Happy New Knee Year!

1 January 2017: Eight weeks post op left TKR: Eleven months post op right TKR

It is nice to start the new year with two gorgeous new knees.

You will see that the scar on the left knee is healing well and the swelling is reducing. Eleven months on, the right knee is still a bit swollen and it has dark marks (hyper pigmentation) around the scar. The marks are not painful and I am hoping they will gradually fade.

In the last couple of weeks over the festive season I have made superb progress with my left knee:

- I have stopped taking tramadol. It wasn't as easy as I expected and I fear I may have been slightly edgy over Christmas (I think I may have stopped the pills a bit too early). However, I decided that I would like to have a few drinks over Christmas and tramadol and alcohol weren't a great combination for me and made me feel very unwell. So the good news is that I am not taking it any more thank goodness! 

- my walking has increased. Eight weeks after the right knee replacement I was only walking about 2 km. However today (8 weeks after my new left knee) I went for a 3.5km dog walk as well as some general rushing around.

Even better, I have also been able to walk up some gentle hills to revisit places I haven't visited in about 4 years.

I have also been able to stand for longer periods of time - which means I can get up at about 5.30am and go out and water my vegetable garden for about 30 minutes. It is such a nice meditative activity so I am pleased to be able to be in the garden.

Over Christmas, I have also been able to cook meals and have had visitors come and stay. I find I have much more stamina and ease of movement. It is a pleasure to be able to be more normal.

I have also been back to the gym and pool. I still get very tired exercising and I am working on improving my bending and cycling. My knee bends are improving but still not easy and comfortable.

It is great to think that the year ahead will be surgery-free. And my knees will continue to get stronger and more flexible. My plan over the next few weeks is to work on some realistic yet adventurous knee-oriented goals for 2017. I want the year ahead to be the "bees knees".

The road to recovery

18 December 2016: 6 weeks post op Right Knee Replacement

It seems to me that the road to recovery after knee replacement surgery is rather like my driveway - sunny in some patches, shady in others, winding and steep - but ultimately leading to somewhere interesting.

Since the surgery, I have had some gloomy patches with infections and pain (as I reported in previous blogs). But in the last few weeks there have been a lot more bright patches as I have been able to:

- push the pedals on the exercise bike a full rotation (woohoo!)

- drive the car decent distances (100km)

- stand at work and social events and chat to people 

- stand and give a presentation for 45 minutes (actually I did lean on a stool some of the time)

- prepare nice food for my friends 

- go for 2km dog walks and walk nearly 5 kms most days.

And it all feels good. I have also been recalibrating my vision of where the two knee replacements will take me. 

I had been thinking that I wanted to recover to a state that at least as good as before I had surgery. But then I realised that the destination I should be aiming for was more like aiming for a state of fitness and stamina that I had five years ago. And it was quite a change of mindset.

Peter and I were chatting about Fiordland the other night and he said, "when your legs are stronger we could walk the Milford Track". My initial reaction (based on the last five years of thinking was - really? You must be joking!! But then I began thinking about it - and it might just be a realistic possibility. It's an amazingly exciting destination that I hadn't expected or considered for such a long time.

And then last night I met a man who has had two knee replacements - the most recent operation was six months ago. He looked so well and was really pleased with his new knees. He is very active and goes off on adventures with his wife in their bus. And looking at him, I began to think of the possibilities that lie in store for me...

For my regular blog readers, I feel compelled to provide the usual photo update on the knee scar. (You will be pleased that there are no gory  shots in this post).

And the range of motion is also really good - see photo of my bent leg below.

 It is looking good. And with the scar healing well I should be able to go swimming this week.

So, as I say to myself when I am clambering up my rather steep drive way - Onwards and upwards! Let the adventures begin!

A dam strange week!

3 December 2016: One month post op Left knee replacement and ten months post op Right knee replacement

Here in New Zealand it is late spring/ early summer. A time when the temperatures are increasing but the weather is quite temperamental and we can get horrendous winds for a week at a time (100-140km an hour).

In addition to the changeable weather, my post op recovery has had a bit of a mixed report for the last week. Monday I woke up feeling invincible - and ready to go forth and walk long distances. However, our dog Lewis had to be taken to the vet as he had got grass seeds in his eye and foot and he had to have them surgically removed. It was a wild day with gale force winds. After dropping the dog in for surgery, I was getting into the car (rather awkwardly - with my leg balanced against the door for support) when a violent gust of wind hit the door  and concertina-ed my leg into a tight bend. Not an ideal position and it hurt like crazy.  So I didn't feel invincible for long and spent much of the next few days sitting around with ice on my leg trying to get it back to its feel-good state. Lewis recovers much faster than me and he was ready to get up to mischief by Tuesday!!

By Wednesday I was beginning to feel much better and I decided to go for a walk down our drive to our dam. It is about 500m away. When I had my right knee surgery I wasn't able to walk down there until after the fifth week and it was rather an epic journey taking 45 minutes for the round trip. This week I wandered down and back, and had a chat with Peter who was down there gardening, and made the round trip in less than 25 minutes.

The trees we have planted around the dam are looking glorious and the water hole has been covered over with red weed which is great cover for all the frogs living in the water.

One of the other things that happened on Wednesday was that I noticed a suture had started to work its way through the scar tissue of my left knee. This happened with the right knee and last time the surgeon told me not to touch the suture and just let the suture make its way out naturally. So I decided this was all pretty normal. However on Thursday the area around the "piece of string" started to pinken and I went down and talked to the pharmacist about whether I should panic or whether an antiseptic cream would be useful to manage the pinkness.

He thought it would be fine with some antiseptic cream and told me that if it got any worse I should go and see a doctor. Peter was embarrassed as he thought I was making a big deal out of it and he thought I should relax about it. However, by Friday night I thought it was getting angrier and so on Saturday morning, I got Peter to drop me off at the doctors in Hastings while he took Lewis for a walk. By the time I got to the doctors it was looking nastier with pus and blood coming out.

So the doctor dug around in the scar and pulled out the suture end and cut it off with a scalpel. It was all rather gruesome. And I am back again on a higher dose of antibiotics than I took two weeks ago. He confirmed that I hadn't been over reacting and that I needed to take action to make sure the infection didn't get worse and or affect my implant.

So - in summary - I can walk further and more confidently now than I could after the previous surgery. I can sleep well. I have really needed the painkillers this week - so haven't been able to wind back on the pills - and in fact I am taking more pills - taking a second course of antibiotics that upset my stomach. Because of the risk of wound infection I can't get back swimming until the scar heals.

I am really hoping next week is more straight forward and I can get out and spend time in my vegetable garden and get back to watch frogs by the dam.

Feeling good

25 November 2016: 21 days post op Left knee and 10 months post op Right knee

We have had a lovely warm, sunny and optimistic week here in the Hawkes Bay with far less rain and drama than last week.

The garden is blooming and I have been making great progress with my new left knee. It is now more than a week since the staples were removed and the scar is looking really great.

I have been looking back at my blog from the right knee replacement and this scar is so much better when I compare it with my right knee 3 weeks post op. The left knee has far less bruising and swelling than the right one shown below.

Other comparisons between the two surgical events:

- The left knee now has 110 degrees range of motion - the right knee only had 100 degrees

- I can now walk around inside the house "crutchless" - after the previous op I was  relying on one crutch. I generally still use the crutches when I am outside so I can fend off people in the street and the crutches also give me confidence walking over undulating paddocks.

- I am doing about the same amount of walking each day - around 3 kms

- I can now sleep for 6 hours at a stretch in pretty much normal sleeping positions. With the previous right knee surgery I was barely able to sleep more than 3 hours at a stretch and wasn't able to start sleeping on my side until after one month.

- I have been to the gym and the Physio. I did some very low impact cycling and general stuff at the gym (actually it was mostly chatting if I am honest). There wasn't much the Physio could suggest I do - she just said do the same exercises as last time. She thinks that given how well the scar is healing I should go ahead and have a bath and I can also get back to the pool next week - so that is a week earlier than with the right knee replacement.

I drove home from the gym today and that seemed to go pretty well. I don't feel quite ready to drive for more than 10 minutes as it requires a lot of manoeuvring to get my left knee into the drivers seat. It was easier to get into the drivers seat last time as I installed my body first and then only needed to bend my injured knee a small distance.

In addition, I have been feeling great - better than I have felt in such a long time. The decision to have the surgery has been so positive. Hard work - but positive. 

When I was at the gym I caught up with an older gent in his 70s who has been waiting for knee replacements for more than two years. A few months ago I helped him get his GP to refer him for a specialist assessment. The surgeon thought he needed bilateral knee replacement and he was booked in to have the first operation about three weeks ago. A day before the operation, the public hospital phoned him to say he was no longer eligible for surgery and he now has no expectation of getting replacement knees. I felt so disapponted for him - he lives by himself and is unable to get out and he can't sleep because of his knee pain and he has no insurance nor the funds to pay the $27,000 per knee replacement. Now that I know what a change the surgery can make to your life, I really question why there isn't more public access to this surgery.

As you will see from my recent X-rays - it is very invasive surgery and there are considerable risks - but the potential for positive impact on your life is huge.

A bruising week

19 November 2016: 14 days post surgery on my left knee

At the start of this week, my leg was a blue and purple haze of bruising.

As the week as progressed, the hues of colours have changed, and reduced and the swelling has receded. So today, my leg looks like this.

I was supposed to have the staples removed from my scar 10-12 days after the surgery - so I booked into have them removed by my Wellington based GP on 14 November. However, in the very early hours of that morning, we were awoken by a massive 7.8 earthquake and this was followed by a cascade of significant aftershocks. Being rather slow moving at the moment, I dressed as fast as possible in case we had to evacuate to higher ground because of the tsunami threat. But luckily the threat to our area in Kapiti was downgraded. I am also please that our house was unscathed by the movement. However, the central business district of Wellington was closed for the day while buildings (including the GPs premises) were checked for damage. (If you want to know more about the earthquake - here is a link https://en.m.wikipedia.org/wiki/2016_Kaikoura_earthquake)

Ordinarily, there would be no problem rescheduling the staple removal by a day, however over the weekend, I had developed a red lump under my bra strap and I wanted to get the doctor to check it out as I was concerned it was developing into a red and inflamed boil. So I sent an email and photo off to my GP and asked if she thought it could wait til she saw me. We agreed that it should be ok until the next day. However, Tuesday was a day of torrential rain. So much rain and flooding that all the roads and transport options into Wellington were closed.

I sent an update photo to the GP who said she thought I needed some antibiotics as she was concerned that the boil was getting bigger and she didn't want to risk any chance of infection transferring to my prosthetic. (This is one of the rare but severe risks associated with joint replacement).

I tried to phone a local GP but they didn't answer any of the four calls I made to their clinic. So in the end, I phoned my friendly neighbour Colin (he is a doctor) and asked him for a script for antibiotics. He kindly provided one and then we set off in the pouring rain to get the medicines. Even though we were travelling away from Wellington, what should have been a 20 minute round trip turned into a 2.5 hour trip. Later that evening my GP phoned and said that she had looked at the photo again and thought I should lance the boil with a sterilised needle. Yik. Well - I tried but wasn't very successful at getting the pus out. So decided that I would just have to hope and pray I could get to the doctor the next day.

On Wednesday the roads were still blocked but luckily we were able to get through the road blocks to Wellington to see the GP for our third rescheduled appointment. After a rather brutal encounter with a scalpel, the GP lanced the boil. Overall she was very impressed with the progress with the knee replacement and thought that I was moving well and that the leg wasn't too inflamed or swollen.  Then it was off to see the nurse to have the staples removed. I was again surprised at what a long and painful process it is - it took over half an hour. Thankfully this time the scar was well healed and the nurse didn't have to dig into the flesh to pull out bits of metal (like she had to with the right knee).

The scar is dry and isn't as oozy as the right knee scar was.  The scar has been covered in steri-strips and a bandage which has to stay on for five days... And then I can have a bath 😄 

My sleeping is progressing well. I have tentatively tried sleeping on both sides and I can now creep to the toilet in the middle of the night without clomping around on my crutches.

I am getting more confident walking around the house unaided for very short periods of time and the rest of the time I am just using one crutch. I still use both crutches outside. Yesterday I wandered around for 2.5kms

The knee and leg are still painful so I haven't started to reduce my pain meds yet. But it is tolerable.

We came back home on Thursday and I was not too uncomfortable managing the 2.5 hour trip in the car. It is great to be home and to be out of the earthquake zone and perpetual aftershocks - and also out of the unending rain.

Overall, I would say that this surgery feels quite different from the first knee replacement. To date, the recovery is much speedier, the bruising is resolving faster and wasn't as extensive. I am able to sleep well and I have a greater range of motion in my leg. So - despite the small glitch with the boil - things are looking very promising.

Same, same but different

11 November 2016: One week after TKR replacement (left knee) - 9 months + 1 week after TKR (right knee)

This time last week I was heading into hospital feeling anxious and apprehensive. Although I had first hand experience of the surgery earlier this year, the risks of the surgery were still front of mind. Especially after being at the Cochrane Colloquium where many of the people I talked to were AMAZED I had a good outcome with the first surgery and gave me the very strong impression they thought I was nuts risking the operation - not once but twice! No matter how much you know in your heart that you have made a reasonable and evidence informed judgment that suits your own personal circumstances, it is sometimes really hard to describe or defend the reasoning to people who are primarily focussed on research.

Anyway - I am delighted to report that the surgery went pretty smoothly. But there have been some interesting similarities and differences between the two procedures.

The hospital check-in protocols were pretty much the same. 

The surgeon came in and marked up my leg and got me to tell him what procedure he was going to perform (it's a rather unnerving question - you think hasn't he got it written on his records?!)

This time there was also an ECG undertaken (nothing of interest to report) and a different anaesthetist. Many of the kind and friendly staff at Wakefield that I met last time were also there. The same people wheeled me down to theatre. Just as I was being hoisted onto the operating table, Peter the surgeon, introduced me to the team as a frequent flyer - "she loved the last knee we gave her so much, she's come back for another one", he said.

Surgery took about 2 hours and then I was back in the recovery room and given a very welcome lemon iceblock (ice lolly). This time however the nurses in the recovery room were very worried about my low blood pressure and called the anaesthetist in from home to come and check me out. Last time my blood pressure was low for about 24 hours and then was back to normal. This time, it took about 3 days to get back to normal.

Once I was wheeled back to my room I was just starting to get myself settled when the nausea started. Unfortunately there was no receptical in sight - and all I could see in front of me was my iPad and a plate of sandwiches. The nurse sprinted for a container from the next room and then came back lunging towards me just in the nick of time! Luckily - she brought two containers. If I hadn't been vomiting it would have been funny. Last time the vomiting volume was much less and certainly the delivery was less dramatic.

On Saturday morning my blood pressure had increased up to 97/66. When my partner Peter came to visit he was surprised at how well I was looking and how lucid I was.

I was delighted that the new knee wasn't too bloated and was also quite flexible.

When the Physio came to visit I was able to bend my knee to 100 degrees 

I was able to get up and wander down the corridor using a walker.

My time in hospital progressed well. Sunday I was able to have a shower by myself and get up on my crutches (BP 100/58).  There was some concern about my urine output (It is a bit creepy having people collecting you wee in jugs and measuring it). I was threatened with a bladder scan and recatheterisation unless I produced more urine. I was drinking as much as I could and when they decided to do the bladder scan they could only find 13ml of urine in my bladder. So I was let off the catheter hook (whew).

Monday (BP 103/60) I was able to walk up and down stairs carefully and slowly on the crutches and I had my knee X-rayed. The X-rays showed the operation had gone well and I was discharged on Tuesday morning (BP 127/73). 

My stay at Wakefield had been good and the permanent staff there are just fantastic professionals who know their jobs well and also go out of their way to make you feel cared for. However it seems that they must have a new policy in place, allocating their permanent staff to those with the highest need. So on Sunday/Monday as I was getting back on my feet (so to speak), I was allocated to 4 different agency staff across 4 different shifts. While the agency nurses seemed like nice people with good intentions, most had never worked at Wakefield hospital before and didn't do any of the automatic things I had taken for granted - like introduce themselves and tell me their names and their roles, or  bring ice for my leg every two hours, or close the curtains at night and turn off the light (all of which are pretty hard to do on crutches).

I also found that  some agency nurses didn't know how to use the equipment ef taking up to 4 attempts to take a BP reading with an automatic blood pressure monitor (yes - I did consider just doing it myself!!!) and they had a pretty casual attitude to dispensing medications. I ended up in an argument with one nurse telling him he had already given me the particular medicine only two hours beforehand - and that it wasn't due for another 10 hours and needed to be taken with food. In hospital, with the high volume of pain meds coursing through your body it takes a huge amount of effort to try and keep your head clear, so I tend to just take whatever pills are thrust at me on the grounds that they will probably be beneficial. As a safety management practice, nurses ask you to give your name and date of birth every time they hand over the pills. But this approach doesn't work as the patient isn't given a list of the medicines to cross match against. It just happens that I recognised the pill the nurse was giving me and remembered specifically taking one with my dinner two hours earlier. The next morning I reported the incident to the nurse manager and I guess I will have to write a letter about it when I have the headspace.

One of the differences between the two surgical events is that this time, the clear dressing on my knee wasn't replaced before heading home. Apparently they have decided against using the adsorbent dressing in favour of retaining the clear dressing applied in theatre. The impact of this is that after one week, while my surgical wound looks pretty clean, the oozy blood coming from the site collects making my leg look like a packet of supermarket meat marked for "URGENT SALE" or some kind of elaborate Halloween costume.

Other differences between this surgery and the last are:

- no trips to the Emergency Department. In February we were concerned that the right knee had developed an infection as it became hot, painful and engorged - like a sausage in the frying pan just about to burst its skin. This pain and swelling was caused by two large haematomas that had developed around the scar of the right knee. While the left leg is bruised and swollen, the skin has remained loose, and sore as opposed to horrendously painful and there are no haematomas

- my leg is much less touch sensitive. Last time I avoided covering my knee with trousers or sheets for about 6 weeks. This time, it is really easy to wear lightweight soft knit pants. There is none of the electric flashes of pain when the fabric touches my leg. Last time I couldn't cope if the dog accidentally touched my leg, for example.

- I can now sleep reasonably well. With my right knee it took about two months before I could sleep for more than a few hours at a time or sleep on my side. I am pleased to report that I am sleeping up to four hours a night and can comfortably sleep on my right side with my left knee resting on a pillow on top of my right leg. It feels comfortingly normal.

The last few days have been very sore but overall the left knee recovery has been much smoother. Apparently the wear and tear on the joints in each knee were comparable. The left knee has had the benefit of longer "prehab" exercises (12 months as opposed to 3 months) and is stronger and with a greater pre-operative range of motion and function.

Having been through the surgery relatively recently, I have been more aware of what to expect and how to respond and perhaps able to tolerate the discomfort more. But I think that the main difference has been that the left leg didn't swell up right from the beginning.

In any case, it will still be a long road to recovery, but at least this time I can sleep and I can enjoy the comforts of a small hairy companion hanging out with me as I go through the healing process.

I am off to see the Wizard

....The wonderful wizard of knees!

4 November 2016: Total knee replacement on my left knee

Feeling apprehensive but somewhat reassured given that I know what to expect from the process after having my right knee replaced in January.

My bag is packed. I have the spare bed all made up with lovely fresh bed linen. Have spent the morning distracted and unable to think in complete sentences.

Have taken a photo of my knees (I knew my blog readers would demand one ;-) )

The left leg is a lot slimmer than the right knee but has a lot of lumpy fluid surrounding the knee cap. My left knee has been a trouper and helped me manage the recovery of my right knee and has done well over the last nine months. But it has become really obvious that the left knee can't keep up - and this has knock on effects with my hair and the lopsided way I have been walking, badly affects my hips. So - I know I am making the right choice.

Got to the hospital and have had my bloods taken (but it took three people to find my veins). BP sky high as you can imagine. Now dressed for success in the surgical gears ( yes Di - the paper panty

 shot is just for you).

I have had an ECG  and wiped myself down with wet cloths.  A few more hours to wait before surgery. It already seems like it has been a very long day.

It has been lovely to get kind wishes and thoughts from friends and family - thanks everyone - it is great to have your support and love.

Nine month report - Dancing Queen!

29 October 2016: 9 months post op

It is hard to believe that 9 months has passed since the TKR surgery on my Right knee. To celebrate, I am pleased to report I have had a wee dance here at the Cochrane Colloquium - and it was fun.

I have also managed some standing chit chat at coffee breaks but wasn't able to stand up for hours at a time for the welcome reception. I had to go and find myself a chair and sit down, watching from the sidelines.

(I thought these young performers had fantastic knees!)

I have also had a little bit of time to do some sightseeing and travelling around Seoul and Gueongju, South Korea.

As you will see, I am still using my walking poles to walk. They even out my gait and keep me walking straight rather than hunched. My new right knee has been sore over the last ten days or so - probably from the flying and wandering around - plus I have been up and down a lot of stairs - but it is the left knee that is the most painful. And it collapses frequently which makes me waddle (hence the sticks).

As usual I am posting an up to date photo of my right knee

I was showing off my scar to some of my colleagues here at the colloquium (both are surgeons) and they told me that the discolouration around the scar is not bruising but is hyper-pigmentation which happens with surgical scarring. They recommended that I should take it up with my surgeon and have laser treatment to resolve it. So I will ask him about it - but it is not too of my mind as it doesn't hurt.

I am booked to have a Total Knee Replacement on my left knee in just under a week. So that is really my top priority. 

So in another month or two, I will be ready for a little more gentle dancing, and more travel and adventures.

Eight months post surgery update

1 October 2016: 8 months post TKR surgery on right knee

Spring is in the air. The blossoms are out and the grass is growing and there is the promise of longer sunny days ahead.

I have been noticing in the last few weeks that my new right knee has been making some subtle, slow and steady progress.

I went along to a meeting last week that started with drinks and meeting/ greeting small talk. In the past this was a hellish scenario that would have been painful and embarrassing. Happily,I was able to stand and chat to people and have a drink for 15 minutes or more without having to rush to sit down. 

In my last post I mentioned my difficulties getting up from the floor and kneeling. So every day at the pool I get into the toddler's pool and practice kneeling. I have been getting a lot more confident with the moves and so on an evening last week I decided to try out the manoeuvre on land. So I said to Peter - "watch this" and I slithered out of my chair onto the floor and then hoisted myself (relatively easily) off the ground while leaning on the coffee table. He was quite surprised. He has been watching my ungainly attempts to launch myself from the floor over the last few months - so it was a surprise to see me get up in a fairly swift move without cursing or rolling about laughing.

The bruising around the scar on my right knee is also calming down and the swelling still reducing slowly but surely.

Now that my right knee is coming into its own, I have been focussing on the 5 weeks until I have the left knee replaced. 

I have been thinking a lot about what that will mean for me. I am expecting that the recovery might be easier as I know something about what to expect from the surgery.  I will have the advantage of a good strong right knee to get me mobilised. I have started stashing away  meals in the freezer.  My tomatoes and sunflowers are planted in my garden hoping that they will be ready to fruit and flower in December and I am picturing myself back on the Hawkes Bay cycles ways zipping from vineyard to vineyard. So I am thinking 2016 will be a year of reconstruction and stabilisation - so I will be ready to enjoy the opportunities the new year will bring.

Bring it on!

 

Seven month update on my right knee replacement

15 September 2016 - 7 1/2 months post surgery on my right knee

It is spring time here in NZ. The days are getting longer and the weather is improving.

My right knee is going well and is nice and strong. I am still making progress - but can't yet manage to get up from the floor elegantly. Apparently it takes at least a year for the tissue to heal and become less sensitive so that you are able to tolerate kneeling. I recently went along to an industrial safety wear shop and bought myself some industrial strength knee pads (only available in "noir"). And I have been practicing kneeling and standing up when I go to the pool in the mornings - in the kiddies swimming pool. 

Incredibly, the bruising around the scar remains but isn't sensitive or sore and the gruesome dark hairs seem to have receded.

In my last blog post, I reported that I was planning a visit to see the surgeon about my left knee because it collapsed when I go walking and is really painful.

The left knee doesn't give me the same degree of pain and discomfort as I had this time last year when I was in constant pain, more or less house bound and couldn't sleep. But it means that I have problems walking without a limp /waddle and this makes my hips and back really sore. I tend to use my walking sticks when going any distance to reduce the limp. I am still reliant on anti-inflammatories to manage the pain and the left knee is very swollen and puffy. My cycling at the gym has become very painful and I am now concentrating my exercise on pool based activities. So it really limits the progress I was making with my new right knee.

Peter, the surgeon, was pleased with my right knee - I now have full range of motion. He prodded my left knee - making it creak and grate - and viewed the X-rays. He said that the left knee is in the same condition as the right knee was prior to surgery although it is more flexible than the right knee was. After talking it through - I have booked in to have the left knee replaced on 4 November. 

So I will be fully bionic (and hopefully dynamic) by Christmas! And I look forward to getting back on my bike to enjoy some summer cycling.

Post script:

In the last month, the Oxford Centre for Evidence-based Medicine have released the video of a key note presentation I made at their Evidence Live conference in June 2016. In the presentation I talked about my experience of getting good reliable information to help me consider my options for managing the osteoarthritis in my knees. 

Here is a link http://youtu.be/62N9cFMmhJ4

Six month update

Just over 6 months post surgery - 9 August 2016

Way back in January, prior to the surgery on my right knee, it was hard to imagine what it would be like to have had a new knee for six months. 

The first two months after surgery were times of pretty rapid change and improvement. The last four months have been much slower with steady improvements and benefits. 

I have just been sent the post op questionnaire from the Orthopaedic Society. It is based in the Oxford Knee Score - a survey I found when I was first considering options for knee surgery last year. Last November I filled the questionnaire out (see scores in red). And it was interesting to identify where the significant changes in function have occurred six months after knee replacement (see black circled numbers)

The biggest improvement has been in pain relief as well as much greater mobility. I was really pleased that while we were travelling in the UK last month I was walking 10,000 to 12,000 steps a day. Now back at the gym I am regularly cycling 10km as part of my gym session so that feels good too.

As I have previously mentioned, my left knee is now my biggest restriction and it tires quickly and is painful most of the time. So, I took myself off to the local Waipukurau hospital to have the left knee x-rayed.

As you can see, it is a pretty small hospital and very low key.  While I was standing around in my undies waiting to have the X-rays, I had a chat with one of the GPs who was snacking on his lunch in the adjoining room! There is no such thing as privacy in a small town.

And this is what it looks like inside my left knee.... Not much space between those bones and lots of spurs and sharp pointy  boney growths - arthritis.

I have made an appointment to see the surgeon about this knee in a few weeks time. I feel reluctant to go to this appointment but as my GP said to me - "last year you came here and told me you needed a new knee and you were completely right. So what makes you think this left knee is going to get any better by itself?" (I get on really well with my GP and I love her shoot from the hip approach). 

So - in the next blog I will give an update on plans. In the interim - here is a  photo of both knees. The scar on the right knee is really smooth and well healed. I am amazed that six months on there is still bruising and swelling.

You can see the effusion/ bulge on the inside of my left knee where all the fluid is collecting.

Finally, all this knee talk has become something of an obsession. I was at a meeting last week and one of my colleagues at the meeting had a knee replacement three months ago. I couldn't resist asking her to show me her scar and having a look at her knee. It probably wasn't polite but luckily she was pretty delighted about her new knee and keen to show it off. So there we were in this board room with our trouser legs hitched up gazing intently into each other's knees. Her knee was also still swollen but also nicely healed. She had just returned from a snorkelling holiday and was just as delighted with the result as I am with mine. 

Five months with a new knee

3 July 2016: 5 months post surgery

I am sitting out on the Yorkshire Moors reflecting on my knee replacement journey over the last five months. 

It feels great to have had the opportunity to come to the UK to speak at a conference and to have a few days holiday afterwards to relax.

My conference topic at  http://evidencelive.org was about getting the heart into evidence - and I talked about how difficult I had found it (as an informed and somewhat bolshy health consumer) to get reliable evidence-based information about  management of my arthritic knees. See graphic summary below.

It was about a year ago that I went to see the first surgeon who told me to go away - and come back in 10 years. I am so thankful I sought other opinions and I am really pleased with my new knee. My levels of pain and discomfort have reduced so much. My whole outlook has really changed and improved. However I wanted to make it clear to the people at the conference that different people in the same situation may have made different choices. But that's the Point - people need to have access to good accurate information about risks and benefits of options - and then decide on what option will be best for them.  It was interesting that after my presentation about 6 people came up to me and talked to me about their knee or hip issues. It was also nice to hear people "tweeting" about the value of hearing a consumer perspective at the conference.

On this trip I have stepped up my walking to around 6-8kms a day. But I get quite tired doing those distances. I am still using walking poles as my left knee is getting weaker and I now find I am starting to limp/ lumber  again.

I am not able to keep up with Peter - but he is an epic walker...so we have worked out ways to do things we both enjoy together and then I drop him off so he can wander. 

It has become very apparent to me that I am going to need to have the left knee replaced sooner rather than later. I had hoped that it would last a few more years but it is getting more and more swollen and sore. I have no desire to rush into surgery again this year - but I don't think I am going to get the full range of benefits of my new right knee if the left knee keeps hobbling along. This situation was made really apparent while we stayed in a small two storey cottage. The cottage had very narrow stairs with the toilet on the top floor. It took a tremendous effort for me to clamber/crawl up the stairs on my hands. Not something you want to be doing at 2am with a full bladder!

To summarise - since the last blog a month ago - there has only been gradual/ incremental change. I have increased my walking an additional 1-2kms a day. I am still taking NSAIDs and I have also gone back to taking panadol as well in the last few weeks. My left knee is swelling more as a result of this activity - but overall I feel GOOD - positive, healthy and enjoying life.

I really hope that this Blog provides some insight and information for others with arthritic knees - and informs others who may have friends and family with arthritic conditions.