Tuesday, October 21, 2014

Second knee surgery update

I saw the surgeon last Friday, Oct. 17, for a follow-up visit. He was very pleased with my progress: my extension (straightening) is perfect(!) and my flexion (bending) is 95. He said I could quit therapy if I want to, or keep going for more improvement. I said I want to keep going to try to get a little more bending, so he wrote me down for 3 more weeks. I will see him again in mid-December for a final check-up.

I went to therapy today (Tuesday) instead of Monday, as we kept the grandchildren, and we're having our chimney repaired, so Tommy wanted to be at home with the chimney work while I stayed with the grandchildren. The older one was at school, and I took the baby and the 3 year old for a walk several blocks down their neighborhood. The weather was very pleasant. We saw a worm, and granddaughter was very proud of herself because she didn't "freak out." She was leery of it, and stayed as close to me as possible.

So, I went to therapy today and will go again tomorrow, then Friday. Today I got to 100 with flexion!! Woo hoo!! I've been working on it at home, bending as much as possible and holding it to a count of 10 or 15 even while I am sitting apparently doing nothing, and bending at the fireplace, with my foot on the raised hearth (when the men are not here working), and still doing my heel slides.

Saturday, October 11, 2014

Second, and last, knee surgery, God willing

I don't have any more knees, but I suppose something could happen that would result in a need for another surgery. I hope not!

Therapy dog in hospital
While I was in the hospital, I was visited by a Therapy Dog, Dodi, a sweet, gentle girl.

This time was different. Upon discharge from the hospital, after 3 days, I entered a rehabilitation facility, Rehab Select at Hillview Terrace. Hillview Terrace is a long term care/skilled nursing/nursing home facility. It was basically clean and comfortable, not a resort hotel by any means, but adequate. The food was okay, but my appetite was low, so I didn't want much. We had eggs and grits for breakfast every day, and I soon learned I could ask for cold cereal, which I did. Raisin bran every morning, with black coffee, skim milk and orange juice. Lunch and dinner were usually meat, green veggie, and a carb, plus a roll or cornbread and dessert. Sometimes that was fruit, sometimes pudding or cake, pie, or cookies. I learned not to drink coffee with supper, even though it was served at 5:00 in the evening. It would still keep me awake. Maybe my body is changing. I usually chose skim milk or water, and fruit juices and iced tea were also available.
Bed at rehab center
A good meal, pork chop, sweet potato, and turnip greens

My room was a double room. I had a total of 3 roommates, one at a time. The first one stayed overnight. She begged her family to come get her first thing in the morning, complaining about how "dirty" it was. She either had higher standards or better eyesight than I did; in any case it was clean enough that I didn't get sick.
My second roommate and I became friends almost immediately; we were like kindred spirits; we liked and disliked many of the same things and really enjoyed one another's company! She was discharged about a week before I was, but before she left she paid for me to have a shampoo at the center's beauty shop! What a nice treat, and the hairdresser did a good job, too!
My new friend

My third roommate complained a lot, and her emotions went up and down - high and giggly one minute, then angry at the world the next. It got a little tiring, but she was ok, and didn't watch much TV, which is good. She did (and does) have serious health problems. I feel sorry for her, and hope she will be ok.

In summary, I would recommend researching all possible sites for post-op therapy before committing. I wish I had done that. My first choice was HealthSouth, which was recommended by my outpatient therapist, but I did not meet the qualifications for Medicare to cover my going there. I don't know what the qualifications were. By the time I learned that, I didn't have much time to choose one, so I picked the one closest to our home. If I had it to do over again, I would have planned ahead and visited all the facilities in town and asked people about their experiences.

I think a rehab facility should be supportive of the patient's therapy in all respects, including timing of meals and quietness of halls at night. I had 2 hours of therapy each morning. One hour was Occupational Therapy, which included exercises to strengthen my upper body and arms, and my stamina for standing several minutes, and later, my ability to fold, hang, and put away clothes and to load and unload an upper kitchen cabinet and a dishwasher, and to make a bed. The 2nd hour was Physical Therapy, the exercises I had done before: walking with a walker, leg raises, ankle pumps, glute and quad muscle training, heel slides, and riding a little, low-to-the ground bicycle - just the foot pedals, not bending my knees much at all. This was not actually very demanding, and I later wished that I had been pushed harder.

In the afternoons, I was supposed to have 4 hours on the CPM machine (Continuous Passive Motion), which bent and straightened my knee as I lay on my bed. In actuality, the therapist usually came up to start me on it at 2:00, and supper was served at 5:00. The attendant turned off my machine and helped me off it, then served my supper in bed. We took all our meals in our rooms, either sitting in a chair or in bed. That gave me only 3 hours on the CPM machine.

At night, especially the first few nights, the halls were extremely noisy, and much of it could have been eliminated, I think. The workers talked loudly and called out to one another, slammed doors, and sounded like they were running races with the carts. One of the residents, I think she was a long-term care patient and not a therapy patient, called out often during the day and night, calling for someone to help her. That couldn't be helped; the poor lady was not in her right mind (but couldn't they house long-term care patients separately from therapy patients?) I complained about the noise to my therapist and to the nurses on the hall, and I think it got better, but maybe I just became accustomed to it. We did keep our door closed, and I played soft music on my phone, thanks to Pandora Radio and the facility's free Wifi. My last roommate was on an oxygen machine, which also made a "white noise."

I had an appointment with my surgeon a week and a day after my arrival at Rehab Select. He thought I was making good progress, and I have another appointment for October 17. While away from "jail", I had a shampoo at my beauty salon, and enjoyed a nice lunch with my husband at Chicken Salad Chick http://www.chickensaladchick.com/, so it was like a "date afternoon!"
Day off, lunch out!
(I don't know these ladies; they were across from us.)

On Wednesday of the next week, I was told by my P.T. that my last therapy would be the next day, Thursday, and I would be discharged Friday. When Thursday came, my O.T. said, "You're going home today!" I said I thought it was tomorrow, and she checked with Admissions, and it was that day! So I called my husband, and he came for me shortly after lunch! I'm so glad to be home again!
Physical therapist
My Physical Therapist
Mobility Paraphenalia

I had had a bad time on Tues night/Wed morning. I hadn't had a bm in 3 or 4 days, and they gave me a laxative. I was up several times Tues night, in the bathroom, and Wed morning my tummy was really upset, unpleasantly so. I was reluctant to leave my room for therapy, and both O.T. and P.T. came to work with me in my room, for which I was very grateful. I was better by afternoon. I wished they had given me prunes and/or Activia yogurt!

Once home, I started out using my walker all the time and sleeping in the recliner, then gradually moved to the bed, and now am using my cane when away from home, to reassure my balance and also to warn others that I am slower than they are. At home, I am not using the cane and only minimally touching a wall or piece of furniture, and trying hard not to limp but to walk as normally as possible and to bend my knees while walking! (Thinking of the old TV show Gunsmoke's Chester).

I am going to outpatient therapy at Premier Physical Therapy, as I did with the left knee. They are busier now; business must be good for them. Many more patients, and a couple of new therapists; I'm happy for them. This past Wednesday I rode the bicycle backwards and was very proud; I remember how long it took me to achieve that with my left knee - well not exactly how long it took, but that it took a long time! And Friday, yesterday, I rode it forwards!! Woo hoo!!
I'm having more trouble with extension (straightening) this time. Last time I don't remember having any problem with that, only with flexion (bending). That's not what it needs to be yet, either, but they say I am making progress. If they've measured it, they haven't told me what it is, though. I'm sure I will find out before I see the surgeon next week.

Exercise buddy
My exercise buddy! (but sometimes he gets too playful and I have to shoo him out)

I am faithfully doing my exercises at home, too (in fact, it's time to do them again ...) I do six 4-5 times a day: 1) Quad sets, sitting with my legs straight out in front of me and tightening the thigh muscles, holding for a count of ten, 20 times; 2) Ankle pumps, moving my feet up and down or around in circles for 3 minutes; 3) hamstring stretch, lying down with my leg straight up, held with a bathrobe sash around the arch of my foot, for a count of 30, 3 times; 4) heel slides, while lying down, moving my heel up toward my buttocks, thus raising my knee, holding it with the bathrobe sash behind my knee and stretching it for a second or two, for 4 minutes; 5) hamstring stretch, sitting up with leg straight in front of me, leaning forward to touch my toes, thus stretching the back of leg muscles; and 6) the dreaded "passive extension", or "hanging" - with my heels on a folded pillow or rolled up towel, laying there in pain for 10 minutes -- SO glad when that timer goes off! I pass the time with Facebook and Solitaire on my phone, but it still hurts. I had a little pity party on Facebook about it, but prayed about it and am really trying to have a better attitude with Scripture verses such as Philippians 4:13 and Hebrews 12:11, which deals with spiritual discipline, but I have applied it to the physical discipline or correction of my knee and leg, which wants to be bent slightly and not to be "right" or "straight." (Derecho in Spanish means both "right" and "straight.") I am hoping that it will be straight soon, and I can stop doing that last one!
Passive Extension
Me doing Passive Extension, or "hanging" -- not as comfortable as it looks!

(Blog post about first knee surgery here )