3. A ‘Knee First’ Day

cropped-tuscany-sunrise1.jpgAdmittedly, my little adventure last night on the metro expanded to include looking at an apartment we are thinking of renting. Getting to it required two more sets of metro stairs, standing on the metro and climbing back down two flights of stairs plus walking an additional kilometer al tol.  This enlarged adventure came to a grinding halt when I started to walk from our last metro stop home. The tibia plateau on the lower leg began to shoot with pain and the thought that I was ruining my knee quickly got the better of me.  We took a Tuk Tuk, or a small motorized rickshaw the rest of the way home, and thankfully.  This morning, I paid the price by not being able to stand on my leg for any amount of time.  I cancelled a well-planned morning out looking at several apartments and settled on the couch for a day of serious rest. This means mindfully making decisions for the betterment of my knee, and not for my mind, others, and  “… house, home or hearth”.  Putting the knee first takes a certain kind of healthy selfishness and honesty, moving only if the knee allows me to or only if my bladder requires me to.  The illusion of ease putting the knee first is harder than I once thought, especially when feeling responsible for other matters in my life.  Given the trauma of working through a knee replacement and then a revised knee replacement finally settled in my mind that ‘knee first’ thinking is not only OK, but essential if the future is to be as orthopedically-free as one can be with joint replacements.

Exercises today

  • Anything that keeps me off my feet. Today that included organizing my photos online; answering some emails, (trying to) sign up for a grocery delivery service, watching some Netflix (online) and closing my eyes for awhile.
  • Practicing letting go of images and thoughts that leave me feeling older than I am, alone and permanently immobile.
  • Thanking those elements and people in my life that help me to feel hopeful and capable. Today, I am particularly appreciative of the working internet, my caring husband and my ever listening friend Jean. A big shout out goes to the real estate agent who readily and graciously agreed to postpone viewing the list of apartments she had arranged for us to visit today. I have something to look forward to and, given her lack of concern about the listings, allows me to feel patient for my own recovery from this hiccup.  We will soon get out there and on with settling in this city, thanks to her patience, that can also now be mine.

2. Revised Knee, revised life, unless moving house

                            Moving Chair                                       

Lesson relearned:  Establishing strength and stamina requires discipline – and a long, uninterrupted period of time, daily.

After ten days in the hospital, I lost a great deal of exercise time because we needed to complete a major move from Rome, Italy to Bangkok Thailand. Between July 12 when I had revision knee surgery and  September 24 when we flew out of Italy, we had to do what moving people have to do: sell many of our household items, arrange for movers, pay off utilities, demolished our car, thin out our supplies, scrub down the apartment and say goodbye to choice friends.  Thanks to a three-week visit from my sister, I was able to incorporate some physical therapy between these essential moving demands and was allowed a bit more rest in between activities.  And, thanks to a rolling office chair, I  was able to roll around the house doing what I needed to do when my knee was too tired or painful from bearing my weight walking or standing.  Even with the pushing and pulling required by the rolling chair, and my three-day a week PT sessions followed by some thera-band work at home, I did not know just how much I had regressed.

When I arrived in Bangkok, the first appointment I made was with an orthopedic specialist in revision surgery.  He made quite clear that I needed to resume physical therapy as if I had just completed surgery – I had regressed that much due to moving distractions. Thanks to his sound PT direction, I am now feeling stronger and more confident.

Here is what I now strive for daily, finally after 11 weeks and 4 days since my surgery.

Exercise routine for Strengthening 

100 Straight legged lifts = Straighten leg, lift 30-40 degrees off firm couch, bed,or  bench, with toes lifting towards knee.  Hold for ten seconds, leg down (completely!), repeat. Pull heel towards wall in front of you to help position the leg correctly.  Quads should feel tight and the knee should feel strong. Watch for hyper extension of the knee and adjust.

100 Hamstring lifts = On same firm couch, bed or bench and with firm rolled blankets or pillow or cushion under your pelvis, bend knee towards buttocks to a 25-70 degree angle.  Feel for an angle that tightens your thigh muscles and pulls from your buttocks, keep lower pelvis pressed into the cushion so that your lower back straightens rather than crushes your lower vertebrae. Hold bend for ten seconds, bring leg down (completely), repeat. Hams should feel nicely tightened after this routine.  Check for more shapely legs in a week!

 Exercises for Stretching

1)  Straight legged bend = Sitting straight backed, legs straight out in front of you, lean chest towards knees keeping back straight – feel the stretch for 10-20 seconds, release. Repeat.

2) Knee Bends =  Stand and with hand or belt,  grasp ankle and bend knee behind you, hold until the knee joint tells you to stop and or/ the front quad stretch has been exhausted.  Repeat 2 more times, several times a day.

3) Various Yoga twists that massage the spine and that stretches the Iliotibial Band

Exercises in a Pool

1) All stretches named above, using the ladder into the pool to hold the ankle or to flatten both feet to reach for a Hamstring/Iliotibial stretch.

2) Bicycle motion for endless periods of time (usually between 10-20 minutes).

3) Straight legged crawl kick with or without a floating device (5-10 minutes). If you are a swimmer, enjoy swimming the crawl but mind the need for straight legs while doing it.

4) Kickboard drops = With kickboard, hold board down with revised knee leg, let board rise, push down, lift and push down repeatedly (i.e.3 sets of 20 per).

5)  Walk backwards in water levels that you are comfortable with. The lower the level the more weight your knee bears (5 minutes) .

6)  Walk forwards (5 minutes).

7) V to l – shaped sitting kick =sitting in deeper end of pool, press lower abdomen muscles towards spine using arms to hold you up, separate legs from hips to either side of your torso, turning feet toward each other press legs together.  Turning feet away from each other, push legs apart. Repeat (60 times).

8) Leg Pulls = In lower end of pool, bend knees and lower body so that when the legs straighten out in front of you your chest to neck remain out of the water. Bend knees, take revised leg and straighten it out in front of you with the heel down on the pool floor.  Require the leg to pull you forward until your straightened leg is now bent under you. Repeat with other leg. Right then left.  Feel the quads tighten and the ham strings work (5 minutes).

Walking:  1.5 hours today in humid Bangkok.  Home rest of the day. Still stiff legged and out of balance. Lower leg pain restrains me from walking anymore than I have today.

Golden Rule: Do not feel pain to gain strength. Feel tightening and then release. Feel for agreement by the knee to accept these exercises. No acute pain allowed, and no additional swelling encouraged. Tailor these exercises to your needs. Enjoy your icepacks afterwards if needed.

CHALLENGES:

I have about one hour’s worth of walking stamina to manage the out of doors in humid Bangkok.  Having the stamina to walk to metro stops and to grocery stores and back are currently a real challenge. Pavement is bad, sidewalks are crowded and traffic does not stop for pedestrians, even if they use the zebra-stripes….Today, I will take the metro two  stops and back, with a half hour walk in between and a meeting in the late afternoon, a few stops north.  I trust this will work….?

What do you do on a daily basis?  What are your Challenges?

1. The Journey Begins

 

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Good company on a journey makes the way seem shorter. — Izaak Walton

Hello and welcome to my blog site.  This site serves to provide companionship to those who share the (growing) minority of people required to invest themselves in a revised knee replacement.

My revision story began three years ago when I started experiencing acute and shocking moments of pain in my left knee.  One day of rest would usually calm the joint and off I would go again to swim laps, hike park paths or walk the cobblestones of Rome where I was living for ten years.  Eventually these moments of pain elongated into 2 to 3 days of complete bed rest to control swelling and pain that came from one twist, one stumble or one oddly stepped moment in my daily activities.  My circle of friends became accustomed to my carrying a cane or a pair of crutches when we met.  They also understood my situation when I would call to cancel a planned arrangement with the statement, “It went out again.”  Sitting at a café or office table with an additional chair to rest the leg was commonplace.  When I taught, the additional empty chair was for my knee, not another student.  Then on March 28, 2018, seemingly out of the blue, I took my first step from the bed and could not believe the acute shooting pain that enveloped only the knee joint.  Every step after that was excruciating.  My world became the path from the bedroom to the bathroom to the kitchen and back again, if I had to really use the other rooms.  A week later, when I could finally get myself up and to a doctor, fitted with a knee brace, poked for blood tests to rule out infection, and x-rayed for hints of cause for the pain, I began a methodical route to the surgical ward for a revision of the knee (a full story of this phase is coming up on a new page).

I trust my recovery period will evolve into more self sufficiency and confidence.  Orthopedic specialists both here in Bangkok and in Milan and Rome, Italy tell me to expect a year before I feel truly able. I believe them. Knowing myself, I also believe that I will not waste a moment to push myself in hopes of turning twelve months into six.  And that is where my repair problem lies.  There is no pushing when it comes to joint replacements.  Different cultural approaches to physical therapy may form the issue differently, but the healing goal is the same: steady walk, capacity to meet daily needs and to be pain-free.  In so many words, hard work proves that five general rules prevail:  listen to your joint, exercise regularly but, stop when it hurts, and rest.  Befriend your ice-packs. Then go at it again tomorrow.  While I want, at age 62, for tomorrow to start today, learning to have even more patience is now required.  Let’s share that steep learning curve together.