Saturday, April 9, 2011

KNEE REPLACEMENT DIARY: THE PHYSICAL THERAPIST SETS US STRAIGHT!

This is a steep learning curve for us, and yesterday made a couple of things crystal clear:

Rehab and convalescence aren’t the same thing.  Rehab is ACTIVE, pain-producing and time-consuming!  And, in the near future, all of Odel’s time will be spent on rehab and pain management; all of Laurie’s time will be spent on everything else.

Friday, Odel’s second day at home, started poorly.  His knee was stiff, far more swollen than it had been previously, and very painful when he moved from the bed to the sofa.  He was discouraged and a little worried, and still waiting for the Senior Cocktail (and several other recommended remedies) to have the desired effect.

Lift under thigh and knee, push leg back to stop pointThen Sandy arrived and turned our world around!  Sandy is Odel’s at-home physical therapist, full of information, straightforward, and empathetic.  We three clicked right away, and Sandy spent half an hour putting Odel’s concerns to rest, admiring his knee (in her opinion, it looked GREAT), adjusting his expectations, and setting us on the right course. 

Lesson One:  No walking unless absolutely necessary.  Although the hospital Physical Therapist has you up and walking (a few steps) within 24 hours, that is only to make sure you CAN, and that you are mobile enough to go home.  After you get home, walking is not a good thing.  Walking makes your knee swell, and swelling gets in the way of the rehab exercises that are so important.  All the little ways Odel was hoping he could help out as he healed?  Forget it!  Everything he does standing on his feet, at least in this early stage, SLOWS rehab and healing.

Lesson Two: Elevating your leg doesn’t mean putting it on a footstool while you sit in a chair, or putting it on the sofa while you semi-recline.  It means getting your knee above your heart.  For Odel, that translates to laying flat on his back on the bed with a huge pyramid of pillows (every one we own, plus towels and quilts) elevating his leg at a steep angle.  Elevation is half the battle in bringing down swelling (allows the fluids to drain out of the leg); the other half is icing.

Lesson Three: Icing your knee doesn’t mean cooling it down; it means shocking the swollen joint with major COLD, and a lot of it.  Make that knee yelp “Yikes”!  To this end, Sandy gave me a recipe to create icing packs with rubbing alcohol, water, and gallon zip-lock baggies (1 part 70% alcohol to 4 parts water; mix in a gallon baggie, press out the air, zip, double bag, freeze).  That stuff gets COLD!

Lesson Four: The Number One Priority of the first 4 weeks of rehab is to get the knee totally straight.  The window for complete straightening is 4 weeks – and if you CAN’T straighten your knee completely, you will not be able to walk without a limp.  Work that joint!

Lesson Five:  The great flexion Odel achieved in the hospital was typical while the drain is still in, and the loss of flexion once the drain has been removed and the joint swells is completely normal.  In the hospital, Odel’s flexion was around 2 to 90+ degrees; here at home, when Sandy measured him pre-exercise, it was 5 to 62 degrees.  The next 6 weeks are critical for regaining full range of motion, 0 to 110-120 degrees.  If you don’t do the work now, you’re going to have a disappointing result (read: LIMP).

Every pillow in the houseSandy spent another 45 minutes showing Odel and I how to do the three exercises that he needs to do 3 times a day for the next week (we’ll add more after that).  Two of them require my assistance, and one of them makes me hurt him.  I don’t like that!  After the exercises were done, we built the pillow pyramid, elevated his leg, and iced it with our sub-optimal bags of peas. 

So, Odel’s schedule: Manage pain (take pills every four hours).  Manage blood thinner regimen (pills and injections).  Rehab (painful rehab exercises three times a day; painless circulation exercises at least once an hour when awake; deep breathing once an hour when awake).  Elevate the knee at least 3 times a day for a minimum of 45 minutes.  Ice 10-15 minutes maximum 3 times a day.  Consume all sorts of high fiber food and supplements and get those guts working again*.  

Laurie’s schedule: Everything else.  Most of the work I anticipated – just add Odel’s household chores to mine, along with a few oddball tasks like helping Odel dress.  Three things I didn’t anticipate: I need to actively help with some of Odel’s exercises; I make at LEAST one trip to some store each day to pickup something we need but don’t have; and I spend an inordinate amount of time moving “stuff” (pillows, pills, water, food, computer, blankets) from one place to another.  Keeping a path open, keeping paperwork corralled, and staying on schedule with pills, exercises, and meals is a challenge!

*As of this writing, we have blast-off, so to speak.  That put a smile on Odel’s face!  Thanks to all of you who offered your remedies.

30 comments:

  1. Good luck Laurie and Odel. With your drive and determination I'm sure Odel will get full range of motion back. I haven't had a knee replacement but I did have orthroscopic surgery on my knee and a lot of the advice is the same (except for the walking which they wanted me to do). A work colleague had the same operation a little before me. The major difference was that he did not go for physical therapy. Today he limps badly and can hardly walk any distance. I, on the other hand, don't limp and can walk 3 - 5 km at a time. So do the exercise even if it hurts.

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  2. YIKES! Sounds like Odel has some work ahead of him...and sounds like the PT was a drill Sargent in her past life! I DO remember when Den broke his knee...LOTS of painful sandbag lifting to get the knee flexing again..He would totally soak himself with sweat ...but, by God he has a good knee to this day. Tell Odel , don't give up..It WILL get better, but it is more work than ANYONE will tell ya before hand...Hang in there, you two...walking pain free is not so far off!!!

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  3. Good wishes to both of you. What a ton of work. I had no clue.

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  4. Do you have a lounge chair like a La Fuma? Gary is still sleeping in his and it elevates his legs quite nicely. Probably not enough for Odel's knee to be above his heart, but might require fewer pillows to get to that point.

    Virtual hugs,

    Judie

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  5. Hang in there Laurie! And Odel! ;-) Having been through this sort of thing a few times with Johnny the toughest part is always keeping him focused on doing ONLY the things he's supposed to because he feels so bad about me having to take up the rest of things. I just tell him payback will come down the road when I need him to do for me so he better get fully recovered!

    It's very interesting seeing/hearing all the different approaches to post knee surgery recovery. Johnny's ex had her knee replaced a few weeks ago and the recovery/therapy strategy from her doctors was completely different than Johnny's was.

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  6. Boy, I wish I'd had Sandy to teach me all that! I never did get fully straight so now I have lower back problems from not standing upright. That's why I have my chair cane, I can only stand just so long before I have to sit. Really, really do those exercises!

    Here's one they taught me too late in the game. Once Odel has healed enough to be able to lay on his stomach, have him lie on the bed face down with his leg below the knee hanging off. Gravity will then help pull that leg down. Before rising in the morning is a good time to do this one. I was able to add weights to my ankle to help but, like I said, it was too late in the game for me. Ask Sandy about this before trying it, please, as it may be one of the ones you mentioned she plans to add at an appropriate time.

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  7. Yea for blast off--that has to make him feel better!!! Both my mom and dad had a machine that flexed the knee for them--it worked great when first home from the hospital.

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  8. You've really got a full time job now!

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  9. It is always a question if this is really going to ever be better than it was before. But it will. If it didn't people wouldn't go in for the second knee!

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  10. Odel, hang in there buddy, it gets better from here. I didnt get a replacement, but a completely rebuilt knee, with a few pins & screws, after a serious traffic accident. The rehab exercises are critical. Just keep picturing yourself teeing off and walking your favorite course, while doing all these painfull exercises. pretty soon you'll actually be out there swinging that 9 iron again.

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  11. Hand in there and you will both do well. Our friend Jerry had a total knee replacement and they (he and his wife Lynda) worked hard on the exercises but was super faithful in doing them and he walks now with no problems.

    Glad the innards are moving again!!!

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  12. WHEW, I'm worn out from just reading your post! Sounds like you both have your work cut out for you. Now that you have a plan of action, can't wait to hear about the progress.

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  13. How about some really hilarious movies - it's a proven fact that laughter is a great healer!

    (Jimmy said Odel's internal adventures had him sitting on the edge of his toilet seat!!!) hmmmm

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  14. sounds like 'nurse Laurie' has her work cut out for her!..hang in there..it will all be worth it in the end!..at least you have a good support system..and lots of pillows!!

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  15. I have followed your travels with interest but never commented. I have had 2 knee replacements and hips as well. I can't emphasize enough to do what the therapist says to get back to full range of motion. It hurts, sometimes agonizingly so, but it will get better. Please don't let up on the exercises. I thought I was gonna lose it many times in therapy, but I am so glad that I persevered. You can too. Go, Odel, go. Laurie, hang tough as the therapist assistant.

    All the best,
    Caryl

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  16. Aren't you happy you are doing this as fulltimers and not have Laurie working outside the house? That would be really, really hard to manage all the activities and exercises you have to do daily. Thank you again for the detailed daily explanations. It really is interesting to read about.

    Bobbie C.

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  17. Keep up the good work, Odel. You can do it!

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  18. Hang in there. It's going to be rough, but it will be great having a working knee again. Judie's suggestion of a LaFuma is a good one.

    Sending positive thoughts your way,

    Fred

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  19. Kelly's Mother will be undergoing full blown knee surgery next week so we have sent your link to Kelly's 2 Sisters & Brother who will be directly involved in their Mother's recovery. Your posts will give them a head's up on what to expect. Kelly will be spending a week helping her Mother as well later in the month. It's a good thing we live in the medical age we do. I used to like watching Sesame Street years ago & on there they had a character by the name of Harvey Kneeslapper. When I thought of Odel this morning, I thought of Harvey Kneeslapper:))

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  20. I'm glad she was able to ease your fears and reset your expectations. I know you both will be having a difficult time for the next few weeks. Hang in there patient and nurse!

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  21. Persevere and be faithful with the exercises and the pay off will be huge. In this case it is no pain no gain. At least if it hurts you know you are still alive. :-)

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  22. Odel and Laurie, You both have important jobs to do during these first few weeks. Take it one step at a time and do your best. You'll be happy you did when good results are evident, as others have advised. Don was encouraged to walk after his knee replacement in June '09, but then he didn't have the swelling problems for some reason. You can do it, just hang in there and soon you'll be looking back and realizing the hard work paid off!

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  23. You are both going to be fine. I had nurse Rick and he lived through the experience too :)
    I cannot stress the straightening part of the rehab enough! It hurts and you just don't want to do it BUT if you don't, you will never walk normally. It is SO worth it.

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  24. Hey there, all this sounds so familiar as I used to work for a knee surgeon who did these surgeries daily. Sounds like you have a good team working together, especially Laurie. Working in the Doctor's office I missed seeing all the rehab process. I just saw the patient on his return visits to the office and could easily tell how hard they worked on the exercise regime or not. Hang in there! We'll be sending positive vibs to full wellness. Marlene and Richard

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  25. Good luck on your recovery Odel, before you know it you will be back on the golf course.

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  26. Sounds like Sandy was a gift from God! I have one question - How do you own so many pillows?!?!?

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  27. Thanks for all your advice and good wishes! Odel is completely determined to rehab his new knee to perfection! Diana, isn't that funny about the pillows? With the exception of our sleeping pillows, every pillow we own is in that photo (four that we keep in the living room on the couch and a chair, and one that I use for reading in the bedroom), along with a quilt and rolled up towels!

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  28. Oh, BTW, Judie, I dragged the La Fuma up from the basement last night to make Odel try it out... he has never liked that chair, and decided he is still more comfortable on the couch or bed. Seemed to ME like a good idea!

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  29. Laurie, thank s for keeping this "diary" of the ordeal. When I bow to the inevitable, it will help me through. Glad to see that Odel is back in a functioning groove.

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  30. Just wanted to offer some words of encouragement to both of you brave adventurers. How can Odel not recover completely, what with your loving assistance and perseverance. It's also wonderful to know you have such a huge support group! Ray and I are rooting for you!

    Hugs - Paulette/Ray

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