Wednesday, February 26, 2014

Recovery and therapy following knee replacement surgery

Some of my friends who are considering having knee replacement surgery have expressed interest in my experiences, so I have decided to write about it and share my journey.

Monday, January 13-Thursday, Jan. 16
I don't remember surgery; I was out like a light! Even the days in the hospital are becoming a blur. My left leg was numb from a pain block. It worked very well! I also had a push button for self-regulated pain relief. I remember using it quite often the first afternoon after I recovered consciousness, but less after that.
I didn't eat much in the hospital; nothing was good. Just a few bites of each meal. Even after I came home, my appetite was very low, and my sweet tooth was gone! I took one bite of ice cream and pushed it away saying it was way too sweet! Totally unlike me, my sweet tooth is my downfall. However, I lost about 14 pounds, and since my appetite and sweet tooth have returned, I have managed to keep it off and even lose a bit more. I still have a long way to go, but I am making a start!
I did have one excellent caregiver; I don't remember what her title was (it used to be CRT I think, when my mother was in the nursing home, but they seem to have changed it. PC something, I think.) Anyway, she had a very pleasant personality, went out of her way to keep me clean and comfortable, and even suggested I use the hospital's free Wifi to listen to soothing music from Pandora on my phone! Everyone who came in my room, nurses, staff, visitors, wanted to stay because of the soothing music. :-)
Physical therapy in the hospital consisted of walking in the hall with a walker (without wheels). I made it past the nurses' station and to the elevator doors by the third day after surgery. I also began using the CPR machine, Continuous Passive Movement (description and explanation later).


I was dismissed to go home on Thursday, Jan. 16. I discovered that I couldn't get in my car, a 2009 Honda Accord! I did manage it with help after we moved the seat all the way back and lowered the seat back to a reclining position. After a week or two, I didn't need to recline it anymore and can get in and out without  help, but 6 weeks on I still need to move it all the way back. I have a temporary Handicapped tag to allow me to park in Handicapped spaces until mid April.

At home, January 16 - February 14
I haven't felt much like sitting at the computer; I can't get my leg comfortable, and I don't have a lot of free time in my day either. For the first couple of weeks or so, the strong pain medications were keeping me from hurting much at all. I was on Oxycodone when I first came home, then moved down to Hydrocodone 10 mg. On the 14th, he dropped me down to 5 mg, and I can really tell the difference. My right knee, which still needs surgery, is hurting, along with my right arm, from using it too hard on the cane and to push myself up from sitting probably. This is especially noticeable when it's almost time for the next pill.  
I do exercises in the morning and afternoon, and spend four hours a day on the Continuous Passive Movement machine, called CPM but I call it "the horse." Not because of my screen name, that was coincidental, but because I put my leg and foot in a stirrup-like device, and then the machine moves my leg up and down, backward and forward, bending and stretching. It's not bad in itself, but time consuming. Four hours a day on it! I break it up into three sessions: 1 1/2 hours in the morning; 1 1/2 hours in the afternoon, and one hour in the evening. It seems like every time I turn around I am facing more time on the "horse". I played endless games of solitaire on my phone, and even made the top 15% daily score a few times. That's wa-a-a-y too much solitaire! I finally got smart and checked out some audio books from the library.
(My favorite was a light-hearted piece by Debbie Macomber, "Summer on Blossom Street." It was read by the radio star, Delilah. I like to listen to Delilah on the radio occasionally, but didn't care for her reading. She put too much emotion, and sometimes inappropriate emotion for the context, in my opinion. I found that distracting.)
CPM machine, another view


Today (Feb. 14) they came and took the CPM machine back where it came from! Good riddance! I was very happy to see the last of it!

The Home Health care physical therapists were excellent, very patient, encouraging, and helpful. There were two of them, Cameron was the "head;" she gave me the exercises and increased the number of reps or added weights, etc. as needed. She usually came on Fridays to evaluate how I was doing. Amber was also very helpful, and had some creative ideas to help me gain flexibility. One of them, probably the most important one as far as my progress, was lunging forward with my left foot up on the fireplace hearth. That really helped me bend! I did that ten times, holding the position for a count of 20.

I did six other standing up exercises as well: "tippy-toe" - rising to my toes and then down 30 times; "deep knee bends" - as deep as I could anyway, and improved as time went on, 30 times; "marching in place" alternating legs, 30 times; "knee curls" - bending my left knee as much as possible while standing 30 times; "sideways stretch" - with knee straight, raising left leg sideway 30 times. (Some of the names of the exercises are from the instruction sheet they gave me and others are my own invention.)

Three sitting down exercises: "leg lifts" - alternate legs, raising 30 times, sort of a "marching in place while sitting down;" "straight leg lifts" - raising legs with knees straight, holding for a count of two, tightening my front thigh muscles while doing this 30 times. After 3 weeks, she added a two-pound ankle weight to my left leg with these two. Then the "knee bends" - while sitting, slide left foot toward me, to the floor under my seat, then use the right foot to pull it even more, as much as possible, 30 times.

Six "lying down" exercises on a bed:  "Ankle pumps" - move feet up and down 30 times, this can be done sitting or lying down, helps with blood circulation to prevent clots; "heel slides" - using a twisted bedsheet as a sort of "rope", looping it around the arch of my left foot, then pulling my leg toward my buttocks while lying on my back. Pulling as far as I could, 30 times; "windshield wiper" - lying on back, moving left leg out to the side and then back 30 times (later, she added a 2-lb. ankle weight); "short arc extensions" - with a tightly rolled towel under my left knee, raising my leg to a straight position and hold for 2 seconds. Do this 30 times. (2-lb. weight added later) "Hamstring stretch" - use the twisted bedsheet looped around the arch of my left foot, raise left leg straight up, as straight as possible, and hold for a count of 30. Do this three times. "Sideways windshield wiper" - lie on right side, lift left leg straight  up 30 times (later added the 2-lb. weight).

After four weeks, HHC discharged me, saying I had met all their goals! Whee, go me! Then, that afternoon I saw the surgeon for another post-op checkup; he said these were his minimal goals, and of course I know I need much more flexibility before I will feel "normal again.

Feb. 17, 2014
I had planned to go to the Physical Therapy unit that is a part of my surgeon's group and in the same building. I was told to see Lisa to set it up after my dr's appt. on the 14th. When I arrived, I was told that Lisa had gone for the day and I should call her after 8:00 Monday morning. I tried to call several times and got either a busy signal or voice mail. I left messages but they were not answered. We had some errands anyway, so we stopped by the dr's office to try to see her in person. She wasn't available, and the receptionist at the front desk told me that PT was all booked up until the middle of next week. So, I made an appointment, but I was very upset as the dr. wanted me to start PT right away.

My husband persuaded me to stop in at Premier Physical Therapy, where he had had PT for a pinched nerve in his shoulder last November. He liked them very much, but I didn't want to; I was in a bad mood and almost on the verge of tears. (I cry when I get mad - not very effective, and certainly frustrating for me, but I can't seem to help it.) I agreed finally, and they were very pleasant, said they certainly could take me, and had me fill out paperwork immediately. I still had the dr's orders for the other therapist, and Premier called for the referral. I didn't have to do anything else, and was given an appointment for the next day! 

 Feb. 18 - 26
The first day was mostly evaluation and answering questions, with a few exercises very similar to the ones I have been doing. The PT was very patient and gentle, not at all like my fears of "Physical Terrorists"! I had been imagining something like Marine boot camp!
He did give me exercises to do at home: Hamstring Stretch - sitting on a flat surface ( I use the bed, as I can't get down and up from the floor), stretch my left leg in front until I feel a "pull" in the back muscle, then reach with my hands toward my ankle and toes, hold for a count of 15. Do this five times per set. Short Arc Knee Extension - again with the rolled up towel under my knee, but do it ten times, holding for a count of five, then resting for a count of five. Heel Slides - This time, put a bathrobe sash under my knee and slide my left heel toward my buttocks without pulling until I've gone as far as I can, then pull gently until I slide a little more. Set a timer and do this for 2 seconds, working up to 4 seconds. Fortunately, I have a timer on my cell phone, which is nearly always with me. I am still doing some of the exercises the HHC therapists gave me, the standing ones particularly, mostly to get warmed up and flex my knee. I do each of these exercises five times a day, and the Short Arc Knee Extension six times daily. I made a chart to help me keep up with them, there happens to be a dry erase board in our purple guestroom. (It was the girls' bedroom when the previous owners lived here, and is now our granddaughters' play room.)
Exercise chart following knee surgery

At the facility I am seeing all three PTs; Jason is the manager and he decides what I need to do, and Lewis and John direct me in doing the exercises there. Mostly, I am on a sort of low padded table doing knee lifts, hamstring stretches, calf strengthening, heel slides, and short arc extensions. Today, the first thing I did was sitting in a chair machine that had a sort of lever that I was raise up and down with my left hand; it fit on my leg near the foot to push my knee to a full flexed position. After a few of these, he moved the bar to behind my leg, to raise it up to a straightened position then down again several times, then moved to the padded table.  After exercising, they measure the flex and the straight for range of motion, then ice me down with electrodes to stimulate my muscles around my knee. Very cold, and I'm glad when that's over! I was imagining the hot tomato soup I would have for lunch!

In summary
I have made a great deal of progress since the surgery, but I still have a long way to go. Then,will have to go through this all over again with my right knee! A few weeks ago, I wondered what I had done to myself and doubted that I wanted to do it again, but now I find that I have much less pain in my left knee and it's getting better and better. The pain in my right knee tells me that it was indeed worth it, and I will do it again. 

Updates:

On May 22 I wrote: A small but significant update on my knee surgery
I am completely off narcotic pain medication! I haven't had a pain pill since Sunday, except Aleve, and I've been feeling fine! Even my right knee, which still needs surgery, hasn't been hurting.

When I saw the surgeon in mid April, I was only taking two 7.5 Hydrocodone pills a day, and he took me down to 5.0 with the intent of that being my last prescription. The 5.0s didn't touch the pain, and I had some 7.5s left, so I took them, working myself down to one a day. Then I woke up Monday morning, not hurting, so I didn't take any pain pills, not even OTC (over the counter, non prescription). I do need the Aleve, though.

I haven't needed to use my cane either.

On June 25 I wrote: I've scheduled my second knee replacement surgery in September. That way, I should be through with physical therapy by the first of the year (not knowing what to expect from US health care changes).

August 1: I saw the surgeon yesterday for the final post-op visit on my left knee surgery, and the pre-op visit for my right knee surgery. He was pleased with my progress and approves my decision to have the second one next month. It is scheduled for September 8. I will find out later what time, and I will pre-register on Sept. 4. I will stop taking my "baby" aspirin (low dose) on Aug. 31, and will not eat or drink anything after midnight Sept. 7.

Not really looking forward to surgery and recovery, but am looking forward to the outcome! Hoping I won't be an invalid for as long as I was following the first surgery. I have lost some weight, and still working on that, and I feel stronger in both legs.

September 3, 2014
Less than a week to go! I have decided to enter an inpatient rehab facility upon discharge from hospital. My husband has been having terrible back trouble the last six weeks or so, and it will be harder for him to care for me this time.

7 comments:

Lynn said...

Wow. What an ordeal. Might pass your link on to my husband who will also be facing a knee replacement. He needs to be realistic about what it entails. Continue to heal. Wishing you a full recovery.

maedeans said...

Thank God, my knees are okay so far at 78. I do know what it's like to have foot surgery twice on the same foot over 30 years apart -- enough pain experience to suit me for the rest of my life. Wish you well so you can once again "be like new."

Martin LaBar said...

I'm saving this for future reference, just in case. Get well!

Cherdecor said...

What an ordeal! Hydrocodone! Is that the drug they are calling the "frightening drug?" Just read something about it yesterday. At least you are getting better and better and will not need it much longer. So glad you are recovering well.

FancyHorse said...

Cherdecor, I hadn't heard that about hydrocodone, but I looked it up. My surgeon has been gradually taking me down in the strength of my pain meds, from Oxycodone to Hydrocodone 10 mg to Hydrocodone 5 mg. He is weaning me off of them, which is a good thing. You're right, I won't be needing it much longer.

FancyHorse said...

Something I didn't remember to say in the original post, in the first weeks after surgery (about a month I think) I had a burning sensation in the shin of my left (operated on) leg. I couldn't stand anything touching it, not even lightweight nylon pajamas. That gradually went away. The therapists and the doctor and his staff had never heard of anyone else experiencing this. One of those little mysteries of life.

FancyHorse said...

On May 22, 2014 I wrote this entry, and today decided to add it here as a comment to the original post: "I am completely off narcotic pain medication! I haven't had a pain pill since Sunday, except Aleve, and I've been feeling fine! Even my right knee, which still needs surgery, hasn't been hurting.

When I saw the surgeon in mid April, I was only taking two 7.5 Hydrocodone pills a day, and he took me down to 5.0 with the intent of that being my last prescription. The 5.0s didn't touch the pain, and I had some 7.5s left, so I took them, working myself down to one a day. Then I woke up Monday morning, not hurting, so I didn't take any pain pills, not even OTC (over the counter, non prescription). I do need the Aleve, though.

I haven't needed to use my cane either except when I am very tired or going up or down hills.".