Six Weeks, Post-Op

I have finally hit that 6-week mark. I feel like the last 3 weeks have been a process of "two steps forward, one step back." I began this journey anticipating a fairly easy ride with no complications. Too bad it didn't quite go that way--but life is made up of such things. Here is where I stand today:

• The infection at the base of my knee is on the run, but not conquered.
• I am off the antibiotics, because they led to a yeast infection.
• I can navigate most stairs going up, but I try to always take it mindfully and slowly. I apply my knowledge of proper step-technique by leaning forward from the hips, and using my glutes to lift my body.
• I can go down stairs, but have to be able to support some weight by holding onto handrails-preferably on both sides.
• Yesterday I sat down and crossed my "new" knee over the other, without even thinking about what I was doing. It felt good! (I know, sitting with the legs crossed isn't good for the knees, spine and hips. But it is a benchmark to be able to do it.)
• I walked a mile the other day.
• I did a full hour of Yoga..not all the poses I did before, but most.
• Tomorrow I start back to all my normal activity schedule, which means teaching a Yoga class and a line dance class, taking part in two Zumba Gold classes plus all my work about the house.
• I can work in the garden for an hour: did a little bit of digging with a shovel (gently, and only for a few minutes)--worked with the weed whacker (maybe 15 minutes)--pulling weeds (20 minutes)
• I can straighten my "new" leg to the same extent as my other leg! (Prior to surgery, it would not go completely straight. There was about a 3-inch gap between my knee and the floor.)

My goals for the next few weeks:

1. Kick the infections

2. Continue to build flexion of my knee.

Progress! Finally.

The last three days have finally brought a sense of progress. My energy is returning more quickly than I had dared to hope. The first day of "normalcy" was pretty slow, as I discovered as few as 20 minutes would require an hour to recover. 

The next day (Thursday), I met with my new physical therapist. I don't know yet if I am going to be happy with her or not. So far in this process, I have felt that all the therapists are too focused on my glutes, and not enough focused on my knee. It frustrates me that they do not give me specific exercises and goals to work on. So I have decided to take the bull by the horns, and write my own fitness program.

Taking control this way gives me a sense of purpose and progress. So I am back to walking on my street, and have started a specific exercise program focusing on flexion/extension in fluid movements, even pacing when I walk, good posture, and strength for all the leg muscles. 

I had a client a few years ago who had total knee replacement of both knees. I was his rehab person after the first 3 weeks. He did great! So I suppose I can take care of me as well as anyone. 

And meanwhile, the therapist can look to my future. Both of the therapists I have worked with since my surgery have focused on the glute activation which current studies indicate will protect the knees and hips in the long run. So I learn what I can from them, and take care of myself at the same time. Win-Win.

Friday showed marked improvement. I discovered that as long as I take it very slow and mindfully, I can actually navigate the staircase in our house using my new knee to lift or lower my body on a step. This is a BIG step for me! 

For the last two weeks I have gone down the stairs backward, (carefully and holding both rails), and up the stairs by leaning way forward and placing my hands on the steps, so kind of crouching/crawling my way up the stairs. In each case my focus has been to lift and lower myself with glute power, and not knees. This little technique comes from years of teaching step class students to lift with their glutes and not their knees. It's a good thing.

Thinking about the connection between step exercise and my apparently useless glutes makes me wonder...how much of what these therapists are seeing is a result of the past three years of deterioration? Makes me want to go back to step class!!

So this is looking good. Today is a day of rest, and then tomorrow I get back to working my knee. Oh, and finally yesterday, the little infection spot looks a little better, and didn't hurt every time I touched it. Perhaps the castor oil bandage is helping? I don't know. But it's nice to see some indication of healing, finally!

Forward progress, Hopefully!

After 7 days of moving as little as possible, I see my doctor again. The infected spot is no longer oozing, but it is very tender, and quite red. My doctor explained the purpose of barely moving. 

A test was done with two Petrie dishes of bacteria, one kept still, and the other on a gently vibrating platform. The vibrated bacteria grew significantly faster. So what we have done is allow my body the maximum opportunity to fight the infection by keeping its growth rate done, and assaulting it with antibiotics. 

Now the course of action shifts: it is time to put a bit of stress on the knee. I continue antibiotics for another 7 days, and watch it closely. If the red area grows, or I start to see streaks of red from it, or if I develop a fever, it's an emergency call to the doctor. If it starts to ooze again, I go back to clean/neosporin/bandage daily. 

I begin physical therapy again, and start back toward my normal lifestyle. I am mentally eager to get moving again! I am also scared that this infection is going to move into the joint and require drastic intervention. 

Today I took it fairly easily..my energy is low due to the inactivity of the past weeks. So I watch the clock: 1 hour sitting (I still have a quilt to finish!); followed by movement and exercise for 20-40 minutes. I focus on doing exercise and movements that will flex and stretch the knee to promote blood flow and fluidity of movement. I go for a walk,  (Yay!), and I go to the store to get m prescription refilled.

I am to check with my doctor again in 7 days. I have also decided to put a castor oil soaked bandage on the red spot at night, to promote healing and to keep the skin soft. I don't know if this is wise, or if it will help. But I have used herbs and natural remedies for many years, and castor oil is supposed to be good for healing infection. I have used it in the past for bruises/muscle strains. 

Days 31 - 33

Even though today is Day 31, I am going to get ahead of myself today. I am still resting and allowing my body to fight the infection. There isn't going to be anything new to add until I see the doctor again at the end of Day 33. So....there is nothing to report for the next three days: just more of the same: rest, rest, rest-fight off frustration and boredom--and try to keep a positive focus and expect a good outcome. 

I may finish that quilt yet!

Day 30

Sit, sit, sit. I am so very tired of sitting!!! I really had expected to be fairly back to normal by now. I feel too good to be so sedentary. 

The good news is that the infection seems to be going away. When I do get up to move about a little, I can walk quite normally. The staircase is getting easier to manage, although I still cannot go down the stairs with alternating steps. 

I want to share a little tip on stairs: Going down backward is easy on the knees!

I spent 15 years teaching step classes. One of the first thing a step instructor is taught is that stepping forward off the step bench during exercise is very dangerous and damaging to the knee, but backing down is safe and not damaging.

During my 6 years as a personal trainer, I worked with a number of clients who were recovering from knee problems, or had joint replacements. One of the things that was always a challenge for these clients was going down the stairs. I always encouraged them to (carefully!) back down stairs to take the pressure off their knees. 

Since my surgery, I have needed to go down the stairs in what I call "baby steps" - bad-foot/good-foot for each step. The problem is,  my "good" knee was taking a beating! I live in a two story house, and even though I try, sometimes, I just need to go up and down during the day. 

So when I felt I could try it, I tested going down the stairs backward, with both hands on the rails, watching closely my foot placement, and leaning forward so that my glutes have to take the weight. It didn't cause any pain, so I have been backing down the stairs since then. 

IF YOU WANT TO TRY THIS: it is ESSENTIAL that you can hold on firmly and go slowly enough that you don't fall!!!

Day 29

I saw the doctor again this morning. The infected spot seems to be a bit better. It has been draining on the bandaids, and the area around it isn't quite so red and puffy. My doctor is pleased and feels that the antibiotics plus the povidone/iodine--antibacterial ointment--bandaid treatment are doing the job. 

I am to continue that process, and stay inactive for another 5 days...I may finish this quilt yet!! I sure am glad I have plenty of movies to entertain me, and the doggies are good company. 

Word to the wise: if you work in an office, then it is reasonable to be pretty much back to normal in 30 days; but if you have a job that requires you to be on your feet, or have a very active lifestyle..better allow at least 6 weeks to recuperate before you expect to be back to normal. 

I'm glad that I have two more weeks before I have to be back teaching my line dance class, althoug I would be thrilled to be back to teaching now, I am not read to do so.

Day 28: Boredom of a sort

I spend the day doing pretty much nothing, sitting with my feet up, and the doggies on each side of me on the couch. I feel a bit bored, because I finally am feeling like I want to be more active and doing things about the house. Up until now, I have actually enjoyed the inactivity.

I have been busy all this time, mostly doing needlework: I made 3 sweaters for the doggies, a shawl for me, and have been working on the decorative stitching of a quilt. Until the last few days, my brain has been a bit foggy, and I have enjoyed working my way through our video library. 

The spot at the base of my knee is sensitive to touch, and the redness has spread a bit. It feels quite hot. I am taking antibiotics, and eager for the day to pass. I see the doctor again tomorrow morning, and look forward to hearing good news...and fear hearing bad news. I don't know what the next step might be if he thinks the infection is not just a stitch. Not knowing creates fear. I push it constantly away from my mind. 

One interesting thing: I asked my doctor for the surgical report...very interesting to read through. Now I understand why my shin has felt bruised....it is! 

Day 27: Set-Back

My incision continues to be itchy and stiff. I am massaging it, and gently rubbing it to desensitize and soften it. But this morning I noticed a red bump on each side of the incision at the very base. It isn't very big..but as I massaged it mid-day I found a tiny bit of pus coming out of it. So I canceled going to Zumba Gold class (bummer!) - and called the doctor. Then waited until late afternoon to go see my doctor.

His assessment: "It is not unusual for this spot to have a problem, because there isn't much blood supply here. If we are lucky, it is just a stitch that hasn't dissolved yet. If we're not, then we have a joint infection." 

He didn't say what happens if it is a joint infection, and I am not asking, because I am hoping for the best! So it's shower/betadyne solution/anti-bacterial creme/bandage for the next two days, then I see my doctor again.

It is quite uncomfortable, and a bit discouraging, as I was just starting to feel like I could move about a bit more, and now I need to be "very quiet" - not quite "go to bed" - but close to that. And no more Zumba for "a couple weeks." 

Bummer! - - - - but hoping for the best; and for now, back to my couch.

Day 26

Not much to report today. Still feeling the frustration of wanting to do more, and not able to do so. I did manage a half mile walk...in two pieces: one in the morning and one in the evening. But each time I get back to the house huffing and puffing like I normally would be at the end of 15 minutes of medium-high intensity low-impact aerobics! Disgusting. 

Must practice a LOT more patience!! 

I spent part of the day locating a physical therapy out-patient clinic. So at least that job is done. I am on my own though, for a week and a half.

Day 25: Mother's Day, 2013

I wish I had known how tired I would still be at this point of recovery! I would love to take today to hop in the car and go spend some time with my mom. Fortunately, my mom is a sweetie and has had both knee and shoulder replacements, and understands recovery.

So. Another day of laying around on the sofa. I took a bit of a walk, got tired. I had visits from my children, a phone visit with my mom. My son came and cooked barbecue dinner..scrumptious! And sitting at the table for half an hour, the thermometer at 80 degrees inside and 92 outside, was enough to send me back to my couch to put my feet up. We all had a good time, and then watched the ending of the movie "Ever After" together. It was a GOOD day.

Unfortunately, at this point I am daily fighting frustration, because I want to get busy again, my brain fog is clearing, but I am quickly reminded that my body is just not ready! Fortunately, I am surrounded by people willing to remind me to take it easy and heal.

I am moving better, and the scar is softening and allowing a bit more movement. The outer side of my knee, where the prosthesis is, has a funny kind-of-numb feeling. The bottom of the scar, and the spot where the IT band was detached and reattached is still very sensitive to touch. 

For a page with a good illustration of the IT band, click here.

Day 24: Sabbath

What a lovey morning!!! I awoke to find that the sheet on my knee didn't bother me at all! It feels so lovely, that I just lay in bed and enjoyed it. Then I sat up to read a bit, and when I did, I pulled both knees up to support my iPad.....wow! It bent!! Without any effort at all! And no sense of having to work to hold it in that position.

Now THAT's what I call progress! So apparently the "desensitizing" and the massage worked wonders. 

I will be playing my flute at church today. Church is quite a challenge, especially since I still don't feel up to sitting normally yet. 

Everyone is so happy to see me and how well I can walk. However, in the process of getting ready driving over, visiting before services, I am quite tired by the time church starts. After I play, I move out and sit in the lobby to listen to the rest of the services from there. That way I can sit on the landing of the stairs, with my legs extended and lean my back on the wall. It's more comfortable than you would think! 

After services, I visit with a few more people before heading home to grab an ice bag and put my feet up.. It has been a good day. This is probably the most activity I have had yet. It's amazing how tired I am!

Day 23

Today was my last at-home physical therapy. I have to say I thought I would be much better by this point in time. I really expected to be back to almost normal in a month. This may seem unrealistic but considering my fitness level and background, I just expected to heal much faster.  

So this is my reality: I still spend most of my time sitting with my feet up..not above my heart, but level with my hips. (I have had very little swelling. If I had more, then I would be long down with my feet above my heart.) I can manage about 90 minutes up and about, and then I am quite tired and need to rest and apply ice. 

I can't bend my knee much beyond 90 degrees without feeling a lot of resistance from my incision, and it is so sensitive to touch that even the sheet laying across it at night is painful. The area where the new joint is in place is mostly numb. The spot on my shin where the computer leads were feels bruised. The spot just below my knee where the IT band inserts feels bruised. I can walk without a limp...as long as I think about every step.

Today my therapist taught me how to "desensitize" my scar..by gently brushing it with the softest fabric I have available. I think I am going to go through the roof as she demonstrates this technique for 2-3 minutes! 

And she showed my how to gently massage and move the skin on each side of the scar to loosen up the scar tissue which has developed as a natural part of healing. This process will ensemble the scar to stretch and help me to bend my knee.

I still need a lot of help! I hope my insurance will consent to out-patient physical therapy. 

Day 22

My physical therapist yesterday told me, "It's ONLY three and a half weeks since your surgery! If you said you wanted to take the next week and do nothing but rest, that would be perfectly normal!" 

Every fiber in my fitness-professional-being rebels at that!! I want to be up and doing. I want to start building muscle, work up a good sweat don't aerobic exercise! 

Here's my reality: I am not your average person. I am more fit in my age group than most people. I could be better, however the last few years have limited me...but that's not the point. I expected to be almost back to normal four weeks after surgery. I'm not going to make it. That frustrates me. So I must adjust my expectations and move forward.

I went to my Zumba Gold class today, and was able to do the entire class..no sitting down. No, I didn't work as hard as I want to. For now, I am just happy to be able to be there. After class I stopped at a store for a short shopping trip, then home and apply ice pack to my knee. Not pain afterward, so that's a good sign. 

The weather, and needing the rest up after doing too much a week ago, have stopped me from my daily walk. It's supposed to clear up in the next few days, and I feel back on track, so I will be back at working toward that one-mile-a-day goal.  

Have discovered that the improvements to my performance have made practicing the flute a joy again. (See my other blog: FluteSoloMusic for details)

Other thoughts:

• I am very glad it's my left leg! If it were the right, I would not be able to drive yet
• It is going to take longer to heal than you think! 
• One day of over-doing can lead to several days to recover
• Patience is key to recovery

Oh, and the last of the scab is off..so it's looking much better! Life is good.

Day 21--Things are looking up!

I have really been looking forward to today! The stitches came out...such a relief! Also, most of the scabs are off. The doctor is happy with my progress and answers questions:

• Is it called a prosthesis or an implant? -- Both
• What is the metal? -- titanium on the lower bone, cobalt chrome on the top, polyethylene cushion
• Can I put vitamin E oil on the incision/scar? -- Yes
• What activities should I never do? (Other than running, which I know is bad for joints) -- Doctor G's Law: if it hurts, don't do it.  Basically, my body will tell me what works for me and what doesn't. He tells me that his body rebels at walking for exercise, but likes stationary bike. Interesting...
• Why does the spot just below the knee hurt so much? -- that is where the IT Band connects, and it had to be detached and reattached...in other words, it is still healing!
• When will it stop being uncomfortable to have clothing touch it? (I have lived in shorts for 3 weeks!) -- Unknown. Some scars stay sensitive for years, but you get to where you don't notice it so much. Every body is unique. 
• What were the little incisions above and below that had stitches? -- That's where the computer leads,robot connections and reflectors go. It allows for the practically perfect alignment that makes this surgery so successful.
• Can I abandon the TED stockings? (compression stockings) -- They are for circulation, so mostly you need them when you are sitting with the legs down. 
• Now, come back in a month and we will check your progress.

I am now walking with no cane. I don't need the ballistic pain pills, but an occasional acetaminophen. I ice it when it aches--1-3 times a day. And today, I go to Zumba Gold. I am very, very cautious in my movements, and only stay for 1/2 of the class...it's enough! It does feel wonderful to see my "girls" again, and to be able to enjoy some activity. 

A real red-letter day.

Day 20: Up and Down!

Well, I had hoped the last two days of resting would pay off. But I did not sleep last night...grrrr! I simply could not get comfortable. The incision is itchy and sensitive to fabric brushing against it. I still can't sleep in my normal position, kind of on my tummy with a knee tucked up. When I turn on my side, with the surgery leg in top, the sheet rubs on the incision. So turn to the other side, and the mattress presses against the incision, and the top leg adds pressure...there is simply no comfortable position!

Seep and I are not friends to begin with. I would not say that I have insomnia, but rather that I tend to not need a lot of sleep--6-7 hours is quite normal for me. And forget about sleeping through a full moon! I can expect 2-3 nights where I only get 2-4 hours sleep at best. (But I don't usually feel tired from it). The only time I my life that I can ever remember this not being true was during pregnancy: 10 hours a night, from the day I got pregnant util the baby was born!

Since the surgery, I have averaged 8-9 hours most nights. I figure that makes sense: my body is healing, and should need more sleep. Until last night, I could take half a pain pill and that would help me sleep. It didn't work last night. I finally got to sleep about 6am and slept til 8. So I felt a bit "off" throughout the day.

But my physical therapy session went well, and about 1/2 hour after I realized how hard I had worked! I paid attention to applying ice as needed. No outside walk, it was raining. Went to bed at 9pm and slept til 7 the next morning.

Really looking forward to day 21: I get these annoying stitches removed!!

Days 19

Day 19

Well, I had a good sleep, but still feel kind of tired. I guess two days of doing too much requires two days to recover! I still spent a lot of time with my feet up, and paid attention to the clock. I spent the day in this pattern: 
---sit with feet level for an hour; 
---get up and walk back and forth, do an exercise or two.
---lie down, feet above my heart, sometimes with ice on the knee for 30 minutes, depending on which exercises I had done.

I did walk outside, but it was cold and windy, and I got very tired..maybe only walked a little over 1/4 mile. 

I finished making the hairpin lace shawl that I started two weeks ago. So I have learned a new skill and used up some yarn in the process. I am getting very eager for my post-op appointment in two days.

Day 18: New Realization

A day of rest. For the last 41 years, I have taken the 7th day of the week to rest, pray, attend church. You would think after all those years, I have learned it all..not so. 

My body took control and so today I simply rested. I took pain pills (ugh). I used ice...a lot! (4 times during the day/evening). And this is what I discovered:

The frustration of the last two days was because I had done too much, pushed too hard, on day 16!! I kind of thought so, and so on Day 17, I tried to take it a bit easier...and did too much again! I didn't spend enough time with my legs above my heart..I didn't use the ice enough..I shunned the pain pills.  Result: by that evening I finally noticed my legs were a bit swollen at bedtime. I took a pain pill, and went to bed.

Still, when I got up this morning, I felt achy and tired. So I made the hard choice, to stay home from church, get my feet up, and apply ice. No long walk, but just what I needed to do to take care of food, toilet, etc. I did get nicely dressed, and, because it is so close, went over to church after services to see my friends, (after listening into services on the Internet connection). I took the non-narcotic pain pill so it would be safe to drive the short distance. And as soon as I returned home, I lay down, grabbed my ice bag, elevated.

Then early to bed with the narcotic pain pill. Hopefully day 19 will have me feeling well enough that I can get back to a good walk. 

I do think my brain is waking up and getting ahead of my knee capacity. So I am going to do my best to watch the clock tomorrow: 1 hour down, then walk a bit, or sit a bit, the down again..onward!!

Days 16 & 17

I am over the half-way mark! There is a certain amount of excitement, but also a bit of frustration. I still cannot climb stairs normally. I am tired much of the time, and still need to spend time lying down during the day. I had hoped to be further along....

However, my therapist tells me I am ahead of the norm, so I must be satisfied with that.

Day 16
A red-letter day: I am sooooo close to hitting the mile I want to be walking. I feel. Pretty good, although the scab is annoying. I make new gains on flexion of my knee by using the new way my therapist taught me to work at it using gravity and a balance ball. I go out to lunch with my daughter and granddaughter and then we stop at Target to pick up a few things...I am very tired by the time we get home and happy to lie down and ice my knee.

Day 17
Not so good. My knee feels achy, especially across the front of my leg just below the knee. This spot has felt bruised all along, and today it just hurts a bit more. I feel tired, too. Physical therapy is getting a bit frustrating, partly because I know we are almost out of visits (2 left!), and I feel like there is still soooo much I need help with! 

My therapist encourages me by telling me that I am ahead of the norm, and that I will be OK on my own. I do know quite a lot about rehab of knees, because I have worked with many clients in this way as a personal trainer. I shorten my walk, and take a pain pill at bed time. Onward!

Two weeks down, but remember:

It occurs to me that this is a good time to repeat my disclaimers: I started this blog so my friends could track my progress, but also to help anyone who is facing knee replacement surgery. My doctor advised me to DO MY OWN INTERNET RESEARCH before making my decision. He told me to avoid sites like this, because EVERY INDIVIDUAL IS DIFFERENT! 

So, THIS IS MY PERSONAL, UNIQUE EXPERIENCE! I AM NOT A DOCTOR. VIEW THIS BLOG AS AN EXAMPLE ONLY, AND FOLLOW THE ADVICE OF YOUR OWN DOCTORS!

Day 15

I am feeling a sense of progress again. I can see the incision healing, and the steritapes are coming off. I can comfortably walk 3/4 of a mile, and will easily reach my goal of a mile by next week. I do find that I must be mindful to stretch my calves at the end of a walk, or they will cramp up the next day. Silly muscles!

I am ever-so-tired of the feeling of the scab across my knee! But on the other hand, I am aware of healing, because I am less content to spend the day watching movies, icing and exercising by the clock. I am eager to dance again, get out and work in my garden...there is so much to be done this time of year!!! Must stay on top of the weeds and keep them from reproducing!!

Going up and down the stairs is the latest challenge. I am tired of the "baby-step, two feet per step technique! So far my therapist has had me working I a step bench at 4 inches, and stepping up is improving, but the step down aggravates my OTHER knee.... (Sigh).

So I am working on patience, and focusing on exercises that move my progress forward. 

Days 13 & 14

Day 13

I am still feeling a bit of the frustration from yesterday.. I guess it is mainly that I feel enough better to be more active...and then get tired very easily. I also notice my brain is still a bit foggy...I burned my cast iron pan this morning, becauseI forgot to turn the fire off when I used my breakfast!

Physical therapy went very well, though. I learned today that I have apparently been compensating for a much longer time than I thought. So I am having to completely change the way I walk. I have a very hard time placing an even load on my left leg. I tend to walk flat footed, instead of picking up the knee on my left leg and stepping heel-toe. I don't step as far forward with the right leg, and I don't extend the left leg behind. So much work to do. 

My daily walk is improving significantly..I actually hit my goal of 1/2 mile, although broke it into two walks, with a rest in between.

Day 14
That frustration seems to have gone away. I enjoy my half mile walk so much, that I take a second one later on in the day--about 1,000 feet.

I feel pretty good most of the day, although I catch myself hobbling about the 
house instead of walking correctly. It is amazing how hard it is to change my gait!! 

I once read a Reader's Digest Article: "Three Weeks to a Better Me." (Don't try to find it on the Internet..I just looked and what pops up is not what I am referring to). The article explained that if you want to build better habits, and can keep yourself on track for three weeks, you can establish the new habit in place of an older, bad habit. So I am going to put it to the test, and see if I ca fix my walk in three weeks, starting tomorrow.