Left Knee Surgery Journal Oct. 25th -

 

Left Knee Replacment Journal

 

Date of surgery: October 25, 2022   Surgeon: Dr. Richard Johnston  Place: Missouri Baptist Hospital

                                                     

 My surgery was scheduled for 1 PM, and I checked into the hospital at 11 AM.  Once I was taken to my room my knee and surrounding area was shaved, and shortly before I was wheeled into the operating room an IV was inserted in my left arm.  I was given 3 shots before surgery, one in my left thigh, and one too numb the site where the general anesthetic was injected, and then the anesthetic injected into my spine.  There was no "countdown" like my first surgery where they just injected me and put me to sleep.  I just remember the shots and then laying back down on the operating table.  The next thing I remember was waking up in the recovery room, then being wheeled into my room.  Like the first knee replacement, I was fortunate enough to have a room by myself.  I've had many surgeries in my life, a laminectomy to repair a herniated disc, repair of a torn Achilles tendon, and the other knee.  I was unable to pee following each of those surgeries, and a rather painful catheter was inserted.  This time I asked that the catheter be done while I was still unconscious from the surgery, and they did that for me.  Shortly after I returned to my room they removed it, and I had no problems peeing after that. 

The night nurses were fantastic. I had jello for my first meal, but later one of the nurses brought me a Snickers from the cafeteria. Dr. Johnston told Mary Rose that my knee was really a mess, but during surgery it didn't bleed much so I didn't need a drain installed in my leg like the first time.  

The next morning they had me walk around the floor, and then they showed me how to get in and out of a car with a mock model of one, and how to sit down and get up from a chair. I went home later in the morning.  I rested that day and the next.

On October 27th, 2 days after my surgery, a physical therapist came to our house and checked my dressing and changed the bandage.  Then she showed me some exercises to do, and directed me to walk around the house every day for 10 minutes. 

On October 28th a nurse came to the house, took my vital signs, blood pressure, temperature, and checked the dressing.  She gave me some bandages to use and directed me to change my dressing in between her and the physical therapist's visits.

This is what I wrote on Facebook on October 27, 2022:

"I had a mini P.T. session yesterday, and today a nurse and a P.T. person is coming in the afternoon. I"m able to sit at the kitchen table and type this, and get in and out of my recliner in the living room and eat dinner with MR there, and watch TV after that. They gave me some oxycodene for pain, and I am able to stretch the doses from every 4 hours to every 8 hours. I plan on weaning myself from that to just Tylenol in about a week. This morning I forgot to use the walker and walked without anything from my bedroom to MR's office, and that's a no no this early after surgery just 2 days ago. Yikes! After knee surgery last time I was only able to sleep 2 hours a night. Last night, except for the 3 times I got up to pee because one of my pills drys out my mouth and I drink a lot of water, I basically slept from 11 PM to 4:15 AM. Poor Mary Rose had to get up at 4:30 AM to feed the dogs and let them out. They're used to doing it at that time because that's when I normally start my day. Today a nurse and a P.T. lady are coming in the afternoon."

October 28, 2022:

"Nurse came to house yesterday and changed the bandage on my knee. There was blood so I'm seeing my doctor this morning. Day 3 after surgery is the worst. I am achy and everything I do hurts. Just finished my 2nd 10 minute walk around the house and did my morning exercises. Dogs are great about steering clear of the walker. Time to do the breathing exercises. MR took over my cooking responsibilities and she's doing a great job."

Left Knee Replacement - incision glued

Right Knee Replacement - incision stapled

                                                                                                                  

  October 29, 2022:

"Saturday - 3rd day after surgery. Anyone who has had a knee replacement knows day 3 is a rough one. The swelling and tightening really kicks. I did my first set of laps around the house, and painful leg exercises. The real torture begins with outside P.T. Mary Rose is really earning her stripes being my caretaker. I dressed myself this morning except for the compression socks which are really hard to put on. I never slept well even before this surgery so lousy sleep now is no surprise. The dogs have been great. They move out of the way when the Walker approaches."

That was my public Facebook post.  Privately, I wrote my family this:

"It's 4 am, and I have been up for the past 4 hours due to gerding, or to put it another way, acid reflux.   From what I could find out on Youtube videos, a lot of the things I ingest may be the cause.  I dread acid reflux much more than any pain I'm enduring because it can destroy my esophagus.

Among the foods on the "no NO" list are coffee, sugar, whole grain prodects, red sauce, cheese, and dozens of other things I enjoy eating.

 Also a biggie is Calcium, which I am taking daily at Dr. Johnston's orders, beside the fact the I eat my daily shredded wheat with lots of milk.

 Yesterday, I did all of my exercise twice, the breathe thing 5 times, and I walked twice for 10 minutes.  I don't know if I'll have the strength for that today, given how little sleep I got.

 Mary Rose was wiped out yesterday.  I mean literally worn down to a nub trying to do everything to take care of me, and that's with me trying to do anything I could by myself to spare her.

 We cut the evening short and she went to bed around 7:30. I watched TV in my room until 10 and went to sleep then.  I woke up at 12 midnight when the a id reflux began.  It's still going on, probably will until I get out of bed and stay on my feet for a while.  I'm afraid to eat anything now.

 My new compresion sock came yesterday.  I have 8 new pair.  They don't have openings at the end but they are sturdy, and unlike the white pair the hospital put on me, these are machine washable.

 October 31, 2022:  In looking back at this email I sent my family,  I can see two things.  1st, I'm under the impression that my digestive problems may be permanent (they weren't), and I'm trying to take on my prior household responsibilities as much as my surgery will permit to ease the burden on Mary Rose.  This is what I wrote that morning:

 Dear Family,

Yesterday I managed to do two sets of walking for 10 minutes, and one set of knee exercises.  I also used the breathing "toy" they gave me to increase my lung capacity and avoid pneumonia.  I didn't have the strength to do the 2nd set of knee exercises.

 I took my 2nd shower, using the waterproof leg sleeve, and that went without any problems.

 I'm now fully into the phase where my knee is very swollen, and very achy.  There are no comfortable positions and no escape from the pain.  I'm now in Lani's world.

 Here's the good news.  We had a wonderful chat with Ben.  That always brightens both our days.

I have transitioned from coffee to tea, which is a move based on my efforts to eliminate obvious known causes of acid reflux.  I've been checking on line to see what's good and what's bad.  My lifelong love of onions took a hit - onions, bad! 

 That means no red onions in our salads, and when I cook they may be gone as well, which really sucks because onions add so much flavor.  So does garlic, which is also on the list of bad foods for people with acid reflux.

 I have switched from shredded wheat to oat meal, which I like so that's no real hardship.

 Mary Rose was quite perky and animated yesterday, having gotten some extra sleep since I took back the morning feeding of the dogs.  She got 3 more hours of sleep as a result.  

I can bend enough to put a scoop in their food bins.  I'll need to ask her today to fill the bins.  The higher the food, the less I have to bend.

 I fed them again tomorrow and will continue to do so as long as I can.

 I know things are still going to get worse before they get better.  That being said, I went the whole night without an acid reflux episode.  I slept in segments, and altogether it probably added up to 4 or 5 hours.  I'm tired, but then I'm always tired, with the exception of a rare night of 6 hour sleep.

I went to bed at 8:30 PM or thereabouts.  I fell asleep watching tv and when I woke up it was already 11:00 PM.  I am forced to sleep on my back, which is uncomfortable because I also have a leg propped up by pillows.  I usually sleep on my side.  

 The 2nd installment of sleep was an hour or two and when I woke up this time my t-shirt was soaked in sweat.  I got up and changed shirts, used the toilet, and returned to bed.  I didn't really sleep much after that.

 At 4:30 AM I started my day and got the dogs and fed them, and gave them their after feeding treat when they came in for the last time.

 Mary Rose went to two stores, and bought everything on the list I made including some ginger and tumeric tea.  She got down the little teapot we have in one of the upper cabinets. We used this one in the b&B.  She set it up with water and put it on the range, ready for me to use this morning.

 I got the water going after I fed the dogs, and had a "pre-breakfast" of tea and a piece of toast with honey.  Honey will be my primary sweetner for hot drinks, and to put on toast.  It's on the "good" list.

 So, no more coffee for now.

 I may or may not have to adhere to this diet forever.  For the most part, I only occasionally had acid reflux with my twice a day famatodine.  But now, they've added calcium to my diet, and lots of other things are different.  We'll see.

 Between 8 and 8:30 AM the P. T. lady comes, and then the real fun begins!"

 November 1, 2022

 By this time the CPM machine has been delivered and I've begun to use. I'm getting twice a week visits from the physical therapist and the nurse. It's been 8 days since my surgery and I'm beginning the transition from the walker to a cane.  Here's the morning email to my family.

 Dear Family,

I'm writing this email from my basement office.  Yesterday, when Kelly from Home Health came she had me transition from the walker to a cane. Then she showed me how to walk down stairs and back up with a cane.  She said initially, to still used the walker when I first get up, and later at night.

 She showed me some new exercises, and checked my bandage.  There was no seepage.

 After she left I did a half hour in the CPM machine.

 I hope to go to my office each morning, but will only stay there a half hour or less. They don't want me sitting for more than a half hour at a time.

 If I do everything I've been directed to do, (and I'll try) my PT at home is nearly a full day.  I'm supposed to do 3 sets of everything, in addition to 3 half hour sessions in the CPM machine.  Then there is the ice machine.  I'm also supposed to use it after every exercise session.  It's a lot to do, and a lot to remember.

 Mary Rose went to her deep water aerobics class and enjoyed it.  Again, I'll say I'm really happy she has this class, to give her a break from her caretaker duties with me.

 Following a day full of exercise, including a full set of everything after dinner, I had one of my roughest nights yet.  It was hard to find a comfortable position.  My sleep was in small segments, and after the longest block of sleep, from 10:30 PM to 2:00 AM, I woke up and my t-shirt was drenched in sweat.

 I got up to put a new shirt on, and use the rest room.  An hour later, I was up again, and one hour after that I gave up, turned on a light, and read news on my cell phone until it got closer to 4:30 AM.  

 In addition to new pain in my leg from the new exercises and 2 1/2 hour sessions on the cpm machine, I had a pretty decent headache, which I think may be caffeine withdrawal.  

 I decided not to torture myself, and at 4:40 AM I swapped a Tylenol for an Oxy, and added coffee and water to the coffee maker so I could have a cup today.

 You can imagine how great that cup of coffee tasted this morning, and between the upgrade in pain medication, and the coffee, I feel much better now.  

 I am going to try to offset the coffee by eating foods today that are recommended to help with acid reflux.  I had an apple so far, and I'll eat some shredded wheat for breakfast, and make sure I eat some Greek yogurt as well.

 Valerie said I can stop wearing the compression socks on Thanksgiving.

 Last night MR baked some chicken fritters, and she made a delicious spinach salad, and mashed potatoes.

 Mid-evening I had a couple of graham crackers for a snack.

 Well, Miss Stormie reverted to her old bad behavior in the crate and chewed a hole in the old dog bed we put in there for her.

 It's been in the 70's this week.   I briefly had my windows open for some fresh air.

 Love to all,

Stu

 Dr. Jones, the surgeon that did my right knee replacement 5 years before the left one was done by Dr. Johnston, didn't have me do anything in advance of my surgery back then.  At that time, I didn't have anyone coming to the house twice a week after the surgery.  I also wasn't directed to take vitamin supplements both before and after surgery as I was with Dr. Johnston.

 Besides those differences, Dr. Johnston prescribed compression socks, inflatable sleeves to wear on my ankles, and the CPM.

 November 1, 2022

 Here is the family email:

 Dear Family,

 I am a major fuzz brain again.  I can see why people get hooked on oxy.  I took one yesterday morning in anticipation of Kelly the P.T. lady coming.  My level of achyness and pain with just one of them was significantly less that it was last night when I went to bed.

 We tried out the machine where your foot is strapped in, and the machine slowly bends your knee.  It was on a low setting and not very uncomfortable.  The "Spanish Inquistion" levels will arrived soon enough.

 Kelly changed the bandage, and I had been in communitcation wtih Dr. Johnstons' office.  I emailed them a picture of my wound, which is still oozing, and was directed to not use the machine.  I had already used it once and let them know.  They said I could resume it on Wednesday.

 Kelly set it up on my bed, and It's easy enough to slide across and get into.  I will need MR's help strapping my foot in.

 I did my 2 sets of walks, and besides the exercises I did with Kelly, I did another set later alone.

 MR baked some chicken thighs I had previously made in the Instant Pot, and made a baked potato and steamed broccoli.  All delciious.

 I was in bed before 9 and that's when the real fun began.  I forced myself to stay up until 10 PM.  I took 1 regular Tyelenol for pain, and 1 Tylenol PM like I normally do.

.  The oxy wore off, and it hurt to move - I could get comfortable in any direction, plus I was up 6 times between 10 and 4 AM to use the bathroom.  The longest chunk of sleep I had was an hour and 49 minutes. My leg felt like little needles.

 At 4:25 AM I walked down the hall and let the dogs out and took care of them, think MR would be sleeping later like the day before.  She didn't.  She was in the kitchen 5 minutes after I fed them.  She thanked me for "trying".

 I realize now that I am in the midst of this recovery and probably each night will be worse than the last for a couple more weeks.

 Today, the nurse is coming between 12 and 1 pm.

 Love,

 Stu

 Here is a picture of me in the CPM machine on November 1, 2022:

 I posted the following on Facebook that day -

 "Afternoon Update on the Update: I saw my doctor this morning. No more CPM! My doctor is going to try to help me straighten out the billing issue with Essence. I'm going to try to get Stormie back into my room tonight. I've gone from 5:00 AM until now without taking anything for pain! I was cleared to drive, and drove myself to the Maryland Heights Community center this afternoon and spent a few minutes on a recumbent bike, and walked 3/7's of a mile. Still can't take a shower without the vinyl sleeve because a tiny

area hasn't completely sealed on my incision. I can live with that. MR no longer has to drive me to P.T. or anywhere else. She also doesn't have to prepare the ice machine. :::::::::::::::::::::: Update on knee surgery. I got through the home health visits with a physical therapist and nurse. I transitioned to a cane by the 2nd week. I started outside P.T. last week, and reunited with the physical therapist I had for my first knee replacement. The goal is for me to have 120 degree bend, and -10 degrees with my leg fully extended on a flat surface. At the start of my first outside P.T. session I measured at 100, and by the end I was at 105. I've been able to dress and undress myself, as well as put on a vinyl sleeve to shower. Of course, it's much easier with Mary Rose helping me. I've been going down and up the basement stairs, doing "The Texas One Step." I had two nights with zero sleep due to pain and not being able to find a comfortable position. I have committed to doing my walking, exercises, and getting into the CPM (I call it "The Rack") twice a day. I hit my low point last week. Between the constant pain and lack of sleep, I had a good cry with Mary Rose. Things have gotten better since then. The pain has decreased. I never did take the Oxy round the clock, but interspersed Tylenol with it. I did take one Oxy just before my outside P.T. last week. I'm currently stressing over the fact that my insurance company is declining to cover the anesthetic charges because the doctor is "out of network" and my surgeon didn't submit his name prior to surgery. His office tells me they didn't know who it would be until that day. Fun! I had two rough weeks where my acid reflux made me think I'd have to give up coffee and just about every kind of food I enjoy. Once I got back on my regular meds for that, it's been smooth sailing and I'm back to eating whatever I want. I did NOT enjoy the great weight loss that I did with my first knee. I lost 30 lbs that time. I never lost my appetite this time, but I plan on going to the gym 2-3 times a week once I'm able. My wife is a saint. She took over the grocery shopping, meal planning, and meal preparation. I was able to help with a couple of meals. I started playing my guitar again last week, and I get a lot of joy from that. I miss having Stormie in my bed at night. The CPM is taking up the entire right side of the bed, where Stormie usually sleeps. The next two weeks are critical to my rehab. I am ready for the pain, because I know what's at stake."

 In retrospect, I can see that I was probably doing too much for that stage of my recovery.  There were no ill effects other than I probably brought on more swelling and pain with all of that premature activity.

 For the first month following my surgery I was taking showers wearing a vinyl sleeve that I used after my first knee surgery.  I started taking showers a few days after I came home, carefully getting in and out of the shower.  The first time I used the vinyl sleeve I had Mary Rose help me get it on and off.  After that,  I was able to do it by myself.  The same is true for putting on my socks.  Initially, Mary Rose helped, and then I used a device the hospital sent home with me to put on the left sock.

 November 11, 2022

 Family Letter -

Dear Family,

 Yesterday was the last of my "Home Health" visits.  Kelly did some measurements.  She measured my extension on my left leg.  I think she said it was 97, and the goal was 110.  She also counted out 10 paces in the kitchen and asked me to walk to the dining room table and back to my chair in the kitchen "as fast as I could safely do it."

 She timed me and said I did it in 8 seconds, and the goal was 10, so I beat that by 2 seconds.

 On Monday she asked me what brand my shoes were and where I got them?  I told her they were "Zebras" and I got the online.  Yesterday, she said she bought a pair for her father.

 She added a few more exercises to my daily regimen, and we said our "good-byes".  

 Both ladies from St. Louis Home Health were nice.

 I'm still struggling at night.  I tried something different last night.  I took an Oxy at 8 AM, and another at 12:45 AM.  It didn't make a bit of difference.  There was less pain, but still less sleep.

 That worries me because the body needs sleep to heal.

 For dinner MR baked some chicken corden blue and baked a potato, and steamed some broccoli - nice dinner.

 I had 2 episodes of acid reflux last night, and then swigged some Pepto and that took care of it.

 Love to all,

 Stu

 November 13, 2022

 Family Letter:

 Dear Family,

 I'm tempted to put a hold on my daily emails until I have something positive to share with you.  I see no reason to subject you all to a daily ration of bad news.  Tomorrow I start outpatient P.T.  It's hard enough to begin with, but on less than 2 hours of sleep I can't imagine what's facing me.

 In other bright news, Stormie had a seizure this morning at 5:00 AM.  I wasn't able to get on the kitchen floor with her to hold her so she didn't slam her head against something so I had to yell for MR.   Mary Rose is not in the best of shape to be on the ground - she has a variety of issues herself, but she came in and sat down with her and held her until the seizure passed.  Stormie rewarded her with a turd.

 MR said the vet told her they're seeing an uptick in dogs with seizures.  That tells us there's something toxic here.  I would have been long gone from here except it stressed the hell out of MR and I gave up that notion for her welfare.  I just hope 5 years from now we both don't come down with cancer.

 Last night I took my trazedone sleeping pill.  The bottle says it should be taken with food so I ate 2 graham crackers.  Then I worried about my acid reflux, eating just before I went to sleep.

 I fell asleep fairly fast, and woke up after about a half hour. Then I was up for the next 4 hours.  I slept one more hour and that was it.

 I tried to spare MR a meal, and made dinner Saturday night.  I made a cheesy broccoli chicken rice casserole.  I tried to modify it because of my acid reflux. As it was, just before I went to bed my stomach was upset.    See what I mean about my letters being filled with one horrible thing after another.

 I tried to call Lani yesterday, around 3 our time.  As I was on the phone letting it ring an email came in from her, so I know that's why she didn't answer the phone.  She was on her computer.

 Sorry, Lani.  

 Love,

 Stu

 In November due lack of sleep, constant pain, and the stress of knowing I was going to start outside physical therapy, I hit an emotional wall, and had a good cry while hugging Mary Rose. 

 That was my low point.

 November 27, 2022

 Here is my post on Facebook:

 "I'm entering the last phase of my recovery from knee replacement surgery. Got rid of the CPM (rack). I can now shower without having to wear the vinyl sleeve. I am starting to walk without the cane some of the time. My knee bend measured 112 degrees on Friday - the goal is 120, so I'm not that far off. On the minus side, I'm just at the beginning of my left leg learning new muscle memory so that I walk naturally, and as a result my left hip hurts. Sleep is still elusive - I only sleep about 2 hours a night and most nights just can't get comfortable, and can only sleep on my back. Nights are soooo long right now! Pain meds are minimal, mostly on days when I have outside P.T. I've cooked a couple of meals and drove myself to Schnuck's and Walmart and did a little grocery shopping. I can put on my socks without help most of the time. A lot of the swelling has gone away, but each time I exercise or walk it's back to some degree. MR and I are going to have milestone birthdays next year - 65 for her, 75 for me, and we'll be celebrating our 25th wedding anniversary January 2024. The best is that Stormie sleeps with me again - I feel sorry for her. I'm up a lot at night, but she doesn't complain. Last night we got MR's birthday dinner at our favorite local Italian restaurant, Massa's. MR got Chicken Bianca, and I got the Chicken Parmesan. Yum! I'm ready for Spring - hate the cold!"

I described my progress as entering the "last phase" of my recovery," however, if it was, it was the longest phase of it.  100 per cent healing of a total knee replacement can take up to a year.  On November 27, 2022, I was barely 1 month from my surgery.  I still had a long way to go.

 November 30, 2022

 Facebook Post:

 "Yesterday was a good one for me. At P.T. I reached 117 degrees on the knee bend. In the morning our good friend Larry H. one of our shuffleboard buddies, came by for some "basement shuffleboard." I haven't seen a friend since September, and was thrilled I was able to play a full game, as well as having Larry stay for lunch afterwards. I am walking most of the time now without the cane. Sleep is still elusive. Last night, on top of everything else, my skin started itching everywhere! I think I got 30 minutes of sleep."

 By December 2022 I was becoming more active.  Here is the December 7, 2022 Family Letter:

 Dear Family,

 Yesterday at P.T. I started on the recumbent bike.  Jen stopped me short of a mile to put me on the leg press machine.  It's one where you use your feet and legs to move a large square plate you feet rest on.  She started me at 70 lbs for both legs, then 30 for just my left leg.

 She spent a few minutes checking my knee for nylon stitch ends, and found two that she pulled out.  One of them hurt enough to make me groan.

 She did the usual knee bend and knee flatten, the ones that hurt the most.  She said I was very close to where I should be for the straight knee measurement.

 We talked about how much longer I would come, and it looks like after the next 7 scheduled appointments are done, that will be it.  Of course, I will continue to do my at home P.T., and I plan to start going back to the gym to walk, bike, and swim.

 Dr. Johnston got back to me yesterday morning and okayed me to ease back into swimming.  I will give my knee a few more days before I start since the two small holes where the stiches came out need to heal over.  At least now I know approximately when I can start that phase of my rehab.

 MR dropped me off at P.T. and went back home and filled the bird feeders, then came back and paid my co-pay and waited for me to finish the icing at the end.

 When we got home I made myself some maple oatmeal and a scrambled egg.  Then I took a nap for just under an hour.  I literally passed out as soon as I closed my eyes.

 Because I had several new exercises, later in the day I had several new pains in my knee.  I had one sharp throbbing pain that stayed with me for the next 20 hours.  Last night was one of the most painful ones in weeks.  It finally subsided a bit by 4:30 AM when I got out of bed.

 The Steak n Shake near us has opened and closed multiple times since the onset of Covid.  The service and food has suffered over the past few years and many like us stopped going there.  Recently, it closed for a few months, and recently reopened under new management.

 We decided after reading some favorable reviews on Nextdoor.com to give another try.  Last night we drove through for dinner.  Everything was good.  The car line moved smoothly, the man who took our order was efficient and polite, and the food order was correct.  More importantly the food was good too.  We both ordered off of the $4 menu, and got single Steak n Shaker burgers and french fries.  We meant to delete the cheese, but both of our sandwiches came with it, as well as grilled onions.  All good.

 While I napped yesterday MR went to Costco for Tango's meds.

 I hope to do the grocery shopping this morning when Aldi opens at 9 AM.

 Love to all,

 Stu

 On December 7,2022 I felt up to doing a project at home.  As is my custom, I posted about it on Facebook.

 ” Today's Project: Repair broken and missing grout on bathroom floor. This was my first project since my knee surgery on Oct. 25th. It was an easy one."

 December 12, 2022 Facebook Post:

 "Post Knee Surgery Update: This will be the 7th week since I had my left knee replaced. I've been going to physical therapy twice a week, as well as walking and doing exercises at home twice a day. Sleep is still elusive. Most nights, even with a prescription sleeping pill, I only manage 1-2 hours of sleep. I no longer need the cane. Pain is constant, but at a low enough level that most days I don't need to take anything for it. I've played a couple of single games of shuffleboard on our mini court in the basement. I have done some driving and grocery shopping, and am doing most of the cooking again for our dinners. Aside from the pain and trying to relearn how to walk naturally, the biggest challenge has been boredom. 7 weeks of nothing much but physical therapy, laying in bed, putting ice on my knee, etc. is hard for a guy used to doing multiple projects each day. I've started to go up and down stairs with both legs. This morning I did a set of curls with my barbell. Before surgery I could curl 40 lbs 100 times. Today I just did 10 curls to gradually ease back into it. I have learned the hard way too many times the pitfalls to rushing back into an activity. I have been given the okay by my doctor to go back to the gym, and plan on doing that sometime this week. I'll walk, use the recumbent bike, the leg press, and slowly start swimming again. Right now I only have 4 more P.T. sessions scheduled. After that it will be on me to continue to work my knee so eventually it will function as well as the other one. I am sure my chronic sleep deprivation has made this recovery much harder than it could have been, but no matter what I do, I can't seem to improve on that."

 December 12, 2022 Family Letter - I finally got more than 2 hours of sleep!  Yay!

 Dear Family,

Yesterday I did my morning and afternoon at home P.T.  I only napped in the morning.

 I made myself a biscuit with scrambled eggs and sausages for breakfast.  MR made us both tuna fish salad sandwiches for lunch.

 In the afternoon I went to Schnuck's.  I had a craving for some Fitz's root beer, and I knew we were going to Jersey Mike's for subs for dinner, so that would make the meal even more special.

 While I was there I got some more bananas and a large piece of tiramisu.

 After MR fed the dogs we went picked up our subs to go.  MR got a chicken bacon ranch sub, and I got a turkey with provolone cheese sub.  

 When we sat down for dinner we each sampled each other's sandwiches.  Hers was really good - so good, in fact, that next time we go there that's what I'll order.

 Usually, a local coupon booklet includes a buy one get one free coupon for subs at Jersey Mikes, which is what we used last night for dinner.

 The tiramisu was big enough for both of us to have a nice sized slice, with enough left over for another round of it tonight.

 I tried an experiment last night when I went to bed.  First, I was thirsty, and didn't limit the amount of water I drank.  I figured it couldn't be worse than the night before when I was up peeing 5 times in 5 hours.

 Secondly, for the first time since I had my surgery I took 2 Tylenol PM.  I have been taking 1 extra strength Tylenol and 1 Tylenol PM to help me sleep, which really hasn't helped me stay asleep.

 Last night I "slept" from 10:30 PM until 3:30 AM.  I went that long without having to get up to use the bathroom.  Of course, I've been up for almost 90 minutes now, and I'm still groggy from the double dose of sleeping pills, but at least I finally broke the zero to 2 hour cycle of sleep I've been locked into for over 6 weeks.

 I'm not planning on going anywhere today, so the grogginess shouldn't be a problem.

 I was able to get my left sock on this morning without the handicapped tool.

 I had my "pre-breakfast" breakfast which consisted of a cup of instant coffee and the last buttermilk biscuit.

 Love,

 Stu

 December 28, 2023 - Family Letter:

 Dear Family,

Yesterday I was glad my appointment for P.T. was an hour later, at 8 AM.  I was able to see all the snow and ice in the lot and on the walk so I could carefully walk to and from the car.  My next appointment is on Friday and by then it will all be melted.

Each session now has more intense P.T. than the one before it.  I biked a mile, then got on the leg press and Jen had me do 90 lbs with both legs, and 45 lbs with just the left one.  I did some deep knee bends, and she did the two most painful things while I was on the table.  She pressed down on my knee to get it as straight as possible, and then worked on the bending part.  

After that she took measurements.  Without using a belt or any other kind of assistance to bend my knee, I got it to 115, which she said was good.  

I have 2 more appointments and then it's up to me to do the rest.

I took two naps, and Tango slept next to me both times.  

For dinner I made penne pasta with red sauce and Italian sausage, and 5 cheese Texas toast.

I decided to hold off swimming for a week or two, or until it's easier for me to put on socks in a locker room.  This morning I'm going to Maryland Heights to walk, bike, and see if they have a leg press that can be set below 60 lbs.

Love,

Stu

December 30, 2023 - I received a bill from Ballas Anesthesia for their services during my operation.  Apparently, my health insurance company didn't pay $2, 534 of their invoice. I contacted Essence, my provider, and they initially claimed that Ballas Anesthesia was not in my network.  I posted about it on Facebook, and one of my wife's friends Ellen posted about a new Federal Law prohibiting large surprise medical bills.  I challenged Essence's denial of claim and posted this on Facebook:

 "My thanks to Ellen Folluo Wilke, who referenced the new Federal Law prohibiting large "surprise" medical bills after I posted that Essence, my advantage plan provider, was denying payment of the anesthesia charges I incurred when I had my knee replaced in October. My justification for appealing the denial was two fold. First, I made every effort in advance to try to get all the necessary approvals before my surgery, which I documented. Secondly, I referenced the new law. I received official notice yesterday that I will not be responsible for the $700 charges, that Essence is going to pay it instead. Thanks Ellen. Yay!"

 I received a letter from Essence that indicated I won my appeal and they would pay the Ballas Anesthesia invoice in full.  However, on January 6, 2023 I got a 2nd invoice from Ballas Anesthesia.  I called up Essence and was told, "You don't owe them anything."

Essence was slow paying the bill they said they'd cover, and on January 20, 2023 I got another invoice from Ballas Anesthesia and called Essence again.  This time they said, "You should have not received this bill, we're sending this over to our senior claims analyst."

It took until February 17, 2023 for Essence to actually pay that bill.  I really didn't need that extra stress.

January 4, 2023 Facebook Post -

"Knee recovery update: It's been 10 weeks since my surgery. This morning I am going to my last physical therapy appointment. I should have been done last week, but I cancelled an appointment on a morning when it was -2 degrees. I'm done with pain killing drugs, though not the pain, but it's tolerable without taking anything for it. I still walk with a noticeable limp, and it will probably be a while before that goes away. The same for my knee's reaction to just about anything that taxes it. Whatever activity I do brings on swelling, pain, and aches, including just standing for any length of time. I imagine that will go on for a few more months. The good news is that I am sleeping a little better at night. The bad news is that my knee is still too tender to sleep in any position other than on my back. From this point on I am completely responsible for my own physical therapy, which will consist of exercises and walking at home, and at one of the local gyms. It's really hard for me to limit myself so I don't "over do it." The other day I went to the Marilyn Heights Community Center. I biked a little, walked a little, and did some leg presses, and only a few stairs with both legs - quite conservative for me. Then I proceeded to go to three different stores to look at sofas and recliners, and probably walked another 2 miles (the last two stores were at West County Center). Yep, my knee swelled up like a grapefruit. The hardest thing isn't the pain, it's my impatience. There is no rushing a total knee replacement recovery. The average knee replacement takes 12 to 18 months before it's completely healed, so I just need to "suck it up, Buttercup!"

                                                             Left Knee January 4, 2023

 At this point I am only taking pain meds at night; 1 Extra Strength Tylenol, and 1 Tylenol PM.  My knee still gets swollen from anything I do, especially at the gym.  I  still can only sleep on my back, but I keep trying to find a comfortable position to sleep on my side each night.

January  4, 2023 Family Letter:

Dear Family,

Yesterday I took it easy, hoping some of the swelling and achyness of my knee would go down so that I could get a good measurement of knee bend and straightening this morning at my final physical therapy appointment.  I won't be taking any drugs before hand. I did do one set of exercises, but did not use both legs going up and down the stairs.

 What I did do was make a couple of calls.  I set up my next dental appointment, which won't be until April.  I contacted Grout Medics and got them to lower their price $50, and after reviewing their proposal again saw that it lacked one thing I discussed with the estimator.  I emailed them and they sent me a revised proposal with that item and the new terms.  They will be coming out next Thursday to do the work.

 I spent a few minutes printing out some questions I have for Jen at P.T. this morning.  I'm taking my exercise sheet to review with her to see if I should continue to do the sames exercises or she has any recommendations for any changes.

 It got up to 70 degrees yesterday and I tossed a tennis ball to Stormie 21 times.  It's cooler again today, going down to the low 40's.

 Love,

 Stu

 January 12, 2023 - I've been going up and down the basement stairs several times a day with both legs.  Going up only mildly hurts.  It hurts much more going down stairs.  For two weeks I asked Mary Rose to do two things that my physical therapist Jen was doing.  Both were extremely painful.  First, I layed on my bed and had MR press down on my knee for 15 seconds.  Ouch!  The 2nd thing was having her slide her arm under the bend in my knee and used her other hand to push my shin until I told her to stop.  Usually, I let her push until I couldn't stand the pain, and hold that for 5 seconds.  After about 2 weeks I stopped having her do that.  I figured I didn't do that the first time and my knee turned out okay, so I really didn't need the extra pain and swelling.

 At some point I concluded that my lack of sleep contributed to some questionably choices, and this doing these two extreme procedures was one of them.

 I started doing curls with a 40 lb barbell about 6 weeks after my surgery.  I started out doing just 10 and by mid-January I was up to 80 curls.  I was able to start letting the dogs lay in my lap again, something that I've always ejoyed and missed until my knee could tolerate it.

 January 24, 2023 Family Letter:

 Dear Family,

 I'm starting to sleep 4 hours at night more consistently.  Now, if I can only add one or two more hours to that, I'd feel like I'm getting what my body  really needs.

 I'm entering a new phase of knee stiffness and aches/pain.  That's because I'm now using both legs 1-2 times a day when I go down to my office and back upstairs.  In addition, I'm doing knee bends both standing near the sink counter (in case I lose my balance, which so far I haven't) and in the swimming pool.

 This morning I'm pretty sure I woke up after 4 hours because I turned in my sleep and felt some decent pain in my leg as a result.  I'm still waiting for that magical night when I can sleep on my side again, and turn without experience a sudden jolt of pain in my knee.

 For dinner I baked a Stouffer's rice and chicken entree, and MR made a salad.

 Last night, for the 5th straight day in a row, Stormie got up on the couch and laid on our laps.  

 Towards the end of the evening Tango came over to me, and I invited him up. It's amazing that such a big dog somehow knows I've got an issue with one of my knees, and very carefully moves into a position where he's not directly on it.

 Here's a link to a one minute video from last night when Tango got on my lap.

 Tango on Stu's Lap

 Love,

 Stu

 January 27, 2023  I started doing deep knee bends, but decided unless I was in the swimming pool doing them, that they were counterproductive to do on land in terms of the excessive swelling and pain they caused.  I did continue to go up and down the basement stairs twice a day.

 February 2, 2023  I'm up to 100 curls with my barbells.

 February 10, 2023  Last night I was reviewing our credit card purchases and there was one I didn't recognize.  Someone ordering chicken from Raising Cane using Door Dash.  I called our credit company and they cancelled our current credit card and are issuing us a new one.  We won't be charged the $18.32 for the purchase. This morning they sent me an email with instructions what to do next.

 I had a horrible night - is that a surprise, going to bed right after dealing with credit card fraud?  Besides that and other things on my mind, I had to pee 4 times, and when I dozed off the last time, pain in my knee woke me up.  That was a little before 4 AM, and I gave up trying to get any more sleep.

 February 14, 2023  I was able to sleep for an hour on my left side during yesterday's nap, and I'm down to just one pillow under my knees when I'm on my back.  I put it between my knees when I'm on my side.  Right after the operation I used 3 pillows.  Two under my knees, and one for my feet.  So slowly, I'm getting back to normal.  I'm starting to feel some real easing in the swelling and other symptoms.  I'd say I'm about 1/4 of the way back to a normal operating replacement knee.  I was stuck at 1/8th for weeks, but now I see progress!  Yay!  

In the beginning if I introduced a new exercise, or did an old one more than before, or just did deep knee bends on land - all of those things made me extra swollen & achy for two days.  Yesterday I did my exercises, 5 deep knee bends, and walked up and down the stairs with both legs 3 times, and shortly after I put cold packs on my knee, a good part of the swelling and aches went away. 

 February 15, 2023 Family Letter

 Dear Family,

 Yesterday morning held so much promise.  I was feeling somewhat rested, and decided to give the Y another shot.  I checked the schedule and it wasn't a "Master Swim" day.  I found out people pay to swim on those days.

 I got to the Y at 5:24 AM, and was in my swimming suit waiting for them to unlock the door to the pool at 5:29 AM.  I managed to get to the first lane right after the guy I shared it with the last time and asked him if I could share it again. He said, "Yes" but as it turned out, there were actually 2 empty lanes then. Go figure!

 I swam my first lap and was surprised at how strong I felt, and how I was just a little bit winded.  I only had to wait about 20 seconds to do the 2nd lap.

 I was climbing the ladder to get out of the pool when I banged my left toe, the one that was ingrown, into the step.  I went to the other side of the pool where no one was swimming, and did my water arthritis exercises, and 10 deep knee bends.  I walked down and up the stairs at the Y instead of taking the elevator.

 It was only after I showered and was drying off that I saw that I had dislodged my already slightly ripped toenail.  Half of the right side was now laying on top of the skin.  YIKES!  I took pictures that I showed MR, but I'll spare you all and not include them.

 I dried off and got dressed and skipped the rest of my workout.  Instead, I went home and removed my shoes and sock, and trimmed the nail, then put a bandage around it, and then some medical tape.  It wasn't hurting, so I decided to do walk in the house for 10 minutes.

 I am very disheartened, because now I can't swim for months.  I can't take a chance on catching what's left of the nail on something, and they won't let you in the pool with bandaids or bandages on.  I can still walk and use the bike and leg press, so I'll just do that.  The only upside is that I won't need to take a gym bag for that stuff.  I never work up a sweat doing those exercises.

 At 8:00 AM I had breakfast with MR.  I made scrambled eggs and heated the left over Italian sausage from the night I made spaghetti with it.  It was awful, and I only ate the scrambled eggs.  Note to self: Only buy Johnsonville sausage, not Aldi's.

 After breakfast I went to bed and slept for 90 minutes.  When I got up I went to put gasoline in my car, and for the first time in decades, I paid with cash.

 Around noon we had lunch.  We ate some of the pork loin and shrimp with linguini and both acknowledge we're sick of these leftovers.  They just weren't as good now as the night I made them.

 To continue the trend of ill fortune, when I brushed my teeth after lunch, I used hydrocortisone cream instead of tooth paste.  That's the second time in 10 years that I've done that. Fortunately, as soon as I put my toothbrush in my mouth and moved it once, I realized what I had done. YIKES again!

 I had to cancel my shuffleboard with Elly this morning.  At 11 AM it's going to be below 60, which is too cool for my hands.  I called and let her know. She wanted to know if I wanted to play later, but it wouldn't have been warm enough until 3 PM, which would have put us going home right in the middle of the rush hour.

 For our Valentine's Day dinner, we drove through Lee's Chicken and got our usual choices - 2 piece dark meet with coleslaw and mashed potatoes and gravy, and for me a breast meal with the same side orders. They both came with biscuits.

 Love,

 Stu

 February 21, 2023  I thought I was going to the gym this morning but I woke up at 3 AM, and just dozed on and off, and the next thing I knew it was after 5 AM and I decided since I have an eye exam this morning I'd skip it.

 February 25, 2023  I overcame my inertia and went to MH and walked 5 laps, biked a mile, and did 10 leg presses.  When I got home I did 120 curls.

 Facebook Post February 25, 2023:

 Knee update - It's the end of week 17, and I've had a few milestones in the past 2 weeks. I am comfortably sleeping on my side again, and back to my former 4-5 hours a night, sometimes a little more. It's often in "installments," as in getting up to use the bathroom, but I'm falling back to sleep quickly. I'm also only taking 1 generic Tylenol PM when I go to bed, which is what I took before my surgery. I've been off any pain meds for weeks. I can get in and out of my car without moving the seat all the way back. It's getting easier to put on my left sock. Going down stairs still hurts a little, but not nearly as much as it was. A fair amount of the swelling is gone and with it my range of motion has increased. I still put cold packs on my knee after I exercise at home or at the gym. I still have a long way to go, but the worst is over. My thanks to my wonderful wife MaryRose Lucas Cassell, for picking up the slack while I was completely disabled.

 February 26, 2023  In one of our last telephone conversations, before my sister Carol died on January 29, 2021, she told me that taking 10 deep breathes when she went to bed, helped her fall asleep quicker.  I started doing that both when I went to sleep at night, and before my afternoon naps, and it does seem to help.  I usually fall asleep fairly fast, but since starting the deep breathing exercises, I fall asleep within 2 minutes of doing them.

 I am now able to sleep on either side, although I do better on the left side.  I have been sleeping on my side for years, but the surgery forced me to sleep just on my back for several months.  I also seem to sleep a little longer since I've been doing exercises 7 days a week.

 The swelling and stiffness just above my knee has gone down considerably this week for the first time since surgery.

 It still hurts to go down stairs.

March 12, 2023 - At this point I can sit at my desk in my office for over an hour at a time without too much discomfort.  Going down stairs is still a little painful but much less than before.  I am sleeping some nights all the way through and 5-6 hours now that I can comfortably sleep on either side.  I usually sleep on my left side.  I do 10 deep breaths when I'm ready to sleep, and within 3 minutes I'm sound asleep.  Putting a sock on my surgery leg is no longer a problem. I can't quite reach as much as my other leg, but it's getting close.

I try to go to the gym twice a week.  This past week I was able to go from 5 laps to 6 laps at Maryland Heights Community Center (7 is a mile), bike 1.5 miles, and do 20 leg presses.  

I am starting to limp less and less, mostly after either sitting for a long time, or when I first finish at the gym.  A little icing using takes care of that.

The top half of my knee is no longer achy, just the middle to lower part around the knee. 

I was able to kneel on a folded towel with both knees while I fixed a stopped bathroom drain this past week.

In bed I can pretty much move my legs around with very little pain. 

I am coming up on my 20th week since my surgery.

On Friday, we went to Mary Rose's friend Diane Baron's house to lend her my toilet seat riser, a large cold pack, and the device I used to put on my left sock before I could bend my knee enough to do it without it.

I am still doing my basic 10 minute walk and exercises, and stairs with both legs each day, except when I go to the gym.

Because of an injury to my left big toenail, I have avoided swimming for now.