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.

To Sleep or not to Sleep: 20 days post-op

I have always had a relatively good sleep pattern, and generally speaking, I sleep well at night.  But things have changed in the past three weeks as far as sleeping goes.  First of all, I found myself, especially early on after the surgery, needing naps during the day.  Generally, I am not a napper, but since the surgery, naps rule.  I have spoken about this with any number of people, including the nurse, Karyn, and Bud, the PT.  The short answer is that surgery takes a lot out of you, anesthesia can remain in your system for weeks, and therefore, you get tired easier.  Makes sense.

So I've been going with the flow, and napping as necessary.  But now, almost three weeks post surgery, I am finally feeling better during the day, and not in need of as much mid-day rest.

But the other side of that coin is sleeping at night, and that is a problem.  Common wisdom says that if you nap during the day, you might not sleep as well as night, but I don't think that is my problem.  What bothers me at night is an inability to get comfortable.    It's not so much Pain as it is discomfort.  It's best described as follows:

• I feel as if there is a sock full of sand in my knee.  It is heavy, thick, it doesn't bend the way it should. There is an alien in there. This creates a discomfort when I'm trying to get settled in bed.
• Following the surgery, there were black and blue marks from my buttocks/groin/thigh down to my ankle/foot.  These have been a minor annoyance in the overall scheme of things, but they exist nonetheless, and they make themselves known when I move around in bed.
• I have lost skin sensation in the front of my lower leg.  It is almost numb.  This adds  to the list of strange sensations.
• The staples are out, but the scabbing creates a tightness that rubs against the sheets/blankets.
• The quads are sore.

All of this adds up to a problem trying to sleep.

During the first week or so, I was taking pain meds, and this allowed me to sleep.  But once I realized the pain was minimal, I stopped the pain meds, to the detriment of a good night's sleep.  So last night at 2 am, tired of tossing and turning, I took a Percocet and slept well for 5 hours.  I chose to sleep.

14 days Post-op

The nurse, Karyn, came today to remove the staples.  22 staples later:

I am staple free and I can shower! Oh, and look how straight that leg is!

Pain - Eleven days post-op

Pain is very subjective.  My criteria for the level of my pain dates back six or seven years when I had severe back pain. The pain itself was in my left thigh, but it emanated from my back and that pain is the worse I have experienced since childbirth.  I spent 6 weeks flat on my back.  But I learned what a ten was on my personal scale. The pain in my leg went from a murmur to a whisper  to talking,  to an angry voice and then to YELLING.  But when that leg would SCREAM at me, it was a nine. It was unrelenting, and was hardly ever a 2 or 3 for that period of time, and that is also when I was first introduced to pain meds, and the pain meds were what allowed me a few hours a day of normal activity.  The rest of the time I was in bed or on the couch.  So I had my own personal pain scale for when the hospital staff asked me my pain level.  Today is 11 days post op, and the highest it has been is maybe a 6, and that was the second night when the femoral had worn off and I hadn't yet gotten the pain meds right, and that included PT.  Much lower than my expectations.  Of course, earlier, I had "kept ahead of the pain" with pain medications, but that's what they are for, and if taking the pain meds allowed me to put in a better effort to get better results, go for it.  Now, though, I am taking maybe two a day, one at bed time to help get a good night's sleep, and one before physical therapy.  And my pain level has been practically nil.  The most surprising to me is that I was in more pain before the knee surgery than I am now.  Yesterday, after going with the PT to the fitness center here at HH and trying out the bicycle, Bill and I went to Target, and I could walk around Target in less pain than I did prior to the surgery.  This is a result I expected to achieve eventually, but not ten days post op.  

The Cool Machine - A Tip

This little baby was one good investment.

As we were leaving my last appointment with Dr. Kerina before the surgery, he told us to go pick up an ice machine from OrthoCare, for which he gave us a prescription.  We rented it for two weeks for $50, and were told to bring it to the hospital with us.  I think the hospital can provide it, but Medicare does not pay for it, so Dr. Kerina tells his patients to rent one.  Just put ice and water in the cooler, plug it in and wrap the magic suction wrap around your knee secured with the wrap provided.  The motor then circulates the cold water through the octopus-like wrap.  The hospital staff kept it cold for me and applied it as necessary.  It works to keep the swelling down, and it is easy to use at home.  We put 8 bottles of water in the freezer, and each morning Bill puts 4 bottles of the frozen water into the cooler with water to the water line, and it is ready to go for the rest of the day.  The other 4 bottles go back in the freezer.  I find myself regularly going and elevating my leg with the wrap on it, and it is very soothing.