PT---Down to one more week

The therapist today remarked that my leg extension is 180 degrees, completely flat on table.  Prior to surgery, I couldn't even make my leg touch the table.  She said often in those cases, patients have difficulty, and often need additional therapy or surgery.  I told her the doctor said he wanted to do that leg first so he could straighten it.  She said it's better not to know how that's done.  (I picture a football player with a sledgehammer.) She said that's what surgeons do; a patient she knew some years ago had his knee replaced by the eminent Dr. F. (since retired), and the patient asked him about what kind of medicines might be helpful.  Dr. F. replied, "Damn it!
Don't ask me those questions.  I don't know about medicine; I'm a surgeon; I do carpentry.

Diminishing Descriptors

  I am no longer anyone's granddaughter, daughter, niece, employee, advocate, lector or teacher.  Wife, mother, sister, cousin, grandmother still apply, but the tipping point approaches when these identifiers too become irrelevant, stripping away all but concept of self.  Maybe that's why people go to the gym, or into therapy of one type or another---to avoid being defined by one' s relationship to others. 

Even Therapists Take Vacations

   I learned today that Sandie, my physical therapist, will be away next week on vacation.  So next week,  I'll have a different therapist.  The Government has July 3 as the end date of my therapy, and so I can't skip a week and wait for Sandie to return.  She will be back in time for my 2 last sessions, and to write up my paperwork.  The week after that, I return to the P.A. in East Greenbush office this time; I don't know what to expect from him.  After that, I believe I'll see the surgeon, don't know what to expect there either.  At initial consultation, he was reserved in his suggestions, advising that I may want to go home and think about it and  talk it over before deciding on surgery.  But in the hospital, he blithely said for me to have the other knee replaced also, and Danny said he used the word terrible or awful or such to describe the knee, so who knows what lies ahead.  Everybody has to be somewhere.

Therapy

    Tuesday  marked the 4th week since my TKR, and my third week of physical therapy.  Although the woman who motivated me to seriously consider the surgery warned against out-patient physical therapy,saying it was too rigorous,  I have to say I have found it to be interesting, effective, and not brutal as described.  Today the angle of flexion of my right knee was 122 degrees, which the therapist says is the normal range.  But of course the normal flexion at that range would not be painful, as it definitely is at present.  But the pain will lessen as the knee gets used to bending that far. 
   It seems strange to be receiving comments that my progress is extraordinary, and I have to believe it because everyone from the nurses in the hospital to the home health workers, the P.A. and the physical therapists at the Rehab Center remarks on it constantly.  I have never been particularly athletic or overly motivated, so I have to believe the surgery was a kind of fortunate fluke.  The surgeon who operated on me performed 8 ortho-surgeries last Friday, and he has used the newer Signature implant many times before, and evidently without such striking results.  I've watched several different real-time videos of the procedure, including one on a cadaver, and the only observation I made  that could account for my super range of motion is the way the surgeon manipulates the leg after inserting the implant, to be sure the range of motion is good. It looks like the leg is flailed back and forth like a dead fish.
    And there's something I don't understand about anesthesia; supposedly there is a nerve block to prevent pain, and then the administration of the type of sedation that is not general anesthesia, but rather the kind that just makes you forget what  has happened.  I don't buy that; I'm sure I'd have some memory of the sounds of the cutting and the hammering, but above all if I were even minimally awake, I know I would remember somebody putting that white elastic stocking on my other leg.  How could anybody force your leg into a tight tube without your knowledge if you had any consciousness at all.
    But for me the most interesting part of attending physical therapy is a feeling of independent autonomy.  I'm one of the few people I know who has never  been in a gym, not even Curves, which attracted almost every woman I knew a few years ago.  So it's all new to me, and all I have to do is walk into the room, where I know nobody and they don't know me, or anybody who knows me.  It's all a clean slate, and the therapy is all there is.  It is a simple thing; almost Zen-like.   I find it easy to detach myself and just concentrate on the activities.  Possibly that's why I can work through the discomfort and even the pain.  My patient advocate in the hospital said there would be real pain, the woman skipping around the polling place last November was advocating the surgery, but advising me to say no to the on-site therapy, and even my orthopedic surgeon said I would be hating him at my appointment after rehab was completed.  No exaggeration--I hear the words tough, stoic, amazing, remarkable, unparalleled.   I don't have any explanation, but it is gratifying for me to have a straight-line focus where I am able to do something which is known only to me, and of course to you, Oh Blog.

Birth of a Knee

The revised knee is 3 weeks old today. I have been driving my car since 13 days after surgery.  The scar is healed, the swelling is mostly gone, the physical therapist seems to have run out of exercises for me, and I pretty much forget about the surgery during the day, so what's the big deal about a total knee replacement.  It's more like having a dental crown-like cap placed on the ends of your leg bones with the insertion of a small cushion for separation.  Truthfully, I'd rather have my bones worked on than my teeth anyway.  I still get nightmares over a tooth restoration process called a crown-lengthening which was once proposed but turned out not to be.  I still think about the surgeon I almost went to who has all his patients restricted to a walker for 4 weeks.  Word is he's very good, but 4 weeks with a walker!

Time in Hell

The zone of discomfort, formerly 5 seconds, has been expanded to 10 seconds.  If pain can reach the apex of sublime, does time matter?  If you've lived a wonderful life for many years, but die in a spasm of agony, does the end cancel out all that has gone before?  (As far as you're concerned anyway.)

Rehab #2

Sandie, the therapist, told me that Dr. Marotta, who is one of the top orthopedist docs in Troy, restricts all his TKR patients to 4 weeks in the walker.  I had considered him for surgery, but am so glad that I'm not using a walker.  I think I'd be stir crazy if I had another 2 weeks of "invalidism."

Threshold

I'm stoic, I've been told, that I have a low threshold of pain.  But I think that should be a high threshold of pain, if the threshold is the point at which you begin to feel pain, or at least react to it.  This term is similar to the dreaded double negative;  I'm still working on the line from "The Man Without A Country" :  "He loved his country like no other man has loved her, but no man deserved less at her hands." 

Re-hab #1

Though I've had 4 Home Visits which included light exercises, today was the first visit to the Facility.  The worst part was waiting; the room was cold.  The next downside was watching while the other waiting patients were joined with their therapists.  One by one, I discounted the therapists as unsuitable for me---too goofy, too sullen, too cavalier.  I was already planning to take back my scrip and go elsewhere.  I despise hospital settings anyway.  Matters didn't improve when I dropped the clipboard on my "bad" foot, skinning it slightly,  but they did give me a bandaid.  Then my assigned therapist introduced herself to me, and she seemed like the ideal therapist.  She took all the salient information, measured the affected parts of the knee and entire leg, and then the other leg for comparison purposes. One detriment of having my severely crooked and grotesque right leg straightened with the insertion of the knee implant  is that the right leg is now just under 1/2 inch longer than the left.  So until the left  knee is replaced with the accompanied straightening of that leg, I could benefit by a shoe insert in the left shoe.
   Went through all the usual exercises, and a few new ones.  Only one put pressure on my lower back in area once home to herniated disc, so she agreed to eliminate that exercise.  Another was new to me, and one of the few where the therapist is involved, forcing my knee backward into the "zone of discomfort" and holding it there for 5 seconds.  Okay, no problem, 5 seconds is just that.  She told me later that most people yell out during that maneuver, and for the third time this week, I heard the word tough used in connection to me.  I AM A PIONEER.  
   Sandie, my therapist, told me that I have had the fastest recovery at this point of all the patients she's had, not even adjusting for age.  She said the progress so far was amazing.  Again, I could wish that I was being commended for some other life accomplishment, but at this point, I guess  I'll just have to go with what comes my way.  We ended the session with me on an enormous exercise bike, pedaling away to an Adele song---and even that didn't bring me to tears.

First F.U. Appt.

One day short of 2 weeks from surgery, I receive clearance for everything but soaking my knee or swimming.  I am okay to drive, I'm told.  I know I could have safely driven a week ago, but decided to wait for the official word.  But the naysayers have doubts:  "What if you need to stop really fast and need to stomp your foot on the brake with full force?"  "How can you drive with that horrible looking incision still on your knee?"   "What if......?"
I guess I'll just sit here and have other people haul my carcass around.   And then when I get to Rehab, I'll break into tears because it's so darn hard.  That's me, all right.

Cipro

 After you are prescribed a powerful antibiotic, such as Ciprofloxacin, be sure to roll in the dirt and wallow in the mud.  You do NOT want all of your germs to be dead.