New Knee Status: Three Month Checkup

Two momentous things on the calendar today: I started back to work and I had my three month check with the surgeon.

Funnest part of the doctor visit was getting X-Rays. I am just geeky enough to enjoy getting to see the new hardware in my knee. I had actually thought that I still had the lower screw in (leftover from my ACL repair back in the day). As it turns out it was my upper screw that the doctor left in. I posted the after picture on my blog page and if you look at the line of the inner leg in the before and after picture you can see how bow legged I was in the before shot. The doctor was quite happy with everything he saw in the X-Ray. He reiterated his admonishment that this process was a 9 month process and I was not there yet. I still have numbness on the outside side of the knee and I still have stiffness and pain after sitting for any length of time. These are gradually getting better and it is rare that I have to take pain meds to manage discomfort.
Even though it was a very short work day because of doctor and physical therapy visits I was glad to get in and get into my computer and reset my long forgotten passwords! I brought the laptop home with me so I could attempt to catch up with work email.

New Knee: Week 7 - WWDC

Here I am down in San Francisco attending Apple's World Wide Developer Conference!

I signed up for the ticket lottery whIle recovering from surgery anesthetic and lucked out by getting in. At first I was afraid I would not be able to attend so soon after surgery and I even contacted the Apple Developers support team about the possibility of bowing out. They would have let me but luckily when I talked to my doctor he gave me the go ahead to fly down and attend. For me it is only a couple hours flight so not a huge issue. 

I talked to MrBikePT and he gave me a few pointers. I had already booked a slightly more expensive hotel because it was really close to the Conference center. He suggested I take an ace bandage to use for a little compression therapy at the end of day. Also told me to find the ice machine and if available I might want to use a whirlpool. 

As it turned out the week has not been too hard on the knee. The worst was day one when we spent hours in lines! By two thirds through that day I was ready to pack it in and found a seat where I could download the software I wanted and then headed back to the hotel. I had brought along a gallon ziplock bag which I filled up with ice for a bit of a lie down with feet up and ice on. 

Between Conference and a bit of sight-seeing I didn't take time out to workout in the gym.... Bad Linda! I did manage to get my leg up with ice on it every day (I needed it!) and I booked a massage where I had the masseuse  work on my legs mostly. I did have to skip out on several sessions as I was not able to sit for full days.

New Knee: First Hike!

One of my hopes for the new knee is that I will be able to get back into hiking again. This weekend was a gorgeous northwest weekend so seemed to be the ideal time to drive out of the city and do a little hike. And yes I do mean little! I used the Washington Trails Association Hike search (http://www.wta.org) to look for hikes UNDER 3 miles in the central cascades. I came up with Lake Elizabeth on the way to Stevens Pass.

Becky, Beethoven and I headed off after a fortifying breakfast to find what turned out to be the elusive Lake Elizabeth and circumnavigate it on foot! The circumnavigation was 0.7 miles and involved a small amount of stepping up roots and over streams on rocks. I had my hiking poles which helped on the sketchier bits.
I wore my sturdy running shoes although I had my hiking boots in the car in case I though I would need them. The trail was just muddy enough to do a number on Becky's cute shoes....

New Knee: Heat - part 2

More on the 'Heat in the New Knee' phenomenon. 
Seems that there are a couple aspects - First and the one that lead me here is the fact that my new rebuilt knee feels warmer than my other one. 
The second I discovered during my poking about on the internet today and that is that the New Knee may in fact run hotter later on! Cool eh?!

So off we go....
Google search: joint replacement heat in joint

At the Twin cities hospital: 

"How long will my knee feel hot?"

"Expect to feel warmth for six to 12 months after surgery. The heat is the body’s indicator that healing is occurring."

The University of Texas has almost the same statement on their site.
But this doesn't really speak to the mechanics what does it really mean that "healing is occurring"?

For more on that question we hit the internet again....

Google search: heat generation in joint healing

After poking around a bit in sites about using heat to help joint healing I came upon the Britannica site:

  inflammation | pathology | Encyclopedia Britannica

"Inflammation a response triggered by damage to living tissue". The inflammatory response is a defense mechanism that evolved in higher organisms to protect them from infection and injury. Its purpose is to localize and eliminate the injurious agent and to remove damaged tissue components so that the body can begin to heal. The response consists of changes in blood flow, an increase in permeability of blood vessels, and the migration of fluid, proteins, and white blood cells (leukocytes) from the circulation to the site of tissue damage. An inflammatory response that lasts only a few days is called acute inflammation, while a response of longer duration is referred to as chronic inflammation."

 I recommend going over there and poking around for yourself. Quite fun!

New Knee: Heat

All during my rehab I have noticed that my new knee is hotter (literally) than my old knee. Sort of cool but weird. Why is this? My imagination says it has a lot of blood flow and super antibodies hard at work healing and putting off heat.

The side affect of this though is that when I overdue things my whole body starts feeling a little feverish. Last night it was noticible enough for me to find my thermometer and check my temperature. It was normal which for me is a tiny bit high. 

Next step? Google this. What is really going on?

New Knee Day 20

Yesterday was the first outpatient PT day I had a nice hour session getting the leg stretched, bent, massaged, ultrasounded and electrostimulated! After the session my knee was loose enough for me to walk normally down the 2 flights of steps out of the PT office! (Of course shortly after that it tightened up again.)

For anyone who has not spent quality time with a physical therapist I'll try to give some details....

Typically your session starts with some procedure designed to break up scar tissue and adhesions like massage as well as something to help blood flow like ultrasound. 

You may spend some time on one of the exercise machines. And at some point you can expect some stretching and bending of the leg. This tends to be the most teeth grinding part of the visit. Your job is to try to get your muscles to release and not work against your PT. You should also give helpful feedback so the PT knows when you are at your current maximum stretch or bend. This is where being a wuss only hurts yourself! Erik will typically gradually bend my leg and ask if that is a stretch. Once I start to feel it I will tell him and he will hold that position for a bit. Generally he will get a bit more stretch in between asking and my response. Erik and I have worked together for a while now and so he is used to my feedback. Be sure that you let whoever you are working with know what you are feeling and where you are feeling it. It helps to understand what they are trying to accomplish also so feel free to ask questions. Asking things like: "Is it supposed to feel like there is a hot poker in the side of my knee?" can often be enlightening.
Again when stretching and bending hurts you need to work within your pain tolerances. If you have a low pain tolerance you will likely want to take some pain meds before physical therapy. Your goal is to work the leg enough to get it moving correctly.

Today is my follow up appointment with my surgeon. 

New Knee Day 12: Progress Report

Sitting here on my recumbent bike doing a 30 minute pedal fest and trying to come up with a status report. This is Day 12 after operation and I am feeling like I am making progress.

First of all I still cannot do a full rotation on the bike pedals but I am very close!

Getting on the bike is much easier. I can lift my leg up without a lot of pain. The same thing goes for getting in and out of bed and up and down from sitting position. I have less pain and more flexibility which makes getting around much easier. 

I am down to one crutch (with PT approval) and when walking on the flat I can walk almost normally crutch free. Still have a bit of a limp though so need to work on that. 

My wound still has steri strips on but they are looking pretty ragged. A few more showers will likely see them come off. 

My leg never bruised up badly and except for the wound and a small amount of swelling it looks pretty normal. 

Speaking of showers I am able to put my good leg up on the toilet seat and dry off while standing with full weight on my robo leg. Just need to be careful to balance well with no twisting. 

Similarly I am able to get my socks and shorts on without too much problem. Again balance on new leg is good. I tend to be careful to hold on to something still but the weight bearing is no problem. 

As to pain level I am down to about 3-4 OxyCodin a day. Night is still a problem which is generally where the 4th oxy comes in. I am making progress. I can finally  sleep on my side without a lot of pain in the knee.  The biggest issue at night and early morning has been my quad muscle wanting to tighten up almost like a spasm or cramp. I feel it when that happens!

As to general well being I am feeling pretty good. My energy levels are definitely lower still. It takes a lot more to bounce back after any energy drain and I do need more rest time during the day. I am sleeping longer hours although the sleep is pretty broken so it is hard to quantify actual sleep time. After getting up early for the Anzac sunrise service Saturday I spent the rest of the day in bed! 

I am a little frustrated as there is so much I see that I need or want to do around the house but most takes a little more mobility than I have at the moment. I am trying to remember that my focus now should be working on my rehabilitation. 

New Knee Day 4: Home PT

So far I have had a pretty normal day. Brunch at Portage Bay Cafe on Roosevelt followed by a visit from the home health Physical Therapist.
The PT and I went through all the drugs I was taking which involved her quizzing me on what each drug was for and why I was taking them, etc. We then went around the house so she could make sure I was comfortable doing what I needed to do. She encouraged me to have someone stand by more often for a while. Like when I take a shower or use the stairs. She also figuratively slapped my hand for occasionally taking a full step going upstairs instead of the same leg up. She encouraged me to do my exercises 3 times a day. Or if that was too boring pick a couple one hour and a couple more the next then cycle through them all. Next person will spend more time on actual exercise and not paperwork. For the next two weeks we have home PT scheduled 3 times a week.

New Knee Workout

Feeling awesome!! Physical Therapist came in and got me up. I walked 50feet with walker! A little sore but way easier than I imagined. Of course I still have a nerve block in that knee so will have to wait until tomorrow for a more accurate taste of the pain levels. He also measured my range of motion: 8 to 94 degrees which is awesome! Of course with pain meds I am betting tomorrow's measurement will be less.

The PT asked a lot of questions about numbers of stairs in my house and where I had handrails. They will train me on both walker and crutches so I am glad I brought my crutches with me. Of course Mr. BikePT Erik already got me going there so I am hoping for a smooth day tomorrow. He warned me to be careful with my pup dog. Lots of people trip and fall or there dog jumps up and hurts them.