Tuesday, June 24, 2014

Three Weeks After Knee Replacement

(No Warning Today -- picture of wound is included... but I don't think its gross enough to warrant a warning!)  

Today is the third week anniversary of my new knee.  A lot has happened in the last week.  

I went to my surgeon for my follow up early this week and he is quite pleased with the progress. Nearly giddy I think :-)   He said doing surgery on younger people is a catch 22 -- you hate to do it to someone so young who may need a second one down the road but it was nice to see how fast someone young heals from it.   Good news was that at just 2 weeks and a day he gave me the clearance to swim.

At physical therapy I discovered that while I have enough bend to put my operated leg on a higher step, my quad muscle is not strong enough to lift my body up to it.  Not even close.  That is disappointing so I decided to make that a goal in my homework this week.   Since I could get in the pool, I used the buoyancy of the water to help.   I started with water walking, making sure to do the heel strike and push off the ball of my foot.   Once I had a little whirl pool going, I reversed and went against the flow of the water.  Then I held the side of the pool and stepped up.  Once I had that down, I did it without holding the side of the pool.  I fell a few times but since the water "caught" me it wasn't a bid deal.  Then I repeated the series.

This is surprisingly hard.  Who would guess that walking up a step would be that fatiguing to a muscle?   The good news is that its improved throughout the week.  The bad news is that its still hard and its still not very controlled.

I no longer use a cane or crutch, even on uneven ground.    I DO walk VERY slowly on uneven ground.  I went to the barn a couple of times this week and cleaned some stalls and one of the days took a few pads of hay out to the paddock.  Its embarrassing how slow I walk on uneven ground.  I still don't feel safe pushing the wheelbarrow across the uneven ground or leading the horses so I am still fairly useless at the barn.  Irritating because I want to be helpful and I am relying on my ever generous neighbor friend.

Okay... here is the last tidbit... don't tell anyone but I am driving ... a little.   I have driven to the barn twice and feel okay but don't think I'd feel comfortable driving over about 20 miles an hour so I think that is as far as I will go for now.  Luckily the barn just down the street from my house and on a back road so I can drive slow.

So that's where I am at week three.  Ahead of schedule but still not as quick as I would like.

Want to read more about knee replacement?  Put "knee replacement" in the search box to pull up all my postings on the subject.

Wednesday, June 18, 2014

Two Weeks After Knee Replacement

(Standard Warning:  wound pic at the end of this post.  However, it is looking better and not so gross!).

Its now two weeks after my surgery and I think things are going well.  Two weeks is the mark when a good percentage of infections occur so I am happy to be past that.  I finished at home physical therapy yesterday and began outpatient therapy today.  I have been able to get to the barn a few times thanks to a friend who picks me up.   I have even cleaned a few stalls.  I am not strong or stable enough to lead a horse but I'm happy to at least be a little helpful.

Walking has gotten much easier but I am still pretty unstable on uneven ground.   In home physical therapy said I can walk unassisted (no cane or crutch) on flat stable ground as long as I continue to walk with a normal gait (push off with the toe, land on the heel, bend the knee).

At my first outpatient therapy they were pretty pleased with my progress and said I may only need another three weeks of therapy!  Woohoo!!!   The most exciting thing that happened today was I was able to do a full rotation on the stationary bike.  It seems like such a small thing but its pretty exciting when it happens.  I have full extension but my flexion is only at 98 degrees.  I would like to get to 120 degrees.   We shall see.  Tomorrow I go for my follow up visit with the surgeon so I'll ask what he thinks I should expect in terms of flexion.  I'm also hoping he gives me the go ahead to do some pool walking.   The wound looks closed to me ..... I hope he agrees.

The biggest issue I have is that my nerves are "refiring" and out of nowhere I get shooting electric shocks through the knee.  Supposed to be normal and I remember this from my last replacement but doesn't make it any more fun.

Things went so well today that I wondered if I could drive before the suggested five weeks.  Its only been two but I thought it was worth giving it a try just around my driveway.   So I grabbed the keys and headed to the car.   Opened the door and realized I couldn't even get my leg up high enough to get in the car!   That was a slap of reality.  I have more work to do!

So mostly pleased with the progress but certainly have a lot more work to get to the finish line.  I set a goal today to be on the horse by week six.   Hope I make it.

So what do you think?  Ready for the pool?

Wednesday, June 11, 2014

One Week After Knee Replacement

(Warning again... for those following along so they can see what to expect on their knee replacement journey... there is another picture at the end of the wound..... stop before the end if that is not your thing.)

Things are going well... maybe too well.  Physical therapy came out on Monday and said I was doing very well and to "keep up the good work".  I was quite full of myself and felt like I could conquer the world.... so I tried to do just that on Tuesday.

I got up Tuesday feeling pretty good too.   Despite waking multiple times during the night to the dog trying to escape from the mud room where she was jailed for coming in at bedtime a muddy mess and the cat who decided at 3 am it was a good idea to play World Cup soccer with a pen in the dining room, I had little pain and lots of energy.

After the family left for school and work, I tackled the kitchen mess and then headed upstairs for a shower.  While upstairs I decided to vacuum the floors.  That went well so I had my son bring the vacuum downstairs for me to take care of the downstairs carpets later in the day.  I interrupted my cleaning so my friend could take me for a visit to my horse.  She hand grazed him and we talked and I exercised my leg by standing equally on both legs for about a half hour.  Dang ... I was superwoman!

When I got home, I realized I was pretty hungry so fixed myself a sandwich and then collapsed on the sofa.   I felt a bit sick to my stomach and weak in the head.   Then I noticed my ankle on the right was much bigger than the other.  Oh shoot... the thigh too.   Duh.... I knew better.  Despite me wanting to be a superwoman, apparently I'm just a regular person with a bum leg.

So the rest of the day was spent on the sofa with ice and pillows to elevate.

Today was more of the same until my physical therapist came.   We worked hard while she was here but she cautioned me that my job right now was to rest and do my exercises effectively and housework was not one of my exercises.    Point taken.

Despite my hard headed decision to do more than I should, things are going well.  I am able to put full weight on the leg although I am using the crutch as directed so I protect it and walk with the proper form -- heel first, toe pushing off, knee bent.   The therapist confirmed that I have full extension of my leg and am about 85 degrees bent.   Hoping for a bit more bend once all the swelling I caused goes down.  Patience......

Getting there... the puckers are the internal
stitches.  They should smooth out once it heals inside.

Saturday, June 7, 2014

Four Days After Knee Replacement, At home and Adjusting

(WARNING:  at the end of this article I post a pic of my wound and stitches.   It doesnt look bad but if you dont like pics of wounds, you may want to stop halfway through reading this.)  I got released from the hospital yesterday and while its great to be home there are new adjustments that need to made.  The sofa I am sleeping on is lower than the hospital bed, as well as all the chairs, so figuring out how to get up and down from it was a new challenge.   And while this may be TMI, figuring out how to sit on a toilet lower than a hospital one was also a challenge.  I stick the operated leg out as far as I can straight, pull the non-operated close to the toilet, lean against the wall and slowly slide down, hoping that I don't jar the injured leg.  Its a very elegant sight!

Just being home was exhausting so luckily I slept better than I had been at the hospital.  I still woke about every two to three hours, visited the bathroom and did my exercices but was then able to get back to sleep.   Had much more sleep last night than any previous night since the surgery.   Pain is becoming less - I haven't had a Percocet since last night (still on Celebrex) but will probably give in and take one this afternoon.

I got up at 6:30 am this morning, had breakfast and did some bending exercises.  That tired me out!  I then took a two hour nap!   I going to try to stay awake now until something close to bedtime but no promises.

The challenge now is to get some bend in my leg.  I am able to get it quite straight (which is the opposite of my experience with my partial knee replacement) but still cannot get a 90 degree bend.  Am trying to at least get close today.   You can see in this pic that I have a ways to go until I have  90 degree bend.

I am using a dog leash wrapped around my foot to help me pull the foot closer to the body to complete what the therapists call "heel slides".  Each time I get closer but still not there.

This surgery they placed a drain in my leg which has helped minimize the bruising.   I have some bruising under my knee and at the drain hole but not much more than that.  I have bruising also inside my elbows where they took their daily blood draw.  Not bad though.

The wound is healing well.  I just keep some light gauze on it and an ace bandage and there is no drainage or bleeding.  Still keeping a close eye on it for increased heat or drainage as a sign of infection.  Looks good so far.    Home therapy comes tomorrow and will continue until next week when I start outpatient.  Considering how difficult it was to get in and out of the car with a leg that only goes straight, I think the home therapy was a good idea.    And now the wound pic!

Thursday, June 5, 2014

Day Two After Knee Replacement -- Getting Unhooked

During the night I started to feel a bit better and have more mobility.  I was able to get in and out of bed using my "good" leg to move the bad one without total fear that it was going to fall and hurt like the dickens. So I started the day with some high hopes that PT was going to be easy.

Hah!  I got assigned a PT person who worked me hard.  (Which is a good thing - I want to be worked hard.) We started off by getting up using crutches instead of a walker and took a lap around the nurses station.  Then we hit a flight of stairs going both up and down.  I thought that was pretty good but she had more in store for me.  We did ankle pumps (easy - yeah!), some heel slides (not too bad) and then she had me lay back in the bed with a roll under the knee and told me to lift my foot up, contracting my quad muscles.  Hah!  I quite firmly told my leg to do so and it completely ignored me.   She then supported my ankle some and I was able to do some lifts that she made me hold for 3 seconds and then repeat.  Next was lifting the leg with it straight out.  Same issue.  I told my leg to lift but no go.  With some assistance I was able to but wow, did it hurt!

We finished with me sitting in a chair attempting to get the leg at a 90 degree angle.  It couldn't get all the way there but got close.   Hanging it from the chair position though was quite painful.   I sat in the chair for the rest of the day though and kept stretching it back and forth and it did get better as the day continued.

My quad muscle feels like a hard rock as if I am contracting it all the time.  With some massage it loosens up some but never completely relaxes.  I remember this from my first knee replacements so I am not surprised but like childbirth, you kind of forget about it.

Still on Percocet which makes me loopy so no idea if any of this makes sense but hopefully so.   My kids came by to see me and I wasn't sure what I was saying to them.   I think I was drifting in and out and mixing what they were saying with what I was dreaming.   They thought it was quite funny to hear their Mom all nuts.

I am slowly being unhooked from items.  I no longer have the compression pad on my "good" leg and they removed the drain from my operated leg.  I anticipated that hurting but really it just felt weird -- like someone pulling a tube through my muscles.  IV is still in but not hooked up except when I am getting antibiotics.   The ice machine is hooked up when I am in bed and not doing exercises.

I should be released from the hospital tomorrow. Only thing that might hold it back is that my white blood cell count is a little elevated so that may keep me here to get additional IV antibiotics.  We shall see.

Wednesday, June 4, 2014

First Day After Knee Replacement

I had my full knee replacement yesterday and it went well.  The doc came by to see me today and was quite pleased.  Said that the range of motion he got was very good and  he thought the results would be good.  Its nice to see your doc excited about your surgery!

It  hurts today but that is certainly to be expected.  I have good leg extension (being able to lay your leg flat) but its hard to bend it right now.  I can get it about 40 degrees but only with the therapist moving it to that point.  I was able to make a lap around the nurse station twice today.  Woohoo!  With a walker of course.

I have a continuous ice machine attached to my operated leg.  It has a small cooler of ice and it circulates cold water around my leg.  The blue wrap is where the cool water is.

The other leg has an air pack that continuously pumps and massages my leg to help prevent blood clots.

I'm surprisingly hungry and despite the hospital food probably not really tasting all that great.... I think its delicious and have eaten it all.  I'm also very thirsty and have drunk four pitchers of water since yesterday afternoon.  Good to help build back up the blood lost during surgery and also to flush out the anestetia.

During my morning physical therapy, they started by having me sit up on the side of my bed and I felt a bit weak headed so they just helped into a chair and had me sit there for a half hour or so when my blood pressure stabilized.  Didn't want to collect me from the floor after passing out!

After my walk, we put a sheet under my foot and I used it to pull my foot in a heel slide toward me to help get that bend going in my knee.  Couldn't go very far but it got better each effort so we will get there.

So mostly I have done a bunch of heel pumps, a couple walks, and a whole lot of napping.   The tv was on today but I have no idea what I watched as I kept falling asleep during each show.   Hope tomorrow I have a bit more knee flexibility and am able to navigate some stairs.

Fun times.  I'll finish with a picture of myself... I don't like quite as good as before I looked before surgery -- still kinda weak looking.   One step at a time!

Monday, June 2, 2014

My horse and I are both Lame and an Update on PRP Therapy

I realized that I never gave an update on how the PRP (Platelet Rich Plasma) therapy went.   A few months ago I decided to give a fairly new therapy a try to help my arthritic knee.   Essentially the medical pros take blood from your arm, centrifuge it, extract the platelets from the blood and inject the platelets and plasma into your knee in hopes of regenerating cartilage and providing some pain relief.    Its been FDA approved but because the results are still iffy and its not been determined which patients it works for and which not, insurance usually will not cover it.

Golly enjoying his "vacation"
I decided to give it a try though and while it did help the achiness in the soft tissue, it did not make much difference in the join pain so I decided to move forward with my second knee replacement which is scheduled for tomorrow.

About the same time that I decided to go for the second knee replacement, Golly came up lame and after a vet exam, it was determined that he had a mild suspensory pull and was confined to stall rest.  He has been in his stall for the last month and is now allowed out part of the day in a small paddock part of the day.   Lest you feel sorry for him, he's living the life of luxury as my girlfriend is loaning me her big airy double stall for him and his current job is his favorite thing -- doing nothing... and eating.

Its been a bit of a struggle making sure his belly is full, he is occupied mentally and he doesn't gain weight but I'll fill you in on that in another post.

He will be starting rehab with hand walking a couple of weeks before I can ride and then once I can ride, we will start with just walking for ten minutes at a time -- perfect timing for us both as we will both have limited ability.   Only major issue is that I have to rely on GREAT friends to do the hand walking and do the first couple rides under saddle ... just in case he is a bit frisky the first time out.

Stay tuned for some recovery pics as this knee heals.