Tai Chi improves quality of life in heart failure patients

By Nancy Walsh, Staff Writer, MedPage Today
Published: April 25, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner


Heart failure patients may experience improvements in their quality of life and mood by participating in a tai chi exercise program, a randomized study suggested.

The small study of patients with chronic systolic heart failure found that disease-specific quality of life -- measured on the Minnesota Living with Heart Failure Questionnaire -- showed benefits among those who took tai chi, with scores falling from a median of 28 at baseline to 9 at 12 weeks, according to Gloria Y. Yeh, MD, of Harvard in Boston, and colleagues.

In contrast, quality of life scores for the HF patients in an education-only control group were 21 at baseline and 22 at week 12 (P=0.02), the researchers reported in the April 25 Archives of Internal Medicine.

Action Points
________________________________________
 Explains that patients with heart failure may experience improvements in their quality of life and mood by taking part in a tai chi program.

 Note that limitations of this study include lack of blinding and its short follow-up period.
As well, mood improved among the tai chi group as measured by the Profile of Mood States, decreasing from a baseline score of 10 to 4 after 12 weeks, compared with scores of among controls that stayed close to baseline levels at week 12 (P<0.001).
Tai chi, with its "gentle meditative exercise of flowing circular movements, balance and weight shifting, breathing techniques, visualization, and focused internal awareness," is increasingly being adopted for use in various medical contexts, Yeh and colleagues observed.
They postulated that tai chi could be particularly helpful for frail older patients with debilitating heart failure, because of its multiple effects including increasing strength, training of the extremities, and mild aerobic actions.
To explore this issue, the researchers enrolled 100 patients, between May 1, 2005, and September 30, 2008, randomizing them to hour-long classes twice weekly of tai chi or to educational modules designed by the Heart Failure Society of America.
Mean age was 67, mean left ventricular ejection fraction at study entry was 29%, and peak oxygen uptake was 13.5 mL/kg/min.
Most patients had New York Heart Association class II heart failure and were receiving a beta-blocker and an angiotensin-converting enzyme inhibitor.
Almost one-third of the patients had a history of depression and anxiety.
After 12 weeks, there were no differences between the groups in change in six-minute walk distance or in peak oxygen uptake.
There was, however, an increase in metabolic expenditure outside of the class in the tai chi group (323 versus 156, P=0.05).
Patients in the tai chi group also reported benefits on mood.
Those patients improved on the total mood disturbance subscale of the Profile of Mood States -- consisting of 65 single-word items rated on a five-point scale to indicate recent mood in six dimensions.
Patients in the tai chi group decreased from an overall baseline score of 10 to a score of 4, while those in the control group had scores of 18 at baseline and 17 at week 12 (P<0.001).
On the depression subscale of that rating tool, scores decreased from 2 to 0 in the tai chi group, and increased from 3 to 4 in the control group (P=0.004).
On the vigor subscale, the tai chi group increased from 8.5 to 9, while the controls fell from 8 to -2 (P<0.001).
Significant benefits also were seen in exercise self-efficacy (P<0.001).
In addition, post-hoc analyses showed benefits for tai chi in patients without implanted cardioverter-defibrillators (P=0.04), in those with class II and class III symptoms (P=0.01), and in patients whose heart failure was not ischemic (P=0.03).
There also were greater improvements in disease-specific quality of life among patients in the tai chi group who had higher baseline resting heart rate.
"One of the purported mechanisms of mind-body exercises, such as tai chi, is favorable modulation of the autonomic nervous system," the researchers explained.
This may help explain their post-hoc finding of greater benefits in patients with high resting heart rates, "and presumably more sympathetic nervous system overdrive," they suggested.
The researchers noted that the importance of patient quality of life in heart failure increasingly is being valued.
"We observed large, clinically significant changes in quality of life in this study, similar to or even greater than what has been seen with cardiac resynchronization therapy," they wrote.
The improvements in mood were "highly relevant," they said, emphasizing the close link between heart failure and depression.
Limitations of the study include lack of blinding and its short follow-up period.
Additionally, only a small proportion of the more than 500 patients who met inclusion criteria actually enrolled in the trial, producing a small sample size which could have introduced selection bias.
To minimize potential disappointment among the education-only group (which could have affected scores), tai chi classes were offered at the end of the follow-up period.
The investigators were also unable to provide a "definitive physiological mechanism for tai chi's effects."
Nonetheless, they argue, this study provides informative data from the first large-scale clinical trial of tai chi exercise in an HF population.
Future work should address the potential mechanisms of effect as well as how programs such as this could be implemented into community practice.
In an invited commentary, John R. Teerlink, MD, of the San Francisco Veterans Affairs Medical Center echoed the call for further research into mind-body approaches such as this for heart failure.
"Mind-body medicine holds tremendous potential to improve both functional capacity and health-related quality of life in patients with [heart failure]; it is time to give these therapies the studies they deserve," he wrote.
The study was supported by the National Center for Complementary and Alternative Medicine and the National Institutes of Health.
The authors and editorialist reported no financial disclosures.


Primary source: Archives of Internal Medicine
Source reference:
Yeh G, et al "Tai chi exercise in patients with chronic heart failure: a randomized clinical trial" Arch Intern Med 2011; 171: 750-757.

Additional source: Archives of Internal Medicine
Source reference:
Teerlink J "Mind or body: evaluating mind-body therapy efficacy in heart failure trials" Arch Intern Med 2011;171:758-759.

Poem written at 27

Do your own thing

When you don’t succeed in what you face
Be like the fly
But don’t die
Or tell a lie
Let it by.

When time comes at too fast a pace
Always delayed?

Time is weighed

Decide, not dismay

Play, don’t be played

Always want to have a seat and not race
Instead of your client
Never be suppliant
Or always reliant
Just a little defiant

You say you get to use the place

Because you obey the rule

Let efficiency be your tool
And laziness your jewel
Stay on that mule!

Have you always wanted to have your space?
Hear songbirds sing?
An Italian bell ring
Instead your hands wring?
Do your own thing.


Doin it then



Doin it now

Alaska Hideaway Trivia Contest

For each question, please fill in the blank, or, where indicated, circle the correct answer. Please use ink.
1. “Kid Shelleen” appears as a character in what feature motion picture? ______________________ (extra credit – who played the part?) _____________________

2. One of Superman’s foes must be made to say his name backwards to cause his return back to the fifth dimension. What is that foe’s name backwards?________________________________

3. What is unusual about the following paragraph?

“Have we lost the green earth that once we shared? Soon our air will be too foul to breathe, the sun but a blur, fish and birds gone, our trees dead, our food scarce. It’s hard to know whom to blame, what to do, where to start. But there is hope. We can learn the facts, so we can be of some help, each in his or her own way. May we count on you? Will you join us? Act now. Please send your thoughts to ‘Face Lift U.S.A.,’ care of Al Gore, the White House. Thank you.”


4. George Bessselo is the real name of what former TV actor? ______________________________

5. A certain magic word changes Billy Batson into Captain Marvel and back again. What does the fourth letter in that word stand for? ____________________________________________

6. Name the first female member of England’s Parliament. ______________________________

7. “_________________________________________” (three words) are licenses to “fit out” armed vessels and employ them in the capture of an enemy’s merchant shipping.


8. Who composed “Lucia di Lammermoor?” ___________________________________

9. What is the answer to the riddle, “Brothers and sisters I have none, but this man’s father is my father’s son”? ____________________________________________________


10. The initials BVD (yes, the men’s underwear) stand for the names of the three men who originally manufactured BVDs. Who were they? _______________________ _____________________ and ___________________________

11. Besides their colorful names, what do the following men have in common?
Shine Cortazzo, Buttercup Dickerson, Malachi Kittridge, Tex Neuer, Prince Oana, Orval Overall, Ty Pickup, Squiz Pillion, Shadow Pyle, Tony Suck, Clay Touchstone, Yats Wuestling, Earl Yingling. __________________________________________________________________________

12. What is the shortest verse in the Bible? ___________________________ Chapter & Verse?
____________________ _________________________

13. Name two words that contain the vowels a,e,I,o and u in their prescribed alphabetical order? __________________________________ __________________________________

14. What is peculiar about the following date and time – the sixth day of May, 1978, at 12:34 –that will not be repeated again until the year 2078? ______________________________________ ________________________________________________


15. Who spoke the line, “Play it again, Sam,” in Casablanca”? ______________________________

16. Is “Comfort the aggrieved” one of the 7 works of Mercy? Yes No

17.What is Chuck Stobb’s claim to baseball fame? _______________________________________

18. For what distinction in literature are the falls of Reichenbach known? ____________________________________________________________________________________

19. This word describes a Calvinist who believes that God’s determination of the elect preceded the fall of man from grace and that the fall itself had been predestined. Name it: _______________________________________________

20. Which feature motion picture famously boasted the song “Indian Love Call”? ________________________________________________________________________

Answers to Alaska Hideaway Trivia Contest

1. "Cat Ballou" Lee Marvin played the academy award winning role.
2. KLPTZYXM
3. this paragraph has exactly 100 words, all of one syllable.
4. George Reeves, who played Superman. Other names published as his real names are George Basselo, or George Brewer.
5. SHAZAM Z stands for Zeus' power.
6. Nancy, Viscountess Astor.
7. "Letters of marque"
8. Gaetano Donizetti
9. "this man's father is me(yourself). "This man" is your son.
10. Bradley, Voorhies and Day, the last names of the founders of the company.
11. They are all former Major League baseball players who played pre World War II, some only one game. The are now all deceased.
12. "Jesus wept", John 11, verse 35.
13. abstemious and facetious.
14. the consecutive numbers 1 to 8: 12:34 5/6/78
15. No one. The actual line was "Play it, Sam".
16. It is NOT one of the 7 Works of Mercy.
17. Chuck Stobbs was the pitcher who threw the pitch that Mickey Mantle hit out of Griffith Stadium for his famous 565 foot home run.
18. Reichenbach Falls was the place where Sherlock Holms and James Moriarty died in the Arthur Conan Doyle story "The Final Problem" published in Strand magazine.
19. supralapsarian
20. "Rose Marie" (1936, starring Nelson Eddy and Jeanette McDonald)

This trivia contest was nationwide and offered a prize of a vacation home in Wasilla. I was the winner of this contest. The minimum amount of money raised at $100.00 an entry was not met. I won about $9,000. This contest was held in 1995 before internet searches were possible. I spent a total of two solid weeks in the Anchorage Public Library researching the results.
There was a legal disagreement about the answer to question 19. Another contestant gave a more general term as his answer: predestinarian. All predestinairians are not Supralapsarians.

Meeting Rules written by Alaska Native Students

Traditional Rules for Conducting Meetings
• Listen without agenda.

• Everyone has his or her own truth, and each person’s truth is equally valid as everyone else’s.

• What we choose to focus on becomes our reality.

• Negative words, criticism and personal attacks close peoples’ hearts and prevent real listening and dialogue.

• Affirmations stimulate listening and respectful dialogue.

• Humor is important.

• Discussion and decisions made should be made with the health and wellbeing of future generations in mind.

• Consensus should be the goal of any gathering.

• Emotions and feelings are good to express, as long as it is not directed to hurt anyone.

Meeting Rules

• When someone is speaking, others should not interrupt.

• There should be no personal attacks, only affirmation if possible.

• Be considerate of others who wish to speak and be mindful of the amount of time that you use to make your points.

• Treat everyone with respect at all times.

• Understand that words have power to hurt others or to empower them.

• As much as possible, focus on solutions. We are good at talking about the problems and not as good talking about the solutions.

• Listen without agenda to hear the truth of those who speak.

Tai Chi and Healing

From “O” Magazine, April, 2011 entitled Feeling Good, Healing Thoughts p.128

“Try Meditative Exercise. We know tai chi has all sorts of benefits, and here’s one more: In research conducted at UCLA, 61 older adults took tai chi classes three times a week, while 61 others attended health education classes. At the end of four months, both groups received a dose of the shingles vaccine—and the tai chi group achieved twice the level of immunity. ‘It’s likely the meditation component that is causing the effect.’ Says study author Michael R Irwin. ‘Which means it’s possible other forms of meditative exercise, like yoga, would lead to a similar boost.’”

My Day as an Election Official

April 5, 2011.


The Anchorage Municipal Elections were held Tuesday. I agreed to be an official again, which I vowed I wouldn’t do after the November general election left me exhausted, but my friend Barbara asked again.

I arrived at 6:30am just as a snow storm began with big white flakes. From our vantage, it looked like the snow on TV when it isn’t in tune with the station. The halls of West High were unusually quiet because the 9th and 10th graders were testing. They gave us one less table because of this.

As the voters drifted in through the snow, one or two at a time, we watched the snack and drink machines being refilled, and a security guard sitting suspiciously quiet by the front door. I later tried to get a drink but the machine kept taking quarters and not registering any money. I left my cell phone in the bathroom where I had removed my long underwear since we didn’t have a cold draft as I had anticipated. The sly sleepy security guard had it, thank goodness.

My job was to find the voter’s name on the register, highlight the box above it, X in the box whether they gave me a Voter ID, were personally known (PK), or “other ID”. This was usually a driver’s license, but could be a soldier’s ID who just got back from Iraq and couldn’t wait to go again (he came with his parents who were very proud). Then I turned the whole register around for their signature in the highlighted rectangle. If it was busy, they received a card saying “Signed register” and passed it to Pat who handed them a ballot inside a security folder, and then were told to be sure to vote both sides of the ballot.

Another official stood by the big black box where the voter put the security sleeve with ballet. It magically sucked the ballot out and counted the votes. You could put the ballot in either side top or bottom and it still could count correctly. At this station, you got to hand the voters their “I voted today” sticker. While you waited for a finished voter to supervise the sucking of the ballot (sometimes they wouldn’t go through), you could tear off stickers ahead of time. Barbara told us that years ago the League of Women Voters gave out small yellow feathers to voters, but they became too expensive.

I had the alphabet from A to K, and Margaret had K to Z. In the morning, the line was longer at K to Z. In the afternoon, it was reversed. Someone said that A to K slept in. Everyone was patient in line, even when the official knew the signing voter and was having a conversation about their children or their recent travels, plumbing problems or knitting.

Most of the officials have been doing this job for 30 years or more. The voters still asked about Pauline Martin who died two years ago who was the head official for eons. The other long time official, whom I think I replaced, just lost her husband, so she may be able to replace me when I move. This continuity of service results in a neighborhood open house. Everyone has the opportunity to catch up on all their neighbors, and not just the officials. Voters talk with other neighbor voters. We should offer coffee and cookies so they could justify staying even longer and running into even more neighbors. Our precinct has a higher that usual turnout, most likely because of this once or twice a year gathering. Margaret knows so many people (she is proud to mark PK when they sign the register), that she can recognize and differentiate Elizabeth S _____ and Elizabeth K ______ who both have the same last name.

It amazes me that there are so many elderly voters who come faithfully. Wheelchairs, canes, shuffling walk, (through that snow, remember). Many have family members or caregivers assisting. One elderly lady said she had voted in every election since she was 21. Old sourdoughs, whose names everyone in Anchorage are familiar with were there. One such lady (I PK her because she is a neighbor) still has her upturned 1950’s glasses and ‘50’s fur coat, all decked out with full makeup and high heels. Another conversation in this over 80 (even 90 to 100) crowd is about who died last year. One notable voter who lost her former Governor husband recently, and always wears a hat, probably voted absentee this year. We all looked for her.

The most interesting part for me was recognizing the faces of so many people I have known who have drifted in and out of my life through the 35 years I’ve been in Anchorage, and how much older some of them look today. I guess I look older to them as well. It is even more poignant since my husband and I will be moving out of Anchorage in June.

Throughout the day television crews visit our precinct. For some reason they always choose Precinct 645. I was probably on two channels at least. We usually have a notable candidate or two who vote here. Too bad we don’t have Sarah Palin. I would have been interested to see if she had a retinue, and if she brought a child or two or three.

We have over 1,600 people on our register. However I recognized several, who had passed on, or moved out of state, or lived elsewhere now. Questioned ballots, a tedious process, are usually used by voters who have moved and don’t know yet where their new precinct is located. The questioned ballots are “gently” folded in thirds and placed in a special envelope by the voter.  One couple who could have given birth to their twins that day, lived within walking distance, but their precinct was at North Star school.  They patiently filled out their questioned ballots after venturing to the State voting location which was closed.

So out of 1,600 on the roles, we had 596 ballots. If you allow for a 20% inaccuracy of the register, and the number of absentee and early voters (another 10%), we had a pretty good turnout. I get 57%. At the general election in November with the write in candidacy of Lisa Murkowski which drew lots of reluctant voters, we did exceptionally well for a mere Municipal election. With these calculations Iget 57%. Usually Municipal elections garner 20 to 30%. All day we set goals, the first being 400 voters. We cheered when we reached 500 and were rooting for 4 more voters to make the total 600. We had one last “runner” at 7:59pm. We actually had over 600 if you count the questioned ballots.  We still got comments from the older voters about how sad it is that so many US citizens don't vote, and how many wars we fought to have the privilege.

At the end of the night, all the officials have to sign the results tape to certify the election in our Precinct. At that time we get to see how the vote went. The advantage of being an official is this firsthand knowledge of the results. For example, I knew right away in November that Lisa won.

We have to sign many other forms and pack all the materials in a certain way (this envelope goes in the green bag, this is sealed and goes in the red bag, etc.). All the leftover ballots are counted and returned, even the stubs. Thank goodness we don’t have to disassemble the booths, tables and chairs or the big black box. A separate crew does that in the morning. Our officials need every one of us to help 80 plus year old Barbara put the materials in the back of her car to take to election headquarters. Helpers unload it for her. Our day ended at 9:00pm, 12 ½ hours later.  The 4 inches of snowfall had all melted.

Random Reflections on Growing Old

Excerpts from:
Random Reflections on Growing Old, compiled by Edna B. McBride
This is a small blue hand yarn tied book published by Gateway Printing, Seattle, date unknown (very old book)

Let me grow lovely growing old,
So many fine things do:
Laces and ivory and gold
And silks need not be new.

And there is healing in old trees;
Old streets a glamour hold;
Why should not I as well as these
Grow lovely growing old?

The Old Woman

As the white candle in a holy place,
So is the beauty of an aged face;
As the spent radiance of the winter sun,
So is the woman with her travail done,
Her brood gone from her, and her thoughts as still
As the waters under a ruined mill.

In youth, mistakes seem irreparable, calamities intolerable, disappointments unbearable. But mistakes can often be set right, calamities may have compensation, and a disappointment is often of itself a rich incentive to try again.

Much more important than adding years to one’s life, is adding life to one’s years.

Beauty in youth is but an accident of nature; beauty in age bespeaks a beautiful life.

Ida M. Tarbell at 75 said, “Growing old is living in the past. Living in the present is the secret of not growing old.”

They used to say that a woman is as old as she looks, and a man as old as he feels. I believe thy are both as old as they think.

“Daddy, are you getting taller and taller? ‘Cause the top of your head is poking up through your hair!”

We do not count a man’s years until he has nothing else to count. – Emerson.

If you keep your spirits high you won’t need to have your face lifted.

For a long life, be moderate in all things, -- but don’t miss anything.

Probably the greatest ten years in a woman’s life are the years from twenty-eight to thirty.

When Oliver Wendell Holmes was still on the Supreme Court Bench, he and Justice Brandeis took daily walks. On one occasion Holmes, then ninety-two, paused to gaze in frank admiration at a beautiful young girl. “Ah,” he sighed, “what wouldn’t I give to be seventy again!”

The great essentials of happiness are: something to do, something to love, and something to hope for.

Diary of a knee replacement

Knee Replacement Diary by Dorothy Case, wife of David Case who had the replacement, beginning January 13, 2011
Dr. Linda Rasmussen performed a knee replacement of David’s right knee around 11:00am Friday 1/13/2011. It took her 39 minutes to perform. She said it went perfectly. However, his knee was really a mess. She said from a 1 to 10, his was a 10. She said other doctors send their problem cases to her. Hopefully that is true and this is a success.
Day 1: David came back to his hospital private room in the Ho’Okipa ward at Castle Medical Center in Kauai, HI around 2:30pm. He felt great. He had a hearty lunch at 3:00 and then ate the regular dinner as well. I left around 4:00 to beat the H 1 traffic. He was doing well on all the drugs. He could feel his feet and could move his toes. He did his breath exercises and sat up in a chair.
Day 2: Saturday, I got there in the AM early and he was sitting in a chair. His PT was bending your ankle forward and back and sliding the knee up and back using a cheat sheet in bed. He had PT in the afternoon. He achieved a 108 bend and almost able to straighten it to 180. Nothing hurt. He shaved. He ate heartily lunch and dinner. I left a little later. He had an okay night. His hgb was 8.6 – low. He used the urinal and bedside commode. He put on his own shirt and the black baggy pants which ended up being a problem maneuvering what with the knee drain and leg squeezers and the IV tubes.
Day 3: Sunday, his hbg was 7.6. I called and he was up walking to the bathroom with a walker. He was feeling weak. They gave him a shot of Procrit. They offered to give him a transfusion. He consulted with my brother David and agreed that he needed it more than the risks. They began the transfusion shortly after I got there. We were supposed to have a celebratory lunch together provided by the hospital, but David didn’t even want to eat. His leg was cramping a lot and it helped to massage it. You could tell that the whole leg had swollen a lot. He could no longer straighten his leg or bend it as much. I think the pain meds they injected right into the knee finally wore off. He lay in bed and slept most of the time for the transfusion. About 3:30 after it was infused, he started to feel better. He shaved. He ate a light meal. I left at 5:30 and felt guilty I had to leave. He seemed to rally the rest of the evening and tolerated some more PT. He used the urinal and bedside commode.
Day 4: Monday. I got a new rental car, a Chevrolet crossover which has a hand hold and bucket seats that are higher so he can get in and out. When I got to the hospital, he was much better. He had already shaved. PT included instructions on walking with the walker: you don’t have to look down, take even steps, Up with good leg, down with bad. Going up stairs can be one step at a time, good leg first, or sideways. More ankle pumps and knee bends with the cheat sheet. Saw a going home movie and got the walker he can take home. He achieved his goals of walking up and down three times, own personal care, bowel movement, knee flex of 88 degrees, up from bed while flat, ate dinner in a chair.
Day 5: Tuesday. Marriott provided a shower chair, a toilet riser, and a wheel chair. Discharge day spent talking to Dr. Rasmussen about therapy. Got prescriptions but their pharmacy wouldn’t fill them so we went to Costco. David took a shower and ate lunch, leaving about 1:00pm. We stopped at Costco for pills. Not open. Took him back to hotel and I returned alone and got the pills and shopped for two weeks of food.
Day 6, Wednesday. David spent most of his time in bed, got up to the deck, ate dinner at the table, iced when down, did exercises, was very concerned about bowel movement. He ate papaya, took the senna tablets, and made a lot of noises. There are a lot of sound effects associated with this recovery. His voice is softer again, and he coughs a lot. He is getting stronger. He took a shower. I am sleeping in the other bedroom. The ice pump is going, he is up and down, using the urinal, etc. I don’t see how anyone could sleep in the same bed as a knee replacement patient for quite awhile.
Day 7: Thursday. I made Hawaiian sweet bread French toast for breakfast. Then we went to PT in Kailua with Kelly at 1:00PM. Dropped David off and I went to the beach. Had a disagreement about how much help he needed. He didn’t want me to be telling him what to do or help him, so I didn’t, but then I didn’t help him when I should have. Hopefully we have worked it out. My neck, shoulder and elbow are sore and I could not lift the wheelchair into the car which it turned out we didn’t need. I was surprised that PT was all the way on the 2nd floor, impossible to get to without a wheelchair. We switched the appts all to that one location, but for some reason, the next appt isn’t until next week. This week is crucial for the therapy, so he will have to work extra hard on his own. He has three sets of exercises to do a day. This was a frustrating day for me.
Day 8: Friday. He wanted an egg for breakfast. He says his body is craving certain foods which he never remembers doing before, mostly protein and fruit. He did his exercises, took a shower and shaved, and then we went to the Ihilani Hotel for lunch using the wheelchair. Along the way it broke, so we exchanged it. Had a nice lunch at their pool and watched the high surf crash over the rocks. The lagoons are closed for the first time ever because of the heavy rains Monday night (that I drove home in) that washed debris from a dump. It is a real disaster for the resorts. No one has been on the beach for a week. We spent 2.5 hours on our outing, so we came back and he did his exercises in bed and iced. My routine is getting ice for the ice bucket, ice for the water pitcher, feed him etc. It is actually a good thing we are here for me because I don‘t have to worry about distractions like wanting to go walking, work out, bridge, OLE classes, etc. Since I’m not there, I can’t do them! So I am free to just have the stress of taking care of David and nothing else.
Day 9: Saturday Jan 22: I started writing this diary. David is learning when to take the pain pills and how much. Papaya and lots of fruit is helping the constipation. He still craves eggs and protein and is doing his exercises faithfully. We put a pressure sock on last night and this morning to help the swelling. They didn’t tell him to keep it on after he got out of the hospital and the PT wondered why he didn’t have it on.
Day 10: Sunday Jan 23: David is better and better he says. He walked from the walker about 3 steps to the wheel chair. We spent some time at the pool; he was on a pool recliner. He wheeled himself in the Naia tower to check out the location of our new room. At sunset he wheeled himself to see it at the end of the wheelchair ramp. His exercises are better; he can initiate lifting his leg straight, and sitting in a chair. It looks like the swelling is going down, maybe 1/3 what it was. Swelling is still preventing further bending progress as is the scar tissue. He knows he has to take a pain pill before doing the exercises. He does them 3 times a day. We moved rooms which was quite a hassle and tiring.
Day 14: Jan 27, Thursday. Today David had his therapy. He was told he could graduate to a cane now instead of the walker. His extension is pretty good. They had him do stuff on a bike. They tried to push his flexion and got to 108 degrees. That is the part that is very difficult and painful because of so much swelling still. He still has bruises. They told him to move the tissue around the incision to break away the adhesions there. We read that he should be using compression socks for 4 to 6 weeks. He hasn’t been using them for a week. He goes again tomorrow, so I guess they are going to push on his leg more to get more flexion and it will hurt. He is still coughing and has fevers at night. His hip is hampering and so is his ankle. I don’t see this as being a piece of cake for him. Kelly said he’s seen better and worse at this stage. He was going to do some work on the computer at Nancy Shannon’s while I played bridge but he walked around in the yard and got tired and rested. He gets pooped out at night.
Day 17: Sunday, Jan 30¸2011. The big move day from Marriott to Paradise Bay “Resort”. We had to pack last night and get out of there early in order to take the car to Avis and get over to the Windward side before the ProBowl traffic, which we did. We hung out at Nancy Shannon’s while David iced and did his exercises. Then we checked in over here. So we do have two bedrooms, a kitchen and TV and even a handicap type of bath. The manager bought David a nice walker but he is now using the cane exclusively. We gave up the wheel chair. Yesterday at Ko’ Olina we went on a long walk/wheelchair ride where he got out and walked for awhile. Then we went to the pool and he swam a little. The routine is he exercises in the am before I am awake, then ices after. Exercise in PM, ice, evening, ice, with icing, walking, daily tasks, in between. The swelling is down but not gone, the scar is getting less red; he is using mucinex expectorant to get the stuff out of his chest, and taking pain meds on a regular basis. I guess he has the constipation under control with the senna they gave him and fruit. He seems to be tireder than usual today. Nancy says there are good days and bad. It was really nice of her to let us hang out there. David achieved a lot of bend the other day, and there is a wrinkle at the top of his knee scar where the skin allowed the new movement it seems. He also wears compression socks all the time now. We are here now for a month and I have no idea what we are going to do. It is a cramped space and nothing to do around here. There is a pool. Everything is really run down but they are slowly fixing it up. We walked down the road among the feral chickens, cats and peacock. Across the street is a teal colored parrot.
I have to have a paragraph about Nancy Shannon and how wonderful she is. We literally couldn’t have had this surgery without her and all her help and hospitality. It was her knee doctor, and she recommended David get the surgery in Hawaii. Several times we stayed at their house and David rested and Nancy cooked dinner. We really enjoyed her and Don’s company. They made it happen.
Day 19: Tuesday Feb 1: yesterday we walked around the property. Then we went into town to the P.O. and shopping for groceries. Then we went to Frommagio’s for lunch, risking our groceries. We took the frozen stuff inside the restaurant! Drove home. David rested and iced. Stayed in room resting until after Ellen TV show. Then we walked down to a park and watched fishermen who had walked way way out into Kaneohe Bay. Then walked back. David was exhausted. They were sawing and pounding with electric tools all day here but they say the main building will be done today. It is a little quieter now. Anyway, yesterday, he did a lot and got really tired. He is taking pain meds all day long. We are massaging the scar and he wears compression socks all the time and elevates his leg. He just uses the cane.
Day 20: Wednesday: Therapy at 2:45. He went all the way around on the bike. Kelly had him lie on his back to get the leg straighter; do stuff with his back to the wall, and with his legs on the wall lying on his back. He only took one pain pill. We went swimming a little. The cool water is nice and he can stretch. He gets really tired. The routine is activity, rest and ice, exercises, rest and ice. Had the Wednseay night dinner and Hawaiian music. Very nice evening. He pooped out early. Bruising is almost entirely gone. The glue used to close the wound is now gone from scar.
Day 21: Thursday. Went to see Dr. Wakasuki, the ankle doctor. He has done 5 replacement ankles. There are two ankle replacement surgeries, the star and the agility. Agility you need to have a bone fuse. Star has been done in Europe for years. Dr. Roger Mann does it in San Francisco. Howie and Barb told us about him. He does the Star. Both surgeries make an incision down the center of the shin to the foot, midline. The Star removes the bottom of shin and top of talus. No bones are required to fuse. Two metal plates with a plastic device in-between. Biggest problem is the healing of the incision. Need to choose patients with good circulation (pulse, hair on toes, see veins.). David has limited mobility in both of his ankle joints, one that goes up and down, and one that goes side to side. He may need to fuse the side to side one. Tower said that was okay, but maybe not now. Both require no pressure at all on foot for two weeks or so for the incision to heal. That has to heal before anything else. You will have more mobility with replacement, but not be able to do anything. If David got a fusion, he may need to do both joints. Fusion is what would happen if the replacement fails. Plastic can wear out and can be changed. Can’t do impact sports, but walking, hiking, dancing, maybe skiing, biking for sure.
David’s x-rays show bone on bone and very little space in the other joint area.
Star: In hospital for at least two days. Surgery takes 2 hours. Use crutches. After stitches are out, you move to a boot. No weight bearing for 2 to 3 months for fusion.
David can go back and forth if living in Kona. Would have to stay in SF for a month or so probably.
Came back home, set David up in the deck with computer and went to play bridge. He worked, took nap, swam again, sat on deck, and rested after dinner. He really rests a lot. His voice is getting very soft, yesterday and today it is very bad. He just has one small scab to come off the scar, swelling down, bruising gone.
Day 23: Saturday, February 05, 2011, had a massage. Then we got some Epsom salts to use on the top part of David’s wound. Still swelling around the knee itself. He still takes pain meds. Went in the water. That looks like it would be really good for his leg and knee. He got tired. Seems a little better. He is walking without the cane sometimes. He is trying out one pill every 4 hours, except yesterday he took two before therapy. The therapist, Jill, massaged his knee and scar first, then had him do exercises. Then she offered a cold pack at the end. I thought she was very good.
Day 24: Sunday. Drove into Waikiki to the Royal Hawaiian. Brought the cryo cuff and stuff but David seemed to do well. We had lunch with Judy and Larry and then drove to Nancy and Don Shannon’s to watch the Super Bowl 45 P:ackers vs Steelers. Other than his voice which you can barely hear, he seemed to be alert and able to have the stamina to go all day like that. The Shannon’s have a nice chair that leans back and he could ice. Went out to dinner and back to watch the half time show and got home at 8:30pm, about 10 hours later. Swelling now mostly in knee.
Day 25: Monday Feb 7: Went to therapy. She massaged first. She measured 115. David forgot to take his pain meds until the actual time of the appt. He did okay I guess. Had lunch in the cafeteria, then came home to rest and ice. He had a telemeeting in AM and in afternoon did work. Went back to see Dr. Rasmusson at end of day. She took Xrays and they gave us a copy of the before and after and the ankle on a CD. She said he was good to go, to do whatever he felt like doing. Got the meds renewed and the PT for another couple weeks. Then went to meet Nancy at the mall at Ruby Tuesday’s for dinner. Walked through Macy’s. It seemed strange to me. My former life. David got really pooped and came home and crashed. Rainy all day.
Day 27: Wed: I set David up on the porch with computer and ice and he did his thing all day while I went into town and hung out with Sharron and Bill at Alamoana Beach. Went to the mall and Nordstrom rack. Came back over at 1:30 to go to the Macy’s in Kaneohe and get Davids’ drugs. Got a pedicure. David wrote one letter for work, got the laundry, moved himself back and forth and seemed to survive okay. Steve & girl came for dinner. He pooped out. Leg hot, just knee swollen.
Day 28: Thursday February 10, 2011 PT with Kelly. He didn’t massage or warm up, just wanted to see his numbers. Had him do standing on one leg to strengthen his quads and hamstrings and then had him step up and down on a step. Both in front of a mirror. No cool down after. Went to Nancy’s while I played bridge. He did some work but is in pain. Made appts for next two weeks in Kaneohe.
Day 36: Friday, Feb 18, 2011. Today is the 5th week from the surgery. David has been walking without a cane now for a few days, and going on short walks, up and down stairs, and doing a lot more exercises including standing up without arms from a seated position, ones on his tummy on the bed, massaging the scar, etc. The scar still has some stuck parts, and the knee is still swollen. He is down to one pill every 6 hours for pain. The thing that is disturbing is his hoarse voice. We went to Dr. Tan who found a bump on his right vocal cord and said anything to be done about it was beyond his expertise. He showed David how not to cough and clear his throat, and to gargle often with water. He is doing that now. But when he talks to people he strains his voice. The Dr. said a tincture of time, and I interpret that as also resting his voice as much as possible. I try to get closer to him so he doesn’t have to strain. It is difficult to get into these new habits, and is just one more thing on top of all the other things. So far he has managed to get ahead of one problem and another one appears right away or even sooner. He has good spirits and is still looking forward to going to the coffee farm, but you can’t help but think that the Big Island vog can’t be good for someone who already can’t talk. We are experiencing the vog here, but I am sure it isn’t anything like over there. We’ll see.
Day 40: Tuesday, February 22, 2011 Therapy at 8:00am. He measured straightness off one degree, with a push, he got to 123 bend. He is concentrating on making sure David gets all the correct muscles firing to walk correctly. His ankle still makes him walk slightly off, however. But he is concentrating and trying very hard. Went swimming and he does lots of exercised in the pool. Then he is tired. He is taking 1 pill every 6 hours, but I think he would like to take more, at least more often.
Day 48: Thursday, March 03, 2011. We are at the Braund farm. David had therapy yesterday and she said he had edema in his calf. He slept with me in the queen bed and didn’t elevate. He is not using ice as often either. He wasn’t able to do his exercises as much. Ie he is getting out of his routine of exercise, ice elevate and rest, do something, exercise, ice and rest, etc. He was able to stop taking the oxycodone finally and he doesn’t have the withdrawal symptoms anymore I guess. He is taking Aleve now. He is getting therapy at “the Club” here in Kona which is connected with a gym so he is getting transitioned to doing stuff in a gym. His weight is about 170 with clothes on. His knee still looks way bigger and different than his other knee. It may not ever be the same. He used two hiking poles yesterday to walk around the farm which is volcanic rock and very unstable.
Day 53: March 8, 2011 We walked all the way down the steep road to the newspaper mailboxes as well as around the bottom of the farm. David uses two poles and says he feels safe that way. Yesterday we walked this route twice and the day before once. He has not used ice afterwards or needed to rest like usual. Yesterday he went to therapy and then we went snorkeling after, and no ice or rest after. He seems to have his stamina back. They are using the “electric” machine on his knee to reduce the swelling. I forget the name but I used to do it at MPFC. He says it helps. We picked some Noni leaves to wrap around his knee, but he didn’t do it. He said the adhesions from the scar seem to be better. It doesn’t sting anymore. He is concentrating on walking correctly. He goes pretty slow and steady.
Day 54: Left Hawaii for Anchorage.
Day 79: April 3, 2011. David has been back at work, more than he would like. He has a hard time getting to the athletic club to workout, and probably only does some knee exercises once a day. The ENT doctor here said he didn’t have a bump on his vocal chord and that it was just thin from aging. His voice has steadily gotten stronger and better able to be heard, except you can tell it is worse in the evening.
The black and blue on the back of his leg was gone way before we left Hawaii, but there is still swelling. The scar is all flat and even straight, although at first it was a jagged thing. He no longer uses the ice. Now the exciting thing is what happens to him at the airport. So far they have always patted him down completely. He has to get to the airport early. We go for walks, but he is slower, however not as slow as in Hawaii by any means. He was back at full speed I would say after we got home, which was day 54, or eight weeks post op.