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TKR Two (almost) matching knees at last!

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Yay!--put the kid to work. :wink:
 
Had a rough night. Had been able to stretch my waking-hour Norcos out to 6-hr. intervals. Was on my feet cooking (crab cakes from scratch), and I might have paid dearly for it. When I was in rehab, I'd slept 6-8 hrs. at a time on 2 Norcos, and since I'd taken only 3 all day yesterday I decided to split the difference with 1-1/2 at midnight. Got 2 hrs. of sleep until Bob came upstairs. Despite my earplugs and the A/C cranked, his snoring woke me and because he slept diagonally, leaving me with 1/4 of a king size bed), he kept kicking and bumping me. Couldn't fall back asleep, as my leg ached deeply. Got up and took another Norco at 4:30, and pleaded with him to give me more room--so he got up angrily at 6, saying I was waking him up, and went off to work(!). Tossed and turned, with occasional nightmares, till 9:30am when I took another Norco--and spent a sleepless hour while my leg spasmed deeply from rump to ankle. Came downstairs to find my housekeeper took the day off because of a sinus headache (which I also had)--she was off yesterday for her husband's medical appointments and will be off all weekend. So I looked at the sink full of dirty dishes and the three cats clamoring to be fed (each of them needs to be fed a different food in a different room) and just sobbed. Went to the bathroom and sat down w/o looking--either my husband or son had removed the booster seat from our fashionably-low-slung toilet and failed to replace it. Son's friend had come over to give our senior cat his hydration infusion, so she did the dishes. Heck with the vacuuming, beds & laundry. (I know I sound like a spoiled-rotten brat). Lay down to ice & elevate, and my back and hamstring were throbbing. (The higher I elevate, the worse it hurts). Then my satellite box's internal breaker tripped and I spent the next hour rebooting it.

Had my last home PT visit. I was sure I'd lost all the ROM progress I'd made Monday, but I did manage to get 105 degrees of flex. Told my therapist about the pain and he suggested it was the falling barometric pressure coupled with dehydration. Mea culpa on the latter--dunno why I can't seem to drink more than a glass or two a day. So I iced and elevated till the phone began constantly ringing and neighbors & deliverymen came to the door (always at the same time).

So I did a crossword puzzle, paid a couple of bills, and decided to just veg out till my next Norco at dinnertime. Whatever happens, happens. But I am trying to down a liter of water by then.
 
What a difference a few hours makes. Bob & I texted each other (practically simultaneously) apologizing for last night. He managed to get enough work done early that he can take most of the weekend off. He promises to sleep parallel to me at least when he gets into bed; I promised to realize that I can make up for insomnia by napping. But just to be on the safe side, he's going to look into a dental anti-snoring appliance or CPAP; and I just ordered a memory-foam mattress topper for the daybed downstairs so that whoever of us needs to sleep there occasionally can be comfy. He brought home a peace offering of fish & chips and non-alcoholic dark beer, so we ate together at home for the first time in a week. (I could barely get through half my meal, so Gordy will have something to nosh when he gets back from the Pearl Jam concert). Speaking of fish & chips, it was the first batter-fried food I've tried since January. Let me tell you, it works nearly as well as do prunes...
 
The C-Pap machine is a blessed tool. My husband has had one for about the last 8-9 years. Not only do I not have to hear him snore, but his sleep apnea is not shortening his life which I guess is the better deal.
 
Remember the old adage, "Physician, heal thyself?" Bob won't take the time off to do a sleep study to determine why he snores--he claims he doesn't have the night to spare and doesn't want to do the co-pay. I had a sleep study last year at my peri-op internist's insistence when she noticed my "throat was crowded." It didn't reveal apnea per se but instead "multiple brief awakenings." Well, duh--ever since I was a kid and developed sinus problems, I automatically turn over whenever one nostril fills up, which was what happened in the sleep lab. (Which was across the street from NWMemorial, in a luxury hotel--designer linens, Tempur-Pedic/sleep number bed, flat screen TV, wi-fi, and a bathroom to die for: all marble & granite, with hi-velocity multi-nozzle shower and hairdryer--both of which had digital temp controls. Irony was that for thousands of bucks per night, one would expect to be able to check in before 9pm and not have to check out at 7am--much less have to buy my own morning latte)!

So I opted, rather than get a CPAP, to follow the internist's advice to spend a little more and get a nighttime bite-adjuster to move my lower jaw forward and open my airway. Worked fine the first night, but each progressive morning the TMJ pain when I removed it was more intense and lasted longer; by the fourth morning the TMJ didn't abate for several days. So I took it back to the dentist, and he's having the lab remake it after he took new impressions. I don't think it'd work for Bob, who already has a bit of an underbite. We might end up with his & hers CPAPs or BiPAPs.

Anyway, yesterday I took my midday Norco (and 2 Tylenol) at 4.5 hrs in order to facilitate my last in-home PT session, but after that decided to space it out to 6 hrs. At midnight, I took one and a whole valium. Didn't awaken till nearly 8 am! So I think that'll be the key on non-PT days--6 hr intervals during waking hrs., take something for sleep other than doubling up the Norco, and sleep as long as I can. Meanwhile, though, the downside is that I still can't sleep on either side without deep knee aches, so I sleep on my back--but that is making my lower back rather sore. But if I use a wedge beneath my knees to prevent back strain, that'll inhibit knee extension. I don't want to get one of those disabling back spasms that comes every 1-2 yrs. and throws me out of commission for at least a week or two. (And it's been 16 mos. since my last one, so I'm "ripe"). So I'm icing again--but this time my back and not my knee. And this recliner is not the best thing for my back, either; I have to prop myself up with pillows to be sitting properly with my legs up. I will ask my PT (same one I had for "prehab") what exercises I can do or positions I can take for my back that won't aggravate my knees and vice versa. I suspect there'll be some compromise--one or both will hurt nonetheless.
 
As Roseanne Roseannadanna used to say, "It's always something."
 
Another milestone--went to dinner down in Lincoln Park tonight, meeting Bob there. (He was stuck on S. Lake Shore in Phish concert traffic, so he couldn't come and get me and still make our reservation in time). Rather than kill time ordering a taxi online, I walked to the corner and hailed one. I was able to sit in the back, though it was a tight squeeze getting in! And had my first glass of wine in almost 6 weeks (a Sancerre, with a cold seafood platter). I let Bob drive us home, though--didn't want to press my luck. My knee aches a bit, but certainly not enough to take my Norco before 6 hrs. are up.
 
My husband and I both have CPAP machines and it has made all the difference in our sleep. He's the big snorer and sometimes can manage to snore through his mask. We highly recommend them.

Dorothy
 
First outpatient PT session at the same gym and with the same therapist I had for "prehab." Had a crisis this morning with a sofa order that was cancelled suddenly when the model was discontinued; then discovered to my horror that within less than 48 hrs. a healthy and copiously-bearing raspberry cane in my garden had completely withered, dried up and died (sort of like that gourd in the story of Jonah); and that several of my herb plants had been trampled, most likely by my neighbor's fence-installation workmen. Was so frazzled that I forgot to take my pre-PT meds and got to the facility >4 hrs. after my last Norco.

Bad news was that my flexion was only 102. Good news is that this therapist measures only the flexion I can do on my own without pain, without any assistance from her. (My rehab and home therapists measured only passive flexion, with them doing the pushing). She says that had she pushed I probably would have gotten closer to 110 but she doesn't believe in pushing post-TKR patients. She was pleasantly surprised that I had almost no swelling, and said I was fine for 6 weeks out. Most of the session consisted of initial evaluation and massage to un-knot some trigger points along my hamstring--far gentler than the lymphatic massage I had last year. No NuStep or bike (recumbent or upright) today, but she dismissed my concern about not being able to do a full pedal revolution on my upright--whereas by this time last year I was already able to do 15 min. with resistance, at 70 RPM. She says to still use the upright as a stretching device, and that Wed. I will warm up on the NuStep. She sent me home with a printed sheet of exercises, most of which I've been doing on my off-days anyway, and a leg-strap so that I can do hamstring stretches. She also says to bring my fitness ball so that she can inflate it for me.
 
Sounds like you're doing well and have a good PT who will help you follow the BoneSmart mantra

Dorothy
 
Wouldn't at all be surprised if she's a lurker here! And today proved to me that gentle PT doesn't require a bolus of painkillers, whether OTC or opioid. I think I will begin extending the interval between Norcos beyond my current 6 hrs. (7-8 overnight). Not going overboard on the exercise or activity, but I might live dangerously and drive in search of less-outrageously-priced gas tomorrow. 100 miles to empty, acc. to my gauge--this is the last of the tank I bought June 8 in Sparta, IL ($3.59/gal--ah, memories)!
 
Well, I did it--I finally drove! Had to--my son informed me his shrink appt. was up in Highland Park (gulp!) late this afternoon, and he doesn't drive. Rationalized that it was an opportunity to fill my tank at Lake County (rather than Cook) prices. $4.09, but I one-upped Bob, who brags about how much less he pays on the SW side. He paid $4.29! Took my first Norco at 10:45 am; and wanted to wait at least 6 hrs. But that'd have put me behind the wheel too soon. So I popped a couple of Arthritis Tylenol and rubbed some Voltaren gel on the knee. No problem getting up there at 4:45, but something told me not to take the second Norco of the day at 5:30 when leaving for home, lest it kick in while I was still behind the wheel.

Darn good thing: traffic south on I-94 was HORRIBLE--stop & go all the way from the county line to my exit! The last 5 miles home toward the lakefront were murder--my left knee made me quite angrily aware of its presence. Didn't get home till 6:45! Popped the Norco, slapped an ice pack on my knee, and elevated for a blissful hour. Then nuked some Buffalo wings--I have a mani tomorrow morning, so I figured if ever there was an excuse to turn my nails orange I ought to go for it.

About to have my first champagne since before my TKR. Mumm's Napa "Santana" cuvee--yup, THAT Santana. Who knew he was an "a-fizz-cionado?"
 
Having trouble editing--what I meant to say was that I didn't want to hit the road so long after my morning Norco yet didn't want to pop the afternoon one and get behind the wheel. Hence the Tylenol.
 
Glad you made it home safe and sound and hope you can take it easy today. We noticed the high gas prices in Chicago, at least a dollar a gallon more than here in Houston. Fortunately you have public transportation and it's easy to get a cab. Have a great day.

Dorothy
 
Yes, it is a great feeling to be mobile again and not have to depend on others for rides! I saw gas yesterday for $3.99, but didn't have time to stop. Hoping when I go today it won't have gone up .25 cents or more like it has in the past!
 
Had my second outpatient PT visit Wed. and it was quite different from the first (which was largely evaluative). I warmed up with 6 minutes on the NuStep (at only "1" resistance). My therapist still did not flex my knee beyond my "STOP!" point (and didn't haul out the Dial of Doom until I did my self-powered heel slide...104). Then we did the usual stuff: quad sets, supine hamstring stretches, straight leg raises, (all bilateral), massage; after which she handed me off to her assistant. He added weightbearing straightening (using elastic bands affixed to the wall), the dreaded "crabwalk" (yellow Thera-Band), the balance board and the calf stretch. But instead of the fitness-ball "wall-sit," I was led to a contraption called a "Wall-Crawler," which consists of a frame, a bicycle seat and foam bars to grip or rest my arms. The seat is on some sort of spring or counterweight, but the principle is the same as the fitness-ball "wall-sit," without the possibility of falling. I was instructed to take none of these exercises past the point of discomfort, and I obeyed. And I was admonished to take the next day off from doing my home exercises. Then we iced--but with my L ankle propped on a little foam bar. The ice bag seemed to weigh a ton, so they let me move it to below my knee and ice that afterward.

But the difference was the duration: number of reps, sets and sheer number of exercises. I felt loosey-goosey and okay after, and made a couple of stops at the pharmacy and the coffeehouse (needed some decaf espresso beans). As with Monday's session, I took 2 Tylenol about 3/4 hr. before my session because this time I drove to the gym. So as soon as I got home I popped my Norco (about 7 hrs. since my morning one), lay down and elevated, and plopped a big fat ice bag on my L knee. By bedtime, my L knee was noticeably stiffer; by morning my R quad was sore too. So I iced and elevated quite a bit more yesterday, especially after getting a mani-pedi that required I sit for a couple of hours.

Today the swelling's gone again and I can "march" my L knee nearly to waist height (my usual yardstick). So tonight I will haul out the leg-leash and fitness ball and do my home stretches and bridges again. And I will mount my upright bike to see if I can do a full revolution at last. THAT is my immediate milestone, not any number on a goniometer!

BTW, for those complaining of poor appetite, I have a caveat. As you wean off the opioids your appetite will return, so be careful: my home PT explained that my then indifference to sweets was likely due to my brain's "pleasure centers" being sated by the opioids. And he was right: I'm finding I want something sweet or starchy (good bread, pizza or last night's ravioli Bolognese) more often now that I am down to three 10 mg. Norco per day (and tomorrow about to ratchet the dose down to 7.5 mg.--half each of a 10 and a 5). So as of this morning I have reluctantly resumed my "dead-animals-and-leaves" diet (except for small amts. of fruit and a little piece of dark chocolate) in order to be proactive. I have too much invested in new clothes (and emotionally invested in vanity) to regain the weight I lost! All in all, though, I'd rather have to watch my carbs & calories than need opioids.
 
Tomorrow is July 27, but it's gonna feel like April 27! (Oh, well--lower electric bill since I can turn off the A/C). So I can pull out my jeans, long sleeves and even a blazer or cardigan; been living in shorts, capris and t-shirt dresses since my surgery.

Debating about the next step in weaning off the Norco. For the past 3 days I've been taking three 10/325s a day: one each on arising, late aft. or early evening, and bedtime (as I'm back to my night-owl ways, that's between 1-2 am). At bedtime I also take 2 Arthritis formula (650mg) Tylenol. Been sleeping through the night, even on my side (finally!). Tomorrow I will cut back each dose to 7.5/325 (splitting a 10 and a 5 in half). But I'm wondering whether to keep to the same schedule, or in order to get more used to the lower per-dose amt., start for a couple of days taking four doses a day (which would still give me the same 30 mg. of hydrocodone, since 3 x 10 = 4 x7.5) and then going back down to three doses a day for three days; then cutting back to 5 mg. 4 x day for three more days before going down to 5 mg. three times a day. At this point. I'm just trying to make sure to stay ahead of what relatively little pain I have without abrupt withdrawal symptoms.

So I'm off to spend some quality time with my pill-splitter. The 10s I get at the pharmacy are yellow and coated, and can't be broken in half by hand the way the white 5s can (or the white 10s they gave me in rehab).
 
Was a shameless slug-a-bed--slept 9 hrs, and by the time I was showered, dressed & ready for brunch (too late to call it "breakfast") it was already noon! So rather than cut 30mg/day of Norco into 4 doses instead of 3, I'm just going to go with 7.5mg 3 times a day during waking hours. I have reached the point where I am not necessarily relieving pain but trying to keep it from breaking through; and cutting out that extra dose of acetaminophen frees up space in my 3-gm "allowance" for either breakthrough pain or before exercises/therapy.

A bit disappointed in that before bedtime I couldn't quite manage getting my left bike pedal shaft fully vertical, so I didn't dare try to make a full revolution. But it was a nice relaxing stretch, and a full revolution's in my future soon enough. Our lodger (son's ex-g.f.) will be moving into her own apt. this coming Thurs. so she'll be removing her stuff from my old recumbent bike in the upstairs office. Said bike's a "p.o.s."--an abbreviation for a term we Yanks know well and you UK-ers can infer without spelling out the cuss-word--bought for a pittance years ago on QVC. It's rickety and uncomfortable to use for aerobic exercise, which is why Bob bought me the fancy upright for my most recent birthday. But if it's easier for me to make a full-pedal revolution, I'll give it a go as the stepping-stone to being able to use my upright for its intended cardio workout. If not, out it goes, which will free up floor space in the office for a used NuStep (oh, how I LOVE those machines)! I am once again strong enough to need to resume concentrating on burning calories and improving aerobic capacity, per my FP's orders. I am hoping that once my HC placard expires at the end of Jan. 2014, I won't need to renew it. (I KNOW my OS won't sign the application, though my FP will; Bob refuses--and rightly so--to treat family members except in an emergency). After January, IL will no longer exempt placard holders from paying parking meters, so the only reason to retain the placard after then would be to park in a HC space. And I eschew those already if there are close enough regular parking spaces, lest I usurp a HC space from someone in a wheelchair, scooter or on oxygen.

Today will be an "ADL" (activities of daily living) challenge: must get a haircut--which requires I drive and then sit for at least an hour; replenish my supply of low-carb bread (shipped in from a Tampa bakery and sold only at a health-food shop in Evanston); and then buy a new living room sofa, which has been trashed by 26 years of cats honing their claws on it: the embroidery's torn; the stuffing's coming out; the staples holding the fabric to the back have been pounded back into place countless times and are no longer holding. Refurbishing it or having a slipcover made will cost more than a new sofa! Moreover, not only is that pattern (also on the loveseat & easy chair, which the cats haven't wrecked) no longer being made, but the furniture megastore where I bought the ensemble bit the dust over a decade ago. When I bought the stuff, I brought a pic of the Oriental rug on the floor to the store and the designer helped me choose not just the fabric but a "photonegative" version for the wallpaper. So I'm going to snap an iPhone pic of the rug and bring a sofa-pillow with me to Macy's, which is having a sale this weekend. It's a half-hr. drive in each direction, and of course Macy's is located mid-mall--an equidistant bit of a trek from either parking lot. (Same shopping center where I played the French Market a couple of weeks ago--but no roving golf carts this time).

I will reward myself tonight by slapping a ribeye on the grill (weather permitting) and nursing a nice Cabernet. (Bob's working late, alas, so no restaurant meal). Funny--ever since returning home, I never considered cooking a chore.

Bonesmarties, I offer you virtual steaks, wine and lattes!
 
Yesterday, I got on my recumbent bike for the first time just to see what I could do. When I was in therapy in the hospital, the PT told me it would be great to just move the pedals up and back w/o making a full revolution. I asked my home PT about it when he first started, and he said it was too soon, so I've not done anything on it. However, I'm missing my home PT today since we're out of town, so I thought I'd give it a try. The back and forth was easy/peasy so I gingerly tried a backward revolution and had no problem. Then I thought I'd try one forward and again, no problem. I did about 10 minutes mostly back and forth with an occasional revolution. I will see my home PT on Thurs, and see what he thinks about adding it in.
 
Hey, congrats! Might try that tomorrow. Meanwhile, after Saturday's excursion to Old Orchard (when I miscalculated Macy's location and parked so far away I walked 1/4 mile), I spent most of Sunday & yesterday icing, elevating and doing only gentle Swiss-ball and leg-leash stretches, bridges and heel slides (and one session, at that) when I wasn't cooking or on the computer. Today at PT, after my therapist watched me do the slides, she asked me if I wanted to measure. I figured, why not? To my surprise, I got to 108 on my own (to the point not of pain but rather the limit of what my quad could handle), and 115 with her bending it to my "Enough!" point. All the other exercises today seemed much easier than they were last week. She even suggested I might want to switch from the NuStep to the upright bike next time. She said that apparently whatever I'd been doing between sessions was working. So I'm taking another "kneecation" tomorrow and see what develops at our next session on Friday! I did a jaunt around Target today, using the shopping cart as a walker. Tired, a bit stiff, but happy--iced some more and will take my second Norco dose (7.5) of the day and a nap with legs elevated. (The Swiss ball elevates even better than the leg-wedge, except when my cat tries to bat it out from beneath my legs).
 
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