Thursday, November 22, 2007

Total Knee Replacement - Surgery Plus Three Weeks

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Total Knee Replacement

What a relief to get rid of the walker. As much as it helped me get around, it was awkward, noisy, got caught on rugs, door sills and made it much harder to manuvoeur around the dogs. A pain to load in the car, as well. Well, not that big a deal once I figured out how to fold it up.

I never bothered getting a "Handicapped Parking" plaque, if I even could have. So I park the car wherever. There was a smug satisfaction to be had, pushing my walker past the perfectly health people getting out of their vehicles in the HP spots. I always made a point of staring. You know, like I was trying to figure out what their handicap was.

The cane is smoother and makes transitting the house easier. Of course, I started using it early, for going up and down the stairs. Walkers are no good for stairs. It was a real pain to honk the walker up and down the stairs but unless I was just going to grab a book out of the bookcase at the landing, or have a word with Lynn when she was exercising, it was a necessary evil.

It's important to make an effort to walk erect and operate smoothly with a cane. My therapist, even in the hospital, told me I had to bend my knee when I stepped. If you let yourself get away with walking straight legged, it makes it tougher to get your flexibility back.

Continued exercise has made a big difference in the degree of bend I can achieve in my knee. Easily 100 degrees at this point, I would say. I credit the exercise, but also just having less swelling is a big help.

Almost every night I get in the tub for a nice long soak. As hot as I can stand it, and after about 10 minutes, I prop the leg up on the wall at the end of the tub and allow myself to slump down, so my foot is as high up on the wall as I can manage. I'm letting gravity do the work, while I have artificially ramped up my bloods circulation rate. I think it is helping. Hey it feels good. And I get a nice lomng read in, and a glass of wine. Who cares if it's helping, I'm living the "Life of Reilly" as they used to say.

Total Knee Replacement - Heal Faster

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I was doing some noodling around on the internet and slid on over to

I love being able to do a TON of quick research using keywords and only getting back abstracts of published articles in medical journals. I found some support for things I've known intuitively or through anecodotal stories or by reading popular media, but didn't necessarily have direct reference to research to understand the mechanisms.

I'm talking about the link between healing and exercise.

There are a couple of factors that can negatively impact healing. Stress is a big one. Poor circulation is another. Nutrition is definitely in there and I have talked about that in this blog before. Immune system functioning is important as well.

It turns out exercise helps in all these areas except nutrition (well...after working out, I always eat a little something, and make a point of only taking in protein and complex carbs, so I guess you can cover nutrition off a little bit as well).

As you might guess, after any major surgery, such as total knee replacement one of the biggest problems for the patient is reduced function and mobility. Reduced function and mobility inevitably leads to increased stress for the patient.

Stress has a negative impact on the healing process. In Neuroimmunomodulation, Vol 13, 2006 Glaser and Christian write that “…stress can significantly slow wound healing: stressors … impair healing in humans and animals. For example, in humans…the relatively brief stress of academic examinations impedes healing.” They go on further to state “Recent evidence suggests that interventions designed to reduce stress and its concomitants (e.g., exercise, social support) can prevent stress-induced impairments in healing.”
PubMed 1

In 2005 report was published in the Journals of Gerontology describing a study on exercise and healing among older adults. There were some surprising results. The study divided 28 adults, with an average age of 61, who had not exercised in the previous 6 months into two groups. Half the group exercised for 75 minutes, three times a week. The other half did their normal routine. After 4 weeks, all the adults got small puncture wounds on their upper arms. They were also given stress tests, once at the beginning and once at the end of the study. Their cortisol levels were measured both before and after each stress test.

Neither group had an increase in cortisol levels after the stress test. Normally exercise increases cortisol levels. With age, the body loses its ability to produce cortisol. This is important because cortisol helps the efficiency of the immune system. Older adults typically take longer to heal than younger people.

The conclusion of the study was that the exercisers healed 25% faster, taking 29 days instead of the 39 days for the non-exercisers. Now the researchers expected this. Afterall exercise increases circulation, and that should improve the flow of nutrients to the wound site and the flow of wastes away from it. The surprise came when they administered the stress tests at the end of the study. The exercisers showed increased cortisol levels typical of younger adults. They reasoned that the increase in cortisol levels may have helped promote improved healing.
PubMed 2

Exercise also plays another important role in adittion to boosting healing rates. Patients that undergo total knee or hip replacements are dependent on walkers and canes for mobility during their recovery. Increased exercise load on the upper body can lead to soreness and pain.

In 2007, the May issue of Journal of Strength and Conditioning Research reported on the results of a case study involving two TKA patients. One follwoed a 4 weeks program of pre-habilitation exercises. (Pre-habilitation is physical therapy delivered before any surgical intervention). There were significant differences in both function and self-reported pain perception in the exercising case than in the non-exercising case.
PubMed 3

An earlier study, reported in the February 2002 issue of Applied Nursing Research, found that when they looked at the effect of preoperative exercise, anesthesia, or analgesia on the ability to walk after surgery, anesthesia, or analgesia had no effect. But subjects who exercised before surgery were able to walk significantly greater distances afterwards.
PubMed 4

So boil it all down and what do we have? Easy. Exercise helps promote circulation for wound healing. It regulates cortisol levels, especially in older adults. It strengthens the body, particularly important if you are going to be using assistive devices like walkers or canes that you are not used to. And it reduces stress, by helping make you more fit, therefore more able to cope on your own, and as a simple rphysical release for stress.

Wednesday, November 14, 2007

Total Knee Replacement - Preparing for Your Surgery

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I want to take a break from simply listing what has happened to me and talk a little more about what I did do and what I could have/should have done before my knee replacement surgery. Having a knee replaced is a significant procedure. It requires frequent therapy and exercise sessions after the operation to regain both strength and mobility. It is possible to shorten the recovery time afterwards. One of the simplest things you can do is to exercise in advance of the surgery to build strength in the joint muscles.

Deteriorating knees move the patient into a destructive cycle that makes recovery more difficult. Increased pain leads to a reduction in activity. Reduced activity means a gradual weakening of the joints associated muscles. And weak muscles mean recovery afterward is prolonged and made more difficult.

Talk to your doctor about pain management before the operation. With reduced levels of pain, higher levels of exercise are tolerated by the individual. They can embark on a muscle strengthening program before the surgery, ensuring they are in optimum condition for recovery afterwards.

Fortunately for me, I was in little pain or discomfort before my operation, which meant I could use my home exercise equipment at a relatively high level of intensity. Lynn and I had decided last winter to outfit a home gym, since our work schedules, and our inclinations made going to an outside establishment difficult. We picked up a very good quality elliptical device and an all-in-one weight machine. The elliptical is a very good quality, basic model. We elected to spend more for a basic machine and are happy we did. It feels very sturdy, and is whisper quiet. The weight machine is leverage based. You add plates to the bars and have to rearrange things for the different exercises, but it is not a huge deal. And, most importantly, it allows you to do squats, dead lifts and all of the major pressing exercises safely.

The weight machine is built by Powertec, and the elliptical is by Eurosport. They both make it easy to exercise, but they aren’t essential. Body weight exercises can do the job quite well. I’ll talk about some I use.

Exercising for flexibility, while useful, is not as critical as exercising for strength. Simple exercises using your own body weight are sufficient to make a difference in post-surgery recovery. Two simple exercises that the individual can do at home are described here.

1. Leg Extensions - Sitting on a straight back chair, place one hand on your thigh muscle and simply extend your leg in front of you, pointing your foot back towards yourself as much as possible. You should feel your thigh muscle tighten up. Try and get your leg straight and level at full extension. Do ten repetitions, holding your leg extended for a count of 6 for each rep. If you can do this easily, try extending the length of time it takes you to lift your leg. That is, lift the leg very slowly, taking 5 seconds or so to get it fully extended. Then hold it for a count of 6. Then take a full 5 seconds to lower it to a relaxed position. If this is still easy, try putting on a heavy shoe or boot while you do the exercise, making the leg work harder. You can repeat this exercise twice a day in the months leading up to your operation.

2. Step Ups - Standing at the bottom of a set of stairs, or a step, facing the handrail or wall, and place your foot up on the next higher step. Do you understand. You are actually standing sideways on the stairs. Using your hands to balance yourself on a handrail or door frame, slowly step up by shifting your weight to the higher leg and extending it. The key here is to do this exercise slowly, until you have fully extended your leg. Then slowly bend at the knee and allow yourself to lower back down to your starting position. No additional weight is necessary for this exercise. If you find it easy to do, do it slower. If you find it hard to do, use the back of a chair or an extended cane to help boost yourself. Maintain an upright posture, avoid stooping or bending sideways and take it easy the first week or so you do this. Perform 10 repetitions twice a day.

3. Assisted squats - Find a sturdy door, not a closet door, but something more along the lines of an exterior door. With the door partially open place one hand on each door knob. Now simply squat down until your thighs are parallel to the floor. You don't want your knee caps extended past your toes. In fact, if you are leaning back a little, supported from falling by the door knobs, you will be able to keep the angle made by your thigh and lower leg close to ninety degrees, which is as low as you want to go. Once you get to ninety, stand back up. Now, the last thing you need to do is fall. So the door knobs (or whatever else you may choose to hang onto) must be strong enough to support you. I used a steel column in my basement. It held me just fine.

The key with any exercise program is to start slow and build gradually. Do not fight through high levels of pain. Pain is a message. Find the best time of the day to do the exercises. For many people this will be morning. Consider placing a cool pack or bag of frozen peas or beans wrapped in a towel on your joint after exercise. As with any exercise program, discuss this with your doctor. Follow your doctors recommendations and best of luck.

Here's a couple of links to websites that talk about post surgery exercises. You should get well familiar with these exercises before you go into hospital.

University of Virginia

American Academy of Orthoepedic Surgeons

Total Knee Replacement - Surgery Plus Fourteen Days

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When I had my knee replacement surgery, they closed up the incision with staples. This was a first for me. Any incisions I’ve received in the past have been closed with stitches. I posted a picture of what the staples looked like in a previous entry.

Knee With Staples

Two weeks after the knee surgery I went to get the staples out.

Originally they were supposed to be removed at home by a nurse provided by the Health Care service. I was told, just before I left the hospital, that they were booked solid and I should arrange for my own doctor to do it. So that is what I did. Of course, my own doctor was not available for the removal, but the medical center where his office is located arranged for a resident to do the job.

I thought I was ready for anything. My daughter reassured me it was a simple procedure. “It was one of my favorite things to do when I was doing my placements. There’s nothing to it.” So I steeled myself a little. Thirty staples being released from their death grip on my flesh with some kind of pliers device didn’t seem like a “nothing to it” type of thing, but I’m a big, strong, brave guy. I could handle it. Until the resident walked in. He looked about 18 years old.

He seemed sure of himself during the introduction and I felt quite okay until we got to the point where he wanted to check out the staples. I hiked up my track pants and I swear his eyes actually bugged out a little. “Well,” he said. “You’ve got quite a few in there. The incision looks like it’s healing quite well. Could you excuse me a minute?” He got up and smiled at me as he left the room.

I looked up at Lynn. She had wanted to come along and see how staples are removed. “Do you get the feeling he just went to find a nurse and ask about staple removal,” I asked. She just laughed. “Maybe he’s gone to find the staple removal instructions.” Was I going to be his first? Was the young resident a staple removal virgin? Inquiring minds want to know.

I must admit that this was my first really queasy moment in the whole total knee replacement adventure. We watched him struggle to get his surgical gloves on. His hands were about two sizes to small for the gloves in the office, there was a lot of loose latex flopping around and he looked incredibly awkward as he slipped his fingers into the handle of the removal device. Check out the picture and imagine how it looked to me.

He was a little tentative as he approached his first staple, but he was trying hard to act confident as he slipped the tips of the device under the staples edge. One squeeze on the handles and the staple obediently let loose its clasp of my skin and came free.

You could tell he wanted to triumphantly look up at Lynn and I, but he restrained himself and acted as if this was just what he expected. By the time he got to staple number 15 it was old hat, and the last few almost came out by themselves.

The whole process went smoothly, with virtually no discomfort for me, and only a little for him, right at the beginning. I was pleased that I had been his first. He said his intention was to work as a GP, so I was doubly pleased to be helping a young one help fill the gap in family doctors that exist right now in Ontario.

I want to reassure anyone that may be looking at staple removal that there is no pain associated with it. I had been expecting some kind of local, but nothing of the sort, nor was it required. I remembered Dr. Blastorah telling me that my knee would feel a little funny, with some loss of sensation on the surface, after the operation. And that is true. Maybe that's one reason there was no discomfort.

All in all I would say it was an educational day, all the way around. Last but not least, here's a look at my stapleless knee.

Friday, November 9, 2007

Total Knee Replacement – Surgery Plus Twelve Days

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The satellite guy finally gets here on Tuesday, and finds and fixes the problem in 5 minutes. I was completely shocked. I had thought it might take him 7 or 8 minutes. Is it just me, or does there seem to be something wrong when a 5 minute fix takes a week to happen in our “information and service oriented” society. Or maybe I misunderstood the service part.

Having knee surgery has really slowed me down. I’m certainly no where near ready to drive a car yet so am feeling a little isolated. But with internet access again I will feel a little more in touch. But the thing is, it will really make Lynn happy, the little internet addict. Not having access to the internet and the online horse sites, and email has been driving her nuts in the midst of her search for a new horse.

Well it’s 12 days since the knee replacement and I’m not doing too badly. The walker really helps and I am right into the swing of things using it. I can’t get too cavalier with it, because it does get caught on the little step from living room to the main hallway. Somehow taking a tumble over my walker is probably not on the list of exercises my physiotherapist wants me to do.

Speaking of physiotherapists, she is not particularly pleased with this post knee replacement client. My flexibility is still not where she would like it to be. There is still a lot of swelling at the joint. That makes it difficult to bend. But I just have to persist. Also I have not been keeping it elevated enough. Now I am spending an hour at a time, a couple of times a day , on the couch, with my leg propped up by three bed pillows, and the rest of my lying flat, with my head propped up enough to watch TV or read. I am going to let gravity help drain the excess fluids away, at her suggestion. I should have been doing this right from the start.

Speaking of swelling, here’s a picture of the knee from the end of last week; you can see where I shaved the hairs off. I can tell you, changing bandages was a lot easier after that.

I'm getting the staples out in a few days. I wonder what that will be like?

A good time to prop the leg up is right after exercising. Then I can get out the bag of frozen beans or peas and ice down the joint while it is in the air, so to speak. Reduce the tendency to swell with a two pronged attack.

I have started to use the cane a little, at least at night. I think I mentioned that Lynn and I had pulled up the white carpet in the bedroom when we moved in. The hardwood to finish the floor is now in the basement and will wait on increased mobility on my part for installation. So it is bare plywood in the bedroom right now. So in the middle of the night, when I get up for my trip to the can, grab the walker and start moving, it sounds like a can full of gravel rolling across a concrete driveway. I don’t have one of those deluxe models with pneumatic tires or anything like that. Solid plastic wheels, lightweight aluminum construction. I might as well just reach across to Lynn and give her a shake and say “Honey, I’m going to the can now.”

I could have started using the cane for the few steps to the john a few days ago if I’d thought of it. Interrupted sleep might explain Lynn’s grumpiness since I got home. I thought it was emotional turmoil from worrying about me. (grin)

I get the sense that the first few weeks of therapy and exercise after knee surgery will have a significant impact on how the recovery goes. My surgeon told me I would be off work a minimum of 8 weeks. I can believe it. But I wonder what makes the difference? He actually gave me a range of 8 – 12 weeks. What can I do that would get me there at 8 weeks instead of 12 weeks? Now that I have internet again, I can do some cruising on google using keywords like "healing from surgery" and see what I get.

Total Knee Replacement Surgery Plus Nine Days

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Total Knee Replacement

Full meal deal for breakfast. Bacon, eggs, toast – that’s what I’m talkin’ about. You can’t recover from major surgery on porridge and soy milk. At least, I don’t think I can. Lynn is so indulgent of me. Fortunately, that’s just what I need.

I slacked off on the exercises on Friday. I can feel the difference today. Weird. It’s almost as if, after your knee surgery, you need to do at least two sessions a day, just to maintain where you are strength and flexibility wise. Then you need that last session to make some progress. If you skip one, session, you stagnate. If you skip two, you fall behind and now have to catch up. I resolve not to miss any more exercise periods. I want this knee replacement to have been for something good. I have the uneasy feeling that what you do in the first couple of months after recovery has a lot to do with how things ultimately turnout.

I get a phone call from Malcolm’s son. They are going to come up and I should see them about 1:00 PM. I discuss my need for a wireless network and troubleshooting. Mark will pick up what is needed and I will settle up with him when he gets here. I suggest he bring up his Dad. No problem, that was part of the plan.

Lynn takes off for another trip to visit some horses that sound promising. I don’t expect her back until close to supper time. On my own again. But by now I am quite handy at getting around. Time for a shower. I’m expecting company.

A few delays for Malcolm and Mark to get here. Oh well, not like I was scurrying around cleaning and primping, waiting for them. And I didn’t bake a cake. When they arrive it’s great. I’ve never met Mark, and Malcolm’s never been to this house. A little chit chat then down to work. Playing host is a bit tougher when you can’t move very much. Here they are to do me a favour, and for thanks they get to be directed around by me. Go get that chair, no the cupboard to your right, yeah, under the counter etc. They are both gracious guests and everything moves right along.

Mark knows his stuff and after a while Malc and I leave him downstairs while we migrate back upstairs, closer to the coffee. We have a nice chat about what he’s doing, what I’ve been doing and we talk about the knee replacement and the physiotherapy and flexibility exercises.

Lynn gets back and Malc and Mark are still here, so that works out nicely. We all sit and chat for a bit. Then Mark comes up, defeated. There definitely seems to a problem with satellite modem. He ran into a few other problems. He also spent some time on the phone with the xplornet tech support folks. It looks like we are going to have to wait for them to resolve their issues before moving forward. Mark stays and we all visit for a bit, then he and his Dad go. Almost seven o’clock. They decline a supper invitation and are gone.

A nice visit and I feel somewhat vindicated for not being able to resolve the internet access problems myself. I mean, we always want to get our problems fixed, but it is ever so much better when somebody doesn’t come along and go “Here’s the problem. It wasn’t plugged in.” I prefer my problems to be true technical dilemmas that require high level consultations and possibly the construction of whole new infrastructures with technologies just now being invented by rocket scientists at some skunk works somewhere.

Wednesday, November 7, 2007

Total Knee Replacement - Doctor Payouts

I just came across this item about "deferred prosecution agreements a US Attorney made with four makers of orthopedic devices (Biomet, DePuy Orthopaedics (a unit of Johnson & Johnson), Zimmer Holdings, and Smith & Nephew), and an agreement allowing federal supervision of Stryker Orthopedics (a unit of Stryker Inc)."

It seems that the four companies have been making large payouts to doctors. as "consultants" to use their products. I'm talking about payouts of up to six million dollars to individual doctors.

The companies were charged with violating anti-kickback laws. The upshot is the companies agreed to post the names of every doctor who recieved "consulting" fees. In total we are talking about 1805 doctors, including 46 doctors or organizations that received individual payouots of over a million dollars. Read more about it here.

Health Care Renewal: A Few Answers, and Many More Questions About Device Manufacturers' Payments to Orthopedic Surgeons

Now, my doctors name wasn't on the list. On the other hand, I don't know the details of the agreement reached with the companies. Maybe it was only to reveal the names of American doctors/organizations, since only they could be charged with an American violation.

At any rate, have a look for yourself. Don't be afraid to question your own orthopedic surgeon about his affiliation, if his name is on the list.

Total Knee Replacement Surgery Plus Eight Days

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Total Knee Replacement

Every day I have a little more strength and movement in the leg. My flexibility still hasn’t increased a great amount since the knee replacement, still less than 90 degrees of bend at my knee, but my strength has. The fear of having to independently move my leg has gone (okay, diminished). There are still twinges. Lynn was helping me take off the stocking and when it suddenly came off, my leg bobbed up about six inches, and then there was no support under it so dropped. I automatically tensed up and slowed the descent, but the knee didn’t like uncontrolled flight. Not really painful, just a clear reminder that things needed to be more controlled.

I really don’t have much appetite since I am not doing much. I guess all of the nutrients needed to heal a 10 inch (25 cm) incision in my leg are probably contained in a handful of food. I’m taking 3-4 one-a-days each day, a couple in the morning and another one or two each night. And a protein shake every morning, depending on whether Lynn has time or thinks of it in the morning, while she is getting ready for work.

It is certainly decadent-like to just lie there each morning, drinking the hand delivered coffee and juice/shake while she gets ready. Every once in a while I scratch the dogs on top of their heads or behind their ears. Lynn and I just chat about what’s on the radio or the coming day. She has the great good sense to make sure everything important that I am to do is written down for me.

The dogs start barking like crazy. I look outside and see a service truck. Then about 10 minutes later the phone rings. Bell telephone (or their contracted service rep I should say) tells me that the fuses in the junction box outside on my house wall had blown. They have been replaced. They no doubt saved me from significant damage inside and all is right with the world of telephone communications now. I thank him. Then smack my forehead. I should have asked him for the spec for those fuses. I need to get some for the next time. To think that a $2 part and 15 minutes of work would have saved me from 2 ½ days of no phone service. I will have to find out what is required. Once I get internet access again it shouldn’t be hard.

Now that I have phone service I make contact with xplornet again and once more we walk through all the reboot, power up and power down stuff. They decide it might be a problem with their equipment and assure me that they will assign a ticket to a local service rep. Here we go again, I think. There is nothing I can do. They are the only game in town.

I’m hitting the sack every night about 10:00. By the end of the day, I have had enough of hobbling around and look forward to resting in bed. I have been catching the odd ½ to 1 hour naps as well, usually after lunch. They seem to help with the energy levels.

Total Knee Replacement

Total Knee Replacement Surgery Plus Seven Days

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Total Knee Replacement

Bright and early, 7:00 AM, here’s the nurse from the blood services lab to sample my blood. They need to check how the cuomadin is working to sort the dosage rate out. The samples they took in the hospital aren’t sufficient. These people are so proficient. I guess after 10,000 needle sticks you get pretty smooth.

Both Lynn and I slept the sleep of the dead last night. My leg isn’t too bad considering the workout it got yesterday. I am sleeping with it propped up on pillows at night. I think it helps keep the swelling down, maybe even helps it drain a little through the night. I am still wearing the stocking and I think it is helping. I do take it off every day or so, just to give my little toes a chance to flutter in the air. I am not sure that stocking was designed for feet and legs the size that I carry around.

I call up my good buddy Malcolm at work. His son has a computer service on wheels thing going part time. It was me that gave Malcolm that idea, to pass along to his son, who was working as a help desk guy for an ISP. He is doing pretty well with it and this is a great opportunity for him to say thanks for the idea.

That’s all set. Malc’s son will call me back and set up a time on the weekend to check out my end of the computer/internet connection

I try calling the xplornet people and get a very helpful and pleasant young woman from Fredericton. She walks me through the boot process I have already used. Lynn is assisting because the modem is up on top of the bookcase and awkward for me to get to. I’m the phone link to Fredericton, she is the hands on. I missed a “static discharge procedure” in my efforts on Wednesday. Our Tech person guides us through. Eventually we lose cell phone contact. But we do get internet connection going.

Lynn runs upstairs to check her computer. No connection there. An hour of screwing around ensues, switching cables, redoing everything again. No luck. And the internet seems god-awful slow. It takes 7 minutes to download three email messages. I give up. Tomorrow the regular phone lines will be back and I will try again.

It’s funny how exhausted I get, just doing a little bit of moving around. I am still only one week out of total knee replacement surgery so I guess it is to be expected.

Total Knee Replacement

Thursday, November 1, 2007

total Knee Replacement - Surgery Plus Six Days

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Total Knee Replacement

The internet is down. I’m not surprised, with the storm we went through. Because we are in the country, with no tower nearby that allows us to access wireless service, we have a satellite receiver on the side of the house for internet access. It is not unusual to lose the signal. This usually requires a trip downstairs to power down everything, then power it back up in a particular sequence. I finally get around to doing this after lunch. My first trip downstairs with the cane. Of course, I have to get the walker down with me because the cane on its own won’t let me move around down there. Fortunately I have a landing half-way down and can reach the walker and after I am down 4 steps and move it to the landing with one hand, then descend, shift the walker, go down four steps, move the walker to the basement floor, then finish descending. What a pain. Why didn’t they put an elevator in this house when they built it?

All my magic doesn’t work so I try calling xplornet, my service provider. Damn. Somebody left a phone off the hook. Back up stairs, tracking down all the cordless phones. They all seem fine, so back downstairs, because I didn’t bother with the ones down there. They are all good. Maybe the lightning strike took out the phone service.

Thank God for cell phones. I call Ma Bell. They have no indication of a problem on their end. They inform me that there is a phone jack either inside my house, where the service comes through the wall, in their little junction box, or outside the house, where the service comes in. If I plug a phone into the phone jack in their service box, I can tell if I am getting service from the telephone pole to there. Then I will know if it is their problem or my problem. As if I care. I just want phone service. I’ve had my leg sawn up, people. I need phone and internet.

Back downstairs. First disconnect the one phone we have that isn’t cordless (gotta have one corded phone in case of power outages), then find something to carry it around in. I locate an old WWII ammo bag with shoulder strap that my dad used for holding fishing gear and dump the phone in that, then start searching for the junction box.

Well, I find the service coming in and being split into the different lines for distribution in the house, but that’s not what she was talking about. So outside I go. Yes, walkers are useable on grass that hasn’t been cut for a few weeks. I find the junction box. Of course, it’s only about two feet off the ground. I get down and squirm my way under to where I can get a look. I can’t see any phone jack. I get up and pry the lid off the thing. No phone jack. Damn. Why do these people lie? Is it just to force you through this hassle?

Back on the cell phone. No problem. They’ll assign a ticket to my problem and have a contractor come and look at it. More outsourcing. Does no one maintain their own service network these days? The help desk I was talking to was probably in New Delhi. The person was polite, and considerate, but my issues with mobility and need for communication were not their issues. Someone would be out to my house to check sometime between 8:00 AM and 5:00 PM on Friday. Two days before the phone service could be restored. I wondered how many phone messages were already piled up from potential horse sellers looking for Lynn and Access Center workers trying to get in touch with me to schedule visits.

Shan calls and wants to borrow my laptop so she can have a slide show running on it at the two wedding shows she is going to this weekend. I am reluctant, because I have been typing out this blog and a couple of other writing projects on the laptop, while sitting in an easy chair with my leg propped up. It is a lot more comfortable that trying to sit at the regular computer desks we have at home. After 20 minutes of that and my knee starts throbbing. Oh well, I don’t have internet access anyway, so it’s not like I can post the blog entries or do research for my writing. I’ll get the laptop back by Sunday or Monday night.

Total Knee Replacement _ Surgery Plus Five Days

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Total Knee Replacement

We both have a tough night. I did more in 1 day, yesterday, than in the previous 5 combined. My knee feels like it this morning. In addition I had to get up and hit the bathroom a couple of times in the night. I reveled in my freedom from urinals until I started pushing my walker across the plywood floor. (We pulled up the white shag carpet the previous owners laid down and have the Peruvian Cherry hardwood downstairs, but there’s been no time to install it). The walker sounded like a train of grocery carts going over a badly repaired concrete road bed. I woke Lynn up for each trip to the can. So she didn’t get much more sleep than I did, and she has to get up at 06:30 to get ready for work.

Today’s a day for watching movies, reading and starting Season 1 of Deadwood (thanks Trevor).

Lynn is dead beat when she gets home. She calls on her way home and I suggest a ready made barbecued chicken from the grocery store and a salad. She is all over that. And so am I once she prepares it. So this is what Oliver meant when he sang “Food, Glorious Food!”

I cut back to one Tylenol 3 a couple times today, but started the day with two and elect to end the day with the same dose. My knee feels well used by the time the day is done, and even though I am throwing a towel-wrapped bag of frozen beans on it after each exercise session, it still seems more swollen by bedtime than it was in the morning.

The day doesn’t end smoothly. A tremendous downpour and thunderstorm, just before midnight and again at about 4:00 AM. On one lightning strike the flash and sound are virtually simultaneous. That means it was within a few hundred feet of the house, if not closer. I look outside but can’t see any smoking craters, and didn’t hear the sound of a tree coming down, so maybe we are alright.

Total Knee Replacement