Wednesday, April 27, 2016

Step Five: Pee in a Bottle...

I hope if the last part left you a little nauseous, you are feeling better.

Following my little incident with the low heart rate (reported in Part Three), I was resting comfortably just waiting to get moved to a room for my overnight stay at BAMC.  At this point, I still had not seen Eva, though she had received a full report from Dr V. and his team.  Apparently, there was some sort of back-up in the recovery ward they were sending me to.

When I finally made it to my room, I was hooked up to the usual lines and given a quick introduction to the nurse and tech.  The tech brought in a spiffy ice chest with tubes leading to a wrap around bag to put my knee on ice.  This is used to reduce the massive swelling.  In fact, the last time my body experienced this much swelling was when I got my vasectomy.  TMI?  Probably so.

Someone handed me a menu card with vague instructions on ordering food and my daughter quickly called in a sandwich from the dining facility.  At this point, I just wanted to sleep so the fact that the nursing staff was going through a shift change didn't really register with me.  The result was, the outgoing staff didn't really give a good turnover to the incoming staff, and the incoming staff did not realize I had not had any pain meds since leaving post-op.  It also meant that since I got into my room after normal duty hours, I had not seen the people from Physical Therapy.  Their goal is to get you up, show you how to use the walker and safely get to the restroom when needed.

If it sounds like I'm about to complain, please know I'm just trying to give some information to any readers who may find themselves in a similar situation.

While we were in pre-op waiting, one of Eva's friends from school who happens to be a nurse at BAMC, stopped in to say hello.  She told me that during recovery, when they asked me what my pain level was (they use a zero to ten scale), to always say at least five or six.  This way, they are always ready to administer my next dosage of drugs.  She told me that for the first 24 hours, just stay as medicated as possible so I could sleep through the pain. I think this was fantastic advice.

I got my last dosage of pain meds right before I left the post-op ward at around 5:30 in the afternoon and in spite of the fact that I was reporting my pain level as six or seven or eight, I didn't get my next real pain meds until close to midnight.  This was a result of shift change and the fact that I was too polite to complain.
Then, at some point I realized that I had not pee'd since around 7AM. I started to remove the ice bandage from my knee but then realized that I had an IV and no walker.  I was able to get the attention of one of the techs and told him that I needed to pee.  He went and got the nurse and she asked me where my walker was.  I told her I didn't have one.  She then asked me if I had seen Physical Therapy and I explained that I got into the room after hours.  "Oh, then you can't go to the bathroom until you see physical therapy in the morning. Didn't anyone give you a bottle?"

I honestly thought she was kidding, but sure enough, she came back a minute later with a large plastic pee bottle.  She handed that to me, then put the ice pack back on my knee and finally fixed my blanket situation.  Did I mention that pretty much everyone in BAMC had seen my man-parts hanging out in the breeze?

I will tell you that the overnight nurse I had was good.  She recognized that I was in pain and started loading me up in order to try to minimize the discomfort.  She would explain what each medication was and give me the option of jumping right to the Morphine drip.  Though the idea sounds comforting, I decided that I was not going to go the morphine route unless the pain was simply unbearable.

Overnight, sleep was sporadic at best and downright uncomfortable.  When morning finally came my main focus was just getting discharged and taking my chances at being home.  If you have to be miserable, be miserable in your own king size bed.

They brought me in a recliner type chair so I wouldn't have to lay in bed all day.  My first move, getting from the bed to the recliner was actually not that eventful.  I thought that the smart thing to do would be to put my weight on my good leg and simply scoot myself over to the chair.  In reality, with all the wires and stuff, I ended up just standing and placing weight gingerly on my new knee.  There was no excruciating pain like I expected and once seated, I was pretty happy.
I got a visit from the a functional therapy lady who brought me a little grabbing stick.  Think of a grabber like you might use for picking up trash along the highway if you were on probation or a high school kid doing service hours.  Using this picker-upper-grabby thing, she showed me how to put on pants, how to untie shoes, how to scratch my back and a whole host of other tricks that, in all honesty I never really used.
She also had a spiffy device used for putting on socks.  The people who invent these gadgets are so smart.  I also never actually used that one either.
The final surprise she had for me was a leg mover.  It was a long strap that looked like a dog leash but was fairly stiff with loops on either end.  The point of this device is to be able to place the foot in the bottom loop, then lift your leg up, soy for instance when you were climbing into bed.  I think even people who haven't had knee surgery could find use for this one.

Next up, a man from the medical supply company came in to provide me with a walker and a potty seat.  The potty seat is what they call a three-in-one.  You can either place it over the toilet and sit on it o you don't have to squat down as far, or you can use the handy bucket and just poop right into there, then have some able-bodied person (think: your wife) empty your poop for you (not likely). And the third thing it was for was to act as a seat for in the shower.

I can report that I did use it the first time I took a shower, just because Eva insisted, but I never once used it for the other two purposes.  I'm sure these things are useful, but, no thanks.

After breakfast the guys from Physical Therapy came around.  The first attempt at getting me to stand up and use the walker came to a sudden halt when I nearly passed out due to nausea and dizziness.  A nurse gave me some Zofran to calm my stomach and in about twenty minutes I was up on the walker and making first trip around the ward.  I also took a quick detour to the bathroom where I was able to demonstrate that I could pee without dribbling all over a plastic cup.

The goal was to have me do several laps around the ward using the walker and show that I could get in and out of bed, in and out of a chair and get into the car that would take me home.  I also need to get cleared by the surgeon and get all my meds squared away.  I don't remember when I actually was released but the long wait was getting the meds ordered and getting someone from the ward to go down and get them for me.  Once again, a shift change was involved and I think the oncoming shift finally got tired of me asking for a status.

I know a lot of this sounds whiny and it is. The truth is, this was major surgery but it was an optional surgery.  When you are at BAMC, it is really hard to complain about how bad you think you have it when you need only look in any direction and see wounded warriors of every description.  Young guys with missing ears, gals with missing limbs.  I'm sure they'd be amused that my knees hurt from running too much.   In the grand scheme of things, I had to pee in a bottle, wait for some meds, and watch a little TV connected to my bed.  We should all be so lucky.

Next time I'll tell you about my home therapy and my amazingly fast recovery.

Squirrel Nuts: Not Just for Breakfast Anymore...

We were a little worried that we might lose touch with all the nature we left in our old home when we moved back into the city.  Thankfully, we've found that no matter where you go, Mother Nature offers evidence of her presence.
Just yesterday, we saw this little act of kindness.  Mr. Squirrel had gotten tired during his journey across the street and his friend, Miss Buzzard gave him a helpful drag the rest of the way.

Que Cute!

Tuesday, April 26, 2016

Step Four: Avert Your Eyes if You're Squeamish...

As warned, this is the part where I show you the pictures.  Oh, don't be a baby.  This is real life right here.  Just think, if you found yourself to be a member of The Donner Party, this would be a nice juicy steak.
As a recap, this was the original x-ray where Dr. V. showed me just how bad things were.

The day following surgery when he and Dr. W., his resident came down to see how I was, he showed me these pictures.  My wife had already requested copies, so I present them for your viewing.

These show the actual procedure in progress.  I'm not smart enough to figure what is what but you can see that they have cut open the knee and and are monkeying around with it.  I think it is cool how they use a tool to spread it all open.  What may not be apparent in the picture is that my skin is covered in a film of sort.  One of the big things they are trying to protect against is the spread of germs.  Everything is super sterile (though I'm pretty sure my man-nuggets were flapping around unprotected).
This is the hardware pretty much installed.  On the top part, you see the new metal or Titanium knee.  That nylon part makes it all work smoothly when I bend it.  You can also understand why my knee is was so swollen after the fact.

For those into specifics, the system used is the Stryker Triathlon knee.  And no, there is no expectation that I'll be running in a triathlon any time ever.

Monday, April 25, 2016

Step Three: Don't Follow the Light...

If you haven't read parts one and two, you might want to go back by clicking here.

Okay, no more trickery; this is the part where I see the brightness people often report during near-death experiences.  

They rolled me from the operating room to the post-op recovery area.  I knew at the time that I was still very much enjoying the affects of the night-night juice they gave me for sedation.  Though I was conscious, I felt like I had smoked a pound of weed (if that's what that feels like).  I've seen all these videos on YouTube of people saying and doing silly things after having their wisdom teeth removed, and it was my intent not to do anything stupid.

I was placed in a bed in post-op with my own nurse checking my vitals, keeping me company and chit-chatting as best I could.  I don't want to get too specific, but on the other side of the curtain was a woman I had seen in pre-op.  She was in the room next to me and what I figured out was that she had severe personality issues.  As my nurse would take my blood pressure and such, we would hear an outburst from this young lady, wanting more drugs, wanting to see the doctor, wanting her husband, and generally being crazy.

Some of the things she said were more than outlandish and to be honest, I was impressed with how the staff on the other side of the curtain tried to calm her down and stay positive.  There were several times when she said something extremely crazy and the nurse and I would look at each other and try to suppress our giggles.  She whispered to me, "This is so unprofessional of me, I shouldn't laugh."

"A new knee and free entertainment.  I love this place." We both laughed but admonished ourselves for such insensitivity.

I don't know how long I had been there but it probably wasn't long when I started to feel a little nauseous.  I said to my nurse, "I promise, I won't throw-up on you, but I seriously need to puke."

She quickly handed me a vomit bag and told me she could give me something for nausea.  She then asked me if I was feeling any dizziness.  

It hit about that quick.  I told her, "Yeah.  I'm about to pass out in Three, two, one..."

I'm not sure if I actually passed out or not, but the next thing I knew, there were about ten people standing around me and the commander I had seen before was yelling for someone to get the anesthesiologist.  This tall, very attractive nurse had come over and was holding my hand.  She looked like Callie from "Grey's Anatomy" and she had these big shiny bright teeth.  She was stroking my hand and telling me I was okay.

I know for a moment I saw the so-called bright light but in reality, I think I was staring at her teeth.  During my moments of bliss the anesthesiologist gave me something to reverse the problem and as quick as the crowd of people were standing around me, mostly all of them moved off to other patients.  The commander directed the anesthesiologist to stay with me until he knew I was okay.  The conversation was not pleasant at all and it was obvious that someone had screwed up somewhere.

In the mean time, the nurse on my left was explaining to me that they had given me too much Epidural and that it had gone above my waist and up to the level of my heart.  My pulse rate had dropped to 40 BPM, and apparently that can cause you to pass out.  The nurse on my right (Callie as our family now calls her) continued to hold my hand and smile, though by this point, I realized that I wasn't actually going to die, but I also didn't bother to inform her of this.  

My daughter has told me that any time an older guy prefaces a statement with "I don't mean to be creepy, but...", it is a good sign that he is being creepy.  Thank goodness nobody from YouTube was around to record me, but I did tell the commander that his nurse was beautiful and she had the most beautiful smile and it was so nice of her to hold my hand while I was dying.  He just looked at me and blinked several times and then told the nurse she could go home early.  Traumatized, I suspect.

After all the excitement was over, the anesthesiologist told me that whenever I woke up on the operating table, he must have added a bit extra and as a result, that was why I had the problem.  He was very apologetic and in fact, the following day, he came to my room and asked how I was doing and apologized again.  Honestly, I don't know how serious it really was, I mean, it seems like depending on a person's weight, body type etc., it would seem like a difficult thing to calculate the right dosage.  Either way, I don't have any bad feelings about it.

I really didn't have any concept of time, but I do know that I did not get into my room in recovery until close to 6 PM.  By then, the nursing staff was going through shift change and that led to a really uncomfortable stay overnight.  I'll tell you about that in the next part.  Also, as a way of luring you back, I'll show pictures of my actual knee and the hardware that was installed.  You'll have to bring your own barf bag. 

Sunday, April 24, 2016

Step Two: Wake Up on the Operating Table...

If you haven't read part one, you probably want to click here.

We set a surgery date of the 3rd of March and that gave me about six weeks to prepare myself.  I'm one of those guys who escaped childhood without any broken bones and aside from a few minor procedures, never have experienced any major, stay the night sort of operation.  Even though, when people would ask me if I was nervous or having second thoughts, the answer was absolutely not.  To put it into some perspective, I've been in pain for years with these knees and if I had to experience even excruciating pain for a short period in order to fix things, I was welcoming the opportunity.

The wife of a co-worker who works in rehab for orthopedic patients told me the best thing I could do was to prepare myself with pre-op exercises.  This would strengthen the muscles in the areas that will be traumatized with the idea being that, once I start post-op therapy, it won't be such a shock.  This was incredible advice.  I got a copy of about six or seven different exercises that would be helpful and for most of the days leading up to the surgery, I spent about twenty minutes on them.  Not a huge investment for the positive outcome.

I know, you want to know how I almost died.  I'll get there, but I'm hoping that if anyone who is considering knee replacement surgery stumbles across this via Google, they will find the information helpful.

Up to the day before surgery, I was planning for two partial knee replacements.  The idea of doing both at the same time, though clearly a rougher go at recovery, seemed like a guarantee that I would not chicken out on doing the second knee if the first knee was a bad experience.  I was sitting at work, pretty much setting up my Out of Office messages, finishing up last minute paperwork and such.  I figured that I could be out for up to twelve weeks.  That's another thing I hadn't experienced.  I don't think I've ever taken more than a week, maybe two off at a time from work, and the idea of being out for so long was more of a concern than the surgery and recovery.

About an hour before I was leaving work, I got a call from Dr. V.  He said that he got a chance to look at the MRI I had done after our initial meeting and he concluded that both knees required full knee replacement versus partial. The only question was, which knee did I want to do first?  We talked about it and I decided that the right knee really needed to get fixed first, though in all honesty, I could have just flipped a coin because they are both so bad.

On the day of surgery, we showed up at BAMC which is also called SAMMC for San Antonio Military Medical Center.  SAMMC is really made up of BAMC and WHASC (Wilford Hall Ambulatory Surgical Center) and a host of clinics that serve the San Antonio military population.  I just thought I'd throw that in in case you wondered.
My knee waiting for pre-op.
Eva and I signed in and it wasn't even ten minutes before we were called back to the pre-op area.  The nurse handed me a gown and some socks and told me to get nekkid (well, might as well have been nekkid considering my junk was flapping in the breeze for any interested parties to see).  I got into the bed and started a fairly long waiting process since my doctor had one patient ahead of me.

While we waited, I would get visits from various technicians, doctors, the anesthesiologist, and eventually my surgical team so they could meet Eva and let her know how things would work.

There are a lot of interesting things going on with the pre-op staff as they attend to business.  A lot of it is waiting around in the central area.  All the pre-op rooms are along the outer walls with the staff stationed in the center.  They leave the curtains to each room open except for when some sensitive procedure is taking place (like when you get nekkid), so any f the staff can see into the rooms.  When they are attending to one of the patients, they sit in the center and have a little gab fest.  At one point, my nurse was teaching the other nurses how to Salsa dance.  That was entertaining, especially when the commander of the until walked in on them.  She was embarrassed, but they all got a good laugh out of it.

Eva was looking around at the other rooms noting people coming in and then leaving on their way to the OR.  At one point, she noticed a really older man across from us had his old man balls exposed for anyone to see.  Perhaps his wife could sense the exposure because she eventually covered him with a blanket, much to the appreciation of everyone involved.

For the record, I'm pretty sure medical people see more than they care to on a daily basis, but for us civilians, I think they should let us wear our underwear during these things.  I constantly felt the blanket riding up and in truth, I feel certain that everybody in BAMC has seen my old man balls, too.
My only tattoo.
Dr. V's resident came in and asked me all my identifying information, asked me which knee they were operating on and then pulled out his Sharpie and wrote on it to make sure nobody made a mistake.  I have no idea what it even says, must be some secret medical code.

Finally, the anesthesiologist came in and asked me some questions, then explained that his goal was for me to have no memory of the surgery at all.  They do an Epidural to block the feeling from the waist down, then give you some of that night-night juice to keep you conscious, but fairly knocked out.  Because I am a veteran of two colonoscopies, I'm familiar with the scenario where you close your eyes just as they start to intrude your backside then, eight seconds later, wake up to a technician wiping down the hose.  As an aside, if you ever fear the colonoscopy, I promise, the preparation is a lot worse than the actual shoving of a camera up your butt.

I was given some drugs to help reduce the pain for the Epidural, then they wheeled me off to the OR.  As soon as you get to the OR, the temperature drops to just above freezing.  I do remember the room looking very warehouse like, almost like a weird empty room that had all sort of medical equipment rolled into it.  Maybe it was just my imagination.  Aside from them telling me they were giving me the epidural, I don't recall a whole lot of pain.

The next thing I know, I woke up and I felt great.  I could hear the sound of hammering, but I could not feel it.  I looked forward and could see Dr. V banging away on my knee.  Then I looked up at the anesthesiologist and said, "This feels great."

He looked at me and asked if I could feel anything.

"No, nothing at all, but I have to tell you, this is the best sleep I've had in months."

"Well, technically, you aren't in REM sleep, but I'm sure it feels pretty good." He offered.

"It's wonderful!" I added.

At that point, our conversation was disrupted by Dr. V semi-yelling, "Hey, you wanna put this guy back to sleep?"

And then I woke up while the technicians were cleaning everything up and they were preparing to wheel me down to post-op.

Post-op is where I had my near death experience, so I'll have to explain how that happened in our next installment.  Spoiler alert:  I survived.

Saturday, April 23, 2016

Step One: Cut Off Your Old Knee...

It seems like a logical starting point for a blog about New Stoney Island would be some of the details regarding our transformation from the house we purchased to the home we've created for ourselves.  You know, pictures of the flagstone patio we installed, the building of the deck to house our hot tub.  But instead, there is something more exciting than all of that - I know, sounds impossible - and that is my new knee.

I have whined for years about my knees.  I developed really bad osteoarthritis which I directly attribute to my last year in the military trying to avoid the fat-boy program.  During that year, before the Air Force thought it was a smart idea to make everybody do PT a few times a week like our brothers and sisters in the Army and other services, we were left to our own devices to stay in shape.

I could go into a long diatribe about how aggravatingly stupid the Air Force has been with regards to fitness.  I could tell you story after story of incredible people who either got out of the military or who spent the majority of their careers dodging the bullet of random weigh-ins and tapes, but I'd only make you, the reader want to write your congressperson. 

Suffice it to say, every morning before work, I ran five miles on hard road and the final result was seriously jacked-up knees.  I can't blame the Air Force for that, of course, but I do think that an organized, structured program could have prevented me from the resulting pain.

So for the last decade I have tried to keep these bad knees from preventing activities I enjoy, like yard work, walking, well, I guess that sums it up.  It usually hurts to walk and sometimes I've looked like a serious gimp, limping around not sure which knee hurt more.  At some point I realized that I needed to do more than take the occasional Tylenol.  Several years ago I got a referral to the Orthopedic clinic at Big Willy, and I got the first in a series of not very helpful shots. 

From shots every several months to the attempt at a knee lubricant I now forget the name of; to braces that provided some temporary relief but were fairly nonfunctional, I continued to whine about the pain in my knees.  At each step of the way, I recall them asking me which knee hurt more, as if it was some sort of contest, or like they would treat only the really bad one and leave the other bad one alone.

I had a doctor who I really liked offer me some narcotic style pain meds.  I immediately declined telling him that I didn't want to chance anything addictive, so as an alternative, he got me hooked on Tramadol.  Tramadol is supposed to be like an opioid, but non-narcotic.  I think it really is an opioid, but what do I know?

I'm not one of those people who complains about the military medical care system because in truth, I know how very good they have been for my family.  But the worst advice I ever got from one of my care providers was the ortho guy who told me when I was fifty years old, point blank, I needed two new knees but that I should wait until I was sixty to have the surgery.  That was horrible advice.

Late last year I got this strange urge to stop taking the Tramadol.  I just felt like it was a bad idea to take it, even if it wasn't a narcotic.  It took me all of two days to find myself going through the symptoms of withdraw.  Don't get me wrong; it wasn't like I was a junkie needing a fix, but it was a very uncomfortable experience and I actually left work - not something I'm prone to doing.

I lasted about a week, maybe, before I realized that I could not stand the constant pain from my knees grinding bone on bone.  Firmly back on Tramadol, I went to my doctor and asked for a referral to Brooke Army Medical Center, bluntly telling her that I did not want to see the Ortho folks at Wilford Hall anymore.

During my meeting with the Ortho surgeon at BAMC, I described the the various efforts I had gone through, the injections and braces, the meds.

Dr. V, an Air Force surgeon, pulled out a copy of my X-Rays and showed me my knees.  He agreed that I needed surgery and that as soon as I was ready, he would perform it. His initial thought was that he could get away with partial knee replacements, saving the good parts of the knees.
But he also warned me that if he got in there and found they were worse than expected, he would be prepared to go with the full knee replacement. I hobbled away from the consultation with a true sense of relief, the idea that there was a light at the end of the tunnel.

And I'll tell you more about my exciting near death experience, when I can.

Saturday, April 16, 2016

The New Stoney Island - Introduction

To say that my wife Eva and I made this decision on a whim is not stating anything new.  In 2010 we were driving home from a Town Hall meeting at The Great Northwest Community Improvement Association, and in the less than the five minutes it took to get to our house, we made the decision to move.  This time, for completely different reasons, we were driving down the road to grab some dinner, and before we made it to the restaurant, I think the decision had already been made.

We closed on our new home in Helotes, Texas, five years to the day from when we moved into our home in Natalia, Texas.  You can read all about our incredible experience in Natalia at Living Out Here, a blog that chronicled our time on three acres of fun known as Stoney Island.

In our new home, the change is incredible.  While I think our house itself is slightly nicer (okay, a lot nicer) than what we had, the property is like cramming ten gallons of shit into a five gallon jug.  We can pretty much fit our entire yard into our old house; it's that tiny.  Looking out the windows and seeing someone else's window is a change; being able to give an ounce by ounce status of their hair shampoo is a shock!

So your first thought has to be, why?  Why move?  After all, moving to Natalia was one of the greatest decisions we've ever made.  We have never, not even once had a single regret in that decision, and we wouldn't trade our time there for anything.  When we moved to Natalia, both our kids were in the military and lived in other states.  If it wasn't for my job, something I'm somewhat attached to, we could have moved anywhere because there were no other real attachments (no offense to family and friends).  Then, our kids moved back to San Antonio and they started producing grandchildren!  We went from having one granddaughter to four, all rather quickly.  Eva found herself driving into town almost daily, just to get her fill of grandbabies.

So the conversation that led to the move was based upon a frazzled Eva, having made multiple trips to watch kids and admitting that the drive was getting to her.  What if we could sell our house, make enough money to put a good down payment on a new house, closer to the kids, yet still enjoy to comfort of a large yard with room for the grandkids and our dog Gracie to play?  What if we could recreate our outdoor oasis, a fire pit, a place to enjoy the cool nights like we did in Natalia?

Honestly, that was enough motivation to give the idea some real thought.  And by the time we were eating our chicken at the Bill Miller's, it was settled that we would give it a serious looking into.  An hour later, I had crafted an e-mail to our Realtor, Justin, and not long after he had replied with, "I absolutely cannot believe this!" 

On the first weekend our house was listed on the market, it rained all day Saturday.  On Sunday, we had back to back showings.  By Sunday evening, we had sold our house!

Eva and I were very methodical in our search for a new home.  We had figured out the features that we needed and drew a circle on a map to narrow the search considerably.  We made great use of the resources from our Realtor, but also used Zillow and Trulia to help get looks into the homes we thought we might like to see.  It is amazing how you can eliminate potential showings simply by doing some homework.

On the big day, we had at least ten properties lined up, most of them in the Alamo Ranch area.  We hit it first thing in the morning and had only one or two houses that we would consider going back for a second look if it came down to it.  Our plan was to take a break for lunch and then start again in the afternoon, but Justin suggested we take a quick tour of a house that was closer to Helotes and La Cantera.

I walked in first and before Eva had even made it inside, I had already announced to Justin that this was the house.  The size of the yard was laughable compared to our three acres in Natalia, but inside, it was exactly what we were looking for.  The floor plan worked, and the features of the home really sold it.  I did have to ask if the bidet in the restroom conveyed.  

On the fifth anniversary of closing on the house in Natalia, we closed on our new house in Helotes, or as we like to call it, New Stoney Island.  I am hoping that I can find enough free time to provide some updates to this blog, tell you about the work we do on the house and the places that have become our local favorites.  And if you happen to be in the area, we'd very much appreciate your suggestions on restaurants and neat places to visit.