Eight month update

Eight months and two days ago I had a life-changing operation.  I was gifted with two new knees.  I use the word "gifted" because, even though the process was not cheap, I now have a new lease on life. 

This past weekend I walked around in a large shopping centre for the first time in years.  The walk in January in the shopping centre was to a specific shop and back.  This time I walked, like a normal person. I walked with knees that bent at the appropriate time in the step.  I walked without agony.  I walked further than I have walked for ages.  And I walked with a smile on my face. 

It is still a miracle and thrill to me every now and then when I realise I can take a normal step - like everyone else.  If you're reading this and have not had knee problems needing replacements, you may not appreciate the miracle.  If you have the knee problems, you'll appreciate that shopping centres can be places of torture with long passages and not many places to sit - and when you do find a place to sit the seat is so low you struggle to get up. And you walk stiff-legged, like an arthritic pug (okay, I did).

Back to the update:

• the scars have faded - still there, but practically the same colour as my flesh;
• if I was exercising regularly I would be more mobile, but I don't.  Big note - this problem is not the knees, the problem is the supporting muscles which I am not exercising regularly.  So stairs and inclines are still a little challenging;
• exercise - when I do exercise, I am still using the heated rehab pool at the gym - following the physiotherapist and biokineticist programmes.  I need to tackle the stationery bike and elliptical trainer some time soon, just have to get out of the comfort zone and do it;
• we have cold, wet winters here - and no associated pain and discomfort;
• mobility is excellent and I can fully bend my knees;
• I struggle to sit down on and get up from low chairs and toilets - once again, this is because of lack of exercise.  If I had exercised more my legs would have been stronger;
• I find I have to re-train my brain as to what I can do.  With hurting knees your life becomes very small.  I'm constantly amazed at how much bigger my world is, how many places I can go to now - how many places I can actually walk to now! Don't get limited by your mind, test your knees - you'll be surprised how quickly your world expands!

Big lesson learned is to try and stay disciplined and do your exercises to strengthen your legs. If I did I would be able to tackle stairs and get up off low chaires better.  My next goal ... a 5km charity walk  in September / October (may need to revise the date).

If you've had the op - enjoy the miracle. If you're not sure about the op -  get the knees and get a life!!

Regards
Charmaine

5.5 MONTHS UPDATE

Wow - five and a bit months ago I was probably just being pushed back to the ward!  What a new lease on life!!!

Quick update. 

• Scars - slightly fading but not that much difference;
• Pins & needles / numbness - still there but not intrusive until I massage my legs and then its noticeable;
• Pain - fine, hardly anything ... unless you drive for six hours with basically a quick leg stretch and a lunch break (like this weekend on my extended weekend up the West Coast).  Even then, nothing that two Stilpayne and a good night's sleep does not ease; 
• Flexibility - really good but would definitely have been much better if I did exercise - any exercise - more regularly than once every few weeks. Went walking on a soft beach and definitely felt uncomfortable afterwards - but as previously mentioned, two tablets and a night's sleep and all's fine, a little stiff, but fine.

Ha ha moment - and lesson learnt a few weeks ago. Did not concentrate when I sat back on the exercise ball ... and it rolled away from me!!! In slow mo, with back support from the ball, I found myself sinking to the ground - my thigh muscles were not ready to support and stop the sink! Next moment I'm on my butt on the floor in my study - no one around and no way I could yank myself up.  Tried to kneel - definitely ouch and not ready. Then a moment of brilliance. Reached for an old garden seat cushion conveniently lying on a footstool, wiggled it under my butt and then wiggled my way out of the study, through the patio door (opening that from a seated position in itself an exercise of endurance), across the patio to the stairs leading down to the garden. Thankfully I could use the stairs to get up!!

Biggest lesson is keep up the exercise, something I have definitely not been doing.  I don't feel like swimming on a cold autumn / winter morning, even if the pool is heated.  Definitely time to hit the stationery bike, eliptical machine and, in a few months, the stairmaster. 

Hopefully I'll stay resolved and be ready to achieve my goal in September / October - 5km walk!!!

Chat soon!!

Milestones, Lessons and Wows!

Yesterday I went to work - and left the crutch in the car! Mega milestone! In February I went from two crutches to one crutch with the aim of no crutch by end February (did not happen), okay then end March (not ready) so then ...

The thing about crutches in one's life (literally or metaphorically) is that one starts to depend on them even though, in essence, they are a hindrance, a nuisance and often uncomfortable. But it keeps you in that comfort zone, gives you the illusion of security - even if you occasionally nearly trip over the darn thing.  The problem with comfort zones is that they create invisible barriers that restrict you.

When I got into the office I announced to all and sundry - Look Ma no crutch (then my boss quipped - Look Ma no teeth!  Nice!). I grinned all day and felt so free I positively strode down the passages (at least in my head).

This got me thinking about other things I can now do since my TKR - sometimes silly things that one takes for granted, e.g.:

• I can stand on one leg to put on underwear and pants - in the past I always had to sit;
• I can walk in a shopping centre - in the past I only went to shops on the periphery;
• I can wander through large shops and markets - small convenience stores were my limit in the past and Expos were a form of torture;
• I can stand for longer than 5 minutes - gets a little uncomfortable, but nothing like it used to!
• I can climb stairs - slowly - but without agonising pain;
• People tell me I look younger and more alive - that's definitely because there is no longer constant, draining, energy-sapping pain and harsh medication;
• I can swim and kick my legs at the same time - the past year or two my legs just floated, lifeless apendages, whilst I swam.  I now grab the noodle and enthusiastically kick my way the full length of the pool - no kid could have half as much fun!
• I can park on the other side of the parking lot!
• I can walk to buildings on the far side of our large office complex;
• I no longer walk like an arthritic ancient pug!
• I can sit and bend my knees comfortably to paint my toes;
• I'm more comfortable pottering in the garden.

Four months after the op and I have freedom!! Freedom to do things I never even realised I was no longer able to do.  How awesome is that!!!

Is the pain gone?  Most of the time - and when I feel it, usually after a day of a little more exertion than usual, I pop two painkillers before I go to sleep and next day it usually is tolerable, often pain-free. Still not yet dancing up and down stairs - in fact, still not yet dancing.  Stairs and chairs still a challenge - but considering where I was four months ago? Wow, Wow, Wow!!!

Four Month Milestone

Can you believe - today four months ago I had the bilateral total knee replacements!

So let's check in:

Scars:  The scars look great - I don't scar well, so I reckon this looks pretty good:


Bilateral TKR Operation : 4/12/12

Four months later : 4/4/13

Numb areas: Its normal to feel areas that are numb / slight pins and needles around the knees.  I think the size of the areas is getting smaller.

Swelling: The swelling is going down because there are days I can clearly hear the knees clicking - totally normal sound of the prosthetic at work.

Movement: I still use one crutch for "stairs n chairs" and for uneven areas - rather be safe than sorry. I was rather down mid-March because I was still using the crutch.  My biokineticist pointed out that it was only 12 weeks after the op and I should stop being impatient.  I aim to be "crutch-free" by end of April - going downstairs is till going to need some work and I still cannot manage the top two steps at the gym's pool - especially getting out! We'll get there - with much laughter - and with starting up the bed exercises again - physio bed exercises! I'm sure my thighs would be much stronger if I had kept up these exercises - I may even have been climbing stairs unaided! I also need to work out more in the pool!

Pain:  I stopped using the opiates at the end of February.  March - I used Stilpayne as needed (usually at night) and have eased down to occasionally using Panadol during the day and Stilpayne only at night if very sore.  Most of the time I find that if I do a few stretches, it eases itself. So pain is now totally manageable.

Comfort: 
Walking: Walking is great, though I do get tired after a while - but my world is so, so much bigger! I've been to places I've not seen for more than two years!  We went to Riebeeck Kasteel and Riebeeck West one weekend recently. I was able, for the first time in years, to park my car and then walk up and down streets in a ±500 m radius, rambling through shops, walking up to a restaurant (enjoyed a delicious pizza at Mama Cucina) and then walking back to my car! I have not been able to do that comfortably for more than two years!

Stairs:I even manage stairs quite well - though using the crutch for support. Going up is a heck of a lot easier than down and I still have to remind myself to alternate legs.

Sitting: I find that I still to prefer sitting with my knees at a greater than 90% angle and often sit on cushions on low couches.  There are times I still prefer sitting in the shower chair which now seems to have a semi-permanent spot in the lounge!

Challenges: Baths.  At home I shower.  At the Riebeek Valley hotel the en suite only had a deep, divine bath.  Sadly I could not enjoy it as I would not have been able to get out.  So, solution - sit on the side of the bath, use the hand-shower and get everything wet!

Sensitive viewers - skip the next bit - it gets graphic: My worst are toilets. My loo at home is a decent height but its amazing how many toilets are really low. I was at a Toastmasters meeting last night and the venue's loos were really low.  What to do? I had to go, but it was too low to sit down (who the heck are they accommodating!!!) and impossible to get up (have I mentioned I'm Rubenesque ... would definitely not have wanted to be part of that rescue mission!!!). So I just had to quasi-squat, use lots of loo paper and hope for the best!  The disabled loos had the requisite handles, etc. but the loos were still really low!

Would I do this again? It was flippin' sore, but YES, YES, YES!  Quality of life has improved dramatically.  People keep on telling me how great I look (one never realises how old and tired pain and constant medication can make one look!) and I'm getting to see more of the world.

Back in due course with further updates!

Hey Ho Silver!!

TKR Physio Exercises - beauty or the beast!

Physio, physio, physio - after your TKR you will seem to spend practically every waking minute (and when you have restless legs, even the sleeping minutes) doing physiotherapy - working your knees and legs constantly. 

Initially you will have a therapist who ladens you with hateful exercises, then - like me - you may progress to a biokineticist and eventually you'll be doing your own thing.

I have a love-hate relationship with physiotherapists - I appreciate that the work they are doing will help but holy maloney does it hurt!!! And why must some of them be so dour! Smile - laugh - it eases the stress and discomfort ... truly - as a patient I can attest to that!

In the hospital, physio consisted of bending the knees, flapping the feet, trying to get myself out of bed and walking.  Step-down clinic physio ran me through the bendy knee, flappy feet, etc. routine in bed then I walked and climbed stairs and learned to get up from chairs and toilets and out of cars.

Home physio visits were not that much different from the hospital visits initially but we started doing standing exercises as well.

Simple exercises you can start doing prior to going into the surgery to build muscle memory (very important).  You will also do these post surgery (always check with your doctor and/or physio before doing these exercises - and remember to engage your core muscles all the time - tuck in your belly button as far as you can):

• Lie flat on your back on the bed - flap your feet (good for circulation);
• Lie flat on your back on the bed - alternate bending your knees to your chest;
• Lie flat on your back on the bed - put a ball / rolled towel under your knee and straighten your leg in the air;
• Lie flat on your back on the bed - tuck your feet up behind your buttocks and then force yourself up into the air (bridge);
• Lie flat on your back on the bed - alternately raise your straight leg;
• Lie flat on your back on the bed - alternately raise your straight leg then sway leg side to side in the air;
• Lie flat on your back on the bed - put a rolled towel under your ankle and push your knee back down into the bed;
• Lie flat on your stomach on the bed - tuck your toes in and push your knees back as straight as possible (great calf stretch);
• Lie flat on your stomach on the bed - bend your legs one by one.  This quickly became and still is one of my favourite exercises.  Post-op it may initially feel very wobbly and quite difficult to control, but this exercise seems to stretch the muscles over your knees.  After a day in the office sitting down most of the time, a few of these in the evening can feel quite blissful!

There are also standing exercises which you'll start doing week three'ish.

Absolutely the best was six weeks later when I could get into the pool.  I go to the rehab pool at Virgin Active gym, Tygervalley. The water is warm and it is bliss!!! Unfortunately now I have to go at 6.00 in the morning as the pool is full of kids till 8.00 / 8.30 pm at night doing swimming lessons! (I must be very old-fashioned - I reckon kids should be at home by 6.00 pm finalising schoolwork and getting ready for dinner and bed, especially the littlies I see at the pool in the evening.)

I love the pool - you will walk forward, back, sideways - nearly have a heart-attack when a week later the physio suggests you run, do lunges and star jumps ... it was years and years and years ago I did that.  There will be stationery and ambient exercises - just remember to engage the core muscles - and smile and laugh with everyone! 

You may also start cycling and using the eliptical trainer - eish! The "hate" part of my physio relationship!!

Important tips:  Try and do as much of the exercises as you can beforehand to strengthen your body and build muscle memory; Its really sore but keep on doing the exercises two or three times daily post op; Your legs may get sore especially in the beginning - but realise that you have hardly used many muscles in the past; engage your core muscles - will prevent back ache!!

Breath and smile, this too shall pass!!!

Home Sweet Home

I could not wait to get home but had some reservations:

(a)  the dreaded stairs;
(b)  I did not have a snatchy thingy to help me pick things up; and
(c)  I had not made a sling thingy to help me lift my legs from the bed to the ground.

The last two were recommended by the book - and I found I did not need them at all.

Stairs were fine - I took them slowly at my own pace and my housemate sorted out luggage. The stairs from the driveway to the house were fine as there was a railing.  The stairs from first to second level were deep and no rails.  I managed.

Two non-negotiable items if you can get them (luckily for me friends could assist with both):

1) Lifted toilet chair - I moved mine over the loo; and
2) Shower chair / stool - mine looks like a comfy garden chair - absolute, absolute bliss!

My greatest challenge was - and still is - to rise from a 90 degrees or lower angle. I was fortunate that my bed was high off the ground and both the loo and shower chairs were higher than 90 degrees.

The sofa was too low - solution: I added four thin garden chair cushions - and still sit on them.  To raise myself I pile cushions on the side to push off with my hands.  Our couch looks ridiculous. On H's side are a 2 to 3 cushions for back support.  On my side?  Chaos. 4 garden chair cushions, plus a host of cushions at the back for support and a whole lot on the side ... cushion carnival!

We have an old bar stool which is light and, even now, gets carried around to where needed. In the beginning it stayed in the kitchen, but I even carried it outside when hanging up washing.  Hildegard cooked the first week or so and then I took over (I usually cook and she does the dishes).

In the beginning I spent a fair amount of time in bed, sleeping or doing my exercises. I had two extra pillows to prop my legs as needed - eventually got rid of them towards the end of January.

Diego keeping me company (note extra two pillows in the background)

On the discomfort level I experienced the following:  Pain, especially like severe growing pains; restless legs (they seemed to have a life of their own - best to just take sleeping pills and let the mind rest while the legs go all jumpy); cramps and at times a concentrated stitch pain or two - so severe it hurt to move my leg for a day or two. I also found that I was constantly, often involuntarily really stretching my legs. Physio did not seem concerned so I just accepted that it was part of the healing process.  If possible, take pain medication about 30 minutes before a physio session - helps cope with the pain. I found I had to take extra paracetamol some time after the sessions just to cope.

This is not the time to get neurotic about using drugs.  Forget about being brave.  Its going to be really sore - use drugs and get really friendly with ice-packs.  We tried to make our own ice-packs using water and surgical alcohol - varying results, but always helpful (see link for instructions)!

The magic word is exercise - exercise, exercise, exercise.  It helped that I had a few visits from the physio ... next blog - we get moving, moving!

Step-down clinic and stairs at home

I must admit that my gardening session yesterday only extended to cutting lavendar flowers - which I plan to use to fill up my lavendar wreath.

Back to the TKR:

I was doing rather well - and the wounds were looking really good - see pic below. This photo was taken on 11 December, one week after the op, the first time the dressing was changed (is it not beautiful!!):

In fact I was doing so well that my physician and physio suggested I go to a step-down facility.  If you don't know, a step-down facility still looks like a hospital facility but the care is less intensive and you are encouraged to do more for yourself.  The centre I went to also caters for rehabilitation patients, especially Alheimers, cardiac and stroke patients and patients who have lost limbs. My knee guy on the other hand did not think it was the right place for me but he was eventually convinced. 

He was right though - as I said to him at our first consultation, if I had his mobile number I would have phoned him during the night to come rescue me!!!!

I hated most of the step-down experience but on the other hand, it motivated me to work really hard to get out of there as soon as possible.

I felt really emotional when I left the hospital - Ward E's staff at Panorama Hospital are absolutely amazing!!! I was thrilled to discover that Discovery Medical Aid had a discretionary Care Programme for rehab patients, which covers reasonable costs of the rehab process.  This is a major, major, major benefit.  They covered the step-down facility and out-of-hospital physio sessions - awesome!!!

Panorama Hospital arranged to take me through to the step-down facility. I won't mention their name - don't want to give them more publicity than needed, but if you want information, contact me!

Sadly, I hated most of my time at the step-down facility.  They do awesome work but I did have the following problems:

• I was placed in a room with three elderly ladies, two of whom had dementia. I hardly had any sleep the first night as one of the patients was a stroke patient who had come in during the afternoon.  They insisted she use an adult nappy as they had not assessed her yet.  They would not take her to the loo or give her a bedpan.  We are taught from small not to wet our pants - and then, at her age, she was being told to just lie there and void herself, in her pants. Furthermore, they told her to ring the bell when necessary - but she was unable to do so because of the stroke - she could not reach the bell or push the button.  This poor woman was extremely stressed because she had an uncomfortably full bladder, could not get any relief and could not ring the bell.  Her solution: she kept thumping her arm against the bed trying to attract attention so that someone else in the room would ring the bell - which was me, because I was lying semi-awake in pain and the sleeping pill had no effect. The first night was awful - I was really sore and I was constantly being woken by a very frustrated patient.  Thank heavens on Thursday morning they moved me to a room at the other end of the centre where my fellow-patient was about my age and also had knee problems - why could they not have done this from the start?!!!!!

• The food was horrible - same caterers as Panorama Hospital so therefore cannot understand why it was so bad.  My first dinner (served at about 5.30 pm) was hard carrots, musty rice and something that was supposed to be curried mince - I think ;

My first meal at the Stepdown Clinic

• They refused to give me the medication prescribed by my doctor as it could be habit-forming and gave me something else which was not as effective. Furthermore it took ages for my medication to arrive which meant that I had a longer stretch between medication (there's a pharmacy downstairs but they order from a pharmacy two blocks away!)  Thank heavens I found some Stilpayne in my bag and self-medicated throughout the night just trying to cope with the pain.  Big note here - especially in the beginning, take your medicine as prescribed - wait too long and it takes ages to get the pain back under control;

• My knee guy had insisted that the dressings are not to be removed till our first appointment - but the step-down clinic's doctor insisted on removing the dressings and replaced them with an inferior quality product which meant that the dressings constantly peeled off.

The biggest concern about me going home was that we live in a multi-level home linked with stairs, stairs and more stairs.  I was warned that it would be really difficult to handle stairs after the surgery.  This was a problem as that meant I would not be able to get from our driveway into the house and from the lounge / kitchen level to the bedroom / bathroom level.

BIG NEWS! They're wrong!!! With a little persistance and much repetitive exercise, I mastered the flight of stairs in one morning - I had to, I wanted to get out of there asap. They reckoned I'd be there a week - I reckoned much, much less.

Timeline: 

• Admitted Wednesday afternoon - lousy dinner so ate a slab of chocolate left by a visitor; Awful night - but best thing was that the only "disabled" toilet (i.e. one with the necessary handles to drag yourself up off the loo) was quite some way down the passage - I got a fair amount of exercise Wednesday evening;
• Thursday morning - saw the doctor, who promptly removed my dressing despite the specialist's request not to; horrible breakfast, ate nothing; I was moved to a new room; taught how to climb stairs (NOTE TO SELF: there is no right way, only a suggested way - adapt whatever method works best for yourself); taught how to shower and how to use a toilet that does not have the necessary "handicap" handles; walked more, climbed stairs; physio session - informed all I was leaving the next day - they laughed saying I would likely be there for another week as I had to first pass the checklist; Worked even harder;
• Friday morning had the best meal ever at the facility (suggested by my roommate - muesli & yoghurt)!!!  Told all I was ready to do the check-out evaluation ... did it twice to convince them and left at midday!!! YAY!!!!!

It was time to go home!