When Three Degrees Can Mean So Much

The two main areas that the physical therapists have focused on are knee flexion and knee extension. The picture above is an example of a knee extension exercise: you place the heel of your foot on a surface like another chair or a table and then relax the knee, let it hang there. Then push it down even farther, using your hamstrings. The aim is to get the leg to zero degrees - straight.

I have no idea when either of my legs was ever straight. I am guessing it's been 20 or 30 years at this point. Now I have a chance to get it there and keep it there. But it's been hell, the getting there. When I left the transitional care center I was at -8 degrees - eight degrees from zero. By the time I met with the at-home physical therapist, Wade, I had gone up to -12 degrees. That's the wrong direction. We worked on it and worked on it and last Friday it was back to -8 degrees. Over the long weekend I have been working it and it simply does not seem to get straighter. I admitted a feeling of lack of progress to Wade when he arrived this afternoon.

You do know that "physical therapist" is another name for "torturer"? Just so you know.

As Wade put it, his friends said, "you're in physical therapy school? I bet you give great massages!". He said they never asked a second time, because "we accomplish something". When he pushes on a muscle you know it, and it makes a difference.

So today we worked on various techniques to loosen the joint: moving the patella back and forth, up and down, and wiggling it when it got to each place; pulling on different parts of the joint (this was Wade's action); massaging the leg to loosen up the edema, massaging the wound, and then lying on my back and pressing my knee into the mattress to a count of five breaths, working harder with each breath (then letting it relax and doing it again, ten times, 11 times, I forget how many). The first time I pushed into the mattress Wade pushed it further and I gained another three degrees - for a measurement of five degrees from zero. After that, I had to keep doing it to maintain those extra degrees.

It feels so good to get that little bit of extra movement! I'm newly energized.  And did I mention - no pain meds today??

I Can Drive! I Can Drive!

But don't be calling on me to pick you up any time soon. This driving thing, even with an automatic, takes it out of me right now. I am not in a hurry to drive around just yet.

Daughter Elaine left for home at about noon today. She helped me a LOT while she was here. I could get used to this invalid situation, almost. It is really nice not being expected to dive in and do this and do that, but instead just to sit back. Elaine took off with my car, a manual shift, and left me their automatic Toyota Corolla.

I had to fill a prescription for Percocet, because mine ran out. I decided to go to CVS because it's closer and smaller than Costco, even though I knew it would cost more. It took just as long, about 20 minutes.  Getting in and out of the car was a little hard on my knee but not bad. What's clear is that I won't do any long drives soon because my leg would stiffen up soon and be that much harder to get out of the car.

I'm not sure where the energy went but it may have something to do with the difficult nights. One more week of this brace and there should be at least some relief in that department. As for now, nap time.

Bella Bella and More

My daughter arrived Wednesday evening, with dog Bella (see above). Bella is the type dog that has a lot of energy and needs to get out and use it every day. If she doesn't, she goes a little crazy. So Elaine brought her along so she could be company when Elaine hikes or walks and to make it a good time for both of them.

What neither of us expected is that scaredy-cat Peanut (also see above) would not freak out with Bella around. I'm not saying he has gone all lovey-dovey with Bella, but he is not much bothered by her, either. Usually, when faced with another person or animal, Peanut takes off as fast as a speeding bullet, far faster than his heft would suggest he could do. 

Thus the Bella visit has satisfied yet another need: to see how Peanut would react to having a dog in the house. And everyone is getting along with harmony, at least as well as one can imagine. 

Yesterday was another physical therapy day. Toonces loves these visits. He tried very hard to help, too. When Wade was massaging the "ropy" threads in the back of my knees (that should not be there, that need to be broken up), Toonces naturally wanted to do some kneading of his own. But of course he did not retract his claws sufficiently. He means well.

There is much to do yet, to get this knee to bend both directions as much as it should. It feels discouraging at times. But I have had a couple of nights of decent sleep without the intense pain (mainly because I took the nurse's advice and took Ambien plus two Percocet tablets before going to bed) and I think this helps my outlook a bit. I still have a fentanyl patch on my shoulder, but when it comes off tomorrow evening that will be the end of that, and I am thinking I will be fine without it. Being able to do the exercises during the day, without having to add extra pain relief, is a great thing. 

Quality, Not Quantity

Yesterday I worked with a professional organizer for four hours, met with the home health nurse for about an hour, and then with a physical therapist for an hour. In between I honestly had difficulty getting any food in me, and I felt a little stressed.

The organizer and I got a lot done but there is a lot yet to do. I like her approach: it makes a lot of sense to work from broad strokes to finer ones. So we organized one file drawer and several parts of the office in a more general way that can be refined over time. Later I took out a waste basket full of trash and another full of recyclables, and several items ended up in the donation pile, which is currently behind the door into the office. I made an appointment with her to continue next month. By then I hope to have solved at least one of the spacial problems that remain in the office.

The nurse said I was no fun. Nothing much for her to watch, frankly. The wound is healed and looks great; I don't have other health issues, like diabetes or heart trouble, and I am managing the meds well for now. I told her I do have difficulty with pain at night. She had no magic solution. I will keep trying to find some way to get through it.  She will come back Thursday and very likely will take my blood to check the Coumadin effects. Gradually I will be off that blood thinner altogether, which is good news to me.

The physical therapist, Wade, mostly did paperwork (as did the nurse, actually), saying that of all the different places he has worked, the home health agency requires the most. It really seemed endless. Finally he watched me walk, watched my simulate using the toilet (I really do need a 3-in-1 commode to fit over the toilet, but not for long), and watched me get on and off my bed. When on my bed he checked the range of motion and extension of my knee. He showed me an exercise to help the extension (straightness) of the leg, to use in addition to those I already know, and said to group my exercises into those that deal with extension and those that deal with range of motion, and do one of those sets in the morning and the other in the afternoon. This seemed contrary to usual exercise practice to me, so I asked why. The reason is that working different ways on one goal does help stretch it out and warm it up. Makes sense.

He said he really likes to take this opportunity to get rid of the bad habits we develop when we have knee problems, so that we walk well, not just "good for having a knee replacement". To that end he suggested yet one more thing to think about when I walk around. I am thinking about exaggerating the heel-to-toe movement, lifting my leg consciously,  aiming for the inside of my foot when I step (to put the weight on) instead of the outside (as I have done all my life) and now I am to push the leg back to get it as straight as I can on each step.  This is a lot to think about as I walk. And on that note, he said, "Think quality, not quantity". "We know you can move," he said, so the aim is to move really well. I can agree with this goal wholeheartedly. I don't want to be limping for the rest of my life, but instead walking gracefully and with good balance. Again, yay physical therapists! You creators of better lives.

Interestingly, the nurse is almost-vegetarian and the physical therapist is vegetarian. So neither had any quarrel with my being vegan, even commended me for it.

Today I am following up on some of the work we did organizing, and doing the exercises as recommended by the therapist.  It's slow going as I am not exactly full of energy. These nights, even though I do sleep, do take it out of me and I find myself collapsing into naps now and then. If I could put off taking naps I might do better at night, but lordy, that is hard!

The Good News Just Keeps Coming

I had an appointment with the surgeon this afternoon. First a tech took an x-ray of the knee face-forward and one from the side. Then Dr. W came in. He said the x-rays look great, everything is as it should be. He then looked at my knee scar and asked about how much movement I had gotten. I told him 98 degree bend and -8 degrees on the knee extension. He said that was great.

I asked if there were another, perhaps smaller, brace that I could change into. He said unfortunately no, this is about all there is for this situation. BUT I can take it off in two weeks, not three!  Everything is healing so well.

I asked about driving. I said I have a manual shift car but my daughter has offered to trade cars with her automatic. So when can I drive? "When you make that trade...and when you're off the narcotics". So that's good news! Not so wonderful news for Elaine, who offered this trade: she is going to drive eight hours each way for me. Otherwise she would have flown. This is very generous of her!

Finally, I asked when I could get the other knee done. Eight to ten weeks, he said. Wow. We'll decide whether I want to do this when I have my next appointment in about two weeks.  It seems like a good idea to go ahead about as soon as I can.  Anyway, I already miss those guys at the transitional care center.

Afterwards, dear Maryann gave me a ride to Costco to pick up a prescription for coumadin, and then to Vons to get some groceries.  I'm set for several days now, if not more.  Right now simple is my watchword.  Brown rice, potatoes, veggies, nothing that takes much time or effort to make, just yet. Gotta save the energy for other things.

Home Again...or is that Home Alone?

I'm both, of course, home again alone. Home alone again. Something like that. It is quiet except for the occasional excited chatter by cat Toonces, who has been trying to catch me up on what's been happening here.

I have taken a couple of naps and watched some recorded television shows. I have adjusted my brace about 50 times, which is average, and arranged my leg different ways. I have iced the knee, and I have walked around the house with my cane. I can see why the cane, I must admit. Although I can get around without it, I am able to maintain better posture and leg work with it.

I can manage everything in my house. No, I am not going to reorganize a lower cupboard in the kitchen, but other than that it is all as I expected, achievable.

Tomorrow I see the doc in the afternoon, and if I am up for it, I'll do a little grocery shopping, courtesy of driver Maryann of course. The following day, Tuesday, the professional organizer comes in to help me organize my office! One four-hour block mostly morning. I am going to have to be getting up and down during that time but I think that's fine. My main challenge before Tuesday is to move the four-drawer file cabinet to a different location. If I take one thing at a time I think I can do it.

Back to my book and a little television...

Rehab This!

Over the years I have developed ways of using my body that are not all
excellent. For example, I have walked on the outside of my feet since I
was a little girl. I don't have the best balance, and I am sure that
this is part of the reason, along with the disintegration of the knee
joints so that my knees met in the middle.

As I have worked with the physical therapists here, some of these
lifelong habits have come out, and the therapists have given me
exercises to help correct them. When I think about the future I see it
brighter in a way I did not previously conceive. I see my feet walking
straight and firmly, my ankles strong, and I see myself standing tall
and being balanced. And I wonder, why didn't I do this sooner? Or, more
correctly really, why don't we think about getting body checkups?
Whether or not we have knee problems? Wouldn't that be a good kind of
regular checkup,something that would be of real value?

The first time I saw a physical therapy department my impression was one
of wonder: this is where people do good things. I am even more convinced
that this is an area that needs to be brought out from the basement and
given greater exposure. We could all benefit.