December 27: Looking back over 2013: "The Year of the Knee"

I find that I am feeling very retrospective at this point. It's almost the end of 2013, and I have spent a year preparing for, having and recuperating from knee surgery. Here's my year in brief: 

• January: my left knee was so painful: it would catch and lock, then pop and hurt. I didn't know what could be done about it.
• February: saw my long-time orthopedist. His x-ray showed loose bits of bone and cartilage in the joint. He recommended physical therapy. After 1 session, I wondered how exercises could change the catching/locking/sharp pains.
• March: Found Dr. Gilbert. He tells me I am a good candidate for Partial Knee Replacement with Mako-Plasty surgery. I do my research.
• April 15: Tax day, and the day my left knee was fixed
• May: I suffer a set-back as the bottom stitch in the incision festers and infects.
• June: Back to all my normal activities. My leg gets stronger every day. I start noticing that the right knee hurts….ALL the time.
• July-Sept: Left knee gets better, right knee gets worse. In July I am finally able to stand sitting in the car long enough to go to visit my mom: a 3 hour trip. In October, we travel north for our annual Fall Holy Day observance: 8 hours driving the first day, 4 the second. My leg feels wonderful.
• October: My right knee has begun to make me nervous driving. I am worried about pain preventing me from stepping on the brake in an emergency. At my 6-month checkup I discuss it with Dr. Gilbert. Result: another repair.
• November: Surgery to repair my right knee.
• December: I am almost back to myself again. I still have some pain due to swelling that is within the joint. I don't quite have full flexibility back, but I will. The happiest thing is that it is healing, getting stronger daily. I will go back to my normal active schedule in January, Zumba Gold, Line dancing, gardening, playing flute, and best of all--running up and down stairs.

It has been quite a year! I hope that I will never need a full knee replacement in either knee. You see, the partial knee replacement assumes that the other half of the knee will stay strong because the knee is back in alignment. There is always the chance that the other side will deteriorate, and a full knee replacement will be needed. I hope if it does, I will get a good 10 years out of my partials!

Day 28: 4 Weeks After Surgery

I love daily noticeable improvements!! Today I walked across the room, and started down the stairs without thinking about it. I had taken 3 steps when I realized I was walking FORWARD down the stairs! So exciting!!! So now I grip both handrails, and slowly and carefully walk down the stairs. I feel like a princess, descending grandly down a staircase.

Evening as still the hardest part of the day, and sleeping. I am still sleeping mostly on my back. When I do roll onto my side, it doesn't last long, and it always hurts to roll out of the position. 

I have stopped taking pain pills, because it doesn't hurt anymore. I apply ice to my knee 1-2 times a day,

I have begun to be more active, but still focusing on taking it very easy. I have two more weeks to get back to normal activities. So for now it's up and active for an hour, then resting for an hour to an hour and a half.

Day 27: Milestone Reached!!

It was on day 27 last time around that I discovered a little blister at the base of my incision. If you look back in the archives you can see the result of that. It set me back 2-3 weeks in my recovery process! So one goal this time was to keep my activity levels lower up to this point. I have felt like I could be moving around and doing more, but for the last 7 days I have made it a point to rest and elevate more than I thought I needed to. 

Today the incision looks good, no redness, no tenderness. Yay! There are still 2 scabs of dermabond, and the tape the nurse applied at the bottom where the dermabond came off at the 2-week mark. But if I press gently along the edges, there is no tenderness like there was when I developed the infection last time.

Progress so far:

• I drove the car around the block yesterday. It felt surprisingly normal. My husband rode along, and at his insistence I made a quick stop to imitate what would happen if someone pulled out in front of me suddenly. So I can now may short trips driving, although I am not in a hurry to do so.
• I can walk up any of our stairs with alternating steps. The front steps are a bit of a challenge, as they are very high, but I can do it!
• Still walking a mile most days, still slowly, but I am less tired at the end.
• Still very tired and crabby at the end of the day..tired of sitting, tired of not bending my knee. At this time, I try to focus on progress made, and relax.
• I can lay on my right side for 10-15 minutes, on my left side with a pillow under my knee for about 5 minutes. It gives my back a little relief.
• I still spend most of the day on the couch, legs either elevated or extended.
• I apply ice after every exercise session..about 1-2 times a day now.
• I can bend my knee comfortably when sitting in a chair.

My goal at this point: back to normal activities by the end of two more weeks.

Day 24: Making Steady Progress

Over the last few days, I have increased the amount of time sitting at the computer. It is so easy to over-do!! I did too much yesterday and the result was an ache in the back of the knee during the evening and night. I try to spend no more than 15 minutes at a time. My therapist explained it to me this way: "there is still swelling in the knee, so sitting with it bent allows the chair edge to put a lot of pressure in that spot...result: pain." My plan now is to treat sitting time the same as exercises: do a bit, then apply ice.

I can finally bend my knee enough, that when I am sitting in bed, I can prop a book on my knees...well, for a few minutes, anyway. I can comfortably walk a mile--slowly, and having to focus hard on stepping evenly and keeping my balance. 

I'm still wearing the TED stockings. The post-surgery directions are to wear them daily for 4 weeks unless tolerating 1 mile walk "regularly." Since I'm not really sure what "regularly" means, and it's only 3 more days to the 4-week mark, I am going to keep wearing them. They aren't uncomfortable, and they keep my legs warm!

There are still 2 spots of dermabond on my incision, but the parts that I can see look pretty good. 

I also tried siting in the car, and much to my (pleasant) surprise, I found it was easy to move my leg back and forth between the gas and brake pedals. It was also easy to press the brake down, so I started the car up and moved it back and forth about 6 feet in the driveway. I predict I will be safe to drive next week. But I am practicing not rushing anything, so we shall see.

Beginning Week Three.

I have made good progress! In the last two days I have increased my walking distance to the magic one mile mark. Why is it magic? Because if I can walk a mile daily and no discomfort, then I can get rid of my TED stockings by the end of this week. That's only a week sooner than my post-surgery instructions, but how nice to be out of them. Actually, they are quite comfortable. I'm just tired of having white legs.

I am now able to go up our staircase with alternating steps. I go slowly and lean forward from the hip to keep the pressure off the knees, and in the glutes, where it belongs. I can also go down the stairs the same way, but only by backing down. The trick with backing down is to have a staircase where you can hold on both sides, then lean forward and watch your feet. I can't recommend backing down to everyone! But if you have the balance, it is so much easier on your knees!

I can also tolerate sitting at the computer for 15-20 minutes at a time. I try to limit it, as my goal is to stay fairly still throughout this week. It's getting hard to be so sedentary, because I feel pretty good.

I don't have much pain, but I take pain pills as soon as I notice discomfort. I don't feel like I NEED the pills - but I have been told that it is better to take them in order to avoid any build-up of inflammation. 

I still can't sleep on my side, and am ever so tired of sleeping on my back. I have discovered that I can lay on my side for a few minutes, but that's not enough for good sleep. 

My knee is 2 weeks old.

It seems like so much longer than 2 weeks since my surgery! The stitches have been removed, and two little strips of tape were placed across the spots. The dermabond (glue) that seals the incision is half gone. It was loose and the nurse lifted it off with tweezers, and placed two strips of tape over that section of the incision. 

I still have tenderness around the lower stitches, a little bruise shows under the edge of the tape, and my thigh still feels a little bruised. I am walking pretty well, no crutches needed. I do carry a cane when I walk outside, but I barely need it at all. 

I am really tired of not being able to bend my knee when I sit up in bed, or sleep on my side. But hey, it's only TWO WEEKS! I am working hard at keeping my focus and not doing too much. The guideline of two hours up, two hours down is good, but I find I tire in less than an hour, then need 2 hours to rest up. So it's more like 40 minutes up, 2 hours down. 

I still apply ice after moving around for a bit. The ice feels good, and helps prevent swelling. 

I finished three projects: 
1. the memory quilt I made for my daughter is now done. 
2. Flute cleaning cloths with a little "bubble" at the top so it's easy to get all the moisture out of the head joint. I made enough for myself, my teacher, and each of her other students.
3. I made a pouch to put my iPod touch in so it doesn't get scratched. It's actually a project I began a few years ago: a tatted "evening bag" - I made a liner of felt, and added a fastener across the top. 

Look for pictures to be posted to a new page: "photos 2"

Saturday and Sunday

Saturday
I am now walking with full weight on my leg, tapping along with the crutches using a 4-point gait. That means the crutches move one at a time, alternating with the opposite leg. I am not putting any weight on my hands, simply bringing the crutches along for the purpose of balance. I shortened my walk today, because I don't want to overdue. I still managed almost a quarter mile. 

I am making steady progress on finishing my daughter's quilt. Following the doctor's revelation about the exercises has got me thinking once again about the physical therapy protocol..but I'll save that for a separate post.

Sunday
I increased my walking distance, and feel comfortable walking a bit faster. The exciting thing for today is standing up from a chair. I have a bit of understanding of the principles of Alexander Technique. It's a whole system of movement best learned from a teacher who is trained in the technique.

I have had a couple lessons, read a book, and articles on it. The awesomeness of Alexander Technique is effortlessly standing up. Until today, I wasn't bending my knee enough to use it, and mostly have been pushing/pulling myself up with my hands. This morning I decided to see if I could rise from a chair, allowing my body to lift upward from the top of my head. It worked!  Very little push needed from my hands! Yay! So that's the big thing for today. 

I am starting to walk in the house with no support. 

Monday morning:  My knee didn't ache during the night, so I guess it isn't hurting me, but it does affect my gait, so I think I will try using the cane today. Feels good to be progressing forward.

Thursday and Friday

Thursday: unremarkable. Tried to do some exercises, but found my muscles were too fatigued. So I just had a nice, unremarkable day. I am making progress on the quilt I am working on. Finished the edge finishing, which was tricky because of the 8-point star shape. It's a matter of making the fabric fold over the inside angle, and lay flat at the same time. Now I am doing the final step..quilting designs in the areas not already tied. It's looking pretty.

I am sick of leaning on crutches. Makes my hands hurt.

Friday

Physical Therapy in the morning: Getting over the fear of putting full weight on my leg. It feels wonderful to walk without leaning on the crutches, but takes me several passes back and forth in the living room to be brave enough not to. I was able to out full weight on my leg a week ago, but doing so created 3 days of pain, so that's the source of the fear. If I get through tonight without pain, then I will know that the knee is ready.

One of the exercises causes a sharp pain just below the knee on the medial side of the incision. It is leg extension while lying on my back with a pillow to hold the leg at a 45 degree angle. Then a couple other exercises create the same pain. My therapist massages (gently!) the pain away, and since I am seeing my doctor this afternoon, tells me to be sure to ask him about it.

For the rest of the day, I walk with crutches simply for balance...so nice for my hands!

When I see the doctor, stitches come out, X-ray of my knee is taken, when I ask him about the spot that hurt and describe the exercise, he says. "Why do you want to do that? If it hurts, don't do it!" My fitness background screams in my mind: "I have to do that exercise to strengthen my knee!"  As we talk I come to understand that I don't have to do that particular exercise..when my knee is ready, it won't hurt to do it, and then it will be effective.

The other cool thing he explains is that with the medial replacement they have to "disturb" the joint capsule... ie. open it up, then close it... It takes a whole to heal, and that's why I keep getting sudden pain in that spot. Ah-hah! So now I won't worry about it. I won't do exercises that aggravate it. (There is more than one way to work on knee extension!)

And lest I give a wrong impression: after a couple tries my therapist abandoned that particular exercise and gave me leg extensions that did not hurt. So she was already doing what the doctor recommended. He just added the extra bit of info. 

I did not take a walk today, because between physical therapy and getting to the doctor appointment it was enough. It was nice to get out and away from the house for a bit. 

Wednesday. Let's talk about pain...

I have a very high threshold for pain. It may come from living most of my life with some sort of chronic pain..headaches for 28 years (eyestrain--contacts fixed that), pain in my wrists for 6-7 years (caused by an injury-carrying suitcases-eventually resolved when I began weight training), shoulder pain (tension, child rearing, sewing), neck pain for 2 years (a lifetime of bad posture, which, when cured set the muscles into spasms because they had never been used properly before), migraines (menopause) and most recently, knee joint pain for the last 7 years (osteoarthritis).

The result of living with all this pain is that I don't bother with pain pills much, at least not until it gets really, really bad. I did learn with the migraines that if you are going to take something, do it ASAP, before the headache gets a grip on you.

But here is what I learned today from my nurse case worker: if you are in pain you won't heal. Somehow taking pain meds and keeping the pain under control helps your body to heal. Hmmm, who knew? So I took a pill as soon as we got off the phone. 

Today was pretty good. I can finally lift the leg without supporting it, although I am babying it. I elevated the leg twice, first thing in the morning, and after my exercises.
I put ice on it 4 times during the day, and took a pain pill before exercising and another after my walk. I practiced for the first time since the day before my surgery..such a delight to make music! I had a nice walk, and made progress on finishing the quilt which is my priority project for this convalescence. 

Things are looking up!

Tuesday, Day 8: feeling much better!

My knee is much improved! Or rather, my pain is much improved. 
Here is what I have decided:

• The exercises were OK. I didn't do too much...well maybe a tiny bit!
• The outdoors walk, using crutches is fine.
• Walking inside the house with only a cane is too much
• I probably got a little dehydrated, also not good
• I twist my knee when I get up and down, just a little, but repeated twists are not good.
• I really, really need to find a way to get the leg above the heart at least some every day.

My therapist comes and confirms my conclusion. She has me doing straight leg lifts, first with her helping me, and then on my own. (Until now, that lift really hurt. I have needed to use a band to help me lift my leg up and down.) Progress finally!!

I almost skipped my outside walk, but decided to walk anyway. My leg was hurting just a bit at bedtime, so I took a pill..slept well!!

My knee is 1 week old today!

Assessment: 
Pain levels: not good
Walking ability: terrific!
Flexion: stinks
Incision: healed and dry, so can be left without a bandage...I still put one on at night.
Stitches: look good, healing nicely.

Last evening and night were the same as Saturday night...painful. 
My therapist had to reschedule for tomorrow, so I am on my own. I am wanting to worry that something is wrong, but I squash that thought. I review the post surgery handout from the hospital, and my pain doesn't fit in the categories that require calling the doctors office or going to the hospital. I do communicate with one of the nurses at the hospital who assures me that the first two weeks can be very difficult, and everyone's experience is different.

The goal today:

• Get that leg elevated somehow. (Have you ever tried getting your knee above your heart, and resting there? I decide my resistance ball may work--It does.)
• Rest lying down more 
• No cane .. Use crutches every time I get up
• Walk the same distance (I can't resist the lure, and actually go farther)
• Be very careful every time I move the leg to support it and not twist it (getting off the toilet without twisting is pretty tough)

Evening: some aching but not as bad as the last two nights

Tuesday morning: I actually slept all night without pain pills!! 

Conclusion: even though I CAN walk without the crutches, I shouldn't. Darn.

Sunday

Yesterday, in the early evening, my leg began to ache. Every so often a slight movement would hurt with intensity. Sleeping was pretty rough, and at one point I managed to roll slightly into my side (So heavenly to get off my back!) but when I rolled back and tried to lift my leg to put it back on its pillow....I felt like I was stabbed in the side of the knee!! Then it ached. I sat up and gently massaged it until the acute pain subsided, took a pain pill and was able to go back to sleep.

So I concluded I did too much yesterday. I don't think it was the long walk...that simply feels good every step of the way. The exercises are a different story. Each exercise is supposed to tire the leg, but not cause pain. Sometimes it hurts before I realize it is going to. 

The goal today is to do the same walk, but skip the exercises. If my leg hurts in the evening again, then that should indicate the walking is the problem. 

It hurts, the same as last night. I am still not convinced that the walk is the problem. So I need to evaluate the problem.

As I look at today's activities, I decide that perhaps the problem is walking around in the house. When I take my outdoors walk I use the crutches so that I can focus on correct gait, and have extra stability over bumpy surfaces and the slight hill. However, in the house, I simply carry a cane along, and hardly use it at all. I also puttered about a lot during the day..transplanted some seedlings into little pots (sitting on the porch steps), fixing my own lunch (multiple trips back and forth to carry things) and sitting up more than lying down.

The biggest pain creator is when I get up or down and swing the leg out in space. If I don't move slowly, and support the leg with a strap around my foot it hurts. 

So tomorrow's plan is to still walk, lie down a lot, elevate,the leg, and use only crutches. My therapist is scheduled to come, and maybe she can shed some light on it.

Onward!!

The Sabbath, Day 5

Rest! and rest some more...it gets hard. 

I would really like to be up and busy. My mind is ready to start on projects, but my knee is not ready. It's a beautiful warm sunny November day...the kind that makes you just feel happy to be outside. We take our walk In the morning, because church is is the afternoon. I poke along at my slow, controlled pace, watching the ground in front of me for twigs, leaves and other hazards. It feels so good to be outside!

The professionals really want me walking on level, smooth surfaces..yeah...not going to happen. Our block has old trees, cracked sidewalks, and goes downhill into the middle, then back up again. So I pick the least uphill part and head west. Once I get to the corner and can turn it, there is less incline. I have to be more cautious going downhill, and uphill makes me puff a bit. 

The Therapist in the hospital taught me to use the crutches and "walk" them alternating and opposing the feet. So the left crutch moves forward with the right foot. I feel like the giraffes in the stage production of "The Lion King." It's really nice, though.

Anyway, it's so lovely out, and at my slow pace, I just keep going until I realize I have gone much farther than I thought I could! I feel like I could go even farther yet, but decide to go back anyway. 

Even though I am walking so well, stairs are another matter..and my flexion is very poor. I am so tired of keeping my leg straight, and sitting/lying on my back! I did set up a regular list of exercises, and did them morning and afternoon, plus a nice long walk in the morning, which felt really good. 

Day 4: Friday

Rain! I love a rainy day, especially when I can stay inside, cozy and warm, and watch it come down. It is a quiet day and I rest a lot. Late in the afternoon I have a visit from Sally, my Physical Therapist. Sally worked with me on my left knee, and the confusion checking out of the hospital had to do with connecting with her agency so that I could continue with someone I like, respect and trust.

It's very hard for me to work with Physical Therapy professionals. I respect their training and knowledge, and expect them to do the same for me. Yes, I am "only" a Personal Trainer, but I am highly self-educated. I understand body mechanics, and many of my clients were in the rehab process. Unfortunately, I have not always been able to find someone who would work with me from of basis of my knowledge, and that defeats the purpose of recovery. 

Sally and I have worked out the kinks, and have a good working relationship. So today's visit was to determine my status: set up base-lines in terms of ability to flex and extend my knee, walk, get up and down. We evaluated the exercises I am doing, and added a couple of goals. 

Due to the rain and the therapy, no outside walk today.

Late in the evening the kids arrive for a visit, and bring turkey, potatoes, yams, green beans and pie. Yum. (They had chosen to have their Thanksgiving Dinner today, so my daughter got a day off between school and cooking.)