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.