I’D FEEL GREAT IF I COULD CUT OFF MY HEAD!

While Odel has been (and continues to) making great progress on his recovery, I am a mess, battling what appears to be an allergic reaction for the past three weeks. I don't remember ever having an allergic reaction before, but this one is a doozy and today is the worst it has ever been.  Though I had decided not to mention it on the blog, I’ve changed my mind in hopes that a reader might have a suggestion that could help.

My skin around my eyes, my lips, and the skin around my lips itches like crazy.  It is somewhat raw, and very swollen.  The only relief from the itching comes from keeping it greased up with Aquaphor, though I have tried many different potential treatments.  Sometimes my tongue tingles (itches), too.
 
I have none of the classic hay fever symptoms.  No stuffiness, no congestion.  My eyeballs themselves are fine, except that the greasy Aquaphor occasionally blurs my vision.
 
It is spring there in Sacramento, so there is a LOT of pollen in the air.  These symptoms began around three weeks ago, then worsened considerably on Monday when the wind blew quite strongly and I spent about half an hour outside.  It has been very dry and windy here since then, so I have stayed indoors as much possible.  Yesterday I vacuumed and dusted, and we have been keeping all the windows tightly closed.  I changed the pillowcases on the bed, too - yet my eyes were almost completely swollen shut this morning - by far the worst they have been.  My lips feel about double their size (though they look pretty normal, just very pink and chapped all around the edges).  My stomach feels a little upset, and more parts of my skin seem a little itchy - but maybe that is just my overactive imagination.
 
As chance would have it, I had appointments set up with both my ophthalmologist and my primary care doctor when this was getting underway.  The eye doc gave me anti-allergy eye drops; my primary care physician recommended Allerga.  Neither has made any difference - things just keep getting worse.  Benedryl doesn’t seem to do much, either (make that “doesn’t do anything”).
 
Although it seems like pollen might be the culprit, I wonder if it is a food allergy.  I've been writing down things I can think of that might have brought it on, and have eliminated a few things from my diet totally, to no obvious effect - almond milk, almonds, soymilk, red wine... right now, I am wondering about wheat, another total shot in the dark (but we had whole wheat pasta for dinner last night).
 
It is always worst in the morning, whether that is because I have had my eyelids closed for a long time or ??? - I don't know. Due to itching, I get up around 4 am to bathe my eyes in cool water and reapply Aquaphor.  At that point, when all the Aquaphor I applied before bed has been absorbed, the skin in the folds of my eyelids is dry and scaly, very sensitive to the touch and itchy.  Tonight I am going to sleep on the couch, not using my normal pillow, to see if that makes any difference.  I am really getting desperate to find a solution.
 
If Odel didn't need to be here for his knee, we would fire up the engine and move out of the Sacramento valley, but that isn't in the cards for another couple of weeks.  For now, I use cold compresses, Aquaphor, and Allegra, and remember all the folks I know who have far more significant problems than I do… but my inability to figure out what’s going on or how to improve the situation is driving me crazy.  :(   If anything occurs to you after reading all of this, suggestions are welcome! 

Fortunately, Odel continues to do VERY well.

KNEE REPLACEMENT DIARY: A SMALL DOSE OF REALITY

Last week, during an interesting conversation with Christine (PT), she told us that it takes SIX days to recover from ONE day spent in bed.  By “recover”, she meant to regain muscular strength and energy, to get back to where you were prior to becoming bedridden. 

This took on real meaning for me yesterday, when Odel had his first big outing – a visit to Sydney’s and Frank’s house for a family get-together.  He walked 20+/- yards to our car, rode for 50 minutes, walked another 20 yards into their house.  There he sat in a comfortable chair with his leg on a footstool watching golf on TV, except when he went a few steps to the table for our brunch.  Then back to the chair… back to the car… 50 minute ride…back inside our home.  We were gone six or seven hours.

We ate dinner at 6 pm, and he fell asleep on the couch at 7 pm – just like he used to do when he walked 18 holes (several miles, carrying his clubs) on the golf course! 

Because Odel has been making good progress on his rehabilitation, it slipped our minds that there are consequences to surgery for more than just the affected joint.  The surgery itself is such a trauma, to say nothing of the side effects of all the drugs AND the loss of strength and energy simply due to lack of movement.  What seemed to us like a day of relative inactivity seemed to his body to be the equivalent of walking several miles during a round of golf.

We have a few more outings planned this week, and I know that getting out of the RV and into the company of friends is good medicine.  After yesterday’s outing, though, we’ll be a bit more realistic about fatigue.

Odel’s surgery was just three weeks ago.   Over the past several days, he has cut his pain pill consumption by about half.  Swelling is way down.  He still has a problem find a sleeping position that is comfortable for a prolonged time.  He continues his prescribed active exercises at least three times a day, along with some passive stretching to straight his leg.  He ices and elevates his leg after each set of exercises, and uses ice from time to time to reduce pain.  It is easy to see that the last few degrees of flexion and extension will be more difficult to attain than the first many degrees, but we are both very determined!  :)

Thanks again to everyone for your useful and encouraging comments.  So many of you have gone through this before, and many of you more than once.  We have many things to treasure in our lives, but GOOD HEALTH is right up there at the top of the list these days!

KNEE REPLACEMENT DIARY: WALKING AGAIN AT TWO AND A HALF WEEKS

It’s been a very good week!

Christine (physical therapist) had Odel out of the motorhome again on Wednesday, taking a short walk back and forth along the concrete slab where we park.  We determined that the walker was unnecessary, and she suggested a cane sized correctly for Odel’s height.  As soon as she left, we loaded ourselves into the Jeep and drove over to CVS.  I ran in and, minutes later, Odel had his new cane.

Then we were off to Panda Express, for some of the greasy food Odel has been craving.  We zipped into a disabled parking slot right in front of the door, hung the temporary disabled placard (be sure you get one of these prior to your knee surgery!) from the mirror, and Odel had his first excursion away from the motorhome.  Yippee!

So, Week Three brought big changes.  Odel has been cleared to walk (short distances); has been taught a series of standing exercises for stretching and strengthening; has been able to get into the car for excursions.  He moves around the motorhome quite easily.  We’ve been able to take the lawn chair back outside, as he can sit comfortably on the couch again, and stand up from there.  He has begun to cut back on the pain medication, both in the quantity and the interval.

When Christine measured on Monday, Odel had 101 degrees of flexion (aiming for 110-120) and –5 degrees of extension (the goal is 0), and his knee’s circumference was 42.8 cm.  By Friday, he had 107 degrees of flexion (111 if Christine pushed his knee as far as he could tolerate), –3 degrees of extension, and his swelling had reduced to 41.8 cm circumference. 

What does all the mean in the real world?  It means he can stand.  He can do dishes!  He grilled our lamb chops for dinner last night!  He can carry things around, and can get his ice packs out of the freezer when I am not home.  And… he’s getting antsy, tempted to push himself just a little more than he should.  It’s not so difficult to watch daytime TV all day long when you’re a pain-pill addled invalid, but he is leaving those days behind – and fast.

KNEE REPLACEMENT DIARY: TWO WEEKS POST-SURGERY, ODEL STEPS OUTSIDE!

Wow, what progress Odel has made in just two weeks!  For the past several days, he has been able to move relatively freely inside (barely using his cane), to dress himself (including socks), and to situate himself on the bed, chair or couch without my assistance.  The biggest news?  Today, he took his first trip down our steep front steps and enjoyed a few minutes of walking outdoors.  Suddenly, I can begin to imagine life returning to normal.  :)

Christine, Odel’s physical therapist, comes on Monday, Wednesday and Friday.  She is patient, knowledgeable, and fun; we look forward to her visits.  At the end of each session, she measures Odel’s range of motion in degrees: how acutely he can bend his knee, and how well he can extend it.  That gives Odel a goal, to keep him motivated as he runs though his daily rehab routine – actively exercising, elevating, icing, or using gravity to passively stretch his healing leg muscles. 

Today’s report: he can bend his knee to 101 degrees (90 degrees are necessary to be able to rise easily from a chair; 110-120 is his ultimate goal) and is within 5 degrees of straightening his leg completely (necessary to walk without a limp).  There is a 4-week post-surgery “window” to achieve this particular goal (full extension), so Odel works on it daily - and has just 5 degrees to go!

The life of the caregiver is busy, busy, busy – but that, too, has eased dramatically during the past week.  Odel handles all of his various drugs without my help.  His increased mobility means that I can be away from the motorhome for longer periods, and that I do less jumping up and down when home.  He does most of his exercises without assistance now – I usually help during just one of his exercise routines. 

With my newfound free time, I took Saturday off!  After making sure Odel had plenty of easy-to-access food and all the drugs he needed, my sister Nancy and I headed east into the foothills of the Sierra to visit our parents for a bit.  Mid-morning, we drove another 5 miles to Sydney’s and Frank’s house (sister and BIL), where we jumped into their new Prius and headed to Sutter Creek, an enjoyable Gold Rush town on Highway 49. 

The weather was springtime perfect, and we enjoyed a long day of home touring (a fundraiser), lunch with wine tasting, and shopping along Main Street.  Get this: we used ONE gallon of gas for the 48+ mile round trip!  I didn’t have to do any planning OR driving, and came home loose and relaxed to find nothing at all amiss with Odel, who had enjoyed a day of watching sports on TV.  It was a caregiver’s dream of a day – thanks, sisters, Frank, and Odel!

On Sunday, I buckled down to some of Odel’s usual jobs – dumping the black water, and washing the Jeep.  I find I don’t mind the dumping much – though I wouldn’t say I LIKE the chore, it is something both parties should be able to handle (like driving).  Washing the Jeep is another story.  Odel and I have joked about how dirty the Jeep would have to be before I would wash it.  Well, now we know… a thick layer of yellow pollen baked on by morning dew and warm sunshine, splattered with just a few raindrops from a light evening shower – and several blobs of bird poop on the windshield, the last straw.

So, as we head into Week 3, the patient is far more mobile, and beginning to reduce the dosage of pain pills he has been taking since the surgery.  The caregiver has regained reasonable autonomy with several periods of downtime each day.  Still no recreational walking allowed for Odel (that is a long way off), and I know he won’t be able to help with grocery shopping for quite some time (I miss that). 

Now, gotta’ run… time to help with Odel’s afternoon exercise session, empty the trash, put together a batch of chicken enchiladas, check the laundry bin…

Oh, guess what?  My official Weight Watchers weight loss: 4.6 pounds, and falling. I’ve missed a few meetings, but did manage to make it in do be weighed last week, and the trend is downward.   Life is GOOD!

KNEE REPLACEMENT DIARY: THINGS TO REMEMBER FOR “NEXT TIME”!

I mentioned earlier that Odel and I took a two and a half hour, pre-joint surgery class offered by Sutter General Hospital. It was great, and our first glimpse of what was to come. Now that we are just over a week post-op, here are a few things we didn’t know, some related to our special living situation and others more general. We’ll want to remember these things if Odel ever goes through this again, and they might be helpful to others in this situation.

MANAGING THE SIDE EFFECTS OF ANESTHESIA, IRON SUPPLEMENTS AND PAIN MEDICATIONS: To put it bluntly, constipation is a major, on-going problem. The health care professionals mention it – frequently – but don’t really prepare you for what that means: lots of discomfort for the patient and very little appetite at a time when they should be getting extra protein to promote healing. I ended up making several trips to the store for prunes (now called dried plums); prune juice, apricot nectar, and Karo syrup for the Senior Cocktail; Senakot and Senna tea; and laxative suppositories. Today we are experimenting with licorice. When things finally DO get moving, it is difficult to keep up any regularity. Have what you need on hand, start using it right away, and keep it up.

Although the medical folks advised that Odel should have plenty of protein and particularly red meat (to keep iron levels up) as he recovered, meat sitting in an immobile gut is an unappealing idea, even to a carnivore like Odel. We found a very tasty brand of Greek-style yogurt – with twice the protein as non-Greek yogurt – at Costco, Chobani. It has no fat and comes in 3 yummy flavors in each carton of 12 cups: peach, strawberry and blueberry. We mix tasteless, quick dissolving Benefiber into each cup, which Odel eats two or three times a day. Supports beneficial intestinal flora, too. :)

USING COLD TO REDUCE PAIN AND SWELLING: Ice packs are an important part of therapy. Because we have a smallish freezer (not particularly cold, either), we had exactly zero ice packs on hand. Our PT, Sandy, brought us her recipe for cheap ice packs, and it works very well: 1 part 70% rubbing alcohol (be sure you use 70% solution) to 3 parts water, double-bagged in gallon baggies. I ended up making four of these, which we rotate in pairs so each pair has more resting/chilling time in the freezer. Also, a tip for those of us with less efficient freezers: put one cup of alcohol in a 4 cup measuring cup. Add a couple cups of ice, then fill to the four cup line with water. Dump it into the baggie and repeat (a total of 8 cups per ice pack). The ice in the mixture will give you a head start on the freezing. I numbered our ice packs 1 through 4, so I knew which ones were used most recently, but decided to keep two in each part of the double-door freezer. A sticky note that we move from one door to the other reminds use which ice packs were used last.

USING ELEVATION TO REDUCE SWELLING: Another key to reducing swelling is elevation. I posted a photo earlier of our pillow pyramid; though it elevated Odel’s leg sufficiently, it tended to collapse slowly to one side or the other. I wasn’t keen to fork out $100 for the specialized foam wedge available for this purpose, particularly when it would just be another thing to get rid of once Odel is healed. Costco had a “body pillow”, about 4 feet long, that offered a better alternative than our pile of pillows and cost just $11 – cheap enough to discard or give away when it is no longer needed. Here is a photo of our new elevator.

MANAGING INSIDE THE RV: Unless you have a quad slide rig (and perhaps even then), it is likely that the walker you come home with will not be practical in the bathroom or bedroom. As I mentioned, Odel uses our cane/seat in place of the walker, and of course we have plenty of sturdy, built-in furniture and countertops to help him mobilize. One thing no one mentioned to us that has been invaluable is the big plastic donut that raises the toilet seat by 4 1/2 inches, eliminating the need for help when arising from the throne. We were able to BORROW this from my good friend Becky – everyone should be so lucky. :)

Along those same lines… in the hospital, Odel had a plastic urinal to use to eliminate the need to get out of bed to visit the bathroom. Be sure you bring that home with you (as our nurse said, “You paid for it!”); it is a big help in the early days and at night. I don’t know what female patients do, and hope I don’t have to find out.

The physical therapists also recommend a sturdy chair with arms and a flat seat. The sofa didn’t have enough arm support; my Euro-lounger was too low; our built-in dinette was completely useless. We brought in Odel’s lawn chair that he uses outdoors, which worked pretty well. (The sturdy and comfortable passenger chair might have worked, too, but doesn’t face the TV comfortably, so was disqualified!) The lawn chair is stationed next to the couch, in the way but workable. I don’t think we’ll need if much longer, but it has been a necessity during this first week.

WHAT TO WEAR: At the pre-surgery class, it was suggested that patients come to the hospital dressed in loose clothing with a drawstring waist, making it easier to dress to leave the hospital. Odel bought an inexpensive pair of lightweight cotton pants (I think they are pajama bottoms, but they are suitable for public viewing) with a drawstring, which have turned out to be the only pants he has that are comfortable and practical enough for post-surgical use. Though he has a pair of heavier sweatpants, the elastic at the end of the leg makes it too difficult to maneuver over his foot, and jeans would be impossible. I went back to Target to get him another pair yesterday, along with a similar pair of shorts. The man is stylin’ now!

Here’s hoping YOU never need to have any of this information!

KNEE REPLACEMENT DIARY: ONE WEEK AFTER SURGERY, THE STAPLES COME OUT

A week ago last Sunday, Odel and I took a walk along the levee of the American River, knowing it was our last walk together for several weeks.  A week ago today (Monday, though I probably won’t get this posted until Tuesday), he had his surgery.  Today, the home health nurse arrived to draw blood and remove the staples from the incision.  In 24 hours, Odel will have his first shower since the surgery.  Whoopee!

Once again, I’m posting photos of the incision in a smaller format so those of you who are more squeamish can avoid the full force of the pictures!  Click on any picture if this seems tame compared to what you see on TV.

The staple remover.	Incision with staples.	Staples are gone.	Clean, new Steri-strips

We made great progress this week.  Strength is returning to Odel’s leg, noticeable when we work on his rehab exercises and even more noticeable in day-to-day changes.  When he came home on Wednesday afternoon (two days after his surgery), he was completely dependent on his caregiver – me – to lift his leg on to the bed and onto the pillow pyramid.  He couldn’t put on a sock or put his foot/leg into his pants.  There was a total disconnect between his upper and lower leg… and his thigh didn’t want to do what his brain ordered.

This morning (Tuesday), eight days after his surgery, he can use his own leg muscles to lift his leg onto the bed or a footstool, and can put on his own pants (I don’t think he could do a sock yet).  He moves freely – slowly, but freely - around the motorhome with the aid of the cane-stool (and of course is trying to do way too much around the house).

During the first few days of caregiving, we had a couple of issues.  The first was that we didn’t have a good handle on a schedule.  Particularly at night, we forgot (or slept through) the regularly scheduled (every four hours) dosages of pain pills.  We needed to remember to do the exercises about a hour after a dose of medication – which needed to mesh with a reasonable meal schedule (recovering from surgery, patients should have another 500 calories worth of protein per day, AND we need to be vigilant about fiber, fighting the ongoing constipating effects of the pain medication).  And then the home health people pop in for a couple of hours – the nurse on Thursday, the PT on Friday…  After three days, I didn’t know whether I was coming or going.

The other problem was keeping track of all the little things Odel needs to have nearby to be happy and stay on track: cell phone, glasses, medications, water, pen, paper.  When he was in the bedroom, his phone would ring in the living room.  When he was in the living room, his reading glasses were on the bedside table.  When the PT called to let him know when she would arrive, he didn’t have anything to write with or on.  Though it was a short distance for me to get whatever he needed, I knew I could find a better solution for that problem.

None of the home health professionals came over the weekend, so I had time to get us organized!

So we wouldn’t forget the pain pills, we began to set our timer to go off every four hours, day and night.  That created a little problem of its own – I needed my timer for other uses (like keeping track of the 15 minute interval for icing his knee).  Odel now has a new timer of his own, with a memory.  When it goes off, pushing the memory button resets it for 4 more hours.  Cool.  Problem solved.

At the same time I bought the new timer, I picked up a “picnic organizer”.  Instead of silverware, napkins, and squeeze bottles of condiments, his organizer holds a water bottle, meds, a small flashlight (for nighttime medicating), pen, pad of paper, cellphone, and a printed weekly calendar of each day’s activities: drugs, exercise, meals and visits from the nurse and physical therapist.

Sometimes Odel will carry his organizer from place to place, but usually I move it from room to room when we resettle him – so I am moving everything he needs at once.  He can answer his own phone, schedule his appointments, renew his prescription, take and track his own meds – as long as his organizer is with him.  The printed schedule is a big help to me, making it easier to find blocks of time when I can take a walk, go to the grocery store, or pick up prescriptions or whatever (it is incredible how much “whatever” we have needed!) at the drug store.

So, at the end of our first week, we’re on a good track.  Odel can do more things for himself, and is showing noticeable improvement from his laser focus on rehab: exercises, elevation, and icing.  I have a couple periods of downtime each day, and I’m starting to remember the things that aren’t normally part of my routine – take a bag of trash EVERY TIME I leave the motorhome, for instance!  Yesterday, for the first time ever, I put a bag of trash in the car with me, planning to drop it off at the dumpster on my way to the grocery store.  It went to the store with me and sat ripening in the sunshine while I shopped.  I did manage to remember to toss it in the dumpster – 100 steps from our front door – before I parked, and we have only the slightest lingering scent of banana peel in the Jeep.  :)

KNEE REPLACEMENT DIARY: THE PHYSICAL THERAPIST SETS US STRAIGHT!

This is a steep learning curve for us, and yesterday made a couple of things crystal clear:

Rehab and convalescence aren’t the same thing.  Rehab is ACTIVE, pain-producing and time-consuming!  And, in the near future, all of Odel’s time will be spent on rehab and pain management; all of Laurie’s time will be spent on everything else.

Friday, Odel’s second day at home, started poorly.  His knee was stiff, far more swollen than it had been previously, and very painful when he moved from the bed to the sofa.  He was discouraged and a little worried, and still waiting for the Senior Cocktail (and several other recommended remedies) to have the desired effect.

Then Sandy arrived and turned our world around!  Sandy is Odel’s at-home physical therapist, full of information, straightforward, and empathetic.  We three clicked right away, and Sandy spent half an hour putting Odel’s concerns to rest, admiring his knee (in her opinion, it looked GREAT), adjusting his expectations, and setting us on the right course. 

Lesson One:  No walking unless absolutely necessary.  Although the hospital Physical Therapist has you up and walking (a few steps) within 24 hours, that is only to make sure you CAN, and that you are mobile enough to go home.  After you get home, walking is not a good thing.  Walking makes your knee swell, and swelling gets in the way of the rehab exercises that are so important.  All the little ways Odel was hoping he could help out as he healed?  Forget it!  Everything he does standing on his feet, at least in this early stage, SLOWS rehab and healing.

Lesson Two: Elevating your leg doesn’t mean putting it on a footstool while you sit in a chair, or putting it on the sofa while you semi-recline.  It means getting your knee above your heart.  For Odel, that translates to laying flat on his back on the bed with a huge pyramid of pillows (every one we own, plus towels and quilts) elevating his leg at a steep angle.  Elevation is half the battle in bringing down swelling (allows the fluids to drain out of the leg); the other half is icing.

Lesson Three: Icing your knee doesn’t mean cooling it down; it means shocking the swollen joint with major COLD, and a lot of it.  Make that knee yelp “Yikes”!  To this end, Sandy gave me a recipe to create icing packs with rubbing alcohol, water, and gallon zip-lock baggies (1 part 70% alcohol to 4 parts water; mix in a gallon baggie, press out the air, zip, double bag, freeze).  That stuff gets COLD!

Lesson Four: The Number One Priority of the first 4 weeks of rehab is to get the knee totally straight.  The window for complete straightening is 4 weeks – and if you CAN’T straighten your knee completely, you will not be able to walk without a limp.  Work that joint!

Lesson Five:  The great flexion Odel achieved in the hospital was typical while the drain is still in, and the loss of flexion once the drain has been removed and the joint swells is completely normal.  In the hospital, Odel’s flexion was around 2 to 90+ degrees; here at home, when Sandy measured him pre-exercise, it was 5 to 62 degrees.  The next 6 weeks are critical for regaining full range of motion, 0 to 110-120 degrees.  If you don’t do the work now, you’re going to have a disappointing result (read: LIMP).

Sandy spent another 45 minutes showing Odel and I how to do the three exercises that he needs to do 3 times a day for the next week (we’ll add more after that).  Two of them require my assistance, and one of them makes me hurt him.  I don’t like that!  After the exercises were done, we built the pillow pyramid, elevated his leg, and iced it with our sub-optimal bags of peas. 

So, Odel’s schedule: Manage pain (take pills every four hours).  Manage blood thinner regimen (pills and injections).  Rehab (painful rehab exercises three times a day; painless circulation exercises at least once an hour when awake; deep breathing once an hour when awake).  Elevate the knee at least 3 times a day for a minimum of 45 minutes.  Ice 10-15 minutes maximum 3 times a day.  Consume all sorts of high fiber food and supplements and get those guts working again*.  

Laurie’s schedule: Everything else.  Most of the work I anticipated – just add Odel’s household chores to mine, along with a few oddball tasks like helping Odel dress.  Three things I didn’t anticipate: I need to actively help with some of Odel’s exercises; I make at LEAST one trip to some store each day to pickup something we need but don’t have; and I spend an inordinate amount of time moving “stuff” (pillows, pills, water, food, computer, blankets) from one place to another.  Keeping a path open, keeping paperwork corralled, and staying on schedule with pills, exercises, and meals is a challenge!

*As of this writing, we have blast-off, so to speak.  That put a smile on Odel’s face!  Thanks to all of you who offered your remedies.

KNEE REPLACEMENT SURGERY: SIDE EFFECTS

First, many, many thanks to our friends (virtual and otherwise) who sent good wishes to Odel, and good advice. He is by nature positive and optimistic, but I know it adds to his feeling of well-being to read the comments and emails you have written.

And hello to new readers who have joined us in the last week or two. Who knows what you found appealing in these detailed descriptions of Odel’s most recent health adventure (!), but your comments and advice are welcome. Many readers seem to appreciate the details of the surgery and recovery, particularly the unusual constraints caused by our tiny abode. If Odel’s experience can be helpful to those RV’ers (or others) facing similar surgery, good!

I wasn’t sure where I would ultimately draw the line between sufficient detail and Too Much Information. I’m still not sure I have found that spot, but I had it in mind when Anna, the home health nurse, visited this morning.

High on Odel’s list of questions was (paraphrasing now!) “How can I get my guts moving again?” The triple whammy of iron supplements, anesthesia, and pain medication had been touched on by various health care professionals (and mentioned by many readers), but none had prepared Odel for total absence of normal intestinal function. Since he didn’t have much appetite last night, it was my opinion that the major post-dinner puking incident I mentioned yesterday was simply his body’s indelicate way of saying “Hey, no more room in here” – and Anna agreed.

SHE, on the other hand, knew just what to expect and came armed with a special one page handout on the 5 steps to take to Get Things Moving. The first step is what I nicknamed the Senior Cocktail: one ounce each of prune juice, apricot nectar, water and Karo syrup! (When I asked Anna about the Karo, she said that a blast of sugar will sometimes get things moving.)

As soon as Anna left, I zipped over to the supermarket to pick up the ingredients (along with a box of bran cereal as a breakfast treat). When the cocktail produced rumbling noises, I suggested Odel massage his inflated belly to help move things along. He did, then smacked his hand against the very firm abdominal bulge and pronounced it “my six-pack.” He, he, he! Guess that’s ONE way to get rock-hard abs!

KNEE REPLACEMENT SURGERY: DISCHARGED–THE NEW REALITY

Goodbye, friendly nursing staff and convenient call button.  Goodbye, tubes, endless noises, and every-two-hour nighttime checkups.  Goodbye, hospital food. 

Hello, steep motorhome steps.  Hello, narrow hallway spaces.  Hello, sunshine pouring in the windows.  Hello, fresh fruit whenever you want it.  Hello, woefully untrained nursing staff!

After two pain-free days of optimism, Odel awoke to a new reality on Wednesday morning.  The drain to remove fluid from his knee had been taken out Tuesday, and his knee was swollen, tight and painful.  During his morning stretching with Doug, his pain level moved towards the wrong end of the pain scale.  Very unhappy face!   The new reality has set in.

The hospital stay for a full knee replacement is usually 3 nights; for a partial, it can be as few as 2 – and we were determined to get him out of there.  I arrived at the hospital mid-morning (with fresh pineapple and a banana) just in time to view the incision (I posted a small photo here; those of you with more interest can click on it if you’d like to see the gory details enlarged).

Once Brian was done changing the dressing, Odel had visitors (Sydney and Frank) and lunch arrived.  After that, we spent most of the afternoon waiting, and bird-dogging the various staff we needed to see prior to discharge. 

Doug the therapist wheeled Odel to the stairwell to practice going up and down stairs, then signed off on discharge.  The medical supply rep came by with Odel’s brand new wheeled walker, provided by Medicare (no more than 1 per 5 years, so we got a long lecture on keeping it).

The hospital pharmacist came by to discuss Coumadin, the blood thinner every surgical patient takes before and after surgery, and the pain medication prescribed for Odel.  And, finally, late in the afternoon, RN Mindy signed the discharge papers, we loaded Odel into the car (ouch, ouch, ouch, that hurt!) and took off for home with a stop at the pharmacy along the way.

We pictured our biggest challenge as the narrow, steep steps into the motorhome, but they weren’t much of a problem.  The obvious immediate problem, once we got inside, was the uselessness of the walker in our confined space.  Only the main living room/kitchen is wide enough to accommodate it easily; it cannot maneuver well in the hallway, and doesn’t fit at all in the bathroom or bedroom.

Many fulltime RV’ers have an item or two that one spouse clings to while the other questions their logic.  Several years ago, I bought one of those little three-legged “seat canes” – works as a cane while walking and converts to a small seat when desired.  Who knows why I bought it?  The only thing I’ve ever used it for was a small cocktail table outdoors… and Odel complains periodically about carrying it around in our storage bays.

Stand back – it’s his new best friend!  Because Odel is able to put a reasonable amount of weight of his injured leg, using the cane and the always-close-by counters and tabletops, he can move reasonably freely everywhere he wants to go.  Problem solved; we’ll save the walker for outdoor use in a week or two.

Setting up for Odel’s homecoming required some rearranging.  He needed a chair with a firm seat and back, and arms, so I brought his lawn chair inside.  He can settle comfortable there or on the couch or in the bed, hobbling from place to place.   After the stress we’d put on his knee, it was ready for icing, so I settled him on the bed and went to get the ice packs (aka bags of frozen peas). 

I pulled back the cover, settled the peas on his knee, asked “how’s that?” and he answered “wrong knee”!  Oops!  Guess the bandage should have been the clue!  It was our last hearty laugh of the evening, which went on to include a major puking event, an injection of another blood thinner, and other un-fun stuff.  By 7 pm, he was back in bed, took his pain pills, and settled in for what he hoped was a good night’s sleep.

And it was. 

As I write this, Anna, the home health nurse is here changing Odel’s dressing and drawing blood.  She will arrange for the physical therapist’s visits, and will return in a few days to remove the staples in Odel’s leg.  I’ve got a list of supplies to pickup to get Odel’s guts functioning again, and we’ll need a couple of days to work out our new routine.  It may not be as efficient as the hospital, but it is SO GOOD to have Odel back home!

KNEE REPLACEMENT DIARY: DAY TWO

Two weeks before his surgery, Odel and I attended a two and a half hour long class about knee and hip replacement, offered by Sutter General Hospital.  Among the many aspects of the surgery covered in this useful class, there was much emphasis on the importance of pain management.  They introduced us to an easy to remember pain management graphic illustrating the 0 to 10 scale of pain.

A smiley face represents Level Zero – no pain.  Around Level Four – starting to hurt consistently, but still manageable – the smile turns into a flat line… pain is intruding into well-being.  By Level Eight, the expression is quite dismal and at Level Ten, all hell has broken loose – big frown with copious tears.

Ideal pain management means taking another pill as you approach level Four, the flat-line mouth.  EVERYONE stresses the importance of staying “ahead of the pain”, which allows you to take LESS pain medication and to participate fully in rehabilitation, which begins the day of surgery.

When I called Odel at 7 am the day after surgery, with the help of Norco (a no doubt addictive pain killer), his pain level was One, almost non-existent.  Good news! 

I arrived at room 4101 around 10 am, practically running into Ron Ulm who was wrapping up another visit to Odel (Ron works at Sutter).  Odel had already been seen by Dr. Bargar (surgeon), Dr. Tak (primary care physician), and Brian, Dr. Bargar’s assistant.  As I took a seat, in walked Douglas, the physical therapist.  No rest for the weary (which Odel was, after being awakened every two hours during the night) - time to get to work on therapy again!

Both of Odel’s legs were wrapped in long, pulsing sleeves that help prevent blood pooling and clots.  Doug removed the sleeves and got to work bending and straightening Odel’s leg.  Both Odel and Doug moved slowly, their faces reflecting concern over possible pain… which never materialized.  Before long, Doug had Odel sitting on the side of the bed, and soon he was up, walking slowly around the room with his walker.

Once again, Doug emphasized range of motion and the importance of exercising the knee to improve its range.  Walking, other than “functional walking” (as opposed to recreational walking), is discouraged because it promotes swelling, the enemy of range of motion.  Sitting around with bags of peas on and under the knee to fight swelling is good; going for a pleasure walk in the springtime sunshine is bad. 

Doug introduced us to the goniometer, a little plastic gizmo that measures the angle of bend in the knee, and was impressed to find that Odel could already bend his knee at a 92 degree angle.

After practicing with his walker, Odel sat in a chair while we talked with Doug about living in an RV, favorite places (Doug is very interested in paranormal activity, and entertained us with a few stories of strange encounters while staying overnight at the Copper Queen Hotel in Bisbee), and the problems we might encounter when Odel comes home (currently anticipated to be Wednesday afternoon).

When the work was finally done, Masial, the nursing assistant from Panama, arrived with a warmed pack of wet wipes and I was able to give Odel a sponge bath.  We pulled the curtain across the entry and got to enjoy some private time.  It felt good to me to do something useful and intimate, and we both laughed over the moaning noises Odel made as I scratched his back with fingernails wrapped in a soft, warm wet wipe.  After he was dressed in a fresh hospital gown, Masial returned to change the sheets on his bed and he brushed his teeth.  At last, he was presentable for his photograph.  :)

I took off to continue preparing for his return (mainly, setting up a place for him to sit with the kind of easy access and support he needs).  Our good friend Becky took Odel a Diet Pepsi (for which they share a fondness), and calls came in from various friends.  Douglas returned for the afternoon therapy and exercise session and the goniometer showed an improvement, from 92 to 95 degrees.  When I called at 4 pm, Odel sounded groggy – he told me he was just drifting off to sleep, very difficult to come by in the busy hospital environment.  

So far, only one aspect of his care has been less than optimal: the hospital food!  Breakfast was cream of wheat (which Odel hates), dry (overcooked) scrambled eggs, a slightly warmed English muffin, apple juice and milk.  No fruit, fresh or otherwise.  Lunch was an open faced turkey sandwich with mashed potatoes and gravy and – finally – some steamed vegetables.  Where are his minimum five fruits and vegetables each day?  When I pulled out an apple to eat while I visited, Odel’s eyes grew big, round, and expressive.  Something fresh, juicy and crunchy!  We shared it, and I’m gonna take some REAL food on my next visit!

KNEE REPLACEMENT DIARY: DAY OF SURGERY

Knowing you need to be out of bed at 4 am for an early morning trip to the hospital is not conducive to a night of sound sleep.  We both tossed and turned for most of our short night; it was rather a relief to get out of bed and get our long day started.

While Odel took the last shower he will be allowed until 24 hours after his staples are removed (which will be a week to 10 days), I had a quick breakfast.  Nothing for Odel – his last food and drink was prior to midnight.  At 4:45, we stepped outside into darkness and drove the short distance to Sutter General hospital (usually a 10-15 minute drive) on roads eerily empty of commuters.

5 am: Check in time.  After a brief wait in the main lobby, we were escorted upstairs to the joint surgery unit, to join another half dozen patients and their caregivers in a smaller lounge.  One by one, the patients were called, and soon it was Odel’s turn.  After he was prepped for surgery, I joined Odel where he waited on his gurney.

Between 6 and 7 am, Odel was questioned, wired to machines, and outfitted with a thicket of needles and tubes.  The big toe on his left foot was marked with a big black dot that meant “work on this side”.  Nurses came and went; the entire suite of ten curtained cubicles was a beehive of pre-dawn activity. 

Around 6:30, Dr. Mystery (that IS his name, but I think it might be spelled differently), the anesthesiologist, arrived.  He confirmed information gathered about Odel over the past two weeks of medical tests and consultations, and explained which anesthetics he planned to use: a spinal block to eliminate all feeling in the lower extremities and a light sedation that would allow Odel to respond without being totally conscious.

6:50 am: Dr. Bargar arrived to visit with us, mark Odel’s left knee with a special pen, and give us the chance to ask any last minute questions.  We both were feeling as confident as possible, and Odel was ready to get the surgery behind him.  At 7 am, the nurse rolled Odel down the hall on his gurney, and I went in search of the surgery waiting room, where I would learn the news once Odel’s surgery was finished.

Once I knew where the waiting room was, I headed back to the car and home for breakfast and a shower.  Two hours later, back in the waiting room, Dr. Bargar arrived with fresh X-rays and the EXCELLENT news that he did a partial (medial) replacement, along with the removal of a bone spur and a “kissing lesion” under Odel’s kneecap.  As he has done each time we have met with him, Dr. Bargar consulted as though he had no other place to be, as if Odel was his only patient and he had all the time in the world to answer questions.  After he had answered all of mine, he advised me to take advantage of Odel’s recovery time to take a walk outside to enjoy Sacramento’s beautiful spring day – good advice that I promptly took.

As I stopped in the parking garage to pick up Odel’s hospital bag after my walk, my phone rang: Odel was in his (private!) room* and wondered when I’d show up!  Ten minutes later, there he was, groggy but smiling, in no pain.  Let the healing begin!

The remainder of the day crept slowly by.  I met Odel’s nurse and nursing assistant, both in and out of the room constantly, adjusting machinery, making sure he was comfortable and doing his jobs: “paddling” his feet frequently as feeling returned (to keep the blood moving) and deep breathing into a plastic doo-dad that measures his lung capacity (to keep fluid out of his lungs).  Before long, Odel made me breath into it, too – so he could glory in his ability to take a deeper breath than I can.  That guy is SO COMPETITIVE!  I can see that keeping him from overdoing his walking during recovery will be a challenge.

In mid-afternoon, I went home for a much needed nap.  While I was away, the physical therapist arrived for the first workout: sitting up on the side of the bed, standing in the safety of the walker, and taking two steps in each direction.  Odel’s first visitor, our good friend Ron Ulm, stopped by with magazines for Odel, and I returned in time for Odel’s first solid food, a dinner of soup, a pathetic looking hamburger, and a piece of cake.  He gobbled it down while the nurses worried that he might throw up… I can see they don’t know Odel.  :)

I left at 6, when the final matchup of March Madness came on.  Odel looked happy and drowsy in his bed, in full control of his TV remote.  It couldn’t have gone better.   As of 7:30 pm, when we talked on the phone, he had experienced NO pain, even as the spinal block dwindled away.

Now the real work begins!

* When I asked Michelle, Odel’s nurse, how he happened to score a private room, she said that Monday is the best day to schedule your surgery – most of the rooms empty out over the weekend, so those who have early surgery on Monday morning has a good chance of a private room assignment.  Good to know.

ALL READY TO GO!

The classes, the checklists, the doctor visits, the vials of blood drawn and analyzed… the X-rays, scans, tests… it’s all done.  Odel has pre-registered for the hospital admission, which is scheduled for the gawd-awful hour of 5 am tomorrow.  His bag is packed, checked, and double –checked.  He has watched the DVD we received from the hospital, and we’ve gathered the equipment we are most likely to need (and that fits in an RV).

Latest word from the surgeon, after the most recent X-rays, is that a partial knee replacement is a good possibility, with fewer days in the hospital and a faster recovery schedule – welcome news.  Pre-surgery instructions call for a shower tonight, and one tomorrow morning (which means 4 am to make that 5 am admission!) with special attention to his feet (bacteria removal)!  No food after midnight. 

We took a leisurely walk along the levee in the sunshine today; Odel couldn’t stop hamming it up when I wanted a photo.  He is in good spirits, ready to get this over with.  It will be so nice this summer to be able to walk pain-free!

P.S. (edited at 4:22 am as we get ready to leave for the hospital): In a burst of true love and dedication, I learned how to dump the black water tank!  No crawling around on his knees for awhile… :)