2017  HIKING, CYCLING,

& RV TRAVEL ADVENTURES

Lake McIntosh @ Line Creek Nature Area, Peachtree City, GA

 

   
 
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   SUE'S TOTAL KNEE REPLACEMENT, p. 4:
RECOVERY DURING WEEKS 3 TO 5

THURSDAY, OCTOBER 26

 
"Don't limit your challenges. Challenge your limits."  
~ inspirational fitness poster
 
 
 

Continued from the previous page.

WEEK THREE

The in-home therapist encouraged me to discuss my frustrations with the out-patient therapist and see if he'd start giving me harder exercises to do. We talked at the next session (#3 with him, #6 overall) and I think he heard me:  I am not your average 68-year-old female patient who is sedentary and most likely overweight.

I told him then about getting my own bike resistance trainer and beginning to ride it at a moderate pace (about 60 RPM) for 20-30 minutes at a time with no pain:


Casey and Holly play nearby while I ride the indoor trainer.

The remaining three sessions he had me warm up first on a recumbent bike, then proceeded with increasingly difficult range of motion, strength, and balance exercises.

Yay! I was happy with that.

He measured the degree of passive knee bend (112 that time, I think) and ability to keep the leg straight (zero degrees under the knee every time, which was the goal). I made progress each time I saw him because I was working diligently on all the exercises at home.

At the end of Week 3 I'd had a total of seven physical therapy sessions (three in-home, four out-patient) and had a 115-degree passive (without assistance) knee bend. In his 4th session, my 7th total, the therapist had me doing more difficult resistance, balance, reduced risk-of-falling, and strength exercises.

A new goal for Week 4 was getting up and down very slowly from chairs with no plopping my butt down hard and without using my hands/arms. I hadn't consciously tried that at home yet so it was a new challenge. It was hard do it with my hands on my hips but I did better after several tries and improved after working on it more at home. (Now it's easy after five weeks.)

At the end of the 2nd session of the 3rd week he predicted that I would meet my goals within two weeks and could stop formal physical therapy unless there was a setback. That surprised me. I reiterated that I'm OK with continuing through November or even December if it helps my other leg, too. I won't be having surgery on it until the end of December.

He also decided one session a week was adequate instead of two since I was moving so quickly toward my goals, was compliant with doing the exercises at home, and wanted to make sure I had enough remaining sessions available after the second knee surgery since Medicare has a limit to what they will pay each year for physical therapy.

A paranoid person might think the therapist was just trying to get rid of me.

Maybe he was! I was just happy that he recognized I was working hard on my recovery. It was more confirmation that I was doing what I needed to do to reach my goals, regardless of a few skeptics and critics.


Pretty scene along the cart/bike path where I like to walk; most leaves haven't turned in Oct. yet.

By the end of the 3rd week I was also walking a mile a day with our dogs, riding my bike indoors on the trainer for up to 30 minutes at a moderate RPM, and doing 45-60 additional minutes of PT exercises on my own every day.

Pain management:

During the 3rd week I took Tramadol only twice a day -- when I got up in the morning and before I went to bed at night. The prescription NSAID (Diclofenac), acetaminophen, and/or ibuprofen took care of any knee pain when the Tramadol wore off.

My leg was still restless at night; I needed to get up every two to three hours to move it a little bit. It ached or involuntarily twitched more than hurt. I was still lying mostly on my back. I gradually began leaning toward my right (non-surgical) side for some variety but sometimes that did hurt as I was moving my leg into position. I was advised not to lie on my surgical side for several weeks.

Both the leg swelling and bruising were nearly gone at the end of the 3rd week. I still elevated my leg and iced the knee several times a day because it was warm to the touch after any activity. My toes were still purple into the 4th week.

WEEK FOUR:

The more progress my body made, the faster my leg/knee seemed to get even stronger and the more motivated I became to get it to its "new normal."

Even with an implant, I should be able to reach the same range of knee motion I had previously (the range the other leg still has) and I hope eventually the muscles will be as strong as they once were -- maybe even stronger with all this physical therapy!

Progress can be measured in many ways. During the 4th week I hit several small but confidence-building "milestones:

  • I could finally see the definition of my left quads and the blood vessels and tendons in my foot again (still not as skinny as the other one, but close). The swelling in my leg was still there but minimal, even after more activity and less elevation of the leg.
  • I was walking some days up to four miles, including walking solo or with the dogs on the nearby hilly bike paths, back and forth in the house (I don't sit still for long), out in the yard, and shopping in big box stores.

A new part of the bike path I recently discovered (above)
has some steps (below) I can practice on with my new knee.

  • I continued cycling up to 30 min. at a time on the bike resistance trainer.
  • I got down to one Tramadol a day, taken when I got up so all that activity and the PT exercises I did in the morning were easier.

I still had leg stiffness while sleeping and when I sat for more than 20-30 minutes. That could last for several more months, from what I've heard, read, and seen (with Jim).

Physical therapy:

In my 5th out-patient PT session (8th PT session total) at the end of Week 4 my progress could be measured more than just anecdotally:

  • my L. (implant) knee, calf, and ankle were almost the same circumference as the R. one,

  • my resistance was as good with the L. leg as the R.,

  • and I was able to bend my L. knee passively (w/out assistance) to 116 degrees and 122 with the therapist pushing it a little farther (active resistance) until it just started to be uncomfortable.

The therapy goal for me was to reach 120 degrees knee bend passively and 125 actively. The "good" knee was 126 degrees passively, so I still had a little ways to go to reach both of those numbers. It was an improvement over the previous week, though, so I was happy.  

I got to try several new things in this session, which made me happy:

  • Going up and over 5", 6" and 7" steps with 10# weights strapped to both ankles, double the weight I'd been using previously. Those suckers were heavy but I could do the 5" and 6" steps without falling or having much pain in my implant knee. What hurt was the other knee that needs surgery! The cortisone is wearing off and it hurts at other times, too. The 7" step was not comfortable for either knee with that much weight so we stopped doing that one.

  • Leg raises in two positions (up/extension while sitting, up at 90 degrees in the back while standing) with those weights on both ankles. That was easier on both knees than going up and down the steps with the weights on.

  • Sitting down very slowly without plopping onto a cushioned bench the therapist could raise and lower. I was able to sit down and get back up from various heights without using my hands. I still needed more practice on that, however, because I favored the "good" side and sometimes sat down too hard.

  • Using a resistance band to walk sideways in both directions, with the loop at thigh level (easier) and ankle level (more difficult). I have several different resistance levels of the bands at home so can make that harder as time goes on.

Abduction/adduction morphed from moving the leg in and out while lying down (above),
to doing it standing up, to doing it with a resistance band and stepping to the R and L about 30 feet.

WEEK FIVE

This past week I've felt almost back to normal! Now that's what I call progress.

  • By the end of the week I was off Tramadol (a mild opioid) completely. I'm taking two Diclofenac (prescription NSAID) pills a day and whatever supplemental acetaminophen and ibuprofen I need, if any. The only reason I might need to resume taking Tramadol before I have surgery on the other knee in late December is if that knee gets too sore to walk comfortably as the cortisone wears off.

  • The swelling is almost gone in the implant leg, although the lower leg and foot are a little more red than the other leg and foot. Not sure what that's about, but I assume it involves all the healing that will be going on inside for a good while yet.

  • I got my first massage since surgery and that has helped my whole body feel better. It should help with any lingering leg swelling, too.

  • I moved back into my own bed for the whole night! My leg still gets stiff and ache-y after a few hours so I have to get up once or twice during the night but our king-sized bed is wide enough that I haven't been waking Jim up when I get up or change positions carefully. The other bed is there if I get too wiggly . . .

  • I am able to sleep on either side comfortably and move the knee into place without any pain.

  • I continued doing one or two 45-minute PT sessions at home every day.

  • I walked from 3-5 miles a day this week with no pain and lots of enjoyment! It feels so good to be back out on the hilly bike paths for longer walks again.


Some leaves are starting to turn near the end of October, helping make Lake Peachtree look a
little better while it's drained to construct a new spillway. The water is usually up near this tree.

  • And I started riding my bike outside on the cart/bike paths. I was afraid the hills would be too hard but so far, so good. I plan my routes to avoid going up the hardest hills until my knee has healed more. I'm being more conservative ramping up the bike distance and speed than I am with walking/hiking because riding the bike is more risky. I'm much less likely to fall when walking than on the bike and if I wreck, I'll do more damage.

After the last PT session I went to Walmart and bought my own set of 10# ankle weights and used them all week in the three exercises the therapist had me do while he watched my form. They really made both of my legs tired so I did fewer reps.

Physical therapy:

At the end of Week 5 I had my 6th and final out-patient PT session.

When I told the physical therapist that I'd bought the 10# weights, he recommended I take them back because they are too heavy for me. I didn't realize he was just testing my strength that session. He said I can build muscle strength much more effectively -- and safely -- with 5# weights and more reps. We already have 5# weights at home so we took back the heavier ones for a refund.

I was tested again in several ways for resistance, strength, and range of motion.

My implant knee/leg still lay flat against the padded table (full leg extension), the circumference of both knees and ankles were almost the same, and the implant knee was at 125 degrees passive bend; the therapist didn't even try to move it farther but he knew he could. My other knee was 126 degrees passive bend so they were almost equal.

This is what Dr. Schmidt's "Commonly Asked Questions" sheet says about knee motion:

"Range of motion after surgery will depend on several factors, but your range of motion before surgery will be a good indicator. At 6 weeks most people will be at 100 degrees of bending and close to full extension. The average patient achieves approximately 120 degrees of bending one year after surgery."

Wow. I never realized I am as flexible as I am, compared to the general population.

After a lifetime of long distance running and hiking my massage therapists had so often said my quad, calf, hamstring, and other leg muscles were tight. I never seemed to be able to stretch as much as some other people could. So I was real surprised to have reached this amount of passive bend in five weeks and discover that it's more than average knee replacement patients achieve in a year.

In just four weeks I had met the therapy goals set out in our 1st out-patient session at the beginning of Week 2! This was my 9th session overall and 6th with the out-patient therapist. He released me exactly five weeks post-surgery.

The only thing different I plan to do re: physical therapy for the other knee replacement is to have home therapy for two weeks instead of one. It's super-convenient and if I'm ready to use steps and a stationary bike the second week, now I've got those options at home.

NOW WHAT??

I'll just keep on keeping on.

Today is five weeks from surgery and the day my out-patient physical therapist released me from PT. I may have reached my therapy goals faster than average and gotten an early release from physical therapy but it doesn't mean I can slack off.

It can take a year or more for a knee and leg with an implant to fully heal, especially at my age. Even a fit 68+ year old woman's body just doesn't heal as fast as it used to.  <another sigh>

Although I have met the immediate therapy goals, I will continue to do the range of motion, balance, and strength exercises diligently at home so I'll have the best outcome for both knees. My "good knee" hurts more now than the one that had surgery because the cortisone I got in it five weeks ago has mostly worn off and I can't get any more injections before I have surgery on it two months from now. It's only going to get worse by then.

I don't dread the second surgery, as I've heard so many knee replacement patients apparently do. I'd do it tomorrow if Dr. Schmidt would allow it! I want both knees to feel good without injections or pain pills so I can get back to my favorite non-impact sports (walking/hiking, cycling, kayaking) and other activities like gardening as soon as possible next year.


Path by Line Creek at Line Creek Nature Center in Peachtree City

Another reason I'm eager to have the second knee replaced is the knowledge I gained during the experience with the first surgery. Knowing what to expect really helps. Even being by Jim's side after his partial knee replacement last winter lessened the fear I had with my recent surgery and recovery.

In retrospect, my first total knee replacement wasn't all that bad. In fact, at the time it wasn't all that bad!

(The first or second out-patient PT session my therapist asked if I have a high pain threshold. I told him anyone who has run 50- or 100-mile races probably has a higher than average pain threshold, but I have no way of comparing myself that way to anyone else.)

I don't know if I'll respond as quickly after the second surgery as I did with the first replacement because of the trauma my body has been through for this one. I have to trust that after three months of healing I'll be ready to handle it just as well. If not, I'll take it one step at a time -- literally and figuratively -- and do my very best to suck it up.

The pain is temporary and I know for certain now that the outcome will be worth it.

One more thing -- next time, I won't have any more self-doubts when someone questions how fast I'm doing certain things after surgery. I know what I'm capable of, how to proceed gradually, and when to stop before I get hurt.

Next entry:  Jim's surgery for Cubital Tunnel Syndrome in his dominant arm and hand

Happy trails,

Sue
"Runtrails & Company" - Sue Norwood, Jim O'Neil, Cody, Casey, and Holly-pup

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