Marié Digby

As I was listening to pandora.com today, I heard Say It Again by Marie Digby. I had never heard of the artist before, but enjoyed it so much I decided to download the song. Well, for $4 more I downloaded the whole album--Unfold. I'm definitely not disappointed. She reminds me a little of Mandy Moore.

But...ugh! She too has Umbrella on her album. How many artists are going to sing this song?!?!

Post-Op Day 4

I apologize for the crappy photos, they are coming from my camera phone. Either way, here's my knee today. I think it looks almost exactly the same, perhaps a little less swelling.

I'm no longer using a crutch to walk. I might have a slight limp, but I feel like it's the same with and without a crutch.

I'm back to sleeping in the bed. Joe hasn't rolled over onto the knee, and I feel like the pain is down enough to finally be able to get into a comfortable position. Before I was sleeping on the couch.

I still have to take stairs one step at a time, and I'm trying to limit them completely. I tried alternating feet, but it put way too much pressure on my left knee and caused pain.

I'm being very diligent with my exercises. Day one I could hardly flex my knee, today I'm at over 90 degrees. The first day it hurt too much to do the bike, today I could do 10 minutes. Mind you, I'm not biking near the speed before surgery, but it feels good to be able to do start to do things again. Plus, I'm all about limiting the degree of scar tissue that forms.

I'm not going to lie, my knee can tell when I've been doing too much and I'm glad I don't have to start a rotation tomorrow. That would be too much pain for sure. I'm on the max dose of ibuprofen, and that's enough as long as I take it on a scheduled basis. I didn't like the feeling the hydrocodone gave me.

I'm starting to get antsy just sitting around. I'd love to try some more recipes, but I think that's too much standing for now. Perhaps in the next couple of days. I'm catching up on my reading, but I can only read so much in one day. I've also started cross stitching again.

I have a research paper I need to write by the end of the year. I'd be remiss if I didn't use this time to do some hard core work on it, so that's part of my plan for tomorrow.

Mom left for Baltimore yesterday. I am so glad she came out to visit and help. I definitely underestimated how little I would be able/want to do the first two days after surgery.

Plica Removal

If you can't tell, I'm bored. Here's a little tutorial on my plica removal and why I needed it.

Provided by the Bones Health Channel on eMedTV.com

I think "tightness" is a great way to describe my knee pain, especially after working out.

Provided by the Bones Health Channel on eMedTV.com

However, it seems having a plica was not my only problem, so the doc did a lateral release as well, see previous post.

So what's a lateral release?

Browsing you-tube I found some videos of arthroscopic surgeries. Some are probably better than others, but without the commentary, I have no clue what's going on. These are not my knee. I don't know if they recorded mine or not, I guess I'll find out at my post-op appointment. I also won't know my official diagnosis based on what they saw until my post-op appointment, September 3rd.

Here's an image of the forces on the knee cap. We suspect a large part of my knee pain is due to too much tension from the iliotibial band pulling my knee cap towards the outside of my body. This causes the knee cap to come out of it's natural tracking and cause pain and inflammation from the friction. When stretching and strengthening doesn't work, lateral release is a way to help decrease some of this tension. Some docs completely cut the lateral retinaculum (on the left of image above), but that can make the knee too lose. My doc does more of a "hashing" to give it some more stretch, but not a complete release. Several years ago, surgeons did way too many lateral releases and often the patients didn't have much improvement. Fortunately, my physical therapist says that her patients who have a lateral release done by my doc have almost always had improvement. She believes a large part of it is due his "hashing" technique and that he does it through an open procedure.

The videos below show the lateral release done completely arthroscopically and a full cut, not the small cuts my doc did. Either way, it gives you a better idea of what went on.

Day of Surgery

I'm already starting to get bored, so I figured I'd record my experience the day of my surgery.

The night before the surgery I hardly slept. After working evenings at the ER, my circadian rhythms had me going to bed around 2 am and I needed to wake up by 5 am for the surgery. I couldn't fall asleep any earlier, so I was exhausted that morning.

Pre-op wasn't anything exciting, just peeing in a cup, reviewing health history, etc.

I know I had IV's when I was a kid, but I don't think I've ever had IV antibiotics. We get into the OR room and they start to give me the versed, fentanyl, and antibiotics. I've always heard the nurses warn the patients that it might sting going in. Oh, my, goodness. Yes it does. Fortunately I was out right after that and don't remember anymore.

My surgery only lasted about 35 minutes. When I woke up in recovery, my first thought was, "man, that was some great sleep, finally." Then I open my eyes and realize I don't know the woman who's sitting next to me. Then it dawns on me where I am. It took me five minutes to become coherent and I know I asked her name at least twice. She mentioned my blood pressure and heart rate increased after waking up, but not to worry, it's due the pain. I realize that, but I also wonder if it could be due to blood loss, even though I know it's not a bloody surgery. The nurse looked a little surprised when I asked for my estimated blood loss. I guess that's part of treating someone with medical knowledge. Supposedly my blood loss was zero, but I have a hard time believing I didn't lose anything.

After my heart rate and blood pressure decreased, they wheeled me over to post-op. My post-op nurse was amazing and so patient. She could tell I was still in pain and offered some morphine. It's fairly common for morphine to cause a local rash and itch after being injected. I noticed my arm was extremely itchy just a few minutes after she gave me the morphine. She was spending an large amount of time with me and I wanted to make sure I wasn't taking her away from her other patients. In my half asleep state I ask her if I'm her only patient and if so if she could get me some benadryl and point to my arm. She responds, "you do have quite a rash developing there." I was out before she even finished injecting the benadryl. Mom said it looked like I was catching flies.

As an aside, getting a rash after receiving morphine is common and is not considered an allergic reaction. So if it happens to you, just ask for some anti-histamine and the itching will go away.

Post-Op Day 1

I initially thought I'd post today in the style of a progress note we'd write on rounds, but I figured I'd spare you the medical jargon. Plus, I really don't think you care if I've been able to have a bowel movement or pass gas yet. I've felt a little dizzy and nauseous today. It's hard to say if it's my body reacting to pain or the side effects of my pain meds. They gave me Norco, which has hydrocodone and Tylenol. I'm trying to switch over to ibuprofen. It's what we give our women after c-sections, so I figure it should be enough for me too. So far so good. I just woke up from my evening nap, it's sore, but not a sharp pain or anything.

Today was my first physical therapy session after surgery. They unwrapped the dressing and worked on range of motion. I definitely can't flex my knee as much as before surgery, but the PT says I'm doing well enough for day 1. She tried to put me on the bike to get more blood flowing to my leg. My knee was definitely sore and I started to get dizzy. I have a history of fainting and I didn't want fall off the bike, so we'll try that again tomorrow.

Here's my knee day 1. It's a little swollen, but not too much. I don't really think the blue is bruising, but more of the "yes" marker. The three smaller holes are about 1/2 inch. The longer scar is about 2 inches and that's where they went in to do the lateral release. Something I find funny, both Dad and Joe made the comments, "I wonder how big your scars will be." Me, I personally don't care about scars as long as my knee's starting to feel better.

I'm still walking with a single crutch, but I think I'll be able to get rid of that in the next couple of days. I have the next two weeks off from rotations, so I'm going to go light and not try to force myself. That being said, I'm already tired of living purely on the couch.

25th Book

I just finished my 25th book of the year! It's probably the only New Year's Resolution I've kept. Perhaps, one can argue I've also kept the one about keeping up with my knee exercises, but I digress. Audiobooks really helped me to my goal. I've learned I'd much rather listen to a book while driving than the radio. When I told Joe I planned on reading 25 books this year, Joe laughed and said, "I don't think I've read 25 books in my lifetime." Sigh. I'm not stopping here, but perhaps now I'll try to work on my wedding scrapbook a little more. We'll see.

Surgery Today

Today was the big day. I remember absolutely nothing of the surgery, which is always good. They put me up on the table, gave me some fentanyl and versad, and then I was out. I woke up in recovery and my first thought was, "Wow, that was some good sleep." Then I opened up my eyes and remembered I just had surgery.

Last night I realized what I was most nervous about. It wasn't the surgery, but the IV. I have small rolling veins and have passed out after several attempts to get me. They usually have to use a butterfly, but since I was getting fluids, it had to be a bigger needle. Surprisingly, at this hospital the anesthesiologists are the ones who place the IV. He numbed up the site with a little lidocaine and then stuck me first try. He said they always numb it up first.

Before surgery, Joe stopped by to say hello. Isn't he handsome in his scrubs? Then the doc came in and marked correct leg. Don't want to operate on the wrong one of course.

The doc removed my plica. He said it wasn't as large as they thought it was and my knee cap needed some more realignment, so they did a lateral release. I'm glad they did everything at once, it just means my recovery will be a little bit longer.

Mom and Joe have been so helpful. I can get around, but it's easier not to always be refilling my cup, etc. Mom's funny. She keeps asking Joe where her messy daughter went, Joe just smirks. Joe's also funny, he laughs every time I ask him to do something for me. When asked why, "I'm just so not used to you asking for stuff. You usually do everything yourself."

General Tso-Tso

I found the recipe on sparkpeople.com. I know it's the diet version, but the sauce didn't taste like General Tso at all. As Joe says, "it was so, so." I have vastly improved on my fried rice abilities though =). Overall, I'd give the dish a B, but not for imitating General Tso's. I probably won't be making this again.

Ingredients

1 tsp ground ginger
1 tsp red pepper flakes
4 tsp olive oil
2 cloves garlic, minced
2 medium scallions, chopped
4 Tbsp soy sauce, low sodium
3 Tbsp splenda (or sugar)
3 Tbsp corn starch
1 lbs boneless skinless chicken, cut ino bite size cubes
1.5 C chicken broth, low sodium
2 Tbsp vinegar

Directions

In a medium bowl, whisk together broth, cornstarch, sugar, soy sauce, vinegar and ginger; set aside.

Heat oil in a wok or large skillet over medium-high heat. Add scallions, garlic and pepper and cook 2 minutes. Add chicken and cook until browned all over, about 5 minutes.

Add reserved sauce and simmer until sauce thickens and chicken is cooked through, about 3 minutes.

Serve chicken and sauce over rice.

A Taste of Baltimore

Mom flew to Omaha to help out after my surgery. She was kind enough to bring us some crab chips. The flight wasn't kind enough to keep the chips intact. The flattened bag isn't empty, just crushed. Perhaps I'll try some crab chip crusted chicken breasts.

Searching For Signal

And our satellite issues continue... A little background. Joe and I live in a co-op community with housing-association-like rules. One of which regards satellite usage...they can't be larger than x width, must be within 1 foot of your house, cannot be on the roof, etc. When we purchased our home we had no idea our house faced in the opposite direction of DirectTV's signal. Fortunately the house caddyshack to us on the otherside had DirectTV and we were able to connect our cables to their dish and run it through our basement window. We had a verbal agreement with them that this was all fine and dandy.

So, let's talk about last night. Joe turns on the TV and it's repeatedly says, "searching for signal." This is not new since a tree intermittently blocks the signal. We reset our receiver, the usual solution. No improvement. Joe goes around to the other side and checks the dish. The DirectTV dish is gone and in it's place is a Dish Network dish! Now mind you, this is 11 o'clock at night. Joe is furious!! I mean hotter than hot. I try to calm him down, explaining the dish isn't on our property, yada yada. Never the less, we're out there with flashlights trying to trace the wires and see what home they enter. Lo and behold, it appears they enter the townhome who's property the dish is on. Joe knocks on their door, fortunately they were awake, and asks what happened. They knew someone on the other side was sharing a dish, but they didn't know which house. Ends up they wanted to switch to Dish Network. Joe explained that DirectTV is the only way he can get his Ravens games, we'll be moving around May, would this guy mind another dish in his yard until then? Fortunately our neighbor understood and agreed to that. Unfortunately, DirectTV doesn't have any openings until Wednesday afternoon...when I'll be recovering from surgery, so we'll have to use the next available time, Friday afternoon. I am truly curious to see how Joe handles no cable for 5 days. So, yet another reason to avoid satellite--your dish can get removed at any time by neighbors =(

Lemon Blueberry Bread

Delicious! This was my first time ever zesting citrus. It's no where as difficult as I made it out to be in my mind. Here's the recipe from Bella Bistro's Blog. I baked my for about 50 minutes and used the cooking spray with flour to grease the pan, came out perfectly.

INGREDIENTS
1 1/2C. All-purpose flour
1t. Baking powder
1/4t. Salt
6T. Unsalted butter, room temperature
3/4C. Granulated white sugar
2 Large eggs
1/2t. Pure vanilla extract
1T.Grated lemon zest
1/2C. Milk
1C. Fresh blueberries

Lemon Glaze
1/4C. Granulated white sugar
2T. Fresh lemon juice

DIRECTIONS
Preheat oven to 350 degrees. Grease and flour a loaf pan.

In a separate bowl, whisk together the flour, baking powder and salt.

In the bowl of your stand mixer, beat the butter until softened (about 1 minute). Add the sugar and continue to beat until light and fluffy. Add the eggs, one at a time, beating well after each addition. Beat in the vanilla extract and lemon zest. With the mixer on low, add the flour mixture (in three additions) and milk (in two additions) alternately, starting and ending with the flour. Mix only until combined. Gently fold in the blueberries.

Scrape the batter into the prepared pan and bake for about 55 to 65 minutes (mine took 60), or until the bread is golden brown and a toothpick inserted in the center comes out clean.

Meanwhile, in a small saucepan, bring the sugar and lemon juice to a boil, stirring until the sugar dissolves.

When the bread is done, remove from oven and place on a wire rack. Pierce the hot loaf all over with a wooden skewer or toothpick and then brush the top of the loaf with the hot lemon glaze. Cool the loaf in the pan for about 30 minutes then remove from pan and let cool completely on a wire rack.

Surgery Scheduled - August 26th

Yes, my ortho doc is still on vacation, but I was looking at my schedule and with the help of school letting me rearrange my schedule a little, next week looked like the best time to get the surgery done before residency interviews and such. So I called up the physician assistant and they said they could go ahead and schedule it but I still need meet with the doc Monday. So that's the plan, pre-op visit Monday August 24th, surgery Wednesday August 26th. It'll start as an arthroscopic surgery to remove the plica, but if it looks like my knee cap is misaligned and I need a lateral release, they'll have to open my knee up for that. If it's purely arthroscopic, they predict crutches for a day. If they have to open my knee, they predict crutches for a week and a little longer recovery.

This may sound completely outlandish to some, but I am truly excited to be getting this surgery. Joe can vouch for me, I've been a great patient doing my exercises, etc, and these past 2 months of PT offered no relief. After having pain for 8 years, I'm ready to be radical and forget the conservative approach. I know I may still have pain after the surgery and I know it'll take a while for me to get back to running, or even the elliptical, but I feel that at least we're trying something else. That offers me hope.

Another exciting development of surgery--Mom is flying out to help me post-op. I feel bad because I sprung the surgery on her, she hates to fly, flights are higher than if we knew about this a couple of weeks ago, and it's probably inconveniencing her work schedule. I think I could manage on my own (Joe doesn't have any paid time off right now) and would if Mom didn't offer to come out, but it will be much less stressful with her here. Plus, she's never been to our house, so I'm glad she gets to see where we've been living.

I'm determined not to have anything prevent me from having the surgery and having a UTI can. For my one and only UTI, the only symptom was foul-smelling urine. Right now I'm not having any symptoms of a UTI, but since I didn't really last time, I went to the drug store and bought an over the counter UTI test. Negative, plus cheaper than the copay for the doc's. Now let's just hope my blood count isn't crazy out of whack, which I don't think it will.

Since I'm having surgery on my knee, I thought I'd be kind enough to shave just before surgery. Nope, I can't shave less than 48 hours before surgery, plus they give me this special soap I have to shower with the day before and that morning. Umm...I have to be at the hospital at 6am, what time am I going to have to get up just to shower with the special soap? Oh well, I will because I know it's meant to decrease my risk of infection.

So that's where I stand right now.

MRI Results

Results are in, and they found something. It's bittersweet. At the very least I have an infrapatellar plica and small medial popliteal cyst. The cyst is likely secondary to the plica.

So it seems I have plica syndrome. I had never heard of it before, but the description completely fits my history of knee pain. My doc is on vacation this week, but I have an appointment to talk with him next week. Based on my research and talking with my physical therapist, it's likely I'll need surgery to remove the plica or else it will continue to become inflamed, hypertrophy, and cause pain. I'm not sure when I'll be able to have the surgery with my schedule, but hopefully before the end of the year since we've met our deductible for the year. I'm actually glad they found something so I can hopefully stop the pain and eventually be able to start running again.

Ironed Jawed Angels

I am ashamed to say that I had never heard of the Ironed Jawed Angels until the HBO movie came up as a netflix suggestion. I do not know the actual story and order of events, but I think the movie did a great job illustrating the struggle and sacrifices our ancestors made to grant females the right to vote. If you haven't seen it, I recommend it! Thank you women suffragists!

As an aside, I've never liked Hilary Swank before, and I absolutely loved her in this film!

Now off to find a biography on Alice Paul and Lucy Burns to add to my "to be read" pile...

Buttermilk Pumpkin Cake

Absolutely delicious and wonderfully moist! I used a little more cinnamon than the recipe callled for and I think I'll use some nutmeg next time too. Joe's coworkers were quite glad I decided to bake, they were asking Joe, "when's Amanda going to make another cake?"

Here's the recipe from Whipped's blog.

Pumpkin Buttermilk Bundt Cake
2 sticks (1 cup) unsalted butter, softened, plus additional for greasing bundt pan
2 1/4 cups all-purpose flour plus additional for dusting pan
2 teaspoons baking powder
1 teaspoon baking soda
1 1/2 teaspoons cinnamon (I used 2 teaspoons)
1 teaspoon ground allspice
1/2 teaspoon salt
1 1/4 cups canned solid-pack pumpkin (from a 15-oz can; not pie filling)
3/4 cup well-shaken buttermilk
1 teaspoon vanilla
1 1/4 cups granulated sugar
3 large eggs

For glaze:
2 T butter
1 cup powdered sugar
1-3 T cream or milk

Preheat oven to 350°F. Butter and flour bundt pan. Combine together flour, baking powder, baking soda, cinnamon, allspice, and salt in a bowl. Whisk together pumpkin, buttermilk and vanilla in another bowl.

Beat butter and granulated sugar in a large bowl with an electric mixer at medium-high speed until pale and fluffy, 3 to 5 minutes, then add eggs and beat 1 minute. Reduce speed to low and add flour and pumpkin mixtures alternately in batches, beginning and ending with flour mixture and mixing until batter is just smooth.

Spoon batter into pan. Shake a few times to be sure to remove any bumps then bake until a wooden pick or skewer inserted in center of cake comes out clean, 45 to 50 minutes. Cool cake in pan on a rack 15 minutes, then invert rack over cake and reinvert cake onto rack. Cool 10 minutes more.

To make glaze, heat butter until melted. Stir in sifted powdered sugar. Mix in cream or milk 1 Tablespoon at a time until desired consistency. Drizzle over cake while it is on a wire rack so excess falls through.

MRI of my Knee

This is my 7th week of physical therapy for my knee pain. This past week I climbed back on the elliptical and the pain was still there! Ten minutes in, my left knee just starts aching and then my left leg muscles are so tight the next day.

I have been truly diligent with doing my exercises and my physical therapist thinks I should be getting more relief than I am by now. That being said, we decided to go looking for more pathology. My ortho doc agreed, so I had an MRI today. I'm not sure when I'll get the results. I'm also not sure what I want the results to say--I really don't think I've torn any ligaments or menisci, because I think I'd be in much more pain. At the same time, I almost want the MRI to find something so that I can get relief. I am just way too young to be having knee pain.

Where's the Tall Department?

Ugh! I get so frustrated that stores don't have a separate talls department similar to the petite department. I need an interview suit for residency interviews. I know I have time to find one, but I'm in the mood to shop now, and that's something I can justify. I hate having to order multiple sizes of the same item and then having to pay for shipping. Don't get me wrong, I'm grateful that I can at least find talls online, but my life would be so much easier if I didn't have to order 3 times more than I need and then go back to the store to return what I don't want/didn't fit right.

So, department store gods...can you hear us? The tall women of the world are standing up screaming for their own department! Long pants just aren't enough, we have long arms and torsos too!

Residency Application Photo

Our residency applications require a photo, plus the school requests a photo of all of the seniors. Here's mine. I think I'll keep my hair brown until after interview season is over so I look like my application photo. I'm tired of dying my hair though, so we'll see.

For Joe

Posted by a nestie on the book club board. I immediately thought of Joe!

Old Bay Chicken Wings

Joe says he doesn't like Old Bay on his chicken wings, but he doesn't remember loving these wings at Bateman's one night. He' s not feeling well, so I won't give him a hard time tonight for not trying them. And no fear, I'll definitely be making them for a gathering before we leave Omaha...I must introduce Old Bay to my classmates. :p

I came across several recipes and just kind combined them all into my own. I brushed the wings with melted butter, which I think was unnecessary and made them extra greasy. I opted to bake the wings instead of frying, but with all of the butter I used, I should have just fried them. I would have liked them just a tad more crispy, and I think frying would have done the trick.

Recipe:

2 pounds of chicken wings - cut the two pieces of each wing, if they aren't already
1/2 c melted butter - would not use again
Old Bay - random amount, I just sprinkled the can so that each side was about 60% coated

Place on foil-lined cookie sheet. Bake about 30 minutes, flip, bake another 30 minutes. Definitely line the cookie sheet, it makes clean-up so much easier!

Enjoy!

Peanut Butter Bread

I'd give this a B+. I like my desserts sweet and my breakfasts more healthy, this was somewhere in between. It tasted yummy, but didn't really satisfy my desired choice of dessert or breakfast. I added chocolate chips (sorry didn't measure) and doubled the peanut butter. Joe said the nurses at his worked LOVED it though.

Recipe adapted from Allrecipes.

INGREDIENTS

• 1 3/4 cups all-purpose flour
• 1 teaspoon baking soda
• 1/2 teaspoon salt
• 1 cup brown sugar
• 1/3 cup peanut butter (I used 2/3 cup)
  
• 1 egg, beaten
• 1/2 teaspoon vanilla extract
• 1 cup buttermilk
  

DIRECTIONS

1. Preheat oven to 350 degrees F (175 degrees C). Lightly grease an 8x4 inch baking pan.

2. Sift together flour, soda and salt. In a large bowl, cream sugar and peanut butter together. Beat in egg and vanilla until smooth. Stir in flour and milk alternately, beating until smooth after each addition. Spoon batter into prepared pan.

3. Bake in preheated oven for 1 hour, until well browned. Remove from the pan to cool. Store in a covered container.

Rosette Cake

To help destress the day before Step 2, I decorated a cake =)

My New "Bible"

I was like a kid on Christmas yesterday. I ordered the daddy of all pediatric textbooks and UPS said it was supposed to be delivered yesterday. I alternated between checking the computer and the door. I truly wanted to read about some of the things I saw in the ER the night before and wanted to use my new "toy" instead of just the internet. Well...my book finally came at 7pm! How often does UPS deliver that late? And go figure, I didn't feel like reading anymore, Joe was home. The text weighs about 10 pounds and is 5 inches thick! It's love.

Damn, Knee Pain is Expensive!

I knew I needed new orthotics no matter what, so I didn't look to see if our insurance covered them, nope! I also knew I needed to give physical therapy another go...another charge not covered by insurance until I meet my deductible. My loans this year didn't factor in this much for health care costs...ugh. Looking at my bill will just be more and more motivation to keep up at my knee exercises!

P.S. I know it's been a while since I blogged. I'm finished with Step 2, woo hoo! Soon I'll update with another cake, peanut butter bread, and trip to Baltimore.