had unfortunately lost both his parents, and in tribute to them, he'd gotten tattoos with  their names, birthdates, and dates of death, as well as the entire Our Father.  It was a heartfelt gesture, but an ugly sight with all that ink spread out over various areas of his spindly little body.  The girls' tattoos are often solicited on FB: "I want to get a tattoo---what do you suggest?' So in general, I would say I don't care much for the art of the tattoo.
    But that has changed:
        I mean, I don't care what age or sex you are, or even how much pain you may be in, if you are a hospital patient, and the nurse comes to take your vitals or give you  meds, would you like that to be done by the  unblighted arms of a traditional nurse, or would you rather peer through the darkness of the room to see a rather edgy looking young man with  artistic black and gray sleeve tattoos in an intricate design.  (Think Adam Levine.)  My medical source tells me there is a major drive to recruit male nurses.  I don't know what countries are being canvassed, but I say good move.
  

Wampahoofus

What does a successful Total Knee Replacement patient have in common with a Sidehill Gouger?  OMG

Sic Transit Gloria

Today I was cautioned by a Home Health Care Nurse that some of the physical rehabilitation exercises will be so strenuous that I may cry.  It's times like these that make me regret that the most powerful weapon in my home arsenal is my cat.

Crazy Cat Lady: Maybe

     Yesterday, May 26, 2013, I officially entered the ranks of Home Health Care Patient, so I guess I should not be surprised at any preconceptions, assumptions, or potential problems that the representative Visiting Nurse might raise. I'm sure they see everything in their line of work.   But still, I was taken somewhat aback when the first question she asked after introducing herself was, "How many cats do you have?"  Maybe's litter box is far removed from the interior of the house, and is diligently emptied on a daily basis, so there couldn't have been an odor.  Did I just seem to be a cat hoarder, I wondered.  "I saw the figure of a cat slip from one room to another down the hallway,"  she added, waiting for my answer. 
     Maybe had, uncharacteristically, gone into a furtive, slinking mode, not easy for an animal of her weight and girth.  She weighs under 20 lbs. still, and is endowed with a great amount of fur.  Ordinarily, she is at the door when she hears someone approaching, and then plops herself front and center on the floor.  But not this day; this day she was actually slinking and trying to hide.  I thought about going for the comic relief and answering that I had 45 cats, but thought better of it and told the truth.  Even the thought of my house harboring dozens of semi-feral cats skulking and slinking through its various  rooms was too much for me.   Besides, who needs Social Services dispatching an animal abuse team to my house?

Pain Hurts

     No one likes to be in pain, and that is as true for me as for anyone else, but the measurement of pain is such an subjective matter that it defies assessment.  On a scale of 0 to 10, zero represents no pain and ten is unbearable pain, the worst one can experience.  They ask me at what level I would be likely to want relief from pain, and I say a 7.  I try to amend my answer by saying that if the pain went on for a long time,  I would probably want some relief sooner, but I sense my addendum is too late; the 7 has already been entered on my chart.  I reassure myself that I'm the one who will be calling out the number, and only I will know whether it's a low 7 or a high 8 or any other number for that matter.  Anyway, I've never known a surgical patient to be denied pain killers, and the Patient Guide insures freedom from pain, as it were. 
   That slightly  snarky little anesthesiologist had been trying  to educate me as to what sedation should/could/ would be administered, but at the time I was unable to process what she was saying.  It turned out that one of the elements was an epidural in the hip, along with whatever that drug is that causes you not to remember.  I do remember saying I prefer not to have general anesthesia.  Had it once before, hated it.  So when I woke up in the Recovery Room, I was feeling no pain, none at all.  But when they asked, I found out that both my legs were completely numb, I couldn't move them at all, not even to wiggle the toes on my other foot.  This seemed to be what was expected, and gradually feeling and then some motion came back to my left leg.  I think I must have stayed in Recovery for an hour and a half or so, and must have had some sensation in the right leg by then, though it was still pretty immobilized.  I was asked how bad is the pain in your knee, and I said I had no pain.  Still anesthesized, I figured.

Remembrances of Things Past

May 21, about 9:30 a.m. That dreaded consult with the anesthesiologist; I've always felt they hold an unfair advantage in any exchange of conversation, stealth assassins that they are, so when I realize this interview is not going so well, for reasons that are completely lost to me now, I think, "oh s#*t," and stop talking.  Of all the people to be on less than favorable terms with......
 My next memory, after a gentle (or not)  remonstrance from my "caretaker" is waking up in the recovery room.  The time was 11:20 a.m., if I read the clock correctly.  (I've heard the most commonly asked question by those awakening from anesthesia is "What time is it?," and I try to avoid the cliche by finding out for  myself.) The surgeon had left by then of course, but had spoken to the surviving members of my family. I saw him briefly later in the day.  He asked how my knee was feeling; I said fine. It seems the time in the operating room was just about 2 hours. 

In and Out

Check-in time 7:30 A.M. May 21, 2013
Check out 9:30 A.M. May 25, 2 days later than expected due to *non-surgery issues
       * One of the issues was Oxygen level, which tended to be a little low.  That can be because anesthesia can repress the breathing in some, and I don't do well with most medications. They (who, I don't really know) ordered a chest X-ray.  It was the kind brought right into the room and taken while I was sitting in bed. This was Fri. afternoon.  (There was some other lab level that was low also, but I forget what it was.) So I had been  expecting to go home on Fri., but was delayed.  When the nurse, Vance, came in the evening, I told him about having to wait for discharge time pending the results of the chest X-ray and whatever the other lab was.  He left after the usual nurse duties, but returned about 10 minutes later to tell me he had checked and the X-ray was perfectly clear, and the other test completely normal. I felt relief at not having to think about bad X-rays throughout the night, and thought it was very nice of him to deliver this information to me on short notice.  Thanks, Vance!
From the Patient Portal Records:
   Post-op hematocrit was 30.  Normal range is 38-46
   Low saturation-82
   Low magnesium
   Chest X-Ray negative

Surcease of Sorrow

"Take thy beak from out my heart,
And take thy form from off my door."

Retraction, Mea Culpa, Apologia

I had several interactions today with medical professionals, and without exception, they couldn't have been nicer.  My telephone appeal was addressed in a timely and satisfactory manner, and pleasantly and cheerfully in addition.  The PAT staff were courteous and friendly for my return visit.  I had a routine visit at the nephrologist's  and, though he is not involved in my present treatment, he was very concerned and made several telepnone calls to OrthoNy and the surgeon himself so he could share his observations with them.  He also said that Veena, my substitute clearance physician, is a wonderful doctor, a sweetheart who does all she can to help her patients.  She is the doctor who said she would come to my house if I needed her to.  Dr. G. even shook hands with me and wished me well.  Notwithstanding, the tests were all clear; the only concern is that I'm presently on antibiotics, so that could be an issue later.  However, the surgeon assured the nephrologist that he would keep me on antbiotics until all is clear.  Geez, there's no way out.

Form and Function

    Facing the prospect of the first major surgery of your life, if you're like me anyway, as the date nears, you start to focus on what the probable course of events will be, and that involves an inordinate amount of time devoted not only to your own physiology, but as it connects to the hospital complex itself, the doctors and the staff.  The building looms up as rather mysterious in its workings, welcoming on the surface, but foreboding in its potential.  You regard the medical staff and personnel as presented in the hospital brochures, part of an efficient and coordinated team of professionals working in cohort to deliver to you the patient the best care possible.  You have researched your surgeon, seeking to find professional expertise in combination with a caring manner.  Hospital, staff, surgeon----you think of them a lot as the time draws closer.
    Think long enough, though, and the myth is dispelled.  The hospital is bricks and mortar, nothing else.  Think Catholic churches.  The medical staff signs in to work every day, beset with their own life issues, and not knowing what mortal coil they will need to tend to on any given day.  The surgeon is by definition a rare breed.  Congenial or not, a surgeon has chosen a career based on cutting into humans' flesh, not dealing with their emotional needs.  I figure I've seen the surgeon one time, weeks ago, will not see him on the day of surgery, and may see him a few months after the surgery.  The patient is destined  to remember this day, whatever the outcome, for a lifetime.  The patient, to the medical community involved, is a "Date of Birth" attached to a knee.  ***My Knee Saga blog is intended to document my journey and clear my thoughts, but I don't know if this is helping............  

Saga Winding Down

I have one pre-surgery lab test left to be performed; it was not done at the time of the PAT because I was on an antibiotic, so they postponed it to the morning of the surgery.  This is not making sense to me; if the results are needed to determine my suitability for the surgery, and I assume that is the case, then the timing would be rather late, for all concerned.  The person who drives me there will turn around and drive me home; the surgeon will pack up my customized knee-mold, and twiddle  his thumbs until his next patient's surgery.  I'm going to call the hospital tomorrow, and tell them that if I can't have the final test done the day before, that I'll cancel.  I don't see myself undergoing the torture of preparation, both mental and physical, without knowing if the surgery will go forth.  Of course, there are always last minute emergency conditions where operations are not performed, but that should not be dictated by a simple lab test whose results are not of the moment.  **We'll see.
    P.S.  I called, and  they agreed to test the day before. Results were negative for any infection, so all systems are go. 

Last Request

May 26, 2011 was the last time Dorothy ever asked me to do anything for her.  She seldom asked for anything; she always was the giver.  But on that date, she had an appointment with Dr. Collea, her oncologist.  Her hands were unsteady, too unsteady to apply her eye makeup, so she asked me to do it for her.  I tried my best.  We didn't know that would be her last appointment with him.   She was gone six days later. 

Bullet to the Knee

     Had my knee been the victim of violence, or accidental injury, I would have absolutely no compunctions about surgery.  But I'm sitting at the computer this morning for an hour or so now, and my knee is as problem-free as it could possibly be, with not an ache or a twinge of any kind.  I'm no more aware of it than of my left collar bone or my right elbow.  I have to remind myself of yesterday when I was planting a few seeds and it was so painful to walk across the yard, especially so on uneven ground.  I conjure up the sight of the x-rays showing the lack of cartilage and the presence of nasty-looking bone spurs.  I could stand in front of the hall mirror and see how my right leg is way out of alignment.  I'm down with it--slice off the old crappy parts and put a nice smooth substance in there instead. 
    Sounds simple, but it's the "elective" part that keeps me from rejoicing.   I  recall the time right after my first cataract surgery:  I came home with a patch over the operated eye, which was to be left on for 4 hours.  I lay down, fell asleep still kind of woozy from the sedation.  I woke up, looked at the clock, and it was still a little under the 4 hours, but I was anxious to check my sight, so I carefully peeled the bandage back, opened my eye, and could see--------nothing!  I was instantly struck with an intense shock of remorse.  What had I allowed to happen to myself?  Why hadn't I left well enough alone!  I wanted to go back and undo my decision to have surgery.  I stuck the eyepatch back on and grieved for my stupid mistake.  When the 4-hour window arrived, for real this time, I removed the patch, blinked a few times, and Hallelujah, I could see!  When I kept my F.U. visit the next day, the doctor said I tested the best she had ever seen at that point post surgery.  So it was anticipation, regret, ultimately satisfaction.  I'm hoping for the same.   (Of course, cat surgery is painless, and the only rehab is inserting drops in your eye.)

Getting there...

   When I was about 25 years old, I taught at a high school which, due to attrition that year, had hired a number of new teachers, all single and about the same age.  We did a lot of things together, something every weekend, and after the winter holidays, several of the young women teachers thought it would be interesting to take a trip, and the destination chosen was New Orleans. The organizers asked me to go, as one of the single teachers in the group and therefore unrestricted in any way.  Of course I agreed, though in actuality I never planned to go.  I hated flying, or at least the thought of it, because I'd never been on an airplane, and was terrified at the prospect.  The trip talk was ongoing, plans were discussed, and I blithely went along with their inclusion of me.  I had plenty of time to back out; any excuse would be accepted.  No one would mind.  January came and went, and one February morning I found myself aboard an airplane bound for The Big Easy.  I remember being almost in a state of shock, finding it hard to believe that I'd gotten carried along with the flow. I'd never made a conscious decision to go, but I was on my way.
    Here I am in a state of deja vu:  what started out as a generalized survey of options has morphed into what appears to be a definite plan.  Back then, I remember driving my car to a friend's  house, picking up another person and riding  to NYC. Even then, I had no vision of myself actually getting on a plane.  I'm not sure how it happened, my memory is empty, no recall.  I'm sure my friends didn't force me, so I guess I decided.  Can't remember though.  At present, I can project absolutely no mental image of  my being in Troy on Tuesday.  Somehow  a plan of action sparked, ignited, and has swept me along in a firestorm.  Funny, how things happen....

The Hover and Touch

    I dislike it when someone issues orders to me; I look upon it as an insult to autonomy, but what I dread even more is the physical violation of my psychic space.  Typically Irish, our family was not of the touchy-feely nature, so we grew up with the sense that our body was our own territory, except, of course, in instances of mutual waivers.  Or at least that's my explanation.
    I know women who look forward to going to the beauty salon for a shampoo and hair treatment as an opportunity to relax.  I have never felt comfortable with somebody else's hands on my head, though I used to tolerate it on a fairly regular basis.  I have never had either a manicure or a pedicure, not because I don't stand the need, but because of the stress I would feel sitting there with my hands and.or feet being worked on by another person.  I have received gift certificates for massages, but they went unredeemed.  Undergoing a massage would be  my idea of a punishment.
    I am particularly uneasy about the issue of being "tended to"  if  I am to become a patient.  Maybe I wouldn't mind if I looked like Angelina Jolie, but I don't relish the idea of being regarded as a passive entity, something to be manipulated, and charted, with no voice in the matter.  I suppose it's a control issue, but it's in my mind for now.
    But what really bothers me is the role of the anesthesiologist.  I find them to be creepy.  Yes, you might be told you will have a consultation with him (her) prior to surgery, but in my experience if that so-called consult does  take place, it's when you're already partly sedated, so not much information is exchanged.  After that brief encounter, they disappear like a ghostly figure into the invisible space behind you, while you  are already at their mercy via the IV line.  Try as you might to remain aware of what is taking place, you're unable to.  When consciousness finally returns, the anesthesiologist has long since disappeared into the mist from whence he came, never to be seen again.  I'm starting to scare myself; I think I'll go back to bed. 

Don't tell me what to do

     When we were kids, though our upbringing was far from what would be considered  liberal, neither were we bound by sets of rigid rules.  Rather there was a general understanding of what  was expected.  We never had a set bedtime, were never required to clean our plates at mealtime, did not have to run home when the mill whistle blew, as many of our playmates did.  Of course, since most of the play activity occurred in our yard or on our porch, we already were home, but that wouldn't have mattered anyway.  We were expected to know what to do, to not cause or get into any trouble, and to pretty much exercise our own judgment, and follow our own counsel.  My mother did not use lot of words to direct our behavior; we instinctively knew what she meant, and, at least as it pertained to me, tried to oblige in every way possible. 
    In school there were rules, but if you followed them, as I happily did, there was no necessity to be told what to do.  I don't remember a single instance of having to be ordered to do something.  I knew the rules and followed them.   That's pretty much how it's been all my life.  Obey traffic rules and you don't need to go to court. Do your job the right way, and no one demands you do things any different.  Marry someone who doesn't care what's for supper, or what you spend on a shopping trip.  You can live your life without having to follow orders from  another person. It's worked fine for me---up to now.
    Now I'm voluntarily about to put myself in a position of subjugating myself to authority that will completely dictate my behavior for at least three days.  I hate having people tell me what to do. 
   

Bad news, good news

    I don't exactly understand which medical providers access my Patient Portal which I activated through my Nephrologist, but I checked it and found that my labs from yesterday's  pre-surgery Samaritan visit have already  been entered:  my Blood Type is O Pos, which is the most common, and all 25 of the lab reports are in the normal range.  That could be the bad news part; the "good" part being that there are still 2 factors that could prevent the surgery.
   One is the urinalysis that was not done yesterday because I am on antibiotic; that will be done on the morning of the prospective surgery.  The other potential deal-breaker is the clearance from my Primary doctor, who has been sick, so another doctor in the practice had to sign the form.  She evidently takes her job very seriously, insisting that she receive medical reports from all the doctors and hospitals where I've been treated over the last year, including the cardiologist's clearance (which he signed in less than a 10-minute visit) and even more extreme, the findings of the hospital's pre-admission test from yesterday. She wants that report faxed to her before she signs the clearance form: they said no one has ever asked that before.  She also wants my blood pressure, which is labile, to be stabilized before the surgery.  That will be impossible, I'm quite certain, so I don't know how much veto power she can exert.  I hope my primary doctor returns to the practice, so I won't even visit her again.  But she said she would come to my house if I ask her to.  I should have known this wasn't going to be easy.  Life is not  a victory march.

Progress X

Anything can happen. 

Whiter Shade of Pale

   "We'd like to know a little bit about you for our files," says the hospital pharmacist.  Well, maybe not exactly in those words, but "In addition to your other meds, tell me what you take for anxiety.  What?  Nothing? Really?  Why not?"    I reply that when I worry, I want it perfectly clear what I'm worrying about.  I don't want  all that energy to be dissipated into a blur.  She seems to understand, but when I segue into the next interview, the questioner with my chart says, "I see you suffer from anxiety."  I can't imagine where that came from. 

Numbers

  Can you imagine what it must be like to have performed 600,000 colonoscopies?  That's an awful lot of  a**holes.  But that's what he said: maybe he's going for a career million, and the Golden Stool Award.

Now, or Never

As is said, one step forward, two steps back, but no one ever mentioned all the sidestepping.....

Hold

More and more on hold......

On hold....

....Hold on......

The Corridor

    Once it was pointed out to you, you couldn't miss it.  It being a gray chair, straight-backed and naughahyde covered, and it stood against the wall outside a doorway at the end of the hall.  After you registered for your treatment, you stayed in the waiting area of the facility until one by one you were to take your place in the gray chair.   When the door to the treatment room opened, releasing a patient, the inhabitant of the chair would enter the room, and another would proceed to the gray chair.   I waited for that chair to empty for a total of 36 days, consecutive except for weekends, and early in the morning, 8:00 a.m., because I was working then almost every day, about  an hour's drive from my home. 
   I never once sat in that gray chair.  Not that I was trying to prove a point or because I resented being told what to do:   I just didn't want to.  Nobody minded, as long as you were in the right place at the designated time, which I faithfully adhered to.  Instead of sitting, I would stand in the hall, usually not more than 15 minutes, and look at the artwork displayed on the walls, the usual depressing works painted by a dying patient, or by the children of staff members, paintings or drawings which struck me as both beautiful and repulsive.   The last time I was there was the Sunday before Thanksgiving, a makeup day rescheduled due to equipment failure.  

Next....

I'm trying to schedule a visit with a paleontologist, but can't find any listings in the phone book.

Uh,oh!

  After the empty ritual that's known as a cardio clearance, I decided I might as well get my blood test over with, the labs ordered by my ENDOCRINOLOGIST which I believe are meant to assess the relationship between hyperthyroidism and the formation of kidney stones.  I prefer to go to the hospital lab in the office building off Hoosick Street, mainly because it's not a hospital.  I entered the room where the only patient there was talking to the nurse on duty behind the desk.  She's describing some kind of violent activity about somebody pounding somebody else, man against woman, it seems.  I pick up the pen attached to the sign-in pad when I hear her say, "So, yes, I did hit him, and where he'd gotten cut from the other guy, he was bleeding, and I got his blood on me.  And he has herpes!"  I quickly, though most likely too late, dropped the pen I was about to sign in with, and fumbled through my purse to find my own pen, which I always mean to do anyway.  Fortunately, I also had inside my purse one of those little vials of spray antiseptic cleaner, which can be used discreetly if one has to.
    Another benefit of using this particular lab is that it is connected to the Patient Portal through my NEPHROLOGIST'S office, and so lab results can be accessed without a visit or even a call to the doctor's office, and so  avoid the hell that is the phone system.  I'm not sure if labs ordered by other doctors are accessible this way, but I think  those  results  cc'ed back to him through the chain of command are also entered into the Portal.  By chance, I decided to take a look this evening, and found that some results are already entered.  One finding was slightly elevated, indicating the possibility of  a wayward kidney stone, or it could be the result of dehydration.  I suppose I'll have to call the UROLOGIST tomorrow to see what he might suggest.  Such is life.

Go there, not here

     I'm at the check-out counter in the doctor's office, paperwork clutched in hand.  There are 2 "ports" each with a patient being served so I obediently stand back until there is an opening.  The woman behind the counter is doing something with papers, ostensibly from the patient who has just left.  "Take a seat on the bench," she says, "It'll be a minute."  I answer, "Well, if it's only going to be a minute, I don't mind standing."  I really don't feel like ripping someone's face off this early in the day, but it's not out of the question either.  The woman at the other window volunteers that I'm welcome to stand in front of her desk; she actually seems to have a sense of humanity about her.  So I do, and the necessary ritual of the checkout is conducted with no problem. 
   I like children, and my own childhood was the best time of my life, but those days are gone, and I no longer enjoy being treated like a child.  That may be why I barely tolerate doctors' offices, and I abhor the idea of being a hospital patient.  I really don't like people telling me what to do.  Stand back, wait here, sit there are all bad enough. To have somebody telling me to lie down, get up, eat this, drink that, hold onto this, stretch that, is going to test the limits of my patience, and that's how I feel before I'm experiencing pain or discomfort.  I hope against all that's holy that I don't have to hear someone say to me anything like  "I need you to to do this or that,"  or "Will you drink this for me?"  Everybody has a breaking point, and I'd hate to be on one foot when I reach mine.

Signage

  It's important to post signs and provide  written advisories about expected behavior, especially in a cardiologist's office.  A number of cardiologists  share the office, so the lines can be long while you wait attention from the staff behind the desk (none of whom portrays the epitome of cardiac health), but I digress.  The line extends to the door so you have to move to get out of the way of incomers while still preserving your place in line.  There is a sign instructing you to wait until the person ahead of you moves away from the desk, for privacy reasons.  Yet when it's your turn, someone  bellows out your full name from one of the doorways.  Today a woman stood up, hearing her name called, but knew not from what doorway, just stood looking baffled.  So I made sure to keep my eyes open so I wouldn't look like another lost soul---"I know I heard my name, but where am I supposed to go? " 
     Another sign warns not to stand too close to one doorway because it opens outward. In addition, If you need  a prescription refill, say so in the office.  A service charge will be applied for renewals between visits.  Those taking Coumadin need to have protime levels checked, by appointment only.  And if you go to another location, such as your primary, a monthly service charge will apply.  If you have lab work and tests done in this office, you will be contacted only for significant abnormalties, as we do not call or mail out tests on a routine basis; you will be provided results at next visit.  If you do not pay your co-pay at the time of your visit, there is a service feeof $10.00.  The same applies to any balance not covered by insurance.  (They don't know about my changed insurance yet.)  There was formerly a sign assessing a charge for returned checks, but I didn't see it this time, probably not room on the wall, or could be they no longer accept checks. 
   Such measures may be necessary, but they seem somewhat harsh, especially for cardiac patients who are supposed to avoid stress.  The esteemed doctors could at least take a tip from the television ads where the banks advertise no waiting lines, and other user-friendly features. 

Static

  Now that I have cardio clearance, I need additional clearance from my primary care doctor. Such visits are to be not more than 3 weeks before The Date.  Kind Dr. P. said not to bother scheduling until after Clearance #1, so I called today to find that Dr. P. will be out of the office all of this week, and they're not sure if he'll be back next week either. So I had to schedule with some unknown whom I've never seen or heard of.  Ironically, of all the doctors I've encountered, Dr. P. is one of the few I feel comfortable talking to.   I was afraid to ask his whereabouts.  I hope he's on vacation

Now Clear This

Cardiovascular clearance accomplished in less time than it takes to ride that bull named Fu Manchu.  "It's fine, and you look good,"  Now get out of my office. It's a busy Monday.  I did snag him long enough to bring up the 3 points I wanted to cover.  (1) Elevated CRP----he wouldn't worry about it.  (2) Change in BP drug as advised by nephrologist----good idea, the replacement is a very mild drug and in a low dose.  (3) Fragile Retina subject to low night time blood pressure-----ummm,( Damn, I'm not in medical school anymore), in agreement with new Rx.  Come back in a month.  A month?  Not likely-----

White Stockings---No!

  I read, because nobody tells  me anything, that after surgery the patient must wear compression stockings.  I'm always glad when the weather warms up enough so I don't have to wear socks; I dislike and don't wear white, or even light-colored socks; I absolutely hate socks that are tight.  When the weather dictates, I wear black, short, loose-fitting socks.  If my feet get cold at night and I wear socks to bed, I always have to peel them off before I can get to sleep.  I'm sure I'll suffer a kind of claustrophobia if I have to wear those awful white sausage casings. Not to mention the grotesquerie of looking like Alice in Wonderland.  O, The Horror, the Horror.

Signature

At least it's not a hacksaw, but a CUTTING JIG, technology  like something from  Dick Tracy or James Bond.  A plastic  mold is made based on the MRI scan which fiits on the bone, perfectly they say, and is held in place by pins.  The aforementioned cutting jig, a harmless-looking little rectangular thing, is put in place, and then--------these sharp little saw blades come through a slot in the jig to make the cut of the bone.  OMG

Cinco de Mayo

   Let's see---I still have the feeling that if I were to tug on the last tooth in my jaw, that all the connected teeth would come out in a single strand; maybe it's phantom pain.   I continue to have dull ache in my lower abdomen, but it goes away when I get out of bed.  Can't be too serious then.  Yesterday my knees went to the Opening Day Parade, the VFW,  the  Schaghticoke Craft Expo, the VF Library (with stairs), and local store.  They don't seem to be any the worse for wear.  BTW, saw Rich McNally, who said he was running for State Supreme Court Judge.  He had George, his Labrador, with him, who is recovering from knee surgery, ligament repair.  The dog is only 3 years old, the surgery cost $3,000, and the problem could recur, and even in another leg.  So I guess Rich has to keep working.

May 4 Countdown?

      Went to  Baseball Opening Day this morning at the VFW. Alonzo fireworks and all.  Then to the Schaghticoke Fairgrounds Craft Show because I wanted to buy pure maple syrup for my youngest child.  He had told me that his  pure maple  syrup, which is the only kind he uses, none of that pseudo Aunt Jemimah stuff, had mold on it, which he skimmed off, and then  boiled the syrup for future use.  I was appalled, thought he was doomed to some kind of mold sickness or other.  I told him to throw it out, and I would buy him some new syrup.  So I found the Pure Maple Syrup stand at the craft-y-ish fair, which was run by a very nice man from Hoosick Falls.  He told me that skimming off the mold was very safe and acceptable, and that it's  even written on the packaging.  I bought a tin of the syrup anyway.
     When I got home, there was an email telling me of his arrival  plans for May.   My reaction:  is this really happening?  
     

Checking In

   Woke up with insidious ache--headache, toothache, sinus infection---not sure.  Also not sure about that kidney stone problem.  And I still don't like the looks of my arms and legs.

Assessment

The road to perdition---when you're waiting to be "cleared" for surgery, at least in my view, you tend to be in too close contact with your body, trying to assess whether all parts are in passable condition.
   Several years ago, I sat in a doctor's waiting room where another patient and the woman accompanying her were also waiting, for a considerable time I might add.  The woman was elderly (meaning older than I), and she sat looking down toward the floor;   "I don't like the look of my legs,"  she said.  Her companion, glancing at the legs in question, asked her why, they didn't look swollen to her. The patient replied they just didn't look right.  Now I, sitting across from them, was more or less forced to take a look too, though I  didn't really feel like it.    The legs, in proportion to the woman herself, were scrawny, whitish with  kind of mottled bluish areas on the skin.  As I was processing this unwanted bit of information, the woman spoke again.  "And I wonder if the doctor will say anything about my arms," she went on. "I don't like the looks of them either."  I didn't look this time, though she was wearing a cardigan sweater, of course, but even not being her doctor, I could diagnose what was wrong with the looks of her arms and legs:  they were old. 
    When I wake up these mornings in May, I try to keep everything in perspective.   But I am scheduled for at least 2 clearances in the coming week, so of course I need to be aware.  This morning I woke up with a kind of toothache.  Not in the area of the late Tooth #3, but in the problematic Old #12, which was the reason for my dental referrals in the first place, and for which #3 was sacrificed, perhaps unnecessarily so.    Or maybe it's a sinus infection after all: I hear they're going around.  I take aspirin and hope for the best.  I go outside, and feel a sharp twinge in my right side.  A kidney stone that missed detection?  A gallstone?  Maybe just a spasm of some kind.  I drink some Gatorade, and it subsides. 
    There is danger in being overly involved with our mortal coils.  We shouldn't have to be aware; remember the days when we never thought of how our bodies functioned unless we  were having  a science test that day.
I sit outside, in the sun, trying to increase my drastically low Vitamin D level.  I expose my limbs to the sun, and I really don't like the looks of either my arms or my legs....
   

All clear?

I came home from a staff meeting in Albany to find a telephone message reminding me of my appointment on Monday for a clearance examination.  What are they talking about?

"I Want To Be Sedated" Or do I?

   Today is May 2.  I woke up with no pain, at least not in my knees.  Actually, they're in better shape today, have no idea why.  I started thinking about operations, procedures, and anesthesia.
   The first 3 times I was ever in the hospital, and in line for anesthesia, was for childbirth.  The first time, I was administered Demerol, which caused me to be in a state of sheer oblivion, and stopped all progression of any sort,so the doctor ordered I be given no more drugs until the actual birth.  (The things they did to you after the child was born were evidently worse than the birthing itself.)  The second time, the baby was born so soon after I got to the hospital, whatever anesthesia was given occurred pretty much simultaneously with the birth, so I don't remember much about it.  The third birth occurred in "modern times,"  and I opted for no anesthesia.  It turned out to be not much different than having drugs only at the last few minutes anyway.
    I avoided hospitals and procedures for about another 15 years until I began the ritual of routine colonoscopies, every 5 years.  It was always an outpatient procedure, and I think any sedation was mild and short-lasting since the procedure takes only about 15-20 minutes.
  In 2003, I underwent 3 surgeries: all were  outpatient, and whatever anesthesia was administered for the first operation left me feeling really nauseated.  The surgeon for the next 2 operations promised me she  wouldn't let that happen again, and it didn't, either time.
   In 2009 and 2011, I was lightly sedated for cataract surgery, again a 15-30 minute procedure where you are awake, but "foggy" for the duration of the phacoemulsificaction.
    That brings me up to the last year, which involved my having anesthesia multiple times:  the first, and most ominous, a bladder biopsy; the second, a ureteroscopy with kidney stone removal, then 2 separate  lithotripsies, and the latest colonoscopy.  I can't recall what anesthetics were given, but after one procedure, I felt nauseated.  These procedures were all out-patient, though given the emergency basis of the kidney stone, the surgeon couldn't operate until 5:30 P.M. so I spent the night in the hospital.  Hated it.  The oral surgeon offered Valium, which I declined, laughing gas, which she prefaced by saying it wouldn't really make me laugh, which I also declined, and finally, someone to hold my hand.  No, Thank You. Just let me out of here. 
    So here I am, evaluating.  The past year, I've had more procedures, and more anesthesia, than in my whole life before that.  What if I've reached my limit?  Except for maternity stays, I've never been an in-patient at a hospital, though I did spend that one night after the evening kidney stone retrieval.  I absolutely hated every minute of that horrible room.  So do I really want to experience that again, I ask myself.  Because, as I said before, nobody knows, but you.  I think that's also a song.
  
  

  

May 1 _Part 3

   My idea was to keep a journal from May 1st on  of my knee project, but as usual I get involved in reasons why I'm writing, and so veer off on a tangent.  That happens when my mind is flooded with other things I don't want to think about, so I'll  try to stay with the topic at hand---in this case knee replacement surgery. 
   It seems to me that the orthopedic center and the facility, the doctor and the hospital, are rather casual about the surgery.  Of the 85+  medical visits in the past year, only 2 are directly related to the TKR--the initial visit to the orthopedist and the referral to have an MRI to enable prosthetic fitting.  They specify only 2 more visits, pre-surgical clearances from my primary care doctor, and from my cardiologist, since I have one.  The Ortho office scheduled a follow-up visit with the para-person 2 weeks post-surgery and then a visit in several weeks to be scheduled with the surgeon.*
    They provided no information about pre-surgical exercises or nothing definite about what to expect after surgery. 
    It's almost as if they don't care about me.    Either!
* Change here:  I did have an appointment with the P.A. one day short of 2 weeks post-surgery, and then was scheduled for a second visit with P.A. six weeks post surgery, though it was extended a week b/c of holiday, to July 10.  Am not sure about visit to surgeon.

May 1

    I had the notion that when May arrived, I would document my thoughts as to my elective knee surgery on May 21.  I felt the need to first write a kind of prologue to justify my blog entries, but, really, why would I even have had such a thought. This is my blog and will disappear when I want it to:  remember, nobody cares.
    With the theory of self, and the premise that nobody knows what happens to you, or what makes you into the kind of person you are, or are becoming, here is my Knee Journal as of today.  It proves the aforesaid, in that there is not a living person who could reprise  my medical events of the past year. 
      Before this past year, I would have an annual mammogram, annual visits to ophthalmologist, cardiologist  and gynocologist.  And dental cleaning, usually one per year. ( Except for horrific year of 2003; since then, annual visit to oncologist-hope to keep it that way.) I would schedule colonoscopy every 5 years.  Until the last 5 or 6 years I didn't even have a Primary Care doctor, didn't need referral for insurance, so Primary was unnecessary.  I received my flu shot at Rite Aid.  All bases covered, in 5 or 6 medical visits per year.
   But on April 26 of 2012, I started on the journey of many, many medical visits. I have a record of 86 visits for one or another types of medical interactions in that one-year period.   Except for 5 visits , which required sedation in some form and therefore a driver,  I attended by myself.  I underwent those visits and procedures, and not a single person, in most cases, knew any of the details, or of the visits themselves. Relating your doctor's visits is like trying to tell someone of your dreams; nobody wants to hear.  I can't even imagine a reality where anything otherwise  would be true. I was a patient of at least 16 doctors this past year; probably nobody could name half of them.  My point is that you are not only your best advocate, but in the truest sense, your only advocate.  Nobody knows what you live through.
  
   

May 1

    The positive about a Blog is that it can be deleted at will, just the way a life is.  One final touch, and it's as if it never existed.  I've deleted many posts so far, on other blogs besides this one, many in the early hours  that never saw daylight. I keep this post in defiance of the maxim that nobody cares about your troubles and many are glad you've got them.  Blogs owe nothing to anyone, and are at the total discretion of the owner, as far as I know anyway.  I will delete my entire blog when the time is right;  I blog as a way to exorcise the thoughts that pervade my mind, as a way to keep in contact with how I thought at an earlier time, thoughts that have meaning only to me.  Though others  may "care about you,"  they, being preoccupied with themselves, are  never able to care enough.  No one cares anough to want to know how you think, or what you think, especially as you age.  You live the realization that any investment is doomed to be short-term,  not a solvent venture. To not  accept the inevitability that you  are the sole and ultimate source of your own self is to travel down the path of submitting your mind, and body, to the control of others, who can have no idea of who you really are.  Nobody knows. 

May Day

     Way back in March, or was it February, when the date was set for May 21st, surgery  seemed so far away.  Tomorrow will be May 1st, and time for me to gain clearance  from my cardiologist as well as primary care doctor.  Those visits are to be no more than 3 weeks before the surgery.  I suppose I'll have an electrocardiogram, and blood pressure reading and the old breathe in, breathe out drill.  I can't believe ekg's as administered now can be very effective; they last only 90 seconds, hardly time for a heart problem to show up unless you're near death, I would think. The nephrologist I was referred to by the urologist believes I should be taking a different blood-pressure medication than that ordered by my cardiologist.  I haven't broken this news to the cardiologist as yet, not that he'd give a rat's part, but it might be enough to throw him a little.  Moreover, the endocrinologist I was referred to seems to agree with the nephrologist, said that the drug I'm on is the one that was popular in the 1960's.  Maybe I won't tell him that either.    I also may not bring up the fact that 2 of the last 4 opthalmologists I've seen have warned me against the dangers of having my blood pressure drop while I'm asleep, since it could damage my fragile retina.  I also have a question about my extremely elevated CRP level.  The cardiologist usually attributes that to arthritis, not heart disease.  Maybe I won't mention that either.
     I have even less faith in the validity of a visit to my primary doctor; he seems unrushed and interested, sort of, but seems a little indecisive as to what course to embark on if there is a question.  I could go through all of the above issues, and then throw in that I've also had a problem with my teeth, and one tooth's problem is still unresolved, despite visits to dentist, endodontist (2 of them), periodontist, and (alas) oral surgeon.  I could tell him about the kidney stone issues which began 1 year ago, on April 27, which necessitated visits to first the gynocologist, then the ER, referral to urologist, bladder biopsy surgery, ureteroscopy operation, and 2 lithotripsies.    The biopsy was negative, and the stones are finally (almost) gone, I'm told, though I'm not so sure about that.  I was referred from urologist to nephrologist and then endocrinologist because of an elevated parathyroid level, and a low Vitamin D level, and I'm scheduled for further tests for that.  And, I could mention that during last month's colonoscopy, I completely collapsed from what the gastroenterologist said was extreme dehydration (unless I was coming down with the flu--or something.)  He said I had no cancer.  Finally, I did have an annual mammogram and examination, which were normal.  And, oh, a bone density test. And that minor surgical procedure at the dermatologist's where the lesion was diagnosed a harmless actinic keratosis. 
      So when I visit my 2 doctors for pre-surgery clearance, and each asks me how I'm feeling, I'll say fine, as I usually do.  Let them figure it out.