Monday, May 30, 2016

Better the Second Time

I've just been killing some time answering a question. I've had to go back through old blog postings, starting after March 2nd, the day of the first surgery. I know some things were worse the second time, and some things  just seemed worse the second time, and some actually seemed better. I wanted to try to figure out what was real from what was well-medicated memory.

There are differences even with the medication. I started with a higher dosage, leaving the hospital, and taking those more frequently. It took a while to ease back and sort out a schedule, both. This time I had the 6-hour-thing already set, and added in the ibuprofin even earlier - I think - than before. But results have been a bit mixed, partly because starting points have been different, and partly, I'm told, because the second knee is just ... different.

I'm in better shape this time. Most of you might have been in worse shape this soom after the first knee, having to back off from old activity levels. In my case I has already backed off from activity levels so far that crossing the house itself made me feel ill before the first surgery. By the 10 weeks to the 2nd surgery I had developed some stamina as well as some strength. I could walk, for example, from wherever the car was parked all the way through to the PT waiting room without a couple stops on the way. I still needed / need the walker, but it's not a full 2 weeks yet. Patience! I am, however, looking forward to a quicker trip down the hall, or being able to carry a hot cup or plate with me from the kitchen. Or just a full one, any temperature.

(Note: I took an extra couple days before posting this - part ennui, part caffeine deprivation - to wait and make it exactly 2 weeks.  Yesterday was still a bit soon. Still some walking pain, a bit of a wobble on a sudden corner after bumping the other knee. But today is just perfect, so yes, I'm again walker-free at the two weeks mark.)

The arms retained much of the strength gained from pushing my up out of a chair after the 1st knee, and quickly returned to needed strength. The habit had already been mostly lost, however, as at 10 weeks I was mostly rocking rather than pushing off to a stand. While I was getting back into automatic on that, I managed the second go-through to avoid hitting my head on the bathroom towel bar, strategically placed by the previous thoughtful owner in the exact space necessary to make that a challenge. Muscle memory!

While most of sitting/standing was better, there have been a couple new issues. There is a muscle clump on the back of that thigh which contains a nerve which pinches every time I sit quickly. Since most of my sitting on a toilet is done when I am in a hurry, this is a frequent problem. If I hold myself up off the toilet seat too long, other unwanted things occur. Standing is also still painful, but I have to keep reminding myself how short a time into the process it still is. It's quite likely I'm doing better than before.

I have PT later this afternoon. I will be getting ready by having my first real self-cleaning session at the kitchen sink. Yes, still keeping the incision area dry, still letting the counter handle my weight and balance for me. I think this is right on schedule from last time.

I hadn't noticed how much definition I either kept or quickly regained in the first foot. About all I had noticed those first couple weeks was how dirty it was, how long the ink stayed before getting washed off, how long it took to put my own sock back on. All I see so far are the differences in how puffy the second foot got in the first place. I referred to it as a fat sausage with tiny wiggly toes on the end. Now it moves internally, not just as a whole swollen tube; the toes seem to be emerging from the sausage, gaining in length, and those major bulges under which vessels and tissues hide are taking on definition. Not there yet, but progress. Since I can't compare it to the first surgery, this time I'll just happily be satisfied in its progress compared to itself. After all, not two weeks yet, remember?

Swelling on the whole was more widespread this time, I believe. I hadn't noted it much the first go round, so it's hard to compare, but I recall being surprised at how wide the whole joint was. Along with that, it seems to have been more difficult managing to bend it, but that can better be checked by comparing PT records. They're in my file, kept together as a whole, so I can ask. Where the pain is located is some different this time, complicated by that pinched nerve in my back since junior high being located on this side now. I have to be sure to lie down for short periods to ease that one, but at least I know the routine for it and add it into the home PT schedule accordingly.

(Another delayed info post: After checking all my numbers with my therapist, I find everything pretty much on track with last time. One kind of bend may be a degree off one way, a different one a degree off the other. Average is on schedule!)

It only took me a few days to be able to locate a comfy spot for the operated knee the first time through. It's still not happening, but I have the use of the lift chair for sleeping after giving up completely on finding something that works. While this is not what I'd call progress, I'm at least better prepared to deal with it, and by the time I have given up, the back is relaxed enough that the lift chair is again comfortable. I'n knocking this up to the first knee having something "normal" to bump up and snuggle against. The second knee is not finding that.

I'm using ice packs less this time around, and needing them less. I hope that's progress and not just stubbornness. Cold packs likely will regain their appeal as the summer heat, long delayed this spring, reaches back up into the three digits, forecast for early June now. I remember the packs cooling all of me down.  Speaking of which, I am not having the problem - at least not yet - of being unable to control body temperature. How much of that was caused by which factors last time we may never know, but I'm aware and prepared, even to the drastic step of turning on the house AC. (Hey, had to do it 4X already this month!)

Back to those meds: the lower dose seems to be meeting my needs, though I add a half tablet back in the midnight dose to make it 7.5 to enable sleep. Back to the first time, nighttime doses were 10 with days at 7.5, and I do not know if that's what made the difference with side sleeping or if other factors were at work. I do know, reading back, that the side effects are lessened this go round. While dreams are still highly improbable, I seldom wake with the feeling of actually holding something in my hands. I'm doing much less subjective time-jumping, and what I do now is much more closely related to a few minutes of a nap than flashing out, flashing in.

I am getting better at recognizing the odd new symptoms as my body trying to tell me to take a nap. That can include sudden and subtle not-well-ness, restless legs, inability for make a 5 or 10 second short term memory. It was always just a feeling of tiredness, gritty eyelids, and I was off to Neverland: bing! Whether this is a long-term change or just from the meds remains to be seen. We'll also see if I can wake from what seems like a couple hours nap and find the clock taunting me with having moved only ten minutes. This too may be from the meds.

On the whole, what can be measured at this point seems to be the same or even better than last go-round. I'll settle for that. Staples come out Friday, the 2 1/2 week point, and I'm more than ready for a date with the pool!

And the shower too.

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