Mrs. HM KNEEds Further Care

My appointment Monday with my regular Nurse Practitioner went well. I wasn't sure what to expect. Farmer H drove me there. It's just over in Bill-Paying Town, in a new building, separate from the orthopedist office in the clinic connected to the hospital. I've been there twice. Farmer H insisted on coming into the exam room with me, but I forbade that. It's not like I was seeing a specialist for a life-threatening condition.

Anyhoo... we got there early. I had done the dang YourChart check-in on Saturday. I was called to an exam room by my appointment time. After vitals from the same polite young nurse I'd had in December, I waited 5-10 minutes for NP.

NP asked what brought me there. I resisted saying "Farmer H's sweaving." He seemed informed about the tale I told from Dr. Ortho. NP took a look at my lower leg. Said that yes, Dr. Ortho was right to be concerned about healing. That the redness is likely due to lymphedema, as he noticed some swelling. He did not press on it to see if his thumb left an indent like Dr. Ortho had. According to NP, it's something that we "might be able to get a handle on right now," before it could worsen into something that could "turn into a bad situation."

"I've had this redness for over 20 years. It doesn't bother me. Doesn't hurt. I just thought that was normal for me. But there's something new... It's HORRIFYING! Here, let me show you.

Dr. Ortho didn't look at my right leg, because we weren't considering surgery for it. It's also got the redness, and has for years. But since I saw you in December, something else has come up. I think I have psoriasis!"

I pulled up the leg of my sweatpants to show NP the scaly patch on the outer side of my left lower leg. Irregular. Flaky. Kind of grayish white.

"It's been there since sometime in January. I've had things like this before, but smaller. They take a while to clear up. They don't itch or hurt."

"Oh, yes. It's weeping."

"Not as much as in the beginning. I don't know what triggered it. I must have scraped my leg sliding out of the car, or rubbed it too hard with the washcloth. I cover it with a folded paper towel and ACE bandage."

"That's good."

"I've tried antibiotic ointment. And lotion after the shower. Nothing seems to affect it in a bad or good way. Oh, and that dark place? It's lint off my sweatpants just now! I saw it on Thursday, and thought, 'Oh, no! I've got gangrene!' But it's just lint that comes off these pants. I can pick off the threads. I can't really scrub the area with a washcloth, because then it has to weep some more before it starts closing up."

"I'm going to get you an appointment with our Wound Care Clinic. They can tell you the best way to treat it and speed up the healing. And for the lymphedema, they work wonders. They can get you started with some compression hose. They're really good over there. It's on the back of the hospital. Where the old ER entrance used to be. They've built a new one now, but left the roof over the old ambulance bay. Just walk up to the doors, and they'll let you in. There's parking right across from the doors."

"I know where that is! I went in that way when I had both my babies. Should I call them?"

"They will call you to set up an appointment."

So... that's kind of a relief. I don't have to travel north or south to a specialist. They have doctors/NPs/nurses right here that can do what I need. We'll see how effective further treatment may be. NP wants to see me again in two months, to see if there's any progress. He also wanted four vials of blood! No fasting necessary.

When I sat down by Farmer H in the waiting room, waiting to be called to the lab, I handed him my cane and print-outs from the visit. You'd think he had a thirst for knowledge, the way Farmer H combed through those papers. Almost as if he thought I was hiding something. 

Nice To Knee-t You

I was early for my appointment, so I got in pretty quick. Well. If you don't count the time it took me to hobble down the hall to the exam room. Farmer H insisted on accompanying me. I don't really like that. But in retrospect, he probably would have thought I was lying if he hadn't heard it all for himself.

A tall tattooed gal took my vitals. She had a full sleeve on her left arm. She was friendly and efficient. When she left the room, Farmer H had to voice his opinion. 

"I don't know why young gals ruin their appearance with tattoos!"

"She was just fine. It's none of your business. Don't be so judgmental." (As I told The Pony later on the phone: "Dad has no idea what else she might do in her off time. Maybe she has a side job as a dominatrix! Her life and her skin are not his business".)

Farmer H also spent time looking at the charts on the wall. Diagrams of various bone-related maladies. "See there? That's what I have wrong with my hand. It's all bent out of shape by the arthritis."

"This is NOT all about you! Make your own appointment."

Dr. Ortho knocked, and entered the exam room. He was probably early 40s. He reached out to shake my hand. I introduced Farmer H. Dr. Ortho sat down on a rolly stool, and rolled over to sit right in front of my chair. I was relieved that he didn't ask me to get up on the exam table. I don't know if I could have made it, despite the stepstool with a tall handle on it.

Dr. Ortho asked me to pull up the leg of my sweatpants, which I had chosen to wear for just that reason. It's hard enough stepping in and out of pants at home with my usual leaning supports. He felt around my kneecap. Picked up my foot behind the heel, and stretched out my right leg.

"How far can you extend?"

"Ouch."

"You're missing the last 30 degrees." He set my foot down. "Now pull your foot back, and bend it as far as you can."

"That's it."

"About 80 degrees. Here are your x-rays." Dr. Ortho stood up and turned on the screen. "Here's the right knee. And the left. You can see how they're bent. The right one bends in, and the left one bends out. You have degenerative arthritis. The cartilage is gone. So you have bone on bone."

"It really hurts when I stand more than about 10 minutes."

"I don't doubt it."

"It's hard for me to even get up from a chair like this. With no arms to push up from. I can't get my knees bent far enough back to get them under me and stand up."

Dr. Ortho sat down on his rolly stool. Ran his hand around my kneecap, pressing.

"That's where it hurts. On the inside. And down below the kneecap."

"Yes. The cartilage is gone. The tibia hurts where the femur is pressing on it." He ran his hands down my lower leg. "I see you have some redness here. You need to get that checked out. I won't be doing a knee replacement on you. This operation will mess up circulation for a while. I'm concerned that this redness could develop into cellulitis, and spread up the leg, and get into the joint. I'd like you to see your regular practitioner again, and get a referral to a cardiologist, or a lymphatic doctor, to see if this can be cleared up."

"I have an appointment in June."

"It needs to be before that. I'd LOVE to do a knee replacement on you. Maybe you can come back in six months, and we'll see where we're at. It will change the quality of your life. In the meantime, I could offer you a steroid injection to help with the pain."

"Yes. I think I'd like to try that."

Of course Farmer H was chiming in that HE'D had a steroid injection in his knee, and it worked for about six months.

"Well, you were very lucky if it lasted that long. This is good for about three months. I could give it again in four months if it's helping. I'll go get it ready."

Dr. Ortho left. The tattooed gal came back with a tray holding a syringe and a vial. "I'll just get his injection ready."

"There's not any lidocaine in there, is there? Because I have a sensitivity to that, and it raises my blood pressure and speeds up my heart."

"No. This is just Kenalog, and some saline." She left, and Dr. Ortho came back about five minutes later.

Dr. Ortho took out his inkpen. "I'm just marking my landmarks." He didn't seem to be writing on my skin. Just poking the pen at the side of my kneecap, and above. Then he got up to get the syringe.

"I'm going to try not to look."

"That's what I always do!" said Dr. Ortho. Heh, heh. Doctor humor. I HOPE!

He stuck the needle in the side of my knee. It wasn't painful. Just pressure inside as the fluid went into my knee cavity. Dr. Ortho said he was going to send a note to my NP about his concerns. I made the appointment on Friday, and see the NP on Monday (lucky that they had a cancellation).

I've gotta say, I really like Dr. Ortho. I don't know if I'll ever "be able" to get a knee replacement. The injection of Kenalog seems to be helping already. At least at home, I don't have to grab onto things to get around the house now.

A Journey Of 1000 Hoops Begins On Just One Knee

So many hoops to jump through to get somebody to look at your knee! I made my orthopedist appointment back in December, at my yearly visit with my Nurse Practitioner. I'd asked about getting that knee checked out years ago, and NP mentioned a knee replacement, but said I was considered too young, that it would wear out and need a replacement for the replacement. I was kind of in a holding pattern until the past couple years when it got worse.

The orthopedist's office left a message that I would need to get there 20 minutes early, and have an x-ray before the appointment, at the lab on the same floor. Farmer H, who has never been to that clinic, and only visited in the hospital below, told me I would need to go to the hospital lab on the 1st floor to get that x-ray. I disagreed. I had been to the 3rd floor lab many times. I know they do a lot of different labby things, not just blood draws. I figured they might have x-ray facilities.

Farmer H dropped me off at the front door of the hospital. The elevators are to the right. The hospital lab is straight ahead through a couple waiting areas. There's an information desk across from the doors. That's where I went, while Farmer H was parking A-Cad in one of two open handicap spaces he saw. He has my other placard. He doesn't get around so great either, after his back surgery.

The gal at the information desk said that I should go up to the 3rd floor for my x-rays. Farmer H came in as I was hobbling with my cane to the elevator. Thank the Gummi Mary, he was there to hold the closing door open while I got in. At the 3rd floor, I went to the regular lab to ask them. Passing by a window marked with Orthopedic Imaging. I thought that might be what I needed, but chose to walk (I use that term loosely) about 20 more feet to the regular lab window and ask, rather than going into that imaging suite, which was not there the last time I was on 3rd floor. Of course that's where I needed to be: Orthopedic Imaging. If they'd just called it that instead of the "lab," it would have been clear.

Inside Orthopedic Imaging, I paid my co-pay and sat down to wait. Within five minutes, I was called back. The Tech was SO KIND! She was probably mid-20s. A dishwater blond wearing blue scrubs. She explained exactly what she was going to do.

It was mainly standing with my knees up against a plate mounted on the wall, while Tech went into her radiation-proof room to take the pictures, cautioning me, "Don't move." It was hard to get my knees as close together as I could for the view of the front. She let me keep my cane for that. I couldn't use it for the back view. She leaned my cane against the wall, and showed me where I could hang onto the plate my kneecaps were against. Then she came back and returned my cane. Positioned me sideways, knees slightly bent, one step apart.

Then came the hard part! I had to sit down on the end of the x-ray table, and "move your feet back as far as possible under the table." Welp! That wasn't happening! I couldn't even get my feet directly under my knees. That picture was taken from above. After that I was done. Tech came back, and held out her blue-gloved hand to help me get up. Then she stood there a minute.

"Are you okay?"

"Yes. I'm fine."

"Because if you're not, we can wait a minute."

"No. I'm good. It just takes me a minute to get going."

She was SO NICE! Definitely a people person, good with the elderly.

From there we went down the hall to the orthopedist's office. Which is tomorrow's story.

Mrs HM Is In Knee-nial

Lets get right to it today. Put the horse before the cart, and deliver the knews (heh, heh) that everybody has been waiting for:

Mrs. HM is NOT a candidate for knee replacement surgery!

At least not at this time. I was initially relieved. And then disappointed. Without the imminent threat of going under the knife, it dawned on me that nothing has changed. I'm still saddled with a painful knee that limits my mobility. However...

I may have a second chance. It depends upon some follow-up care, and perhaps a miracle. I don't know why I'm secretly hoping that my knee can be sliced open and its innards reamed out and metal parts be jammed and hammered into place. Farmer H is my biggest cheerleader. I'm hoping that it's not (another) clandestine attempt at trying to kill me.

I left the orthopedists office with a shot of Kenalog in my right knee. That's a steroid used for treating inflammation in joints. My knee already feels better. Of course I'm sure that's all in my head. My Estranged BFF Google says that Kenalog takes about 5 days before the effects are felt.

Over the next few days, I will share the details of my appointment, diagnosis, and care plan. I'm sure you'll be enthralled, heh, heh. 

A Brief Intermission

Sorry that I can't share my knee story today. I usually type up my posts a day ahead of publishing, around noon. But I was at the KNEE DOCTOR this morning. I didn't have internet when I got home! And it's been just one dang thing after another! Luckily I was ahead with my not-so-secret blog and the attempt to buy another flip house. It was already in the can of SET TO PUBLISH, thanks to me splitting the long story into parts.

Right now it's 10:05 on Thursday night, and I still haven't had supper. Which will take 30 minutes to get ready. So this is all you get!

I'll have plenty of tales when time allows. Starting with the knee appointment.

Knee Day

As you read this, it will be KNEE DAY for Mrs. HM. My appointment with the orthopedic surgeon. Which doesn't necessarily mean I'll be having surgery, I hope! Though that is certainly a possibility.

Both times I got a call from their office, I was up doing something else. Like out on the back porch to pet Pepper, or in the kitchen doing dishes. I heard that call, but couldn't get back to the living room in time to answer. Because of my KNEES, you know! I think there's some irony in that scenario...

Anyhoo... they left a message. One was just the appointment reminder, to confirm. They also sent a text, so I confirmed that way. The other left a voicemail. It said to arrive 20 minutes early, and get an x-ray at their lab before the appointment.

Well. That was not quite clear. Was I supposed to check in at their office window first? And THEN go back down the hall to the lab? Or should I just stop by the lab first, and then check in? It's a clinic, where my old doctor and NP used to have offices before moving to a new facility down the street. So both the lab and office are on the 3rd floor here.

I decided to call and make sure. The gal who answered did not seem all that friendly. In fact, I would describe her as downright surly! I called at 10:48. Maybe she was getting ready for lunch. Maybe she had someone at the counter. She spoke with a clipped, impatient tone. No reason for that (that I could see over the phone). Maybe she was one of those Gen Z people who hate to talk on the phone. In which case I recommend: 

LOOK FOR ANOTHER JOB!

Anyhoo... I was not "wasting" her time. I quickly identified myself, said I had an appointment Thursday and received a call saying to get an x-ray before my appointment. Should I do it BEFORE check-in, or AFTER check-in? She said, "That's fine. Do that." Without specifying! So I had to confirm: "So I can get the x-ray first, and then come to your office?" She agreed.

Here's the thing: I didn't know if the lab would already have an order for my x-ray. That's why I was unsure which came first. I know the doctor wants to look at it while/before seeing me. But might want to know if I actually show up in person before sending the order. Which is most likely done by the office staff anyway. The ones who would check me in.

I also went online to YourChart to update my information. Which they call checking in online. Which doesn't mean you'll actually show up... 

Not that I'm getting cold feet. Or cold knees, heh, heh! I've had that since December, when my appointment was first scheduled. By a perfectly cheerful gal over the phone.

Doctored Pepper

Pepper the new puppy had his first vet visit on Monday. Farmer H tossed him in a big box on the seat of SilverRedO. I was skeptical about the travel arrangements. Pretty sure Pepper would jump on the side of the box and tip it, and might get under Farmer H's feet while driving. 

My recommendation of using the pet carrier was scoffed at. I don't know how they made it, but Farmer H said Pepper vomited in the box, and chewed on his hand the whole way there. Thank the Gummi Mary, it's only five miles and 10 minutes. Just past Mick the Mechanic's shop, by the bowling alley.

This vet bill was not as expensive as I expected. "Only" $80.

Farmer H asked about getting Pepper chipped. It's not that he's valuable, or that we expect him to be anywhere that has capability to scan a chip. But we've had several dogs disappear. It's disconcerting. Heartbreaking. If somebody would abscond with Pepper, and he got loose, he COULD end up at the city pound. They scan.

Anyhoo... the vet people said that Pepper can't be chipped until his very special operation later in the summer, when he's six months old. That's because the needle to insert the chip is too big right now for little Pepper. He goes back in three weeks for more shots.

And now I must have a fit of outrage. PEPPER WAS MIS-BREEDED! The thing these days is to get your nose out of joint when something like this happens, right? I don't get it, but that's what these younger generations do. 

Here's the issue:

It's at the top of the bill. I agree that Pepper is a canine. I can believe that Pepper weighed 9.8 pounds. I CANNOT fathom why they called our dear sweet Pepper a GERMAN SHEPHERD MIX!

Our little guy is quite obviously a HEELER MIX! Or Australian Cattle Dog mix, if they want to sound all scientific-y (even though it's an American breed, nothing to do with Australia).

I hope Farmer H will ask them to change it when Pepper goes back to the vet. Just for accuracy. As accurate as you can be, guessing a mixed breed's heritage. I don't expect Pepper to grow as large as a German Shepherd, nor have the same temperament. It's quite possible that Farmer H gave the wrong information when he called to make the appointment, or that he was misunderstood with bad phone reception.

Anyhoo... Pepper is fine after his first shots and pills.