Eight weeks at Easter

T26 March 2016: 8 weeks post op

I have felt really great these last few days. This week I have had a few long walks and have been busy with work and planning my trip to England next week.

On Wednesday we went for a beach walk. It seems like more than a year since  I walked on the beach and it was great to    be on the sand and to breathe wonderful sea air. I took my walking poles and was able to go for about 2 km.

Lewis also had a great time bouncing around and chasing sticks.

Today we had a fun walk with Lewis's mother and brother. This was the first time we had walked with them and it was quite boisterous and full-on.

It was the first time I have been for a walk  with people who didn't know I have had a knee replacement. Although I had my walking poles I didn't feel as if I walked too slowly or was noticeably disabled. Peter has also observed in the last few days that I am no longer limping and I haven't been using my crutches much. I have been back into my working routines and not resting or sitting down during the day.

It has taken quite a lot of background organising to get things sorted for my trip next week. I had to get a doctor's certificate to say I was fit for travel. This information was required by the travel Insurer and also by Jetstar. I also had to be "medically assessed" by the travel insurer for my "pre-existing condition" - ie my new knee. I was asked a series of formulaic questions and then told that for an extra $75 the insurer would cover me for any issues related to the knee. What they didn't tell me was that they also charged me another $50 to do the assessment. What a cheek!

I have also arranged to be wheelchaired through the airports. It seems that all airlines are quite happy to make these arrangement of you ask. Since the recent tragic attack at Brussels airport, I am guessing that the transit through airports is going to involve even more delays - so I think the wheelchairs will be a saviour.

I am also preparing myself to go "beep" as I go through the security alarms. I am guessing that my scar (which is healing well) will be a bit of a give away.

I have been really touched by how kind and helpful people have been making the travel arrangements for my trip; such as organising ground floor rooms and transfers from the airport etc. It has made the travel much less daunting.

I look forward to reporting on my knee related travel experiences next week.

Seven week progress report

18 March 2016: Seven weeks since the TKR

It is hard to believe that I have been on this recovery journey for 7 weeks. Sometimes it seems much longer.  It is a wet autumn day today and Lewis has been getting into the "orthopaedic surgery" groove today by demolishing the leg bone of an extinct brontosaurus.

Lewis munching on his bone and being stalked by Abby

It is two weeks since the last blog update and I have had a few ups and downs. I last reported that I was feeling pretty pleased with myself after a couple of walks - but in the following days I was really really tired so had a few days with my knees up. I kept up with my pool exercises and my flexibility and balance is improving.

Creepy gap in scar

In the last blog I included x-rays of the implant and was wondering what was going on underneath the skin. Last week I had the weird sensation of scratching what I thought was a small piece of dried skin on the scar - only to find that it was in fact part of a 1 cm suture which I was able to pull out of the scar. The next day a couple of weird little blue-black blood blisters bubbled through the scar and then some blood oozed out. It didn't gush out but the scar started to open up. I wasn't really sure about whether this was normal. So I popped along to local physiotherapist to get a more informed opinion (Yes - I admit it - I googled "blood blisters on scars" and was rather alarmed by someone who said that hers turned out to be the beginning of an MRSA infection). So the physio and I decided that it probably wasn't infected - it was just a bit of trapped blood that was rising to the surface. But it put a stop to my swimming in the pool for about a week.


I also ventured out into the real world - the local DHB held an evening meeting of local health services and I went along to represent the Takapau Health Service (I am one of the Trustees). It was all rather daunting walking with crutches in to a meeting room with about 60 people all standing around talking and having snacks and cups of tea. It rather freaked me out as I realised pretty quickly that I wasn't yet up to social chit chat and standing around - so I quickly went and sat down at my table and spoke to my colleagues who came to say Hi. At one point during the evening when we were reporting back on our table discussions, I was asked to stand up and speak. However I just wasn't up to it and so had to say - "sorry - ask someone else - I can't stand up and speak".  It is interesting how intimidating small, seemingly inconsequential or easy things can strike the fear of god into you...So still some progress to be made there...

We went down to Wellington last weekend as I had an appointment with the surgeon on Monday the 14th. During the weekend I even took Lewis for a walk by myself. That turned out to be pretty exhausting as Lewis was intent on racing around much faster than I could walk - but luckily he came back when I hollered and whistled. It took me about 45 minutes to go 1.5km. I estimate that Lewis ran at least 5-10km. I was pretty stonkered after the walk!

Over the weekend, it was very nice to catch up with my mother and friends Colin and Ruth, and Marama and Gavin over the weekend. It was great to hear Marama observe how differently I now walk (no more lumbering from side to side).

Knee is coming along well -
you can still see the lumpy haematomas

On Monday,  the specialist was very enthusiastic about my progress. He said:

• my right knee is coming along beautifully 
• I now have a range of motion from 2-125 degrees. 
• he was pretty relaxed about the oozy blood and just said it was related to the stitches below the skin dissolving. 
• that I should stop taking  tramadol (a pain relief medication) as it was probably what was making my brain so fuzzy and making it hard to concentrate. He recommended that I should try a new anti-inflammatory medication - Arcoxia and gave me a script for that.

He was very confident I would progress well over the coming months and that I would be fit to travel to England to speak at a conference in June. 

It was nice to hear that he was pleased with progress as I had been feeling pretty tired and deflated at how hard short walks seem to be. 

The next morning I received an email inviting me to join the international steering group of Cochrane. For those of you who don't know about Cochrane - it is the most amazing group of medical researchers located around the world who go through massive libraries of health research to identify the best health evidence to help clinicians, consumer and policymakers make informed choices about treatment. There are more than 30,000 people involved in Cochrane and I have always been hugely impressed by the Cochrane people I have worked with and the way the collaboration is organised - so I was delighted to be invited to join their Steering Group. 

As part of joining the Steering Group, I need to travel to London in a few week's time to attend their Board meeting in early April. While I really want to travel, it has been interesting to have to rethink what it means to travel so recently after surgery and when I am still not sure-footed. So...

• I checked with the surgeon that I would be fit to fly - and he said YES! So that also means I will be able to get travel insurance cover
• I found out that I can arrange a wheel chair assistance service to wheel me through Immigration and Customs - so that I don't have to try and stand for long periods of time
• I was told to wear graduated compression hose on the flight. However as my leg is still swollen (51cm around the calf) and hardly any compression socks will fit fit me. But after lots of internet searching I located a very nice person who couriered 6 sample socks for me to try out - and just like Cinderella - one fitted.

The other nice thing about this trip is that I will be travelling along with Cindy Farquhar and other people that I know, so I am hoping that will make it all a little less daunting and more enjoyable.

With the trip in mind (and the leaky scar)- I have been back to the gym for the last few days. I managed 500m on the treadmill (13 minutes) and 1 km of the exercycle (5 minutes). It was lovely cycling on the exercycle - it felt so fast and free...so I will be working on that some more in the weeks to come.

I hadn't expected to be travelling so soon after the operation and it is a little daunting. I am really clear that getting back my fitness and walking ability is my number one priority this year - so I am seeing this as an opportunity to look at doing things in a slightly different way to how I have traveled before. So - no more heavy bags, a very pared down wardrobe and a walking stick... although maybe a broomstick would be more fun :-)

One other interesting thing to report. On my way home from Wellington I stopped at a pharmacy to get my new script filled. I was rather surprised when the pharmacist came over and said they couldn't fill the script as they didn't have any Arcoxia available but they could order it in. She also said - did I realise that Arcoxia wasn't funded and that it would cost around $120 per month.  I was rather surprised about it and decided to wait til I got home when I could talk to my local pharmacist.  I did some preliminary searching about Arcoxia. I went first to the Medsafe site and saw that it listed quite a few concerns about Arcoxia - a COX-2 inhibitor. The medicines risks were all pretty smoothed over on the sponsored website so I decided to phone up my pharmacist and have a conversation about whether it would interact with my existing blood pressure medications. She advised me to go and look at another part of the Medsafe website that contained warnings from 2005. I recalled the concerns about celebrex but Arcoxia wasn't on my radar. The pharmacist went through my current meds list and said that she wouldn't recommend it and that I should discuss the prescription with my GP.

I am now using this great app - Manage My Health - which allows me to email my GP with questions. So I flicked her an email and she replied that she didn't think I needed Arcoxia and that I should go back to using the anti-inflammatories (naproxen) I had been using before the surgery. 

The Naproxen isn't without its own risks, but I know it works for me and it helps me to manage the discomfort as I get more active. It isn't addictive like the tramadol.  

It is a minefield out there and it amazes me how much time is taken up trying to get the right health information. I really worry for people who don't have the time or the knowledge of where to go to get information they need to manage their health.

Seasonal changes

 5 March 2016 - 5 weeks post op

Summer has technically ended and the weather is starting to change. We have cooler mornings (around 8 degrees) with fantastic moody mist...but then the days continue to sparkle with hot hot days of about 28 degrees. 

Like the change in the seasons, the changes in my rehabilitation after five weeks, are subtle and stealthy.  

My leg now looks more normal. Even the strange indentation that appeared after the surgery (as seen on previous photos) 

has completely vanished.  In the photo below you can still see a slight dark area to the left of the scar but otherwise the skin is smooth and the scar is becoming less raw and red.

It is interesting to think about what has been happening beneath the surface.

Earlier this week I downloaded the X-rays of my implant. The X-rays show the gorgeous new implant and you can even see the little row of metal staples closing the wound.

I have been quite fascinated by these images and have begun thinking about how it is technically possible to make such massive cuts to the bone - with such precision - while keeping all my flesh and tendons out of the way of the power tools. Ok - it's a rather gruesome thought - but anyone who has done any wood work would have to admit it must be pretty awkward getting into the leg to make all those cuts and to rebate the implant.

To change the subject away from the technical proceeses involved in total knee replacements - I have been a bit more adventurous with my walking. Earlier this week Peter went out for a bike ride. So it seemed to me the perfect opportunity to try wandering down our drive to our dam.

As you can see from this Google map, it is quite a long drive - nearly 1km there and back-  and it is a relatively steep drive. But I managed to get there and back in about 45 minutes. 

This morning I also managed to walk the full distance around the dog park (approx 1.8km).  Slowly - but it progress is none the less. 

I have been to the pool every morning and have started a few more adventurous stretches, squats and exercises and as a result my calf and knee have been feeling more relaxed. And this has made sleeping much easier.  I have been much less wakeful and even had a bit of a sleep in until 6.30 one morning.

As you know, I like cooking and it has been a busy week harvesting our plums, apples, crab apples and pears. Peter and I have been boiling up cauldrons of fruit to stash away in the freezer to eat at a later date. I have been enjoying cooking with the gorgeous tomatoes and herbs from our garden. I still have to sit on a stool when I am cooking, and I can't manage anything too complex - but it is nice to be contributing to the household activities at a time when there is an abundance of produce that we have been nurturing and cultivating over the last few months and in the case of the fruit - years.

In between the harvesting we went to the movies (The Old Lady in the Van), watched the first series of The Legacy (Arvingerne) and the latest BBC series of Lewis, and met up with friends for lunch and coffees. I am also pleased to report that my driving stamina is improving. I drove for 90 minutes today without any problem.

One of the things that hasn't progressed is my ability to stand in queues or even stand and chat. We popped into a shop today and asked a question about a new freezer (to store all out fruit). The salesman was quite chatty and seemed to have a lot of time on his hands. He kept rushing around collecting booklets etc. Standing around leads to discomfort that just overwhelms me. I couldn't take it for more than 3-4 minutes and I had to go off and find somewhere to sit down. I probably should have taken my crutches into the store as they provide me with a bit more tolerance. I just wanted fast answers and no chitchat!  Peter often seems surprised when I just have to sit down after a minute or two when we are in the middle of having a chat or wandering around the house talking.  My need to sit down to stop my legs from hurting just overwhelmes me and I can't be polite about it.  I am also noticing that the arthritic pain in my left knee is becoming more noticeable as I increase my walking distances. I am hoping that as the musles in my new right knee build up they will provide some strength to counterbalance the weakness of the left knee.

Overall, it has been a lovely week.  I am looking forward to more slow and steady seasonal changes over the next week - both with my knee and in the garden.