Wednesday, January 26, 2011

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.

Wednesday, January 19, 2011

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.

Wednesday, January 12, 2011

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!

Wednesday, January 5, 2011

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.