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.