One Year After Surgery

This will be my final entry for this blog.

I am happy to say that I have survived my total knee replacement of the right knee with amazing success. As of December 8, 2011, I celebrated my one year anniversary with my new knee. I visited Dr. David Denzin who performed the knee replacement one year ago for the one year evaluation. An x-ray was taken, and everything looked good. My knee flexion after one year is 125 degrees, which is in the normal range. By comparison my left knee can flex to 135 degrees. Dr. Denzin noted that while most knee replacement patients improve up to one year after surgery, some continue to improve up to 3 years post surgery. So, I might get a few more degrees as well.

At the one year evaluation, I asked Dr. Denzin about carrying weight with the knee replacement, such as lifting and moving a couch across the living room or carrying something heavy in the 100 pound range. He did not seem overly concerned, and only commented that I should use commen sense when lifting anything, but not to limit myself because of the knee prosthesis alone. The only restriction he stated was to avoid running as a sport, but that running was okay if I needed to move quickly across a busy street.

One other item to note was bowling with my knee prosthesis. I bowled for the first time since the surgery on December 21. My bowling form was off, and it fell awkward rolling the bowling ball. As I am a right-handed bowler, I had to balance and bend my right knee while releasing the 16 pound bowling ball with my right hand. My knee was not comfortable with the motion, as the bowling position required the full weight of my body on the right leg with a bowling ball in motion with the right knee flexed at about 40 degrees. It was not painful, but the knee felt stiff and uncomfortable. I suspect with exercise focused on that particular movement, I could regain comfort when bowling. Since I bowl infrequently, I will not give bowling further concern other than to note it here in the blog for readers who may be avid bowlers.

11 Months After Surgery

This will perhaps be my shortest status update. With shorter days and colder temperatures here in Michigan, I have stopped road biking and switched back to swimming. In addition to morning workouts on the elliptical machine, I am now swimming two times a week for 45 minutes at the local Bally's Health Club. My leg feels very strong swimming.

Other than continued good news, I have nothing else new to report at a little over 11 months post surgery for my right knee replacment. Everything is fine, and I am looking forward to the one-year follow-up visit with Dr. David Denzin who peformed the surgery. I will be seeing Dr. Denzin sometime in December for an x-ray and evaluation. I am expecting to hear very good news on my progress.

Thought I would throw in a picture taken this past weekend in Grand Rapids, Michigan. This is my wife Margaret and I. We attended a wedding celebration for my youngest sister Tonya who lives in Grand Rapids.

10 Months After Surgery

Another month has passed, and I am happy to report only good news once again. My new knee continues to feel fine. I traveled via plane to Philadelphia for the EDUCAUSE conference last week. Everything went well. Security check-in at both Detroit and Philadelphia went smoothly. Both airports had the full body scanner which made the "security check" fast and easy.

I also traveled in Canada from Windsor, Ontario to Niagara Falls, Ontario  with my wife Margaret, her sister Gudrun, and her husband Jim via train. We had a great time and walked several miles each day seeing the sights of  Niagara Falls. Probably the most walking I have done since surgery over a short period of time. I would estimate that we walked 12 miles over the 3 days in Canada, and my leg felt fine the whole time. There was no swelling or stiffness.

Only one disconcerting thing happend when I was traveling. While in Philadelphia at the Sheraton hotel, I was in the fitness room working out one morning, and I accidentally stepped off a three foot step into the weight room and landed with my full weight on the surgical leg. With the full force of my weight coming down on the right knee there was a sensation of discomfort, but no subsequent swelling or pain. Doing this, quickly reminded my why Dr. Denzin recommended against running with a knee prosthesis as the continuous impact (like this) will prematurely wear out the prosthesis.

Only two more status reports (11th and 12th months) before completing this one year blog on a total knee replacement. The December report (the one year anniversary) will be the last blog entry.

Nine Months after Surgery

Very little to report at the ninth month as things continue to go very well. My knee feels great. Perhaps the only thing to report is that I have noticed gradual improvement of the stiff feeling in the outside of my surgical right knee when doing stretches. Until recently, I have noticed stiffnes in my knee when doing "potatoe picker" exercises or any stretching exercise where I stand with my legs spread far apart. In one stretching exercise, I stand with my legs spread wide apart and bend at the waist to touch my right foot with my left hand, and then swith to the other foot with the right hand. The stiff feeling in the outer side of the right knee is nearly gone. I suspect that healing continues as the bone of the knee area continues to adapt to the embedded prosthesis.

One other small item to report is the discomfort I feel when kneeling down on my surgical knee to wash floors or do yard work. I have noticed that my surgical knee does not feel comfortable in a kneeling position against a hard surface such as a wooden or cement floor. If I am kneeling on a soft surface such as a couch, bed, or cushioned chair, there is no discomfort. Wearing kneed pads as some carpenters or roofers do is the solution to kneeling on hard surfaces.

I will report progress on my total knee replacement for three more months, thus completing this one year blog on knee replacment surgery. At the 12 month report, I will be visiting Dr. David Denzin for the one year follow-up which includes an X-Ray of the knee.

Eight Months after Surgery

Just returned to work after a two week vacation. I spent time in Grand Haven, Ludington, and East Tawas Michigan enjoying the Great Lakes--Michigan's fresh water Mecca. I was on my own the first week and traveled to Grand Haven and Ludington with my Mustang and my bike. I rode my bike 20 or more miles each day along the lakeshore, worked out at a local fitness center, and played golf, walking without a cart. My prosthetic knee survived very well without a single problem. In Ludington, I discovered the Health and Racquet club owned by Bob James. The club is a bit dated, but has all the equipment you need for a good workout--out in the woods too on the outskirts of downtown Ludington.

For the second week, Margaret and my sons Chad and Eric joined me at the family cabin on Tawas Lake in East Tawas. We had a great time biking, golfing, fishing, and visiting the beach. Again, my knee survived everything very well. The picture below shows a view of the sunset from the back of the cabin that the family fondly refers to as the "Red Cabin.".

Seven Months after Surgery

Two events to report at the seven month status update. One is my first trip in an airplane since the knee replacement. And the second item is my first competitive 40 mile bike ride with my new knee. For both events, I am happy to report good news....

In late June I traveled by plane from Detroit Metro to the Chicago O'Hare aiport for a three day conference. I was anxious about the trip as I expected a long delay at security including a pat down. I arrived 2.5 hours before the flight departure. I was pleased to learn, however, that both Detroit Metro and Chicago O'Hare airports had full body scanners which made the "security check" brief and easy. At both airports I informed the security personnel that I had a knee prosthesis that would not pass the metal detectors. They responded saying that I should stand in line for the full body scanner. The line was short as many passengers were still not comfortable with the new scanners. I was asked to remove everything from my pockets including paper. I then stood on the footprint templates and raised my hands over my head during the scan. The scan took a few minutes, and then they informed me that I had passed the scan. With full body scanners moving into all US airports, I believe there will be no additional wait time at security with a knee prosthesis.

This past Saturday, July 9, I rode my bike 40 miles in an organized biking event held in Chelsea, Michigan. There were six different routes ranging from 15 miles to 100 miles. I selected the 40 mile route as I regularly work out with 15 mile bike rides. I rode the 40 miles in 2 hours and 35 minutes and only stopped twice at the refreshment sites for water and fruit. My knee survived very well. I did notice a bit of stiffness after the ride, but it abated after a few hours. Below is a picture shortly after I finished the bike ride.

As testimony to the durability of the knee prosthesis, I worked out for 35 minutes the following morning on the Precor Ellipitical machine without any problems.

Six Months after Surgery

I have had my first real awareness that my new knee is not a replacement for the knee I was born with. Over the past few weeks, I have seriously taxed my knee by doing painting and maintenance on my house. With summer weather upon us, I worked the entire Memorial Day weekend from sun-up to sun-down painting, standing for extended periods of time on a 32 foot ladder, moving the ladder, bending and walking about working. At one point while moving the heavy ladder, I felt a strained sensation in my knee and observed a tiny bit of swelling on the outer knee area. The knee also had a slight stiffness feeling to it. Fortunately, there was no pain.

I am assuming that I strained the knee area from all the work, but will watch carefully over the next several days/weeks to be sure that nothing more serious is going on. Of course, several depressing thoughts crossed my mind such as a loosening of the knee prosthesis where it was cemented into my knee or even a possible infection since I had cut my finger a time or two from working on the house.

A few weeks back, I did go to the Dentist for the first time since the knee replacement. I  took 4 capsules of 500MG amoxocillin (antibotic) as a precautionary measure one hour before the dental cleaning. All this went without incident.

I am next scheduled to see my doctor for a follow-up evaluation on the knee replacement in December. December will be the one year mark since the surgery. At the one year follow-up visit, the doctor will take another x-ray to review status and progress of the knee prosthesis.

And as a final entry to the 6 month update, here is a short video with me playing golf with my new knee and my three sons on Father's Day.

Five Months After Surgery

Not much to report at the 5 month post-surgery date other than saying that I am doing fine, and all is well.

I continue to work out 4 to 5 times a week by swimming, riding a bike, and working out on an elliptcal trainer. I am also doing some weight training including leg presses and hamstring pulls.

I find that I do not think very much about the prosthesis in my right knee. I am doing all activities other than running. Even when doing yard work, I find that I can easily move a wheel barrow with a 100 pound load, and carry 50 pound bags of sand and dirt. The knee feels very stable and strong.

Swelling in the surgical knee has abated some since I last reported in this blog. My right knee circumference is 17.5 inches. The left knee by comparison is 16.75 inches. The picture below shows both of my knees (Notice our cat Georgia walking by in the background behind my legs; she is 20 years old!):

This Wednesday I have my first visit to the dentist since my knee surgery. For the remainder of my life I have to take an antibiotic when I visit the dentist. The antibiotic is a precautinary measure to prevent infections. Apparently, there is an increased chance of getting an infection around the prosthesis from dental work which is considered a "dirty procedure". While data is not conclusive in this area, my doctor asked that I take the antibiotic as a safeguard. The drug prescribed to me is amoxicillin. About 1 hour before visiting the dentist, I am to take four capsules of 500MG amoxicillin.

Next report will be in June for the six month update.

Four Months After Surgery

Just a short update here at four months post surgery.

I saw Dr. Denzin on March 21. He continues to be pleased with my progress. My knee bend was 110 degrees at the appointment. He wants to see me for the next follow-up visit this December--one year from the surgery.

I am doing all normal activities now including walking long distances. On a long weekend recently, Margaret and I went to Grand Haven where there is a boardwalk along the river extending out to a pier along Lake Michigan. We walked the entire boardwalk, about 2.5 miles round trip from the Snug Harbor restaurant to the light house. My leg was absolutely fine, no pain or discomfort at all. I am also walking about the U-M campus without concern. Recently, I walked from LSA to the Palmer Commons twice in the same day without issue. At home, I am power walking two miles with our dog Buddy without any pain. Amazingly, I do not feel the need to sit down and rest my leg after walking. Before surgery, I had to rest my leg after long walks due to the arthritis pain in the knee. That is all gone now!

I am also walking up/down steps normally, even walking up/down steps two at a time to work the quadricep muscle a bit more.

In late May, I will be taking a plane to Chicago. This will be my first flight since the surgery. I will have to go through a pat-down since my knee prosthesis will set off the security alarm when passing through the conventional metal detectors. It will also be interesting to see how well my "knee bends" sitting in the cramped airplane seating in coach.

Three Months after Surgery

I am now 3 months post surgery. As recovery from this surgery is now very gradual, I will post future updates on a monthly basis.

Sleep problems seemed to have abated. For the past 10 days, I have not taken the ambien sleeping pill to fall asleep. I am falling asleep normally. I am hardly aware of my surgical leg at night. It is beginning to feel normal when lying in bed.

I have now recovered sufficiently to resume all activities that I did before the surgery. This includes workouts on the stationary bike, 2 mile walks, and 30 minutes on the eliptical machine. All this at the same resistance level that I did before surgery. On the stationary bike, for instance, I am using position 9 for the seat adjustment to achieve a 90 degree bend of the knee, and I am using resistance level 11 and 12 to exercise the quadracep muscle. The video below depicts this:

I am also retiring the cane. I have not used the cane much since early February. I have kept the cane in the trunk of my car just in case I needed it. I am now fully confident in the strength of my knee to retire the cane to the attic with the crutches. Below is a picture of me using the cane at the Detroit Auto Show on January 20. This was the last day where I significantly depended upon it for longer walks and prolonged standing.

After activity, my knee feels a bit stiff and slightly swollen. So I have not achieved the benefit I had hoped for as my knee (pre-surgery) would also swell and become stiff after activites (e.g bike riding, long walks, etc.). I suspect that as I continue to recover over the next several months that my knee will become less prone to swelling and stiffness after activities. I have noticed that my knee is responding better to exercise as time transpires. Increasingly, I am finding myself less aware of the knee as I walk and do errands about the house. This is in contrast to the first six weeks after surgery where I was thinking about every step my surgical leg took as I walked or navigated stairways.

The picture below shows both of my knees side-by-side after 3 months. Unlike the left knee, the right knee (the surgical leg) still does not show the outine of my quadricep muscle, but it is almost coming into view on the inner side of the knee.

10 Weeks After Surgery

At 10 weeks post surgery, I continue to have gradual improvement of motion and strength of the right knee. Over the last two weeks, I swam 50 laps in a pool, and I even walked 1.4 miles outside in my neighborhood. My leg did ache and stiffen a bit after the walk. Ice and ibuprofen helped to abate this.

However, one development that emerged slowly over the last 6 weeks and reached a crescendo this week was difficulty in sleeping. During the past 6 weeks, I increasingly noticed that I was waking up frequenlty at night, sleeping for brief periods--sort of cat naps. This past week, the sleeping difficulty grew into imsomnia, hardly sleeping at all throughout the night. By last weekend, I was spending nearly the entire night tossing and turning, unable to fall into a comfortable sleep. I did not really have pain, just a restless feeling in my leg where I kept moving it for a comfortable position. I was taking 200mg ibuprofen to help with this, but without success. I also checked my blood pressure, and I was shocked to see a reading of 155/95. My normal blood pressure is 130/80. On Tuesday, I called my orthopedic doctor and my family care doctor for advice on this.

Both doctors prescribed medication. The orthopedic doctor prescribed 600mg ibuprofen, suggesting that my sleep problems were the result of low level pain in my knee keeping me awake at night, and the resulting anxiety from this. But my family care doctor warned against stronger ibuprofen as she thought that the ibprofen was contributing to the increase in blood pressure. Instead, she prescribed Norco for pain medication, and ambien medication to help with sleep.

I followed my family care doctor's advice. I am happy to say that the Norco is helping with the low level pain, particularly after physical therapy, while the ambien is helping with sleep. For the last 3 nights, I have slept fairly well. I have also noticed a drop in my blood pressure, where it is approaching normal levels. I suspect that the combination of weeks of inadequate sleep, stress from this, and ibuprofen were contributing to the higher blood pressure readings.

On thing I will add to my workout regimen is going to the driving range to drive golf balls. The doctor told me at the hospital back in December that I would have to retrain my knee for driving a golf ball. He said that chipping and putting should come back easily, but that I would have to work on the "driving" with the new knee. Regaining my golf swing for driving is important since my wife Margaret and I play golf in the summer months. We are fairly well matched in terms of golf, but with our competitiveness, I worry that she may have an edge if I do not recover my golf swing for driving a golf ball. And I cannot let the wife have the edge--<grinning>.

At my February 7 appointment with the Dr. Denzin, I asked several brief questions:

1. While "googling" on the Internet, I discovered that the company Zimmer who makes the Zimmer Nexgen System knee prosthesis that was put into my knee was facing lawsuits. See Zimmer Lawsuit. Dr. Denzin indicated that there were problems with cementing the prosthesis into the knee, but he assured me that my prothesis was cemented in correctly. Nevertheless, this was a bit disconcerting to see on the Internet.
2. I asked about any restrictions. Dr. Denzin responded that other than running and high impact sports that I had no restrictions. He confirmed that I should let the pain and swelling guide my activity level.
3. I asked about hot tubs. He said they are fine and that I should do squats to improve the knee flexion when in the hot tub as the muscles around the knee should be relaxed.
4. I asked about doing curls with 70 pound weights. He said that this was not a problem.
5. I told him that my formal PT will end on February 21, and that I would continue my own private PT with bike riding, swimming, weight training and walking. He thought that this would be fine and indicated that many patients do just fine without formal physical therapy.

My next follow-up appointment with Dr. Denzin is March 21, 2011.

8 Weeks (2 Months) After Surgery

After this entry, I will go to bi-weekly updates, and eventually to monthly updates.

Here are some status updates after 8 weeks of recuperation and physical therapy from total knee replacement:

• At the Physical Therapy clinic this week, my knee bend was measured at 101 degrees, 9 degrees shy of the PT goal of 110 degrees and 19 degrees shy of my goal of 120 degrees. I hope to reach my personal goal of 120 degrees in 6 weeks (by mid-March 2011).
• My ability to walk increasing distances without assistance of a cane is occuring to my satisfaction.
• I think I am starting to sleep better too. While I continue to wake up more often than normal throughout the night, it does seem that sleep interruptions (insomnia) are decreasing. A Google search confirmed that others who have undergone total knee replacement also experience difficulty sleeping during the primary convalescence phase (the first 3 months).
• I am now completely off narcotic pain medication. If there is pain or swelling, I am taking
  over-the-counter ibuprofen or aspirin.
• I am increasing my workout on the stationary bike to 20 minutes. I have also increased the peddle resistance to force the leg muscles to work harder. Hoping to work my way up to 40 minutes by March.
• I swam 40 laps at the pool tonight. This is the first time I have tried to swim since the December 8 surgery. I probably could have swam my normal 60 laps, but I decided not to push things this first time. I also sat in the whirlpool for 5 minutes without issue.
• My formal physical therapy sessions should end in the next week or two. After this, I will continue my own workout program with the hope that I will be able to perform my normal routine (pre-surgery workout) by the early weeks of March. In late March, I may also add the Golf driving range to my workout to begin working on my knee pivot when driving a golf ball. Since Margaret likes to golf, I will need to confirm that my golf swing is working well as we move into Spring here in Michigan.

7 Weeks After Surgery

I will continue to enter weekly updates on the recuperation progress from total knee replacement up through the 8th week. After the 8th week, I will go to bi-weekly updates.

Here is the progress report after 7 weeks of recovery from total knee replacement:

• On Monday, January 24, I returned to work full time. I had been working 1/2 time since January 10. With 3 days of full time work behind me, I can say that I am getting through the day without too much difficulty. My job is generally a desk job. I am not required to walk extensively or stand for long periods of time. If I was working in the trades industry, say construction work involving heavy labor, I would not be able to return to work for several more weeks, perhaps even several more months.
• While my knee remains swollen, there does seem to be improvement day-to-day with less swelling due to activity. At the start of this week, I am finding that I need to ice the knee only after Physical Therapy and during the evening when at home.
• This past weekend, I reached another milestone by taking the dog for a walk around our short block, perhaps a distance of 250 yards. I used the cane to provide stability as there is ice and snow on the road. But I was able to walk around the block for the first time since the surgery. I am noticing that walking longer distances in general is getting easier.
• I continue to use the cane, but less often. I no longer use the cane when walking about my house or walking short distances in the office at work. I store the cane in my car and depend on it when walking outside on longer distances. The quadracep muscle is definitely firing up and I have more confidence in my steps with a stronger leg.
• This past Monday at PT, they measured my knee bend at 97 degrees, so improvement in flexion is occuring. Another indication of improved knee flexion is the maximization of motion on the Biodex machine. I am now maxing out at 100% of motion for knee extension and the knee bend.

I also want to say that I am happy that I did this knee surgery during the winter months here in Michigan. The surgery was done on December 8, and seven weeks later puts the date at January 26--a time when the weather is very cold, and there are few reasons to venture outside. As a result, I have been able to focus on convalescence without distraction of warm weather events outside  . Furthermore, with the schedule of the University of Michigan, I have been able to take 6 weeks off work without falling too far behind as the University work environment slows down dramatically between mid-December and the first week of January.

One other discovery I have made is that total knee replacment is not successful for everyone. Before surgery, I often heard anecdotally that those who did total knee replacment often said, "why did they wait so long since the results were so beneficail". However, testimonies from others I have encounteread at physical therapy have confirmed that total knee replacment is not a cure-all for everyone. Some have continued problems with flexion, pain, and decreased quality of life. Some even have premature failure of the prosthesis, thus requiring another major surgery within a few years of the original surgery. One woman I talked with in her early 50's had three major surgeries on her knee within one year. Another man told me that the first total knee replacment failed after only two years, and he had to get another one in order to walk.

These mixed reports on total knee replacement have given me some reason to pause and question whether I will really be able to achieve my goal of pain free motion for biking, swimming, walking, and general life activities. While I remain optimistic and committed to hard work to make this successful, these stories have made me question the overall success I hope to achieve.

Six Weeks After Surgery

Progress continues to be very gradual, no significant leaps forward. I am noticing increasing strength in my leg. This week I am regularly walking up/down stairways in my home with one foot at a time, but holding on to the railing for support. No noticeable change in the swelling this week. Looks to be the same as the previous week at 18 inches in circumferance. By comparison, my good knee measures  at 16 1/4 inches in circumferance. The picture below shows both of my knees for comparison. The knee to your right is my good knee which shows the quadricep muscle. The knee to your left is my surgical knee which shows excessive swelling, thus concealing the quadricep muscle. However, the incision on the surgical leg appears to be healing nicely.

I continue to go to physical therapy on Monday, Wednesday, and Friday afternoons. I am also doing my own private PT on the alternate days at my home. Saturday is the only day of the week where I rest and refrain from doing any exercise therapy for my surgical leg. Now that I am working 1/2 time, I am also finding that the afternoons are the ideal time to do PT. Doing PT before work would be very difficult as my knee swells/aches after PT which would making moving around at work problematic. Doing PT late in the day is the best time for now as I can go directly home and ice the knee.

I have not been sleeping soundly through the night for weeks. My sleep is broken into 2 and 3 hour increments. At night, my knee sometimes aches and the pain (although mild) wakes me up. I suspect that the nightly pain is due to the late afternoon PT sessions. When awake during the evening, I am not aware of much discomfort, but at night when sleeping, the minor aches when moving my legs seem more pronounced and wake me up. Some times I toss and turn until I fall back to sleep; other times when there is too much discomfort, I take a 1/2 tablet of the Norco pain medication to go to sleep.
Two developments occurred this week. I am now able to rotate the pedals on a stationary bike, and I was able to max out on the Biodex by reaching a knee bend of 100%.  For my "at home workout", I am pedaling on the stationary bike for 10 minutes as a warm-up. I am using a seat position of 11 and a resistance level of 4. When pedaling the stationary bike, my surgical leg feels awkard, not sufficiently coordinated to make the pedaling feel natural. As the muscles in the leg get stronger, I believe the coordination for bike pedaling will return.

A 100% knee bend on the Biodex translates to a 90 to 95 degree knee bend. Over the last week I have been starting the 15 minute session on the Biodex machine at 85% and then advancing it into the 90's. This past Monday, I got up to 100% which really stretched the tissues and muscles around the knee. Maxing out on the Biodex is a good sign of progress for knee flexion. Should I continue to max out on teh Biodex, they may switch me to an exercise that increases knee flexion beyond 100 degrees.

Overall, I think I am doing okay. I am noticing that I am using the cane less often when outside or when at work. However, the cane does give me security when walking outside on ice, and I believe, the cane also serves the purpose of validating to others that I have a temporary disability. People do make accommodations when seeing me walking with a cane.

In the below video you will see two exercises that I am doing at home to improve knee flexion. One exercise is called the floor slide and the other exercise is called the wall slide. Both serve the purpose of stretching the muscles around the knee and forcing it to bend.

Five Weeks After Surgery

I continue to have gradual improvement. Swelling around the knee is still significant, but the swelling has gone down another 1/4 inch since last week. Knee circumferance is now 18 inches. In this past week, I have walked about the house without the cane for the most part--only using the cane after PT when the knee is swollen and tender. With two flights of stairways in my house--one going into the basement, and one going to the upper floor to the master bedroom--I have also started (trying) to walk the stairways with one foot per step. I am cheating a bit by leaning on the railing and twisting my hip a little to accommodate my surgical leg as I walk the stairway. Each day, I am noticing a little more improvement doing this. Walking up the stairway is easier than walking down the stairway. I can almost walk up the stairway normally while using the railing for balance. Going down the stairway is more difficult as I cannot bend my knee sufficiently when my good leg moves to the next step.

I had my one month follow-up with Dr. Denzin this past Monday. He seemed satisfied with my progress, and he approved my request to return to work on a part-time basis for the next two weeks. Provided this two week trial works out, I hope to return to full time work as of January 24. Restrictions for the near term will be limitations on prolonged standing/walking, and only light duties. I asked Dr. Denzin serveral other questions:

1. How long do I have to take the daily aspirin? He said to take it until the full motion has returned to the knee.

2. When can I resume swimming? He said immediately.

3. Do I have to take antibiotics for other things besides seeing the dentist? He said that I only had to take antibiotics for medical procedures that were not sterile. In effect, only the dentist visits will require antibiotics since other procedures will likely be conducted with sterile methods.

4. Can I damage my knee if I really work aggressively to improve flexion of the knee. He said that provided I am bending the knee in the normal direction and trying to obtain a 90 to 110 degree bend, that I will not damage anything other than possibly stretching/tearing scar tissue. And stretching/tearing scar tissue is good as scar tissue build-up can sometimes restrict knee movement.

5. Should I be concerned that my knee is not bending a full 90 degrees at 5 weeks post surgery? Dr. Denzin said that he sees good progress witht my knee flexion and that it is improving, possibly at 80 degrees now since surgery. He believes with agressive PT that I will regain full motion as I had pre-surgery and possibly more if I continue to work hard in PT.

With the green light from Dr. Denzin, I am now working aggressively on knee flexion at physical therapy (PT). I have PT at the St. Joe's clinic Mon, Weds, and Friday for two hours each day. I am also doing my own PT on the other days at my home gym. While the clinic PT is focused almost exclusively on my knee, my home PT is more of a complete body workout for both upper and lower body. I am finding that PT is helping with improving knee flexion, but it is best done late in the day as my leg aches and becomes swollen afterwards. Trying to work after PT is difficult as my knee is less flexible.

I crossed another milestone this week. I successfully rotated the pedals on the stationary bike without too much difficulty. While it is awkward for my leg to move fluidly, I can now rotate the pedals slowly around on the stationary bike for 5 to 10 minutes.

The other milestone this week is my return to work part-time. I am working 4 or more hours a day, trying to spend some of that time in my office at the LSA building of the University of Michigan. As the Director for Information Technology, my job is not physically demanding. Much of my work day entails responding to
e-mail, attending meetings, and reading detailed reports and white papers. Hence, I am able to do this work without taxing the knee too greatly. Only lenghty walks or prolonged standing will be activities that I will have trouble accomplishing for the forseable future.

I was able to work at the office on Monday and Tuesday this week. I found a handicap parking place about 40 yards from my office located in the small parking structure behind the Michigan Daily offices. I was able to walk the 40 yards to my office without too much difficulty. I was also able to attend the one-hour manager's meeting on Tuesday without too much discomfort. I did bring an ice bag to the office, and I have arranaged my extra chairs in my office to elevate my leg as needed. My only concern as I drive to work each day is the available handicap parking places nearest the LSA building. If I do not find available parking in the parking lot behind the Michigan Daily for the 40 yard walk, then my only other option is to use the Fleming parking structure which is 100 yards away from my office. Walking 100 yards will be a real challenge for my knee. Even if I am able to walk the full 100 yards using my cane, I suspect the knee will be very swollen once I arrive to my office. Lengthy walks will be the real challenge for me as I return to work. Hoping to minimize lengthy walks for the next 30 to 45 days by finding shortcuts, getting a ride with a colleague, or asking someone to substitute for me at a meeting.

One final milestone to mention. I retired the urinal (that the hospital gave me) next to my bed this week. I have not used it for a few weeks, but I did find it useful during the initial weeks at home. Instead of having to walk with pain to the bathroom at night, I was able to use the urinal next to my bed instead. Yes, another sign of recuperation!

Four Weeks After Surgery

I have been using a cane to get around for most of the last week. However, on Monday at PT, the Physical Therapist, Cathy, encouraged me to start taking a few steps without a cane. I did this at PT on Monday, and I have begun walking short distances in my home without the cane too. I have to concentrate when I walk unassisted, making certain to step heel to toe. My quadracep has recovered more this past week, and I am gaining confidence that my leg will not buckle as I walk while supporting my full weight. Knee bend is 80 degrees which is progress, but still insufficient to fully rotate the pedals on a stationary bike. My knee continues to swell with activity, but overall the swelling has gone down 1/2 inch since last week. Knee circumferance is now 18 1/4 inch. I weighed in at 184 this morning. Given that I am very sendentary with exception to PT, I am watching my weight in order to keep it in the low 180's. Weight gain on a recovering knee replacment is not a good idea.

Other Developments. With increasing knee bend, I drove my car more often this past week. I was able to drive myself for short distances to the grocery strore and to PT. I have sufficient control over my right leg to negotiate the brake and accelerator. I am more comfortable sitting in the drivers seat this week. I also contacted by boss and colleagues at work and let them know that I may come into work part-time during the week of January 10 to test my abilities at the office. This, of course, is contingent on approval from my doctor who I will see at 8am on January 10. Since my job as a University IT administrator entails sitting at a computer doing e-mail, reading or sitting in meetings and talking with colleagues, I think I will be up to the task on a trial basis. Just depends on how much walking and subsequent swelling my knee endures. Thinking that I may take an ice bag with me to work that I can use while sitting in my office to manage the swelling.

PT has become really intense. Cathy is working me hard. The PT sessions are 1.5 hours and end with an icing of the knee. I am really glad Cathy is pushing me hard. I do want to exercise the muscles around the knee to strengthen them and improve flexibility. The last PT session was exhausting, and I was in pain for the remainder of the day on Monday. Even though I did the norco pain medication, I still had trouble sleeping Monday night. My knee and surrounding area was swollen and stiff. Below you will see one of the exercises I am doing at PT. This exercise is called the wall slide which forces the knee to bend and stretch/tear scar tissue. You will note that Cathy is pushing down on my bent leg to force additional knee bend--working hard to get me to the goal of a 90 degree knee bend. Note the grimace on my face. This is painful, but I realize the benefit for increased flexibility of the knee. Once, I achieve a 90 degree knee bend, I will be able to work on a stationary bike and begin working on climbing steps using one leg per step. Not there yet, but getting closer.

One exercise done at PT is to use the Biodex (continuous motion machine) which bends the knee from a full extension to a potential 100 degree bend. As I am able to control the level on this machine, I was able to get the knee flexion up to 80 degrees this past Monday. My goal was to achieve a full 90 degree bend by January 10. The only problem with this machine is that while it forces good flexion of the knee, the knee will swell afterwards and become less flexible. But I am told that the long term benefit will be improved knee flexion. Ideally, I would like to achieve a 110 to 120 degree knee bend when fully recovered.

On the lighter side of things, I have been getting out of the house a little more this past week. In addition to running a few errands on my own, I was able to travel with my friend John on a tour of Detroit landmarks, and join my wife Margaret for a trip to the Motor City Casino. For both trips I took the cane and ice pack, and I managed to find time to elevate the knee to minimize swelling. For the Detroit trip, John and I toured Wayne and Detroit by car to see landmarks of our childhood. Of several things we saw including the grounds of Tiger Stadium at Michigan and Trumbull, we visited the Penobscot Building (http://en.wikipedia.org/wiki/Penobscot_Building) and the abandoned Detroit Train Station, known as Michigan Central Station (http://en.wikipedia.org/wiki/Michigan_Central_Station). As teenagers, John and I had climbed the stairway of the Penobscot Building to the top of the building while smoking cigars! Sad to see the Michigan Central Station abandoned. There was a banner at the very top of the building stating, "Save the Train Station". So many abandoned builidngs in Detroit--it was depressing. John and I did have a great lunch at Sinbads, near the Detroit Yacht Club. No one at the restaurant seemed to mind that I used a second chair to prop my leg up while we ate lunch.

With plenty of time to sit around convalescing, I have also finished reading two books over the last week. I read the autobiography of Colin Powell and the autobiography (Life) of Keith Richards. Wow, what a contrast in lifestyles. Both had unique and interesting experiences in their lives. Colin Powell had a career in the US Army, served in Vietnam and Desert Storm, and also worked for the Clinton and Bush Administrations. Keith Richards led a counter cultural lifestyle as a rock musician playing lead guitar for the Rolling Stones. Keith, amazingly survived the drug culture of the 1960's and 1970's, and he still plays music today for the Stones touring with Mick Jagger and other band members.