Overall, my wife and I are in a pretty good place in life. I have a great job and I’ve been promoted twice since arriving in Texas in July 2016. We are not fond of Texas in general but the town of Taylor is a nice place to live and that makes it bearable. Unfortunately, about the time we arrived here was about the same time that my left knee started to become very problematic.
My initial left knee injury was pretty ironic as I tore the medial meniscus in it two weeks prior to having my partial knee replacement in my right knee. I succumbed to the most common way of injuring you knee, a flat-footed pivot, for me, it was getting into my car. (Sigh) That was nine years ago and between that injury and a couple other injuries (ACL and MCL tears) time and arthritis, the left knee is pretty well shot. I wear a brace daily and a lot of my activities are affected and or limited by what the knee can tolerate. The dual frustrations of the pain and limitations have been my motivation to get something done about it.
I decided to consult the Veterans Administration (VA) orthopedics clinic in December of 2016 where is was agreed upon immediately that I would benefit from having the surgery. There was only one problem, my weight. While getting the surgery is a bonus for my pain and discomfort, the VA Ortho clinic has guidelines they follow for elective TKR and the one I wasn’t meeting was my Body Mass Index (BMI) of below 35%. This became my first intermediate goal on some life change. The clinic staff let me know that I could get cortisone injections every four months as long as they were helpful and they also gave me a different knee brace to wear while exercising. I weighed about 300 lbs. at the time and I have spent the past two years working on my eating habits and developing an exercise program to slowly lose the excess weight I have gained in the past two decades. I left the Army weighing about 230 lbs., and I would like to get back to under 220 as a long-term goal.
In October 2018, I made my first intermediate goal getting and staying below 272 lbs., (35% BMI). This allowed me to schedule surgery for March 25, 2019 and begin pre-operative screening that the clinic also requires. On the surface, some of the screening seems odd until you look at the demographic of the average veteran that the VA sees for this type of surgery. As a group, we are not in the best of shape and many of us have limits on our routine medical care. VA medical care is needs based and is also dependent on your VA disability rating. It is a complicated process, but let’s just say some treatment is harder to get than others.
The pre-op screening process has included a VA dental exam. (Most veterans do not have routine dental care or dental insurance.) Periodontal disease is not unusual but is averse to any knee implant surgery as the exposing of the bone marrow is an avenue for infection and periodontal disease is one of the easiest routes for infection in the bloodstream. I passed with flying colors due to regular dental care and good insurance. I was interviewed at the Physical Therapy clinic to ensure that I was aware of what I was getting into and they confirmed that I was clear on the post-surgery therapy requirements. I had to show proficiency with a walker, we discussed the issue of stairs (I pointed out that we bought a garden entry home that is a ranch with no steps other than the two-inch step up through the doorway.) and that my wife was already making arrangements with the furniture to accommodate a walker,) The third of these initial screenings is the one that I had a small glitch on, Urology.
You get accustomed to seemingly weird instructions when you visit a new clinic, usually because no one bothers to give you the background on why you get the instruction. But, as a good soldier, I just follow instructions and I generally will learn as the need to know is determined. In this case, Urology said arrive at the appointment with a full bladder. Those familiar with the military medical system know the unofficial motto: “Hurry up, and wait.” Arriving at a new clinic was a concern, but I was glad to see I was called back just a few minutes after my appointment time. The technician was friendly and inquired if I had the requested full bladder. I replied that I did and was directed to go into this room and pee in the white bucket, then meet me in this room across the hall. The white bucket turned out to be a nifty little device that not only measured your urine output, but also the rate of flow and the duration.
After much relief, I went across the hall for the usual vital signs check then we went across the hall again for another test, an ultrasound. She just said to “butterfly my pants” and lay down on the table. The ultrasound determined I had 150 milliliters (ML) of urine left in my bladder (surprising her as I had peed 305 ML.) and I was told to zip up and go back to the waiting room until the doctor called me back. This too wasn’t unexpected.
About the time I was getting ready for the clinic visit, I’d come to the realization that I’d been putting off going to the doctor about my “old man pee” situation because it hadn’t become a severe problem. I’d say very slowly over the past decade I had noticed that I was having minor issues with having to go more often and sometimes very urgently only to have a hard time starting, but I’d never seriously thought about talking to someone about it. After what I had just experienced, I concluded that I likely had an enlarged prostate, which was quickly confirmed when I was called by the Urology Physician’s Assistant (PA). We had a very detailed discussion and I learned they had a very complete screening protocol that resulted in us spending about twenty minutes in a question and answer period about my urinary habits. Then it was across the hall to an exam room for the standard drop your trousers, external exam and digital rectal exam to check for prostatitis and enlargement. No prostate infection (I’d had one over 20 years ago, not fun) but further confirmation of the enlarged prostate. This is apparently present in better than fifty percent of senior males.
I was sent home with a provisional diagnosis of an enlarged prostate, a prescription for FlowMax to see if we could increase my urine flow, a follow-up appointment (next week) and a better understanding of why this was important to a knee replacement patient. During the surgery, you are catheterized and it is normally left in place a day or so post-surgery. The PA explained that with a swollen prostate, the concern is when the catheter is removed, the urethra may swell shut making urination impossible. Therefore, pre-operative treatment is recommended to ensure this issue does not occur. Lord only knows I so not need to make the recovery process any harder than it already will be, so I am glad they have developed these protocols. For what it is worth, FlowMax works for me. It is hard to tell how much you accommodate an issue until you have it treated and see positive results in a couple weeks. Trips to go pee, easily cut in half. Urgency issues almost completed abated. Side effects of the medication so far minimal and easily addressed. (Dizziness on standing is the most notable due to reduction of blood pressure.) The medication works well enough that I recommended it to others.
After my follow-up with Urology where I expect to be given a green light for surgery, then the next hurdle is the 7-appointment day a week and a half prior to surgery. These include:
- Chest X-Ray
- Labs
- Electrocardiograph (EKG)
- Anesthesiology
- Ortho Clinic
- Ortho Ward
Appointments start at 8 A.M. and go through 2 P.M., it should be a fun filled day with lots of time sitting in waiting rooms and maybe two hours of actual productive time getting a test or briefing from someone.
One other fun facet of this, is that it is possible that the timeline for surgery could move up. If someone on the list ahead of me cancels due to health issues or such, they move people up who can accommodate the change in schedule. I volunteered, but as yet, nothing has changed for the original plan. I still have to coordinate both Family and Medical Leave Act (FMLA) to maintain my job while off work and Short-Term Disability (STD) to continue to get paid while off from work in recovery. You would think these would have one combined case worker, no such luck. I learned this with my last knee replacement and I am prepared for the bureaucratic nightmare that taking medical leave can be.
This winter has made playing disc golf (one of my main exercise activities) difficult due to the number of rain days where it is either raining or the courses locally are too wet to play. I’m hoping for some dry weather soon, but the ten-day forecast is not promising. We appear to be finished with cold weather for the most part and I expect we will do the standard Texas skip spring and jump directly to summer and 100-degree heat while I am convalescing.
I have been remiss in my regular writing in the past few months due to laziness and some lack of inspiration. While I am not especially inspired at the moment, I am trying to beat back the specter of laziness and get some of these thoughts (however random) jotted down before I forget again.
Other minor achievements since my last missive have included changes at work (a second promotion since moving to Texas) my job being transferred from one division to another and a new manager as a result. I retired the 2007 Pontiac G6, took my wife’s 2011 Hyundai Elantra and bought her a 2018 Hyundai Sonata Hybrid. There have been some trips to New York (wife went solo last April, we went together in September for my birthday.) and all the kids, daughters-in-law, girlfriend and granddaughter visited the first week of January for a late Christmas. I can truly say I was busy in January 2019 and too busy to write during their visit. No real excuse for no other posts though, just lazy.
I think I’ll wrap this up for now and see what thoughts I can get written down in the next week or so.
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