Monday, August 10, 2015

Recycling Carol: From Knee & Foot Cripple To Walking Again

This prolonged recovery of mine from total knee replacement has given me a lot of reflective time about seniors and illness. I was just relating to an out of town friend that it wasn't the knee surgery that laid me so low, it was the surgical complication to the knee surgery. Every invasive surgery has a list of complications. You can find them all listed online if you look up the surgery.

Specifically, my foot became largely unusable on the same leg because the nerve had gone to sleep. With all the thousands of these surgeries the Cleveland Clinic's niche hospital for this surgery has done, it has only experienced this complication twice. I was the second one. The first patient's nerve woke up over the span of a year. So that a year later she had a working foot again. The knee, of course, had recovered long in advance of it. Mine is following that same trajectory. My toes look weird as hell as they are "up" in all different heights and positions. But they are working again. I was able to get rid of the leg brace, Felix's shoes, and am now walking much better.Evidently we need for our toes to flex and go up and down easily, which mine are now doing, but they don't need to look very good in order to be functional. This, unbelievably, is an enormous improvement!

When I finished telling my friend this tale, her immediate reply was, "That's why I 'd never get plastic surgery." We are both lawyers so I knew exactly what she was talking about. There is no sense of taking on the inherent risk of invasive surgery for a purely elective surgery. There are patients who are left with complications from invasive surgery, like me, or others who outright die either from complications or malpractice. Joan Rivers is the most recent example with her endoscopy ending in a spasm in her throat, loss of oxygen and death. But Olivia Goldsmith, the author, was killed by the anesthetic for her face lift. Kanye West's mother died of complications from her plastic surgery. And the list goes on.

We are nonetheless faced with surgeries which are non-elective and we just have to suck it up and get it done. In my own life this has meant removal of my appendix, gall bladder, colon cancer tumor, two eye surgeries and now knee replacement. The knee replacement was the first where I was the patient who got the surgical complication. It could have happened on any of the others but didn't. These are all statistical risk chances of having the surgery and there is nothing that can be done to take it down to Zero risk.

This has occupied my life in 2015 like nothing I've experienced before. I had never planned on becoming crippled but I've had many months of experiencing what it is like being such a person. The dependency factor is the most overwhelming. 

We were trying to make me more independent until April when I took one heck of a fall for trying too much too soon. We both did a significant step back at that point because we had since met people who had re-broken hips and knees after these surgeries. We did not want to join their ranks. Once was quite enough. 

Thus, my visions of myself diving into the pool this summer faded and were replaced by my using the walker at the pool right up to its edge and then getting in via railings and steps very slowly. Felix continued taking me there and picking me up. We had discovered one of the worst places for walking is around a pool because the decks are covered with water. We were both united on the idea of "no more fall" so were conservatism personified.

Lots of people have come up to me to tell me about their own knee or hip replacement surgeries. Evidently just looking at me was enough for them to guess what I'd had done. These people have been all different ages but with more of them being older. To my astonishment, I was one of the very few who needed this surgery because the cartilage in my knee had completely eroded due to osteoarthritis.  Most of the people who talked to me had gotten the surgery because of a sports injury. Some of them were runners over exceptionally long distances. Others were bikers over a similar long haul. One guy played amateur football on the weekends. Another guy worked as a martial arts instructor and his daily and constant knee repetitive motions had "done him in" knee wise.

Below is the way the UK's NHS faces up to its having old people as patients who need knee replacements.

Thus, it is not surprising that the best aid to recovery I've had is an app for my iPad mini from the UK health system. It is free to download and contains videos and stills of exercises to recover from knee or hip replacement. Every model in the UK app is well over 65, as shown here. The exercises they do bring to mind the tortoise, not the hare. They walk in figure 8s forward, or they walk backwards heel to toe or they use a small exercise ball to manipulate their leg. These are their daily lives post surgery not their lives in some gym or out on some trail pushing themselves to the max. 

By contrast, in America, if you look up any materials for aids in recovery from this surgery, you will find models in their 20s doing all sorts of exuberant exercises. They use a lot of machines. In my own case, the physical therapists put me on an elliptical bike right away and promptly tore open my knee wound. In short, we try to recover in the same way many of us got into the fix in the first place. We overdo it and we pretend we are younger than we are.

This is an older person's malady. Young models being vibrantly physical in every American hospital or doctor's ad for this surgery couldn't be more misleading. Why can the UK face that it has elderly people who need knee replacements while we "face it" by employing a "Mad Men" advertising solution to it? Below are samples from American ads. These look like the grandchildren of the patients in the UK getting knee replacements. Yet go into the American hospitals and the majority of the patients there for this surgery look just like the UK pictures, not the USA ones. These knees are also very expensive. Medicare is good about giving them to you if you need it but I doubt the private insurance situation is as clear cut.

Virtually every person I talked to who got a knee replacement due to a sports injury took up some new sport and is now completely overdoing it in that sport. One woman replaced long distance running with long distance biking. This is not what they should be doing. The material is online about what you can and cannot do with this artificial knee. It is not invincible. It has a limited life span which you can cut radically short by too much exercise in most sports. Some sports your artificial knee is not even made to do at all, like football or running or high impact exercise machines or aerobics. 

Fittingly enough, my non-senior physical therapist had already had a knee replacement himself due to playing amateur football and he continues to play it with the new knee. The manufacturer would be glad to tell him, yet again, that his artificial knee is not made for that. Actually, if you want to do the extremes in sports, you'd be better off being like Oscar Pistorius, where you don't have lower legs, and instead use steel blades to replace your legs. A "Bladerunner" does not need to worry about his knees. We do.

I discovered through trial and error that even swimming could be overdone in my recovery efforts. I had started out with a one hour and fifteen minute swim per day. Over several weeks this built up pain in my knee. I had to scale it back. I now use 45 minutes sessions max. I also have had to use less strokes and spend more time treading water with new ways of swinging my leg through the water. The side stroke especially, unless done in small amounts, really aggravates the knee. Prior to this I actually believed it was impossible to hurt yourself swimming. I spent time walking in the pool, doing those UK walking exercises when I experienced these injuries.

I thought whirlpools were primarily "feel good" enhancements without much therapeutic value. I was wrong. When we switched pools for the summer, we left behind the whirlpool. Within weeks I had to return to it because nothing else loosened up my leg like it did. I've also discovered that using the pulsing water points in the pool on your leg has a similar effect on it to a whirlpool.

Knowledge is power so I will conclude by giving you the basic facts about knee replacement surgery.

Below is the list of the likeliest complications from total knee replacement surgery. My complication is the one headed "Nerve."

And here are the recommended low impact sports activities  for patients after such surgery (for the rest of time). Nothing but low impact is recommended.

1 comment:

  1. Very helpful advice! Thanks for sharing your experience and all the research you've done for your continuing successful recovery. Loved the UK/USA comparisons--someone once said the US is the only country where its citizens believe death is an option!