So here's an interesting sequence of events to ponder:

• Last Friday afternoon I received a message from the orthopedic surgeon's office: "Hello Scott, Hope you are well. I'm reviewing your chart for our upcoming preop clinic visit.  When is your next injection/dose of Tyenne planned?  Are you currently taking the blood thinner pradaxa?"
• I responded within a half hour of receiving the message, informing them that I was not taking blood thinners and that my next Tyenne dosage was scheduled for Monday morning (yesterday morning, as of this writing).
• Sunday afternoon while out bicycling I received but missed a call from Kaiser.  On the way home I was thinking about how strange it was to receive a call from them on the weekend, and it occurred to me that maybe it was about Tyenne.  When I spoke to them later though, it was the home health department calling to schedule a home visit on the day after surgery.
• Monday morning I took my Tyenne injection at the usual time, around 8 AM.  I'm careful to take it at roughly the same time of day each time, partly to insure I don't forget it and partly as a throwback to my daily regimen with Prednisone.
• Roughly a half hour later I received another message from rhe orthopedics office: "Thank you for the information. I heard back from Dr Greenberg - please skip, do NOT take Tyenne today January 12 and avoid further doses until after surgery."
• And later, after I informed them that it was too late, there was this: "Yes, unfortunately this may impact surgery timing but I will check again with your surgeon and rheumatologist and we will get back to you soon."

So it looks likely or at least possible that my knee surgery will be postponed.  I still have not heard back as of this writing, but it won't surprise me if it's postponed for at least a few weeks if not longer.  Surgeries are only performed on Fridays, so if it's determined that it must be postponed it will be a matter of how soon a slot can be opened up.  Rats.

There are several things to note here.  One is that I think Kaiser was remiss in not checking up on my medications until so close to the surgery date; and in not advising me to hold off until hearing back from them in the initial message; and in sending the message late on a Friday afternoon and then presumably leaving the office for the weekend.

And it's bad luck that we're in different time zones.  The one hour difference might have been enough so that I'd have heard the new instruction while there was still time for it to be useful.

Also though, I'm complicit to some degree here too.  It was a failure of imagination on my part to not wonder about why they were asking the Tyenne question in the first place.  The clues were there, if I'd just picked up on them - and once I did my own research by googling 'Tyenne before surgery' I found this advice:  " If you take tocilizumab subcutaneously (by injection or injection pen), it should be stopped at least two weeks before surgery."

The issue apparently is that the drug can reduce your platelet count and increase the risk of uncontrollable bleeding.  It is only 11 days between my last injection and the scheduled surgery date, so I won't be surprised if it's postponed.

So back to that thing about making your own luck.  That's not fully true of course, because some situations really are out of your control.  But you can increase your odds, certainly.  It's like remembering to look both directions before crossing a one-way street.  And I don't really fault myself so much for not having had the inspiration to look this up at the time, but the chance was there to be taken.  Phooey.

__________

In any case, this is the end of our Sonoran sojourn for this season at least. Our flight home leaves tomorrow morning.  Shortly I'll drive over to Fair Wheel Bikes to drop off the bikes for boxing and shipment home (because we don't have the suitcases with us this time, and with my knees it just sounds too difficult to manage boxed bikes at the airport).  After that I'll meet Rachael at Perche' No for lunch and then we'll head home to finish dealing with this:

Heart

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Patrick O'HaraYou guys are experts for this by now.
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