Posts Tagged ‘ACAC Water Therapy’

Bilateral Knee Replacement-Part 2: Recovery and Therapy

For two months before surgery, my number one focus was therapy; to strengthen my muscles to get me ready for recovery after surgery.

For three months after surgery, my number one focus has been therapy; to get me moving, bending and restoring full use of my knees and legs.

I do not like therapy or exercises. It is hard work, takes intense dedication and hurts! But, it is the difference between healing and getting better and becoming a fully functioning human being again.

I think therapists are on speed dial from the surgeon: “Patient is out of surgery, go, RUN!” Their preference is for you to meet with therapy the day of surgery. However, my first therapy session was postponed until the following morning as it was too late in the day when I got out of recovery and my spinal had not worn off yet.

The first week in the hospital is detailed in Part 1. When I left the hospital on Friday, four days after surgery, they asked if I wanted Home Health to come in. That sounded like a great idea-to let them come to me. The thought of having to leave the house to go one mile to therapy sounded like a big deal.

The morning after I was home, Home Health called and by mid-morning they were knocking on my door to do the paperwork, take my vitals and pictures of my knees. I was informed that I was only scheduled for three visits in two weeks. That was all they were allowed to do. That should have raised a flag but I wasn’t processing information very well at this point.

Later in the afternoon, the first therapist, came for the first visit. She was helpful and encouraging and assured me that what I was experiencing was normal but she pushed me to my limits. She was determined that I would get a 90 degree bend in my knees the first session. The most we could squeeze out was 75 degrees on the right and 55 on the left. The left knee just did not want to bend as well as the right. She suggested I cut the ice treatments back and decrease the pain meds.  I was exhausted when she left and took a long nap. It didn’t take long to find out that cut cutting ice or meds in the first week was not a good idea.

By the time the second therapist arrived five days later, I was eleven days past surgery and just getting my second “real” therapy session. I was worried about the length of time between sessions.  My left leg was really stiff, felt like a wooden post, and just would not bend as much as the right.  She wasted no time telling me that she is hard on her joint patients. She looked at my list of ten exercises  that I came home from the hospital with and said, “I want you do three sets of ten twice a day”.  My doctor instructions were to do ten of each exercise twice a day. That meant each exercise that I did ten times, I was now to do a total of thirty times, twice a day.  Physically, mentally and emotionally I could not do it.  I wrote in my journal. “My legs feel terribly tight, and are horribly sore. I can barely walk.” Her next visit was scheduled for eight days later.

The next morning I called my doctor and told him what was happening. I asked him if this is what he wanted in therapy. He said, “Absolutely not.”  He said Home Health is an independent company and they do their own thing. They do not communicate with the doctor, they don’t know what he recommends or wants for his patients.  He suggested that I use Ortho Therapy as it is in the same building as his office.

The Ortho therapist has access to the doctor and my medical records when needed and the doctor has input into the amount and type of therapy.  Ortho couldn’t start me until the beginning of the week which meant it would be sixteen days post surgery before I got on a good therapy schedule and program.  I was impressed with their program and they were very helpful and encouraging and committed to get me going. There was immediate concern about my left knee and we talked about the issue. The therapist mentioned that they can “manual manipulation” if it doesn’t respond to therapy but it is a last option.  Therapy was scheduled for three times a week plus they put me on an exercise program to do twice daily at home.  For the next ten weeks therapy and exercises consumed my days.

As I began to write this blog, I started to notice the post surgery milestones I had posted in my journal:

  • Twelve days: Was able to shower by myself without sitting or using the walker for stability.
  • Fifteen days:  Can leave walker outside of bathroom door.  Much easier to get in and out of bed and chairs.
  • Seventeen days: Started walking in the atrium at our church for exercise. The swelling in the legs is decreasing.
  • Nineteen days: Went out to our feed store for the first time (about an hour) and put in a feed order.  Started doing light office work every couple of days.
  • 3 weeks: At therapy my right leg bends 90 degrees and the  left 55. That is a big difference. The goal is 90 degrees at 2 weeks so I am running behind on the left.  I am now up and moving around most of the day. and cutting back on pain meds.
  • 4 weeks: Started going to church and more comfortable going out.  My legs hurt if I stand still or they “dangle” too long when sitting. I have to choose my chairs and length of time sitting and standing carefully. My legs still hurt at night and keep me awake but during the day, it is not bad. I now have 95 degrees on right knee an 82 on left. I have no trouble cooking and doing laundry as long as Gene helps me with carrying the laundry basket and getting pans out of the lower cabinets. I am now going steps to the office and laundry. I can now put my foot up on the edge of the coffee table to tie my shoes and trim my toe nails!
  • 32 days:  Had an appointment with Dr. Kerr and he is recommending water therapy.  Next week he wants to do a manual manipulation on my left knee. This scares me too death, sounds awful. They said it sounds like Velcro being pulled apart.
    • Started going to a neighbor’s pool to do exercises several times a week.
    • Incisions are healed and started using Coconut Oil and Coca Butter on them.
  • 37 days: Started driving. As long as I was on the strong pain meds I wasn’t allowed to drive.
  • 38 days:  Parked the walker and started using the cane full time.  My left knee cap would give out on me periodically and until we had those muscles strengthen I was suppose to use the walker.

  • 6 weeks: Manual manipulation.  Under sedation, Dr. Kerr was able to get 140 degree bend but when I left the hospital, I could only move it as before. I expected immediate results but discovered I was still going to have to work for it! I was very nervous about this procedure and how bad it would hurt. I knew I would be asleep for it but what about afterwards??? It turned out I was sore for about one day. I had a pool of blood just under the skin to the left of the knee cap that was tender for several weeks until my body absorbed it.

Picture given to me by my surgeon, taken during the manipulation.

    • Several things are affecting my movement. It is not the joints-they are artificial. There is still swelling and some fluid on the knee.  The healed incisions are tight-the skin around them does not move. I have to start massaging the incisions. Because of my poor posture in the months and years leading up to surgery the ligaments in my legs affecting movement have tighten and shorten.  I have to work hard with stretch exercises.
    • Ordered a portable pedal “mini bike” that sits on the floor in front of a chair. The therapist says pedaling is crucial to getting my knees to bend and the ligaments stretched.

    • They started me on a pedal bike in therapy. Man is that tough! The first time I could not do a full petal cycle. The therapist gave my left foot a little push to help it make a full cycle and it made me yelp! By the second session, I could do it.
    • Got rid of the potty “hi-rise seat”. I was waiting until after the manipulation as I didn’t know how things would be.
  • 7 weeks: I am seeing a definite improvement in my gait but still have a slight limp and a slight drag to the left leg.  I have had to relearn how to walk properly. I have to think; lift my knee like a march, come down, heel first then rock to toe. Repeat. Sounds easy, right!!!!!
    • I am working hard with leg extension exercises. My left knee, yes, the bad one, is doing great, but it is my good, right knee that does not want to extend properly so that the back of the knee touches the bed when fully extended. To walk properly and get rid of that drag, it has to happen.  After surgery my measurement was a 12. That is the gap between the back of the knee and a flat surface. That is not good. It needs to be a zero. Right now I am at 3.  After the therapist works on my knee, she can get zero, but I am not able to do it yet on my own.
    • I started making cakes to sell in the store again.
    • Got 96 degree bend on the left leg and 112 on the right. We hi-fived and cheered.
  • 8 weeks: I had my eight week appointment with Dr. Kerr. He was very encouraging and keeps telling me it will come, but it will take some time. He likened it to someone losing weight and stepping on the scales every morning expecting to see results. I said, “That is so me! That is exactly what I do.” I guess I am just impatient, I want instant results.
    • I am working on steps. I can not go fluidly up and down steps. It is one foot up (or down) and then the other foot like a baby learning to walk. I am working on the proper sequence. My left knee is lacking enough strength yet to bear my weight as I step up. I have to do exercises to strengthen the “step” muscles. It will come.
    • I have stopped using the cane in the house.  When practicing steps or going outside on uneven ground, I still use the cane for safety.  They do not want me to fall.

    • We went to the airport to pick up our daughter and family who had been on vacation. Their flight was delayed so we went upstairs where we could sit and watch people coming and going. I had taken my cane but when we came to the escalator, I stopped. I could not figure out how or which foot to put first on the moving steps. The steps looked like they were flying!!!! I didn’t long for me to decide we needed to take the elevator. It is funny what stops you in your tracks. It makes me realize the difficulty and inconvenience handicap people face. I have also faced this at Food Lion and Walmart. At this point I use the motorized carts as the stores are large and there is a lot of walking. If I want something on the top shelf I either have to stand up or use my handy cane; the hook is a “slick trick” for pulling items off the shelf as long as they aren’t glass.
  • 9 weeks: Today at therapy I got 105 degree bend on my left leg and 119 on the right and two days later it was 110 and 120.  The right knee has reached the anticipated goal for therapy and I am almost there on left.  The therapist and I cheered and hi-fived like excited school kids on the accomplishment. It is worth celebrating!!!
    • I am now going to church, therapy and to our store without the cane.
    • I am totally off all pain meds except for Advil and Tylenol on an as needed basis.

At my 8 week appointment, Dr. Kerr again pushed ACAC water therapy. When I questioned him about the difference between the YMCA and my friend’s pool, he said they have a heated salt water pool, medical staff on hand to work with you and the option of group classes in the pool.  They also report back to him on progress.

I finally decided that I was being stubborn like Naaman in the Old Testament (II Kings 5). Naaman had leprosy and his little Jewish slave girl told him that the prophet in her home land could heal him. Naaman went in search of the prophet Samuel and when he was told to go and dip seven times in the Jordan River he refused. He had his own rivers back home he preferred to use, they were cleaner.  But when he relented and obeyed, he was healed. I decided if I want to get better I need to listen to the advice of my doctor.  I signed up for two months at ACAC. The warm 95 degree water is wonderful and so is the huge Jacuzzi!!!!

I am now two days from the 10 week mark.  Today at therapy I got 113 degrees in my left knee and 124 in my right. They changed the way I am to walk. Instead of bending my knee as in a step or  march, I am to keep my leg extended, then heel down, rock to toe. That is to help my leg extension and prevent my “crouching” again. I knew before going to therapy I was improving on my bend. One of my exercises is to sit in a chair and slide my foot back towards the chair as far as I can, using the other leg to help push it back. The blue tape on the floor marks my achievements-where I can get my heel. My left foot almost touches the rung of the chair. I have made amazing progress.

 

Going up and down stairs is greatly improving. Going up is easier than down. On shallow steps I have the up conquered and the down is getting there. Steeper stairs is still a work in progress.  I can now put on panty hose which means I can wear my nicer flats to church.

As I read through my daily journal, I realize the huge progress I have made; little steps almost daily. It helps to look back and see where I came from so that I can keep my eye on the anticipated goal. They say It will take 1-2 years for full recovery.  I also realize that almost every day I write in my journal how bad I hurt during the night. I have trouble getting to sleep, my knees ache and my feet are restless.  During the day I am active and busy and not as aware of the ache.  Every step I take, I am still aware that I have knees. There is a tight band across the knee caps but it is gradually lessening with time.  I am now only going to physical therapy twice a week and  hopefully will done in a few weeks.

Many, many people have prayed for me. God is the ultimate healer and I give Him praise and thanks for what He has done in my life and how he has used the advances of modern medicine to help me. I look forward to complete healing and a new lease on life in the weeks and months ahead.

August 21: I am now between my tenth and eleventh week. I graduated from therapy today!!!!!!! My right knee has a 124 degree bend and my left 115. Because I am doing my home exercises, going to ACAC water therapy, my right leg extension has improved and I basically have full range of motion, the therapist is turning me loose. I will go back in two weeks for a final check-in.  It has been a long road and it feels so good to be moving on to the next phase. Hopefully, no more therapy-ever!!!!

 

Other blog posts about my surgery:

Bilateral Double Knee Replacement-Part 1: Surgery

Rahab and Ruth

Ready or Not, Here I Go

Domino Effect

Highly Motivated

I Can Help You!

 

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