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Baker's Cyst Update

I haven't really thought too much about the Baker's Cyst issue recently but I have noticed from the blog stats that a lot of people search the topic and end up reading my blog. I occurred to me that since my posts dropped off right after the knee issues that this might give people a negative impression of what might happen to them- death, paralysis, etc. This isn't the case so I decided that I should give a little knee update for you Baker's Cyst Google Searchers out there.

The knee is...okay... which is an improvement. The fluid from the ruptured cyst reabsorbed as it was supposed to, although for several months my left shoe(s) were always too tight- a little bit of swelling really affects shoe fit. I got some blisters because of this and also couldn't wear certain shoes at all. Now all my shoes fit fine. At this point the cyst is still there but in the last month it's finally gotten smaller, from golf ball size to not much of anything, just a slight bump behind the knee.

There is still room for improvement as far as knee function. The swelling is finally down, again, just recently. I can walk without pain and am starting (very slowly!) to do a little bit of strength training and recumbent bike. I've tried jogging but that has led to immediate increases in pain and a return of some swelling.

These results/problems are not typical from what I've heard. There's not a lot of data out there on this topic but it may well be that the aromatase inhibitor I take, Femara, and also the Zometa I've received once and will be getting again in December, have had an impact on my joint health and healing. Again, there's not a lot of info out there on the impact of some of these breast cancer treatments and orthopedic issues, but these drugs do affect the bones and joints so it seems plausible.

It's been good to get back to regular exercise, even if it's just walking. I don't know at this point if there will be anymore running in my future. Biking I'm more optimistic about It's not really a big deal since I'm not exactly an elite athlete. As long as I can get a decent amount of exercise in some form and as long as I'm not in pain all the time I'm happy.

Let the Triathlon Training Begin!

As you might guess from this post title the knee is doing much better. I saw the orthopedist yesterday and had the stitches out. He was pretty satisfied with how the knee is coming along, although he does think that at least a couple of physical therapy sessions would be helpful. I'm having a little more difficulty, compared to what most people experience after this type of surgery, straightening the leg. He said I can do a couple of sessions and then evaluate whether to just do whatever exercises/program they give me on my own or whether it would be better to keep going for a full course of 10-12 sessions.

The most satisfying part of the visit was having him go over what he'd done and getting his opinion that going back to running (slowly after building up with a walking, then jogging program, plus the rehab) at any level I choose to should be no problem. Crystal and I are signed up for our second Danskin Triathlon (end of July). I'm confident that I'll be able to do it.

Patches and I celebrated this good news and kicked off triathlon training yesterday with two 15 minute walks up and down our closest dirt road. This morning we were really ambitious and walked a full two mile loop. Now we're reaping the benefits- Patches is asleep on the couch and I just feel BETTER. Gus and Wendy had a walk too, but a shorter one, kicking off the start of their canine weight loss and fitness program- sorely needed after this past winter of not getting nearly enough walks, between the weather and my knee problems. It was so great to get out in the sun and enjoy the signs of spring that are suddenly showing themselves everywhere- sprouts of green coming up on the roadsides, budding trees, ducks on the ponds. Today we saw mergansers- can't remember if they were the hooded or common. Yesterday on one of our walks we saw two piliated woodpeckers. For more on our local birds see Crystal's blog.

*I just checked Crystal's bird photos. It was the hooded mergansers we saw- on Rebecca and Michele's pond.

Surviving a ruptured Baker's cyst

From my new home on the couch, I found this blog post "Surviving a Ruptured Baker's Cyst", and its associated comments, to be both helpful and illuminating.

I notice that first thing in the morning seems to be the worst as far as the pain and stiffness are concerned. This may be due to a few things- probably a combination of all of them. First of all I don't take Vicodin at night because despite its depressant qualities it tends to keep me awake. Michele from across the beaver pond described it well yesterday when she and Rebecca brought over our groceries- that narcotics seem to do this weird thing where you just skim the surface of sleep. The Vicodin makes me feel dreamy and racey at the same time. This can be pleasant during the day, especially since I'd otherwise be in a lot of pain, but at night when I want to sleep, no. I've also, for the last two nights, taken off the compression wrap out of fear of developing blood clots.This may be irrational- or not- I'm not sure. I do know that I did not enjoy the DVT scare last week. During the day, compression and elevation make a big difference. I can't stand for any length of time even with the wrap, and without the wrap forget it. Stretching and moving seem to help, but only when done from a horizontal, not vertical, position. 

A couple of key pieces of information in the various things I've read are that it usually takes a couple of weeks for the body to reabsorb the fluid from the ruptured cyst. Once this happens you usually feel better, except that the cyst tends to recur- unless whatever caused it has been eliminated. Since one of the common causes of these cysts is tears to the meniscus, and since I've had the torn cartilage removed, maybe this will be the end of the cyst. Let's hope so. Vamos a ver... I don't know if the fact that this is a "complex" cyst is of any significance as far as what to do about it. "Complex" in the context of Baker's cysts seems to mean that there is some calcification involved. This explains the grindy sensation I was having at the back of my knee where there's not supposed to be anything hard or crunchy.

The knee itself is definitely improving and better than it was before the surgery. If it weren't for the ruptured cyst situation I might even be up for a walk. Still, today has been better overall. I've been up and about a couple of times and have finally started working on the mid-term I need to have ready for Tuesday night. I have a pretty normal work week scheduled which is a little scary. Monday and Tuesday are pretty light so maybe it won't be so bad.

Meniscus Surgery Recovery Update Day 5

Today marks the 5th day since the meniscus and tibia cartilage trimming and I am finally turning the corner. The shower prohibition ended this morning so in addition to feeling a little better (more on that in a minute) I am also clean. Showers are so taken for granted and under-appreciated for the luxury (both as a pleasure and as a major indulgence in terms of the resources they use) that they really are. I saved a lot of water this week with my washcloth baths and the one hair washing I did at the kitchen sink. It dawned on me, during this at the sink shampooing, that when I was growing up people used to often wash their hair at the kitchen sink. I don't think people do this anymore. I wonder why?

For the most part I've spent the day lying down with my leg up with the calf well wrapped. The wrap makes a huge difference in cutting down on the pain. The rest and elevation seems to have worked its magic. Suddenly this afternoon, for the first time since even before the surgery, I found that I was able to walk without a limp. This was pretty exciting since the whole point of doing all this was to have a functional knee again. Although I'm still not up to spending a lot of time on my feet, I finally feel like I'm headed in the right direction. My plan is to keep doing what I'm doing, with more walking added in as I can tolerate it. I'm still tired- like really wiped out tired- from the systemic impact of being put to sleep and having power tools used inside a major joint. Although the holes they make are really little this stuff takes its toll. Hopefully the recovery process will start to speed up over the next couple of days. I have to teach Tuesday night and it will be little tough doing it if I don't feel a lot better than I do now.

Jim is making dinner again, another soup, this time with potatoes from the Brookfield Farm. This weekend is the last winter share pick-up. We'll have to go tomorrow or we'll be out of luck. It won't be long until the Foodbank Farm opens for the season and we'll start seeing all those greens again.

The dogs continue to get along. Patches is a joy and a nuisance- smart, sweet, and fun, but also good at finding trouble and finding it fast. She's so big and so agile that she can overcome almost any barrier. Put up a gate and she just leaps over it. If she wants something on a counter, say a stick of butter, she can just help herself. Just now while Jim was cooking she got one of my sweaters, luckily an old one, and chewed part of the collar off. Once I'm back on my feet there's going to be some serious dog proofing around here. Good thing she's crate trained or we'd really be in trouble.

Pseudo-Deep Vein Thrombosis (much better than the real thing!)

Friday, March 20th

Today got off to a bad start when I woke up at 6am with REALLY BAD CALF PAIN- like miserable, snap at Jim, hurts even after taking Vicodin kind of pain. It was the most pain I've had since having the surgery. This was finally enough to get me to cave and go to the ER, to not worry about Jim having to reschedule some things at work, and to not worry about canceling the two clients I was going to see today even though I wasn't up to it.

It ended up being a good experience. First of all the place was empty- like they were all just sitting around waiting for a customer. No one rolled their eyes when I said why I was there. On the contrary they were really concerned. The ER doctor was extremely validating of the appropriateness of my decision to come in and was even more validating when he examined my leg. Within a few minutes they'd drawn blood, done an EKG, put in an IV, and sent me down for an ultrasound. The ultrasound technician took a LONG time going over my leg, more than twice as long as they'd told Jim I'd be gone. I could tell she was taking pictures of something she'd found. Although she was very nice and knew I was worried, she wasn't allowed to tell me what. By the end I was pretty much resigning myself to the idea that I did have a blood clot and that they were probably going to admit me.

It was a pleasant surprise when it didn't happen that way. Rather than having the real thing, it turns out that I have a "complex-cyst" (probably caused by my initial knee injury) that has caused pseudo-DVT by leaking fluid into my calf muscles. The symptoms are pretty much impossible to distinguish without ultrasound.  Maybe I'll need to have something done to it or maybe not, but it's no big deal

It's been very pleasant to lie around on the couch this afternoon, reading and snuggling with dogs, without wondering if there's a blood clot waiting to go to my lung.

I enjoyed reading this guy's account of a similar knee injury adventure, as well as his blog in general- makes dreams of bike adventures dance in my head.

Wednesday and Thursday Meniscus Surgery Recovery Updates

Wednesday, March 18th

How am I feeling? A little bit better, thank you! I am pretty wiped out but I can walk a little bit better and can now make it from dose to dose of Vicodin without watching the clock. I slept last night (huge improvement) downstairs in a nest Jim made me on the futon couch in the living room, all bolstered in with pillows and a new faux-down comforter.

I've been mostly camped out here all morning except for bathroom trips and some forays to the kitchen to get food, plus doing the recommended quadriceps and leg exercises to ward off muscle atrophy and blood clots.

There has been plenty of help today. Crystal and Ethan came over a little while after Jim went to work and walked all the dogs- first Patches, then Gus and Wendy. Patches was good with Ethan- no jumping, nice and calm. She hadn't been kid tested prior to us getting her so it was reassuring to see that she doesn't turn into a wild beast when a toddler walks in the door.

After the visit from Crystal and Ethan, Dale, our housecleaner/ helper/family friend came by a little after 9am to do her regular weekly cleaning. She walked the dogs, admired/coveted Patches, cleaned the downstairs, did the dishes, and brought in wood

Crystal took the dogs out again in the afternoon and then before too long Jim was home.

Thursday, March 19th

A lot like yesterday but with more calf pain which is a worry. One of the potential complications of arthroscopic surgery is deep vein thrombosis (DVT). I've been doing the leg exercises like I'm supposed to and taking low dose enteric aspirin but it's hard not too worry. I consider going to the ER as recommended in the discharge instructions on Monday, but then I talk myself out of it. Somehow I feel that unless I'm SURE it's a blood clot I shouldn't waste the trip. I'm not really at peace with not going either. It's a hard issue to resolve since the only ways to really know if it's a blood clot or not are 1) to have it be one and go to your lung (not a good way to find out), or 2) go to the ER and get an ultrasound. The right thing to do, in terms of the instructions, is to go, but somehow I just can't do it. Much as I hate the "blood clot traveling to lung" scenario, I can't stand the idea of going to the ER for nothing.

What's the issue with this? Part of it is that I don't feel so great- tired, hard to walk, etc., and it seems like a lot of work. I also don't want to seem like a wimp- running to get checked out for nothing. I also don't want to put JIm out again- have him either miss work or make him spend the evening driving me and sitting around the ER.

I am not a stranger to this kind of thinking. I did a similar thing toward the end of chemotherapy when we went to Maine for the weekend and I woke up the second morning with chills, a fever, and a raging headache. I procrastinated and procrastinated about calling and leaving a message for the oncologist. When I finally did the doctor didn't call back. Instead of trying again I got this idea that they hadn't called because they thought I was a wimp so I toughed it out. Actually this turned out to my benefit because whatever was wrong with me resolved on its own, and talking to the oncologist later I learned that I would have been hospitalized if the communication had gotten through. This of course would have ruined our little vacation. The bad side is that I was pretty scared for a few hours, in addition to being sick, and thinking that my doctor hated me. It was not fun.

I don't think this weirdness of mind is unique to me. It's the same kind of thing you hear over and over about people when they're having a heart attack.They think, "Maybe it's something I ate," or, "Maybe it's an asthma attack," when really they're on the verge of dropping dead. The weird thing is that in these situations I can somewhat recognize that I might be being irrational, while at the same time being unable to change course.

Dog and Knee Update

I had the knee surgery yesterday morning and it went well, although I am not exactly reaping the benefits just yet. Yesterday I felt great which led me to think I'd been the recipient of a miracle cure, when in reality I'd just been the recipient of lots and lots of really good drugs, including an anti-inflammatory and plenty of local anesthetic put right into the joint before I woke up. Today has been a bit tougher and I'm told tomorrow will likely be similar. Oh, well. The offending torn cartilage has been cleaned up and I should be getting 100% function back once it heals, including back to running. This is hard to imagine right now when I'm living from one dose of Vicodin to the next, but it's definitely something to look forward to. Despite the temporary misery I'm glad I had the surgery because the problems in there were not going to fix themselves.

I really misjudged what the recovery from this would be like. My surgery experience up until now was limited to the mastectomies. As awful as the idea of having your breast chopped off might be and for all the disconcerting pity responses it tends to elicit, it's actually not very hard to recover from. I didn't even need painkillers afterwards. This knee thing almost requires a home health aide. Really. I'm sitting here with Estelle's walker next to me, and I'm grateful to have it.

The dogs are getting along better which is a huge relief for us. Gus seems to be accepting Patches as part of the family and has been close to her a few times today with no attacks. I think our close supervision and clear, strong messages that attacking her is not okay have been very helpful.

Patches will definitely be a great running dog- she needs a couple of runs a day at this point so I better hurry up and get over this knee thing. She's been pretty lively around the house- lots of energy and creativity. She likes to collect things, especially if she's a little bored- you can see her looking around for something to carry off- a pen, a DVD, baby clothes, a jacket, a book off the shelf. She hasn't chewed anything up...yet, and she's been good about handing over whatever she's taken in return for a Nylabone or plushy AKC toy. None of this is unexpected but it sure is a workout.

Calling all local friends. Please don't hesitate to come by if you want to play with her or go for a walk!

Patches and Knee Repair

I am having a much lazier day than I intended, surrounded here by sleeping dogs. I had all sorts of ambitions for this afternoon, but I'm tired. Yesterday was a busy day, with a lot of excitement, including some dog fights. The dog fights were short, because I made them short. Today they're not happening because I've taken control and there's no opportunity for fighting.

Let me back track a little bit. Yesterday we adopted a new dog, Patches, and brought her home. This has been in the works for the last two weeks. Although she's female, friendly, and gentle, with good people and dog social skills, Gus does not approve. His aggression used to be limited strictly to other male dogs but now, in his old age, he's apparently extended this insanity to ANY other dog. We took great care in our introductions- had them meet outdoors on neutral turf, honored Gus' place as top dog in our feeding routines and giving him the attention he's used to- all this to no avail (so far). Given any kind of a chance he goes in for the kill, right for Patches' throat. After a couple of incidents yesterday it was clear that we needed to institute tight controls. As of late in the day yesterday, Gus is ALWAYS on a leash under my control or in the crate when Patches is out loose. At other times Gus has run of the house while she's in the crate. This has worked well so far and they both seem more relaxed. Patches has made friends with Wendy and initiated some play with her. Gus has been minding his own business more and not watching Patches' every move while obviously plotting how to kill her, and we've been praising him for ignoring her. I'm optimistic that with time and good supervision they'll get to the point where they're fine together but we have some work to do in order to get there.

Although Gus may not be so keen on her, it was love at first sight between Patches and me. She's an awesome dog, everything we'd been told she would be and more- pretty, sweet, friendly, SMART, and very, very curious. In the past 24 hours since she arrived she's made a great adjustment and has remained a happy dog in spite of the assasination attempts by Gus. She should be lots of fun to train, and I think I'll be able to do things with her that I've not been able to do with any of my other dogs, like fun clicker training and agility kinds of stuff.

This will have to wait a little bit because I'm having ARTHROSCOPIC KNEE SURGERY tomorrow, FINALLY. I have to be at the hospital by 7:30 am and the surgery is at around 9am. The plan based on the MRI is that the surgeon, Dr. Glenney, will trim off some torn pieces of meniscus that are catching in the joint, maybe do some repair if the tearing is in an area with enough blood supply for healing to be possible (unlikely). I should be home by late afternoon, probably without crutches but with a big immobilizing brace on just for the first 24 hours. After that the brace comes off, then it's bandages for 5 days, then in a couple of weeks I get the stitches out. It sounds fairly possible that I may be walking better and more comfortably by the end of this week that I have for the last three or so months. Vamos a ver... I'm expecting to be back at work seeing clients as usual on Wednesday.
I've heard that some people are ready for light jogging as soon as a month after the surgery- sounds almost too good to be true but I hope it is. I am so eager to start enjoying the outdoors again- walking, biking to work, working in the yard, RUNNING, all that stuff.

Jim is taking Monday and Tuesday off so we'll have a little long weekend together. My experience is that you can make these things into little vacations given the right attitude and expectations. Tuesday I have to go see Parker at Dana-Farber for my regular, every 3-4 month follow-up. Some people sweat it about these visits but I never do. It's more likely that if something (i.e. metastisis) were going on, that I would be the one to notice it. The only thing they do there that "interests" me is labwork- particularly the liver function tests and tumor markers, which can be early indicators of possible "trouble." Anyhow, it is what it is. Mostly I like the social aspects of the trip, seeing my former chemotherapy nurses, Cathy and Ellen, the phelbotomy techs, and going to the Greek restaurant down the street or to Whole Foods in Framingham on the way home.

These days I find that I can usually take the approach to worry that the Dalai Lama recommends. If you can do something about a problem then just do whatever that something is and don't waste your efforts and energy on worry. If you can't do something about a problem, why worry because what's the point? It won't do any good and will just make you miserable. This can be more easily said than done, but for some reason these days I'm actually able to do this and my life is a lot better for it.

I was going to start Zometa infusions on Tuesday but we're holding off for a month or two to let my jaw heal a little more where I had the extractions. No sense in inviting trouble when you can easily avoid it.

Today Jim is out car shopping with Kate, looking for a replacement for the car that got totaled when someone crashed into her this winter. He's also checking out a VW camper that's for sale and that we found intriguing.

Time to do some chores while I can walk around semi-easily. I'd like to rest up from the knee repair in a fairly tidy house. If it's anything like my last surgery I should feel pretty well afterwards. I'm bringing my anesthesia record from Windham so they can try and do basically the same mix of drugs. I woke up from that last surgery feeling great, unlike previous times when I felt like crap, sick and freaked out which is not much fun. Spinal anesthesia is an option for this knee repair and evidently lots of people choose this route, which I find surprising. Being asleep and waking up with the surgery all done and feeling pretty normal seems a lot less weird and creepy that having a needle put in your back and being not being able to feel or move your legs for a few hours, including even after the surgery is over. Shudder. Thanks but no thanks, Dr. Glenney. Wake me up when it's done and you can show me the pictures and tell me all about what you did. If I want to watch an arthroscopic meniscus removal/repair I can find one on YouTube.