I haven't been around for a while and for a pretty good reason -- I was preparing to have my knee totally replaced. There was so much to do to prepare for it because we were basically preparing for leaving in the RV for the winter and doing it in July. A lot was done in that time, to include putting a cabin in the woods on some property we have in central Idaho and getting my MG running and then buttoned up for winter after a great test drive (first drive). The restoration isn't complete, but is coming along nicely.
Anyway, the knee replacement was 5 days ago. I was a little nervous and wondering if it should be done, but there was no more cartilage left and I was feeling better than I had in 5 years so I figured I should "patch the roof while the sun was shining". The entire procedure went well, but there were still wegs-related issues.
I went off mtx about 2 weeks prior to the surgery. Given my mtx schedule and the surgery schedule, I actually went off the mtx about 2.5 weeks early. My rheumy has asked that I stay off the mtx as a test. However, I am still on 7.5mg pred. Actually, on 50mg/day at the moment, but that story is below.
As most of you know, my wegs attacked my pituitary gland and I lost it. That's a pretty vital gland and causes all sorts of additional issues, one of which, is the possibility of an adrenal crisis during times of physical trauma such as having your knee joint sawed out, then drilled and screwed.
The surgeon accounted for the trauma and possible crisis and pretty well loaded me up with additional cortisone, but, nevertheless, I went into adrenal crisis about 8 hours after the surgery.
I'm not sure if the US pain scale is a worldwide thing or not, but we have a pain scale from 1 to 10 where 10 is "the worst you can imagine". I always describe to the nurse that 10, to me, is PW torture excruciating, so that sets the subjective scale at a pretty high threshold. My adrenal crisis pain level was at an 8.5, while I gave the knee surgery itself between 2 and 4. The pain was isolated to my kidneys as they were in shutdown mode. The crisis was pretty painful and lasted several hours until a ward doc could issue more drugs. By the time the ward doc arrived, the nurse had max'ed out her quota of morphine. The doc gave me hydromorphone, but I don't know what amounts. Neither the morphine or hydromorphone relieved the pain. Once the doc determined I was in crisis and gave me a megadose of injectable cortisone, it was all over. The crisis subsides as fast as it comes on, maybe 20 minutes to full recovery. And that was the experience I had with a previous adrenal crisis, too.
This was my second adrenal crisis. The first (post #8) was only a few months ago. You would think I'd learn, but you aren't always in the proper state of mind to put the dots together. But, I think I have the idea now and I just repurchased all my now-expired solucortef for these little emergencies.
Otherwise, the knee surgery was no problem at all. I rate the pain just a little higher than my normal day-to-day issues with wegener's and the pain it causes. Its a different pain (sharper), but no more worse. I left the hospital with a walker, but went on to using just a cane several hours later. I'm now in day 6 after the surgery and I'm walking easily without a limp. I still use the cane, but only to catch myself if I start to trip and fall (which would be seriously bad at this stage).
That's about it for now. I allowed 2 months for recovery, but I think 2 weeks will be closer to the mark and total healing a month from now. Otherwise, all is good and I might have some time to look at the forum more often for a while. Hi to all my friends!
