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.)