Took the new knee out for a spin

Today I did my first big walk. 4000 steps to the bank and back. No dogs. They were pissed. They will have to wait until I'm steadier. It went well. I took my cane but never had to lean on it. It was such a lovely day and it was so good to be out. If I'm not too sore I want to do this every day. 

After the walk I did my physio homework. The knee was not noticeably looser after the walk which surprised me. I did very carefully stretch all the leg and back muscles. My hamstring is tight and weak. I shouldn't be surprised as it hasn't been used much for years. 

Sleep is improving. I changed strategy. Instead of taking very tiny amounts of narcotic I started taking a dose before bed that nearly zero'd the pain. That allows for restful sleep for about 4 hours then I only need a small dose to get through the rest of the night. The knee is so much better after every restful sleep and I only need Tylenol Arthritis during the day. 

Everyday it's a new knee and almost always a better knee. 

Toilet seat height dilemma.

Here we are enjoying July-uary in Vancouver.

I recall that we were promised a summer like last summer. Long, hot and dry. I loved it. I'm still waiting. 

Toilet height is an issue after knee and hip replacement. Very much for the hip replacement. I was prescribed 4" risers for my toilets. Why do I need this? After using these for a day it occurred to me that the 4" increase made for a much more comfortable toilet-ing experience. 

Haven't you ever gone to sit on a toilet and gone down, and down and still fallen the last, terrifying, inch onto the seat?  Why are they so low? Who determined the height of toilets seats? Is it because when toilets came into common use people were shorter? Or is it to do with the height of chamber pots? 

I set out to answer this question. Along the way I came across some very interesting information. The first of which is that most toilets toilet seats are 14 - 15 inches high. It's possible to get taller toilets. These  are becoming popular and this popularity is being blamed on the increase in obesity in North America rather than the overall increase in height due to improved nutrition and health care. Who or how the toilet height  was established is still, at this time, a mystery. I must say that the taller setup would be my choice if I was planning on a bathroom reno.

The other interesting information that I came across was about lower toilet seats or no toilets. Apparently there is ample evidence to show that squatting to do our business, in the bathroom, is far healthier for us then sitting at the current height that we do on our current 15 inch toilet seat. According to the article that I read, the sitting position we are in on our current North American European toilet seats is not conducive for pooping.  Our bum cheeks are too close together and our spine and colon are not curved appropriately or optimally.   When we are  squatting with our bums approximately 9 inches off the ground our spine is curved correctly so that it's, if you pardon the expression, a straight shot. Also in societies where squatting in the bathroom is the standard practice there almost no evidence of haemorrhoids. This, I believe, indicates no evidence of straining.

Being an individual who is physiologically incapable of squatting without falling over this was of great concern and great interest. I approached a friend of mine who lived for a period of time in India and ask her what she thought. She would've had to have gone from having lived the standard North American style of toilet usage to learning how to squat and I wanted to know her thoughts on the issue. She said being a young woman the  Haemorrhoid issue was not something that she could speak to but certainly she found that once you got the hang of it, you certainly got the job over a whole lot quicker.

Here we have a no drug related solution to a fairly common problem. I don't think we're going to get people to give up the regular toilets. Could a squatting situation be created with, say, a step or some sort of risers that you could  pull into position with  a lazy boy chair style lever. Pull the lever and the foot rests come up and now your feet are in the right position you could sort of rock forward on them and perform.  There are still quetions. Does the weight need to be on the feet or can the weight rest on the pelvis? I don't know but it's something to think about

Red light laser therapy - not snake oil!

One of the therapies I have chosen to hasten an effective recovery is red laser light therapy. As a scientist I abhor conclusions based anecdotal information but as this is my knee that is what I am going to relate. There are studies showing the effectiveness of this treatment which can be Googled.

Red light therapy used light in the infrared range. The light warms the tissue and is thought to activate the cell's mitochondria leading to increased cellular activity which increases healing, and reduces swelling and pain. It is considered particularly good for soft tissue injury.

There are three stages to a treatment: red light, infrared, and the probe. The first two are on a flexible band the last is a focused probe the operator directs to particular areas.

Its painless and relaxing. Its also an opportunity to chat with Jerry, my chiro, who is a great guy.

 

My first experience with this was some years ago.  I had just sprained my left ankle for the third time. Playing soccer, of course! I do not do things halfway so the ankle was swollen and draining blood, through the tissue,  into my toes.  I am assured that I have now,  managed to tear everything, the three big ligaments that hold my foot on, and there is nothing left to sprain. I had gone to visit my chiropractor with one of the boys.(http://broadwayburrardchiro.com/) Almost certainly a sports injury for them too.  

 

Jerry, the consummate professional that he is, wanted to know why I was limping. When I explained he got excited and told me about this machine he had just brought home (been talked into) at a conference. My first thought was "total snake oil!". Being me I said so politely. He said that he thought so too but the demos and the numbers they gave were compelling....and he had a 90 day money back guarantee. I agreed to be a guinea pig. It couldn't possibly make the ankle worse.  

 

12 hours after the treatment the swelling was only 50% of what it had been!! Having done this twice before I was well aware of the progression of a sprain and this was unprecedented. I went back for more and was able to rehab the ankle more effectively that either previous injuries. I was sold! 

One of my earliest plans when I decided to get my knee done was to have the red laser therapy in an effort to regain and improve mobility quickly. After the first session the was noticeable improvement. The next session is tomorrow.

1 week to the day Total Knee Replacement- observations

It's hard to believe it's been a week since I was in surgery. I have made so much progress.  I gave up the walker for a single crutch on day 1.  Now I use the crutch outside the house but I need it less and less in the house.  I can stand on my right leg alone with just a finger on something for stability. 

Amazing.   

I noticed yesterday that while I can't squat very far,  the part of the joint that moves through the motion used to be one of the nasty crunchy,grunchy bits and now it's smooth.  What a joy! It is not possible to ask the question - is the pain and discomfort worth it? It's already been proven to be! 

I have been icing multiple times a day and working on my physio homework. This has been frustrating as they scare you with the need to get the maximum straight position and maximum bend before it scars wrong.  I want maximum in both directions. It's the only acceptable result for going through the pain. 

Yesterday I totally overdid it based on the pain at the end of the day.  Bad!! But by the end of the day I was stronger and more stable after all the crutching and stairs so there was a big upside. When one has a day like yesterday it is very important that rest be the primary objective the following day so that the benefits can lock in and healing can continue.  

One of yesterday's appointments was with my marvelous chiropractor for red laser therapy. More to come on this. 

The shoes! So happy!  After seeing the half body X-ray where my right leg was at such an angle compared to the left I thought that all my old shoes would be imprinted with the aspects and issues of the malformation. New shoes for the new knee.  There were some grey sneaks but ...well... Who could resist the fun of these ones? 

At home after knee replacement

Post knee replace I had some minor complications with the anethstesia and hydromorphone. It came down to lots of nausea and vomiting. So not fun and very difficult to manage nutrition plans. 

There are three things to focus on for good recovery. Rest, rehab and nutrition. 

I wasn't sure if I could manage without the hydromorphone because the pain is is stunningly bad.  More on that later. 

Let's jump to rest. 

I opted for a ward room which has 4 beds. I thought that I didn't need to bother with a semi private room for 2 nights. Maybe not the right choice. 2 of my roommates were great. The third was a disaster for all of us. She was a little, fat, Persian lady, with a second new knee, who was all drama. She groaned and moaned, loudly, all the time. Wanted the bedpan, which was not allowed once physio got you up and walking, then wet the bed because you can't void properly with the bedpan. A trip to the bathroom or commode woke everyone and she'd go on and on about her pain. She moaned and grunted on the way to the bathroom, in the bathroom, on the way back and then once she got back into bed. 

The guy across from me was being evaluated for sleep apnea. I couldn't hear him snoring over her!! When the other 2 patients had visitors I couldn't hear their conversations. The Persian lady and her friends conducted their conversations very loudly. Rest, real rest, day and night was impossible. 

I was so glad to get home. My mom (84) picked me up. I was going to get a service to do it but she insisted. #mumisawesome  My nurses and physio were all awesome. They listened and helped and made me feel valued. The first thing I did when I got home was sleep. It's hard to describe how healing that felt. Every sleep has brought measurable improvement. So amazing! 

Part of what allows you to rest is pain management. 

This device is a big part of that. It's a cryo cuff. The physios recommend ice packs or a bag of peas. Having torn and sprained a few things over the years I have learned the value of icing. It's only really cold water but it makes a HUGE difference. So I got serious with the cryocuff. I checked online and there was a physio group that rented them. I was willing to buy one as they are about $170. Well worth it!!

It wraps the joint in icy water and keeps circulating the water so it stays cold. This is key to swelling and pain management. 

July 9 knee versus 

July 6 knee. Ok lighting is not helping. The swelling is less and despite  the visible bruising the swelling is less and the color is better in the July 9 knee. 

The other key is drugs. I mentioned problems with the hydromorphone. It did its job with the pain but I still needed Tylenol. The hydromorphone caused crazy itching, hot flashes, constipation, nausea and vomiting. The vomiting was a big problem because I wasn't keeping any food down. Rather than add a drug - an antiemetic to end the vomiting,  I contacted my Ex, a physician, about dropping the hydromorphone and adding Emtec (like T3s but no caffeine). His response was that hydromorphone is a more powerful drug than codiene and consequently has more side effects. Switching to the codiene was fine as long as pain was managed (allowing for 

the all important rest). So that's what I did and now I can make plans for nutrition including, importantly, my super nutritive Supermix.  

4 days post new knee

The surgery went well. My memories are fuzzy which is good. The only thing I really remember during it was the sound of someone banging in railway ties. "TING, TING". I don't know what was going on and don't feel the need to know. 

Prep was very calm. Lots of cleaning to reduce infection risk. The coolest was sterilizing my nose. Apparently our noses are germ factories or at least hosts and using methylene blue and red laser they sterilize the inside. 60% reduction in post op infections. I'm not saying no to that!

The surgical suite looked like a very clean machine shop with a gurney in the middle. We had a team pre op meeting and I was part of the team not the object. Everyone was really nice, answering all my questions (can the leg be as straight as a leg with a normal joint? Yes) and calming my fears (I pass out at the sight of my own blood, not any blood, just mine). 

All in all a positive experience. 

New knee -T-1day

Last day before surgery. I have given complete freedom to my inner control freak. I've cleaned and organized. The dogs and cats are covered from breakfast to dinner so I don't have  to worry. Good neighbors are a blessing. 

I know the forced inactivity is going to drive me nuts so I have tried to find all the projects and chores that would have me gimping up and down the stairs and get them done now. That way I can do the resting and healing while binge watching some tv without those nagging chores.  I'm saving up the episodes of Preacher and Masterpiece Mystery, then there is Netflix. Awesome! 

Part of the pre surg prep is the apple juice protocol. The anethstesioligists want us to carb load with clear fruit juice. 16 oz before bed and another 8 oz 1 hour before check in.  Now, I was asked during one of the several meetings on pre surg day how many time I get up in the night to pee.  I don't, since I've been taking Zija's Supermix I hardly ever even wake up during the night,  but I also don't drink half a liter of juice before bed! Who wouldn't be needing a trip to the loo in the wee hours after that much liquid? 

Here are the surgery nails.  Clear on the nail beds as required. Toenails are (gasp!) naked!