KNEE REPLACEMENT DIARY: THE PHYSICAL THERAPIST SETS US STRAIGHT!

This is a steep learning curve for us, and yesterday made a couple of things crystal clear:

Rehab and convalescence aren’t the same thing.  Rehab is ACTIVE, pain-producing and time-consuming!  And, in the near future, all of Odel’s time will be spent on rehab and pain management; all of Laurie’s time will be spent on everything else.

Friday, Odel’s second day at home, started poorly.  His knee was stiff, far more swollen than it had been previously, and very painful when he moved from the bed to the sofa.  He was discouraged and a little worried, and still waiting for the Senior Cocktail (and several other recommended remedies) to have the desired effect.

Then Sandy arrived and turned our world around!  Sandy is Odel’s at-home physical therapist, full of information, straightforward, and empathetic.  We three clicked right away, and Sandy spent half an hour putting Odel’s concerns to rest, admiring his knee (in her opinion, it looked GREAT), adjusting his expectations, and setting us on the right course. 

Lesson One:  No walking unless absolutely necessary.  Although the hospital Physical Therapist has you up and walking (a few steps) within 24 hours, that is only to make sure you CAN, and that you are mobile enough to go home.  After you get home, walking is not a good thing.  Walking makes your knee swell, and swelling gets in the way of the rehab exercises that are so important.  All the little ways Odel was hoping he could help out as he healed?  Forget it!  Everything he does standing on his feet, at least in this early stage, SLOWS rehab and healing.

Lesson Two: Elevating your leg doesn’t mean putting it on a footstool while you sit in a chair, or putting it on the sofa while you semi-recline.  It means getting your knee above your heart.  For Odel, that translates to laying flat on his back on the bed with a huge pyramid of pillows (every one we own, plus towels and quilts) elevating his leg at a steep angle.  Elevation is half the battle in bringing down swelling (allows the fluids to drain out of the leg); the other half is icing.

Lesson Three: Icing your knee doesn’t mean cooling it down; it means shocking the swollen joint with major COLD, and a lot of it.  Make that knee yelp “Yikes”!  To this end, Sandy gave me a recipe to create icing packs with rubbing alcohol, water, and gallon zip-lock baggies (1 part 70% alcohol to 4 parts water; mix in a gallon baggie, press out the air, zip, double bag, freeze).  That stuff gets COLD!

Lesson Four: The Number One Priority of the first 4 weeks of rehab is to get the knee totally straight.  The window for complete straightening is 4 weeks – and if you CAN’T straighten your knee completely, you will not be able to walk without a limp.  Work that joint!

Lesson Five:  The great flexion Odel achieved in the hospital was typical while the drain is still in, and the loss of flexion once the drain has been removed and the joint swells is completely normal.  In the hospital, Odel’s flexion was around 2 to 90+ degrees; here at home, when Sandy measured him pre-exercise, it was 5 to 62 degrees.  The next 6 weeks are critical for regaining full range of motion, 0 to 110-120 degrees.  If you don’t do the work now, you’re going to have a disappointing result (read: LIMP).

Sandy spent another 45 minutes showing Odel and I how to do the three exercises that he needs to do 3 times a day for the next week (we’ll add more after that).  Two of them require my assistance, and one of them makes me hurt him.  I don’t like that!  After the exercises were done, we built the pillow pyramid, elevated his leg, and iced it with our sub-optimal bags of peas. 

So, Odel’s schedule: Manage pain (take pills every four hours).  Manage blood thinner regimen (pills and injections).  Rehab (painful rehab exercises three times a day; painless circulation exercises at least once an hour when awake; deep breathing once an hour when awake).  Elevate the knee at least 3 times a day for a minimum of 45 minutes.  Ice 10-15 minutes maximum 3 times a day.  Consume all sorts of high fiber food and supplements and get those guts working again*.  

Laurie’s schedule: Everything else.  Most of the work I anticipated – just add Odel’s household chores to mine, along with a few oddball tasks like helping Odel dress.  Three things I didn’t anticipate: I need to actively help with some of Odel’s exercises; I make at LEAST one trip to some store each day to pickup something we need but don’t have; and I spend an inordinate amount of time moving “stuff” (pillows, pills, water, food, computer, blankets) from one place to another.  Keeping a path open, keeping paperwork corralled, and staying on schedule with pills, exercises, and meals is a challenge!

*As of this writing, we have blast-off, so to speak.  That put a smile on Odel’s face!  Thanks to all of you who offered your remedies.