Nonagenarian Sighting

   We met again, the peripatetic nonagenarian  and I, this time in the ophthalmologist's office.  The tech administering the field-of-vision test said that a 92-year-old woman patient told her that she could follow the test pattern better if the screen image pictured a half-dressed man.   I asked which half she wanted shown, but the tech couldn't answer.  Apparently that question was not covered in the class on Elderly 101---Reassuring the Patient.  

'Nother Knee

   Valerie called today to say she'd just returned from seeing "my boyfriend." I wracked my brain, thinking it must be somebody from those halcyon Cambridge days, teacher or student.  I had that effect on so many.  But she meant Dr. Congiusta; it seems she has also fallen under his spell, as have so many before her.  He was looking good today, she said, in a blue shirt, though my preference is for a white shirt.  She said she mentioned my name, and they said they knew me there, that I was a great patient.  Valerie has harked back to the days of long ago when I was someone to be known, and even acknowledged.  I suspect no one remembers me at all, and they were just being polite. 
   Val said they are here for the winter. Don has "no knee."  It was infected, probably as a result of his first TKR in Florida last year,  and Dr. C. removed all the old prosthetic parts, and inserted a space-maker, infiltrated with antibiotics, and stabilized the knee with splints.  He removed the staples, and Don is feeling better.  He has to have daily antibiotic  infusions through an IV, which last 45 minutes, and which Val takes care of.  I think she said it will be that way for 4 months.  He uses a walker, and was told he could drive if absolutely necessary; it's his left knee.  They are impressed with Dr. C's reputation, that he "is the best around" and an expert in revisions.  Don was also impressed that, like himself, he was a football player, defensive  tackle . 
    We're supposed to get together for dinner, one of these days.  There's a new Italian restaurant in Cambridge.   

Seven Degrees of Separation

     Tuesday, Nov. 12. was my four month checkup for TKR of. left knee.  Dr. Congiusta asked if it was better than before.  I said yes.  I said there had been no pain at all in the knee, only minor pain in the lower shin and foot, and some numbness in the heel which has mostly resolved.  His assessment of the ROM showed 107 degrees, which is a little short of the 115 they aim for.  At P.T.,  the therapist tested the ROM at 121 degrees, but Dr. C. said he doesn't apply any pressure, a pain-free measurement. When I asked if there was still time to improve the ROM, he said most progress usually occurs in the first few months, but it may be possible to increase it, to continue my exercises.  
    Since he had told me before that after about 15 to 20 years or so, the plastic deteriorates or melds into the bone or something, I asked if that process would be incremental, constantly progressing, and he said no, that the patient usually doesn't even know, and that's why they take  X-rays every year or two.  He said the materials  are constantly improving and last longer, and mine will probably not need replacing.  (I wonder why!)  I said what if  I come back in 20 years and he's retired.  He said he'll be here---he has kids and college to think about.  He said he was glad that I was doing so well, and to return for one-year follow up in July, 2015.  Summertime!
      ( It's been four months since anyone besides the surgeon  has looked at, or even asked about, my knee, and that's pretty cursory if you have no problem. I think my TKR has set a record for generating the least amount of attention.  I am so blessed.)

TKR at 3 months Nov. 8, 2014

  Today marks the third month since my knee replacement surgery.  I've been finished with rehab since Sept. 11.  Contrary to much of what I've read, neither of my knees feels much different than before, minus the pain.  I have no sensation of their not being a natural part of my anatomy except when I kneel on them, and I think that may be getting  less noticeable also. 
  With my right knee last May, 2013,  I did not have a lot of pain, none at first, which I attribute to lasting effects of the nerve block administered,  which I think is really effective in my case.  After I started P.T., I would wake at night with dull toothache-like pain down my leg.  It lasted for about 3 weeks, I think.  With the second surgery, I have felt no pain at all in my knee, practically none at all of any kind in the hospital, where my records show I rated it 3 out of 10, and almost no pain at all ever since.  A few times I felt transient pain when I got home, 2 days after surgery, and it was in my foot, and then later minor pain in my lower shin.  But these pains were short-lasting.  By the time I would get to the kitchen to take a Tylenol, the pain would be gone. I couldn't believe that was all the pain there was, so I kept expecting it to appear at some later time, but so far it has not, and I'm eternally grateful.  I have 2 almost full bottles of Oxycodone, and they have not been refilled.
    I had an episode of what I thought was sciatic pain a few days after I got home on July 10,  self diagnosed, I may add.  But when I went for my 2-week checkup, the P.A. suspected it was ITB instead. The Visiting Nurse was familiar with the term, and she really helped me, by finding the troublesome spot.  The next day it was gone.  At my next visit, a month later, this time with the surgeon, I asked him if that were a usual occurrence.  He said no, and that the tendon had probably been stretched.  That was the word he used, "stretched."  I said no more, but think he might be a diagnostic genius, because that reminded me of what happened only 2 days after I was home from the hospital.  People were visiting, and I was walking around as usual, no walker or cane.  I went to put some empty soda cans out in the room  outside the kitchen where we recycle.  I stepped down the one step with my operated leg---and slid!  The cat had puked up a slimy hairball at the bottom of the step, and when my left foot stepped on it, the left leg flew straight out in front, with my weight landing on my right leg, which had buckled beneath me. My fleeting thought was that I'd ruined both knees, but I was lucky to be able to get right up  and say nothing about it.   I did forget (almost) until Dr. C. used the word "stretched." That leg couldn't have stretched any further out from my body.  It was rather eerie, almost as if he knew, but he'll never hear about it from me. 

The Walk

  Today I walked  the Mechanicville Breast Cancer Walk joining two grandsons who walked with the Hoosic Valley Junior National Honor Society.  The walk started at the Elks on Park Avenue, and wound around the city, by The Ugly Rooster, and past Talmadge Park before returning to the starting line.  No one seemed to know the exact distance, but estimated at 1.5 to 2 miles.  When I finished P.T. I filled out a before and after form which asked if I could easily walk a mile.  And the next question was about easily walking 2 miles.  I knew I could walk a mile, and now I can say I could walk 2 miles.  The weather was perfect, and the course was pretty flat with only one small inclined area, so all went well. 

My P.T.

    At 3 months post-op, my P.T. is pretty much confined to 100 steps of stair climbing.  That amounts to 10 counts of climbing the steps on the deck of the pool.  There are 5 steps, so 10 steps times the 10 climbs equals 100.  The only other steps available would be the 13 steps to the cellar, and that scenario is darker and more menacing.  When I get to the deck after my climb, I practice standing on one foot.  I'm getting a little better, but my sense of  balance sucks scissors.  Pathetic routine, but all I can muster.

Flu Shot Flummery

    Choices, options, decisions---Oh, no.   When you get your flu shot this year, be prepared.  It's not that simple.  In past years, I'd request a flu shot, and that was it.
     This year, besides the offering of the REGULAR flu shot, the CDC recommends offering the option of the HIGH DOSE FLU SHOT, specifically designed for those over 65, who may not respond as well to the REGULAR flu shot. The HIGH DOSE FLU SHOT  contains 4 times more antigen than the REGULAR flu shot.  The antigen is the part of the vaccine that stimulates our bodies to create antibodies to fight off viruses. 
     The QUADRIVALENT VACCINE  is another option, containing 4 strains of the flu instead of the traditional  3 strains.  FLUZONE QUAD it is called. 
     The NASAL VACCINE is available only to those under 50, so that's off the table, reducing the choices to just 3.  The pharmacist is youngish and eager to explain his craft.  He seems to think all over 65 could benefit from the Senior form, the HIGH DOSE vaccine.  But I ask why would they make it 4 times stronger, why not start off with 2 times stronger.  Why 4?   His answer amounts to something like just because that's what they did.  I opt for the FLUZONE QUAD instead.  That way I figure I'll be protected against more strains of the flu, though probably to a lesser degree.  Hey, you can't have everything.

September 26, 1964

  On this date, 50 years ago today, Dorothy Evelyn Madigan and Arthur Augustus King were married in Our Lady of Good Counsel Church in Valley Falls.   Amid hopes and dreams, with intrusion of reality. 

Final P.T. and The Sting

  Today was the last day of physical therapy at the  Massry Pavilion, a total of 9 sessions.  The fourth week ended up in limbo because the script, though written for 4 weeks, had an end date of Sept. 12, and I understand Medicare is fussy about those things. 
   The activities on machines have gotten progressively more challenging, but that's okay with me; today I did the weights on the leg lift machine with my left, weaker, leg, with 10 lb. weights, whereas I had been using both legs to lift 30 lbs.   The step and lunge exercises seem simple, but are surprisingly challenging; it' s harder without a machine to rage against.  Sandie measured the ROM at 118 degrees.  My other knee was at 127 when I finished PT last year, and I think it's more now, so I  still have room for improvement on the new knee.  My next appointment with the orthopedist is in November, but I think he'll be happy with my ROM as is. 
    Today, from my vantage point on the exercise bicycle, which is my first task, I spotted a former co-worker across the room, I think beginning his PT. I don't know what for, probably for some chronic condition like post-nasal drip judging from his voice.  As he crossed in front of me, he recognized me and said hello.  I returned his greeting, but I have no desire to talk to him, or with anybody else from that employ either. 

     Today's physical therapy was active enough to take my  mind off the remaining effects from yesterday's attack of the killer bees.   So that was a good thing. 
         I was using the hose to water the  few flowers in front of my house when I felt a sharp sting in my rear.  I knew it was a bee, and I've been stung several times before, but never more than once at a time.  I wasn't prepared to be covered with a whole bevy of bees.  Fortunately, or not, I was close to the house so I opened the front door to escape.  But as I started to enter, I knew I was not alone.  There were bees with me and on me.  Silent, direct, take-action bees.  They stung me right through my clothes, maybe even leaving their stingers in me, I'm not sure.  I closed the door behind me as I ran in, and trapped several bees in the space between the doors.  I took off half my clothes inside the doorway and ran into the bathroom to remove the rest.  I saw a bee stinging me as I took off my shirt, and brushed the thing away.  I put on a housecoat, walked into the kitchen, and was stung again, on my shoulder, under the robe.  Maybe in my hair?  So back to the bathroom to bend my head over and brush my hair out.   Now I see a bunch of bees gathering on the front windows.  I go back to the kitchen and find a fly swatter, but I hesitate. I did close the side front window and enclosed 2 bees in that space; there are more on the large picture window.  If I swat one, I wonder, are the others going to come get me.  I take a chance, swatting the most isolated, and throwing its corpse, or body if it's still alive, into the toilet bowl.  I do this a total of 8 times, for 8 bee bodies in the bowl.  I don't see any more, but I know they could be there.  I assess myself for stings, and count 7:  1 on my rear end, 1 on my shoulder, 1 on my right heel, 1 on my inner arm,  2 mid-arm and 1 on my arm near the wrist. 
    I try remedies to alleviate the stinging:  dish soap, hydrocortisone cream, toothpaste, baking soda and vinegar.  Somewhat soothed, I go to pick up my dropped clothes near the front door, and a bee flies out and gets me--for the final time, I hope. 
      The stinging is soothed, but through the night, the itching starts.  I could scratch forever, but I go through the above regimen again, and finally find relief with ice.  But in the morning, more of the itch.  I take donated Benadryl after I drive home, and hope for the best.

Week #2 at Massry

   This week brought more work on the machines, which I prefer to the step exercises.  I find it more comfortable to rage against the machines than to challenge my own body parts.  Sandie, the therapist, showed how to perform the knee bends lunges by bending one leg to 90 degree angle and then the other.  She brought her back knee almost to the floor,  which I call showing off.  But then, she's never had knee surgery.
    Next week will be my third and final week, though the orthopedist wrote the script for four weeks.  Vacation intervened and Medicare has strict guidelines for enforcing the end date.  I think I'm fine with what I have.  Further sessions would only increase the weights and the number of each exercise.  Of course, if need arises, I'm confident I could obtain another script.  Now that  the physical rehab is in one large space, I can see more patients, who are working with the other therapists.  The killer is the range of motion stretching exercise.  Some obviously suffer, and a few say they've had enough.  The only reason I could schedule one of my next week's sessions was that one man has not shown up for the last two of his sessions.  The wimp!

Endoscopy Danger

   I have undergone only one endoscopy in my lifetime, and it was done in the hospital.  But the gastroenterologist performing the procedure did so with one arm in a cast.  I was already hooked up to an IV when the nurse or tech or whatever told me that the doctor had slipped on the ice and broken his arm.  She said he had cancelled his colonoscopy procedures, but was doing endoscopies.    I remember asking which arm and was he right or left handed, but no one answered.  By the time he entered the room, I was too woozy to see which arm.  I'm lucky to be alive.

Massry Pavilion, Week 1, 8/29/2014

Finished my first week at the new location, courtesy of Dr. C's new script.  No more relaxing heat wraps, mostly work on machines, which is fine with me, except that the therapist keeps increasing the resistance and adding additional weights, which is more tiring.  I could do without the agility exercises, was never one for being agile.  The new location seems to be fine, plenty of parking spaces, more room inside, and has not been crowded, though first 3 sessions there were at 7:30 and 8:00 a.m.  Next week, I'm scheduled for 9:00 and 9:30 a.m., so maybe there will be more people at those times.  I look forward to it, except for the "stretching" part, which is really uncomfortable, and if I allow myself to say it, very painful.  Have to wait and see what happens.

Massry Pavilion

   Today was my first visit to the Massry Pavilion.  My appointment was at 7:30 A.M., so there was a fair amount of work-related traffic, especially apparent when making a left turn off Hoosick Street into the facility.  Next time, I think I'll go through the Frear Park Circle and so take a right turn off Hoosick.  I'm used to seeing a black pickup parked on the Circle and a man tending the flowers there.  I feel bad about driving there because I know the Lansingburgh  murder victim worked there as a landscaper, and I think the picture posted looks like him. 
   Because of the change, I was discharged from the facility at Samaritan, and registered as a new patient at the Massry Pavilion, having to fill out the requisite paperwork.  Security now is tighter, with employees tucked away in their bulletproof enclosures, and paperwork shuttled out to you.  The door to the therapy area is kept closed, and presumably secured.  I mentioned this change to Sandie and she said they never used to even think about security, but already this year they have had 2 "silver alerts." 
    Otherwise, things are pretty much the same.  The exercise bike is the same one I used at Samaritan, recognizable by a chip in the dashboard area.  I used the leg press today for the first time; no problem with any of the routines or exercises except the "zone of discomfort" that accompanies manual flexing, or rather stretching, of the knee.  My right knee was at 124 at this stage, where now the best I've achieved in the left is 115.  It seems like a wider discrepancy to me now, but maybe the right knee has improved.  The "experts" say 90 degrees is enough, all you need for rising from a chair, climbing stairs, or getting in or out of a car, but I would prefer that they match.

New Word

   I know that a number of new words have recently been added to the dictionary.  Most of them I've heard, but would doubt that are in the language  to stay.   I learned a new word today---intensivist---as in "St. Peter's has hired two new "intensivists."     Once you understand what a  hospitalist is, you're on your way to comprehending what an intensivist is. 

Working Out

  I've never worked out, am in horrible condition.  But, with all the P.T. which is focused only on the lower extremities,  I do believe I could leg-wrestle Arnold Schwartznegger and win.  My hamstrings are formidable.

Farewell to P.T. at Samaritan

    Today is the last day before the move.  I'd originally had an appointment for 8:30 a.m., but Sandie, the therapist, had a meeting so we'd  rescheduled.  I thought it was for 11:30 and I'd carefully noted it on my calendar, but I checked the time this morning before leaving and the time looked more like 10:30, blurry because I'd written the change over the old date. So I arrived at 11:00, knowing I was either 30 minutes early or late.  Turned out I was early; time was 11:30;  therapist was free, so we started and ended earlier than usual.  All for the good.  Seems strange, all the equipment, machines and "toys" are color coded with tape as to where they should go, to different locations of St. Peter's Health Partners.  There is some concern that there is too little space at the Massry Pavilion and not enough of some pieces of equipment, like exercise bicycles, for example.  Everybody seems to be experiencing what my mother used to call "the new school feeling."  When/if I  resume my therapy in 2 weeks, everything should be settled.  Or not...

TKR Week 5

  Went to P.T. this morning at 8:00 a.m.  Felt a little creaky, maybe because of the rainy weather, if that's indeed a factor.  Some new exercises aimed at different muscles--not too bad, though repetition makes them surprisingly tiring, especially if leg weights are added. For many of the step exercises, I have the strength, but am lacking in balance.  Thanks owed to the hand rails.  Range of motion still at 115 degrees, with "assistance."  Tomorrow is the last day for the therapy at Samaritan.  On Monday they will be relocated to Massry Pavilion. To make sure we patients can find our way, we were given a tote bag, red, emblazoned with "St. Peter's Health Care Partners."  I will add it to my collection of totes, which over the last 15 years has grown to about 30.  Most have Migrant emblem.  I don't carry the totes but they are useful for storage, file-wise.  St. Peter's also included a nice ball-point pen. 
   After the P.T., I drove to the Troy Ophthalmologist's office because I couldn't find my eyeglasses after last Friday's visit.  Their telephone service was out earlier in the week, so I dropped in, and sure enough, my glasses were there.  The tech always takes them to verify the diopter strength, and so we lose track.
     I drove up Hoosick Street through the city to the Ortho office on Empire Drive in East Greenbush for  a 5-week checkup with the surgeon.  All went well; he is very personable, as am I when it suits the need.  He showed me the X-rays taken at my 2-week visit.  Amazing when you think of it.  There are  those 3 artificial components clear as day inside my knee, and I have no awareness of them.  The before picture shows a bowed-out leg, (or maybe it's bowed-in).  At any rate it was crooked and now is straight.  Dr. C. said he took out all the bad stuff, and now there's no more arthritis. He said the kneecap had to be mostly removed, and fitted on the inside with a plastic "button,"  leaving only a thin original layer.  I said it was great that such procedures exist, because of the inevitability of further damage.  He said it never gets better, left alone.  He measured my range of motion at 100, and asked what the therapist got.  I said 115, but that she was much tougher, and inflicted much more pain to get that number.   He said that was good, because it shows it's possible to achieve. I mentioned that there was still some numbness in the heel and back of my foot and asked if it was usual.  He said it was not usual but probably the result of a nerve that was stretched and will most likely go away, as it does seem to be doing.  He wrote a new script for another 3-4 weeks. I'll miss the first week because we'll most likely be in Cape Cod.  When we return, the P.T. will be at the new site. And I see the Ortho Doc in 3 months----just before I shop for the Thanksgiving turkey.

Boneyard

    I had P.T. #6 today.  My ROM was 115 degrees.  The therapist told me Medicare is strict about requirements, and that if I miss a week, I can't add it on at the end.  I'll see Dr. C. on Wed., and he is to review the note the therapist faxed to him as to future sessions. Sandie thinks I should be fine. 
    When I got home, Dave was gone to his P.T. Ryan, the handyman, arrived to install a railing on the front step---for him, not me.  (I hate it even though I haven't seen it yet.)  He's been drilling for 2 solid hours now.  Dave just asked to borrow my reading glasses so he can adjust his hearing aid.  His glasses are out of adjustment, and he has "to bring them in."   Where I don't know since he bought them online.  He was unable to adjust his hearing aid, so he wants to make appointment "to bring them in."  That would be to the VA.  I think he bent the wire when he couldn't see. 
    So if we have 5 senses, it seems they're all impaired except for maybe the sense of taste.  But that bitter taste is growing every day.
  P.S.  1 may not like the idea of  the front railing, but it does look pretty good.  It looks like pressure-treated wood, probably could be painted.

P.T.August 7, 8 Sessions 4 & 5

   Due to scheduling constraints, I had 3 early morning sessions in a row this week.  No problem except waking up on time.  I missed Monday's: it was cold and dark and I didn't wake up until 8:00 a.m.   I got to spend more time in the machine room, which I prefer to the step-up exercises et al. 
    Sandie is very encouraging.  She calls my progress extraordinary.  It seems I need to pay for those encouraging words.  She wanted to check my progress against last year's but could not access Medical Records. She said some new hire accidently purged a number of files, and thinks that must be what happened to mine. 
    Personally, I think I'm performing  some of the exercises better than last year, because my left, unoperated, knee was not as flexible or strong as my right TKR is now.   But I think I'm quite a bit behind in range of motion. Lying flat, my knee is at 0 degrees, which is ideal, but when bending, the angle of flexion hovers a few degrees above 100, and that's with assistance.  When I was trying to confirm my rehab schedule before I left St. Peter's, the bozo in charge said I probably wouldn't need out-patient P.T. because I was already at 94 degrees, but he was in no position to tell me what to do.  Sandie says the optimum is 120, but I seem to remember being at 124, at least, last year. 
     Last year, I didn't have an appointment with the surgeon until 5 months after surgery, but this time the P.A. set an appointment with him for next week, week 5, probably because of the sciatic/ ITB issue.  That seems to have mostly resolved, except for some numbness in my heel and foot, which is still a little swollen.
   I originally had a script for 12 visits, but the  therapist at Samaritan says I should get a new one from the doctor.  That's if he wants me to continue with therapy.  She is writing in her notes to him that she recommends more work on my flexion.  So it's wait and see.  I hope I get to see their new facility.  Everyone seems a little nervous about the move.  The therapists at Samaritan will join forces with the therapy staff from Seton Health already at the Massry Pavilion. 
  

P.T. Changes

   Today was my third visit at Samaritan's rehabilitation facility.  The therapist I had been assigned is on vacation this week, so Sandie, the therapist I worked with last year, is filling in for her.   She is very encouraging and thinks my 104 degrees of flexion  is very good.  I spent 5 minutes on the exercise bike, and I found it encouraging that I was able to ride with no problem, though no resistance either. I don't care about building muscle; I just want to be  able to do something for exercise.
     Several signs were posted at the desk, informing that after August 18, the facility will no longer exist at Samaritan, but will be moved to the Massry Pavilion on Hoosick Street.  Everything medical is changing and being consolidated.  Hospital employees are suffering from low esteem, I'm told,  not knowing where they may or may not be working next.  A change for the better goes the mantra, but maybe that isn't true of all change.  Time will tell, or maybe it won't.

Office Visit

    "Don't sit by me, Don't sit by me, Please, don't sit by me,"   was the refrain running through my head in the waiting room.  The office was quite full, with patients for the 2 doctors seeing patients that day.  I was there for a follow-up visit, with some minor issues, but when I looked around at the other patients, I felt pretty darn healthy.  A little old man, bent over and appearing almost blind, said, when the nurse greeted him, that he was not doing well.  An extremely obese woman with a walker waited patiently, and across from her sat another woman with a walker/cart that could have held all her earthly belongings.  She was looking through a magazine, and by that I mean she was carefully separating each page, viewing it briefly, and then on to the next page, one by one.  A youngish woman in a wheelchair entered, accompanied by another woman, probably her mother.  The younger woman had only one leg.  A  man sat in the corner, wearing a wrist brace, but appearing otherwise normal.  The room was quiet. 
       The only conversation came from one man, middle-aged, who spoke continually the entire time, but not to anyone else.  He seemed to be speaking from a collection of past thoughts or impressions,  stream-of-consciousness it would be called in the literary world:   "snowballs, stones, bridging the boundaries; They don't tolerate no nonsense; lots of forms, 1971, The pleasure is all mine; Go East but Boston is West; I knew this was coming; I'm radioactive; anthrax; bubble about the moon rays; tar and feathers; murderer, burglar; Wynantskill psychopath."    He spoke fairly softly and no one seemed to notice.  When the nurse called him by name, he looked around:  "Who, me?  I thought you meant the other guy."  He entered into the chamber, never to be seen again.
    My silent plea that the seat next to me remain empty was triggered by the last patient to hobble into  the waiting room while I was still there.  He wore a polo shirt and khaki shorts, and the largest and most prominent catheter bag ever to make a public appearance.  Everything was outside his clothing, including the tubing and the collection bag, about half filled with freely flowing urine.  He really didn't look well at all, and I felt sorry for him and the other patients as well.  I also felt a little sick, and wanted to be home.
    I noticed that the other doctor visited the water cooler twice while I was there.  I thought at first that he might be getting water for a patient, but he drank it all himself.  This must be  tough job.

I'm not the only one...

  In my musings, I have been trying to understand how anesthesia works.  Especially the kind of anesthesia where it's said you are awake and responsive, but have no memory of it afterwards; you have amnesia.  I can only think that if this is true, brain cells must have been destroyed, kind of a virtual  lobotomy.  I have tried to ask anesthesiologists about how this works, but to no avail.  They just don't answer.  In the mandated pre-surgical "consult" the anesthesiologist wants only to employ her or his skills, namely to render you unconscious so they can get on with their job, and the next patient.  I've asked a nurse, and she answered, indicating that the "awake and responsive" is merely a medical term, not meaning what most would think.  She had no documentation for her reasoning, however. 
   Now I read that some are tracing the dementia they are experiencing to the effects of anesthesia.  One man says after being administered Versid he lost  memory of  all that happened for several weeks afterwards.  Another claims to have sporadic episodes of dementia which he attributes to surgical anesthesia.  Evidently, the relationship between dementia and anesthesia is under study, though it would seem sponsorship of such studies would be hard to come by, certainly not from any of the pharmaceutical or medical communities. 
    I have always thought that if something can essentially destroy the function of  brain cells, how can that function ever be recovered?   (During the preparations for my last surgery,when the anesthesiologist was present, as well as several other attendants,  I recall those dread white stockings being  put on my legs, and then other measures being taken.  I asked if this was the part that I would have no memory of later.  Someone answered yes, and I said it seems like I would remember.  And then nothing.  It's probable that I woke up less smart than before. 

July 31, 2014 PT O.P. #2

 Today was my second out-patient PT session.  My knee flexed to 94-97 degrees.  I think it should be greater, but Kathleen, the therapist, says it's good.  She will be on vacation next week, and I'll see Sandi, the therapist I had last year.  I'll ask her where I should be.  Today, besides the equipment (or toy) room, I went into the machine room to work out on some step glider piece of equipment, only for 5 minutes.  I burned 17 calories. Yesterday when I got home, I tried my exercise bike and found my  knee  can make the rotation. Yay!

Pain in the Butt

You might think you have sciatic pain, but you might be wrong.  You might have iliotibial band syndrome, IBS,  which causes your piraformis muscle to be impinged on.   Thought I knew all the body parts likely to cause a problem, but I was wrong.  Good news is successful treatment is available.

Hind Sight

     "Then the law is a ass," wrote Charles Dickens.  I might add, "Medicine is a ass."  I went for a follow-up visit to the specialist who had advised that my status as glaucoma suspect had in his opinion progressed to glaucoma, though of the low or normal tension variety.  I wasn't convinced but agreed, finally, to the SLT, after doing research which indicated it was pretty much risk-free if not always helpful.  So I asked the esteemed doctor a few questions, which seemed reasonable to me, but the answers were either  non-existent or off-base enough as to be meaningless.  He asked, as does his office mate, "What's new?"   Well, what do you want to know? In regard to what? would be my question.  But I mention a few symptoms and he says I should tell them to Dr. S.  I do know the difference between the cornea and the retina, but can't always sort out which symptom goes with what part.  He hunches over the computer and says that the eye pressure is lower than before, but not as low as he would like. My eyes, as usual, fall to his feet; I notice he is wearing a black  leather ankle brace, and wonder if he is in much pain.  The tech had previously told me my eye pressure was 12 and his "target" pressure was 11. I know that eye pressure means nothing in itself.  High can be OK and low can be not OK.  Eye pressure measurements just happen to be a "best test" in assessing the health of the optic nerve.  I ask if all today's testing and pictures show if the optic nerve shows any more damage, but he doesn't respond.   Since I'd had  laser for retinal tear (in other eye) since I'd last seen him, I asked about the effect of physical therapy as possibly being detrimental, since the eye has had 2 tears already.  He said to avoid any exercise that could possibly raise pressure and contribute to another tear, like lifting something heavy for 3 hours or more.  He added to likewise avoid the type of yoga where the head is lowered for several hours.  The ass.  How helpful is that.  Maybe his research paper on oral sex among orangutans was well received by his peers, but he could have spent his time studying human eyes. 
    I mention that my vision is blurry in the mornings.  He believes it to be from the so-called "secondary cataract" and says that is a simple fix with a laser.  I say I think it may be from Fuchs' Dystrophy, but he says that blurriness is not a usual symptom.  All of the renowned ophthalmologists and about 5,000 members of the Corneal Dystrophy Foundation would strongly disagree, and I know he is wrong.  I say nothing, but start to lose trust in  his decisions. He obviously doesn't keep up with latest ophthalmic developments because I'd just read an article on Fuchs' in his waiting room.  If it's true that when all you have is a hammer, everything looks like a nail, then it must be true that when all you have is a laser, everything looks like it needs lasering.

July 28, 2014 Out-Patient P.T.

Physical Therapy, for the uninitiated, is surprisingly hands-off.  The therapist observes and instructs, the patient does the work, pretty much at their own pace.  At my first session today, the therapy was the first human contact I'd had where the person trying to help didn't have a blade in their hand. 

July 23, 2014

  Last night was miserable, not because of any pain in the knee, but because of the nagging discomfort from hip down outside of leg to foot.  I took my quota of aspirin and Tylenol, used ice pack, but somewhere in the early morning hours contemplated taking some Percocet.  I think it may  help me sleep, but the next day my stomach is upset which has happened 2 out of the last 3 times, so I lay there weighing the positive against the negative, and eventually fell asleep without having to make any decision.
   This morning the sciatic pain or the iliatibial band discomfort was still there, and I'm getting tired of it.  It strikes me that what totally occupies my  every waking moment is of zero interest to anyone else in the world.  But wait.  The therapist from The Eddy is to come this morning.  She has to care.  That's her job.  So I tell her that when the tension is affecting the side of my leg that I don't think I should do any of the routine exercises, even though I have already reached a satisfactory level.  I tell her what Michael the P.A. at Ortho NY said yesterday about the ilial band or whatever.  She knew immediately what he meant, and isolated the exact spot where the pain originated.  She left me with some exercises for that condition.  When I asked what could be a possible cause, if that is indeed the correct diagnosis, she said it's usually from a strain or overuse.  So I'm hopeful that this was only a minor bump on the road to recovery.  As a matter of fact, when she isolated the "trigger spot" and worked on it a little, it felt better.  And that feeling I had that something needed to "crack" or move out of the way seems to have dissipated.  Maybe chiropractors are effective after all.
      At discharge from the hospital, you are instructed to contact the surgeon's office for follow up care.   Two weeks later, when you visit the doctor's office (P.A.) you are given a script, and the back sheet has a list of providers for Rehab, at least 20 different offices, and it's up to you where you choose to go,  there or elsewhere.    Some come highly recommended, but I'm leaning toward the familiar.  Sometimes I wish I were as important as the POTUS: it would be a relief to delegate.

Postage Please

   I had FU for knee today.  I was supposed to see Rich Dalaba, but he wasn't there, so had to see another P.A.  As per my home therapist, I asked about the missing Celebrex at the desk and then of the P.A. There was no record of any type that indicated someone from the office was going to mail some out, in lieu of waiting for the physicians review.  The P.A. gave me some anyway, a whole box actually, but he said he would advise against taking them as long as I was on aspirin, though my prescription list clearly stated to take both.
     When we got home, I went out to the mailbox and there was an envelope from Ortho Ny, with the samples of Celebrex inside.  Inside an inner envelope which bore the usps stamp RETURN TO SENDER; MUST HAVE POSTAGE AFFIXED.  If anyone needs Celebrex, let me kniow.

Default Complaint

   This morning the Patient Relations Representative called me to ask about the hospital experience which I had "issues" with.  I did indeed have several issues, but I'd only blogged about them, nothing public.  I had searched the St. Peter's website for responsible people and contact information, but found nothing other than an obscure blurb  that  confirmed the existence of a patient rep without revealing that person's name.  I called a number and was given a name, reluctantly it seemed.  So I did what I often do:  put my thoughts in letter form, and then stash it in a folder.
     So after I relayed to "Rosa" what my issues were, I asked her how she knew to contact me, as I hadn't made any contact  with them.  Yes, I had, she told me, through an email to the chief officer or administrator, and he had contacted her, as the patient representative.  This threw me somewhat, because I knew I'd been unable to recover  either an email or the name of any higher-up.  I started to think that maybe I had been in one of those drug-induced amnesia states, the kind I don't believe in, but what could the explanation be.  I didn't regret their receiving my complaint; I believe people should do their jobs, and those who hold a position of  responsibility  should carry out their function.  But I was sure I hadn't sent an email.   My brain got wracked again, and then I recalled telling the intake coordinator from The Eddy about my health concerns due to the lack of sanitary measures there.  She'd told me I should write a letter, to the head of the hospital and also to the surgeon.  I said maybe, but that I didn't think they'd be interested. She was quite concerned about the risk of infection, and now that I think about it, her position is probably that of a "mandated reporter" (as mine was when an advocate for migrant affairs), and she probably felt required to do so.  But she must have used my name rather than hers?

July 21, 2014 Where am I?

    Knee-wise, I'm not sure.   It will be 2 weeks tomorrow since the left knee surgery.   For last year's TKR, I expected the worst, a lot of pain and a slow recovery.  When that didn't happen right away, I assumed it would come later, with a vengeance.  So I tried to stay humble and hoarded my oxycodone---for when I might really need it.  I know I was never overcome with pain, so I may have understated its presence.  I didn't chronicle pain level, and concede I may have had some.  I was so happy not to have been wracked with agonizing pain, I may have discounted what I did have.  I do remember during the out-patient weeks at Samaritan, especially when using the machines, my shin bone would throb at night, waking me up to take a Tylenol and wrap it up.  I recall that for the 4 1/2  days in the hospital, my pain level was mostly zero, but I was on an IV with pain meds and probably still feeling the effects of the epidural / spinal block.
    This time around is probably much the same, though I was in the hospital only 2 days before discharge in the morning of the 3rd day, and I had no IV since the first day.  I have had no pain in the knee itself, but was briefly awakened several nights with temporary pain in the top of my foot, which went away when I walked around and/or took a Tylenol.  Only 2 nights last week did I take a Percocet, at bedtime, mostly to help me sleep, which may or may not have happened.  Last Wednesday, I noticed a pain-like feeling on the outside of my leg from hip to ankle, mild at first, but building in aggravation  for the last 2 days.  I took another Percocet last night, which seemed to have no effect so for the first time I doubled up and took another, which is what the the Rx is: 1 or 2 every 4 hours.  This morning I felt light-headed and a little sick, maybe from the pills or possibly from eating dinner out--a rare event to eat rich food. 
     What bothers me is that I am not doing the exercises that cause the sciatic pain, and I'm afraid I'll lose the ground I've gained, primarily in degree of flexion.  For the past year, my sole exercise has been to ride about 20 minutes on my exercise bike most days.  I'd been unable to do that for years because my right knee could not make the rotation.  When that was "replaced" I could ride again; the left knee was never bad enough to keep me from riding.  A few days after I got home last week, I got on the bike, and though a little stiff, the left knee could make the circuit.  I tried again after the sciatic nerve became afflicted, thinking it might help to unkink it, but found I could not make the rotation.  So I concluded my knee was worse than before the surgery. Darn!
    Today when the P.T. was here, she said the knee was doing great, better than last week, as long as the exercises and measurements were not done with me in a sitting position.  She said the Celebrex would have helped with the inflammation of the sciatic nerve, but that is the one medicine that I don't have.  The Ortho office was to send me some samples as the drug should have had prior authorization which didn't happen and the review would take at least a week.  It should have been mailed last Tues. morning, but it never came.
   Tomorrow is my 2-week appointment with the P.A.   I'll ask if the office still has my Celebrex, or something else to help the sciatic pain.  I'm sure he'll say I can drive, which I've already done.  Who needs the left leg?  I won't tell him that, though.  And if, as last year, he asks me flat out if I'm glad I had it done, I might say I'm withholding judgment until I can ride the bike.  Maybe the sciatic pain will be gone tomorrow.  Where there's life, there's hope.
   

July 20, 2014

Where has summer gone?  Danny's here, stayed in last night, married life exacting its due, I guess.  Plan is to go to dinner this afternoon in honor of Dave's b'day.  Had a dream last night that a black bull gored a dairy cow to death along the sidelines of an  HVC sports rally.  I have nothing else to say.........

Catharsis---kinda, July 19, 2014

  Late last night, or early this morning, I wrote a letter.  Whether I'll send it or not, I don't know.  I wrote it to the Patient Relations Representative at St. Peter's Hospital.  Curiously, the position of any patient representative or advocate is notably obscured from view.  No one acknowledged such, a difference from my previous experience, where the patient met with an advocate pre-admission, and she provided assurances and contact information.  Nothing like that this time, not  a mention in the handouts of materials: I looked through each page.  Maybe this is why they receive few complaints, I think. 
     I searched the website and finally found a reference to patient representative, but when I opened the site, it merely mentioned that there was such, no name was given, only a telephone number to call.  I called the number to ask who the patient representative was and the person answering the phone gave only the tersest information.  "Who?" She gave a name. "How to contact? Email?"  She said by mail.  "Address?"  Stated an address.  ***  I'm the patient, dammit, looking for a representative--is that too much to ask?  Someone is getting paid for that position, one would assume.  Bring her into the light of day. 
    In any case,  I don't believe that contacting a patient representative can have any benefit for the concerns of a hospital patient.  I think the purpose of that position is to assess any potential for lawsuits, either through deflection or through gathering any contradictory or unsubstantiated bits of information. 

Physical Update

  I guess I should be grateful things are as good as they seem to be, if I can only get rid of that aura of darkness.  Most of the bruising in my upper leg and even in my foot has gone away.  I think of it as bruising, but am told it is pooled blood.  There can be considerable blood loss during knee replacement.  Some patients even store their own blood before surgery in case they need a transfusion.   My chart shows a loss of 150  ml but I don't know how much that is, never got into those liters, etc. I have never seen a single drop of blood, not even on the bandages, so they must do a thorough job of swiffering it away.   The swelling has decreased a lot.  If my foot has been elevated, I can start to see some of the veins reappearing. I have no pain in the knee itself, but still have a persistent sciatic misery down the left side from hip to ankle.  It goes away when walking or lying down, but sitting is uncomfortable.  I can't remember if it was there last time, on the right it would have been.   I know I had an epidural and a femoral nerve block, so am hoping the insult to nerves is only temporary.  My FU appt. is Tues., so I'll ask.  I'm coming more and more to the conclusion that it's not up to me  to make any one else's job easier. 

July 18, 2014 Status

I checked the mail today---no Celebrex, which was to have been mailed out from Ortho office Tues a.m.  Probably forgotten.  Lab report from St. Mary's as ordered from Dr. A., was inconclusive: he'll repeat if I wish.  What the heck, now I have to direct my own medical care, in addition to plotting my way into the hospital and then back home.  I want my mother, and my sister.  When my knees were obviously deteriorating, Dorothy said she could no longer have that surgery but thought I should have it.  I told her I was waiting for her to get strong enough to see me through it, but that didn't happen. 
    I have a vision of Dorothy sitting, waiting for me, in the hospital lobby, alone in the cold darkness of an early morning in late winter of 2003.  I had  arrived for surgery at 5:30  in the morning, and she, who was almost always running late, was already there, all by herself.  It meant so much.....

July 17, 2014

  I took another Percocet before bed last night, and slept through the night, or at least I think I did. Unless I woke up and then forgot.  Yesterday I called Dr. A's office to rule out any infection. The Eddy rep had urged me to do so, said she'd call for me if I wished, but I'm not used to that.  Dr. A sent script for lab test to St. Mary's.  I was there at 7:45 a.m., and have not been contacted, so maybe that's a good sign.
      My knee doesn't hurt at all, but if I sit too long or do stretching exercises, it seems the sciatic nerve on left side from hip to knee goes gnarly.  Aspirin and Tylenol have helped, and if not, I'll always have Percocet.   And no Celebrex via the usps yet either.  I'm so forgotten.

July 16, 2014

     Visiting Nurse from The Eddy was here for 2nd session.  More of the same exercises--leg lifts, toe pumps, bending---nothing too strenuous or difficult.  The only "challenge" is trying to increase the angle of knee flexion, which started at 90 degrees with goal of reaching 125 or so.  She seems anxious to come here for at least 2 more visits.  I told her I have appt. next Tues. with P.A. at Ortho, and I'm certain he'll clear me to drive.  I read in the manual that once you can drive you're not eligible for Home Visits, but she wants to come anyway. Most likely her pay is based on the number of visits.  It's OK with me, I'm very obliging that way. 
    The mail hasn't come, so no Celebrex as yet.  I guess I won't need it.  The therapist left at 1:30 and the house was empty.  I got the urge to drive my car, so toured around the village.  Detected no issues anywhere.  I figure if I'm not on the sofa with all my potential needed items within reach, and a refrigerator stocked with ready-to-eat meals, and all of the other recovering-from-surgery aids and accommodations, there is no reason to baby myself. 

Percocet

And so I took the vaunted pill last night.  No big deal as far as I could tell.  I think I did get more sleep, which was my goal.  Though the sleep was inhabited by Rosalia exclaiming about Thanksgiving dinner and me trying to find a big enough box to ship a rug.   I was aware of aching in my leg, but it didn't seem necessary to do anything about it, even get out of bed as I usually do. 

Wired

Is the term guard rail or guide rail?   Guide wire?  Guard wire?   Which is it?

R.Knee TKR at 1 week July 15, 2014

One week since the TKR, and I haven't dipped into the Percocet yet.  D. just said the pharmacist told him  that Percocet helps you to sleep, so I think I'll take one tonight.  Even without pain, I keep waking up after less than an hour, so maybe popping a pill or two can lift my mood a shade or  two.
    I did have that foot pain this morning, and I do hate that my foot is swollen.  I remember hating it last year too, seems the foot shouldn't even be involved. 
   I had an appointment to check on the retinal laser repair which Dr. Sax did the day before my knee surgery.  Dr. P. said all looked really good.  She is such  a breath of fresh air among the doctors  that I wonder how she even came to work there. 
  I'm anxious to know if my legs are now equal in length, but it's too early to tell for sure.  The swelling in the foot and leg precludes accurate measurement. I got so tired of bouncing against the walls of the hall in the morning before I had my shoes on, and of inserting a heelpad in my left shoe to bring it up to the almost half-inch discrepancy. 
   I pulled the bandage away, but the only thing visible are the steri-strips over the wound.  All looks clean and dry, but I have some concern with where the incision has been made.  The incision in the right knee is not down the middle of the knee, but a good distance to the side.  I'd read that way avoids cutting into some of the ligaments you need to preserve movement.  This time, the incision looks to be right down the middle of the knee.  I hope it works just as well.  I measured and the incision/scar on each knee is exactly the same length---six inches from above to below the kneecap. 
    I celebrated the one-week occasion by a few turns on the exercise bike.  Ouch.

Morpheus

  I wonder what it is about surgery, or anesthesia, or a new knee that eradicates the need for sleep.  I can fall asleep.  I just can't stay asleep. 

Formulary activated

     In May of this year, I was notified of new changes to my Prescription Plan, as per the new contract.  The letter says there will be changes to what we will be paying, as well as the addition of "step therapy."  All of this language was foreign  to me, though I pretty much knew the "changes" meant I would be paying more. We were invited to ask questions to help us understand, but  I let the matter rest  until it arose in real time.  The letter explained that the 3-Tiers allows us to make informed choices and encourages values when choosing prescriptions.  The Step-Therapy encourages judicious and appropriate use of medications.  Sounds as if it's for the good of the subscribers, but of course, it's just a way to cheapen the benefits.
   When I was discharged from the hospital last  Thursday, I was given scripts for 2 medications: Percoset and Celebrex.  The Rite Aid pharmacist said she could not fill the Celebrex Rx until she contacted the prescribing physician.  This drug needs "Prior Authorization."   The reason is to  protect the patients because these drugs have clinical value for only a narrowly defined population, they have potentially serious side effects if used inappropriately and have high potential for misuse or abuse due to consumer advertising or a general lack of understanding on how to use the drug most safely and effectively.  Take that, Celebrex!  Prior authorization "helps assure that the  clinical situation of the patient, including the underlying condition, is appropriate for the use of that particular drug."   "The process involves a  review by our pharmacy management clinical team."   All this to protect us. 
    Today, Monday July 14, I received a call from Ortho NY.  She said that the "process of review" typically takes a week or more, and that I would be off the Celebrex by then, so she kindly offered to send me some sample packets.  They'll be put in the mail Tuesday morning. 
It's so reassuring to know that we're being saved from Big Pharma by Big Insurance Co.  I hope Celebrex was not critical to my healing.  And now I know what that letter meant, and I didn't have to ask a single question.

JUDGING

  I can not place any confidence in a professional who wears gladiator sandals.

July 14, 2014 PT #1

  My first scheduled home visit from the Eddy was today.  If I'd expected essentially the same as last year, that was not to be.  OMG, I don't even know how to get out of it without cancelling the next step, which is the out patient PT, which last year was satisfactorily carried out at Samaritan. 
    That black cloud is still hanging overhead.  What DO I do?

A Dream Come True

    Some dreams really do come true.  I didn't say the good dreams, quite the contrary.  I had a dream earlier in the year, about undergoing a second knee surgery. It's always been an option, and a recommendation ever since my initial orthopedic visit about 12 years ago.  At the time, I was still uncertain as to whether I'd go through another surgery, even though the first surgery was about as as successful as possible.  But I had a dream.
      In the dream, I had had the second knee surgery. While the outcome wasn't clear, the circumstances surrounding it were entirely different from the positive feel of the  previous experience.  I was left in a much darker mood, one that woke me up feeling sad without knowing why.  Though it was only a dream, that exact dream mood has been with me from the day of surgery:  I can only describe it as feeling "low."   I don't quite understand what that even means.  Maybe it will become clear in another dream. 
        
    
    

July 14, 2014 Let's see now...

     This is the morning of the 6th day after surgery.   I have had no significant pain as yet.  Some discomfort, but no real pain, nothing to warrant a Percocet, or oxycodone, though I have a plentiful supply if there should be need.  I think part of the reason may be that the nerve block has not completely worn off yet, but that's only my feeling, no basis for it.
     I'm on my usual medications of  HCTZ 12.5 mg, which I've taken daily for several years, though admittedly not as faithfully as ordered.  I've taken a full-strength aspirin a day for several years, mainly for the arthritis which had been haunting my knees, and then just because it seemed like a good idea.  Doctors approved.  My Ortho instructions have doubled the aspirin dose; it is prescribed now as a blood thinner, to prevent clots. I also take Pepcid as needed, same as before.  I am prescribed Celebrex, but the pharmacy was unable to fill it without contacting the doctor, somebody from the hospital who I've neither seen nor heard of.  I was going to use Tylenol instead, but the visiting nurse said Celebrex is very effective for swelling, so bring it on if it works out that way.  I have 80 Oxycodone (Percocet) tablets, of which I can take "1 or 2 every 4 hours if needed for pain."  That seems like a very wide discretionary margin, but what do I know?  No wonder people become addicted.  But maybe that's not such a bad thing.
     This time, there was no passive motion machine which moved your operated leg for you.  I guess the results didn't compensate for its expense and inconvenience.  I didn't mind using it; you got the sense that something helpful might be occurring even during your inactive time.  The gizmos at the foot of the bed were still there, some type of inflatable cuff attached to the equipment and to the splint-like cuffs that were on your legs.  They were infrequently applied and never explained in any way.  They felt kind of good though, for the brief time they were available.  As before, they applied before the surgery, those white compression stockings, which are to be worn for weeks I understand, but can be removed twice a day or overnight or whatever.  They're difficult to put on if you take them off, and they can be even harder to take off.  I hope they're effective, because they're dreadful.  They say proper sizing is key, but what if the upper part of your legs is larger than the lower part; not everybody has pipe stem legs the same diameter on top as on bottom.  Oh, well.  I've dealt with it before and I can do it again. 
        Something new was a large, heavy, black leg brace that was applied right after surgery; I think I woke up wearing it.  They called it an IMMOBILIZER, which sounded to me like an Arnold Schwartzenegger movie.  And it was just as uncomfortable to wear as the movies were to watch.  It was heavy, dug into your skin when you sat in a chair, and put pressure on the incision.  Somebody must have come up with it as a good way to stabilize the knee post surgery, but the entire focus is on having you move your leg.  It must be all about that delicate balance that eludes us not privileged to know, but I would bet it's not going to last, not in its present format anyway.  so that's pretty much it for meds and equipment. 
      The pain-----for 2 nights I woke up with pain in the area at the top of my foot, kind of sharp and demanding of attention.  I got up and I think once I took a Tylenol, but the pain didn't last either time.  I think they put  your foot in some kind of vise during the surgery.  No one will tell you that; they say the heavy bruising is due to blood flow.  Well, maybe. 
     I'm feeling right now what seems like sciatic pain in my left hip and down  the outside of my leg.  I know the epidural and nerve block are put in the hip, and suppose that's why the pain now.  Maybe the nerve block is finally wearing off.  The top of the thigh muscle is a little sore at times, when I stretch it or do a lot of walking, especially outside. Once in a while, the stitches seem to be pulling a little under the bandage, but only minimal discomfort.  I'll take a Tylenol, and I'm pretty sure that will be enough.  I'm saving the big stuff for major knee pain, but so far all quiet on that front. 

 

Mind Lost in Time

  When I started searching the internet for information on knee replacement, I came across a number of  patient-authored, detailed journals.  Some described the entire hospital stay, including the surgical experience and what happened afterward.  I found it helpful and informative, and I thought I'd try to do the same.  I can only assume that the authors of the articles  had assistance because I failed miserably to write any consistent account.  I'd written several notations on a notepad, but, while some entries are clear, others are not.  The sequence is doubtful.  Some events I would have recalled; others would have been completely forgotten if I hadn't read them, though in reading them, I do remember.
      I had thought that I'd left the hospital the second morning after surgery without having seen the surgeon.  But my "journal" entry reveals that at some point, I had been walking, using the walker I suppose, and accompanied by someone, I also have to suppose, when the surgeon asked how I was doing.  I answered that the knee felt sideways.  His reply, according to my notes, was, "I can assure you that one thing we do not do is install knees sideways."   I told him that of course I didn't mean that the knee was sideways, but that I felt like I was veering  sideways when I was walking on it.  Ah, veering!  Wouldn't you think doctors would know the effects of anesthesia?

July 13, 2014 4;43.A.M.

  I'm sitting here, assessing my situation.  I can't sleep, don't feel like eating, but have no actual pain.  Last year, for the right knee surgery, I left the hospital on the morning of the 5th day, so in a few hours that much time will have elapsed, though I've now been home for 3 days.  My left leg looks a mess.  It is swollen from thigh to foot, with so much bruising and discoloration that it looks like a tractor ran over it.  The stitches beneath the wonderfully smooth bandage are pulling a little, but certainly not enough to warrant a Percocet.  I may be coming paranoid, as I'm more concerned right now that I may have a kidney infection and that my retina, lasered the day before surgery, is going to tear again.  I'm reminded that when our washing machine malfunctioned  a few days ago, we didn't call a repairman.  We ordered a new one.  When one of the parts goes, the others can't be far behind. 

Bright spot----Fernando

    He entered the hospital and signed in on the board in the room, under either Nurse or Tech.  I believe he was Tech.   "My name is Fernando," he told us, and then, "Fernando.  How many people do you know who are called Fernando?  It is different, my name.  You can go downstairs to the kitchen, the garage, anywhere in the hospital and how many are named John.  But Fernando, I am the only one."  He than told us he was feeling a little sad because he was turning 50 on Oct. 23.   I told him he didn't look that age, closer to 37 or so, true I think.  He was grateful and said he used to be a model.  I asked what he modeled and I thought  he said toys, but then he took a picture of himself out of his wallet and showed it to me.  He, shirtless and muscled at age 19,  and wearing what looked like a sailor hat.  I asked if he was a dancer, and he said yes, how did I know.  I didn't want to mention Chippendale's so I just said he looked like a dancer.  He added that for 15 years he had danced in almost all the shows in NYC, off-Broadway, naming Cats and several others.  I wondered if my nephew's wife would have known him, but then again she has probably come across more than one Fernando in her career.

I think I get it....July 12, 2014

      Christine, from the Eddy Visiting Nurse Program, came here today to  assess my status.  She asked how I liked St.. Peter's  new Orthopedic Wing, with private rooms, special beds and all that is needed to  make orthopedic recovery ideal. It was scheduled to open June 30, but unfortunately, I missed out on that as the move is 2 weeks behind schedule.  I related to her the more than several instances of subpar treatment, and she was appalled.  She wants me to write a letter, and said she herself may do the same.  Since I'm expecting as good a surgical result as last year at Samaritan, I told her I was reluctant to complain, now that it's in the past.  But she insisted that the surgeons should know.  I think they're already looking ahead to the new facility, and are just ready to forget the old.  I don't know how many surgeries are scheduled by Ortho NY in the next 2 weeks, but I would think it's a considerable number. 
   Since I'm feeling a little blurry, though I haven't even yet touched the Percocet, I'll list only Christine's major concern:   the risk of infection, ironically enough.
     The emphasis on joint replacement surgery is to avoid infection at all costs.  For 4 days before surgery, the patient is ordered to shower and shampoo as usual, and then wash and shower again using a prescription antibiotic cleanser.  Then for 2 or 3 days to apply the prescription ointment to the nostrils twice a day.  Sheets are to be clean the night before surgery as well as all clothing items after each shower.  It's kind of a pain, but I did it faithfully, wanting to avoid any prospect of infection. 
      I'm a little vague about what happened after the surgery, knowing only that it must have ended around noon,(11:01, I'm told) and that the surgeon reportedly said the  knee was in bad shape.   I can't remember whether I was alone when I was moved to what was to have been my room for the night.  But after my visitors had left, a  woman was moved into  the bed on the other side of the room, which was  definitely neither a private room nor one exclusively for orthopedic patients, even for the first night.   She was murmuring, probably post surgically, and there was no problem until the "visitor" arrived.  He was obviously impaired, probably about 10 years younger than she, and to put it mildly, not well groomed. Not that there's anything wrong with that.  What bothered me to some degree is that he walked into my side of the room and greeted me by name.  I returned his greeting, wondering how he knew my name. I had no idea who the other patient was  and I must say I was becoming uneasy. Men  in their  40's normally are not interested in befriending older women, and ulterior motive entered my mind.
       He made a quick trip into the PATIENTS ONLY BATHROOM, and returned more antic than before.   There is no  way to describe his speech other than ranting.  He must have repeated at least a dozen times that he didn't know where her cane was, resorting to increasing degrees of profanity to make his point .  Not that there's anything wrong with that either, I guess.  He was mumbling by now, and saying something about going out to return bottles and buying something.
      I had written 2 comments on a slip of paper and showed it to the nurse (Karen?) when she came into the room.  I wrote  that the visitor was impaired, and she readily agreed, saying she could tell by his eyes. My other written question was as to when visiting hours ended, and she said that unfortunately visiting hours never end, as per federal law.  I didn't know this, remembering those announcements over the PA system ordering visitors out at 8:30 or so, doesn't seem so long ago, actually.  She said that at a certain time, they lock all doors but the front entrance.  (I guess they haven't had enough hospital shootings yet because it's been years since you could walk into unlocked doors at schools, federal buildings, etc.)  I told her that I didn't want to stay in this room if that was the case, if he could leave, return and be there all night.  She said she'd relay my concern and that's when things escalated.  TBC
                                       Part II
    The nice young nurse reported back that unfortunately there were no other rooms available so I would have to stay there.  I said I wouldn't and would go sleep in the lounge.  I don't really know how this would come about because I had no idea where the lounge might be, or even if one existed, and also was just hours out from surgery and not quite able to even feel where my legs were.  But I found out from the Eddy rep today that I had inadvertently used the magic phrase----that I didn't feel safe there.  I said it because it happened to be true and I'd remembered that was one of the admission questions.  The visiting nurse said it's a prime responsibility of hospitals to insure the safety of patients and if anyone ever wants to make a point, just use the words, "I don't feel safe."
      Anyway, word came back that they had found another room, and so I was moved there.  I've no idea of the room number, but there was another patient already there.  Seems like a victory, but hold on.
      After a time, I needed to have whatever help was needed to go to the bathroom, so I pressed the beeper.  No response.  I'm attached to an IV line, not yet even cleared to get out of bed.  I pressed several more times.  I remember counting up to 7 but continued on well beyond that number.  No one responded.  The woman in the next bed spoke up:  "Would you try to be more considerate; I'm having serious surgery in the morning and am trying to rest."  I apologized for disturbing her, but said I needed to get a nurse, and asked if she would ring her buzzer. She did and within 15 seconds, the nurse, Ann, appeared. She was directed  over to me .  I asked her why she had not responded to my 7-8 calls.  (Actually more like 10-13 calls, but I didn't want to seem extreme.)   Ann was one of the few remaining old school nurses, 40+ years of nursing she let me know, and she took that tone. The tone that makes me see red, even half sedated.  "You're not my only patient, you know."   "But yet you responded to the other patient's beep. That seems like discrimination to me."  She goes deeper: "You're smarter  than that, " she says,  and then digging herself a bigger hole, said that she'd "already fulfilled one request for me."  Grrr.  ""Who are you to assess my intelligence, and is there a quota on requests a patient makes?"  She tried to maintain her position for a while, but all of a sudden she seemed to deflate, and said she agreed with me, that she'd been wrong.  So I got to go to the bathroom, or the nearest thing to it.  Another nurse came in later and said Ann had gone home, that she wasn't feeling well.  Too bad.  I didn't feel so hot myself.
     
   
       
      

Still July 7

    Surgery is scheduled tomorrow for 9:30 a.m.  I'm to be there at 6:30.  The "Patient's Guide"  explains that it is necessary to arrive 2 hours before surgery because "sometimes there are cancellations and your surgery may be earlier.  It allows for the nurses to accommodate all of your needs in preparing you for your surgery. But if the surgery is scheduled for 7:30 , you may report at 5:45 a.m."     The scheduler told me to arrive not 2, but 3, hours before surgery, so I guess all my needs will be well met.  *I later learned that while all other patients are to report 2 hours before surgery, it's 3 hours for orthopedic patients.

July 7, 2014

    I have to wait until at least 1:00 p.m. before calling to find out what time surgery is scheduled.  I'm not anxious to call, am in fact dreading it.  I kept my appointment this morning with Dr. Sax.  Everything seemed good since last Wednesday's episode, so I was somewhat surprised to find there was a "small retinal tear" which the good doctor lasered.  The procedure was uncomfortable, even painful, and I drove home relying on one eye only.  The doctor said to return in 3-4 weeks, but to call right away if I have any more floaters or flashers.  If so,  I suppose I'll have to alert the hospital staff so it won't seem I'm hallucinating.  Overall, I just feel lower than the proverbial snake's belly.  There must be  a snake in Proverbs, mustn't there?

Still July 6, 2014

     Well, the washing machine venture didn't pan out as hoped. The sale was so successful that Lowe's has their deliveries fully booked, so why bother now?  I'm not going to feel like doing any more laundry anyway, though I'm supposed to sleep on clean sheets  the night before.  OMG 
      I left the premises today for the first time in a while, all the way to Schaghticoke for some groceries, but didn't feel like cooking.  I bought corn on the cob just because it seemed cheap, at 5 for $1, cooked it, but didn't feel like eating it.
       Dave mowed the lawn and later found a tick on his leg, but it hadn't settled in yet.  I did my 15 minutes on the bike with no problems; it doesn't even seem  like exercise since I'm sitting down, and with no tension applied; I haven't wanted to blow anything out before my appliance arrives from Belgium or wherever.
         Some absolutely terrible Miley Cyrus Bangerz Tour show was being televised, in addition to Sunday Morning's pimp piece on Robin Thicke.  I tried to watch the new talent show, and decided I'm sick to death of a trite format with mediocre talent: an  African America, a country singer and a sexy young personage trying to be quirky.  I started  a crossword, but it wasn't the Rex Parker edition, so I soon lost interest.
     I heard a chilling story from Mass. which I can't even think about, and then I  learned that Chloe died in her sleep the night before last. 
      While I type, I notice a suspicious-looking spot on my arm.  I've been trying to build up my drastically low Vitamin D level by sitting in the sun for 10-15 minutes a day, and I think my arm has fallen victim.  I need to make an appointment with a dermatologist and that is not a pleasant task.  My original dermatologist in Bennington, the first I'd ever gone to, retired a few years ago. I visited another on Hoosick Street who was horribly obnoxious, and then one in Clifton Park, Dr. Hollywood, who may be competent enough but his practice is so patrician that he schedules follow-up appointments for over the phone, with an allotted time slot to call in. 
      Speaking of obnoxious, I have a morning  appointment with my favorite ophthalmologist. I can expect only good things from that visit.
   

July 6, 2014 Knee Placement

  Somewhere at some physical location is a knee with my name on it.  No, not an actual knee and not even the actual components, though they also exist somewhere as well.  I refer to the customized knee.  The words "customized knee" is not  an accurate description because the knee, meaning the components thereof, is not customized.  The only custom part is the guide, the tool that is used to  guide the cuts that are to be made into the bones.  It is designed from an MRI, and therefore can accurately (ideally)  show how much bone needs to be sliced away.  After the knee is cut open and the bones are exposed, this cutting jig aids the surgeon in where to make the cuts and how much to cut away.  The cutting blades are inserted into the slots built into the jig / guide.  In conjunction with this, there is an assortment of different sized components which are tested until one is a satisfactory (or ideal) fit.  They're numbered as to size.  My understanding is that the surgeon must bring several of each size, for the three different parts: femur, tibia and patella.  It is not one size fits all. 
    So somewhere, out there, is the all-important guide or jig. I read that they were made in Belgium; I don't know if that is still true, but I hope it has arrived safely at the proper orthopedic office, and that it is not forgotten.  That jig is mine alone, custom made for only me.  I don't think I'll claim it though; it may well be considered hazardous waste. 
      *****Several years ago, in my job, I was  at a dental office where a child was being fitted for spacers.  The aide carried  in a large compartmentalized tray with dozens and dozens of different sized spacer appliances, all arranged as to size.  She bumped her arm on one of the office machines and dropped the entire tray on the floor.  They said everything had to be re-sterilized as well as re-organized.  Sounded tedious to me.

July 6, 2014

     Ugh.  So little time, so much crap to do. I've given up on the idea of cleaning house, can do no more.  Who cares anyway?  Bring on the dumpsters when the time comes.  But it's a beautiful day,and let's see what's on the agenda:   I'm supposed to shower as usual for 3 days in a row and then again with a bottle of chlorhexdine, which is NOT to be used on "face, hair, underarms, or groin."  What else is there to wash, I ask you.  Then, in addition to all the other rules and restrictions relating to lifestyle and personal hygiene, something else new.   Mupirocin Ointment which you're  to apply to each nostril twice a day for 2 days before and 3 days after surgery.  All to prevent the spread of infections, which has to be a good thing, though annoying in its implementations. 
      We need to go get a washer.  I waited to see the ads in today's paper, but our newspaper delivery was mixed up today.   The advertising supplements for both papers were missing, replaced by a duplicate copy of the Times Union, and MISSING the critical "UNWIND" section which has the NYT Crossword, and is the only reason I get the paper.  So no ads and no X-word.  Grrr.
       There are no groceries in the house, and I want to see "Jersey Boys." I must recalibrate....
   
  

July 5, 2014

  Right about now, I don't know how I feel.  As with the other knee, I had pictures taken, sitting and standing to see how  crooked the legs are. Last year I was appalled at the deformity.  Yes, that's what they call it, medically.  This time, though the pictures are an ugly sight, I didn't feel so surprised. I guess I'm used to the horror.  I almost think I would feel a little better if I had more pain, in order to fully justify getting rid of it.  Oh, wait, the knee is not replaced, merely resurfaced. I rode for 15 minutes, covering 5 miles, today with minimal discomfort and circled the outside of the house a few times without having to call for assistance.  So.
     I think I feel more nervous this time around, probably mostly because I have a weaker support system.  But I guess that can't be helped, at least by me.  Snookie called this morning to wish me well, and Barbara called this afternoon.  It was good to hear from both of them. The mail brought a card from the Mass. Schroders, cute, with art from the kids.   But I stayed home all day, as I did yesterday. Maybe tomorrow I'll venture out.  We might have to go buy a washing machine: the old one seems to have given up the ghost, a victim of over-zealous workouts due to that clean-everything-before-I-die impulse.  
   I had registered for the MyHealth Patient Portal and today was able to view my labs from July 1, a very convenient program but also a little unsettling because not only this week's results are there, but a comprehensive collection of all  my medical procedures and visits for the last several years from all the doctors and hospitals in the ever-expanding system, including, even, surgical notes from TKR #1.  Of course the site is supposed to be secure, but that often turns out to be a fallible setup.  But then again, who in the whole Ethernet would be likely to care about matters that are of such supreme local indifference.
      Anyway, it doesn't look like any of the results will be obstacles to what has been set in motion.  A few tests slightly away from the norm, but almost all fell into the normal range.  The biggest surprise was my glucose level of 79, because I did buy a mixed bag of Reese's Peanut Butter Cups and KitKat bars (for the kids), and I did tie a double knot in the plastic bag, but then I punched a hole in the side.
    Elective surgery, or any surgery for that matter, is a lone and lonely venture. 

Field of Dreams

    With sleep being restless, what with all I have to do as well as all I've failed to do, the dream state has taken over.  The relevance of the dreams to real life is vague at best.  Last night seemed like a particularly long and all-encompassing struggle of many people to find a summer softball league for Maureen to play in, she being about 12 years of age, and deeply disappointed that her school was not offering such.  Dave had asked one of his doctors if he knew of any softball venue, but the doctor didn't, said he lived in the same school district, and  was in the same boat looking for a place for his daughter to play.  Last I recall. they were going to launch a search on Facebook.  Good luck!

Etymology July 5, 2014

Sawbones----another name for a doctor, who actually uses an actual saw to cut actual  bones.  Replacement, resurfacing---call it what you will----when  sharp saw meets hard bone, the chips begin to fly. 

July 2, 2014 " .....this way comes"

    I've been easing off on the exercise bike, not because it's uncomfortable, as it's not, but I just don't want to have anything drastic happen to my knee in case I do show up for surgery as scheduled.  I took my 5 mile, no tension, ride yesterday afternoon, but did nothing today. 

I want to deny this, but I fear I will be unable to continue to do so.  I've had a persistent floater in my right eye for much of the afternoon and evening.  I can see out of it fine, but the floater circulates around 11:00 o'clock on the eyeball.    I suppose I'll have to call the Doctors Eye tomorrow morning.  We'll see, or not.   (One thing I can't stand about the messages on the Fuchs' Friends site is that often, way too often, members will write something like "being in the dark" and then offer the "no pun intended" remark.  How precious, pretentious, and just plain icky.)  OMG, maybe my mood will change with the weather. Ever since the 1st of July...
  

July 3, 2014

 I had floater issues yesterday, off and on throughout most of the day, especially when at the computer.  Not a single large floater, but a variety of smaller sized ones--the usual black blob, the illusion that a gnat was flying by, an empty watch-stem configuration, but most ominous was that bug that seems suspended just to the upper right, as if caught in my hair.  I saw floaters when I woke up, so I called and got an appointment with Dr. Salgado.  I went through a series of tests with 2 different assistants, both male, before I saw Dr. S.  She said, in essence, there was no visible damage, but advised watching it closely, because of the presence of "lattice."  If any changes, call at once, weekend, or holiday.  She wanted to schedule a return visit with Dr. Sax.  I told of my other plans for next week, and she said to tell the doctor there to contact Dr. Sax if need.  But in the end, she found that Dr. Sax had a cancellation  for Monday at 9: a.m., so I was lucky, she said.  We'll see about that.
     Dr. Salg. said the IOP in my right eye today was 12. and checking my chart said Dr. Weiner is wanting  it to be 11.  So I'm almost there.  I've  have had no treatment in that eye, I told her, the SLT only in my left, which did not have a pressure check today.  I don't see the value in having an SLT to lower eye pressure only a single point, but as he said last visit, everything changes from time to time.
       (I can picture myself, lying in a hospital bed with my knee in a sling while having a laser procedure to my retina.  All I'd need is to have a kidney stone episode.  If I weren't so old, I'd laugh and laugh and ...
                                      So obviously "trained" in dealing with the elderly, she tries to explain the situation in terms that I can understand.  I had asked a question, which signaled to her that I knew nothing. She used the analogy of a cold to show that sometimes the onset of a scratchy throat signals that you are catching a cold and sometimes the scratchiness goes away without a cold developing.  So it goes with floaters: sometimes they can mean that a significant problem is developing, and at other times they are insignificant. (Just like sometimes a cigar is just a cigar, goes through my mind, but of course I don't say that.)   She then stresses that it is critical that I be on guard to note any change and immediately call to report such.  I point out that was why I was there; she confirms that I did the right thing.  Ever since the first day of this month, everything seems just plain stupid, and I don't exempt myself from the equation.  Any progress seems to be subsumed in a circular  pattern, like in those websites that keep bringing you back to the entry page, and blocking you from moving ahead.
    I had asked a question, about a possible association between one of the myriad of eye conditions and another.  She responds by saying that in all her years of practicing ophthalmology, she has never heard of such a thing.  And then she ices the generational cake:   "And I have been in practice for 10 years."  (Again, I don't point out what goes through my mind, that half of the underwear I have on is older than that.)
      I get the sense that she is deferring to her elders to some degree though.  She schedules a follow-up appointment with the esteemed Dr. Sax.  She says she doesn't want anything to be overlooked.  Remember that toy tin train set, the Honeymoon Express or whatever it was called, with the little train that went perpetually in a circle?
    

July 4, 2014

     "It's just another day."  That's what old people used to say about some holiday or momentous occasion that was so earthshakingly fascinating to us.  How could anyone say such a thing!  Christmas is coming, with all its secrets, Halloween with scariness and thrills, birthdays with cake and love, and, probably most anticipated of all, the opening of the Great Schaghticoke Fair.  Speculating and hoping and dreaming all rolled into one remarkable life experience.  "Same old thing," said the old people.  We, unable to comprehend, vowed never to feel that way; why would anyone want to?  In the ignorance of our youth, surrounded always by those who held similar values, the failure to be enthralled by life seemed to be a deliberate choice, a choice way beyond our ken.
      Life, if you live long enough, has a way of getting even, of making you humble, though too late to be of any value or consolation to those long-gone old people.  Isolation and loss levels the playing field, eventually, to a plane where the days all seem as one.  Minus the camaraderie of others who share the joy of expectation, life's color turns to gray.
     After childhood, a portion of our remaining time is spent in trying to recapture what we had for the next generation.  So much anticipation, preparation, and sharing of thoughts and ideas, almost, but not quite, as magical as the first time around.  After that cycle has run its course, and life's magic begins to be handed down yet again, comes the sameness of the days.   The old people have lost a critical connection.  There is no joy in looking forward to that which can only diminish.
    It is raining today, on the Fourth of July.  It's just another day, though a rainy one, which alters nothing.  I have anticipated nothing---no parade, nothing to decorate, no patriotic outfits to coordinate, no festivities to organize or attend, certainly no fireworks-------just another day.

Portentous

     Neuropathy is an insidious condition, one requiring adaptations, at least on a temporary basis.  So we assessed what help may be available, and found, first, the Rensselaer County TRIP program, which provides assistance on a labor-free basis.  A telephone call and then an email went unanswered for several weeks.  I do understand that they have a very limited number of employees, but we wanted  help as soon as possible so as to prevent any of the dreaded bathtub accidents that are so common.  So we found that there is similar help provided through the VA, free to veterans who have applied, no service-related disability  needed.  A call to them informed us that all that was needed was a script from his VA assigned doctor confirming the condition.  A call to that doctor said help would be forthcoming.
      Today was the day.  Both offices responded.  Good news and bad news.  The Rehabilitation Specialist from the Rens. Co. Home Access program arrived first.  What is chilling is what he mapped out as a plan for accessibility.  All that was asked for was the installation of grab bars for the tub and shower, to ease entry and exit and to avoid slipping and falling.  He presented a plan to widen the front step and install a ramp from the doorway to the driveway.  He said that was his job, to survey the scope of future needs.  It is good to know, but sickening to confront.   In the meantime, he said that installing grab bars should be no problem, and would be handled through contact with the Mini Home Repair specialist.  He left an application.
     Shortly after he left, a representative from the VA called and said they were shipping a set of 3 grab bars to us.  No charge, all we need to do is have them installed.  Coincidentally, the Rens. Co. specialist said the bars would be about $40 each, but installation would be free. 
   Moreover, the larger scale accessibility modifications, up to $25,000 are very affordable in that there is a 5-year recapture with payment deferred and being reduced at 20% each year, as long as we live in the house.  If the house is sold before the 5 year mark, then whatever percentage  of the loan is left would be due.  He said he doesn't read obituaries.  So we would pay nothing and the loan would decrease by 20% each year.  If we're both gone in 3 years, for example, only 40% would be owed, but not unless the house is sold, and the deed filed.
     So it's a lot of important and helpful information, and all involved could not have been any nicer, making it a smooth process, but it is one of the saddest days in a long time.

Parking at St. Peter's

    Another plus for Samaritan
     I encountered the banana-eating office rep  by chance in the Down elevator.  She was showing a couple to some venue, and seemed delighted to be able to "point the way" to Valet Parking Access, as she had previously promised.    She is, as self-proclaimed, more tactile than cerebral. I took this opportunity to try to clarify the parking situation. Things have changed:  the first lot is for (I have to say I have now forgotten.  Visitors?)  Patients are to take the new, second turn, which leads right into the hospital with no need to cross the road.  You can get your parking ticket validated and not have to pay the fee.  I ask what is the fee for visitors and she says $5.00.  Valet parking is free for patients, but $6.00 for visitors.  I told her I had parked in the first lot/garage, and she said that was fine; it happens all the time. 
     When I got home and said if anyone wants to visit, they'll have to shell out at least 5 bucks, he said he could be a patient......