Bilateral knee surgery — Five weeks and waiting for “normal”

Last Tuesday, when Mark’s physical therapist asked him how he was doing, Mark said, “I just want to be normal again.”

“If you were normal,” the therapist said, “you’d still be walking with a walker right now.”

As I’ve been pointing out all along, Mark has recovered to this point quickly. He can do most things, excepting the three prohibitions mentioned in the pre-op class. He stopped all prescription pain medicines and is back to taking only Motrin twice a day. We think the Lyrica really helped with the pain because Mark’s discomfort level has risen since he’s  been off of it.

Mark is scheduled for physical therapy twice this week and will need to go once or twice next week. After that, we don’t know. We expect he will be finished soon.

Then it is just a matter of time to heal completely. We were told initially that it takes three months, after that he is no longer prohibited from kneeling, etc.

I wanted to include a video of Mark walking down the hall, getting down on the floor and back up again, and walking down and up a flight of stairs.

I took the video over the weekend but somehow lost most of it in the transition to the computer. All I have left is Mark sitting with his legs up on his desk, sipping a Cosmopolitan, straightening up from getting off the floor, a laugh in the background, and a head shot as Mark approached me during his stroll down the hall. Since I think I was lucky to get the video in the first place, and I don’t believe my actor will be willing to do a retake, you will have to take my word for it.

All is well. And we feel lucky to have made it this far in Mark’s recovery so soon.

Bilateral Knee Surgery – Two weeks post-op and walking with a cane

Two weeks ago today I was sitting in a hospital waiting room while Mark was having his three-hour total knee replacement surgery. Last Thursday Mark put away his walker and started using a cane. His physical therapist continues to tell him he is way ahead of schedule on his recovery. We don’t really have an explanation for that except that his surgeon did a great job with the most updated techniques and appliances, and Mark is determined and has been aggressive with following his recommended exercise routine. I’m thankful for how fast he is recovering and proud of him for how hard he is working at it with little complaint.

Last Friday at therapy he was told he could cut back even further on the CPM machine, but the therapist did not want to  make the decision to stop it, and wanted to wait until the doctor released him from it. So Mark is using the CPM 2hrs on the left leg, which is a little stiffer, and one hour on the right every day.

Mark is finished with the blood thinner shots. He still takes the Lyrica and Celebrex pain meds every day, but has cut way back on the narcotic Percocet and primarily uses it at night if he has trouble sleeping.

He will see the surgeon on Wednesday for his two-week post op appointment. After that we hope to be done with the CPM machine. Mark also hopes to be done with the tight hose he has to wear to promote blood circulation in his legs. He will undoubtedly ask the doctor when he can drive. He also wants the doctor’s advice about when he should back off the other pain medicines. On Wednesday we expect that Mark will have his staples removed and we will see his incisions for the first time. He has been wearing some kind of silver-embedded bandage on each knee since surgery that is supposed to prevent infection. And finally, Mark should be able to shower following his doctor’s appointment.

Mark has three physical therapy appointments this week and again next week. Then we will find out what comes next. The time has gone fast for me so far, but the day of surgery seems a great distance away in my mind. It’s a funny thing about time.

You can find links to the entire series on Bilateral knee replacement surgery here.

A tale of determination, confidence, and the clankety clank of a walker

What in the world is he doing now? I wondered as I woke up for the second time this morning to the sound of Mark’s walker clanking down the hall to the kitchen.

The first time I woke was at 5:00 a.m. when, with the same vigilance as a new mother’s response to the cries of an infant, I heard the movement of Mark’s walker and opened my eyes to see him sitting on the side of the bed.

“What are you going to do?” I asked.

“I’m going to go sit in the recliner in the great room for a while.”

“Just be careful. You can leave the door open,” I said as he left the room to the clankety clank of his walker. I wanted to save him the trouble of trying to manuever around and close the door behind him, but I also wanted to be able to hear better what he was doing, or if he needed me.

Ever since his appointment with out-patient therapy yesterday, Mark has started pushing his boundaries. Like the therapists in the hospital, his therapist here, whose name is Chris, was pleasantly surprised. “Does he always heal this quickly?” Chris asked me at the end of the session.

Chris told Mark that he is well ahead of schedule on his recovery, and that in fact, he is ahead of where many, if not most, single-knee replacement patients are when they come in for their first visit. We’ve been told all along that double-knee recipients lag behind in recovery. And at first in the hospital I believed it when I saw the single-knee patients trotting down the halls. I even wondered, was this a mistake?

All of this praise from the therapists feeds Mark’s ego, I’m sure, but it also feeds his determination and lack of patience I’m afraid. When Mark left the hospital his occupational therapist looked him in the eyes and said, “I want you to hear what I’m saying. You’re the type of person who comes back to the hospital. I don’t want to see you back here.”

So I listened this morning until I heard the cessation of the walker’s clankety clank followed by the squeak and click of the recliner foot rest locking into place. Then I rolled over and went back to sleep.

When I woke up the second time about an hour later to the sound of Mark and his walker moving down the hallway to the kitchen, I wondered, what is he going to try to do now? I heard the refrigerator door open. I heard the microwave door open and close and buttons being pushed. I got up and walked to the kitchen.

Mark was on his way to the refrigerator holding an empty glass in one of his hands while also holding onto the walker. “How are you going to carry that when its full?” I asked. He told me he didn’t want to wake me up.

Some of these tasks would be easier if he would have kept the basket I bought for him on his walker, but initially he didn’t like it, didn’t want it, so I took it back off. Yesterday he started carrying things like his book in his hand along with the walker.

“Why don’t you go ahead and sit down,” I said, “and I’ll take it from here.” He had an English muffin in the toaster, a stick of butter in the microwave to soften, and of course the empty glass for milk. I got him set up with his food and drink and went back to bed.

“Clankety clank,” back down the hall he came a little while later. I opened my eyes and saw him carrying his walker a few inches off the ground as he walked into our room to the bed. He was trying to be quiet.

I always knew Mark had great determination when he set his mind to something. But this surgery has provided an opportunity to display some of his finer human traits in a very visible and measurable way.

See what I’ve been up against all these years?

Now in his own defense, yesterday Chris told Mark to look for a cane and bring it back on Friday for his next appointment. So the days of the walker are numbered. He also can put the braces away; he doesn’t need to wear them at night anymore. Here’s the best news; Chris also told him he can cut back on his time in the CPM machine 50%. That means only a total of 6 hours a day instead of 12. GREAT news.

Finally, echoing the hospital O.T., Chris told him, “Don’t get over confident.”

Lord, help us all.

 

You can find links to the entire series on Bilateral knee replacement surgery here.

We’re doing okay — Living with Alzheimer’s

The menu for meal preparations on Friday at my parents’ house included Sherried Beef Sirloin Tips and Potato-Vegetable Bake, two new recipes from a book I purchased recently called Easy-to-Swallow, Easy-to-Chew Cookbook by  Donna L. Weihofen, JoAnne Robbins, and Paula A. Sullivan.

I try to make or bring a meal or two for Mom and Dad every couple of weeks or so. It gives my mom a break and one recipe typically makes enough food for two or three meals. Mom usually freezes the leftovers to microwave for an easy meal later.

When I arrived at about 11:30, Dad was taking a shower with the help of his home health aide Paula. Mom and I sat at the kitchen table cutting meat and slicing mushrooms for the Sherried Beef Sirloin Tips. Paula pushed Dad into the kitchen to join us when he finished with his shower. He helped scrape the cream of mushroom soup from the can, dump the dried onion soup from the package, and pour the water and sherry into the baking pot over the top of the vegetables and meat. It was a group effort.

I took orders for lunch. Mom wanted a hamburger from Burger King. Dad gave his order by nodding affirmation when I asked, “Would you like a regular hamburger?”

He nodded.

“Do you want mustard and pickle on it?

Another nod.

“Would you like some french fries?”

Nod.

When I came back with the food, Dad was sitting in his wheelchair at the table, nodding his head with his eyes closed.

“Are you asleep?” I asked.

No answer.

Dad often takes a nap after his shower and typically doesn’t eat lunch until he gets back up at 2:00 or a little later.

“I think Dad needs to go back to bed,” I said.

Mom was a little disappointed that Dad would be missing having lunch with us yet again, especially after we had gotten food for him. It’s been a while since the three of us have had lunch together.

Paula helped Dad back to bed before she left at 12:30. Mom and I had lunch.

Mom was expecting the visiting nurse sometime between 1:00 and 3:00. The physical therapist was also coming to discharge Dad from therapy. Dad had completed seven therapy sessions at home doing sitting and standing leg exercises and walking around the house a couple of times with the therapist. The last time the therapist was there Dad got very short of breath and did not do well with his exercises. Mom said Dad did better the first day than later days. It’s sort of hit or miss with him and whether or not his brain is communicating well with his muscles.

“Well, at least you have some exercises you can do with him to help keep his muscles stronger,” I said. “I think it’s good we tried it.”

The nurse came at about 2:00 while Dad was still in bed. His name was Chris. He said Dad could stay right where he was, lying down in bed, while he took his vital signs. Mom talked to him a little about water retention. Sometimes Dad’s feet are swollen. They discussed things like congestive heart failure, the sound of a wet cough, when to call the doctor, and DNRs. I think the visiting nurses will add a sense of security to the situation and help give Mom confidence in caring for Dad at home.

The physical therapist came before Chris left. Her name was MaryAnn. She came in the bedroom and wanted Dad to get up so she could see him walk and do his exercises. When Mom started helping Dad roll over from his side to his back and start the process of getting out of the bed, Dad started crying.

“Don’t worry that he’s crying,” Mom said. “He cries often and easily. It’s not because of anything you said.”

Dad seemed pretty upset to me, as he sat on the end of the bed.

“It’s okay, Dad,” I said. “You’re doing fine. We’re doing okay. Things are okay.”

Dad stopped crying. He might have stopped anyway, but I’ve found in the past that it seems to reassure him if I tell him, “We’re doing okay. It’s a hard situation for you and for Mom, but we’re all helping. And things are going okay. We’re going to be okay.”

Amazingly, just saying the words out loud makes me feel better too.

Managing expectations — Alzheimer’s ups and downs

The list of my dad’s ailments, challenges, or disabilities is daunting at times.

He’s had urinary incontinent since he received radiation treatment for prostate cancer ten years ago. More recently his incontinence has expanded to include occasional bowel accidents. I understand it is possible this too could be a result of all that radiation years ago. It also could simply be a progressive symptom of his Alzheimer’s.

Dad has difficulty walking. He has arthritis and had knee surgery years ago. Some of this could be attributing to his difficulty walking. He can use a walker for short distances if he is monitored.

My mom has to help my dad get in and out of bed. He seems to lose his coordination or strength and is no longer able to sit on the side of a bed and lie down. Mom discovered that the best way to get him in bed is to have him crawl up from the foot of the bed. He likes to sleep on his stomach, so this removes the problem of getting him to roll over in a small space. When he gets up, Mom has to encourage him to roll across the queen-sized bed from his stomach to his side. When he is on the opposite side of the bed, she helps him get his legs down to the floor and lets him pull himself up by holding onto her hands as she stands bracing herself against his pull.

It’s not ideal, but it works.

Part of the problem appears to be that Dad has lost strength in his left side. In fact, we are becoming more and more convinced that in addition to Alzheimer’s, Dad may have also suffered a small stroke at some point leading to the loss of strength on his left side. When Dad initially went to the doctor with cognitive problems in the middle of 2008, he had an MRI that ruled out a stroke. But he could have had one since. A stroke could also be contributing to the fact that Dad cries very easily and fairly often now. It could be attributing to Dad’s problem with eating and swallowing food and the fact that he sometimes “pockets” food in the side of his mouth during a meal.

I suppose a stroke could also be responsible for Dad’s seeming inability or reluctance to speak.

Who knows? How would you tell if his problems are stroke or Alzheimer’s related? What difference would it make?

Mom also believes Dad is depressed and has been for some time. I would be too.

Sometimes when we try to get help for Dad I feel like we are a ball in a bumper pool game. One professional evaluates and then bumps us to the next.

We started with a visiting physician because it has become so difficult to get Dad in and out of a car. Visiting physicians come on a monthly schedule. They don’t have time for unscheduled visits. So if Dad is sick it has to be handled through phone calls or some other way. We recently suspected Dad had a urinary tract infection, which is common with the elderly, and almost a chronic condition for Dad as a result of the side effects of his prostate cancer treatments. We called the visiting physician’s office who asked Mom if we have a visiting nurse.

After a few phone calls and a house visit, we now have a visiting nurse who will stop by and check on Dad weekly. The nurse who assessed Dad’s needs told us she thought he might benefit from therapy: physical, occupational, and speech. She talked about therapists coming three times a week at first. Three therapists, three times a week, a weekly visit from a nurse and a monthly visit from a physician is quite a lot of visits, especially when you consider my dad takes a lengthy nap in the middle of the day.

Mom settled on having just the physical therapist come for now.

The therapist happened to come yesterday to evaluate Dad’s needs when I was visiting my parents . The therapist thinks they may be able to problem-solve Dad’s getting in and out of bed issues and also help him some with his walking.

Here’s where the expectations come in. While the therapist was here, Dad was able to speak one-word answers to most of her questions. I start hoping. I think, maybe most of Dad’s problems are stroke-related. Maybe he can greatly improve with therapy.

And then the therapist started asking him questions: What’s your name? When is your birthdate? Who’s the president? What’s today’s date? How many children do you have? What are their names?

Dad did surprisingly well with many of the questions, although he had to use his little calendar reference to answer the date question and he couldn’t tell her the year. But he didn’t know how many children he had. And at first, he could only give the therapist my sister Annie’s name, who he refers to by her full name, Diane. When I stepped back in the room and he saw me, he was able to tell her my name. I suggested that he start with the oldest and tell her all our names.

“Who is your number 1 daughter?” I asked. Dad used to refer to us by our “number” if he was introducing us to someone. I’m the number 3 daughter. Dad got my oldest sister’s name correct, but was stumped when I asked, “Who’s next?” He struggled for a while and said, “Is Jerry next?” My brother is the youngest. With some additional prodding and some clues, he eventually was able to name all five of us.

Here’s the thing. I can’t allow myself to be falsely lured into believing that Dad is going to get better in more than an incremental way. I have to keep my expectations realistic and under control. I’m not going to get my Dad back.

Maybe therapy will help my dad get in and out of bed a little bit better, but it’s not going to help him always be able to remember my name.