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.