Six Week Follow-up with Dr. Kerina

So, yesterday I had my six-week follow-up with Dr. Kerina.  Bill and I went to the Lady Lake office,  where I received very positive feed-back on my progress.  I had an x-ray taken that shows the new knee in alignment with no instability or soft tissue problems.  He told me there is no reason to work on increasing the range of motion; 130 is higher than any expectation for six week post-op,  and any additional range will come from my normal activity level, which is fairly high.  I don't need any more PT, and he reluctantly said I can hit tennis balls "as long as you don't run."  He also reluctantly said I could use the elliptical machine, but hitting tennis balls is much more fun that that!

I  had previously picked up the Operative Report from Leesburg Hospital; the knee is a "Zimmer Natural Gender (cobalt chrome cast alloy) #1 femur, #2 tibia, 9-mm ultra condylar and tibial bearing, #1 patella."  The patella parts are "ultrahigh molecular weight polyethylene."  He chose that particular knee because I am a tennis player, and the "plastic" parts because the substance is stronger than some other choices, and can better withstand the usage that comes from playing tennis.  He said it should last 20 years of normal use, but my lifestyle is not considered "normal use."  The parts that are most likely to wear are the "plastic" parts, and they can be replaced if necessary.  The other parts are glued in and "aren't going anywhere."  The soft tissue, though, takes longer to heal, hence no running yet.

As for antibiotics and dental work, absolutely I must take antibiotics before any dental work, even cleanings.  "Don't listen to your dentist."  Dr. Kerina said the antibiotics are very important; the mouth is a dirty place, and any infection will seek out the parts that are alien to your body, i.e. the new knee.

And yes, I will set off metal detectors.

Physical Therapy #8: Graduation Day

"Today is graduation day."

It's almost six weeks post-op, and Forwen was working on my knee for the last time, preparing to take the measurement to include in the final PT report to be sent to my surgeon.

Range of Motion:  -3 to 130.

I was told this was an unusually good result for only six weeks out.  He has not had another patient do as well as fast.   It's bittersweet, though, since while I love the fact that I feel as good as I do and can do as much as I can do, I am really going to miss my 3x week at PT.  I think it is partly knowing that 3 times a week, I had an appointment to do something important (sort of like playing tennis?), and now I'm going to have to be disciplined and do the stuff by myself with no one standing over me.   That's no fun!  But I knew from the onset that, whereas tennis was my "job" prior to surgery, that rehabbing was my "job" post surgery.  Of course, I'm passionate about tennis, but, unfortunately, not as passionate about rehabbing.  Oh, well.  On to the next stage in the TKR recovery process!

Pleasant Surprises

So, I drove to Skyview to attend the tennis ladies Cookie Exchange, which I was pleased to be invited to.  On my way home three hours later, I realized that I had stood on my feet for almost the entire time I was there, and was totally unaware of any discomfort.  If anything, I was conscious of how well-balanced and solid I felt.  Last year, I needed to be sitting most of the time.

It's the little realizations like this that are so significant.

Physical Therapy #5 and #6

Today is five weeks since the surgery.  I will have two more PT appointments, and then I will be done.  The physical therapy plan is that you must reach certain goals before being released from PT, including range of motion, certain knee lift/bending with 5 lb. weights, certain balancing, certain level on the bike, etc.  I'm just about there.  My range of motion is  -1 to 127.   I'm up to ten minutes at level 7 on the bike; 5 lbs. on the knee lifts, and have the balancing part nailed, I think.  That's standing on the balance board tossing and catching three balls of ascending weights (one at a time, though), at a small trampoline.

I asked about using certain machines at the fitness center, and Forwen said go ahead.  He said he knows my legs are strong because I can walk up and down stairs.  I can pretty much do what I want to do, with the exception of tennis.  I'm being patient with that, because I am well aware of the damage I can cause if I do something stupid, and playing tennis would be stupid!  Serving, however, I have been doing.  I might as well try to keep one aspect of my game honed.  But I am still shooting for January 1 to be hitting tennis balls.  I see Dr. Kerina next Thursday, and we will see what he says.

Reflections on Range of Motion

I have been aware from the onset that regaining range of motion after TKR is big. Range of Motion is drummed into you from day one.  It is stressed how important it is to the overall recovery to get the best range you can from your new knee.  The "gold standard," as Bud put it, was 0 - 120.  That is the goal to be achieved with PT, and after it is reached, from what I understand, PT is no longer needed.

While still in the hospital, I remember, even in my drugged haze, that Ingrid measured, and I was 0 (perfectly flat) from day one.  That had to be the surgeon's expertise, I think, and I reached 90 degrees before leaving the hospital.  My feeling is that your range of motion before the surgery has to have some impact on the range of motion you are able to reach after the surgery.  My upper range has since been increasing gradually, and has reached a high so far of 127.   I have achieved that because I have worked on it, and have been proactive with the PTs.  For instance, very early on, when Bud was coming every day once I was home from the hospital, I suggested a rocking chair, which we have on the porch.  It is very difficult to increase your range by pushing, but not very difficult if you sit in a rocking chair and "rock" it.  I also asked him about an exercise bicycle, and that is how I have increased it as high as it is now.  Each time I use the exercise bike, I move the seat a notch closer.  Bud showed me how to do that carefully, by going backward very slowly until you can go around, and then cycle at that setting, and the next time move the seat up closer, and repeat.  Had I not been proactive and asked the PT about these things, it would have taken me much longer to achieve some goals.  Of course, the knee had to have been co-operative enough, but in my case, it apparently was.

Physical Therapy #4

Since my last PT, I have gone to the fitness center to use the bike, and I have also tried the elliptical machine.  While the knee is okay with it, the rest of me finds it hard to do for more than a few minutes.  I think I have to work myself up to that level of exercise.  But I do practice going up and down the stairs and am excited to be able to do that!

Each time I go to physical therapy, Forwen adds a degree of difficulty to the various exercises.  Today it was bouncing a 4 lb. ball off a small trampoline while balancing on a balance board.  That's a challenge!

However, on the complaint side, none of my body parts likes this cold weather we are having, especially my new knee.

Physical Therapy #3

"You're doing scarily well."
"What do you mean?"

The danger is that you will do too much, too soon.  You can control the physical therapy, but you cannot control how long it takes for the healing to take place.  You must be careful not to overdo.  It takes a good 6 to 8 weeks for the healing to take place.

Points from Forwen well taken......yet again.

Physical Therapy #2

I had my second appointment with Forwen today, and it was very beneficial.  We were talking about range of motion, and today I am at 0 - 127.  I have added the extra by moving the seat up on the exercise bicycle at the HH fitness center.  But I hadn't really given much thought to the "0" part of the equation, figuring 0 was fine.  But Forwen suggested that -2 or -3 was even better, and the reason is that being at 0 or less allows you to lock your knee.  My question was, why does it matter if I can lock my knee or not?  Because locking your knee allows you to stand without getting tired.  If your knee is less than 0 it will not lock, and if it doesn't lock, you are using your muscles to remain standing, and that will make you tire faster.  The light bulb went off!  For a long, long time, I had not been able to stand for more than five minutes.  I could walk, or move, or play tennis for hours, but I could not stand.  So now I have both a new goal (-2 or -3) and something else to look forward to:  the ability to stand and chat with someone (like Bill does all the time) without having to go find a seat.