Sylvia's Journal

Can one try too hard? It is the hyper achiever in me that tried to beat the odds and accelerate my recovery. Not so fast buddy! I had noticed something hard right behind my knee. Whatever it was, it was getting in the way of the knee bending exercises, the calf stretch, the heel-raise exercise, and walking.  I pointed it out to my physical therapist who started to explore and then massage it. Given that blood clots are still possible at this post-op phase, and that massage of the clot is the worst you can do, I made him nervous when I mentioned this. We cut the therapy session short, and he urged me to have someone make sure it was not a clot. Urgent care or emergency room? We decided to go to urgent care. That turned out to be a smart move. The urgent care doctor ordered an ultrasound which he was able to arrange within the next hour. At one of the local hospitals. We were able to let go of the fear to spend the rest of the day, and maybe even an evening at the ER. We were home a few hours later with the good news that it was not a blood clot but rather a fluid-filled cyst, making me wonder whether it was the result of my overly enthusiastic attempt to get my knee bending like normal as soon as possible.

What to do about the cyst is not clear. I alerted the doctor’s PAs. We’ll see what can be done. In the meantime, I did my own research and learned that one should apply heat. And here I had been putting an icepack at the back and front of my knee three times to four times a day. After putting a hot compress against it a few times, it has not provided much relief (yet).

I also researched post-surgery opioid withdrawal and learned some surprising things. A reputable medical website, and several others I trust, suggest limiting opioid pain meds to no more than two weeks. I had been on them for 4. I (re)discovered that I am very sensitive to opioid pain medication. I will never ever take it again if I can help it (I have another knee replacement ahead of me, maybe next year). On Monday I am starting my 2^nd week of withdrawal. The symptoms (there are many and I have experienced/am experiencing many of them) seem to get worse rather than subside: upset stomach, jittery, chills, too cold or too hot, diarrhea, nausea, nothing tastes good, bad taste in my mouth that no food, no matter how delicious under normal circumstances can remove, and finally no or low appetite. If my last memory of withdrawal from 2 weeks of taking Oxycontin thirteen years ago was only three days of yuck, I may now be in for a whole other week. 

The combination of the cyst and the withdrawal broke the fast (too fast?) linear progression towards recovery. Today I meditated about all this in my Saturday morning Music & Imagery  (M&I) group. In M&I, after an initial meditation we express on how we feel right now using color, shapes, texture, and then express on paper what we want more of. We then listen to 3 pieces of music selected by our facilitator (and friend) Christine and draw what the music brings up in us and give it a title. The last piece is of our own choosing. I choose music that is a very old friend of mine and that not only brings wonderful memories back but also is soothing in the present. The themes in my drawings contain my marching orders for the rest of my recovery. The titles of the 6 images of today were: Can-do-won’t-do; Looking for more humility and less pushy; Looking for some pleasant surprises; No shortcuts; The weather will improve; Drop the main sail, go slow and steady!

Two days after the one-month mark, I realized I may have taken the corner a little too fast. This included getting off the opioids. I had set myself a goal of switching completely to Naproxen and Tylenol. My body didn’t like it and I slid into withdrawal, a feeling I recognized from when I was getting off the Oxycontin after two weeks of use after the plane crash, now 15 years ago. I had not expected to have that experience (it is not as intense, but still) in kicking the Hydrocodone habit, since it has a much shorter shelf life (4 hours instead of a continuous administration every 12 hours).

Despite the uncomfortable nights and the withdrawal symptoms, I have made good progress in bending my knee (120 degrees as of yesterday) and strengthening the muscles surrounding the knee. The accomplishments have required a great deal of perseverance, discipline, and grit to do the 3 times/day exercises and two intense PT visits a week. 

So all in all, everything is going in the right direction.

Close to the four-week milestone of postoperative recovery, I have completed the turn of the first corner. I can do things now that I was unable to do even a short week ago, like getting out of a chair without pushing myself up with my hands or pedaling all the way around on a stationary bike, things I couldn’t do 2 days ago. I am done with the pain pills during the day, only still at bedtime and in the morning when I get ready for my first round of exercises for the day, bringing me closer to the goal of getting off the opioids entirely next week.

Today my physical therapist measured the angle of my bent knee at 115 degrees. This is 10 degrees more than last Monday, and 25 degrees more than when I was released from home care PT on May 19. This has not been an easy accomplishment: three daily rounds of uncomfortable exercises and a lot of huffing and puffing and icing. The goal is 120 degrees. This is the angle at which I should be able to do most of what a knee is supposed to be able to do in terms of daily living activities. Maybe I will get to that next week. We are starting to add a few more strengthening exercises which Axel and I can do together because many of his are the same.

Today we did another walk along the Gloucester Esplanade. It was a beautiful warm day with a cool sea breeze.  I walked for 15 minutes without a cane. That too is progress. For the first time I noticed how smoothly my new knee is operating, not distracted by walker or cane or a knee that didn’t yet want to bend much. It is smoothly sliding back and forth, painless compared to the pre-op grinding of bone on bone. That is still happening with the other knee which made the contrast even more noticeable. In the not too far future, the left knee will need the same treatment. This is one of the reasons I keep this weekly log so that I know what to expect when the pain memories have disappeared. The prize at the far end of this knee replacement business is two sets of artificial knee joints happily gliding along without friction allowing for long walks again. Hopefully sometime in 2024 I can look back and wonder why I waited so long.