First Test Drive -- Optimistic

[herbm]

Today was the initial followup appointment with the Sleep Doc who diagnosed and prescribed my APAP.

23 days in, 100% compliant, Avg AHI 0.9, minimal leaks.

I just took the Rescan reports as PDFs on a thumb drive to the doc (full data & a custom summary that I created) -- they were totally fine with that.

Sleep Doc either didn't notice or didn't care that I took control of my machine from the first minute (even before the first show nap session).

He never mentioned the altered settings nor did he suggest his own changes to the prescription going forward.

So the next appointment is in about a year, although I will probably take my wife into see one of the sleep docs.

(On the way home, I stopped at the DME for them to copy the data off the SDCard to show the insurance company that I am compliant. I still have nothing but good things to say about American Home Patient; this opinion is based on the Austin TX office, so I can't speak directly to their nationwide branches.)

[mjbearit]

Good for you! I hope things continue to be great!

[JWR]

The surgeon said, "You are a good candidate for TKR, and we can do both at the same time."

So my strategy is to wait 4 months or so, but not just to put it off. Instead I will lose 50 lbs and pre-hab my knees to make re-hab on the other side easier.

Started working with my chiropractor and physical therapist already.

(It is possible we'll get my knees back to a place where the surgery won't be immediately necessary but it's probably better to complete this while I am young enough and healthy enough to be a good candidate.)

Hope that goes nearly as well as CPAP is proceeding -- but in any case, we will see.

My combatives motto is this:

"Keep fighting -- God will tell you when you are dead."




Hi Herb . When I had a TKR a year and a half ago at 50 there was a Fella and a Gal that had both knees replaced the day before me they were in there sixty's and made it look easy , They were a Great Inspiration . If these old farts could do it at there age , It shouldn't be a problem at my age . It wasn't . Where I went they have you up and in rehab that afternoon , I can say honesty the knee replacement hurt less then the bone on bone every day and when it would pop out and dumping me on my face because of loosing my ACL when I was 17 . The new knee doesn't require the ACL . Had the surgery on a Tuesday and was back to work the next Monday using a golf putter as a cane . Granted I only stayed a half a day for a week because my wife had to drive me there and I did Rehab the other half . Was driving on my own by the third week , had a little folding stool with a rope attached to it . I would set the stool down climb up in my Dodge dully then pull the stool up and go . I feel like I'm only 35 , have full movement of the new knee even went skiing last month something I haven't done in 12 years . only two things I was told not to do . No running and No jumping . can't wait for summer to get back into skydiving ! So Yes get it done while your health is good and you will bounce back Quick .
jim

Forgot , only way I can tell the weather is changing now is to look out side . lost my built in weather station .

[herbm]

So, first, I am 61, and therefore must qualify as an old fart in your book.

So you lost you ACL prior to the replacement -- do you know if they LEAVE the ACL and other ligaments all attached or do they remove some for access?

I don't like that "no running and no jumping" -- is that a permanent injunction?

I don't run or jump now, so I guess it isn't much of an imposition but I was hoping to get those abilities back.

Also, I do run "short distances" in the combatives I do -- 10-15 feet at times.

Doc said I wouldn't get much mobilities (flexion) back either which really put a damper on my enthusiasm for this.

I was hoping for a LOT more flexion.

There were other cautions on the Internet about what I couldn't do. Much of that I get to do now (BJJ and combatives) so if that's really out, then I am likely going to pass for a few more years.

I teach Combatives and Self-Defense and the only time all week when I am TRULY comfortable is DURING practice.

The adrenaline and endorphins make my knees both comfortable and functional for those few hours.


Chances are I will never parachute jump again, but you never know.....

[ImaSurvivor]

herb, my Dad had both knees done at the same time and he was in his mid 70's. He did fine. He put it off for so long because my Mom has macular degeneration and legally blind and he worried about her on her own. Despite my telling him not to worry about that and we had her back. Also his primary physician tried talking him out of having any knee replacement because he had had a blood clot years ago following a surgery. The surgeon was not at all hesitant. He was is so much pain and his quality of life was poor. Finally his primary physicians assistant pointed out quality of life for him was poor and more or less encouraged. He is now 82 and said he is 100% pain free. He remarks many times over how glad he is that he did the surgery. He just underwent open heart quadruple bypass surgery and he is doing really well. Six weeks have past and they are allowing him to drive again.

[herbm]

herb, my Dad had both knees done at the same time and he was in his mid 70's. He did fine. He put it off for so long because my Mom has macular degeneration and legally blind and he worried about her on her own. Despite my telling him not to worry about that and we had her back. Also his primary physician tried talking him out of having any knee replacement because he had had a blood clot years ago following a surgery. The surgeon was not at all hesitant. He was is so much pain and his quality of life was poor. Finally his primary physicians assistant pointed out quality of life for him was poor and more or less encouraged. He is now 82 and said he is 100% pain free. He remarks many times over how glad he is that he did the surgery. He just underwent open heart quadruple bypass surgery and he is doing really well. Six weeks have past and they are allowing him to drive again.

This, and the report by JWR, are typically what I am hearing from everybody who has it done, words to the effect, "Should have done it sooner."

I do want to do it while I am in good enough health and young enough to make the rehab possible/reasonable.

It's only after talking to the surgeon that I began to realize that it might not help me THAT MUCH.

My pain is near constant but fairly low level. I no longer walk any further than I MUST but I can walk if I must.

Main thing is that I still do the combatives and martial arts which I love and if they tell me the new knees are too fragile for that then keeping the old ones seems preferable.

For now, I am pre-habbing the knees -- and for once getting pretty decent results* so if in 4 months when I have lost the weight and fixed them up, the decision should be easy.

If they are better than the hardware knees then I'll keep them.

Otherwise, the health of the soft tissue in the knees will be as good as I can expect to begin the rehab after the replacement.

50 lbs by August -- sooner if possible -- is not a lot of weight for me to lose. (I am good at losing weight, unfortunately I am also good at putting it back on. )


* Always before when given "exercises" to improve my knees they didn't help must but the trigger point work I am doing with my sports chiropractor is showing some good results in the last 2-3 weeks.

For instance, "rolling out" my hamstrings and or quads and IT Band can immediately improve my ability to walk or to take a stair -- it's not great, but it is greatly improved.

Rolling out is doing various exercises while using a lacrosse ball or foam roller to put (a lot of) pressure on the muscle and thus massage out the tightness and "trigger points" in the tissue.

It's not too unpleasant and doesn't take a LOT of time so since it helps me walk immediately its pretty easy to remain disciplined to do the exercises.

I appreciate all the encouragement and accounts of others as all this is going to be factored into my eventual decision.

[JWR]

I don't run or jump now, so I guess it isn't much of an imposition but I was hoping to get those abilities back.

Also, I do run "short distances" in the combatives I do -- 10-15 feet at times.



Yes they remove one of the other ligaments but with the type of replacement I had you don't need them, It has a center pin that takes over for the ligaments . It is a Striker Triathlon , you see adds for it as the [get around knee] the new knee is just as stable as my good one and at my first year check up the Doc said it matches the movement of the good one . Yes you can run short distances , I do when I have to catch a horse maybe 20 - 50 feet no problem , Oh ya did I mention rode my horse more this year than in the last 5 years . No Pain whatsoever one day I rode 6 hours straight on duty . They just don't want you pounding on the knee like running a Marathon or jumping off of the back of trucks all the time . You do have to work at it to keep the movement in the knees , when you have mobility and no pain its easy to do . I lost nothing but the pain and gained Everything I lost over the years .

jim

[herbm]

Excellent info there. Thanks.

The surgeon said that usually they don't get AS MUCH flexion after the surgery as before -- that was the most disappointing thing I heard.

I had only 115 degrees when he measured officially, and that is likely on a GOOD DAY since it is more than I believe my knees would bend.

Ok, I get the deal about jumping off trucks or houses.

I don't plan any marathons, but would like to be able to run a bit like an airborne shuffle for a couple of miles if needed.

How is the swimming? Right now, my knees "clank" when I kick correctly, which makes swimming (correctly) irritating and unpleasant (not especially painful but it feels WRONG.)

[ImaSurvivor]

My brother had to have a knee replaced due to a football injury when in high school. In the 70's, when he was injured, the surgeries for completely torn ligaments weren't great. He had one surgery that was kind of botched and had to have another a few months later. Because of that injury, he had to have knee replacement at a much earlier age than is preferred and had it the day he turned 50. He is a big time swimmer now and swims laps every morning before work and also a certified scuba diver. No problems with swimming at all. He stays very active. He also enjoys bycycling long distances too.

[JWR]

The surgeon said that usually they don't get AS MUCH flexion after the surgery as before -- that was the most disappointing thing I heard.

I had only 115 degrees when he measured officially, and that is likely on a GOOD DAY since it is more than I believe my knees would bend.




Interesting part about the Stryker Triathlon knee replacement is it has the ability to provide 150 + deg. of stable motion . Not that any of us can get there. I can only get about 130 , still working on more now that I'm active again . My sister had one of her knee replacements go bad and the Doc replaced it with the Triathlon , She can only Say Wow what a difference its stable and had more movement . She's trying to get him to replace the other one now . by the way Herb , she's an old fart too at 65 .. Mom had one of her's replaced in Oct and she's 84 , that makes her a Fossil . I have No problem swimming . even did a little scuba diving last year . I would check out what replacement knee your Doc wants to use . then check them out yourself cause some of them are just plain Jane one size fits all .

To keep this on the Apnea side ,I had a Zero AHI night last night and slept on my back the whole night . not normal for on my back .