Step by step recovery

I"Today has been both high and low. 

No more morphine pump and no more urinary catheter. I have  started to get mobile. 

Unencumbered, I set off with the stroller and had a lovely shower as well as several trips up and down the corridor. However the activity aggravated my knee just above the scar. My pain scores today have wobbled between 4 and 7. So I have been popping more painkillers and I have a lovely cool ice pack on my knee. The nurses here are very thoughtful and kind and look after me well.

I delighted to have friends and family visit - nicely paced throughout the day. Peter came in early and then Sarah and Fifi bowled in. After lunch Ruth and Leonie came in and were followed by old school friends Heather and Diane and my mother, Helen. The room was somewhat congested but we laughed and chatted - and Heather gave me a fabulous foot massage.  Seeing everyone today was a great distraction from my knee pain.

At some stages during the day I found myself drifting into sleep and my head becoming fuzzy. But I guess that is to be expected. The  rehab will literally be slow, step by step progress. I am not yet ready to dance - but I will. 💃

The cut and thrust of surgery

30 January 2016:The new bionic knee has been installed.

The build- up to the surgery was nerve wracking. 

• I was shown to my room on the third floor and given time to put my stuff away in drawers etc and get acclimatised.
• About one hour prior to the surgery, Neil the anaethetist came in to talk through the anaesthetic options. I decided on an epidural along with the general anaesthetic. 
•  Peter the surgeon came in and marked up my right leg with a huge purple arrow and to check if I had any questions.
• I had to shower and, wipe myself down with an antibacterial wipe and then slip into my glamour our blue gown. Thankfully the gown joins at the back so I didn't have to reveal all. The clothes change was also accompanied by some doozie paper pantaloons.

To calm our nerves, Pete and I talked about meaningless trivia and I was touched to receive lots of lovely messages from my friends as they pinged into my iPhone.

Then it was off to theatre. As I went in to theatre, I was impressed by these huge lights and all kinds of machines, people wearing gumboots and music was playing. Rolling Stones I think.  I was told to put on a hair net cover and then had to sign more consent papers. Neil then put in the epidural and I don't remember much after that.

The recovery was a very calm place and I slowly woke up and started drinking water. I was given a lemonade iceblock to sooth my throat. I recall Peter the surgeon popping in and saying the surgery had gone like a dream. Whew!

When I was trundled back to my room, Helen my mother was waiting to see me with a lovely smile and some beautiful flowers. I had a briefing from the nurse about how to use the PCA pain pump and given some more water. However it didn't stay down for long as I started vomiting. Once the vomiting was over I felt a bit better- or maybe that was the drugs kicking in.

My leg is a bright pink colour and was swaddled like a mummy...
The paper pants were no where to be seen. 

In the evening of what they call Day Zero, I managed to stand up for a minute or two (with the assistance of two nurses). They encouraged me to eat so I had some sandwiches and jelly.

I slept well between observations - BP, catheter, oxygen etc plus pain meds. 

When I woke up the next day I began to feel really itchy - a reaction to the morphine. The nurse gave me a pill to reduce the sensation.

Yesterday (Day 1) was a bit up and down. My systolic blood pressure has been quite low around 108 and my head has been quite cloudy and muddled. Pete arrived early in the morning and was here when I had my first try out for a walk. With the assistance of the Physio and nurse, I managed to stand but then nearly collapsed. It was quite unnerving to see everything spin. I had a couple more attempts at standing during the day and the in the evening (much to my relief) I was able to stand and walk around my room. 

I was delighted to have visits from my friends Leonie (she even brought cherries 🍒) And Sarah who came in with some ravishing tiger lilies. I wasn't able to completely focus on the conversation and kept drifting off.  My mother Helen and her husband Bob popped in in the late afternoon too. They have both had knee replacements so we shared "war stories".

Peter the surgeon and Neil the anaesthetist popped in. They were pleased with the surgery. Peter reported that there was no cartilage at all in my knee and that there was a huge amount of inflammation in the joint. He could also see the inflamed bakers cyst. So it is all looking great for the day ahead.

I have been practicing my knee exercise but progress is slow. But it is progress. Lat evening I glimpsed a man hurtling up the corridor with his stroller. He had his knee replaced tow days before me - so I am visualising myself walking with similar confidence in a day or two.

Keep calm and carry on...

29 January 2016 

D-day has arrived. 

- Check-in at 11am. 

- Surgery at approx 2.30pm. 

- Operation takes up to 2 1/2 hours. 

Followed by 2 hours in recovery and then the rehabilitation journey begins.

This last week has been strange - finalising my work projects, packing my hospital bag, sorting things out. 

One of the things keeping me calm has been watching my favourite one eyed chicken - Abby. (Actually she is my only one eyed chicken 😄).

Abby has gone "clucky" and she started incubating a stash of eggs that she had secretly accumulated. By my calculations, if the eggs survived predation by hedgehogs (and Lewis) they were due to hatch while I was in hospital. After some deliberation, I removed the eggs and replaced them with some fake eggs. Abby watched on and then relocated to a new location and made herself a new nest with no eggs. She has been sitting on the new nest calmly for the last week. 

Abby and I both know that in another week or so her hormonal need to nest will go and she will be back in the flock, digging up the garden and generally marauding. But in the interim she happily hoovers up all the treats I ply her with (minced beef, fresh corn, grated carrot and beetroot).

In addition to chicken monitoring (or chicken bothering as my brother calls it), I have  been doing all my pre-hab exercises at the local pool. 

Yesterday I told one of the older ladies who swims at the same time as I do, I was having a knee replacement. She gave me a huge smile and then pulled up both trouser legs and showed me two gorgeous knees with very fine long scars. She said - "how wonderful - you will be so pleased with your operation - it will be amazing! I have had both knees done and it was the best thing!" She positively glowed.

As today edged closer, my friends and family have been phoning, emailing, face-booking and texting messages sending their love, support and best wishes. I feel very touched and honoured to have their love.

I am calm. I have a precious and wonderful treasure trove of love and good wishes to take with me to the hospital. I have done as much preparation as I could do and the knee replacement is the right choice for me.

Bring it on!

Decision Aids and my sources of information

January 2016

Blog readers will have gathered by now that I am really interested in healthcare;  I like to know what my care options are; I like to have an active and informed role in making decisions that affect my health. 

I am not a clinician - but in the last fifteen years I have been immersed in a lot of medical information and I have developed some skills for sorting the wheat from the chaff (apologies to those of you who are gluten free).

I thought other people might find it useful if I  share some of the information I found useful when I went looking for information about options for managing osteoarthritis of the knee. 

Many of the websites I am mentioning also have a wide range of other resources that readers with different health interests (such as cancer, gynaecology, diabetes or heart disease) may also be able to explore these sights and find documents of relevance to them.  Just click the underlined links below to see these websites for yourself.

Decision Aids
I get quite excited about decision aids - I find them really helpful and there is a growing amount of evidence in support of their use in assisting people to make decisions based on their own individual circumstances.

I found two decision aids quite helpful in thinking about my options and forming the questions I was going to discuss with my doctors. 
They were: 

• The Cochrane Musculoskeletal decision aid - What are my options for managing hip or knee osteoarthritis?  I like the way it quite frank and upfront about the serious harms and side effects. 
• The other decision aid I used was from Alberta Canada - Arthritis: Should I have knee replacement surgery? I like the way this decision aid provides a little quiz towards the end to help you clarify the points of importance to you.

Gathering Information about Options
I initially wanted to look at non-surgical options (I was really hoping that I could delay surgery for some years). The website I found the most informative was a US one called Healthline. They have some really straight talking videos (I have just re-watched the knee surgery one and I now feel a bit queasy).  I think these videos are better than the NZ Ministry of Health video on knee replacement - but here is a link if you want to watch it.

In addition to the videos, the Healthline website as well as some clear info about:

•  risks and complications of surgery 
• alternatives to surgery, and 
• clinical outcomes. 

Once I had a summary of the main options - I then went through a search process to find the latest articles about the effectiveness of each of the options.  Probably a bit more obsessive than your average person....(I have just noticed that Healthline also have an article on managing post operative pain - so will just have a quick break from blogging to read that...)

There is also some good material from NHS Choices in the UK which is clear and concise about the options and risks etc.

Along with the information about the surgical and non-surgical options, I also downloaded the most recent reports from the Joint Replacement registries in Australia and New Zealand. The 2015 Australian report for Lay readers talks about the current issues associated with knee replacement (I thought this was quite interesting).However, I thought the NZ report was even better - eg there are 48 different types of knee prosthesis types walking around in NZ, people as young as 8 years of age and as old as 100 years of age have had knee replacements. Around 7,000 knee replacements are performed in NZ each year and most surgeons perform around 33 procedures each per year. 

The report also provides reports on patient based outcome measures. In NZ the Oxford Knee Score is used and can be completed online at the NZ Orthopaedic Association website.  I have completed this survey and printed it out and I plan to compare my preoperative data with my post operative outcomes in a few months.

I have also signed up to a couple of websites:

• the musculoskeletal elf - an evidence-based website that reports on the latest findings from systematic reviews such as exercises
• the US based Arthritis Foundation - they have some useful tips on physical exercise - but are rather prone to ask for donations
• Option Grid - they have either an interactive or static range of decision aids - including some on OA of the knee
• HealthTalk is a nice UK based website that has videos and audio clips of people talking about how they manage their health conditions - and this is accompanied by written evidence-based health advice

Good luck - I hope you find some information that informs you when you use these websites.

Pre-op assessment - going on a voyage to an unknown land...

The last two days have been all about preparing for the operation. I am beginning to feel as if I am embarking on a voyage to an unknown land and I need to get my passport, immunisations, foreign currency,  guidebook and expedition clothing sorted.

The first pre-operative task was to have blood collected so the doctors can assess my kidney function etc and also match my blood type (in case I require a blood transfusion). The surgical coordinator wanted me to have the blood collected down in Wellington because she was not sure of whether the Hawke's Bay service would be able to reliably send them by results within a week. I was also concerned about this as my initial X-rays were "lost" for two weeks because they were sent to a mystery location - not the address on the form or the address I repeated verbally and with a yellow post-it note. 

Once I had found the pathology lab (yes - the lab had been renamed and had moved approx 500m -the information I was supplied was out of date) the phlebotomists didn't want to take my blood. They wanted me to come back next Wednesday to be "collected". I wasnt that pleased and explained that I had driven three hours to get the blood taken and that I was following the instructions of the surgeon. Just at that moment the surgical coordinator just happened to phone me and she confirmed the instructions she had given me... Eventually the phlebotomist conceded to take the samples but gave me a stern warning that I might have to have them done again next week! In all I spent an hour at the lab and was nearly late for my next appointment with Sam.

Sam, the new grad physiotherapist, was assigned to do a pre-operative assessment of my knee and my overall physical health.  Sam talked through what I should expect from the operation, some of the exercises I would need to do post-operatively and he showed me how to use crutches. Apparently I am also going to be using one of those Nana-walkers as I relearn how to walk. Sam seemed a bit surprised that I was taking notes of our conversation - but it helps me remember all the information at a later stage. 

Sam and I also had an interesting conversation about post operative pain. He said that surgical pain is quite different from the long lasting deep angry pain that I currently experience. Yes - that is exactly how it feels.  The other thing he said was that the surgical pain is pain you can push through - it will change and you can exercise through it carefully. I find this fascinating.  I have also just talked to Vanessa about pain and my expectations. Vanessa repeated the message of making sure I listened to my body and pain signals so that I don't get overwhelmed by pain and it doesn't spiral. I also need to spend time over the next week watching people using their knees. This will help me be more mindful of the way I need to use my new knee.

Continuing with my pre op To Do List, I headed off to my dentist to get my fangs checked out. I was somewhat anxious about this in case there was some awful unexpected surprise lurking in the X-rays. Any dental infection could have meant a delay in the operation in order to reduce the risk of bone infection. So I was hugely relieved to get a clean bill of oral health. Sweet!

The final part of my preparation for my trip into this unknown land was to secure my "expedition clothing".   I need to take along some nighties however I only own 1 nightie which is about 4 sizes too large (I bought it about 15 years ago). I do own some PJs but they won't be suitable as I need to have my legs free from coverings. So I have boldly headed off to explore the wild world of night attire. But frankly it is a world inhabited by lots of skimpy, slinky and pastel wear - not my scene at all. I couldn't bear to try the slinky-wear on. So I needed to think laterally to come up with something tolerable. I have found a great alternative - some bright coloured 5xl t-shirts which are voluminous. Plus I will also be able to use my fantastic Marimekko pocket dress I bought in Helsinki several years ago. It is modest yet and best of all  - it is fun and it make me feel happy whenever I wear it.  I now feel as prepared as I can be for my expedition. Bring on next week!

Finally, thanks to all the people who have been so supportive of my blog and my journey. I feel very honoured to have your support and aroha. xx

Getting started on my story...

I am a mid 50's year old woman with vibrant red hair. My partner Peter and I live in a small rural area of Central Hawke's Bay in New Zealand. We have a lively puppy (Lewis), many hens and guinea fowl and we spend a lot of time tending our trees and lifestyle block.

View of our land in summer

I work from home as a health sector consultant. I have a policy and management background and have been working in the health sector since the 1980s.  My particular health interests are in health consumer engagement (back in the 1990's I was involved in the follow up of the Cartwright Inquiry, the development of the Health and Disability Commissioner's Act and the  Code of Health and Disability Services Consumers' Rights, and the development of the Stronger Consumer Voices and Consumer Collaboration of Aotearoa). So I am really interested in finding ways for health consumers to be actively involved in managing their care and making informed decisions. In former jobs I have been involved in the regulation of  health professional bodies (both as a policy adviser and as a registrar of a number of allied health professions), so I know a lot about the importance of quality improvement and professional standards.

I have also spent the last 15 years involved in developing, promoting and implementing evidence-based guidelines. In NZ I was the first Chief Executive of the New Zealand Guidelines Group and I was also one of the founders of the Guidelines International Network. 

Most of the work I now do is providing advice on evidence-based guidelines, implementation of evidence and health quality improvement.
When I am not working, I love to spend time with my dog, cook inventive food (including making my own cheese) and hanging out with my chickens.
I also have osteoarthritis in my knees. 

I have decided to write this blog as a way or recording my experiences as an informed health consumer embarking on a total knee replacement. I hope that some of the information I have collected and some of my experiences will be of assistance to other people considering how to manage their knee pain.

Knee replacements are pretty major surgery - and so I have no work commitments for the next three months - my only commitment is to my recovery from surgery and becoming "bionic". I feel vibrant and energetic - I just need a new knee to feel awesome. 

I have a family history of osteoarthritis (OA) of the knees and I have over the last few decades also had a number of falls and twists that have caused a degree of pain in my knees.  To manage the pain I have been working on the two most effective things I am told that a person with osteoarthritis of the knees should do - lose weight (About 5 years ago I lost 25kg and I have lost 10kg in the last few months) and exercise.

About 5 years ago I went to see a very nice Hawkes's Bay orthopaedic surgeon for advice about my knees. He reported that I had OA in both knees (worse in the Right than the Left) and we agreed on a management plan based around pain medication, physical activity and ongoing weight loss.

That approached worked reasonably well for a few years and meant that I was able to do most things (not always with grace and elegance) but I could still walk our dog Morse, go to the gym, help around the farm and go about my work and social activities. 

Morse

I have been managing my knee pain and discomfort reasonably well for the last five years or so - but this last eighteen months has been really hard.

The more I exercised the sorer my knees got....(yes - I was doing exercises that are recommended for OA)...so sore that most nights I couldn't sleep without writhing from the discomfort of the exercise. Going for dog walks was ok - mostly because my very old dog was just as doddery as I was. So when my old dog Morse died this time last year it was a bit of a relief as I didn't have to go out on walks. 

My trusty bike 

Without my old friend Morse, I took up cycling and started cycling the bike trails around Hawke's Bay. It is such a beautiful region of New Zealand and the trails are usually flat and safe and travel through vineyards and orchards and swoop along the coast. Cycling was a great way to get around and made me feel active and strong. But pretty soon it got so that a 35km/ 2 hour bike ride would take two or three days to recover from. This was due in part to the fact that my right knee won't straighten and so I can't easily push down on the pedals.





Over the last 8 months or so, even "normal" everyday things have started to be a challenge. For example:

• I find I can't stand and talk to people for more than a minute or two. It is pretty embarrassing - people like chatting while standing up - especially at conferences and business meetings where I have most of my interactions with clients. In the past I have been invited to give presentations at conferences and workshops. Last year I had to give a series of presentations of up to 20 minutes a time - standing at a lectern in front of an audience. I was too proud to take along my walking stick or to ask for a chair - choosing instead to increase the doses of painkillers and grin and bear my way through. Not being able to stand for any length of time also makes it hard to go out and pitch for work - a rather critical activity for someone like me who is self employed. I also tend to avoid social occasions that involve lots of chatting and eating standing up or going to the Races or bars.

• Waiting in queues and international travelling is hell - if I have to stand still for any length of time my knees seize up and I can't move...so waiting at the bank when the computer system crashes - or waiting at Immigration at an international airport have become heroic activities.  Just last week I was caught up in a line at the post office and when I got up to the counter the nice guy behind the window casually asked "how are you today?"  He was pretty shocked when he could see I was barely holding back my tears because I felt so sore and uncomfortable and had I had broken out into a ghastly sweat. The sweating is also a bad look when you are standing in front of an Immigration Officer at an Airport!! 

• I absolutely love cooking - but now I find that my cooking has gone way-downhill - I don't have the patience to do anything complex. Cooking for a dinner party is a huge effort. I have to sit on a stool in the kitchen to look after something cooking on the stove top. I have to sit to do most of the food preparation like peeling potatoes, grating cheese and drying the dishes. I now understand what my mother went through when I was a teenager when she had osteoarthritis. For several years all our meals were burnt. I regret now that I didn't understand then what she was going through and what an epic effort she made to continue to cook while in pain.

• My walking has become very limited. When I walk, my knee bones grind and creak. It is hard for me to walk up and downstairs without holding onto a rail or the wall.  Despite being fairly fit (I have been going to the gym or swimming pool most days of the week for the last three years) I find I can only walk about 1km.  Last year Peter and I decided we couldn't live without a dog in our lives - so along came a new puppy, Lewis.  

  

  Lewis

  Lewis , a Long haired Weimaraner, is incredibly large and exuberant and he loves to walk and play - so Pete has primary responsibility for walking him for about 3 hours a day.  My fabulous physio friend, Vanessa, has advised me to use walking poles (and to lift my knees to the clouds when I am walking) and this makes dog walking a lot more manageable. However it is really interesting to watch people's expressions subtly change when they see the sticks in my hands. From my point of view the sticks are fantastic - they give me "lift-off" - a boost that my knees can't produce - and I can highly recommend them for anyone with sore knees.   My difficulty walking has also severely hampered one of life's idle pleasures - window shopping. Thank goodness for the internet as most of my family got Christmas gifts I was able to order online rather than things I would usually have scoured the shops to find. I also tend to go shopping in places where they have shopping trolleys so I have something to hold onto (so this might explain why I tend to frequent only Briscoes and supermarkets).

Other things I will briefly mention that I find hard include:

• the pain in my right knee exacerbates my right ankle (which also has some arthritis). This means I use my left knee - which is also arthritic - has to work more and it becomes sore. With two sore knees and a sore swollen ankle - I tend to use my hips to move - and this means that I now have a sore right hip... I don't even want to ask if that hip is arthritic!!!
• not being able to sleep through the night
• not being able to sit down on a toilet seat without carefully lowering myself down by holding onto the walls
• having my knees seize when I am bending over - eg putting wood on the fire. This causes me to lose balance and fall forward (eg onto the firebox)
• forgetting to take my pain meds. Peter finds this very hard too!!! Not only is it painful - I find it hard to keep a civil tongue in my head. I need to take my pain meds 4 times a day - and if my timing is interrupted or I forget then it takes a day to get back into a tolerable state.

In May 2015, I decided something had to change. I made an appointment with my Wellington based GP and asked her to refer me to a Hawke's Bay orthopaedic surgeon for a review of my knees. The nice guy I went to back in 2011 was on an extended holiday so I made a booking to see another knee specialist (recommended by friends) to ask him about my knee management options.

Being a bit of an enthusiast for evidence-based practice and informed consent - I spent about a month preparing for the appointment, going through Cochrane reviews, decision aids, evidence-based guidelines and journal articles to find out the most likely range of options to discuss at the consult. (I will write a separate blog with links to the information I accessed).

The questions I had prepared were:

1. Has the OA in my knee/s progressed too far to manage by non-surgical means?Are both knees equally affected? 
2. What is happening with my ankle? Is the OA able to be re-mediated? 
3. Is my lumbering gait going to impact on my hips and ankles? 

Are any of these Non- Surgical options viable for my knees?

•       Improving analgesia
•       Ways of reducing inflammation – do I have a Baker’s cyst? If so, can this be drained?
•        Cortisone
•        Weightloss and targeted physical activity /physiotherapy. If exercise what is the best type of exercise – duration and intensity?
•        Prolotherapy
•        PRP – platelet rich plasma injections
•        Hyaluronic acid – visco-supplementation
•        Braces/ strapping

If require I surgery, what are the best options?

•         Implant of a load absorber eg KineSpring Implant?
•        Partial knee replacement/ TKR?
•        Partial resurfacing?
•        Osteotomy?

If surgery is recommended, how many of these types of operations do you do annually?

• What are your revision rates and how do they compare with others?
• What is the satisfaction of your clients with reduction of pain after 6 months and mobility/ stability?

Well - that was a pretty abortive appointment. He didn't want to talk about the items on the list (I see you have been "googling" he observed!). He had two key points: 

• I am too young for a knee replacement - wait 10 years. He said I could only ever get two knee replacements and that younger people wore the implants out quicker than older people - so he preferred to operate on people over 65 years.
• Lose more weight. He advised the paleo diet (so immediately his credibility plummeted).

He said there was no additional pain relief that he could offer - that exercise would have no benefit and that I shouldn't darken his doorstep for another decade.

That was a pretty bleak encounter. So I got back onto the weight loss regime and got madder and madder. Actual I was furious, enraged and especially annoyed because a lot of what he was saying was wrong.  The data for knee replacement revisions only relates to older models of the implants. Every year there are newer improvements and modifications to the implants - but their longevity can't be proven because they haven't been in existence for many years. 

Not only was the surgeon unpleasant and wrong, he seemed to have no regard to my quality of life or the things that mattered to me.  

Documents I had read before the appointment advised that current approaches to pain management recommended interventions to improve tolerance for functional activity and quality of life.  His approach was not consistent with either the Australian Prescriber approach nor the NICE osteoarthrisits guidelines (which recommends a holistic approach to OA assessment and management  as well as pain management that could include paracetomol, topical NSAIDs and the addition of opiods if necessary. In my opinion, he would benefit from reading patient oriented information such as those published by the BMJ  on "What your Patient is Thinking".

I simply couldn't contemplate what my life would be like as my knees, hips and ankles degenerated over the next ten years. All I could see was a bleak vision with me becoming completely unable to move without assistance, we would have to move away from our small farm, I would be unable to work or to travel, I would have no money to afford the surgery in 10 year's time, I would have no social life and I would be a complete bitch to live with. He seemed to want to impose his view that it was worth me suffering while 54 for 10 years so that I could have a good quality of life when I was 65.

After being really mad (and depressed) for a few months and talking to some of my Australian buddies who have been doing some work on the evidence for OA of the knees, I decided I needed to get some further advice and booked another appointment with my GP.  I think I completely stuffed up her Monday morning appointment schedule - but during the course of that rather long and emotional consult we developed a new plan of attack: - increased analgesia (1000mg naprosyn pd, paracetamol and codeine as a backup) and weightloss...and then after a few months if that didn't improve things then referral to another specialist. The second opinion appointment was at the end of November 2015 in Wellington. 

The new orthopaedic surgeon was a completely different kind of person. (This time I selected the specialist after seeking the opinions of three different people - all of whom recommended him as someone they would trust to listen to me and to help with my knee pain. I was also pleased to see that he was a member of the NZ Joint Registry Board which signaled to me that he had a strong interest in quality improvement and safety issues). 

His first questions were about what I did for a job and what my issues were with my knees. He had read all of my notes in advance and he was not in any way dismissive about my questions.

In his view - my Right knee was never going to improve - it was about as bad as it could get. The difficulties with my right knee created the problems with my right ankle and hip and also my left knee. We talked through all of the non-surgical options but in the end he recommended a total knee replacement (TKR) of my right knee. And the surgery is scheduled for 29 January 2016.

Over the last months I have been following a "pre-hab" programme that my fab physio friend, Vanessa, has developed for me. It is mostly oriented around aqua-jogging and water based exercises along with other exercises designed to improve my posture and range of motion. Vanessa has also been great to talk to about pain management. 

....So ...Bring on the Total Knee Replacement!!

While it all seems a bit daunting right now with less than a week to surgery I thought I would use my time to start writing a blog about my experiences as I go through surgery and recovery.

Here are some of my goals once I have what I refer to as my "bionic" knee (You can tell I was a big fan of the $6m man back in the 70s )...

1. Walking with Peter and Lewis on the beach
2. Reducing my reliance on pain medications
3. Going on cycling and other adventures
4. Being able to help around the house - even though that will involve close contact with the vacuum cleaner and moving firewood!
5. Being able to travel and speak at conferences
6. Walking the streets and stairs of Venice (I am always astounded at how far you have to walk and how many steps there are in such a small and gorgeous city). I might even have more fun than I did when I was last there in 2012...watch this space