Thread Closed 
HerbM Bilateral Total KNEE Replacement surgery Oct 21st, 2014 -- WOW!
Author Message
Peter_C Offline

Advisory Members

Posts: 1,308
Joined: Sep 2013

Machine: System One DS960HS
Mask Type: Full face mask
Mask Make & Model: Mirage Quattro "MED"
Humidifier: Attached
CPAP Pressure: Auto mode-script is:15/3/3
CPAP Software: EncoreBasic Other Software

Other Comments: Severe obstructive sleep apnea 1999/Just got an ASV machine

Sex: Male
Location: Akron, Ohio USA

Post: #51
RE: HerbM Bilateral Total KNEE Replacement surgery Oct 21st, 2014 -- WOW!
Sidenote on my own recovery:
Last night I decided to try putting the leg brace on (am still at 2-3 degrees) at bedtime. This with my left arm in a sling to protect it's lack of motion during the night, plus of course my FFM. Having all three items on me, plus my lovely wife and three dogs moving around on our queen sized bed proved too much for me.

While not quite awake, I ripped my left arm out of the sling so I could take off the leg brace (that I needed my lovely wife's help to put on), moving my left arm in ways it wasn't ready to move in - didn't care bout the pain because I was too freaked!

So I woke to a throbbing shoulder... Ortho did say I couldn't do anything to hurt it, but moving it too much still hurts. PT doesn't start til Friday.

I've determined I can only wear one 'item' plus my mask at night without getting weirded out.

For perspective, having one knee replaced at a time - 2 weeks post-op I was barely off the 'walker', and barely out of the bedroom, and went nowhere other than PT. Yes, every one is different, but Herb so far, you are doing really great.

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
11-02-2014 12:23 PM
Find all posts by this user

Donate to Apnea Board
DocWils Offline

Members-b

Posts: 1,271
Joined: Jul 2012

Machine: Philips Remstar series 60
Mask Type: Nasal pillows
Mask Make & Model: ResMed P10
Humidifier: same as machine
CPAP Pressure: 5-15
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Switzerland

Post: #52
RE: HerbM Bilateral Total KNEE Replacement surgery Oct 21st, 2014 -- WOW!
Herb, just caught up on your story - sound like you are doing better than most - pat yourself on the back and give yourself an A Plus. I've done tons of these ops over the years (no more, though - too old and joint replacements are a young man's game - you have to be real fit to hammer and chisel things in the bones) and I can certainly attest to the efficacy of them, although I try to find therapeutic ways for the patient to avoid them or to be top fit before the op so recovery is stellar. Your progress is tip-top and you should be proud, but I would not try to push it too much now - give the whole thing a chance to finish the post-op healing and you will see that all the immense progress you have made will be even more if you now give just a titch of slack for a week or two - don't back off on your therapy, just lower your ambitions for a week or so and let your healing catch up with your progress.

Peter - let me add that it is not unusual to be a bit freaked when too many things are wrapped, covered or bandaged. It kind of feels like you are being mummified on bit at a time and you get claustrophobic. It passes. Pay attention to the part that needs the most tender loving care at night and find ways to minimise motion for the other part so that you don't re-injure yourself, and hang in there.

All in all, though, well done, both of you.
11-02-2014 06:16 PM
Find all posts by this user
herbm Offline

Preferred Members-2

Posts: 852
Joined: Jan 2014

Machine: ResMed AutoSet S9
Mask Type: Oral
Mask Make & Model: ResMed Airfit P10 Nasal Pillow
Humidifier: ResMed H5i
CPAP Pressure: 11-16
CPAP Software: ResScan SleepyHead

Other Comments: Backup Mask: Innomed Hybrid FFM -- Oral+Nasal Pillows

Sex: Male
Location: Austin, TX

Post: #53
RE: HerbM Bilateral Total KNEE Replacement surgery Oct 21st, 2014 -- WOW!
Hope you are Ok, on balance, Peter.

There are two ways those things can go when the doc says, "You can't do anything to hurt it."

He might mean to injure it worse or somehow undo the work he did, OR he could mean you can't do any of that but you CAN still set back your recovery be causing swelling, inflammation, or pain.

If you make a movement that forces you to go to a new ROM or into an entirely new mechanical configuration you MIGHT actually be doing yourself a lot of good even if it HURTS LIKE HELL.

Or you could be causing inflammation and stiffness that will delay comfortable use.

Hopefully your 'event' just hastens your recover or that you are at least Ok, on balance.

You MIGHT want to start by ejecting the 3 puppies before you change YOUR behavior.

My wife is sleeping with me in our King (a perfect waterbed) but I have warned her that she is subject to being awakened at any time if she sleeps here.

(Truthfully, I am up almost all night each night and have been very good about letting her sleep.)

Tomorrow is here surgical procedure for the L4-L5 disk issue so tomorrow night it might be I who must vacate.

If so, I will sleep on the couch with the CPM machine (continuous positive motion for the knee).


Today I KNELT ON MY TWO NEW KNEES.


Actually, when my massage therapist (and friend Michael) finished the body work today, he left me prone on his custom built massage table/bed with instructions to "take a moment for yourself before getting up...."

The 'table' is covered with something much like a giant feather pillow so it is about the softest FIRM surface available.

So it occurred to me that by just pushing up with my arms I could try to slowly take weight on my knees which were already firmly in contact with the padding.

So I did a sort of push-up or push-back into a four post hands and knees position and got the knees well by 90 degrees of flexion.

This was a big milestone out of the way and I had no idea of even trying it for perhaps weeks to come.

My left knee is one that isn't quite a loose and it felt a bit ODD with weight on it. Not painful or uncomfortable but definitely unusual compared with my original equipment.

Either the right felt normal or the left received so much attention that I didn't notice anything on that side.

At the end, I rolled to my right side, taking my full weight on my right arm and right knee.

This was entirely comfortable as well. Another big milestone.

The left needs the most attention (e.g., stretching, exercise, strengthening) but it is not very far behind the right knee.

Right now, the left knee is the "Good Knee" and the right knee is the "Better Knee."

I have been off all narcotics for 40 hours but decided to take one or two (10mg) Oxy's for this evening and bedtime which will still leave me plenty of time to be able to drive by noon tomorrow.

Generally I follow the aviator's rule of "8 hours throttle to bottle", so this will give me 12 to 16 hours of gap before driving.

However this has made Saturday and most of today a bit tougher for me than it might otherwise have been.

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
(This post was last modified: 11-02-2014 10:33 PM by herbm.)
11-02-2014 06:24 PM
Find all posts by this user

Donate to Apnea Board
herbm Offline

Preferred Members-2

Posts: 852
Joined: Jan 2014

Machine: ResMed AutoSet S9
Mask Type: Oral
Mask Make & Model: ResMed Airfit P10 Nasal Pillow
Humidifier: ResMed H5i
CPAP Pressure: 11-16
CPAP Software: ResScan SleepyHead

Other Comments: Backup Mask: Innomed Hybrid FFM -- Oral+Nasal Pillows

Sex: Male
Location: Austin, TX

Post: #54
RE: HerbM Bilateral Total KNEE Replacement surgery Oct 21st, 2014 -- WOW!
The following is the message that I posted on Michael (the massage therapists) Facebook page:
=======================================================================


Michael, today's massage was the finest massage I have ever received.

It was clearly one that will be always fresh in my memory every time someone mentions the word .massage'.

This is not the kind of thing I say to make people feel good. I am an old, fat, bald, white guy and could say "thank your" or compliment you with far less superlative words.

Anyone who lives in the north Austin or Round Rock area should try out your studio but anyone who can ever GET to the Austin area should also do the same.

I don't say it because you are (now, in just a short few weeks) one of my BEST friends, but simply because it is true and the work was astounding.

We have become such good friends so rapidly in just the last 10 weeks since my Total Hip Replacement surgery because you are such an astounding professional (not the other way around.

I hope someday to receive a massage which exceed today's but I hope never again to need such a massage so deeply.

I found Massage + Yoga by doing a Google search -- you were one of the closest hits (just 3.7 miles) to my home when I searched for Yoga or Massage, much less both terms together.

That you are not just my newest training partner and newest massage therapist but also my newest dear friend is a treasure beyond imagination.

Michael Parrish, my friend, please be happy as often and as deeply as you are able, for a long as your able to draw breath. And may that time be long and filled with joy for both your and your family.

I love you Brother, for you are truly my Water Brother now and for always....

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
11-03-2014 04:36 AM
Find all posts by this user
herbm Offline

Preferred Members-2

Posts: 852
Joined: Jan 2014

Machine: ResMed AutoSet S9
Mask Type: Oral
Mask Make & Model: ResMed Airfit P10 Nasal Pillow
Humidifier: ResMed H5i
CPAP Pressure: 11-16
CPAP Software: ResScan SleepyHead

Other Comments: Backup Mask: Innomed Hybrid FFM -- Oral+Nasal Pillows

Sex: Male
Location: Austin, TX

Post: #55
RE: HerbM Bilateral Total KNEE Replacement surgery Oct 21st, 2014 -- WOW!
(11-02-2014 06:16 PM)DocWils Wrote:  ... I would not try to push it too much now - give the whole thing a chance to finish the post-op healing and you will see that all the immense progress you have made will be even more if you now give just a titch of slack for a week or two - don't back off on your therapy, just lower your ambitions for a week or so and let your healing catch up with your progress.


Peter - let me add that it is not unusual to be a bit freaked when too many things are wrapped, covered or bandaged. ...


All in all, though, well done, both of you.

DocWils, were it most anyone else but you recommending "slack off", "lower your ambitions" or "don't push" I would note your good intentions, double check myself to ensure safety etc., and then just ignore the message without further waste of time except perhaps a polite 'thank you' for your concern reply.

[Smile Internally I might also think, "Don't judge other people can or should do by your own limitations" Smile ]

However, most people reading this will not know that earlier this year when my hip went bad without warning, you were a great source of information and advice, in both public comments and private messages between us so I take YOUR SUGGESTIONS much more seriously and review them much more thoroughly.

People may not even fully realized from your comments, that you were ACTUALLY A JOINT REPLACEMENT SURGEON.

When younger, DocWils was a top notch Orthopedic Surgeon whose practice included both knee and hip replacement.


Now he teaches advanced diagnostics to other doctors. Think of the TV show and character "House" without the false drama and egregiously bad personality.

On a side note: For those who watched the TV series "House", the character was himself on "pain management" (either officially or illicitly) throughout.

House's physical issues requiring pain management were primarily neuro-muscular rather than orthopedic however.

House was a super diagnostician who helped and/or taught other doctors to solve the most difficult cases; the show included numerous parallels to Sherlock Holmes (e.g., home = house).

In any case, here is my ACTUAL response to YOUR advice DocWils:


Message received. I hear you and understand.

I will even (perhaps uncharacteristically) try to find opportunities to do that starting with my PT session this morning in 4 hours.

On Friday, I was certainly beyond the red line for much longer than would be prudent, and that day pretty much started with me telling the physical therapist that I wanted an EASY session and even needed to cut off 10-15 minutes to help my wife get here own treatment.

We DID slow down; we did shorten the session; yet still I could have later used much of the energy expended during the 20 minutes of land therapy and 35 minutes of pool. (Instead of 30/45).

During that session, I hit several small milestones without even intended to do so.

Immediately after writing the above, I was forced to STOP to VOMIT.


First time in 2 weeks I've had any nausea. I handled it superbly; I am fine; and I will finish the rest of the response tomorrow because in order to take DocWils advice it is necessary to:

Go freshen myself and get to bed for 2 hours additional sleep.

Good Night, everyone

PS: Peter, as DocWils suggests, you should be very proud and satisfied with your results so far.

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
11-03-2014 05:21 AM
Find all posts by this user

Donate to Apnea Board
Peter_C Offline

Advisory Members

Posts: 1,308
Joined: Sep 2013

Machine: System One DS960HS
Mask Type: Full face mask
Mask Make & Model: Mirage Quattro "MED"
Humidifier: Attached
CPAP Pressure: Auto mode-script is:15/3/3
CPAP Software: EncoreBasic Other Software

Other Comments: Severe obstructive sleep apnea 1999/Just got an ASV machine

Sex: Male
Location: Akron, Ohio USA

Post: #56
RE: HerbM Bilateral Total KNEE Replacement surgery Oct 21st, 2014 -- WOW!
Hi Doc Smile Missed reading your posts lately.

Herb, as you know you and I are quite different people, and I've never had *2* joints done at once. I know 2 other people that have had both knees done at the same time, and you are far and away doing better than they did. A bit of rest won't even come close to putting you behind the curve. One person *did* go back to her job (standing all day) 8 weeks post-op, and survived her first week back with only minor swelling and pain.

As for me, PT starts Friday. I can now 'lock' my right leg, and raise it with no droop. I imagine they will measure me Friday, but getting it straight enough to lock is a good thing. Will just stick with the sling at night for a while. The pups were just the icing on the cake, as the 'mummy' thing was getting pretty bad.

Pain is bouncing between a 2-3 (shoulder), no real pain in the right knee (WOW), meds cut almost in half.

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
11-03-2014 04:18 PM
Find all posts by this user
DocWils Offline

Members-b

Posts: 1,271
Joined: Jul 2012

Machine: Philips Remstar series 60
Mask Type: Nasal pillows
Mask Make & Model: ResMed P10
Humidifier: same as machine
CPAP Pressure: 5-15
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Switzerland

Post: #57
RE: HerbM Bilateral Total KNEE Replacement surgery Oct 21st, 2014 -- WOW!
Herb,

You are withdrawing from some pretty tough pain meds (tough to withdraw from, and tough on the stomach) so I am not surprised to hear you had to vomit (ladies are unwell, children throw up, gentlemen vomit). So long as the pain is manageable without strong pain meds, stay off of them. If you must take something at this time, and your stomach can handle it, may I suggest considering Robax Platinum, a good pain reliever and a muscle relaxant combined, to help ease any tension cycle that is associated with the pain. The stuff, although a bit tough on the stomach (take a PPI with it, or diovol) is less rough your whole system and better tolerated for longer periods, and is not addictive, so no withdrawal. Please note, this is a suggestion, not medical advice. If your doc says otherwise, listen to your doc, not me.

Actually, Peter - same suggestion. Use it to relieve the muscle tension cycle that creates this rotten chain of pain-muscles tense, causing more pain, causing the muscles to tense more, and so on. Your back will thank me. And remember what I said in my PM to you a while back - pay attention to the areas of the shoulder that are often ignored in treatment - the scalenes and supraspinatus, etc. Watch also that the shoulder injury combined with the knee job doesn't result in a compensation injury in your lower spine and hips. Pay attention to how you weight bear and how much you are putting the power into your lower back to do anything. You want to watch it there and see if you can let your abs take up some of the control instead of loading the back with it all. In short, watch your posture and be aware where load is being placed, displaced or compensated for. Sailing ship riggings, remember?

Both of you, well done. Keep at it, and give yourself a pat or three on the back. Don't let hubris and a desire to achieve push you so far that you do yourselves an injury.

And Herb, you got me blushing by your description and comparison. Oh, and House never used the damned cane correctly at all, didn't even hold it in the right hand. Loved the show, though, mostly because I love Hugh Laurie, who's comedy stylings I loved ever since I first saw him together with Steven Fry waaaay back, and I got a real kick out of his version of an American accent. Do Americans spot it as so obviously wrong as Brits do when Americans try to do UK accents?.

As for being a pr**k on the show, believe me I have known worse in my years of practice. In many ways, at least when talking about the personalities of both the doctors and the patients, the show was understating. On the drama side of the whole thing, though, yeah, a bit exaggerated. And his way of running a differential diagnostic was pretty chaotic and free form. We do it quite differently in our unit, although the process would be hard to explain - far drier and no, I don't call anyone an idiot, at least not often, and we have a clear order of being called on, and how each can contribute. I do have a more free form version as well, done with all my charges, but I don't call them differentials - I call them soviets - here anyone can bring up anything and we can brain storm it, with me being a referee, but again it is more of a tool to teach them how to think.

On the whole, House would never be able to run a teaching or a diagnostic unit in this country. Not with his methods. Nor with his nearly killing his patients before rescuing them. Medicine doesn't work like that, not even on the cutting edge or on the mystery patients. We don't allow such risks to be taken, and we don't have malpractice lawsuits like the Americans do. In the US, I don't think he could have been employable with his approach - the insurance companies simply wouldn't have allowed it. Here, no matter how smart he was, he'd have been laughed out of any hospital for his methods and risk taking. Lucky I don't face that problem.

If you wonder who my medical heroes were back in my day, I'd say a big one was Benjamin Franklin Pierce in Richard Hooker's M*A*S*H* and in the sequel M*A*S*H* goes to Maine. The movie and TV show were not the same as the books, and I am speaking of the books. The difference is that he was a thoracic cutter (or became one in the second book in the series) and I became a sawbones. But his caring is what struck me, and taught me much about what it is to be a good doctor. I met Hooker some years after the books were published (that is his pseudonym, his real name was Hornburger) and told him how his book had inspired me to be a better doctor. He was very kind and regaled me with many stories from his practice that did not find its way into the books. I think I secretly wanted to become a nice doctor from Crabapple Cove in Maine, and nearly took up a practice up north in Arbon, on the Bodensee, but She Who Must be Obeyed wanted to stay in Zurich, near her family. It would have been nice.....
11-03-2014 06:15 PM
Find all posts by this user

Donate to Apnea Board
retired_guy Offline

Preferred Members-2

Posts: 2,744
Joined: Jan 2014

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: ResMed
CPAP Pressure: 10.6/14, EPR 3
CPAP Software: ResScan SleepyHead

Other Comments: Is it bedtime yet?

Sex: Male
Location: Beautiful, albeit very wet Oregon Coast

Post: #58
RE: HerbM Bilateral Total KNEE Replacement surgery Oct 21st, 2014 -- WOW!
Well, the only thing I know for sure about all of that is I am never ever ever going to go anywhere near Dr. House's hospital......... Geezzzz, the things his patients go through? I don't fricken think so............. Nope. Not never..
11-03-2014 06:38 PM
Find all posts by this user
herbm Offline

Preferred Members-2

Posts: 852
Joined: Jan 2014

Machine: ResMed AutoSet S9
Mask Type: Oral
Mask Make & Model: ResMed Airfit P10 Nasal Pillow
Humidifier: ResMed H5i
CPAP Pressure: 11-16
CPAP Software: ResScan SleepyHead

Other Comments: Backup Mask: Innomed Hybrid FFM -- Oral+Nasal Pillows

Sex: Male
Location: Austin, TX

Post: #59
RE: HerbM Bilateral Total KNEE Replacement surgery Oct 21st, 2014 -- WOW!
Americans practically NEVER detect Laurie's mistakes -- two likely exceptions might exist/occur: trained linguists knowledgeable of American dialects, and those amateur linguists who heard Laurie speak in his native way BEFORE watching House.

I am in the latter category except that I watched the series prior to seeing Hugh Laurie out of character (talks shows) or in other programs.

In my opinion Laurie is about as good as they come in delivering authentic 'American'.

Peter: You are starting with a MUCH MORE DIFFICULT history and many more complicated problems that I have. You have both my utmost sympathy and utmost respect for the way you deal with that.

Until my hip replacement 11 weeks ago, I had never had ANY surgery, nor any sedation beyond that required for testing, e.g. wisdom teeth removal, for colonoscopy.

DocWils, I almost completely stopped typing immediately experience the bout of nausea so you didn't have all of the facts about the pain meds and the events leading up to the vomiting:

1) I had no significant* problems stopping the oxy on Friday night.

2) On Sunday I became (briefly) ill on restarting the oxy for Sunday night AND POSSIBLY combining that with a Cepacol throat lozenge (apparently there is some serious ingredient in Cepacol because Walmart's check-out called for assistance to verify >18 age.)

3) I am managing quite well with Tylenol during the 'day' and Percoset or just Oxy at night -- I am down from 10-12 x 10mg per day to 0-4 x 10 mg per day.

This is similar to what I did (almost immediately) with the hip recovery.

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
11-04-2014 08:11 AM
Find all posts by this user

Donate to Apnea Board
DocWils Offline

Members-b

Posts: 1,271
Joined: Jul 2012

Machine: Philips Remstar series 60
Mask Type: Nasal pillows
Mask Make & Model: ResMed P10
Humidifier: same as machine
CPAP Pressure: 5-15
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Switzerland

Post: #60
RE: HerbM Bilateral Total KNEE Replacement surgery Oct 21st, 2014 -- WOW!
Herb,

If there is an interaction with the Cepacol, then stay off it - yes, in many cases these can be interaction problems. However, the best method is watchful waiting and see what happens when you take what...
11-04-2014 01:26 PM
Find all posts by this user
Thread Closed 


Possibly Related Threads...
Thread: Author Replies: Views: Last Post
  DIY Tire Pressure Monitoring Sensor replacement surferdude2 12 254 10-27-2016 02:15 PM
Last Post: justMongo
  On my 2nd iPhone 6 replacement in a year cate1898 4 551 12-20-2015 08:16 PM
Last Post: ginzo
  Blather, clicking knees and Hi Herbm! Peter_C 84 6,274 10-29-2014 11:54 AM
Last Post: retired_guy
  Anyone heard from Herbm? justMongo 22 3,375 08-10-2014 01:04 PM
Last Post: herbm
  Australian (Swiss) open tennis men final 2014 zonk 13 2,318 01-26-2014 05:16 PM
Last Post: zonk
  2014 me50 10 2,796 01-03-2014 01:31 AM
Last Post: Surly
  Cataract Surgery May 7th! Schnauzers 5 10 2,937 04-16-2013 11:44 PM
Last Post: Schnauzers 5

Forum Jump:

Who's Online (Complete List)