Neil_B

Only if sleeping is a leg. I slept five hours after the pharmacy visit, and now most of the night and all morning. And I still feel tired.

funrover 

Too much sleep makes one tired LOL

bbeasley

Hey Neil,
I've been away for awhile, sorry to hear about your injury.
Thoughts and prayers go out to you!

Neil_B

I don't want to send this thread into Politics and Religion, nor open a debate about health care costs, but I'm stunned to discover that my new nickname could be the Quarter Million Dollar Man, since that's what the medical care was billed at. Thanks to insurance they all took a fraction of that total.

tergal

what is there to debate about religion each to their own

as to politics American politics make my head hurt


you have to wonder where the money is but huh ? i could have done the same job for you with some pumping joints , welding and a knife..... i would have only charge you 100 bucks too. oh i might have needed duct tape as well

Neil_B

American politics makes my head hurt too... but that's because I bash my head on hard objects to rid my mind of the stupidity I read.

I belong to a Health Maintenance Organization (HMO) which works with a group of doctors, hospitals, clinics, etc, to provide discounted services to members. If I select a care provider in the HMO network the costs are reduced. The care provider agrees to accept the payment the HMO provides. I don't know if you have such things in Australia. I know they don't exist in countries that have National Health Services, such as the UK or Canada.

I won't give the price breakdown, but over the past 30 days I've had:

- physical
- pre-surgical testing at hospital
- admission for surgery
- use of operating facilities for six hours, including nursing staff, surgeon, anathesia, etc.
- five days in surgical hospital
- ambulance ride to rehab hospital.
- ten days in rehab hospital, including nursing care, physical therapy, occupational therapy, etc.
- ambulance ride to emergency room, and treatment.
- four days at hospital with pulmonary embulism
- home nursing (4 visits) and PT (6 visits)

You can see how that might add up. :-)

Neil_B

I found out I'm being discharged from home physical therapy Friday, and by the visiting nurse Monday. The nurse offered to discharge me today, but since insurance pays for one more visit and I still have swollen legs, Monday it is. Physical therapist says there's nothing more he can do with me in the home. My progress is plateauing. Part of Friday will be spent practicing getting in and out of my car.... I might be driving soon.

Driving depends on my being off opiates or pain pills that impair driving, and having motor control of the right foot. Also the surgeon might have something to say. But if he doesn't, it's my call. However, I want to work with outpatient PT first and find out what they think. I've always considered driving to be a priviledge, never a "right" and I want to be a safe operator on the road. I owe that to my fellow cyclists, pedestrians, and motorists.

Neil_B

Swelling is down on the right leg and the color is better. I'm also urinating a lot, which either means I'm very hydrated or I'm discharging the excess fluid. Still, I'm swollen enough that I'm having problems in PT. I'm plateauing. But as the right loses fluid I'll be better able to bend it.

Flexion: 120 L, 100 R
Extension: 10 L, 0 R

tergal

Don't you love the human body, need to go to the bathroom a lot when you would rather not be getting up ...

In regards to health care, with have national system here called medicare which works ok. Plus you can have your private health which stacks. The strange thing here Private is useless for some things and good for others.

Like i have private health cover, but i go see a normal GP who i have been seeing for along time. Primarily because she takes no crap and tells me what to do .

What pain pills are they going to move you to next, If they try to give you patches for the pain tell them to shove it they don't work for anyone i know .

Neil_B

Tylenol and ice. I'm not in any more pain now than I was the three months prior to surgery. My "pain" consists of swelling in my legs and stiffness in the muscles. I would use Ibuprofen but that's a no-no with blood thinners.

I am currrently taking Lyrica (Pregabalin), which was given as much to prevent me from kicking my legs at night as anything. On discussing it with the surgeon I've cut the dose in half and when I run out in the next two weeks I'm done with it.

Of course if I develop pain beyond my ability to manage I'll go back and get a script for something. No need to think about that unless it happens.

Neil_B

According to a message from my doctor, my INR level dropped to 1.5. This means for days I've not been protected against blood clots. And I've been doing things like having my legs elevated above my heart..... Please pray for me as I go into a full-blown panic attack.

Rowan

You'll be right, Neil (at least, I hope so). The fluctuations in INR levels are normal.

I think it took Machka six months before hers stabilised. Her "perfect" range was between 2 and 3, and she fluctuated between 0.5 and 4. It is a matter of getting the dosages right on the Coumadin and they, too, ranged up and down considerably as the readings came back. Her scripts specified certain dosages, and she had two or three little bottles of Coumadin pills of different milligram content so she could mix-and-match.

Fortunately, the technology had improved at that stage where full-scale blood samples were not required to be drawn, and she only had to attend out-patients to have her finger pricked and a drop of blood analysed.

Of course, the final consultation with the blood specialist a year after the DVT developed, identified that gene, and since going on to high dosages of folate, she ditched the Coumadin and hasn't looked back.

The fatigue is a side effect of the pills, as we have discussed before. And you have had major surgery. Patience is the key.

As a sidebar to your observations on medical systems, Machka's DVT occurred while she was classified as a visitor to Australia. Fortunately, she took out travel insurance prior to leaving Canada, and that covered the costs. But as a simplified comparison, the fortnight's stay in hospital cost less than $5,000. Now, getting the insurer to pay was another matter... at one stage the case manager wanted to pay the bills by Diner's Club card!!!

Now that Machka is a classified as a permanent resident, she is covered by Australian Medicare which basically means she wouldn't be charged for similar circumstances. We, as a couple, don't have private health insurance... when I had my heart attack, I did, and it still cost me close to $1000 in specialist fees, but had I been without cover, it wouldn't have cost be a dime. Go figure all that.

Neil_B

Thank you, Rowan. My panic, which unfortunately mimics a PE in certain ways, was because I was probably unprotected for a few days and didn't know it. Nor was playing phone tag with my doctor's office helping. But according to my doctor and an online guide I found I should be back up to safe levels in a couple of days. And I'm a lot more ambulatory than I was, so the odds of another developing are lower.

Meanwhile, partly to keep my mind busy and partly to understand what happened, I spent time online checking Vitamin K contents of foods - does enriched bread have a lot? Does tuna? Do apples? I didn't find a trigger. The best reason I can find is that I'm much better hydrated than I was. That, and because the swelling in my legs is going down, I'm urinating out the excess fluid. Did Machka have to watch her hydration when on the drug?

Rowan

Machka said she didn't have any dehydration/rehydration issues. At the time, we were trying very hard to get back into cycling long distances, and we could do 200s, but 300s were a significant challenge and 400s were overwhelming. But even during those, dehydration wasn't something she worried about.

She was, however, much slower on the single than she thought she would be, and making the cut-off for even a 100km ride with a bit of climbing was marginal. Again, that fatigue factor because of the Coumadin. But as pointed out, you may well find after a while that the Coumadin doesn't effect you so much.

Likely, as you have observed, the increase in urination is the removal of fluid build-up in your leg. How is the temperature? Has it felt like it is starting to reduce to normal? And have the spider webs on the ankles stabilised or diminished? If things are positive in those area, it's likely your leg is making progress in eliminating the clots and preventing new ones from forming. Just be glad the other leg isn't sympathising.

As another aside, the human body is incredible adaptive. In Machka's case, new capillaries were formed around the clots in her upper leg because one clot had blocked a vein entirely. It's a minor point in the context of where you are, and how much of a threat a breakaway clot can be, but fascinating nevertheless.

Neil_B

The swelling in both legs is less, and the heat is gone from the left. The right is still warm and swollen more than the left. My left foot looks normal, but my right still resembles a balloon.

However, the water has to go somewhere, so in the past two and a half hours I've had to empty my bladder twice. The color is near clear, not dark or cloudy. Does this sound like I'm getting ride of the fluid in my legs, or am I just too hydrated? I'd have expected the fluid, even after the kidneys are done with it, to be darker, since its lymphatic and blood. (Cue for my surgeon to comment about all the blood vessels broken when correcting the right leg. I was too ill to notice, but he said the bruising on the right extended from my hip to ankle.)

I agree with you and Machka about the body's ability to adapt. As you observed before, I'm going through that process, learning how to walk without a limp and stand without leaning and slouching. Until the joints gave way I thought I did very well adapting to my odd structure.

Rowan

My conjecture, and that is all it is, on the colour of your urine is that... clear is OK. I'd suggest the blood and lymphatic debris is being taken care of elsewhere (liver likely the main one).

If you are concerned about being too rehydrated, the issue will be more with the effect on your brain, as the sodium levels in your blood become imbalanced. Maybe up your salt intake a smidge if it is of concern, but don't overdo that, either. Undoubtedly your next medical consultation will help sort it out.

I know that after really long events, some people, including Machka, swell up in the ankles. Then for several days afterwards, there is a regular march to the toilet. There was an excellent explanation of what this effect posted by one of the doctor members in the Road Forum 18 months to two years ago. It's probably not totally relevant to your situation, but does indicate that water swelling in the legs does eventually cause lots of peeing.

CraigB

Oh, Neil, you slay me.

Neil_B

Unintentional.

Tom Stormcrowe

And you are absolutely correct, Rowan.

Peter_C

As an FYI? Both after my knee replacement, and my hip replacement - swelling was an issue for me for 3-4 months each time. The feeling I got from both my Ortho and my PT Dr was that this was fairly normal, and nothing to really worry about, but rather a 'thing' to watch, and make sure it doesn't worsen. After my knee settled, some six months later, I would randomly get swelling if I overdid it, but it would go down in a day or so.

With so much to heal, I guess the body just needs some time to get everything adjusted?

Neil_B

Was that the whole leg and foot, Peter C, or just the affected joint area? I expected some swelling at the knee but not my right foot getting so big it doesn't fit in my shoe.

Neil_B

The visiting nurse suggested in addition to the antibiotic, exercise, and elevation, that I lower my sodium intake. I'm eating a lot of easy to prepare foods that are loaded with sodium. That hasn't helped in reducing the volume of water.

Tom Stormcrowe

Neil, edema in the knee leads to edema in the foot, too. Fluid flows downward with gravity. Anytime you're off your feet, you need to have that foot elevated for now. That will help. You may need some compression stockings for a while, as well. Talk to your doctor, though first, because the stockings are a prescription item, and may require custom fit. (Jobst is the best brand, by the way.....). The reason you need to talk to your Dr about it is because improper fit can do damage, and some causes of edema, and the stockings are not an appropriate treatment.

Peter_C

From just above the knee, and ALL the way down into my foot. The worse it was, the further down the leg (and foot) it went. At around 5-6 months, my foot and ankle became pretty much normal - it would start around the knee, and then, travel.

With the hip, it was weird, the swelling was more like a 'saddle-bag', and one cheek was bigger, and it didn't go down past the knee at all. But the pain itself traveled - all over the leg.

Neil_B

Just some random stuff before my PT guy comes for the last time....

My insurance is telling me I have to go the PT place my doctor's office chooses. I am "capitated" to the place I used last year and didn't like. It's 12 miles away, while there's a highly recommended place 2 miles from me the doctor's office says they won't send me to. I'm trying to do get the surgeon to approve aquatic therapy, which would mean I could probably get an "out of cap" clearance to use the place I want to, as the place I don't like doesn't have a pool. Of course both my doctor's office and the surgeon's office closed early for the weekend... I have an appointment scheduled at the PT place I want on Wednesday morning.

I'm debating attending church Sunday morning. Its a mile and a half from my home, but I don't know how easy it will be for me to get in and out of the building.

In case anyone wonders what it's like to have artificial knees, imagine having a set of Speedplay pedals, attempting to click in, and having a little sliding until you are secure. That is the description of my knees. I can feel the upper and lower part of the new joint slide past each other. I understand this feeling disappears with time as the surrounding muscles recover.

The nerve damage in my right leg continues slowly to recover. But I still can't feel much in my foot. Two nights ago the beagle sat on my right foot during dinner and I didn't realize it until I looked down a few minutes later.

While some of these posts sound like complaints, there is one positive I can't emphasize enough. I have no knee pain. I HAVE NO KNEE PAIN! Yes, soreness and stiffness and swelling, but when I stand upright I feel nothing. Its the first time in at least a decade.