Hips and Knees

Since this is a medical blog of sorts, I might as well cover all the issues, since one issue relates to the other  I have been having problems with my left hip, to the degree that I was unable to move on the court and could not play.  Having recently established a relationship with Dr. Moor, I made an appointment to see him for this new problem.

But, I'm at the tennis courts on Tuesday last week watching my team play the last match of the season, and my right knee swelled from out of nowhere and became more painful than the hip.  How do you even limp from two sides at once?  Luckily, I had an appointment scheduled for my hip, so I went to see Dr. Moor for both problems on Wednesday (he had a cancellation).  He ordered an MRI for the hip, though at this point, the hip is my strength, and the least of my problems, because the knee has me totally hobbled.  He drained the knee, but instead of clear fluid, it was bloody, so that needs to be analyzed.  He ordered an MRI of the knee, as well as blood work.  (That fiasco is a separate post.)   I am scheduled to return ten days later (too long).   And I'm cranky. 

Uh uh!

It is now 7 years, 4 months since my TKR.  It has been a great 7 years, mostly pain free, with just the usual flare ups of issues to be expected by a woman my age, especially one who plays tennis 5 or 6 times a week, and sometimes more than once a day.  Until....3 weeks or so ago, when the knee spontaneously swelled during a period of inactivity.  It remained painful and swollen for 3 or 4 days, and then just as suddenly went back to normal.  But, I had made an appointment with an orthopedist, which I decided to keep.  I wanted to be an established patient if this should happen again.  He took an xray, and said it could be an issue with the glue interacting with the bone,  or it could be a fluke.  Let's wait and see, which was fine with me since I was back to normal.

But normal was too good to be true.  Last week it again spontaneously swelled during a period of inactivity, and I was truly gimping.

So, I am bringing back the blog,  since I have a feeling all is not well in there.

Welcome to Arden's Knee II

Two-Year Post-Op

Where does the time go?  Another year, and another visit to Dr. Kerina.  November 8 will be two years since my TKR, and a good two years it has been.  I am spending hours on the tennis courts five or six days a week, and walking for as long as I want.  No pain.  It is truly remarkable.

But, I did have one little hiccup a week or so ago, and that prompted me to push up my annual checkup with Dr. Kerina.  My knee swelled up for no apparent reason, and it swelled on a day when I did not play tennis, but rather was walking around doing normal everyday chores.  I managed to play tennis the next day when it was still swollen, and it brought back distant memories of playing in pain, which I hadn't had to do since the TKR.  Frankly, it was a scary thought.  So, I called, and was lucky, once again, to get in two days later.

Of course, by then the swelling was gone, and all was right with the world.  But I had my list of questions about the whys and wherefores of the swelling, as well as a recap of what happens when it wears out.  Bill and I went together, and with the obligatory forty minute wait, finally met with Dr. Kerina's PA, Martha.  We were both very impressed with her, and I would have no hesitation seeing her in the future for knee related issues.  She spent the time, and answered all the questions we had.  She said the swelling was probably from a ligament that I twisted.  She also reiterated that the knee should last 15 to 20 years, depending on the activity level, and the first thing that will need replacing in the piece that rests between the two metal part of the knee, the artificial meniscus, for lack of a better term. The xray shows that it has not worn down, and the xray will show when it has, and when it needs to be replaced, sometime in the distant future.  That will entail an outpatient procedure where they  open up the knee following the first incision, but replacing the flap is a comparatively simple procedure, and will not result in the same pain and rehab as did the TKR.

Then,  she escorted Dr. Kerina in to look over the xray, and make sure she hadn't missed something.

Dr. Kerina remembers me as "Arden's Knee" and asked if he could put a link to this blog on his web page, which, of course is fine with me, as I told him a year ago.  In exchange, I have some interesting beers to look forward to, a quid pro quo, as it were, since we are both beer enthusiasts , especially beer from micro breweries.  So the good Doctor will provide me with a sampling of some of his favorites.  How fun is that!

Also, the upcoming issue of a local magazine will feature Dr. Kerina on the cover with some news about him and his organization.  I'm looking forward to seeing that.

All in all, the body is doing well for its age, and I really can't complain.

One Year Check-up With Dr. Kerina

It may be a month early, but since my left knee (the one that is real bone and is no longer the good one) has been giving me problems of late (it locks up),  I moved my appointment up a month, and visited Dr. Kerina.   Bill and I arrived early, as is our normal behavior, and seats in the waiting room were at a premium.  After the obligatory wait, we were ushered into the examining room in order to. . . . .wait some more.  But the big guy appeared, looked at me and said, "oh, it's Arden's Knee."  And, was I there for the annual check up or because I need the other knee replaced?  Dr. Kerina has a sense of humor.  Anyway, the correct answer was:   both.

So he checked the xray on the new knee, and congratulated himself on what a good job he did.  And then he looked at the xray of the other knee, and could see the torn meniscus, along with the arthritis.  At my age, and with the arthritis already eating away the cartilage, arthroscopic repair surgery is not an option, since in essence, all that does is scale away additional good cartilage in order to even it out, and what I don't need is less cartilage.  So far, it is not painful. . .unless it locks up, which is what it does.  Usually, I can maneuver it out of the locked position, and as long as I can do that, and as long as I can stay on the tennis court, that is ok.  But the net net is that I am looking at another knee replacement.

Considering the success of the first one, it may be an improvement.  But, prior success does not guarantee a future success, so the mere thought of doing it again is scary.  For the time being, though, I'll just plod along.

11 Months Post-Op

My last post was in May, at six months post-op.  Now, five month later, the knee is still great, still pain-free, and still getting me around on the tennis courts.  I am playing tennis five to six days a week.  All the other new-knee related aches and pains have resolved themselves, for the most part.  I take no medications at all, i.e. no Mobic (meloxicam) or Tylenol or anything, except vitamins and glucosamine, but I do go regularly to the chiropractor to keep everything in alignment.  Of course, my left knee is now making its own complaints, but hopefully, it will hold out for a few more years.  But, I am a 67 year old woman with arthritis and osteoporosis, so there is no telling how long it will last.

Recently, I spent a long weekend in New York and Boston, and for the first time in many years, I could walk the cities for hours.  And of course, both cities are vertical, so if the pub/restaurant dining room is on the street level, rest assured the bathrooms are in the basement.  I no longer think twice about heading to the rest room, and the steps into the girls' apartments are a ho-hummer.  I relish going up and down stairs!

Six Months Post TKR

It's been over three months since I've posted to this blog, and six months since the TKR, and I was reminded that it might be time to either continue it, or close it out.  I figure that the knee won't last forever, and I'm sure issues will arise over time, so I'll continue to post regularly, but not as often.  As of now, though,  here is where I am:

Having this knee replacement has changed our lives in very positive ways.  For me, I am excited to actually have some pain free days.  I say some, because even though my knee causes me no pain whatsoever no matter what I am doing, I do have other arthritic aches and pains to contend with.  The only difference is that pain is now a sometimes thing instead of a constant.

As an example, I just spent four days (well, actually one was spent travelling to and from) in Vegas.  Granted, there is not a lot of physical activity connected with a trip to Vegas, but the point is that I was able to do everything everyone else does as far as everyday activities.  I can walk for miles, stand around watching people play craps, wear high heels (but not too high), and I even contemplated climbing the rock climbing wall in the fitness center, but my better judgment prevailed and I stuck to the elliptical.  (As an aside, I was not prepared for the fact that smoking is permitted in casinos, not to mention that in order to get to the elevators to get to your smoke free room, you have to walk through the casino.  Go figure.)

As for tennis, tennis is great.  Before I made the decision to have this TKR, my biggest concern as far as tennis went, was whether I would ever be able to play at the same level again.  In all my research beforehand, asking people about their experiences, I never really found anyone who played at my level who had the surgery, and then continued playing. Not to say they are not out there, because they are; only to say that I couldn't find anyone like that.  So I have been very pleasantly surprised, to say the least, that my tennis is as good as or better than it was before.  Now, I am able to cover my own lobs, cover my partner's lobs, bend my knees when I'm serving, run down drop shots, and love every minute of it since it is all PAIN FREE.  What a concept!

So now I am mentally planning my next trip to NY and/or Boston and/or London to visit my kids and grandchild knowing that I can keep up with them, even Little Lissy, who is pushing 2.

Of course, at this age, when you fix one body part, other body parts protest, since they got used to being off balance or not used or whatever, and now their job has changed.  So over the past three month, I have been through various other "injuries."  For instance, I was having pains in my lower back/buttocks, which would come and go, on and off the tennis courts.  And, to add insult to injury, my neck also causes problems.  So I have done my best to keep those issues at bay, and have found a good chiropractor to help.

All that being said, life here in beautiful Harbor Hills with Bill is good, and we are on our way to a tennis game this morning.

Little Lissy is visiting Harbor Hills with her mom. Daddy is nearby.  And since this is a knee blog, Little Lissy is a twenty pound ankle weight that I can lift with my new knee; three sets of 12.  

New Knee vs. Old Knee

Having been released by Dr. Kerina three weeks ago to play tennis to my heart's content, I have been on the court every chance the weather has permitted.  My first team match was scheduled for last Tuesday in Gainesville, but after the team drove half way there, we got the call that the match was cancelled due to wet courts.  So my first "real" USTA match was Friday at my old club, Skyview, in fairly cool, very windy conditions.  It was great to be back in a competitive match.  Of course, playing against my old teammates was very difficult.  We didn't prevail, but wait until next time!

I'm trying to get a grasp on how to best describe the way this knee works on the tennis courts, as compared to the way the old knee worked.  Here goes:

The old knee hurt with every step.  I think that when you are playing tennis, the adrenaline helps to block the pain, since my old knee had always felt more painful walking, and doing normal things than it did on the tennis courts.  However, I never walked on the tennis court without taking 3 acetaminophen, in addition to the daily dose of Mobic.

The old knee could not go backwards.  I was always able to move forward, to some degree, but not backward.

The old knee would not push off in any direction.

The old knee could not bend very far.  OK, it could not bend at all.

Now for the new knee.

First of all, from the beginning, I have best described the feeling of the new knee as if there was a sock full of sand in there.  It's still there, but it is becoming smaller.

The new knee does not hurt.....at all.  While I still take Mobic, for other arthritic issues,  I do not take any other pain meds.

The new knee feels strong and it can bend.

The new knee can go forward, backward and sideways.

The new knee can push off.

From my first time hitting tennis ball, I have been in awe of the sense of balance I now have.  As I move around the court, it still amazes me that I am able to do what I can do, movements I have not been able to do for more years than I can remember.  I can now actually get a cardio workout on the tennis court.  It is an exhilarating feeling, and I am excited to be on the court every time.

 I have been playing with Bill for 20+ years, and he knows how I play.  Since I am on the inside looking out, I asked him for his view of the difference, new knee vs. old knee.  He said I am getting to balls I have not been able to get to; I can go back for overheads and up for short balls.  He feels my movement has improved 20%, but I feel it has improved more than that, but I'm on the inside looking out through my rose colored Bolles.

What are you doing on the court? What does your doctor say?

Since Christmas Eve, I have been on the tennis court here at Harbor Hills every chance I get, hitting with my backboard, Bill, and every time someone walks by, they ask if my doctor knows I'm playing tennis.  I'm been fudging the answer, but, truth be told, while he had given a reluctant OK to it as long as I didn't run, fall or twist my knee (as if you can control the latter two caveats), I have been a bit reluctant to actually play a match, even though I keep thinking my new knee will tell me if I do anything I shouldn't be doing.  So far, it is humming along.  I haven't been so pain-free or well-balanced on the tennis court for years, as I have been since this knee replacement.  

I wasn't scheduled to go back to Dr. Kerina for my final post-op appointment, where he really would turn me loose, until February 3, which is over three weeks away.  So I called his office to see if I could get in earlier, and, coincidentally, they had a cancellation for today.  Bill freed up his late afternoon schedule to go with me down to Leesburg.  But this morning, I had a date to hit with John, the pro, and that 40 minutes is quite a workout.  If the knee was ever going to swell, that would have done it.

The big guy (that would be Dr. Kerina) came in and said, "let me take a look at that knee before you tell me what you have been doing that you shouldn't have been doing."  He took a look at the new knee, and said, "Wow, that knee looks good!"  He said it was solid when I came out of surgery, and it is solid now.   Go ahead and play tennis; do what you want, but just don't fall or twist it, and I'll see you in a year.

So, nine weeks and one day from the date of the surgery, following a good-by hug, I have been released to do what I want, and my next appointment will be November 8, 2011, one year following the original surgery.

Back on the Court Ahead of Schedule!

Today is New Year's Day, 2011.  On December 24th, one week and one day ahead of my original wishful thinking date of January 1 (and one full month ahead of my doctor's prediction), I went out on the court and spent 35 minutes hitting tennis balls with my ball machine, Bill.  That was less than seven weeks after the surgery.  Dr. Kerina gave a reluctant OK to hitting tennis balls, as long as I don't run, so I have been out there getting used to this new knee.  It feels and it works differently than my old knee.  This knee, though it still feels as if there is a sock with sand in there, works well, if in a cumbersome way, and doesn't hurt.  My original knee, in the condition it was in pre-surgery, hardly worked at all, and hurt all the time.  So this is a great improvement.  I've been trying to hold myself back from hitting too long and too often.  Pain and swelling would be a warning to stop, but since there is no pain and being on the court doesn't make it swell up any more than the stationary bike or elliptical, and even that swelling is minimal, I continue to hit every day the weather permits.  I have been on the court four or five times since Christmas Eve with Bill and am none the worse for wear.  I'm resisting the urge to start playing doubles, and my better judgment is prevailing.

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.

The Driving Force

So when I saw Dr. Kerina last Monday at my 2-wk post-op appointment, I asked him when I could drive, mentioning that I had been driving the golf cart since the first week.  He said one month, which is one week from today.  Truth be told, I cheated.  I drove myself to PT today, and to the other errands Bill and I ran afterward.  It feels good to drive, and it is not in the least bit uncomfortable, nor do I feel I am putting Bill or myself or anyone else in any danger.  I would prefer to have an automatic transmission instead of my stick shift, but oh well.  Nothing to be done about that.

Out Patient PT - 21 days post-op

Today was my first outpatient PT session.  I am going to Florida Rehabilitation Specialists in Lady Lake.  I chose this location for two reasons:  Forwen Dela Rosa was recommended to me by a friend who lives in The Villages and is a very active person, as am I.  I knew that her expectations for a PT would be very high.  She had her 2nd knee replacement 6 weeks or so ago, and told me how pleased she was with Forwen.  The second reason, is that it is very close to home.

So, I met Forwen today, and we began.  He measured the range of motion, and I am already on the high side at 2 degrees to 120 degrees, the desired ultimate range being 0 - 120.  He thinks I should be able to get to 125 or 130 before we finish, and maybe -2.  He does not think I will need PT very long, a month at most.  He worked me, and I am sore this evening for the first time. . .a good kind of sore.

I'll be going three times a week.