Saturday, June 28, 2014

"Side Effects"

I celebrated my new knee's three-week anniversary a few days ago.

Things continue to move forward, although the pace of recovery has slowed a bit. I am exercising twice a day, but some of the numbers (degree of extension and flexion) are a bit stuck. I guess my body's still playing  catch-up with all the work (exercise) I'm doing. My mood is generally good. It really helps to know that all is fine. Having had unsuccessful surgery in the past, my thankfulness for a good surgical outcome knows no bounds.

Interestingly, I have noted a couple of physical side effects of the surgery that have absolutely nothing to do with my knee.

The first side effect is the almost total disappearance of the chronic cough that has bothered me for about TEN years. I have gone through numerous tests and tried all kinds of products (both over the counter and prescribed by specialists) to get rid of the cough. Nothing worked. But the minute I came out of surgery, the cough was practically gone. The only reason that I can imagine for this quasi-miraculous event is that something was somewhat out of kilter in my throat and that the tubes they no doubt put down my throat during surgery (I had to have a general anesthetic due to back problems that made using an epidural a less than optimal choice) pushed things back into place. I have coughed a couple of times in the last three weeks, but probably no more often than the average person coughs. Extraordinary!

I have also lost a bit of weight since surgery. I suppose this could be viewed as not particularly surprising, although I have also been extremely limited in the amount of movement I do (I normally average about 10K steps a day; now, the number of steps is so low, I'm not even wearing my Fitbit), There's not a lot of calorie burning going on, though as I type this I wonder about the effort my body is going through to simply heal. Up until recently, I've taken most of my meals in bed, since sitting for any period of time brought on further swelling and discomfort. But I definitely have not been trying to limit the amount of food I eat. I just eat what I feel like eating and admittedly, it does seem like somewhat less than what I usually eat.

I also found that during the first ten days or so after surgery, I felt absolutely no desire to eat sweets. As a rule, I am very fond of sweets and I therefore tend to "watch" my consumption fairly closely. My cousin came over with a box of gourmet cupcakes a few days after I came home from the hospital and I was downright disappointed to see them. I at a half a cupcake during her visit and I think I had a bite more of another one in the days that followed. My husband and kids ate the rest. My younger son's girlfriend baked me a lemon cake and I just adore anything with lemon. I was literally able to eat only a crumb of it. The rest was enjoyed by other family members. As time goes by, my friendship with sweets is coming back. I have enjoyed a square or two of chocolate after supper from time to time. I don't think this aversion to sweets will last very long!

I am somewhat curious and slightly concerned about loss of muscle mass due to inactivity. However, although I am still passing a lot more time than I normally do in bed, I think I can honestly say that this is a far from inactive recovery. I am doing some very demanding exercises twice daily--yes, even on the weekends and statutory holidays! So I'm not going to let this concern get to me too much. I'm sure I'll be fine.

Recovering from a total knee replacement is quite the adventure.


  1. Wonderful read. And the cough--that's an amazing thing. Your theory sounds solid...I bet you're spot on!! I was delighted to read your facebook post about walking with your hubby--and the holding hands part--you two--so wonderful... You're recovering and soon you'll be back to feeling normal again! Hang in there... You're doing so well.

  2. That is so amazing about your constant cough! It must be so nice to be rid of it.

    I am so glad your surgery went well and that you are have a good recovery. Do you have a link to your Facebook page? I don't see one here and would love to Like your page.

  3. I'm intermittently on FB (although more often here lately w/renewed contact by SIL - blog post coming! ;-)
    But I'd love to be your "Friend" there as well...

  4. Sean, Val and Kimberely: thanks for the good wishes!

    Val and Kimberley: send me an e-mail (address in the "about me" section) and we'll become friends.

  5. Wow! NewMe! So dang happy to hear you're making such great progress. These things take TIME. And patience. (Lots and lots of patience.)

    One day at a time, yes? :-)

    So. Keep being good to yourself 'cause whatever all you're doing...well, it's working. It shows.

    Now. In case you're curious...

    All the data I've seen suggests that your post op response to food demonstrates a perfectly-performing HPA-axis and stress adaptation response. LOL

    Seriously. If your HPA had been dysregulated, on the other hand, you would have been RAVENOUS by the 3rd day after surgery. Instead, your body did exactly what it's meant to do in a case of "surgical stress"---that's a real medical term, btw. hehe

    That is, your circulating cortisol (anti-inflammatory hormone, duh) was elevated on account of the traumatic physiological alterations---um, discomfort, for instance---and so....hmmm...guess what happy hormone flew into action next?

    YES! YES! LEPTIN!!!!!

    While restoring homeostasis, your good pal leptin went into overdrive and your plasma leptin levels zoomed upward, partly to modulate the GC response, which (scout's honor) you do not ever want to witness running around wild willy nilly.

    Your appetite (especially your desire for dense sugary stuff) was amazingly nonchalant. Leptin likes to whisper, "Darlin, you've got ME...what more could you possibly need?" LOL

    Anyway. That's the honest to goodness (by the book) TRUTH about leptin. (Except for the whispering part.)

    Come on, girl friend...Admit it---aren't our bodies freaking amazing??!!!!


    Love you!

  6. Hey Ruby! Very interesting comment. Makes sense to me. I guess my sweet tooth will return. Hopefully without a vengeance, though.

  7. Hey NewMe, Hmmm. About that "vengeance" possibility...

    You may notice a gradual change in appetite at some point---your neuroendocrine status and HPA-axis responses will stabilize as inflammation decreases, pain lessens, and stress hormones return to more regular baseline levels. Those post-op increases in leptin levels will decline and stabilize as healing processes continue.

    It's possible that your appetite has been higher in the past (pre-op months/years) than it will need to be in the future. If you had chronic pain with inflammation for a long time, then your former appetite may have been chronically higher than it will NEED to be in the future after pain levels, stress responses and inflammation eventually find their new lower baseline.

    Had your surgery been necessary because of a recent injury, instead of a long term pathology, then---after healing from the surgery---normally you could expect your appetite to be about the same as it normally was before the injury.

    But in your case, your appetite may actually stabilize at a lower baseline---probably not as low as those first days and weeks after surgery but lower than in the pre-op past---depending on other physiological and psychological alterations brought about during healing and recovery. (For instance, if your sleep quality ends up better than pre-surg times, that alteration can contribute to a new lower baseline appetite.)

    The problem I've observed for some women after surgery: they lose weight in those early days and weeks, feel elated, buy a smaller size wardrobe, then gradually regain back to their regular weight (and must give up all those nice new duds).

    When you start exercising more, building muscle tissue and so forth, your appetite will fluctuate according to your body's needs for energy and nutrients. So even if your appetite SEEMS to return with a vengeance at some point, don't assume that's its new baseline. So...don't panic. It will drop down again when the temporary increase has accomplished what it was needed for.

    I guess I'm saying that the more you can trust that your body "knows what its doing", and trust that there are normal, rational, necessary reasons for your appetite fluctuations, and take it all in stride, then you may spare your body from having to launch into defensive stress responses (and thus allow your body to avoid the need for further appetite increases.)

    I don't know if I explained that very well. Hopefully, you get the gist, which boils down to this:

    IF your new smaller size entices you to go shopping early in your recovery, then... buy a fabulous hat, a drop-dead scarf, a gorgeous handbag and/or some darling new shoes. Be patient while your body gradually finds its "new normal" during the coming months. You will realize when that has happened---you don't have to trust me on this because you can instead trust your body to send out the right signals and trust yourself to pick up on the cues from this ongoing communication partnership.

    And THEN safely go clothes shopping---boldly, with no fear of future regret. :-) (Unless you've always had a terrible sense of style---unlikely to change---and in that case just bring along a best pal who loves to shop and has FABULOUS fashion instincts.)

    Enjoy your metamorphosis!

    After all, a very wise woman once wrote, " Recovering from a total knee replacement is quite the adventure."

  8. Oh, almost forgot. About that chronic cough...

    Guess which substance in the human body can augment neural compensatory mechanisms in response to upper airway obstructions, pharyngeal irritation, and respiratory hyper-responsiveness---all of which can result in chronic cough---and is also being studied in connection with treating asthma (chronic cough kind) and sleep apnea?


    Starts with...L


    Hey. Obnoxious...maybe.

    But there's a higher spiritual purpose at work here. I'm trying out a crucial, new stress management strategy, almost guaranteed to enhance serenity (mine of course). Mostly, it involves keeping myself amused. :-)

    Hmm...It appears I've reached my weirdness quota for the day. My work here is done.


  9. Hope you're doing well! You're in my thoughts.

  10. Oh. Lord. Ladies and Gents: we now have PROOF, in PUBLIC, showing exactly why Ruby should STEP AWAY from the 'herb'..forever. :-)

    Love ya!

  11. Ruby: I may be wise, but you're pretty wise too. I found your comments really interesting.

    Sean: you're a doll.