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Tuesday, April 12, 2016

1 Week with a Knew Knee makes 1 Strong

I know I know.... you miss me... and you wanna know what's going on.

Ok - Not really but let me live in the fantasy anyway.

So what's been going on Steve Austin?

My new name by the way since I got the Knew Knee.

But let's do a little rewind on the Kinesiology Tape of Life back to where we left off which was Saturday April 2nd and let me just lay out the chronology of the last 7 days as it happened..... in the form of a sequence of texts and pics I exchanged with friends and family which would had been on this blog except that GoogleBlogger has somehow taken away my ability to post straight to my blog from my cell phone.

Bitch Bitch Bitch - I know - so without further adieu let's get this Tale of 2 Knees started.

My presurgery day, Sunday, 04/03/16, went really well.  Watched a movie with my daughter and her boyfriend, caught a few rays on the back porch of my daughter's house....

And then visited with Amy's neighbors and then my daughter drove me up to a Motel about 2 miles from the hospital.  This seemed to be the easiest way to handle the logistics because she was starting her new Nursing rotation in Galveston at 6:30 am Monday morning and she would've had to have dropped me off at the hospital at like 4:30 am which I didn't want to do.

I barely made it out of the car into the motel and on the elevator to the 2nd floor cause my left leg was basically locked up and I couldn't put any weight on it and I had no crutch except for the fact that I was crippled.

I planned on taking an Uber to the hospital the next morning but had never used the service before and got a quick primer from my son and it seemed to be pretty easy so I didn't worry about it.

Did a Hibiclens (antiseptic wash) shower and turned in.

Woke up the next morning at 4:30 am before my alarm and couldn't go back to sleep.  Did another Hibiclens shower per pre-surgery instructions. Waited till about 6:30 am to try the Uber thing and try as I might I just couldn't get it to work.  A later review with my son showed I missed one really simple step which was to hit the arrow to the right after the pickup and destination was input.  So I ended up calling a cab and getting a ride from the motel to Texas Orthopedic Hospital (TOH). Initially gave the cab driver the wrong address and ended up in a parking lot on Fannin and then realized I had substituted Fannin for Main..... this is going well already.

I get to TOH and hobble up to the 2nd floor, take a left and go over to the cashier's desk for the Fondren Orthopedic Group to pay my surgery deposit / insurance deductible.  As previously noted in another post, I had set up a Health Services Account (HSA) and fully funded it to the 2016 Individual limit of $3350 which nearly met my $3500 deductible.  When I set up the account, the bank issued me 3 "temporary" checks - ones without check numbers and my name / address on them.  I had contacted Dr Stocks account manager the week before and told them I was gonna pay the surgery deposit with an HSA check and was that OK?
Yep - it was OK - documented the conversation with a follow up email and we're good - right?

Wrong - when I go to pay with the "temp" check, the cashier manager says "We don't take temporary checks".

"But I have all my HSA account paperwork with me - account number, deposit receipts, etc."

Doesn't matter - they won't take it - so I end up having to put the surgery deposit on my credit card.  I would have to get permanent HSA checks ordered, go back to Lake Jackson after the surgery, and then make a check out to Dr Stocks, mail it back to TOH so they would reverse the payment on the credit card and show the payment out of the HSA - which is a tax deductible account - that's why I got it in the first place cause it would save me nearly $700 on my 2016 taxes by paying my insurance deductible out of there.

Best laid plans of mice and men but truth be told it was my fault - I should've known a temp check wouldn't fly and got permanent checks made in the first place.

Live and Learn..... Die and Forget it All.

So that little debacle is handled and I hobble to the right side into Pre-Surgery admission.

This will be easy because I had already done all my pre-registration back on March 17th when I got my PCP referral and did my pre-surgery test and anesthesiologist interview.


Turns out Texas Orthopedic Hospital has no account for me - despite me having the full packet of documents from pre-registration in my hand which I showed the admissions manager to which after looking in her system replied...

"Oh, that account has been deleted. But we do have another account for you".

Which she pulled up.  Turned out it was the original account from when I had ACL Reconstruction surgery done in 1993.... old address.....old phone number.

Long Story Longer, she has to recreate the account from scratch.... I'm 20 minutes late getting into Pre-Op...

But at least I'm in!

So I meet my pre-op nurse, Monique, and then Dr Stocks comes in and we review everything and I give him a good pre-game pep talk saying pull out all the bells and whistles and bailing wire and duct tape cause I want the Steve Austin, leap tall buildings in a single bound, faster than a speeding bullet model of knee replacement.

Oh yeah.... I'm a happy camper right here cause I know what I got coming out of this thing is gonna be better than what I had going in!

Here's some views of the pre-op room...

I meet with the anesthesiologist and the operating room nurse and the anesthesiologist assistant (who actually does all the work) and somewhere in there Monique slips me a pain cocktail of about 3 or 4 different things and here's what I look like now!

You could cut my leg off and put it back together and I wouldn't know any different....

Hey wait a minute...

And boom it's almost 2:00 pm and I am done and I am headed to post op and some....

You guessed it.... COFFEE!!

Damn Dude - you're not looking too chipper there!

And out of post op and headed for my hospital room!

Whoa..... this place is huge and like the Taj Mahal!

and with a nice view out the window of trees and Rice Village.

Aaah - that's more like it.... after 2 cups of coffee.... It Lives!

And the new hardware is in!

I am on a CPM (Continuous Passive Motion) machine that slowly extends and flexes your leg to varying degrees based on inputs from the remote.  I am already flexing my quads for several reps at full extension and hamstrings at full flexion.  I ended up doing 5 flexes at the end of each 40 second cycle for over an hour which amounted to about 900 flex reps total.  I'm already working out - Yay!

The pain meds are working.... the caffeine is working..... the leg is still attached and the CPM machine is pumping.

All systems go!

And Supper arrives..... Holy Mother of Mercy.... I got ribeye and baked potato and veggies and vegetable soup and fresh fruit cup..... it's time for this Old Man to chow down!

The whole meal was delicious and the nurse told me that the food is so good at Texas Orthopedic Hospital that many patients request discharge after lunch vs before lunch so they can eat one more meal here.

The physical therapist assigned to my case, Tiffany, came by in the afternoon and she did an evaluation and had me use the walker in preparation for the 1st in-hospital PT session tomorrow.  

My biggest concern at this point was getting the leg completely straight because it had been crooked for the last 3 months.

Next morning, Tuesday April 5th was cool and clear!  Just how I like it!

Here was my family update that morning....

Not much sleep last night.  Finally resorted to accepting an Ambien at 11:00 cause they wouldn't let me take any Melatonin I had brought with me.  Naturally they woke me just about every time I went to sleep but I got a few hours of sleep anyway.  Then they told me the doctors start coming by at 6:00 so I got up at 5:45 to have coffee, take a shower and here it is 7:15 and no doctors.

Didn't see Dr Stocks yesterday so no details on surgery but I made up a list of questions for when he shows up.

I got out of the CPM  machine and circulation booties last night at 11:00 to help me sleep and didn't get back into them until 6:00 this morning.

Walk to and from bathroom for beard trim, hair wash and washcloth bath was not a walk but a one-legged venture.

Anesthesia is gone and Mr Pain has come to Willy Town.  I told the Nurse level 5 but it's more like 7.

Incidentally, there are no hair dryers in this hospital so no Big Texas hair for me today.  Note to self - next time bring hair dryer and laptop.

So anyway I did a double dose on the pain meds and got back in the CPM and circulation booties and ate breakfast and am working through my 2nd cup of coffee.

Nice Paleo Breakfast!

With a triple on the meats with ham in the omelette and pan sausage and bacon - that all lasted about 5 mins.

Between caffeine and pain meds I'm gonna kick the shit out of Mr Pain hopefully before the PT shows up for my workout.

So the blinds are open and the sun is shining and I am starting to feel better with a belly full of coffee and meat and eggs and pain meds coursing through my veins.

Gonna read the paper, drink some more coffee.....

Yes I am now...

Had a "chicken salad" lunch which was my least favorite meal for the stay but I doubled up on the veggie soup so it was aiiiiight!

The nurse just kept bringing in and injecting pain meds and muscle relaxers till I felt better and then I had the morning PT session where I made a "walker" walk around the floor and then came back and did "chair" and "laying down" exercises. Checked with the Kroger pharmacy on my Rx's after hospital discharge and came to the fast and harsh realization that despite already meeting my deductible through payment at Fondren Orthopedic Group for Dr Stocks, that deductible payment will not show up  on the BCBSTx insurance system for as long as a month from now meaning all my Rx's and likely most of my rehab will have to be paid out of pocket with a check reimbursement from BCBSTx not likely for at least 2 months from now. 

And the pain continues even after the pain is gone. I don't see how people without a cash reserve navigate these sort of events.  Anyway - there's that good news. 

I have another PT session this afternoon with crutches so that should be fun. 

Geez - today I've met with Brad - the TOH assistant director- who got me a hair dryer, with the Dietary lady Maria who helped me plan and order my next 2 meals, with the Patient advocate, Cathy, and with the Case Manager, Sandra, who informed me that BCBSTx would pay for neither a Walker or a CPM machine if which I wanted neither so there!

Between all these people and the nurse and the PT and the Respiratory Therapist and dealing with the FOG Payments Mgr over the HSA check and the pharmacist at Kroger's and the BCBSTx pharmacy and medical reps....

This is turning into a full time F'g job!

Will fill you in on visit with Dr Stocks. PT just walked in for afternoon session.  

Ok so made 2 around the floor rounds on my crutches and stopped and did 25 dips in the "gym" rehab area and practiced stairs with crutches... Blah Blah Blah. 

PT asked me what kind of workouts I did after seeing me knock out the dips and motor around the floor. I tried to get her to let me make 1/2 a round without crutches but she said "No you still have a limp". To which I said "What's new - had one for 3 months now" which promoted a dissertation on why walking with a limp is bad for you to which I reluctantly agreed. 

So Dr Stocks came in around Noon:30 and here are the highlights:

Surgery went well. 

He spent an extra 20 mins cleaning up bone spurs including several on the outside back of my knee. 

ACL was long gone which is what the July MRI report said. 

PCL was badly stretched and he tried to use it but concluded that knee would not be stable with it so I ended up with the PCL being removed and going with the "center post" design on the bottom joint prosthetic which I was prepared for and am totally OK with. I suspected it was damaged because of the pain I had been having on the inside of the knee. 

Internal condition of knee was one of the worst he had ever seen. Top 5% out of 6000 knee replacements he has done and top 10 of the last 300 he has done. Said he understands now how I couldn't get through airport. All cartilage gone on inside head and outside head - which is highly unusual - almost always cartilage left on outside head. 

The bad condition of the knee - way worse than he expected - was the big surprise for him. 

As he said and I readily agreed... "You waited too long" - that exact statement recorded in a blog post I did 2 weeks ago. 

He was able to get the leg "flattened out" while under anesthesia so it can mechanically get there but he said my hamstring was very tight and would require some work to get the leg straight while conscious. This is a result of the leg being bent at a 5 - 10 degree angle for most of the last 3 months - something I was extremely worried about. Anyway I'll get it there with the rehab exercises I will do for the next 4 weeks and stretching in my PIYO and Dance and Stretch classes after that. 

He was also successful at "straightening" the leg out vertically and I can tell just by looking down at it. So at least I won't be quite as bow-legged now. 

The fit of the knee components was very good. No issues there. 

There is nothing about the surgery that will impede / restrict future movement / use. 

He did remove both screws from the ACL Reconstruction. 

That's about it. 

I will be discharged tomorrow mid morning and will be taking an Uber ride from TOH to Amy's house. I have verified with the nurse that is OK. I also spent some time with Aaron this afternoon using the app and am now confident I can use it properly to secure a ride. 

Here are some images I took Wednesday morning before discharge.

The electronic patient board.

Another view of my spacious room.

The CPM machine and the circulation booties that fit around my feet and compressed and decompressed to minimize chances of blood clotting.

View out my window.

The "gym" where I did my dips and situp pikes on the step up bench to the left.

Practiced going up and down stairs with 1 crutch here.

View of downtown from the window at the end of the hall.

At full extension in the CPM machine.

at 95 degrees flexion in the CPM..... I eventually got to 108 degrees.

Nice artwork in the halls.

I'm about 4th down and due for discharge.

Not looking too bad Paleo Boy!

Can lift the leg up and sit it up on the counter and stand and walk on my own..... Pretty good for 2 days after TKR.

What I would look like with a real beard!

This is my favorite one!

Starbucks right down the hall from my room!

Views from the 5th Floor Starbucks patio.

They came in and took the Ace compression bandage and incision dressing off and Holy Centipedes Crawling down the Leg Batman......that's nasty looking!

Cover that shit up right!

Really spacious bathroom!

I waited around for lunch cause it was Chicken Cordon Bleu - Yummy!

Ended up waiting another hour and a half to get my pain meds and muscle relaxer Rx's filled at a local pharmacy and delivered to the hospital but then ordered my Uber ride and he showed up in 5 mins and it was a great ride with a nice gentleman from India.

We chatted all the way to Lake Jackson. With a $20 coupon from my son, I got home pretty cheap!

Got a call from my employer before I was discharged from hospital with a hot work assignment due that day.

So I got home and set up my laptop and knocked out 4 hours of intense technical document review and edit.... on pain meds.... that was a cool experience, but I got 'er done!

Here's the Thursday morning family text update.....

Slept from 11 - 7:30 with 3 wake ups to pee which is normal. Did a few leg extension quad flexes and leg curl hamstring flexes each time I was awake. 

I am up and have put away hospital things, made bed, 

Sent email to old work buddy trying to get in contact with me (I think he wants me to do some contracting for him), took all meds, did a full set of my leg exercises and now drinking coffee. 

Also took 2 Exlax - hoping coffee and Exlax will do the trick cause taking a dump is now becoming mission critical. 

Got to get a shawa, go get my car handicap tag, pick up the HSA checks, make out one to Dr Stocks office, take to Post Office for next day delivery and then head for PT appointment. 

If I have the energy this afternoon, I'm gonna bring my laptop in my bedroom and lay in bed and put together all the texts and pics I have sent since Sunday into one big blog post documenting the whole TKR experience.  Note:  That didn't happen until today.

It is a beautiful day in LJ and I'm gonna make the most of it!

I guess running wind sprints up and down the bank of the creek in my daughter's back yard is out of the question huh?

Pain is about the same overall but more stiffness and soreness of the teardrop quad and muscles above the knee compared to intense stabbing nerve pain inside joint like it was before surgery.  

As I anticipated, it is the pain of recovery and reformation vs the pain of deterioration and destruction.  

Knee joint feels strong and frankly at this point, I can't "feel" the artificiality of it. That may change as the pain wears off and I'm able to use it more but pleasantly interesting at this point. 

Look how straight  my leg is - hasn't been that straight in 10 years.

Ready to Rumble to my 1st PT session!

At BzRehab.... my old stomping ground!

Did an evaluation for about 30 mins - Extension was -10 degrees and Flexion was 108 degrees which is pretty good starting out.  Everybody was freaking out cause I walked into the PT room without crutches.

Rode the seated stepper for 15 mins and did a few other stretches and then an ice and go.

Went and got my "crippled" car tag, sent off the "real" HSA check to TOH and stopped for a quick lunch at the Top China Buffet.

My knee is not the problem now.

I haven't crapped since noon Sunday.  They gave me stool softeners for 2 days in the hospital and I took an Exlax last night and 2 this morning.

If I don't shit pretty soon, my blue eyes are gonna turn brown!

Note:  All the Shit Talk must've worked cause 30 mins later.....

Speaking of shit talk....

Friday Morning Coffee and a Crutch!

So I'm on 4 Rx's post op:
  • Xarelto 10 mg - Blood thinner to prevent clotting
  • Robaxin 750 mg - Muscle Relaxer
  • Celebrex 200 mg - Anti-Inflammatory
  • Hydrocodone - Acetaminophen 5 - 325 mg for pain
And here's a pic of me walking up the driveway Friday morning.

And here's a video of me walking without a crutch 4 days after left knee Total Knee Replacement surgery:

And here's one of the 24 exercises I have to do twice a day!

It's like CrossFit....

For Cripples....

Guess I can call it....


And here's the most painful one....

You lay on your belly on the bed with your legs hanging off the end of the bed and hang a 3# weight on the end of the surgery leg and let it hang for 3 minutes.

That hurts!

It takes me about an hour to get through each session of these exercises but they help strengthen the leg and improve Range Of Motion and I'm all for that.

Saturday, April 9th text to family....

Not to resume the crap talk but I ain't taking no more Exlax for a while cause after the wonderful El Toro Pollo Bravo dinner last night with a huge raw jalapeƱo and 2 extra helpings of pico de gallo, my belly felt like I had a TBR (Total Belly Replacement) procedure. Won't bore you with the crappy details but suffice it to say that I got in touch with my inner self last night. 

So's anyway - I am up this morning and did the Alzheimer's Moment with the TV forgetting the last step to turn it on but after the 2nd cup of coffee, remembered what I forgot, which is typical for me. 

Earlier this week, my daughter bought me 2 HEB roasted chickens, spring mix, big juicy tomatoes and jalapeƱos and I've been having yummy chicken salads.  We boiled some eggs yesterday and also have some yummy, massive Fuji apples.  So I am eating Paleo and well. 

That and the increased exercise has put some muscle back on my left leg already. Back up to 171.6 which is good for me. 

My daughter's boyfriend set out his 15, 20 and 30# Dumbbells and push up handles for me and is gonna bring by his chin-up bar for me so I can do some additional upper body exercises. 

Spent some time inputting the last few days into my budget worksheet and checking credit card charges. No surprises. HSA check was sent to Dr Stocks on Friday so credit card charge should be reversed within a week or so. 

Ate small bowl of boiled egg, chicken, tomato and apple and took 10:00 am pain pill and muscle relaxer and about to do morning exercises.  

Wanna get out after that so may make an HEB run. 

Emailed pics from last week from iPhone to Yahoo email so they can be uploaded to laptop external hard drive. Plan on using some of those in "Weekly Knee-cap" blog post to document the whole TKR experience. 

Daughter is working today assisting with the move of patients from the old John Sealy unit of UTMB to the new Jeanie Sealy unit.  

Had a FaceTime call with son and granddaughter who exclaimed "I don't like it" after seeing my incision (at son request). I love how she expresses herself.  

12 noon Saturday 4/9:

Just finished all my leg exercises and then knocked out 50 push-ups and 20 reps each with 15# dumbbells: 

Side Raises

Done with leg exercises / workout #1 for the day.

Starving so fixed a bowl of roasted chicken breast, spring mix, tomatoes, carrots, jalapeno, avocado and fuji apple.  Eating that, watching UFC - then gonna hit the beach lounger on the back porch for some vitamin D.

Then a run to HEB for groceries!

I'm kind getting into this handicapped thing.

No better produce department in Texas or New Mexico and the exact location where my old duplex used to be that I lived in for many years and then rented out and then sold to.....


Aaaaah... Ahi tuna steaks for $5..... Now I remember why I like this place so much.

That looks familiar!

Bought the farm and the ranch and HEB....

Now to prep it.

My favorite BBQ seasoned Pork Chops!

Kicked up with a little of Outback Willy's African - Moroccan spice mix!

Which goes on the Tuna Steaks too!

Did a survey of the back yard for a call to my yard guy for clean up.

Nice layout with a skillet and a dutch oven going!

See how that hot cast iron sears the seasonings on the squash and pork chops?

That's the money and the flavor shot!

Beautiful Paleo Plate!

Now to some honey-do's!

Lights on the ceiling fan in my bedroom aren't working.  That little pull switch on the bottom is broken.

Why buy and replace a $100 fan when all it needs is a $4 switch?

Also my showerhead wad plugged up with lime (calcium carbonate) so why buy a new shower head....

When you can fix the old one by dissolving the lime with acetic acid aka.......


Stood on the coffee table and pulled the bottom light assembly off the fan with 3 screws and disconnecting the "wire plugs"

There's the little defective bastard pulled from the hole in the center of the light assembly.

Made a drive and a walk (I like to say walk cause I can now) into Lowe's.....

And there's the new ceiling fan light switch....

For $4.08!

Had to make a run to Walmart too for some tools, tubes, scented oil, incense and tea candles.

Kind of a Yin Yang thang ya know?

Never the wrong place for a selfie....

Including the Walmart bathroom!

Add a few more things including a Western book to read and I think we be ready to go!

Back at la casa, I tested all the holes in the shower head with a paper clip.....

Clean as a whistle!

Replaced the shower head.....

And we got full flow Baby!

And we have Lights!

So that's about it for my week....

A left knee total replacement and 2 days in the hospital.

1st PT session.

Grocery shopping trip.

Couple of projects and a trip to Lowe's and Walmart....

Hey - I'm a blessed man.

I prepared for the TKR for 3 months with a lot of painful PIYO, Dance and Stretch and Core Strength classes and my own light weight workouts, kept riding my bike and stayed mobile and independent to the bitter and painful end of the left knee God gave me.

Picked a great Orthopedic Surgeon, Dr Gregory Stocks, a top rated hospital, Texas Orthopedic Hospital and a great team of rehab therapists at Brazosport Rehabiliation and Wellness.

I've had the support of my family and especially my daughter who I am staying with for a month during recovery.

I am scheduled for my follow up and sutures removal with Dr Stocks on Tuesday, 04/19/16.

I am already walking unassisted by man or crutch and am looking forward to a full and speedy recovery.

Yeah - it was a good week!