I managed to pull a calf muscle on my non-surgical leg, and this has led to an era of disheartenment. Things that had become easy are difficult again.

Also, I feel as if I am not making good Bending Progress. I AM making good…what would we call it. AGENCY Progress. When I first came home from the hospital, my surgical leg felt heavy and unresponsive. The physical therapist would give an instruction, such as marching the leg up, and then she had to reassure me that the important thing was activating the muscle: it was perfectly okay that when I marched my leg up, the foot did not even leave the floor; just please activate the marching muscle ten times. I had to do a lot of in-between exercises, like using my hands to lift my leg up off the floor, and then trying to control its slow descent back to the floor: that works those same lifting muscles, apparently.

So it’s been three weeks and I’ve had a huge improvement in being able to move my leg without needing my hands or a scarf or a belt. I can march my leg up like billy-o. But the amount of BEND I can get from that march doesn’t seem to be any more than what I could get when I had to bend it with my hands. And the bending angle is what the physical therapist has to work on at each visit while I gasp and whimper, so it would be super good to be able to get more of that done on my own. That’s how I pulled the calf muscle: in the pursuit of more bend.

I know it varies hugely, but would you like to know what a knee replacement cost in my case? Just under $58,000. Our portion is a $150 surgical deductible plus a $30 specialist copay. Plus we have one of those exhausting notes where the insurance says the surgeon has billed us $1,500 for something he is not allowed to bill us for, and that we are not responsible for paying it. In my experience, that’s easy for the insurance company to say, and I can plan on needing to make MULTIPLE phone calls to get that straightened out, when the doctor’s office DOES bill us for it and then acts as if they have never heard of an insurance company telling the patient not to pay it, and then assures us they’ll straighten it out, and then sends a bill threatening to send it to collections.

I would expect the itemized bill to be interesting, but it’s only confounding. While I was in recovery, a physical therapist came by to show me how to use my walker, and how to get dressed and use the bathroom, and how to use stairs. My sense of time was very sketchy, but I’d estimate she spent an hour or so with me. There are four separate physical therapy charges, all just labeled “Physical Therapy,” for $388, $300, $300, and $287. There are fourteen separate charges all labeled “Hospital Services,” ranging from to $292 down to $10. There is one Pharmacy charge for $509, and one for $33. (I’m remembering when Elizabeth had her tonsils out, and they charged us $14 for the two chewable children’s Tylenol they gave her.) Three for “Med / Surgical Supply”: $16,720 (I wonder if that’s the replacement knee itself), $4,415, and $4,140.

I am well into the third week of wearing pajamas day and night; I’m not sure I’ve ever gone so long without Real Clothes.

I have started experimenting with walking without the cane, just around the house. Paul, finding the cane standing alone: “Surely a miracle has happened here!!” I still use the cane when I get up at night (many, many times), and first thing in the morning when I’m quite stiff and sore.

It is strange to me how much time I am spending on the care of my physical form. The careful feeding, the hours of exercise, the careful showering and lotioning/ointmenting. It feels even stranger because I am doing little or nothing for other people. I know this is the way it is supposed to be right now, and that it’s temporary, but it feels odd.

Commenters Meg and Kate, and also a couple of local friends, mentioned the importance of stool softeners after surgery, especially if narcotics are involved, and I would like to suggest that you file that information away in your heart under Very Important. Because of the urgent tone of their advice, I took evasive action and was able to avoid distress. I would add that it seemed to me the prescribed docusate did nothing helpful at all, and that it was a good idea to get Miralax and Senokot (or whatever your preferred gentle interventions may be) involved even before the medical professionals were concerned: that is, the medical professionals were saying not to worry until Day 5, and at that point to start additional medications; I would say start dabbling with additional medications by Day 2 or 3. I was concerned things could go too far the other way, but that has proved to be an unnecessary concern.

I also have a little pharmacy tip: your insurance can’t tell you what medications you can or can’t have, they can only say whether or not they will PAY for it. So for example, one of the pain medications my doctor wanted me to have was rejected by our insurance, which said it needed a prior authorization. We waited four days while doctor and insurance and pharmacy went around and around, before finding out that the cash price of the medication was sixteen dollars, so we just paid that sixteen dollars and took my medication home. (And over a week later, we got a letter from our insurance company REJECTING the prior authorization from the doctor ANYWAY.) Obviously some medications are going to be not sixteen dollars but sixteen hundred dollars, and that is a different story—but it is worth asking what the cash price is, especially if you are ill and/or in pain and not up to dealing with the pharmacy/insurance/doctor rigamarole.

In the midst of a flurry of new-president-first-day executive orders/actions that ranged from horrifying to ludicrous, I reached the two-week post-surgical milestone for my knee replacement. I saw the surgeon, who removed the bandages and said the mess underneath looked “beautiful,” and cleared me to remove the compression stockings and, even better, to SHOWER. I went home and took a nice long shower and washed my hair twice and got into clean soft clothes and felt wonderful. Except for all the news, which was unrelenting and terrible.

I sure would appreciate it if journalists could make it clear when it’s “Something he wrote on a piece of paper that will immediately change laws/lives” vs. “Something he wrote on a piece of paper that will take years for the courts to resolve and in the meantime will have no affect on our lives other than the heavy burden of despair that someone would WANT to do this.” I suppose sometimes they don’t know, either. There are a lot of things he “couldn’t do” that he has done, because it turned out the people who were supposed to stop him chose not to stop him, or that there were no stopping mechanisms in place because no one but him has needed to be stopped from doing these things.

Home physical therapy has ended, and I saw the local physical therapist for the first time. She told me I was going to hate her for ten minutes out of every session, and then she told me to relax and breathe, and then she MANUALLY BENT MY KNEE, so much farther than I have so far been able to bend it—WAY past the point where it feels to me as if I come to a hard stop and literally cannot bend it any further. Afterward, while I was panting and wondering how loudly I had yelped, she said “Was I right? Do you hate me?” and I said “Not yet.” Her efforts have made me work harder at my physical therapy exercises at home: the more I can bend myself, the less she will have to bend me.

For those of us who consider this Inauguration Day to be a day steeped in horror and disbelief, a day we were hoping would somehow be prevented at one of the many, Many, MANY points it seemed like it clearly should have been prevented—how are you planning to spend the day? I have been partly in denial/hope, and partly distracted by the knee surgery, and partly not WANTING to think ahead or make plans.

In fact, one possible plan is to have no particular plan and spend the day as we usually would. That’s still a frontrunner for me.

Another possible plan is to mark it in small ways that are more deliberate. For example, posting something on Facebook in commemoration of MLK Jr. Day, though I find it’s hard to get that right. I’m already incredulous that the day is the same day as the inauguration (and pre-mad at some of the things we might see and hear because of that); that makes me even more reluctant to seem to be using MLK Jr. Day as a way to make an “I’m ignoring the inauguration” point, if you see what I mean.

But it’s the KIND of thing I mean. For example, tomorrow would be a real good day to make donations to NPR, the ACLU, Alight, any other organizations that fight against the bad things we expect in this coming era. It would be a good day to order some Ruth Bader Ginsburg forever stamps, or a Dissent is Patriotic t-shirt, or an equality/rainbow yard flag, or a little spontaneous gift for a friend. It would be a good day to do some volunteer work, or to donate blood, or to write some postcards, or to bring treats to a place that’s open despite the holiday. It would be a good day to do anything that feels like Doing Any Small Measure of Good.

(image from usps.com)

(image from ACLU.org)

It would also be a good day to wrap up in a throw blanket and drink something hot and treat yourself like you’re ill, or suffering heartbreak, or recovering from knee-replacement surgery. Watch some riveting or soothing TV. Read a book you got for Christmas and have been saving for a special occasion. Eat soup and saltines and drink ginger ale; or buy a pint of some extra fancy ice cream, maybe get some Pringles too. Use any shampoos/soaps/lotions you save for special. Do some restorative yoga and/or meditation and/or witchcraft. Get take-out. Burn a nice candle.

Maybe that would make you stir-crazy. Maybe you need to take action. Sometimes when I feel crummy, I will tackle chores that make me feel crummy, since I’m already feeling crummy anyway. Clean the bathroom, maybe sob a little. Scrub that irritating mold in the shower that keeps coming back, with clenched teeth. Really put the arm muscles into scrubbing the kitchen sink. Use a toothbrush around the faucets. Do laundry, maybe do a few soak loads with stain treatments. Pay bills and use the RBG stamps.

After my first pregnancy, I knew from experience that when I got a positive pregnancy test, I was on the verge of two months of feeling too tired and sick to do anything, and so I would use those last few interim days to do all the things I thought I’d appreciate when I was feeling tired and sick. Nice clean toilet to barf in! Nice clean shower to cry in! Nice clean sheets to sleep in! Nice clean kitchen to eat saltines / walnuts / grapefruit juice / cold pizza in! What things do we think Future Us will feel grateful to Current Us for doing? (Or maybe you are already Future Us, and it is too late to clean bathrooms.)

Sometimes in anticipation of a storm or a trip or the collapse of democracy, I find it soothing to Get Ready in small assorted ways. I change the batteries in my little pre-lit birch trees and flameless candles, and charge up the batteries I took out. I plug in all our electronic devices, and the back-up batteries for those devices. I buy extras of groceries. I get caught up on laundry.

Maybe it’s time for a distracting project. One of my friends has committed to sending one piece of snail mail every single day for a year; she’s signed up for Postcrossing as part of this. Another friend has signed up for a group sewing class: she wants to learn to make quilts with a sewing machine. I’m planning to send Valentine’s Day care packages to the twins and several of their friends; maybe I will spend some time tomorrow shopping for heartsy things.

Today the visiting home physical therapist switched me from a walker to a cane, though I am still supposed to use the walker at night, or when I am tired or if I am particularly sore. The surgery was just under a week and a half ago, and the physical therapist says she thinks I’m over the worst of it. She will come for the last time on Monday, and then on Tuesday I will begin physical therapy at a local place in town, and on Wednesday I will see the surgeon and he will remove the bandages and see what’s what, AND THEN I WILL BE ABLE TO TAKE A SHOWER.

MOST of not-being-able-to-take-a-shower has not been as bad as I’d thought. It isn’t as if I’m working up a sweat, or even going outside. Every day or two I take a stack of washcloths and a lot of time, and I manage to end up feeling fairly fresh. But my hair. My hair! Ug. I tried using dry shampoo, but if anything that made it worse. I’d thought about going to a salon to get it shampooed, but the reason I qualify for a home physical therapist is that the surgeon declared me medically housebound for two weeks: I am not to leave my home, not only because I’m temporarily disabled but in order to avoid infection and illness. So then it feels iffy to leave to get my hair washed. A friend has offered to help me wash it in the sink, and that’s one option; another friend is sending me a shampooing shower cap, so that’s another option; and there is also the tough-it-out option.

The pain has been a significant issue to deal with, especially now that I am expected to taper off the 0pi0ids. I have been extremely lucky so far in life, and I don’t have experience with dealing with pain that goes on for so long. I only know how to take a pill or rest or stretch, and if those don’t work I am out of ideas. I did ask the physical therapist if there were any soothing exercises I could do (it seems as if we are focusing primarily on strengthening and upsetting the knee), and she said not really. She said heat can be helpful, but the surgeon does not want me to use heat on this incision; she said light massage can be helpful but probably not very. She said the knee is kind of a tricky joint for soothing after surgery; mostly we really do just try to strengthen it and bother it.

Right now it hurts most when I rest it, or hold it still for too long; there is no comfortable sitting/lying position. In some ways this is an advantage: it makes it easy to get up and walk laps around the house every hour, as I am supposed to do; and it makes it pretty easy to make myself do my physical therapy exercises three times a day even though I hate them and they hurt, because moving the knee makes it feel better overall. But it makes sleep difficult. I will startle awake, NEEDING to get up and move the knee. That is not restful. And it huuuuuurts, and it KEEPS HURTING, and as I say I have led a lucky life and so I am short on coping mechanisms. If this were going to go on much longer, I would investigate coping mechanisms. But I suspect there are not many good ones: the people I know who have chronic pain do not seem to get to the point where they’re like “Yep, no big deal, just endless pain!”

By the way, if you are hoping to be distracted from an upcoming looming event, may I recommend knee replacement surgery? Other surgeries may also work. The visiting home physical therapist said she’d see me for the last time on Monday the 20th, and I thought, “The 20th. Why does that date ring a bell?”

Good news so far: I did not die during surgery! I have not lost the leg…YET.

Wednesday night (the surgery was Tuesday morning) I had to go to the ER for pain, and that was miserable (it hurt too much to sit down, which is why I was there, so I had to stand with my walker for hours in the middle of the night—which, to be fair, I would have had to do at home if not at the ER). But I had a nice ER doctor who said that the pain medication I was on was for “delicate old people, and BABIES,” and gave me a shot of Di1audid which did nothing for the pain but knocked me right out so I got a few hours of sleep, and then in the morning Paul called the surgeon who saw us a few hours later and prescribed 0xyc0ntin and m0rphine, and now I can sleep, and sit, and do my little exercises. (The surgeon had not prescribed the 0xyc0ntin earlier, because another doctor 20 years ago said I was allergic to Perc0cet, and people allergic to Perc0cet but not acetaminophen are allergic to 0xyc0ntin. But I am taking the 0xyc0ntin and, separately, acetaminophen, with no allergic reaction. This means mathematically that I am NOT allergic to Perc0cet, and now let’s see how difficult that is to get changed in my records.) (I hope this is all making sense. The pain medications don’t make me feel high, but they do make my thinking feel gappy.)

I am in that stage of recovery where I wake up, make my way to the bathroom, brush my teeth, take my pills, eat some breakfast, wash my face, redo my ponytail, do my physical therapy exercises—and it’s lunchtime and I need a nap. The whole day goes like that. I have not read one single book or magazine. I have broken some of my Wordle and phone-game streaks. It wasn’t until three days after the surgery that I managed to take a patchy sponge bath and change my clothes. I’d thought I was going to binge-watch TV series and be really bored, but the whole day is just eaten up.

I am fairly covered in bruises. It took three tries to do the IV, and I have a big decorative bruise for each one, and also a bunch of pretty bruise-dots where they put the tourniquet. The surgical leg is 1.5 times the width of the other, and is very bruised, including a big garter-like dotted bruise where they put THAT tourniquet. The ER doctor clucked over me in a pleasing way: “Oh, look at this. My goodness. What did they do to you.”

Today (Saturday) is the first day I’ve had an appetite. Paul has been putting food in front of me and I eat it and it tastes good and makes me feel better, but today is the first day I’ve thought of food and wanted some.

I can go up and down stairs with a cane and the railing, but I need someone else to carry my walker up/down and meet me with it when I arrive. If this were going to go on longer than a couple of weeks, I would get a second walker; as it is, people are home anyway and it’s no big deal to ask one of them to transport the walker.

I am still sleeping in the recliner downstairs, even though I can do the stairs. There are several reasons which now seem almost too boring to list. The number of times I get up in the night, and how much noise I make doing so. I can’t roll over anyway, and it’s easier to sleep on my back in a recliner than in a bed. Paul’s snoring. A series of events that meant Paul would be gone several early mornings and I would be stranded upstairs until the kids woke up. The complication of middle-of-the-night medications. Anyway I am still in the recliner, but hope to soon be back in a bed.

I have put my earrings back in. I took them out as instructed for the surgery, and my ears felt weird and naked. But it wasn’t until three days later that I gathered the necessary resources to put most of them back in.

Thank you all so much for your meal-replacement drink suggestions. Every time I ask a question like that, I think this time I am asking TOO NICHE a question and will not be able to get information—and then it turns out that not only do LOTS of people have LOTS of good suggestions, but SOMEONE has just done a NINETY-PAGE COMPARATIVE REPORT ON THE TOPIC!!

I went partly on group opinions, partly on ease/speed of acquisition, partly on price per serving, partly on variety, and partly on vibes, and this time I bought a tub of Orgain meal-replacement powder, a single bottle of FairLife (our grocery store had singles), and a 12-pack of OWYN complete-nutrition shakes on sale. If he is still interested in this idea at the next gift-giving occasion, I have the comments section ready to revisit. I was very keen on the Oats Overnight idea, and will almost certainly get that next time; I would have gotten it this time, but stalled out over the big discount / free bottle they offered for subscribing (when I don’t WANT to subscribe). How to make myself pay $60, plus $9 for a mixing bottle, when they are offering the same bundle for $45 total if I subscribe?? I need 11 months to get over that hurdle.

My knee-replacement surgery is this coming Tuesday, and I am pretty nervous. I have not been sleeping well. I am nervous (as usual with all such things, including for example driving to an unfamiliar location an hour away) that I will die. I am nervous that this will turn out to have been The Wrong Decision, and that I am embarking on a long process of getting an infection, needing to remove and replace the replacement knee, and then of course eventually losing the leg. I am nervous there will be numerous health insurance complications and struggles, and bills suddenly arriving 18 months later, and the provider and the insurance company sending me back and forth between them when truly the only way to solve it (if they wanted to solve it) is for them to talk to each other. I’m nervous about not being able to shower for two weeks.

I am nervous because the instructions in my tidy folder from the hospital are clearly pieced together from multiple surgeons and offices over the last decade, and no one has ever made sure they make sense together. I am instructed on three separate pieces of paperwork to stop drinking alcohol two weeks before surgery, to stop drinking alcohol one week before surgery, and to reduce alcohol two days before surgery. (I cut out alcohol one week before surgery.) I am instructed that I MUST bring a walker to the hospital with me so that Physical Therapy can show me how to use it, or else I will not be discharged; I am instructed to acquire a walker but PLEASE DON’T bring it to the hospital; I am instructed that a walker is an optional but highly-encouraged purchase. (I have acquired a walker and will leave it in the car. Paul can fetch it if needed.) I am instructed that two weeks before my appointment I will be required to present myself at the hospital for a covid test, and that after that I must quarantine completely and be re-tested on the day of surgery; this no longer seems to be the case, but here is the paperwork in my folder. One set of instructions says that there will be a mandatory Joint Replacement class at the hospital taught by a nurse, and that I will be getting a call to set that up; another set says that this mandatory class will be held over Zoom, and that I will receive an email with a link. I have not heard anything else about any class, nor did they mention it during the pre-surgical assessment; there is a stapled print-out in the folder that looks like exactly like a print-out of slides from such a class. One set of instructions says I’ll be going home the same day as the surgery, and that’s what the pre-surgical nurse said; most of the other sets of paperwork assume I will stay at least one night, more likely two or three; I am instructed to bring at least two changes of clothing. (I will bring a bag with spare clothing, and will leave it in the car with the walker.)

I am nervous because I don’t know what the next six weeks after the surgery will be like, and of course it goes differently for different people. I don’t know how much pain to brace for, and of course it’s different for different people. I don’t know when I can go back to work, and of course it’s different for different people/jobs. I don’t know if I’ll be bored and restless, or if I’ll be contented and napping and reading and feeling pretty busy with physical therapy. I don’t even know how often I’ll be going to physical therapy: the paperwork says 1-3 times a week, and I don’t know who decides that, or how. It’s a $30 co-pay each time, so I’m pretty interested.

How did Christmas go, if you do Christmas? Feel free to say things that went well, or vent about things that went poorly, or both. Ours went well, except I found it exhausting, and now we have all caught a cold. This is giving us flashbacks to last year when we caught what the doctors thought was influenza A, and we were sick for weeks, and half of us had ear complications. This time it seems to be just a cold. I am nervous I will be sick too close to my knee-replacement surgery and they will have to postpone it. Apparently they will even postpone it if I have a small cut, like from shaving, so they advised me NOT TO SHAVE for a week before the surgery!

I am trying to avoid buying too much Christmas clearance. I don’t know if this will work for your own temperament, but I find it soothing to think “I have enough”: it seems to calm that impulse to buy MORE MORE MORE BECAUSE IT’S SUCH A GOOD DEAL AND I LIKE IT. I have enough (too many) ornaments, so I said no to many, many cute clearance ornaments, and only bought a very few. I have enough wrapping paper. I have enough Christmas plates/mugs (though I could buy more bowls if I found some). I have far more than enough candy/treats, even if they ARE on a really really good clearance (*experiencing pain*). Yes, I like/wear Christmas jammies/t-shirts, but I have enough of them. I don’t use the decor I already have, so I don’t need more. I have enough!

This is a niche request, but I’m wondering if anyone knows anything about meal-replacement powders/drinks. Rob’s birthday is shortly after Christmas, and he is so hard to buy for, and literally the only idea he’s given me is that he usually drinks Soylent but he’d be interested in trying alternatives. I started looking into it and got almost immediately overwhelmed—and also, I don’t want to accidentally buy one that supports some gross radio host or something. Some(/most) of the marketing of this kind of drink gives me icky Basement Reddit Guy feelings.

Rob drinks at most one meal-replacement drink per day, and his goals are to supplement his nutrition, and to simplify his food (by eliminating one meal he has to think about and shop for and cook) (he has a subscription to the Soylent, so it arrives automatically by mail). He’s a vegetarian but not a vegan. He’s the kind of person who would enjoy an ethical slant: like, he buys eggs from companies that treat the chickens nicely, and he’s mentioned that he might even be willing to eat meat if he could be sure it was ethically/kindly/environmentally raised, and one of the other gift ideas he likes is donations to charities he supports.

So what I’m hoping is that you or someone you know is similar to this, and that this will be your moment to shine and my moment to benefit. You will say “Ah ha!!! I was HOPING someone would ask! THIS meal-replacement drink is women-owned and the proceeds go to support equality, and also it is made from organic, fair-trade ingredients, and also it is surprisingly nutritious for a meal-replacement product!” Well, or it doesn’t have to be THAT perfect. I would also be really glad to hear “I buy this one! It tastes pretty okay and I don’t get too many Icky Reddit Guy vibes from the marketing!”

Did you put together a large Christmas puzzle this year? WAIT! Don’t take it apart just yet! Do what my mom did, and divide it into 25 sections, and put each section into its own lil numbered baggie, and make it an Advent / countdown-to-Christmas calendar for next year! You can number the baggies however you like: maybe you want them RANDOMIZED, so that the little puzzle-segments accumulate on the table but can’t be joined up yet! maybe you want them ORDERLY, so that the upper lefthand corner is day 1, and the next segment to the right is day 2 and joins up with it, and so forth! You can impose your own will, and you can change your mind next year if you want, simply by putting different puzzle-segments into different numbered baggies!

I had photos to illustrate this concept, but I seem to have misplaced them.

I’m so busy. I’m so busy. Are you SO BUSY?? It feels like one thing after another, and never done. But I know we are near the point where suddenly Everything Will Be Done. Ideally without any of us having murdered the spouse relaxing in the next room.

There are holiday things I like to do (festive baking, and distribution of same; holiday festivities with friends; doing a Christmas puzzle; leisurely Christmas shopping in stores; reading Christmas books by the Christmas tree; tipsily watching the movie A Bad Moms Christmas; writing gift-idea posts; thinking in a more leisurely way about presents; contemplating/implementing a wider spreading of festive feelings/treats/donations to people/businesses outside our own household; going to holiday fairs / special Christmas-light displays / holiday performances) that didn’t get done this year because I was busy doing Everything That Literally Had To Be Done; I wonder if next year there are some adjustments that could be made so that people who are 99% enjoying the holiday, and doing every blessed thing they want to do, while jovially complaining about the ONE PERSON they have to shop/wrap for and the ONE SINGLE THING they do to contribute, could be better balanced with those of us 10% enjoying the holiday and doing 99% of the work and missing out on many of the things we want to do.