FOUR FULL MONTHS TKR POST OP

I wasn't sure a couple of weeks ago that I was still making progress, but as has been the trend, as soon as I doubt, I turn a corner.

I am still leaving work a bit early to get in some extra PT time every day.  To be honest, though, I frequently use the time to do errands and just escape that last boring hour of work that feels like it lasts 2 hours!  I still experience enough stiffness by the end of the day that I am taking  my PT seriously most days.  Honest.

I realized about a week ago that when I get out of bed in the morning, I hardly notice my knees - I am back to my lower back being more of a bother than my knees. Hurrah?  By the time I am up and around for awhile I tend to get a bit stiff, so I do a few stretches before I leave for work.

 I started parking up the hill in my usual spot and have given up the luxury of the handicap spot right in front of the building.  I am fine on the hill and the extra walking is good before and after a day of sitting. I am also getting in and out of my car with much more ease.

The biggest issue I have had is a bad tooth infection in a molar I had a root canal in a year ago - I experienced several days of significant pain, stiffness and general feelings of being unwell until the antibiotic kicked in.  Those admonitions about oral health are not to be taken lightly. The infection did not travel to my knees, but they were definitely impacted.

FIFTEEN WEEKS POST TKR - GETTING SOME SLEEP

I am happy to report that I am finally getting some sleep - the medication has been helping a lot.  Not every night, but most nights I am getting at least 6 hours of sleep. I would prefer 7 1/2  so I am taking the meds a bit earlier each night.  The medication I am taking is called Gabapentin.  I still have tender and sensitive incisions, but the sharper nerve spikes have diminished and I am not waking after I am asleep - at least not due to the healing incisions.

I am still leaving work a bit early to do my PT every day.  It really helps to do this - I feel so much stronger and more flexible each week.  I am able to get up and walk around enough at work that I experience much less stiffness, also my walking has improved a lot, hardly any "hitch" in my gait.

I spent several hours on my feet at an event this weekend and rode 10 miles on my bike the next day. I was tired and sore each day, but I think I need to push myself in order to build my strength back.  Besides - before the new knees I could not have stood and walked as much as I did!  I could, however, put many more miles in on the bike - so I have more work to do. I am 10 days away from 4 months post-op.  I think I am still doing really well. Yay.

STARTING BACK TO WORK

I graduated from physical therapy last week about the time I got a paycheck for $54.00.  Time to go back to work so I don't owe them money for my benefits!

Over a week ago, I achieved a flexibility level of 126 on both knees - had no issues from the start with getting to 0 on my straight legs. I have some wobbliness and weakness on my right knee that I am working on strengthening for, but I was the first of my PT group to "graduate".

 I spent my last few sessions working on things like balance, climbing stairs and the hardest for me - getting on and off a regular chair without pushing off with my arms.  Ouch.  (I admit my biggest fear is getting stuck on a low public toilet and not being able to get up!) I had to put my fear of the pain behind me and after a few practice tries at standing up from the low chair in the gym - I could do it pretty well and it got less painful as I went. 

I also started driving during week 7. Freedom!!!  Though I wouldn't want to try to drive very long or far at this point! That driving leg is my weaker one and it gets stiff when I am in stop and go traffic.

At my appointment with the surgeon I asked for a letter to return to work on a limited basis and was given permission so long as I keep in mind this is still "early days" as he put it. So I started last Friday for just 3.5 hours with 1  break to ice and a few stretching out walks around the office.  I went again today for the same amount of time and might try for 4 hours tomorrow. 

Not sure if there was a betting pool on the likelihood of my returning at 8 weeks - but there were some very surprised people...also very welcoming people.  Nice to be out of the house for a few hours a day, then home to do my PT and rest.

Normal here we come.

PEOPLE TOLD ME THIS WOULD HAPPEN - WEEK 6

At least 3 people with experience of surgeries or serious medical issues told me that I would get to a dark place, hit a wall, wish I had never had the surgery - and then I would turn a corner.  Guess my last post came from that dark place and then - I turned the corner into the light.

I got over the stiffness that had been plaguing me for days and managed to hit the 120 degree mark on my flexibility.  Apparently that was my goal - so I need to keep at it, keep working on improving my mobility and get to the place where I can walk without a hitch, get in and out of the car and on and off chairs, up and down stairs and stand and walk for more than 20 or 30 minutes at a time.

I am still working on the pain medication weaning.  I am now able to go all day just using Tylenol. The nights are a different thing.  I am not managing to make it through the night without being awoken in pain - then can't go back to sleep with Tylenol .  If I take another Percocet I am still awake an hour or so before I can sleep again. So need to work on that.  I am down to 2-3 in a 24 hour period but hope to be off entirely next week and see about driving the car....Freedom!!!

FRUSTRATED AT FIVE WEEKS

Prior to surgery for TKR there is a required class, a pile of paperwork, binders full of information all about the pre-op process, the surgery and preparations and equipment needed  for the  home. We are told there will be a call to set up PT appointments and a couple of follow up visits with the surgeon's staff. 

At the time time it seemed like a lot of information.  I was anxious about the realities of  recovery, but I  assumed there would be more guidance offered along the way.  Bad assumption. The last tab in the binder is "Follow-up".  There is one sheet of paper with a phone number. The number is for a general appointment call center.

At two weeks I saw the PA. he took off the dressings and advised on care (basically, do nothing to it - no creams, etc.) renewed the Percocet prescription while suggesting I should start reducing my use, asked about PT and that was it. 

I moved from home based PT to a class twice a week.  We rotate from exercise equipment and stretches and are measured to determine our level of flexibility. I am aware there are goals, but they are not discussed... We are told to do the stretching 3-4 times a day at home, not to spend too much time walking around and over using the joints.  The PTs are very nice and very reluctant to discuss any issues other than the class related exercises - we are told questions should be referred back to orthopedic staff.

So I have been waiting longer to take the pain medication, using ice and elevation more to help the pain, doing my stretches many times during the day, taking breaks between tasks so I don't cause additional swelling, only using the bike once a day as I was told - in other words, doing my best to be a good rehab patient.  I have seen the small increases in flexibility and mobility but wonder if I ould be doing better.

So why am I frustrated at five weeks?  I am still very stiff and experiencing a lot more pain than I was in the first post-op weeks.  I am very pain tolerant - not one to whine.  I find myself whimpering and screeching in pain quite a bit.  I am not afraid of getting hooked on opioids, I have been fine with taking the meds as I feel I need them, but there have been many days and nights the pain has gotten ahead of the medication and there lies much misery. One day I go 7 hours before feeling the pain building and another night I'll wake after 4 hours in throbbing pain and can't sleep. So how do I do this?  I need guidance. 

I emailed the surgeon's office and requested a consult.  They referred me to my GP who offered me a phone consult a week away.  Sigh.  If it is like the last phone consult I had with him, he didn't even know why he was on the phone with me and was not prepared.  It was a complete waste of time.  So I called my future daughter in law, a nurse, to discuss whether I should add an OTC between doses  and how much.  She was a great help.

There doesn't appear to be anyone in the orthopedic office available to discuss the rest of my questions, goals and concerns.  I have a follow up appointment on the 28th, so I hope there will be some answers then.

The other issue weighing on my mind is going back to work.  I can't even imagine it right now.  I can't sit for 8 hours at a computer being kind and helpful when I am in pain after about 20 minutes of sitting and need a break to move around and stretch out.  Can't exactly strap on my ice machines while at my desk!  So how do I get there from here?  I am expected back at work in less than 3 weeks - will everything suddenly turn around?

It doesn't seem reasonable to cut me apart, add new parts and sew me back together and then leave me to figure this out on my own.  Right?

DAY TO DAY RECOVERY - ONE MONTH

The average time time off work for total knee replacement patients returning to a desk job is 8 weeks.  Some say longer for bi-lateral replacements, but not all.  I plan to return after 8 weeks with some possible accommodations.  Maybe a shorter day, longer, more frequent breaks - not sure until I get back to it and see what weaknesses remain.

The biggest mystery of all with this surgery was what the heck will I be doing all day, every day after the initial recovery period.  I can't drive. Not sure what my capacity for housework or yard work might be.  Not making any money so online shopping must be avoided.  Just how much TV and reading can I handle?

So here is where my days are right now.  I can shower and dress myself but it takes time.  I can spend short periods in the kitchen but find it hard to carry anything of any weight even a few steps without support - so just moving from stove to sink to drain water from potatoes felt a bit perilous.  I keep my meals simple, break down the tasks and leave many of the dishes for my spouse to deal with.

I am supposed to save my energy for doing my PT exercises several times a day, so going out for recreational walks is not recommended.  My walking is just around the house, standing at short intervals for meal prep, folding laundry, wiping down a counter and the occasional foray into the world.  Today we will go to Sports Basement to buy protein bars!  WooHoo.

I do about 4 different rounds of my PT exercises and stretching and then get my ice machines strapped on - that lasts about half an hour.  So I figure about 2 hours a days just on icing.

 I can only sit for 10-15 minute intervals to write notes, read the paper or use the computer, then I haul myself up and move about for a while, then sit down again.  These short blog posts take an hour or so to write.

I expect that my stamina will continue to increase and I will be able to spend more time sitting, standing and be be to add in exercise time on my bike which has been set up on a "trainer" in the living room just waiting for me to be able to climb on and put it to use.   Maybe tomorrow will be the day...

FINALLY A CANE

I have been wanting to move on from the walker since week 2 - just a matter of graduating from the clunky equipment to something more subtle.  Not that I didn't NEED the support and ease of the walker, but once I started taking multiple steps without any aid, it seemed like more than I really needed.

Then we went to the store and I was so glad I had the support of the walker.  I am accustomed to moving swifty and surely around the store. Not the case when shopping with my spouse.  I am following my list and simply needed him to follow me and put the items in the cart - but he kept wandering off  and playing with stuff he found on the shelves.  Sigh. Can't wait until I can drive again.

The only other thing I find I miss abut the walker is the bags we had attached for my stuff.  I could easily transport my phone, Kindle, cup, notebook, etc. Now it takes more thought and balancing than I am sometimes up for.  Might have to start wearing a little back pack around the house!

THE DREADED FIRST 2 WEEKS

If you do any research about total knee replacement the time frame emphasised over and over is he first two weeks.  It is built up as a frightening period of time which, once survived, might need to be forgotten like a difficult birth.

For me, it went by in a bit of a haze - probably due to the opioids but also because I had truly loving and excellent caretakers surrounding me.  What I can say is that each day there is a tiny but noticeable improvement. Each day while people are fetching and carrying and hauling me in and out of bed and up out of an ill chosen seat, I can tell I can do a bit more for myself.

The pain meds kept the throb to an ache, the brain kicked in enough to learn to lever the legs up onto the bed using a strap and when the home health tech arrived to do some PT, I was excited to have something definative to do during the day to aid the recovery.

My son's fiance is a nurse and she not only had the kindest touch but a grasp on what was needed to get things organized and tracked properly.  She created a notebook with each day scripted out for meds, other supplements, PT, icing, water intake, etc.  this helped keep track of when meds were taken and what needed to be done each day. I was also on a good schedule for my nutritional needs - and though my appetite was not that good and I felt some nausea most nights, I think I did ok with my bariatric surgery requirements.

At the end of the two weeks, I was so much more self sufficient, I could shower and dress myself, get around the house, and with thought and time, even make myself a cup of tea and get it to my seat. Hey -I am using  walker and there is a step and a water cooler in another room involved in this process!

ONE WEEK WITH NEW KNEES

This was drafted 2 weeks ago today ....


At this moment a week ago, I was maneuvering myself into a car to be taken home after getting both knees replaced.  My surgery began at about 1:30 pm on Wednesday , January 10, and was completed with nerve blocking catheters in each knee by 4 pm. I was wheeled into a large private room, given the once over, some food and a couple of aids hauled me to my feet.  I got dizzy and threw up the food and was put back to bed!

Day 2

In typical hospital fashion - not much time went by during the night without a check-in or new medication interrupting the possibility of sleep. My darling future daughter in law stayed with me in the room and kept me company through the night, including assisting the duty nurse help me with a personal issue which I will not chronicle.

The morning brought another try from the PT department.  I shuffled a few steps and got dizzy again - upon hearing I had not eaten in over 36 hours they determined that was needed and scheduled to come back after lunch.  If they brought me breakfast, I don't recall, but a few bites of a chicken sandwich and some tea and I managed to get up, walk with the walker and go up and down a step and was set for discharge.

By mid-afternoon I was tucked into my bed - family standing by to help with my every need - let the healing begin.

NINETEEN DAYS IN - REGAINING MY BRAIN

It looks like this account is going to be one which moves back and forth in time.  Meds, discomfort and lagging energy keep me from  being able to manage a keyboard  or concentrate long enough to complete a post, so I have a few lines down covering the past 19 days.

Today I had my first physical therapy gym class - a sort of circuit class with others in various stages of recovery from knee replacements.  I am the only bi-lateral total knee replacement in the group - going for 2 is a rarity according to the PT staff I have met. My flexibility is very good, got my knee flat back which is a goal and still working hard on the rest of the of the bendy stuff.

Ice machines strapped on - feels so good!

What people mean when they talk about the pain of knee replacement is the achy/stiff feeling of the knee and surrounding tissues..  There is occasionally sharper pain, but the constant ache and stiffness is what causes sleeplessness and for me at least, around the clock restlessness - the need to stretch, bend and move to relieve the ache. I have been reducing the use pain meds - Percoset - down to just a few a day. And use my ice machines 4-6 times a day.

But I managed to comlete this whole post - so fewer pain meds are ging me my brain back!

HOME PREPPED

I think I finally checked off the last items on my per-op prep list.  The runners are off the floor to make way for the walker which was delivered this week.  I also installed a couple of raised toilet seats - with handles - very fancy.  Tom said he was going to trick out the walker with decals and a bell, but that hasn't happened yet.

I hope to be rid of it a week or so after surgery anyway.

The house is clean - the laundry done.  Lots of comfy clothes up front in the closet for the long recuperation.

The freezer can't hold a single additional item, the pantry is stocked and a list of about 20 meals is written out with ingredients in house. There is even chocolate chip cookie dough for Tom.

 I am very fortunate that my son and his fiancee are coming for the first 10 days to take care of me - she is a nurse about to embark on a doctoral program, so I was lucky to catch her during this particular week.  She has already been giving me advice and lots of lovely gifts of comfy and practical post-op goodies.  As the doctor said to me during my pre-op exam - my son chose well...Not that he's not a fabulous caretaker, himself. 
My youngest daughter is going to take over after the kids return to Reno around the 19th.  She will be with me for about a week - then my husband is up to bat.  Hoping I will be pretty self sufficient by then...He is accustomed to being taken care of by me - this is the first time the tables will be turned.

I find I really, really miss my Advil - didn't realize how much my knees and feet hurt without  anti-inflammatory meds.  It has been hard to sleep with the pain and mounting anxiety. Having my prep done will help my monkey brain settle, I hope!

I have two more days at work and should hear from the surgery scheduler tomorrow about my time on Wednesday. So this is happening.

HAPPY NEW KNEES 2018!

I have been away from blogging for a long time - a combination of tired of hearing my own voice and just plain tired after full time work with commute.

However, I am embarking on a huge challenge in a few days and thought it might be a good time to

December bike outing to Monterey with Tom & Maggie. Can't
really see the bow legs that well in this photo...
I have learned to turn from the camera!

get back on the internet to share my story.  I am going to have both of my knees replaced - yes, at the same time.  Many think this is fool hardy, but I feel up to the challenge.  I have not been able to find much out there about undergoing this surgery and recovery - so I am taking the opportunity to get back into writing with my story.

As my long time "internet friends" know - I had bariatric surgery 5 years ago - I lost 130 pounds and have changed my life in many ways large and small.  I have maintained the weight loss - gotten very into cycling and my doc said I am someone he would allow to do bi-lateral total knee replacement for.  Others in my required "joint class" were jealous, but I explained the circumstances and my hard work to get into shape for this and they were understanding of his decision.

I was also called "young" by an x-ray tech - which blew me away - at 64 I guess I am on the young side for this surgery, but my knees have been bone on bone for about 10 years - I have the bow legs to show for it!!  I hope that I will re-gain the height I have lost when my legs are straight again! See how I am standing on a rock in the photo?

So watch this space - unless I am completely out of my mind with pain and regret I will start posting sometime after  my January 10 surgery date...