Week 3 and Giving Thanks

Peace is that part of Harmony that allows me to focus and move forward with goals.  I truly believe in finding things in life that help keep balance and calmness is essential to my well being.  I'm not a Buddhist but the picture above depicts a small shrine I created in our yard.  Every other day or so I move the stones around to my liking.  I create the look that works for me and this relates to how I shape the paths in my life.  I take the path that leads to the results I'm looking for.

Last week was monumental in regards to the progress I'm having with my TKR recovery and rehab.  I hit two big goals that I had not expected to see so quickly.  But before I go there I want to give thanks for several things in my life during this time of Thanksgiving.

Thanksgiving is a holiday my wife and I try to spend with family or friends and this year we were able to celebrate it in our home with a 2nd cousin who had moved into town with her husband and another friend who is here without family. So we're thankful for the opportunity to share this season with family and friends.  I'm also thankful for the health I have and a body that is responding quickly after Total Knee Replacement.  At this point in my life journey it's something I need to be focused on and am grateful I have the support of a wonderful and loving wife.  It's definitely a team effort and it would be more challenging without her help.

So how is the recovery coming along?  The progress over the last 3 weeks is nothing short of a miracle.  Why?  By all accounts and compared to last years replacement I shouldn't be able to walk without support, make full rotation on a bike, or have the flexibility I do.  Let me break each of those down.

On Friday I met with my outside Physical Therapist Todd, over at Scripps Ranch Physical Therapy.  Great place by the way.  We discussed my progress and goals.  He took some measurements and had me perform some things.  Bending my knee was up to 117 degrees.  Goal is 130 so we are not far off.  The hyper extension was good and almost touching the ground in the center of the knee joint.  Perfect.

He gave me a few new stretching movements and exercises to work on at home.  Lastly he had me get on the stationary bike.  I did 10 minutes no resistance and full rotation.  This was a first so far.  Up to this point I was doing 1/2 turns.  Last TKR is was a month and half before I did this.  Three weeks is way ahead of schedule.

Sunday I wanted to get outside and walk with the dogs so Crystal and I went over to Fiesta Island.  On the backside is a huge dog park right across from Sea World.  (Yes we do live in paradise).  It was a beautiful day at 75 degrees.  Not a cloud in the sky and a soft breeze was blowing.

My plan was to walk as far as I felt comfortable and then cut back as needed.  The loop is about 1 1/2 miles and there are paths that allow you to cut it short.  The dogs love this because they can be off leash along with interaction with other canines.  At the half way point we give them water and Crystal asked how I was doing.  I could feel my knee tightening up but I wasn't in too much pain.  We pushed on and completed the loop.   Here is a picture of my knees.  As you can see the right side, as you face the picture, is swollen but to be expected.  I was able to drive home and upon arrival immediately put ice on it.  Did it hurt...you bet but that's part of the process. Icing and medications help to push beyond those points so I can move forward with my recovery. 

So two goals are accomplished, over a mile walk and full rotation on the bike.  I'm not putting these goals out there and being disappointed if I don't make them by a certain time.  Goals help me stay on track and reach beyond what I think I can sometimes do.  Writing them down gives me a vision.  I'm extremely happy with my progress and even more encouraged to keep doing what I'm doing.

HOLD THE PRESSES:  I was working on this Blog earlier today with plans to review it again this evening before posting.  Between this morning and this evening I had a PT session and came away with another completed goal.  During these sessions there is some hands on with the physical therapist as he pushes and pulls on my new joint.  He then will measure and record my progress.  He measured a 130 degrees bend today which is where my other knee is.  Unheard of to have that much movement in so little time.  Just one more thing to be thankful for this year.

TKR Start of 3rd week

To tell you the truth I really can't believe it was just 2 weeks ago today that I had knee replacement surgery.  When I think back to last year I remember that I was still on crutches and had just started to think about moving over to a cane by this time.  I am walking almost normally, when I force myself to work on it, and feel fairly normal.  When standing I naturally want to lean on my good leg but always catch myself and use both legs.

Today my physical therapist, Barb, took out my 25 staples.  Does it hurt? Some.  Kind of feels like a bee sting.  She then put on the strips you see which will fall off on their own.  Actually after today's PT session some had already started to remove themselves.  This also means I can take a bath now.  Up to this point it's been showers with the knee wrapped in plastic to keep it dry.

My flexibility or bend is now at 108.  Up 3 degrees from last week.  The knee still feels tight or swollen.  It will take time to open up which is the slowest process.  Icing helps to a degree but movement is the best medicine.  Whenever I'm sitting in a chair I try and position the leg back beyond 90 degrees and hold it for a count of 10.  The more I do this the quicker it will adjust.

We've added a lot of exercises to my routine which has upped the amount of time I spend each day to about 30 minutes each session.  Some of the exercises are with weights of one or two pounds.  I'm working just about every muscle in the leg; quads, hamstrings, calf, etc.  I'm in 3 different positions now; floor, chair and standing.  You really don't need anything special to do this at home.  Towels, a chair, stairs, a few large books, etc, will be enough to complete the home therapy.  I have purchased over time small items to create my own little gym:  large exercise ball, balance circle, bands, and small ankle weights. 

I happened to find an application for the iPad on line which covers a lot of what I am doing.  It has little short cartoons demonstrating the exercises.  The app is called Total Knee Replacement and costs .99 at the app store.  There is all sorts of information and tools out there to help with the process.

Because I'm progressing so quickly Friday I start my physical therapy at Scripps Ranch Physical Therapy Clinic near my home.  Normally this would have been another week out. I select this company because they have a focus on sports.  I'm not just trying to walk again, I want to be able to return to many of the activities and sports I enjoy.  I will spend my first day reviewing medical history, where I'm at and goals.  By next week we'll be working that plan.

Sleeping at night has become more enjoyable as well.  I can use many more positions now and not just sleep on my back.  I'm using less and less ice during the night too which is helping with a solid night of rest.  My muscle in the morning are very stiff and I have to start slow letting them warm up.   They feel like cramps which is from the trauma, therapy and icing.

This past weekend Crystal and I did some shopping together and she even let me drive the car a short distance to see how things were going.  We were out a good 3 hours in total.  I did just fine and think I'll be able to get on the road for longer distances in a few weeks.  I first have to be off some of the stronger medications before I drive farther than a few blocks.

I'm really, really happy with my progress and think I'm moving faster because I know what to expect and how far I can push it.  Experience sometimes is the best teacher.

End of First Week after TKR

It's been one full week since the operation.  Today, Tuesday morning, and my mind is asking, "... why  did you do this?"  The pain is very constant and the level hasn't really dropped below a 5 on the scale of 1-10 yet, 10 being unbearable.  There have been times when it's been 9 and that is usually during or right after therapy.  But there is light at the end of this tunnel

Prior to the operation I was having pain but it was a bit different, arthritic.  Arthritic can be hard to explain if you haven't experienced it before.  It's a deep ,in the joint, nagging, and constant irritation.  Maybe a tooth ache would be a good comparison. 

Today's pain is deeper in the bone but to be expected when you understand or see the procedure.  Bone is being cut away to create smooth and level surfaces then holes are drilled for plastic attachments.  Lastly they hammering and glue parts to attach them to the bone.  Kind of like a wood working project.

Ice is one of my main weapons to fight this and I have several different ways in which I use it.  Coupling this with meds, massages and heat pads creates the right mixture of ingredients.

I invested in this last time and have kept it for all kinds of reasons.  The DonJoy Iceman machine is a wonderful tool that can be used on a lot of body parts.  It is a cooler with a small motor that forces water to flow in and out over ice via tubes.  At the end is a pad that you place on the area you want to ice down.  I've found that an ace wrap helps to hold this in place.  Ace wrap is good for hold all kinds of ice packs in place. 

The pump is quiet.  I usually get about 3 to 4 hours out of a cooler full of ice and water.  This is what I use when I'm going to be resting for long periods of time and when sleeping at night.  Other times I use ice packs (two zip lock bagies with ice and water), reusable ice blocks , and soft ice ( it doesn't freese but is cold enough to do the job)

Keeping the blood flowing in the lower legs is something the doctors want and to help with that they have me using a compression machine right from the start. Continuous Enhanced Circulation Therapy (C.E.C.T) is accomplished using a machine that presses your calf area every 15 seconds or so.  It runs on a AC and battery power.  I'll have to use this for the first 10 days after surgery.  I can take it off during showers and exercise other wise it's on almost 24 hours a day.

I've mentioned a few times doing research knowing more about the procedure, recovery and rehab.  I spoke to several people before hand which was in my opinion the best resource to start with.  Those with practical experience made the information I red about easier to understand.

A found a book, "Knee Surgery,"  written by Daniel Fulham O'Neill, MD.  It has a wealth of information about what to do prior to surgery so that you have the best possible outcome and what to do for rehab after.  I specifically use this book because it had a section on Returning to Sports and Competition (chapter 12).  He covers getting back to basketball, tennis, skiing, etc.  Many sports I thought I might have to give up all together. 

I reached out to Dr O'Neill and he provided some thoughts specific to cycling in my recovering process. 

Daily Physical Therapy is the base of recovery just like miles are the base of a successful cycling season.  The physical therapy isn't too hard and each day we add an exercise or two to the routine.  Up to this point it's been mostly isometric muscle work and some flexibility moves.  The hardest is flexibility but it's the most important.  This is basically, how far can you bend your knee back.  For standard everyday living 67 percent of knee flexibility is needed for the swing phase of the gait, 83 percent to climb stairs and 90 percent to descend.  Lastly, 93 percent to rise from a chair.  I'm shooting for way beyond these numbers.

Several methods are used to work on flexing the joint; push, pull and gravity.  Sitting in a chair I can slide my leg backwards as far as I can.  The muscle is tight but there is also swelling which makes it difficult.  I pull back to where I can hold it for 5 seconds and then release or rest.  I do it again and am able to come back a bit further.  10 reps to start.  After the last one I hold it and measure the degree with a Goniometer (kind of like a math protractor).  If you have had a good bike fit you've seen one of these before.

Another method to increase flexibility is to have someone else push your leg.  While in the hospital the physical therapist did this for me because I was still gaining the feeling back in the leg from the block.  They know what they are doing and can watch your expression for pain levels. 

Gravity. Laying on my back I lift up my leg up straight and then bend it at the knee joint slowly controlling it with my muscle.  When I get to a stopping point I very lightly release the muscle and allow gravity to pull it down with support of my hand.  It hurts, a lot.

Yesterday I had my second in home PT session.  We added in ankle raises while standing and squats using a banister for support.  My body tried to shift my weight to the good right leg.  The therapist helped straighten that out pulling my hips to the left as I performed the move.

The huge success in my mind this week are two things:  1) I put my crutches back in the garage as a sign that I won't be needing them during the rest of the this process.  2)  I'm able to climb stairs using both legs going up and down.  It's a slow process and I use the support of the walls or railings some.  The goal is to get full weight support and mental confidence.  I'm not far off from that.

TKR Total Knee Replacement 2011

In 2010 I decided to move forward with a fairly serious operation on my right knee, Total Knee Replacement (TKR). This was after 7 other various operations on the same knee in the last 35 years. I had been told after the first operation I would have arthritis and issues with this knee for the rest of my life. OK, that's always something to look forward to.

At the age of 51 I might seem to be a young candidate for such a procedure but according to my orthopedic, Dr Steven Copp, it's becoming more common in our society for those who are active.  What I mean by active is getting out and felling the sun on your back or sweet on your forehead 4 to 7 times a week.  The pain and issues I was experiencing in both my knees stemmed from those activities.   But in my younger years it was easier to take a Tylenol and start again in the morning. 

I'm not slowing down at this point, life is way too short as I experience with cancer 16 years ago.  (That's another story altogether)  If I reducing things that impact the knee joints the most I can still be active:  cycling, hiking, swimming, surfing, etc..  I did a lot of sports in my earlier years: football, wrestling, basketball, baseball, track, etc.  Another 8 years in the army running in boots certainly wasn't ideal.  I know what really puts strain on those knees now and can get by without many of them.

One of my orthopedics told me to find sports that put less strain and impact on the joint.  He highly recommended cycling.  I hadn't been a focused road rider but I was certainly interested and in 1998 did my first century with the Leukemia & Lymphoma Society, LLS, Team in Training, TNT, program.  Our goal, raise $2500 over 4 months and then ride the Tour De Tucson in AZ in Nov.  That was the start.

I soon found I was having less and less pain in my knee(s) joints...why?  The doctors were telling me that this was because I was moving the joint, always good, which in turn forces the fluids to circulate in that area.  This smooth motion of a pedal stroke also reduced the banging of the bone on bone.  Previous operations had removed the natural shock absorption, meniscus. 

My first knee replacement, right knee, was operated on in Feb 2010 and in Oct of that same year I completed a 620 mile 7 day ride from San Francisco to San Diego with the Challenged Athletes Foundation (CAF) in their major annual fund raising event, Million Dollar Challenge.  No real issues and I had regained my endurance and strength over the 9 month period.  What was really impressive was the daily pain, arthritic in the joint, was gone. With that in mind I decided to have the other knee done this year.  The picture on the right is the result of my operation Monday, Nov 7th just last week.

Since I've started seriously cycling I've increased my knowledge and skills to a level that I often coach and assist others to complete events.  A question that comes up often is around knees and would TKR fix their problem.  I'm not a doctor so I will always say first ask a professional, orthopedic.

In my case it came down to I had tried all the other options and this was the last result.  As I mentioned earlier in this article, it's a serious operation that requires a lot of rehad and focus after.  Here is a link to a YouTube clip on the procedure.  WARNING this is very graphic:  Total Knee Replacement video YouTube

I'm going to follow up over the next weeks and month on my progress with this knee and what I'm experiencing.  I think it will help others think about this as a possible solution but hopefully realize it may not be the answer.  There are a lot of other things to look at and in today's medical field, new solutions are constantly coming out.

Send me your thoughts and questions.  More than willing to provide you feedback and my thoughts.

Thanks

Mike