STOP THE PRESSES!

A few years ago, my mother had back surgery.  I had read that satin sheets would make moving around in bed easier following surgery, so I purchased a set for her.  Before my surgery, I thought about borrowing them, but I didn't.  I used them last night, and oh how I wish I had been using them the whole time!!  Impossible and near impossible moves were totally possible--even without all the grunting and groaning.  They are expensive, but it will be well worth the expense.

Another small advance

Yesterday I returned my Continuous Passive Motion machine. (CPM)  It's a nifty machine that sits on your bed and bends your knee slowly and for the most part without pain.  I began at around a 75 degree bend and gradually increased it every day.  Yesterday I had reached 110-115 degrees on the left knee and 125 on the right.  The amount of bend with the machine measures about 15 degrees less when bending on your own, but still, it feels great to see the progress.  I was supposed to spend 4 hours in the machine with each leg.  That's a lot of time on your back watching TV!    I am a bit apprehensive knowing that now all the bending is up to me.  Today the PT worked on my knees, tugging on them and bending them for me, and I felt better that it was probably not all up to me after all.  After her stretching and tugging, I measured 107 on the left and 117 on the right!


I'm thinking I'm going to spend some of my new found time doing some walking now.   The notes I got from the St. Francis class said by 5 weeks I should be walking 8 blocks--not even close!!  One half block, maybe?  I also plan to use the walking path at church since I am a bit leary of twigs and leaves and pine cones and other such items that could cause me to end up on the ground.  Besides the pain that would cause, I truly don't think I could get up!

4 weeks

Yesterday I had my first post-op visit at 4 weeks.  I was taken for X-rays which was ok until the tech repeated the right knee 4 times.  OK, I'm beginning to get nervous because this is my good knee, the one that bothers me the least.  Is is not so bad because it doesn't even work correctly?  She goes and gets the doctor.  He says, "She's too relaxed.""  That does not sound good.  What pain is he going to inflict on me to decrease my relaxation??!!  He comes in and positions me in an awkward position, they get the X-ray, and all is good.  I was given the freedom to do anything I feel like doing.  He felt safe saying that--heaven knows I won't be doing anything daring.  I also started learning to walk at PT.  At home I am giving up my walker and using a cane.  This has really slowed me down. (My door frames and floor moldings will be happy; I have really beat them up with the walker.)  Prior to surgery, I used my cane in my left hand for 2 years.  Now I have to use my right hand because my left knee is the weaker knee.  So every step is an effort of concentration and exaggerated motion.  When I think about what I was like 4 weeks ago, I realize I have come a long way.  Four weeks ago I was literally dragging my left foot.  I could not move it from side to side or pick it up in any way.  Two days ago I threw my left leg up on the bed, and my husband and I both dropped our jaws at my feat. At the end of each day, I write down any minor improvement I noticed that day.  Most of them have been miniscule, but at the end of the week, they add up to something noticeable.  On the days that I feel discouraged, which is more often now--I think I am getting weary-- I can look at my lists and see the remarkable progress that I have made.  You may remember that my 2 month goal was to be without assistance in the house.  I'm feeling pretty sure I can accomplish that in one month now that I have graduated to the cane already. Now my doctor wants me to work on giving up pain meds.  Since I am now off blood thinner, I can take NSAIDS.  I started out with 2 after breakfast and will take 2 with dinner, then save my narcotics for the break out pain.  Let's just say that the pain broke out sooner than I was hoping.  I am to keep records of how many pills I take over 3 days.  If I took 11 pills over 3 days, then the next 3 days, I am to take 10 or less. Sounds reasonable, but scary, too.

One Word (3 weeks)

CONSTIPATION.  I guess this goes in the ugly category.  This single word will forever strike fear in my heart.  Of course, my southern upbringing and the fact that my mother will be horrified that I am even bringing this subject up will temper what I have to say, but since I am a nurse, there are no topics that are off limits to me.


What a miserable day I had yesterday.  ALL DAY.  I knew that constipation was something that could happen because of the narcotics I am taking.  But I really didn't think it would be a problem for me.  I am so regular, you could practically tell time by my regularity.  I knew to drink lots of fluids.  But drinking fluids in the hospital required getting out of bed, and that was painful, it required calling someone every time I needed to use the commode chair and losing all privacy.  I knew to eat fresh fruits.  In the hospital, I rarely got fresh fruit, but I always made an effort to eat all fruit I was brought --even the nasty, gritty canned pears.


After I got home, I ate and drank even less than I did in the hospital.  I started taking Colace as a preventative. The bottle said 1-3/day.  I took one.  I am now taking THREE.  Yesterday required 2 enemas, and I still was contemplating the ER because I knew I was in serious trouble.  Today I am reminded of the momentos from my first delivery--painful hemmorhoids.


 Do everything you know to avoid this condition. Being more active would help, but doing 8 hours/day in the CPM limits that for me.  I have since learned there are abdominal exercises to do. I don't mind telling you that I have been affected by this physically, emotionally, and psychologically.

Pain, pain go away! (2 weeks)

This is for the 2 people I know who are following me in this journey later this month:


Here is what I have done for the past 2 days.  When I woke up, I  had mild pain, and I took one pain pill anyway.  I can take 1-2 pills every 4-6 hours.  So, every 4 hours, the pain was just beginning to creep up, and I would take one pill. I had 2 pretty good days because my pain was never uncomfortable, and I didn't mind moving around as much because it was not as painful as it has been.  I guess everyone has to figure this out for himself, but moving more freely because I was not guarding against the pain was so liberating.  So all day the past 2 days, I basically took one pill every 4 hours, then 2 at bedtime.


This morning when I woke up, I felt really good.  I had slept like a rock, I had no pain, and getting out of bed was miraculous compared to the past 2 weeks.  I thought this was going to be a really good day.  Did I immediately take my pain medicine? Nooooo.  Did I let the pain get ahead of me?  Yesssssss.  So I spent the rest of the day feeling sorry for myself and  being weepy because of my pain.  My new regimen for the duration will be one pill upon awakening, and paying attention to the clock and my pain level as the day progresses. Paying attention to the clock is more important than to the pain level. I figure eventually 4 hours will turn into 5, then into 6 hours.  

The Grass is not Greener on the Other Side

I've been home almost 3 days.  Coming home was difficult.  While in the hospital, I fantasized about how easier some things would be, and how happy I would be to be home.  It's a whole lot harder;  I've had more pain.  The actual trip-- preparation, leaving, and getting into the house were hard. I was thoroughly exhausted and having more pain than I had expected.  Even though I have great help at home, I am doing a bit more for myself and covering more territory than I did in the hospital.  I figure that contributes to my increased pain. It is hard to make myself do my exercises, but I can plan for my coordinating my pain pills and exercises better.  The day after going home, I went to physical therapy.  I was a bit apprehensive since this would be my first male therapist.  But after Slayer, this guy was quite manageable.  He even massaged my knees, which helped loosen things up in there so much!  After therapy, I was focused on how much time had to pass before I could take more pain medicine, and totally forgot that ice would have given me much relief.  I may have to resort to posting notes around to remind me about pain relief.  Things that I know just don't come to mind when I am in pain! 


Since I have to be on the CPM machine to bend my knees for so many hours, I spend a lot of time in my bed, rather isolated. Last night I went TV shopping online to buy a small TV to help pass the time while on CPM.  It was a planned purchase to be done before my surgery, but it just didn't happen.  I decided that I did not have to thoroughly research this purchase--it was not like I was spending a ton of money for a decision that I might regret.  So I made the purchase at Best Buy, and because of Christmas, they were open until 11PM,  and I sent my guys out to pick it up.  Easy as that.


Before leaving the hospital, the doctor told me that getting back in the water would be the best thing I could do, and it would speed up my progress.  I've decided to continue to be recovering from 2 major surgeries the remainder of the week-end, then go back to the pool and machines next week.  Just getting there will require more energy than I have now, much less exerting energy to do the work.  I may just be talking big.

WOO HOO!!!! I'm going home tomorrow!

I am surprising everyone by going home tomorrow.  This is not to brag one bit, but it has become very clear to me that I was more than prepared physically for this surgery.  Not one person I encountered did not not comment on how well I was doing, especially since I had had 2 knees done.  I kept hearing it over and over, and it made no sense to me.  It was very painful to stand,  it was very painful to walk, I felt like my mother-in-law in her last days, crouched over a walker.  It was very difficult to get out of bed, so I could not imagine that I was doing better than anyone else. As the days passed and the staff and I got more familiar with each other, the stories about others became more animated.  I told them that the pain is very real; maybe I was just more proud.  I had someone at 5:00 in the morning tell me that she had been watching me, and she could not figure out what was different about me.  I proceeded to tell her that I could tell her what was different--about how I spent the last year getting ready for this and what all that involved. Next thing I know, I'm having to talk about it with everyone else working that shift because she has gone back and told them about it.  If I have truly been the star that this staff has led me to believe, it's just wrong that everyone is not required to do prehab prior to surgery.  This has not been easy by any means, but according to everyone who has worked with me, I have made it look that way.  (By the way, I have always considered myself a baby when it comes to pain, so I don't think it's because I had a high pain threshold.)


So I have 3 more hours of therapy in the morning after a real shower.  Then I'm planning on pizza for dinner!

A taste of rehab (1 week)

 (Just read my last post and got tickled at all the mistakes.  Will try to remember to correct them.  I have so many postings in my head-- just hope that I can remember them.  Obviously they will perhaps be out of order.


I have had a good hospital experience thus far.  I spent Monday--Thursday in luxury accommodations.  Wood floors, flat screen TV, wifi, 4 month old bed, and Rick had spacious accommodations in the suite side.  It was impressive and definitely a selling point for the hospital.  The nurses were serious about pain control, so all calls were answered promptly.  Nursing care was efficient and professional. I did have one humiliating day, and I'm still thinking about reporting on that.  Then Thursday, I was transferred to the inpatient rehab unit.  Ugly, dark, and depressing.  It really affected me emotionally.  But the staff has been fantastic and more than made up for the dreary surroundings.


Friday I had an hour and an half of occupational therapy, an hour and an hour and an half of physical therapy.  Thoroughly exhausted me.  Saturday was unbelievable.  Same 3 hours of therapy, but intense.  I cannot go home until my knees bend to 90 degrees, plus I have to master some stairs, and walk a required distance.  The physical therapist proudly told me her nickname was Slayer.  Masochist would be better.  She inflicted great pain, all the while smiling, and asking if we were having fun!  She bent my best knee, the right knee, to 95 degrees, so I guess the right side of my body can go home.  The left knee which is the most painful, sorest, and stiffest, she managed to bend to 82 degrees.  It was truly awful.  I was convinced that my stitches would be busting any minute! Then in OT I had to pedal bike pedals with my arms for 20 minutes, lift 10# weights on a pulley for 180 times, work a rickshaw for 140 times, biceps curls (60), and several other exercises.  Then back to the room to bend each knee for 4 hours on the machine.  When I moved to this unit I was depressed about having Sunday off.  By noon Saturday, I was THRILLED that Sunday was a day of rest.  They let me eat breakfast before bathing, let me snooze before bathing, and the best thing-- put pj's back on instead of dressing!!!  Basically spent 8 hours in the bed on my machine bending my knees.  I would like to tell you that I am ready to get back to work tomorrow after my day of rest, but that would be a lie.  But I know that the work will get me closer to home, and I'm ready for that.

Last month I had surgery

Here it is the first day of December.  Doesn't seem that long ago that I had surgery.  Actually it's been 2 1/2 days.  Surgery went without a hitch as far as I know.  I had a spinal which was interesting in itself.  I was also sedated, but after the first knee the nurse anesthetist brought me back to consciousness, so I was in and out hearing what was going on, even talking some, not sure I made any sense. Recovery was a blur, but once I went back to the room I didn't have to deal with the wooziness of general anesthesia.  There was some concern since it was unknown if I were having partials or total knee replacements, and the time involved was different.  So I got a "super" spinal that kept my lower body numb for about 10 or 12 hours.  I also got femoral nerve blocks to help with the pain following surgery.  The right one worked GREAT, and I have not had one bit of surgical pain in my right knee.  The left knee worked some, but I had had 2 really bad episodes of pain.  My left leg was hurting in the OR and continued all day.  By 6 PM, I finally had the wherewithal to realize that this was not normal, and that this block was not working.  I had been using my pump all day, but it continued to get worse.  I let them know that I had to have more help, so I got Toradol and percocet.  It took a few hours to get the pain under control after that episode.  Then the next night, the back of my left knee was uncomfortable, so I stuck my ice pack under my knee.  Well, my knee pain was getting worse, and I'm thinking maybe I shouldn't have put the ice on it.  The moral of this story is don't wait until you figure out that this is a different kind of pain episode than you've ever experienced, that you must get on top of the pain.  As a migraineur, I should have known that.  Pain will not win over me again--there is no virtue in not taking pain medicine.  You must stay on top of the pain.  Today I learned that if you can take 2 pills, you should.  I don't like the woozy feeling it gives me, so I was just taking one because I was going to physical therapy and was not really in  pain at the time.  Then after a rather grueling physical therapy session, I needed that pain medicine, and they would not give it to me "because that is not the way they do it."  Some people just can't think out of the box.  Lucky for me my doctor called the floor at that time , and they talked to him, and I got a shot of morphine.  (Great, the hospital just lost power. Wonder what kind of experiences that will bring?)


Oh, the biggest shocker came yesterday when someone from rehab came to talk to me about 1-2 weeks of inpatient rehab.  I must admit, Rick looked pretty excited at the prospect.  I will find out tomorrow or Friday if my insurance will pay for it. The doctor in charge today said that almost all double knees qualify for rehab, but it's not a given.

The Final Countdown

Well, this is it... the night before surgery, and all through the house, it has been rather chaotic trying to get everything done that I wanted done.  This has been my week to go without NSAIDS.  Wasn't too bad at first, but as Thanksgiving approached with a birthday party the next night, my poor knees were miserable and were not kind to me.  Note to others, do not do that kind of stuff the week before your surgery.  Being the end of the month, I am furiously trying to get all bills paid and finances taken care of.  Also, getting all laundry done.  Too miserable on Saturday to clean up from the party, so I still have some of that to do.  Like I said, not a good idea.


I have already apologized to Rick for my future behavior.


Got my bags packed. In the event that I get to wear my own clothing, I am taking summer pj's since running a fever is to be expected, and hospitals aren't known for being overly cool.  My plan is to wear winter pj's home if it's cold outside.  That way I am ready to just hop, ha, in my bed.  I really don't like the idea of going to bed with hospital germs on my skin, but I may not have the pain tolerance or energy to do anything about it.


Got my portapotty with arms, walker, and CPM machine. (it bends my knee up and down)  These were delivered the day before Thanksgiving.  My shower seat, bathtub mat, and reacher/grabber came this week, too.  I told Rick that the shower seat and portapotty could provide extra seating at our party--he didn't go for it.


Had my Dial shower.  Waited one hour and used the 6 wipes for different parts of my body.  I will have to repeat this in the morning when I get to the hospital.


My intention is to continue this blog in the hospital, but realistically that might not happen.  You've already seen my typing errors with hydrocodone.  I'll be getting the big guns of pain relief there, so I may be totally incoherent!  Maybe I can dictate to Rick.  Heck, maybe Rick will add his own view--that could be very interesting. 

I think I am physically strong. I did not reach my weight loss goal of 30 pounds, but I'm pleased with what I have accomplished.  I have lost 69.6 pounds off my knees. (17.4 real pounds) I wish I had had more time for flexibility exercises.  Still apprehensive about doing 2 knees, but I am ready to get this all over with. I am so looking forward to getting my life back.  I really hope I can go to Brad's graduation without a cane.   I have great help.  Looks like I'm ready.




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A great blog to peruse--definitely worth your time

http://greattkr.blogspot.com   

Knee-plus-eight-months anniversary: progress continues after my total knee replacement 

http://greattkr.blogspot.com/2005/05/knee-plus-eight-months-anniversary.html 

 I found this blog late in my research.  Otherwise, I probably would have never started my own.  I have not read all of this blog, but what I have read has been really good and helpful.  I would love to copy and paste this guy's blog entry to mine, giving him credit of course, but I don't know if that's cool or not.   So please go to the above posting on 5/24/05.  He gives a great summary of the positives and negatives of having knee replacement, his fears that were unwarranted, and things that he wasn't told ahead of time that would have been helpful information.  I would think that that he even has some stuff that those who have already had knee replacements would like to know.  For example, one of the ladies I do water aerobics with was telling me about how her replacement knee makes "noise", and she guessed that was normal.  He's got an answer for that. 

 He  also has a link to a discussion forum related to orthopedic surgeries.  Of course, there is all the good and bad one can imagine, so read there with caution.  You will be convinced to have surgery in one posting, then reconsider immediately after with reading of the next posting!  It is not for the faint of heart.

This time next week, the deed will be done!

This time =next week i hope to be toatlly doped up and in la las land with my surgery behind me.  Then the REAL WORK begins!  I have had a cold for the past almost 4 weeks that started out pretty benign, but ended up in my larynx plus I have had a pretty bad cough.  It was improving along about week 3, then turned bad again, so I went to the doctor over the week-end and got an anatibioti shot and steroid shot and came home with an antibiotic prescription and hydrocodone cough syrup.  I said all that to say this.  You would not believe all the mistakes I am making writing this little entry.  The brain does not work well with hydrocoodone.  I could be on pain killers for as long as 6 weeks after my surgery.  so if my blog does not make sense,  if it's fuull of misspellings and bad grammar, chalk it up to the influence of drugs.  I've made some corrections, but I think I will leave the others just to give you an idea of how I function on narcotics!

Be Prepared-- the Sequel

http://www.arthritistoday.org/treatments/surgery/post-surgery-recovery.php


Obviously I have not had my surgery yet, but this very good article from "Arthritis Today" is about getting your home ready for when you come home from the hospital. Most importantly, I have someone to care for me.  Rick did a super job of taking care of me after my foot surgery, so I have no qualms there.  Then there is a teenager to run errands.  Fortunately, my bedroom and bathroom are on the first floor, so I don't have to make arrangements for that.  I have been thinking about what kind of equipment I might need just to get along.  The hospital will send me home with a walker and a raised commode seat.  I have safety bars installed from a bathroom remodel--I didn't need them at the time, but I figured I might someday, so I got the white unobtrusive ones around our tub.  I plan to purchase a shower seat and a rubber mat to put on the bottom of our tub.  I have a 21 inch deep soaker/whirpool tub, and I already know getting in and out of it will be a real challenge. A hand held shower head will be a real plus.  I will miss my hot baths in my whirlpool--it will be at least 3 months before I can get down in a bathtub.    I read somewhere that you are not supposed to put your full weight on the replacement for a time.  With 2 knee replacements, I haven't quite figured out how that is going to work getting in and out of a tub.  Guess that's something my PT will have to help me figure out.  I plan to have commonly used clothes items stacked on my dresser to make dressing easier.  I plan to stock up on protein bars.  Protein bars are something Weight Watchers introduced me to, so I have been experimenting with different brands.  One author, Dr. O'Neill?, said that I won't be very hungry, so I need to make everything I eat count--hence the protein bars.  And hey, if I have ice cream, I can survive!  No, I'll try to do better than that!  I do plan to pay attention to my liquid intake.  So lots of water, juices, teas--possibly protein shakes to be stocked up.  Today I bought a Living Social coupon online for $16 of food for $8 at Holiday Ham.  I have been watching coupons and "deals"  for food for Rick to buy.  He'll be the first to admit that he is not a wiz in the kitchen.  He knows a lot about a lot of things, but whipping up a meal in the kitchen is not one of them.  I am also taking note of offers of food from friends that I plan to cash in on.  When my mom had back surgery, we bought her satin sheets to make it easier to slide around in the bed and hopefully make turning easier.  I think I will borrow her sheets to see if that is helpful. I have plenty of home made bed buddies in the freezer--tube socks mostly full with rice and a knot tied in the end. Another suggestion for cold therapy is frozen peas or corn, so I will probably invest in a few bags of that in case my bed buddies are too heavy.  One thing this article mentions that I would like to get is an office chair with wheels to wheel around the kitchen! Superb idea that I wish I had already thought of pre surgery; I might have done more cooking if I had thought of this.  This article also says some thought needs to go into the car that will take you home.  Rick has a small SUV that is hard for me to get in now, much less with 2 surgical knees.  Fortunately I have a bigger sedan that will do the trick.  The article ends with the dreaded bills.  I'm pretty savvy about that, but there are some terms explained that might be helpful for the lucky inexperienced. There are other tips that should be checked out, but these were the ones that were significant for me.

I don't want to beat a dead horse......

but I will anyway.  Here's a quote from this article from Arthritis Today about prehab.www.arthritistoday.org/treatments/surgery/prehab-for-surgery.php

Fifty percent of outcome success is due to the surgeon, and the other 50 percent is due to the patient’s commitment to recovery – starting with pre-hab,” says Vonda Wright, MD, assistant professor of orthopedic surgery at the University of Pittsburgh’s Center for Sports Medicine.

It is recommended to start exercises 6 weeks prior to knee surgery.  I imagine that most of us have been involved in physical therapy prior to making this decision.  If so, time to pull out all those exercises and do them faithfully.  If you haven't had previous physical therapy, there is a link in the above article for exercises to do prior to surgery.

It's getting closer, and the plans might be changing---

I saw my doctor today.  I like him.  There was no reason to see him today, except the fact that it did not feel right to have this big surgery done by someone I had only seen once.  I took Rick with me to meet him and ask questions.  This doctor answered bunches of my questions and never once, by word or deed, made me feel like he had rooms full of other patients. 

You may notice I now have an X-ray on my blog.  Those are my real, anatomical knees.  Notice how the insides of both knees have the thigh bone (femur) sitting right on top of the leg bone. (tibia)  The outsides of both knees have cartilage in between so that a space can be seen between those bones. My pain is caused by bone rubbing bone with every movement.


Here is the plan-- I hope to get 2  partial knee replacements, i.e., replacing only the parts that are bone on bone.  If the other parts of my knees look diseased, then I will get total knee replacements.  Whether or not I get 2 totals is still up in the air.  Our original plan was that if the first knee is a partial, then he will operate on the second knee.  If the first knee is a total (TKR), then he would do just one.  Today he said he would consider doing two TKRs.   Something to think about.  This is BIG!  My physical therapist thinks I have the "fortitude" and "work ethic" to do both. Most days I think I do, too.

18 days and counting

Today I went to a "Joint Class" at St. Francis Hospital for those future patients who are scheduled for joint replacement surgery. (knee or hip) St. Francis has a new Joint and Spine unit of which they are very proud.  All but 5 of the rooms are suites.  They have combined 2 rooms to have a patient room and a coach's room. ("coach"reminds me of childbirth) It is tastefully done in calming colors.  By not having a rollaway bed in the room, it makes for more room for getting around using a walker, crutches, etc.  The coach has his own plasma TV, sofa bed, bathroom, and phone.  His room will be separated from mine with  French doors.  He might even get some sleep since a nurse will not be coming in all night to check on me in HIS room. If it weren't for the pain, this could have possibilities!


Here are some miscellaneous tidbits I picked up today.


1.  In the early 70's, 51% of patients with osteoarthritis in their knees got replacements. Today it is 92%.  Fascinating. Guess the airports have had to make concessions for all the alarm beeping knees and hips!


2.  The night before surgery, after a shower, I will wipe myself down from head to toe with antibacterial wipes that the hospital gave me.  Then I will don clean PJ's and sleep on clean sheets. (A friend of mine was told by her doctor to wash with Dial soap for 2 weeks prior to surgery.  I will do that, too.  Can't do too much to avoid infection.)


3.  Before leaving the house for surgery, place frequently used items at waist level. (remote control, phone, clothes, shoes, etc.)   Dr. O'Neill in his book had mentioned getting pots and pans, food, etc. out on the counter tops for easy access. My friend, Carolyn, who has had knee replacement, said that a grabber/reacher was indispensable-- to use for grabbing/reaching items above or below your waist.


4.  There will definitely be pain to be dealt with.  I will have use of a PCA pump (patient controlled analgesia), a femoral nerve block, injections and pills as part of my armamentaria.  Oh, and ice packs.  I should take pain pills at breakfast and at lunch because I will be having physical therapy after breakfast and after lunch.


Obviously there was much more to be learned, but these are the things that impressed me.  They also gave us a large handout by the National Association of  Orthopedic Nurses about knee replacements.  Very excellent and full of practical and useful information. Oh, lucky you, I just found this wonderful handout on their website to download.  http://www.orthonurse.org/ResearchandPractice/PatientEducation/tabid/490/Default.aspx

The above link no longer works.  Go to this link and download the Total Knee Replacement Patient Education Manual. It is fantastic.
http://www.orthonurse.org/p/cm/ld/fid=29 

A Minor Setback

It may seem that all I do is tout the virtues of exercises for knee health and pre-surgery.  Now I have been given a little insight into why it is so important.  About 2 weeks ago, I had a scratchy throat that settled there and gave me a bad case of laryngitis and an awful cough.  Because of my terrible cough, I went a whole week without going to the pool or to the gym to ride the bike and work-out.  I'm pretty sure I would have been asked to leave since I sounded incredibly infectious! Keep in mind that I am continuing my yoga routine and presurgery exercises.  Ten days later, I rode the bike and that wasn't nearly as bad as I had expected.  Some stiffness that took a few revolutions to work out.  I tired sooner, but overall not a bad ride since I cut back my minutes to 20 minutes.  The next day, my cough was moving all the stuff that had been causing me grief, so I had to stay home and cough and rest between coughs. This past Saturday, I went to the pool.  I can do movements in the water that are difficult or not possible on land.  Ordinarily, it takes 5 minutes or less to get the ol' joints lubricated and moving without pain.  My first day back in the water, it took 25 minutes.  I did my usual hour and expected to pay for it later in the day or that night.  So far, so good.  Then on Sunday,  I was incredibly sore and stiff.  It took about 4 or 5 hours to work it all out and walking was not fun.  Then today, I got in the pool, and it was back to "normal".


So it looks like exercise needs to be consistent, but if I have to miss, I can get back to normal pretty quickly. I noticed today that I was lacking some strength, but I expect I will regain it soon.


By the way, at my medical clearance visit for surgery, my doctor told me to not ignore any infections because of my impending bone surgery.  Infection is a big no no for bones. Anyway, I made 2 unnecessary doctor visits for this illness knowing full well it was viral, but I wanted someone else to make that decision. I sure don't want my surgery--which just happens to be 3 weeks from today-- to be canceled because I have a bacterial infection.

I was listening to my body, but I misunderstood

I have been doing Range of Motion (ROM) exercises from the aforementioned book for the past week. When I first noticed that I had a problem with my knees, the backs of my knees were stiff.  Gradually over the past 2 years,  I noticed that I could not pivot, that it was increasingly more difficult to get up and down off the floor, that I was incredibly stiff in the mornings when I would first get up.  There were just too many ways that I noticed the stiffness in my knees which prevented me from doing what I wanted to do.  I thought that was my body telling me to cool it, give it a rest, this is the limit, you will pay if you keep this up, sister.  Then I read Dr. O'Neill's book where he says how important it is to do ROM exercises because the greater your ROM is before surgery, the better it will be after surgery.  Well, that motivated me, and I did the first exercise/stretch.  It was very uncomfortable, and I could not wait for it to be over.  I had a burning sensation and most of my left leg was very warm, even minutes after I finished the stretch.  My left knee is not only stiff, but it also had numbness in the back of the knee.  About 3 inches above the knee and 2 inches below the knee is numb.  The next day I repeated the exercise with less discomfort and less warm sensations along the leg.  Several days later, I am able to straighten my legs in ways that I thought were impossible.  Not only that, I would say that the numbness is about 75% improved. (Do you know how weird if feels to shave your leg and not feel it?  The razor would be cruising along, and then all of a sudden, it felt like it entered a dead zone and then the pressure of the razor reappeared again!)  Here is a picture of Passive Extension. 

Looks simple enough, but it is almost impossible to relax your stiff joint to go into as straight a position as possible.  Then after your muscles relax, you must "fire" or tighten up your quad muscles while you are pulling your knee downward and hold for 5 seconds. This is not a pleasant stretch, but I am already reaping benefits.  Dr. O'Neill states that this is the most important stretch to do during the first two weeks after surgery. He says to do it 15 minutes of every hour.  Hope I have lots of pain meds!

Exercising my way to surgery

http://www.arthritistoday.org/fitness/exercise-videos-and-photos/surgery-prep-exercises/index.php


The above link goes to the Arthritis Today web site.  Here are some pre-surgery exercises that can be viewed as videos or photos with written descriptions.  I have been given most of these exercises in physical therapy. (Isn't Physical Therapy the coolest profession?)  Some I have continued to do since I first went to physical therapy, but now I am doing all of them to get ready for the big day--November 29th.

Goals

In the previously mentioned book, Dr. O'Neill suggests making 2 short term goals and 1 long term goal post surgery and commit them to writing.  So here goes, I'm putting it out there.




My 2 month goal-- to be free of aids (cane, walker, crutches) while walking in my house.


My 4 month goal--to be back in the pool and on the bicycle, to be able to get up and down off the floor


My 1 year goal--to be walking in my neighborhood 5+miles/week and riding a bike on the Greenline


It's been 5 years since I've walked for exercise.  I had plantar fasciitis first, then the arthritis, tendinitis, and bursitis developed.  I have been using a cane for the past 2 years.  At one level, these goals don't seem like much, but at another level, they are rather lofty, but I believe, realistic.

Be prepared!

http://www.arthritistoday.org/treatments/surgery/preparing-for-surgery.php




 
"Arthritis Today" also has a very good web site. The articles are practical and easy to understand, and the site is easy to navigate.  Here is one of several articles I will post as a must read pre-surgery. I truly don't think one can be over prepared. I feel like I know so much going into this surgery--my doctor did an excellent job of explaining the surgery, possible complications, answering my questions, and basically telling me things I did not know that I did not know.  In addition to his thorough explanations to me, he gave me a large handout that reinforced everything he had told me.  Most of us are aware that it is hard to listen when we are stressed, and sitting in a doctor's office discussing surgery is certainly a stressor.  The best thing would be to have another person with you to take notes while you listen.  For me the next best thing would be to take notes while I listen, but I know not everyone operates this way.  I was thrilled to get that big handout before I left the office.  Fortunately my doctor told me ahead of time that I would be getting a packet to take home that would cover everything we were going to discuss.  That decreased my stress levels so that I could more actively listen.


In the article above, there is a list of questions to ask your doctor.  My doctor answered all of them except the last two without my asking a single question.  I feel certain that he would have volunteered answers to those 2 questions if I had asked or been interested.  Garner as much knowledge as you can before meeting with your orthopedic surgeon.  It will help you to understand what you are being told, and give you a knowledge base on which to build.

What's the big deal?

If you don't know about the magazine, "Arthritis Today", it is a super magazine.  Easy to understand and very practical.  I don't like articles that give general information--I want specifics.  In fact, this magazine is the thing that began the evolution of my thinking about knee replacements.  I mean, at least right now, I know what my situation is.  Surgery could change things and maybe not for the better. But one day I'm sitting in the doctor's office, and I pick up an issue of "Arthritis Today" and on the cover is a title of an article inside titled something like "4 things you can do to improve your health".  I'm curious, and I check it out. I may not remember the exact recommendations, but it was something like




1. Quit smoking
2. Lose weight/Eat better
3. Exercise
4. Get knee replacement


 Really?  Just like that? That got me to thinking that maybe this surgery is not so big a deal.  Of course it is to the one enduring the pain and suffering, but could this be so routine a surgery that getting it would improve my health?  Another way to look at it though,  if I am honest, all of those things on that list are a big deal!  I'm not a smoker, but # 2 & 3 have been hard for me. So my hope is that once I do #4, then #2 and #3 will come easier, and I certainly will be improving my health!

Do you want to perform surgery?

http://www.edheads.org/activities/knee/knee1/index.htm  Check this out!  I've performed this surgery twice.  Is this an awesome site or what?  I'm hoping I'm not going to get a total knee replacement, but if I do, I might could help! If I get spinal anesthesia, I'll be able to watch the monitors (did my doctor tell me this, or did I read it?)  Supposedly my brain would not "know" that was my knee on the monitor! Totally cool!!!

You must read this book!

I am reading this book for the second time.  It is incredibly practical.  Simple things like getting your kitchen ready or having your bed ready for your return from the hospital.  This is written by an orthopedic surgeon who is also a sports psychologist.  The book is filled with exercises to do before surgery to get your knee strong and get the best range of motion possible before surgery. The pictures and descriptions are clear and easy to understand.  I have been doing one stretch exercise for only 2 days, and I can already see an improvement. He thinks that mental preparation is just as important as physical preparation.  I am getting psyched!

Next Phase of the Journey

Today I got a surgery date--I am scheduled for bilateral partial (unicompartmental) knee replacements on November 29, 2010.  I purposely chose this time frame so that my husband, who is a professor, would be able to help me with my recovery.  The expected recovery is a minimum of 6 weeks, so that will give us exactly 6 weeks before his school starts back again in January.  Not great timing with the holidays, but it looks like we will be having no fuss holidays this year.


I made the decision to have surgery in December of 2009.  Every step I took was very painful, and I knew that I was tired of living this way.  I was calculating how many steps were involved for each and every activity I did, no matter how small the activity.  I was constantly figuring out the most efficient use of steps.  I no longer shopped in stores.  I did not go anywhere much because I did not know how far I might have to park, or how many steps I might have to climb.  In short, I had to admit that my arthritic knees were dramatically affecting my life and the quality of it. 


So why am I just now getting a surgery date if I made this decision 10 months ago?  I have spent the last 10 months getting ready for this surgery.  First, I joined Weight Watchers in January.  I have not met my mini weight loss goal, which was not high, but it was realistic. I figured that any weight loss would help with rehabilitation.  Still, I am pleased that I have lost 15 pounds and that is equivalent to 60 pounds off my knees!!  In addition, I have been very purposeful in my exercising.  Three days a week I do deep water aerobics which has made me stronger and keeps my knees flexible.  Another three days a week, I ride a recumbent bicycle (now up to 29 minutes) and about 30 minutes using weight machines to increase my upper body strength. (core and arms)  I also do a yoga routine and physical therapy exercises all 6 days.  Sunday is my day of rest unless I missed a day of exercise that week.  I have been very diligent in doing my exercises with the expectation that my rehab will be easier and that I will be in the best condition for hauling my body around with 2 surgically painful knees.


I want to blog about my preparation over the next 6 weeks or so, my hospital stay, and my recovery at home, my rehab, and my progress over the next year.  Hopefully this will be helpful to someone else who is wondering about having this surgery.  My radar has been up for the past 10 months, and I have talked with any and everyone who has had knee replacements-- including picking the brains of complete strangers if I heard them mention the work "knee"!  My doctor has been very informative, but he hasn't lived it, and I doubt he knows the REAL nitty gritty questions that inquiring minds want to know.