1st Analysis


On Friday, 1 August, I was officially diagnosed with sleep apnea.  Participated in two sleep studies and the result is that I stop breathing approx. 14 times in one hour — not good.  This past Wednesday, I received my CPAP machine, which will take some getting used to.  The mask fits over my nostrils which, for me, is not as claustrophobic as the mask that fits over both nostrils and mouth.  The first night was problematic mainly because I scheduled a colonoscopy for the next day and the prep for the procedure requires taking 4 Dulcolax and mixing one 238-gram bottle of Miralax with 64 ounces of any liquid that contains electrolytes (I used Smart Water) and drinking the entire mixture.  The Dulcolax expels any solids in your body, but the Miralax solution felt like I was peeing through my anus.  I finished drinking the mixture at approx. 6:30 pm (began at 4:30 pm) and was on the toilet until Midnight.  I couldn’t drink it earlier because I wanted to wait for my CPAP machine before drinking.  That first day using the CPAP was difficult because I was constantly on the toilet so I didn’t really use it until after Midnight, even though I wanted to sleep about 9 pm.

The doctor that prescribed the CPAP said that if I don’t lose weight, I’ll be using the machine for the rest of my life.  Good thing is that he also does weight management, so I’ll meet with him in two weeks to begin that program.  Yesterday, I power walked for the first time since I had my second procedure in February and logged 2539 steps.  The walk felt really good with my new knees!  My doctor suggests 6000 steps/day, so I’ll have to eventually triple my walks.  Don’t think that will be a problem since I’m determined to lose weight.

1st Rediscovery


Against the advice of my physical therapist (he’d prefer I wait 2-3 weeks), I went to work this past Friday during the downpour (my kitchen flooded).  I’d forgotten what commuting was like and it took longer than usual to get to work which was frustrating.  I need to calm down and not let NYC traffic raise my blood pressure.

Anyway, work was fine and I felt OK at the beginning of the shift but my left knee began hurting towards the end of the shift.  My left knee ended up hurting from Friday night until Sunday morning.  It was stiff and I had to remind myself with every step to bend my knee and walk heel-toe, heel-toe, opposed to just picking my foot up and stepping down flat.

Walked today and I feel much better.  Need to be careful so I don’t increase my recovery time.

6th Injection


Walked this morning a little after 6 am and I felt good while walking but was sore afterwards.  I didn’t set the Fitness on my iPod Nano properly so I didn’t get any stats but I walked for approx. 10-15 minutes.  Surprisingly, no problems with knees just with breathing but I still need to bend left knee properly when walking.  Otherwise, a good motivation to get outside since the weather is getting nicer.

Watched a lot of documentaries on how we’re destroying the earth and thinking of that as well as my financial and employment situations put me in a mild depression which walking alleviated to some extent.  I feel better.

5th Injection


Only four more PT sessions (2 weeks) covered under insurance. My therapist hopes that Fidelis will extend the sessions since my right knee isn’t recovering as quickly as planned.  Can’t get over how my right leg and foot is still swollen that my toes still don’t lie flat.  Still not walking properly.

4th Injection


Sorry I haven’t written anything in a few weeks.  I saw my orthopedic surgeon, Claudette Lajam, on 6 March for follow-up after surgery; everything’s going as planned even though I’m having more difficulty with my right knee recovery than my left — I feel as though I’m neglecting my left knee for my right.  Some people wait 12 months between procedures if both knees need TKR but I wanted them done sooner rather than later so I could walk again.

For some reason, Fidelis insurance didn’t approve as many at-home physical therapy (PT) sessions for my right knee as they did with my left, and I needed more sessions with my right knee.  After I saw Dr. Lajam, Fidelis did not approve any more home sessions until 14 March so I was on my own with PT for the week.  The thing is I’d already decided to do outpatient PT when the approval came a little too late.  However, my physical therapist from VNSNY, Katarina Erlandsson, is excellent and I wish we had more sessions together; she worked with me on my left knee and I was able to work with her again on my right.  If I could afford it and if I had an area with a massage table, I’d have PT done at home but the most important thing is to exercise daily, no matter how bad you feel.  The therapists suggest doing each set at least three times per day but even if you do each set just once per day, one is better than none and your body really appreciates it.  It also speeds up recovery.

Since I hadn’t seen her for about a week, the next (and last) time I saw Katarina, I had her press down on my right knee for the entire session.  It hurt but afterwards the motion of my knee felt much better.  Below are some exercises Katarina gave me to do at home initially (she added more later):

PT exercises

PT exercises_2

 

 

 

 

 

 

I began outpatient PT the first day of Spring (20 March) yeah!  I’m so fed up with all the snow we had this past winter and am looking forward to more temperate weather.  For outpatient PT, I use Sports PT on Flatbush Avenue in Brooklyn.  The therapists that tend to me, Andrew Labbate, Jr. and Natasha Williams, are both excellent.  I feel fortunate to have gotten excellent therapists both at home and outpatient.  Even though I’d rather have someone come to the house, outpatient is better for me because they have the proper equipment for whatever ails you.  I also like speaking with other patients and realize that no matter how bad I feel, others, regardless of age, ethnicity, physical condition and ailment, are going through something similar or possibly worse.  Yesterday, Andrew had me on the stationary bike but I can’t do complete revolutions — can only do half turns but at least I’m moving my legs.  One thing I purchased from Sports PT is the Stretch Out Strap which really helps with certain exercises.  It comes with a booklet that has exercises for different parts of the body.

Stretch out strap_3

Stretch out strap_4

After I injured my left knee (bone slightly misaligned), I learned to walk without bending my knee which is a problem after surgery since the procedure recitified the situation.  Both Katarina and Vanessa told me to bend my knee when walking and I thought they meant when my foot touches the ground but they meant when I raise my leg to take a step, the same motion as pedaling a bike.  I realized what I was doing wrong about two weeks before my right knee surgery so I didn’t have sufficient time to properly work on walking.  Now I have to think about the motion with every step I take which is worth it because when I don’t bend my knee properly, I waddle when I walk (hello ducks!).  It’s also less stress on my knees walking with the correct motion (no kidding!).

On the advice of a friend, began using Castor Oil as a moisturizer and for joint pain. Castor Oil is said to help with hair loss, wrinkles, stretch marks, as a disinfectant on open wounds, constipation (taken internally) and arthritis and joint pains.  I’ll see what happens in a few months.

I need to get into the pool for exercise but am still having problems with stairs; even though the stairs are steep from the locker room to the pool deck, I’m more concerned with getting in and out of the water for an aerobics class.  I’ll just have to suck it up and pray I don’t need a crane to get me out of the water!


Before my knee surgeries, the last time I was overnight in a hospital was when my daughter Lyndsay was born in November 1986 so I prepared for my stay based on that experience and brought too many things with me as a result.  NYU’s Hospital for Joint Diseases (HJD) provides almost everything a patient needs during their stay — the only things you need to bring are undergarments, slippers (HJD provides socks with treads) and some personal care items such as oral care supplies, soap/cleansers, cleansing cloths, towels and body lotion.  I brought with me facial towelettes (Yes to Cucumbers) which helped since it was knee surgery and I could clean my face without leaving the bed, a neck roll which helps when you’re sleeping on your back, a bathrobe/dressing gown, and Crocs clogs to use as slippers.  HJD also provides three meals and two snacks daily but I don’t care for their food — it’s food service food and I prefer restaurant food.  However, if you order food for delivery on a credit card, the nurses will send someone to the lobby to pick up your meals.

For the most part, you can negotiate with the nurses at HJD what medication you take but the one thing they will not negotiate is blood thinners since they want to reduce the risk of blood clots (pulmonary embolism, deep vein thrombosis) after surgery.  HJD gave me Enoxaparin (Lovenox) as an anticoagulant which is injected once a day and was used for 14 days after my procedures.  Lovenox contains warfarin, the same ingredient used in rat/mouse poison and the first time I was in HJD, my body dried out so much from the Lovenox that when I left HJD, my lips had black spots from being dehydrated and my skin was so dry that I had to reapply lotion every 2-3 hours.  When my skin dries out, all I do is increase my water intake (water, tea/coffee without milk or sugar, juice with no added sugar) but no amount of liquids ingested helped.  Nothing I applied at home helped — butters, oils, thick lotions, various product combinations as well as doubling up.  My skin was still parched.

Before my procedure in November, I ordered Allure Magazine’s Fall 2013 Beauty Box which contains mostly products from their advertisers.  The box arrived a few days after I came home and included a 16 ounce tub of Cetaphil.  Now, I tend to use natural lotions and stay away from products that contain petroleum (mainly because I want to limit my support of the oil industry) so Cetaphil is not a product I would have ever considered but it did an excellent job with my dry skin — was able to use on both face and body, no flaking, peeling or ashy skin and I only had to reapply every eight hours or so, plus it’s fragrance free so there’s no synthetic smells to deal with which I have little tolerance for.  My skin returned to normal about eight days after I stopped injecting Lovenox but I continued using the Cetaphil.  When I was admitted for my second procedure, I couldn’t find Cetaphil in a tube locally so I used Neutrogena’s Norwegian Hand Lotion which was OK but I prefer Cetaphil.  Also, my skin didn’t dry out as badly after the second procedure.

Here are some housekeeping suggestions before being admitted for knee surgery:  do all of your laundry and clean as much as possible.  Even if you’ll have help at home during your recovery, it’s one less thing you’ll have to worry about.  Also, have at least 8-10 days worth of food prepared.  I suggest individual meals in containers which can easily be heated as well as juices/drinks in single serve containers or have a container with a non-spillable lid in which to put liquids.  Even if you’ll have help during the day, there will be times when you’ll need to get food and drink on your own.  If you’ll have no one to help, the Occupational Therapist will be able to show you how to maneuver on your own.  If FreshDirect delivers in your area, they prepare fresh individual microwaveable meals as well as frozen microwaveable meals which come in handy when you’re not able to prepare anything on your own.

My staples were removed 14 days (24 Feb) after my right knee procedure by Crystal Chenshuang Qu, a super awesome nurse from VNSNY who removed the staples quickly and painlessly.  Had post-surgery check-up on Thursday (6 Mar) with Dr. Claudette Lajam and everything seems fine even though I still have swelling in my right leg and my right foot still doesn’t feel normal.  Blistering subsided, scar seems to be healing well and itching is not as bad as before since I began using First Aid Beauty’s Ultra Repair Cream on legs.  Dr. Lajam said it’s OK to go back into the pool but I’m concerned about using public transportation since I’m still having problems walking.  Have to work on straightening and bending knee.

2nd Injection


As mentioned previously, I had both knees replaced at NYU’s Hospital for Joint Diseases (HJD), a facility to consider in NYC for any type of orthopedic surgery.  I believe that whenever you require major surgery, you should use a facility specializing in that field even if it entails traveling.  Depending on what your surgeon orders, physical therapy (PT) begins either the day of or day after your procedure.  With my left knee in November, PT began the day after; with my right knee in February, PT began the same day.  Therapists come to your bed and depending on your ability, work on range of motion exercises you can perform either in bed or seated.  You also use a walker for movement.  My right knee procedure resulted in swelling and pain to the point that I was only able to walk approx. 25% the distance in the hospital that I was able to walk after my left knee.  I had PT twice a day on the second and third days, and once on the day of discharge.

In addition to physical therapists, after each procedure I was seen by an orthopedic doctor (resident?) who saw to the wound and dressing, a pain management doctor who determined what medication I used during my stay, a social worker and an occupational therapist (OT) both of whom determine needs upon discharge, e.g., will you be going home, will you be going to an in-patient facility, how many stairs do you have, will you be alone, etc.  A pharmacist stopped by to determine what medication I would take home, Tramadol after left knee and generic Percoset after right knee.  After my first procedure, I came home with a walker and crutches and used both after the second procedure.  Since I was coming home after the first procedure, Visiting Nurse Service of NY (VNSNY) came to see me at HJD to schedule home care:  nurse, physical and occupational therapists; VNSNY just phoned me at home after second procedure.  The nurse sees you first at home to do intake before VNSNY schedules PTs and OTs.  OTs help with daily tasks such as dressing, bathing, eating, etc. and the VSNNY OT’s determined I did not need their assistance at home since I was able to get around on my own and had help with meals, etc.

Here’s how I set up my bathroom:  attached removable handle to sink to help with standing from toilet; toilet is high enough that I don’t need commode;  removed rugs to use walker; attached removable handle to shower wall which didn’t work because it kept falling — recommend non-removable bar for bath/shower; already had seat in shower but found it easier to take quick standing showers rather than deal with sitting/standing.  My shower isn’t in a tub so it’s easy getting in/out and I also use a pair of Crocs slides (like I use at fitness center) in the shower so I don’t worry about slipping/falling.

I can’t stress how important PT is especially at home when you don’t have a therapist daily and you’ll come up with every excuse why not to exercise!  After the second procedure where it was difficult to move my right leg unassisted, one PT at HJD showed me how to use a bed sheet as a sling/lever to move my leg on my own.  If you have the space at home, I recommend a massage table for PT otherwise you’ll most likely be using your bed.  If that’s the case, make sure the mattress is firm.  Another thing to have is a comfortable sitting chair — I could have used a comfortable recliner the first few days at home which would have been easier than getting in and out of bed.

Staples removed from incision on Monday, fourteen days after procedure.  Interestingly, removal alleviated approx. 20% of pain but there’s still swelling from knee to foot with small blisters around knee.  Hope swelling goes away soon.

First Injection


In 2003/2004, I was diagnosed with severe arthritis of both knees after being hit by a car.  I wasn’t too concerned since I’d planned on managing with exercise so seeing a rheumatologist wasn’t necessary (in my mind).  In January 2011, the step on a minivan from which I was disembarking was too high and  I felt a severe shooting pain in my leg when I finally touched the ground.  A few days after that, NYS Medicaid discontinued my insurance because my income was too high even though my income wasn’t high enough for private insurance.  So for the next few years, both my Unemployment Insurance (UI) and income was too high for medicaid but the plan I could buy into was more than half my monthly UI so I didn’t see a doctor until August 2013 when I no longer had either UI or Income.

During this time, I think the bone in my left knee became slightly misaligned and it felt like I was being stabbed every step I took so I learned to walk without bending my knee.  The worse part was that I could no longer walk for exercise.  When I saw the orthopedic surgeon in August 2013, I thought all she needed to do was realign the bone but x-rays showed I needed both knees replaced.  Actually, the look on her face when she saw my x-rays was like someone watching a horror show that I kept apologizing!  I scheduled the procedure for Monday, 11 November 2013 and planned on having both knees replaced simultaneously.  On the day of the procedure, the anesthesiologist decided against both and I only got my left knee replaced which was a good thing because I wouldn’t have been able to walk since I wouldn’t have had a (slightly) good leg to lean on.

For insurance purposes, total knee replacement (TKR) is considered elective but for me it was mandatory if I ever wanted to walk again.  I’m not into surgery, especially anesthesia, so I was apprehensive and nervous beforehand anticipating the pain level based on my experience from being hit by the car and stepping off the minivan.  Everything was fine with the TKR of my left knee — Dr. Claudette Lajam is an excellent orthopedic surgeon and NYU-Hospital for Joint Diseases (HJD) is a very good facility in NYC for any type of orthopedic surgery.

My rehab in the hospital went well and when I was released on Thursday following the procedure, I was able to walk to the back of the house and down two stairs using the walker with no problems.  That didn’t happen with the second procedure.  The second procedure was on Monday, 10 February 2014 for my right knee and it felt very different afterwards.  There was pain from my knee to my foot and my leg was so swollen that my toes overlapped each other — not a pleasant sight!  I should have realized that my right knee recovery would be different from my left when I was only able to walk 25% of the distance in the hospital with the Physical Therapists that I walked after my left knee replacement.  Also, using the toilet was like climbing a mountain — I was sweating afterwards and I couldn’t get in and out of bed without someone moving my right leg for me.

My daughter Lyndsay picked me up from the hospital the following Thursday, there were rain showers and we had to stop two houses down because that was the only driveway that was clear since I couldn’t walk over snow.  I would take three steps with the walker and then stop, something that didn’t happen after my left knee replacement.  Actually, after Lyndsay left me on the sidewalk, she parked the car down block, came back and I still hadn’t made it to the house.  I couldn’t walk up the one stair to the garden to get to the back of the house and had to “shimmy” past a car in the driveway that doesn’t move and is centered in such a way that there’s not much room on the side to pass.  I should have come home in a wheelchair.

That’s all for now but the moral is every procedure has different outcomes — listen to your body before your head!

Had to "shimmy" past car; mirror doesn't move
Had to “shimmy” past car; mirror doesn’t move
Couldn't walk up stair to get to back of house
Couldn’t walk up stair to get to back of house
Back stairs I walked down following first procedure
Back stairs I walked down following first procedure