Getting Better!

"Flutter your wings frail bird, and rise an inch above the impossible." ~Anonymous

     Today I had a physiotherapy assessment appointment to determine if I was fit enough to participate in the one hour weekly physiotherapy circuit to rebuild strength and flexibility in my knee. It has been exactly 29 days since my surgery. I am pleased to say I passed with flying colors. I am required to walk with crutches out in public spaces until I have my post op six week follow up on March 14th, but I haven't used them to get around inside the boat since the first week after surgery.
    I have 86% bend in my knee which is good but will hopefully improve with the physio class. I am off all pain meds unless I have a particularly long day on my feet in which case I take 20 mgs of Oxycontin and it is all good for the next twelve hours. The pain med saga has been interesting. Medical professionals always want to shift everyone off opiods (morphine based drugs such as Oxycontin, hydrocodone, etc.) as soon as possible because they are addictive. The drug replacement of choice is nearly always NSAIDS such as Ibuprofen, Aleve, and Tylenol (called Paracetamol over here).
     My predicament is that I am allergic to NSAIDS (non-steroidal anti inflammatory drugs) which make me deathly ill and leave me in excruciating pain--feeling as if a metal rake with sharp tines is being drawn the entire length of my intestines--for days. Acetaminophen (Tylenol in the U.S. and Paracetamol over here in Britain) offers me absolutely no analgesic pain relief--and never has. I am 58 years old. Acetaminophen became available over the counter in America in the late 70's.  I have had many opportunities to use it. I have not once received any pain relief with it--not from a toothache, headache, sprained finger, pulled muscle, nothing; zilch, zip, nada. But is is almost impossible to get this through to medical professionals who think I am saying that Tylenol couldn't possible be strong enough to counter the deep pain one experiences with a total knee replacement.
     They didn't listen to me in hospital either and nurses kept giving me Paracetamol with morphine, telling me the Paracetamol actually works synergystically with morphine to boost the analgesic action of the latter.  I don't know about that but I can tell you I was in agony until they took me off Paracetamol and replaced it with IM ( intra muscular) injections of morphine in addition to Oxycontin pills. As I explained to my doctor, I don't take the medicine to get high--I take it to relieve enough pain so I can function; not ALL the pain, carrying me away to oblivion--just enough pain relief to function. So I was sent home with a prescription for 60 mgs of Oxycontin daily: 30 mgs twice a day. I instinctively knew that was far too much for me. I cut it back to 30 mgs a day/15 mgs every twelve hours and that worked perfectly. Being an anomaly is never fun but when it comes to medicine it is frightening sometimes, trying to make one's self understood and advocate for what one knows one needs in the face of medical professionals who "know in text book fashion what is best for you."
     Several of the Physiotherapists who visited me on the boat tried to insist I take Paracetamol anyway, "...as it does no damage to your body and it will boost the analgesic action of the Oxycodone." I replied, "Did you know that caffeine also boosts the pain relieving action of all analgesics?" Surprise, surprise. "Not only that but Acetaminophen is VERY hard on your liver--very hard and taking it twice a day for six weeks would do my liver no good at all at a time when I need it to function well to keep my system clean. Paracetamol is in fact too damaging to my liver to take without getting anything positive from it in return when I can simply drink a cup of tea or coffee with my pain pills and get the same analgesic boost without liver damage." I am happy to say the physio guy checked into my assertions and reported back that they learned something new and valuable from me, so that is a good result! What I can say is throughout this entire journey my care has been splendid--as good as the best care I've received back in the States, and I am eternally grateful.
     The other thing I've been dealing with is what happened while I was on the operating table. I know from having a son in law who is a medical surgical technician that once a patient is under anesthesia on their table, the patient's body is hoiked, twisted, lifted and placed in all kinds of bizarre postures to ensure the surgeon has the maximum access to the surgical site. This can result in patients coming out of surgery with pinched nerves and partially dislocated joints. I was careful to take a close inventory of all my bits and bobs before gong into surgery. When I came out of the recovery room I discovered my fourth and fifth fingers on my left hand were completely numb as was the bottom half of my palm directly under both affected fingers. My left S-I (Sacro-Iliac) joint which most folks commonly refer to as their "hip" was excruciatingly tight. In fact it felt as though it had been hammered into place somewhere up between my shoulder blades! S-I joint issues always affect the function of the knees. It was also causing me pain which made it impossible to get comfortable for more than a few minutes in any one position and this was affecting my sleep. So I made an appointment to see a local osteopath. I had actually seen Elizabeth before back in late August and it was she who told me she could do no more for my knees and really I needed to see a specialist and have my knees replaced. She wrote me a referral letter to the GP here in Warwick.
     Elizabeth told me that the nerves for the hands travel from the spine across our back and near our back ribs. If our back ribs become dislocated they can pinch those nerves causing numbness. I didn't feel any pain in my back rib area but after she worked on me my ribs were tender and the feeling came back to my fingers. As she worked on my left hip and leg, loosening the too-tight muscles of the S-I joint, I gained more bend in my new knee and the pain which kept me from sleeping has gone.
     I should have been started on the Physiotherapy circuit training course after week two at home but Warwick hospital has done so many hip and knee replacement surgeries in January that they have had to add classes and the glut of patients in the queue required me to wait until next week to begin. After we walked back from the assessment, Les took NB Valerie to the water point at the bottom of Cape locks, turned the boat around, and while he filled up with water, I washed the windows. It felt great to be working outside in the afternoon sunshine without a coat, enjoying the fresh air AND I even managed to get on and off the boat at the bow--the first time I've been able to do so in over three months.
     We cruised back down to moor up across from Radford Hill Farm once more, out in the quiet open countryside. Our dinner tonight is a celebration of sorts: breaded scampi, hand cut oven roasted chips, and petit pois peas gently warmed in a honey and mint butter sauce. We will play a couple rounds of London Underground--a game our friends Jennie and Chris lent us to try out. We have several good BBC programs downloaded to watch, and life aboard NBV is moving on at a lovely pace toward the time when we can once again up sticks and actually gets some serious cruising under our belts!