New Knee--10 weeks in...

 Looks like I'm starting to turn the corner a bit now.  I've been going to PT and this has helped (or at least not hurt) my recovery a bit.  I'm getting a lot more m ability in the knee and for a fair amount of time each day I can actually walk around fairly normally--no limp!  The pain is far more manageable and I'm off of all pain killers including Tylenol and am now able to sleep close to 8 hours a night--I still wake up 3-4 times a night but shift around a bit and the pain subsides....much easier to deal with now!

The big news is I am now able to tolerate riding on my Wahoo Kickr/Zwift set-up and after driving home from Kansas last Monday and Tuesday morning, I was able to ride for 6 consecutive days starting Tuesday afternoon.  My last 4 weeks my bike mileage was: 19 miles; 60 miles; 36 miles and 128 miles this past week!  I'm not putting out very impressive power (100-140 watts generally) but Its definitely heading in the right direction.  I'm a little surprised at how challenging it is for my left quad, but I guess the inactivity has really detrained my left leg (and right for that matter).

I'm still just walking about 10 miles/week but I actually did a 2.2-miler yesterday, which was the longest of my post surgery and I plan to do more on it this week.

I'm just swimming 1-3X week right now mostly because of my schedule but I plan to ramp that up after Kara's wedding in a couple of weeks......

Onward and Upward!

Me and my new knee, Day 40

 Lot’s going on post holidays on many fronts, including with my post surgery rehab.

I began to log up to 3 miles a day in 4-5 walks towards the end of December and into January.  I began to spin on first my Wahoo Kickr/Zwift trainer and then on my recumbent.  I started a regular swim block (did 4th swim of year today) which my plan would be to build on.

I suppose, not surprisingly, my knee started complaining louder.  Sleep was a real challenge (never more than 5 hours a night).  Hard to walk first thing.  My Docs had an intervention and I just went through a 6-day stretch of minimal stress on the knee.  To be sure, I’m still doing a lot of PT (more on that in a second) and as I mentioned above, hitting the pool every other day.

I also started working with James Hashimoto “Hash”.  He has given me some pt exercises that are not so much focused on stretching as they are on recruiting and properly sequencing muscle activation so I can regain normal knee mechanics.  It’s been so long since I could straighten my knee when walking that some of my muscles deactivated due to limited use.  Because of this my tibia doesn’t glide relative to my femur in a way that allows me to strike the ground with my heel and a 180% extension of my leg.  So I have to retrain them to fire and in the right sequence.  Turns out you can do this by walking backwards.  Reach back with your toe and then roll your weight back to your heel and presto, your tibia glides and you have a straight leg.  So I walk backwards and then slowly forward to try replicate the activation sequence but in reverse.

Anyways, after sprinting out of the gates, my rehab progress has slowed quite a bit. I’m still progressing but slower than I’d like.  I think patience is required and I’m optimistic that it will be rewarded.  Just going to take a while.

My main near-term fitness goal is to walk my daughter down the aisle, without a limp, in the middle of February. 

Onwards and Upwards!

Day 25

 Merry Christmas!

Day 25 of my Total Knee Replacement recovery. Progress is not particularly quick and there is a fair amount of tedious work that I process through each day, but progress is happening.

On day 13, I had my staples removed which led to being able to add baths and swimming back to the menu. I did my first post surgery swim….just 1,000 yards but it was my first aerobic activity in 2+ weeks.

On Day 22 and yesterday, Day 24, I was able to do very easy spins on my Wahoo Kickr bike. The first ride was just 1-mile and that took 6:35 to complete with a whopping avg power of 41 watts. Yesterday, I spun for 10 minutes and managed to cover 2.6 miles (15.6 mph) with an average power of 84 watts.

The key thing each day is to keep upping the stress on my knee and pushing my range of motion, without causing excessive swelling. In addition to the above, I’m going on 5-8 walks a day and while I haven’t gone as far as a mile yet, most walks now are 10+ minutes and near or over a half-mile. I also have 3 sets of range of motion exercises that I’ve been able to do 3-5 X/day. Lots of elevation and icing as well….

The biggest struggle is sleep. I can generally get 3-4 hours in but then my knee has enough discomfort in it that it wakes me up. This is usually around 2-3am. I usually struggle to get back to sleep and most days (like today), I just get up and start the day (it’s 7:45am as I write this and I’ve already been out for 3 walks in the single digit outside). I take a nap or two later, but the sleep challenge is probably the hardest part of the recovery so far.

Onward and upward!

New Knee Day 20: In the grind now!

 It's been 10 days since the last update on life with my new knee.  

Brian came over to watch Argentina take down Croatia and during halftime on Day 13 he removed my 27 staples.  This turned out to be mostly a non-event (with the exception of one spot where there was a matt of clotted blood and superglue).  Since then, the incision has continued to look better and better--I'll update with a new pic at some point.

With the staples out I was cleared to submerge my knee beginning on Day 14, which meant that baths and swimming were back on the menu.  I've been taking a warm bath each night, which helps with sleeping and I even went swimming on Day 16--just a 1,000 yds, which took almost 19 minutes, but it was good to actually do something quasi-aerobic again!  I'll probably swim a few more times before the end of the year but plan to get into a regular swim routine in January.

I've also been cleared to begin riding my bike trainers at no or very low resistance.  I tried yesterday, Day 19 for the first time on my recumbent and it's still a no go--too much swelling and resistance as my knee gets close too my body on each rotation.  I plan to check my Wahoo Kickr tomorrow but expect that I would be regularly on the bike before the New Year.

I still elevate for lengthy periods of time each day and spend about 2 hours on my Game Ready ice machine each day.  I've found it difficult to do 6-8 cycles of all 3 PT exercises and 5-10 minute walks each day without my knee swelling and suffering a set-back the next day.  I have to take it easier than is my nature but I'm really trying to listen to what my knee has to say about what I put it through each day and right now it's telling me to slow down a bit.

I still wake up from the pain around 2 or so in the morning (after a 10pm bed time) but have recently been able to get back to sleep for another 2-3 hours before dawn--still not enough sleep but a definite improvement.  

As my swelling has subsided my knee has started to "click" a lot which is annoying and a bit disconcerting.  But it appears to be fairly common and the hope would be as I continue to improve my range of motion the clicking will diminish and hopefully go away.

The other issue I have is first thing in the morning (especially at 2am) after a fuller day of PT the day before, when I get up, my knee is very tender and not super functional so I have to baby it a bit until it wakes up.  This also tells me I have to go slow on the day's activities.

I'd say my knee is at about 20-25% of the functionality of my good knee so still a long ways to go.  for reference, I'd say my left was at about 50% before the surgery so I'm hopeful I start moving ahead of where I was over the next month or so....

Trying to be a patient Patient!  Onward and Upward!

Day 10: Life with the new knee...

 The last three days since my Day 6 post have been all about settling into a routine of sorts.  My knee continues to progress, albeit at a slower rate and with steps backwards mixed in with the advances.

Dr. Galinat came by late on Day 6 (Wednesday 12/6) and changed out my dressing for me.  The wound looks good--healing well with no signs of infection:

As you can see, my knee still has quite a bit of swelling (although well down from its cartoonish-peak!)  My range of motion is within the target range but hasn't materially changed over the last 5-6 days.  I can bend to 90 degrees (as you can see above) but its not easy and a bit uncomfortable.  I can't quite get all the way to 180 when I straighten it unless I push it down.  90/180 are my targets for these two exercises until the staples come out.

With the swelling comes a modest bit of pain that unfortunately manifests itself at night and is leading to low quality sleep.  I seem to sleep pretty solid for 2-3 hours and then as the Tylenol begins to wear off, the pain is enough to make me uncomfortable enough to only get little bits of sleep here and there.  My docs both warned me that this second week would probably be the hardest with respect to sleep.  I'll try to muddle through.

I took a PATIENT PATIENT day yesterday as I felt like my knee swelled a bit form a full day of rehab (with my longest walks) on day 8.  Today, I'm going to be a bit cautious again and will walk 4-6 times vs. 7-9, which is a full day.  I've also gone back to limiting the duration to 5 minutes.

My staples will come out early next week and a day or two after that I'll be cleared to swim/take baths again.  I may wait until January before starting a regular swim program but I'll be all over the baths in hopes of helping sleep better.

I've started driving again which is good for my spirits and takes some of the burden off of Judy.  I'm not certain when I'll get cleared for low-resistance cycling but maybe not too long after I get the staples out if I can keep the selling down.

All good!  Onward and upward!

TKR Recovery Day 6

 A couple of quick updates.  I received these Cat Scans of my new knee:

In the first picture, a frontal view, my new knee is obviously on my left (right side above as it is a frontal view).  My left leg is a bit lower in this pic as I must not be lying on the table perfectly straight in the picture.  A couple of things to note: 1. you can see how much smaller my lower left leg is than my right by looking at the outlines of the skin.  It's especially evident the higher up the calf you go.  This is due to many years of my right leg doing more of the work as my knee deteriorated.  This is the longer term rehab I need to undertake--probably a couple year project and realistically, I'll probably never get back to a 50/50 balance.  But I'm sure I can do better than the 62/38 power balance I had on my bike this summer. Second, you can see the extra wide channel (above my knee cap) for the new more athletic implant.

The second picture is a side view.  Notice the nice big space between the two implants--yea!  You can also see the 27 staples on the frontal surface of my skin. (yikes)

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I had a really active day yesterday PT-wise.  I had 5 cycles in by noon but found that I was getting some selling and I started to feel a bit fatigued so I backed off in the afternoon.  I also decided to forgo my 2nd dose of Tylenol last night (and had some red wine with dinner--yea).  This might have been too soon as I didn't feel a lot of pain last night but it was enough to lead to more sporadic sleep.  I've decided to go back on it today and for the next couple of days.  My meds now are 2 Aleve/4 Tylenol/2 aspirin a day.

Lastly, I'm now walking outside as part of my PT and up and down stairs with no assistance!  It's slow but its feels quite easy.  I hope to start driving tomorrow.

Onward and Upward!

TKR surgery recovery: Day 5

 Right of the flight path with my recovery.  On Friday, poor Judy had to drive use at dusk in a fair amount of rain from Lodi to SFO all the while enduring my directions.  We made it.  We got to the airport 5 hours early (am I becoming my parents?) to manage all the transitional stuff with my knee but it was a real breeze and it turns out the Harvey Milk terminal there is fantastic.  Was able to spread out and find a place to elevate my knee and read and chill prior to the flight.

We left an hour late because the inbound from the East coast was an hour late due to exceptionally strong headwinds.  This in fact turned out to be great news as the same wind actually got us to PHL early despite the late start.  In total our flight time was just over 4 hours, which must be close to a record of some kind.  I wasn't able to elevate my leg, even though we were up in First Class but it didn't matter as the leg felt fine.  I got up to go to the restroom at one point and just used my $11 Walmart cane.

We arrived in Philly and had an easy transit home to our house in DE where I set up shop for the day on my couch watching yet more soccer and the EAGLES!  I did 7 cycles of PT (walking/exercises) and did the last walk without the walker, which has now been retired.  I have a Game Ready Ice Machine and I spent 100 minutes on that--its amazing!

I ended up only taking 1 Percocet during the day (I'm prescribed 6) and after talking to my surgeon decided to take one last night and that chapter is not thankfully closed.  I ended up taking 14 of them out of the 42 they had given me for use over 7 days.  So day 5 is Oxy free! 

I'm settling in for a routine recovery week where I expect to basically do the same stuff every day. 7-8 cycles of PT with gradually lengthening walks--line maybe up to 10 minutes a few times a day by the end of the week--most will stay at 5.  I want to be on the Game Ready for at least 2 hours a day.My range of motion is slowly getting better and when I'm sitting around it occurs to me that I have the least amount of pain I've had in 5-10 years!

Onward and Upward!