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Thursday, February 25, 2016

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, " 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!


Anonymous said...

Oh Jaq ... yea!!! outside and washing windows! :-) The next thing you know the two of you will be walking along the towpath again. Beat yourself up lady getting that bend well 100 degrees. You aren't moving in and our of cars and regular chairs much these days but you you really need 100+. Some people can't tolerate ANY pain meds ... great that you can. I had a ^&*( of a time getting my knees to be totally straight too. Can you see the improvement yet? Pre and Post? Hope so. Croesus in Pullman. another yea! Spring is on the move on both sides of the pond.


Carol said...

Hi Jaq, great to hear that you are recovering well, that the pain is now under control and you can get out and wash windows, please feel free to come and do ours too! Keep up the good work. Are you coming south at all this summer? Missing you both. Carol and George xx

Marilyn, nb Waka Huia said...

Excellent news, Jaq. Interesting about the allergic reaction to NSAIDs.
Love and hugs, Mxox

Quaysider said...

I've been dipping in and out of your lives for a long time now - the pair of you are a couple of rays of sunshine ... your kind hearts bursting through whatever is thrown at you...

RE pain management - I too take the oxy which takes the edge of my back trouble but of late I've also been taking 2400mg of gabapentin along side which has drastically improved my ability to function (read work my socks off) - they are addictive but until I get another operation, figure I've no choice...

It might be worth asking if they will be any use in your case though - side effect wise, you just got a bit wooley headed... which I've been for years anyway lol

Keep looking after each other.

all the best, Mark.x

Anonymous said...

Les must be delighted that he can see out of the windows again!

Great to hear you're improving all the time and well done for teaching the medical professionals a thing or two... Can you get coffee on prescription?!

Turning the calendar to March tomorrow - summer isn't too far away.


Mrs. Jaqueline Biggs said...

Hi Karen,
I attended my first physio class at the hospital today; a circuit of 12 exercises--each of which is done for 1 minute and 45 seconds. I was knackered when I left and by the time I walked to the parking lot I was in so much pain I was crying. I barely made it home, where I lied down and cried some more while Les strapped an ice pack to my knee.

four more weeks minimum of classes by I have no doubt I will have the degree of bend required to enter and exit cars and carry on.
Love Jaq xxx

Mrs. Jaqueline Biggs said...

Hi Carol,
Yes well the pain was well in hand until I completed my first physio circuit class today. Now I know exactly how far I have to go and I am trying hard not to feel down hearted. If only they had started me on this sooner. There was no room for me in the courses back at the end of week two when I should have begun them. Anyway, washing windows is the easy part!! :)

We are not heading south this year. We are headed north, meeting up with American friends in Chester in July. Right now we are looking for some place to black our boat. We miss you both too. xxx

Mrs. Jaqueline Biggs said...

Hi Mark,
Lovely to hear from you again. Thank you for the tip on Gabepentin. I will look into it.

I was in tears today on my way back home from my first physio work out. Had I been alone I couldn't have made it back to the boat 'nor could I have managed to deal with the routine chores aboard.

While some of my tears were caused by the sharp, knifing pains shooting from my left knee to my left hip, several were tears of gratitude for Les. I am so fortunate he is my husband and cannot really in any meaningful way express how much I appreciate his loving care of me right now.

Take good care of yourself Mark and good luck with your back.
Jaq xx

Mrs. Jaqueline Biggs said...

Hello Alistair,
I am pretty sure if Coffee was available via prescription both of my daughters would have a permanent canula installed in each arm and bags of coffee hanging from poles in every room! Kwaffee is our go to drug of choice.

Another two weeks and the days will be longer than the nights once more!

Jaq xx

NB Valerie & Steam Train by Les Biggs

NB Valerie & Steam Train by Les Biggs