Week 5, 35 days since surgery. In a way, this has been a long journey. But in another way, the time seems very short. The PT says that I am where most TKR patients are in 12 weeks. I have 123 degrees ROM, and I can use the stationary bike. The PT has added exercises that address my back problems, and they seemed to have helped a little. She is no adding exercises that are designed to build strength around the knee itself. She will be adding exercises that I can use in the swimming pool that will be very helpful.
The OS is pleased with the progress, and is no longer concerned with the sore in the incision. I will see him next week for the last visit.
I have read that some people are not happy or satisfied with the TKR until 6 months to a year. I have been very happy since the first day. Yes, it was difficult to move my leg. Yes, it hurt like the devil. Yes, I had to work at it. But, it was all worth the effort and pain. Today I am walking without any pain in that joint. It is still a little tight, and the muscles are still sore, but there is no pain from the joint itself. I am happy!
During week four I had a bit of an issue with a small place in the incision. At first there was just a red place about the size of a pencil eraser. Then a small place opened and began to drain just a little. I was concerned that it might be infected. I could squeeze it and a bit of bloody pus ran out. I went to see the OS. He said he thought it was just a stitch that might be working its way out. He put antibiotic ointment and a bandage on it, and prescribed a 7-day round of oral antibiotics. At the end of the 7 days the place had pretty much cleared up. There is just a very small scab left. The OS still thinks it was a stitch. I am feeling really good, and I am getting around very well.
Today is the 21st day since surgery. What a difference that makes! The progress I am experiencing is noticeable every day. Getting in and out of the car, sitting in a chair and rising again, showering, and especially being able to sleep in my normal position.
The issue with my ankle remains, but my PT worked wonders this morning. She massaged, manipulated, used electric nodes, twisted and turned my leg in every possible direction. According to her, my problem has more than one source. First of all, part of the issue is the fact that my surgical leg is now straight, and being so forces me to walk in a different way to what I have grown accustomed. And, the muscles in my leg, both upper and lower, are drawn and sore which adds stress in strange places. But the main issue is having to do with the nerves running down my leg. Whatever it is, she helped. The pain is not nearly like it was two days ago. In fact, I was able to walk quite a bit after the PT appointment. Some pain remains, but I am trusting that it will diminish completely over the next few days.
The PT will begin to address the issue of lower back pain that I have been plagued with since 2007. This problem has to play a role in what is going on up and down my leg.
21 days out – God is good! BTW – 120 degrees ROM today!
My ankle continues to plague me today. It seems to be a little better than Friday evening or Saturday, but it is painful to walk on. Having to “give” to it is making it more difficult to negotiate the knee as well. Everything seems to be out-of-whack.
I did manage to walk 1 mile today, and do all my exercises. Not sure if this was good or not. The issue with my ankle feels like tendonitis. If it is, the best solution would probable be to not use it for a few days. If I do that, it will be a negative aspect to my knee therapy. Glad to have an appointment with the PT in the morning!
Physiotherapy today – massage thigh muscle, and calf muscle today. The PT put me on the stationary bike – and lowered the seat two notches. At first I was unable to peddle through, but after taking it very slowly I was able to go both directions. 115 degrees ROM today!
When I walked this afternoon I began to have a pain in my left ankle. It felt much like a shin splint. There was no obvious location of pain, just felt like tendonitis. It was very painful, even to the point that I discontinued walking. Not sure what is going on with this event.
Continuing with exercises, elevating and icing – this never stops!
Today is my first follow-up visit with the Orthopedic Surgeon. He said everything looked great. They removed all bandages, he told me I could use only one or no crutches, he gave permission to drive, and I can now take a shower (getting the wound wet). Next appointment is in about a month.
Today was a good day! I had an appointment with the PT. Of course she massaged my thigh muscle – YIKES! I was able to pedal through the stationary bike in both directions, and my ROM was 110 degrees. A good day indeed.
Continuing daily with exercises, walking, elevating and icing.
I am more able to sleep though the night, not experiencing as much pain as before. When I speak of pain I don’t believe I have ever experienced more than a 5 on a 1 to 10 scale. Other than when the PT massages my thigh muscle! But it is not long lasting, and the benefits certainly out-weigh the pain.
I visited the Orthopedic Surgeon’s office today in order to get the bandage changed on my knee. The wound is looking really good.
After having the dressing changed I had an appointment with the PT. She spent a long time massaging my thigh muscle. Again, this was SO painful. I believe I could have cried if I let myself! She gave me two new exercises – sitting hamstring stretch and standing hamstring stretch. I was able to make a backward round on the stationary bike today, but not a forward round. My ROM has increased to 105 degrees.
As soon as we returned home I slept for over two hours. I was exhausted! When I awoke I did my exercises and walked. Then elevate and ice.
Today we were visited by a couple of our missionary colleagues. They are stationed in West Africa, but were in the Johannesburg area for holiday. They drove to Pretoria to see us. We sat at a local restaurant, had breakfast and visited for several hours. It was very enjoyable, but I paid a price for it later.
I discovered that sitting in one place too long brought a more pronounced level of pain. My knee throbbed and ached for several hours – even with elevation and icing. I am not as strong as I would like to think that I am!
Today is my second visit to the physiotherapist. The PT massaged my calf muscle because of the tightness. This was the most pain I have felt since the beginning. She performed a deep massage and tried to work out all the tightness. After the massage she used a suction cup to draw blood to the tissue in my calf.
I flexed on a stationary bike, not able to pedal a full round either forward or backward. ROM today remains at 90 degrees.
The PT taped my leg in an effort to eliminate the bruising. Surprisingly, this worked really well. Within 2 days the bruising was gone where the tape was.
Continuing to exercise and walk. I have not had very much pain during this process. But, I am unable to sleep through the night. I usually awake around 0300 hrs. I am awake for about 1 to 2 hours.
I am not sure if the pain in my knee wakes me or if the uncomfortableness of sleeping on my back does it. I am able to take my pain medication and go back to sleep in a couple of hours.
Not so much taking place today. Exercises, 4 times today and walking around the parking lot several times during the day. After each session of exercises or walking I would elevate my leg and put an ice bag on my knee.
So, a regular day consists of: exercise, walk, elevate and ice. No magic bullet, just hard work.
Each of the exercises are used to increase ROM (range of motion) of the knee.
It is the second day to be home from the hospital. I didn't sleep much last night, it wasn't because of the pain, more the uncomfortableness of sleeping on my back. Today begins the rehab in earnest, exercises, stretching and walking.
Complete each exercise 10 times. If you are comfortable with the exercise, increase the repetitions by five times each week, until you reach 20 repetitions:
week one: 10 repetitions
week two: 15 repetitions
week three: 20 repetitions
For the most comfort, do your exercises lying down. Your bed is an excellent place to do your exercises.
Ankle pumps and circles
Bend both your ankles up, pulling your toes toward you, then bend both your ankles down, pointing your toes away from you. In addition, rotate each foot clockwise and counterclockwise, keeping your toes pointed toward the ceiling.
Leg slides (abduction/adduction)
Slide your leg out to the side, keeping your kneecap pointed up toward the ceiling. Slide your leg back to return to the starting position. You may want to use a plastic bag under your heel to help it slide easier. Repeat with opposite leg.
Heel slides (hip and knee flexion)
Bend your hip and knee by sliding your heel up toward your buttocks while keeping your heel on the bed. Slide your heel back down to the starting position. Keep your kneecap pointed up toward the ceiling during the exercise. You may want to use a plastic bag under your heel to help it slide easier. Repeat with opposite leg.
Thigh squeezes (quadriceps sets)
Tighten the muscles in front of your thigh by pushing the back of your knee down into the bed. Hold for 5 seconds and relax. Repeat with opposite leg.
Lying kicks (short arc quadriceps)
Lie on your back with a 3-pound coffee can or rolled blanket under your knee. Straighten your knee. Hold for 5 seconds. Slowly lower your leg down and relax. The back of your knee should stay in contact with the can/blanket throughout the exercise. Repeat with opposite leg.
Straight leg raises
Bend one of your legs with your foot flat on the bed. Raise your opposite leg up (about 12 inches), keeping your knee straight. Hold briefly. Progress to holding for 5 seconds. Slowly lower your leg down and relax. Repeat with opposite leg.
Buttocks squeezes (gluteal sets)
Tighten your buttocks muscles by squeezing the muscles together. Hold for 5 seconds.
Butt Raise
Tighten your buttocks muscles and raise your pelvic region completely off the bed. Hold for 5 seconds.
Sitting Hamstring Stretch
Sit on edge of bed with surgical leg extended. Lift shoulders and back high into a straight position. Hold for 30 seconds.
Standing Hamstring Stretch
Stand with surgical leg behind the other leg. Bend leg closest to the wall and stretch the extended leg. Hold for 30 seconds.
Standing Back Stretch
Stand holding to the back of a straight chair. Lift surgical leg as high as possible and hold for 10 seconds.
Heal Slides (sitting knee flexion)
Sit on a chair. Bend your knee back as much as you can. Hold for 5 seconds. Return to the starting position and relax. Repeat 5 times.
Sitting kicks (long arc quads)
Sit in a sturdy chair. Lift your foot, straightening your knee as much as possible. Try to keep your knees level, as if you were holding a tray on your lap. Hold for 5 seconds. Slowly lower your leg down and relax. Return to the starting position and repeat with opposite leg.
Chair push up
Sit on a sturdy chair with arms or in a wheelchair. Grasp the arms of the chair. Push down on the chair arms, straightening your elbows so that you raise your buttocks off the seat of the chair. Hold for 5 seconds. Lower yourself slowly back into the chair. If your arms are weak at first, use your legs to help raise your buttocks off the chair.
Flex Bar
Place foot on bottom of the bar and position the feet in a position that allows a good stretch on the knee when the top of the bar is pulled toward the body. Repeat 10 times and hold the last time 10 seconds. Move the feet closer and repeat.
Here is a video of 4 of the exercises:
All of these exercises were difficult and painful but with each passing day they became easier, and I was gaining more ROM in my knee. I also would walk outside after each set of exercises, eventually working up to 1 to 1.5 miles per day.
My surgery was YESTERDAY! Can’t believe that it is over, I am so happy. I didn’t sleep a lot during the
night, although the pain was not that bad.
I don’t think it ever got beyond a 5 on the 1 -10 scale. It was probably the fact that the “sisters” were
continually in and out of the ward administering medication to the six of us. The Floor Nurse was one of the
first ones on the scene when everyone was getting up. He was concerned with getting a couple of us
dismissed that day. He said that unless
something changed, I would be out of there by noon. That did sound good to me, but I have to
admit that is also was a bit concerting to me.
I was only 24 hours removed from surgery, and they were sending me
home? The OS had explained to me that
his goal was to get his patients out of the hospital the following day if possible because he
felt that it decreased the chances of infection. His words, “After all, this is a hospital and
sick people come to the hospital. Who
knows what germs they are carrying!”
Sounds good to me! One of the sisters came in to
dress my knee and remove the drain tubes before my departure. Yikes!
Drain tubes
Incision
So, with everything ready, all the
paperwork signed, a list of prescriptions to be filled at the hospital pharmacy
on the way out and my wheelchair driver dutifully waiting – away I went. If I thought this would be easy I was
mistaken. Getting into the car was by
far the biggest challenge to this point in time. With the help of my driver I finally made it
though.
Getting home and situated inside
was not difficult. I was so tired and
drained that I went straight to bed. I
am not sure how long I slept, but I did sleep!
After I woke up I walked outside around the parking lot.
The big day! Nurses were in the
ward by 5AM administering medicines to all of us. The first one that came to me
asked, “And what are we doing for you today?” I thought it a bit strange that
she would ask that question, especially since she was holding my medical chart,
but I told her that I was having a LTKR. She gave me pills, started an IV drip
and then put an “X” above my surgical knee with an ink pen.
"X" & smiley face mark the correct knee for surgery!
The ward was very active, and I
was number one on the surgery list for the day. By 0730 an attendant arrived to
wheel me to the theater (name used for operating room in South Africa). Upon
arrival, I was greeted by a new sister (name used for a nurse in South Africa).
She looked at my chart, asked me my name and DOB, then asked, “And what are we
doing for you today?” Really, doesn’t anyone know what they are doing for me today?
I kissed my wife and told her how much I loved her, then they wheeled me to the
coldest room I have ever been in.
And away we go!
OR holding
In the theater, I was asked three
more times, by three different people, “And what are we doing for you today?”
Finally, when the last one asked this question I asked the OS if there was no
one on his staff that knew what was going on. He laughed and assured me that it
was standard operating procedure to ask the
patient repeatedly what was taking place.
"And what are we doing for you today?"
Okay, I'm ready!
The anesthetist had me sit up as
he administered the spinal block. He told me that my bum would start to feel a
bit tingly and then it would travel down my legs – it did! They laid me back
down and a sister put a breathing mask over my face and told me to breathe
deeply – that’s all it took, about 5 seconds of that and I was totally out.
"Are they finished yet?"
The next thing I remember I was
being wheeled back to the Orthopedic Ward. I don’t even remember being in the
recovery room. I was a little groggy, but alert enough to know that my wife was
with me and that was what mattered the most. I had no feeling in either leg or
feet. The dressing around my surgical knee seemed enormous and there were two
drain tubes extending from the wound. I had also been catheterized during the
procedure. The bag collecting urine seemed to have an excessive amount of blood
to me. I asked the sister about it and she had someone come to look. The head
sister deflated the internal bulb a bit, stating that it might have caused a
problem. About 20 minutes later another sister came by to check it and the tube
had completely disengaged itself from me all on its own.
Can you wiggle your toes?
Within 4 hours most of the feeling
had returned to my legs and feet, with the exception of my surgical foot. It
did not seem to have much feeling at all. The sister explained to me that
during the operation the OS “freezes” some of the nerves that run from the knee
to the foot and it would take longer for the feeling to return to that area.
Using a walker, “frame”, I was able to get out of bed and walk to the toilet
with help. I passed
a lot of blood in my urine.
The physical pain during the day
never exceeded a 5 out of 10 for me. I was fairly comfortable all day. The OS
came by to check on me, telling me that all went well and that he saw no
problems except the blood in my urine. He said that he talked with the sister
in the OR and she told him that she inserted the catheter with no problems and
there was a good flow of urine. The OS seemed to think that they might have
inflated bulb in the upper bladder. He also
said that it could have inflated on a polyp. He said that he would probably
order an ultra-sound on my bladder in a few days to make sure nothing was going
on there. I was able to eat and walk to the toilet two more times throughout
the day.
Today is the day.
This has been a very long time in the works, but the time has finally
arrived. I check into the hospital in
about 5 hours. Tomorrow morning, I will
receive a new left knee! I do not
anticipate any problems and, in a way, I am looking forward to this process.
Being able to walk without experiencing the popping and
grinding of bone-on-bone will be quite a change. I hope the right knee will be able to pick up
the slack while my left knee becomes strong again. And just think, I get to do this all over
again in a few months when I trade in my right knee! Checked in at 1500hrs to Life Wilgers Hospital in Pretoria, South Africa. I faced the normal barrage of never-ending paperwork, only to discover that I could have (should have) come a few days earlier for pre-admission which would have avoided this process. After being admitted I was handed a folder containing all my medical information and then sent to the second floor to the Orthopedic Ward where I was assigned a bed. This was a six-bed ward, and I filled the last open space. One gentleman was there for the same reason as me - LTKR; one was there for a left shoulder replacement; one young man was there with complications of a hip replacement gone bad; one man had already had a RTKR and the final one had some sort of back surgery. We all became acquainted quickly and exchanged pleasantries. I must have been more anxious than I realized. When the nurse took my BP it was 197/84. I do experience high blood pressure - even take meds for it - but it has never been 197 before to my knowledge. They took my BP several more times before bedtime and it did recede, some. My wife was able to stay with me in the ward past the posted visiting hours, but she left in time to return to our place of lodging prior to darkness. After her departure I was visited by a gentleman who measured my legs and gave me a pair of the compression stockings to wear. I was to put one on my non-surgical leg immediately, then instructed to put the other one on my surgical leg after the surgery. Then the anesthesiologist came by to explain that he would be using a spinal block and he would put me to sleep, but it would not be general anesthesia. In his, and the OS, words, "Recovery is much better using the spinal rather than a general". After visiting hours were over, I rested well throughout the night.
I had a meeting with a third doctor and my physiotherapist yesterday. This doctor is acting as a liaison between my insurance carrier, the hospital, OS and myself. He is a God-send. I do not have to deal with a lot of issues that would normally be overwhelming.
The physiotherapist was very nice and reassuring. She told me that I would probably be in the hospital a day or so longer than what the OS indicated. She will meet with me just a few hours after the surgery and begin PT almost immediately.
I feel very comfortable with all that I am facing. Can’t wait until Sunday afternoon when I check into the hospital. Surgery will be the following morning.
In exactly one week I will be in the theater having my left leg opened at the knee. This should be a frightening thought, but really it is not. I am anxious to get on with this process, even though I realize it will be long and it will be difficult. Again, I will be glad to start AND finish.
The appointment with the physiotherapist today has been changed to tomorrow. I will meet him/her in the morning. From most all that I read this person could be my worst nightmare, but hopefully that will not be the case. This person could turn out to be my new best friend. I will think like this presently, and wait until the actual rehab starts to make a final determination.
An appointment with the primary care physician is the
priority of the day. The doctor
conducted a complete and thorough physical including a stress test for my
heart. With the exception of a slight
infection in my nasal passage, which will be dealt with by an antibiotic
ointment, everything was in order and the doctor gave his approval for the
surgery. The physiotherapist is the only remaining appointment that I
have prior to the surgery. The PT will
give directions for pre-op activity as well as setting up the schedule for
post-op rehab.
My wife and I are staying in a two-bedroom apartment during
our time in RSA. It is comfortable and
so much better than a hotel room. There
are a few areas of concern though, such as the sofa which is fairly low to the
ground and difficult for me to rise up from.
Since sitting and standing will be difficult after surgery this could be
a challenge. One of the bedrooms is furnished
with a king-sized bed and the other is furnished with two twin beds. The king-sized bed should be fine, but if it is
a problem I can always move to one of the twin beds. Another issue will be the fact that there is
no shower in this apartment, only a tub with a hand-held shower wand and stepping
over into the tube may prove impossible.
Considering all these issues, I am truly grateful for the
accommodations, it could be so much worse!
It is winter in South Africa. I know, you don’t consider that Africa can
have a winter season but it most certainly does. The nights and mornings are nippy to say the
least. Temperatures hover around 37 to
40 degrees. It does warm up in the day
time, but the rooms remain cold. All in
all, it should be perfect for those short mini-walks that I will be taking
throughout the day during my recovery.
Planning for major surgery (TKR) can be difficult anytime, but when you live in Liberia, West Africa it is even more difficult. The issues with insurance, doctors, hospitals, logistics and location are quite formidable, and communication is another major issue all its own.
You are probably wondering why I would deal with all the obstacles, why not just travel to the States and have the surgery performed there especially since that is where our permanent residence is located. The answer to this question is the easiest part of the entire ordeal, insurance. Our medical insurance encourages us to have all of our medical issues taken care of outside the continental United States. In fact, 100% of this TKR is covered by our insurance IF we have it done outside the USA. If we go to the States our insurance covers the normal 80% of allowable charges which means the remainder of costs are out-of-pocket for me. Considering all the issues, I opted to have my TKR done in the Republic of South Africa. RSA has some of the best medical care in the world and rivals most options in the United States.
My wife and I departed Liberia on July 16, and arrived in South Africa on July 17th. My first visit with the orthopedic surgeon was on July 19. All of medical records, including the x-rays from the orthopedic surgeon I visited in the States, were sent to my surgeon here in RSA prior to my arrival. Upon arrival at the surgeon’s office, I was directed to the radiology lab for a complete set of new x-rays. To my surprise, the radiologist handed me an envelope containing all the x-rays after they were developed, and I was instructed to carry them back to the surgeon’s office.
The meeting with the surgeon went quite well. He is very personable, well-disposed and knowledgeable. He performed an extensive exam, viewed the x-rays and without any hesitation at all agreed with the diagnosis given me, almost a year earlier, by the orthopedic surgeon in the States. Surgery was scheduled for August 1, 2016.
The surgeon’s office staff sent me to the on-sight lab to have blood drawn and a complete analysis work-up for the primary care physician that I would see the next day.
If you have decided to join me there is no doubt you are
facing the same journey, or you have already traveled the path, of TKR (total
knee replacement). Either way, you are
welcome. Please feel free to leave
comments, words of encouragement and of course prayers. There is an African expression that says,
"If you want to travel fast, go alone.
If you want to travel far, go with others." Together, we can travel far.
Hard work has been a way of life for most of my 63
years. Lifting and carrying heavy loads
in the West Texas oil fields certainly placed a lot of tension on my knees, and
I felt that this surely was the cause of my problems today. My doctor assures me that my condition is
more probably due to genetics than the hard work. For many years my mother endured the pain of bad
knees, but it was long before TKR was even a possibility.
For longer than I would like to admit, ibuprofen and pain
were my daily companions and they have finally forced me to face the inevitable,
an appointment with an orthopedic surgeon.
His diagnosis was really no surprise: degenerative joint disease
(osteoarthritis) with the recommendation for TKR in both knees. I decided to wait before I made any rash
decisions. After all, I have been
suffering with this for several years, why get in a hurry now? So, after another full year of pain and
limited mobility, it is time for action.
When I decided to embark on this journey I began to research
TKR, and I looked for people that had walked this path before me hoping to
glean from their experiences. A lot of
information was available in fact, there was enough to throw me into
information overload. But it seems that
the personal stories of others were what brought me the encouragement I needed. For this reason, I have decided to keep a
blog of my own journey through TKR.
Maybe someone will find encouragement in my story, and I will find a way
to express my victories, failures, bad decisions and good ones.
