Thursday, October 19, 2006

Post-surgery

It's been a while, I know, since I last posted.  To update, I had my right knee surgery on September 25.  At first, the pain was pretty much nonexistent, that is until the nerve block wore off after a day or two and then it became rather unpleasant for a while. 

Physical therapy began two days after surgery on Wednesday, September 27.  At that first visit, they only had me do some work on quad sets (tensing and releasing the thigh muscle), along with some hamstring and calf stretches, straight leg lifts, and applied electrical stimulation to my quadriceps to help contract those muscles.  The surgeon had called me that morning to see how I was doing and told me that the surgery had gone very well, so I was feeling pretty good about things - that is, until I got home from therapy and discovered that my body does not like narcotic pain medications.  I spent the better part of Wednesday evening in the bathroom throwing up, which was less than pleasant to say the least.  My doctor prescribed me an anti-nausea medicine to help control the vomiting which helped, but did tend to make me very sleepy.

Getting around the house those first few days was rather tricky.  I'm not the most graceful person anyway, and using crutches with having to dodge the dogs and cat took some work!  Once I was allowed to bathe, that was rather difficult as well, as was getting in and out of bed.  I spent the better part of my days during the first week resting on the couch with an ice pack on my knee as per the surgeon's request.

One week after surgery, I had a postoperative appointment to have my sutures removed. Unfortunately, I was once again very sick with nausea and vomiting.  So the physician's assistant recommended completely stopping the narcotics and seeing if I could tolerate the pain using only Tylenol or Advil.  They also replaced the elastic bandage with a TED compression thigh-high stocking.  These things are a nightmare!  They are very snug to help reduce swelling (this particular surgery is associated with a lot of swelling which is what makes recovery so slow), and incredibly awkward to apply.  This was soon replaced with my GenuTrain compression knee sleeve, which isn't very comfortable either, but I continue to wear it every day to help with the swelling.  As it turns out, I did okay without the heavy-duty pain medications, having only minimal to moderate pain, but that was far better than the nausea and vomiting on the narcotics.

At two weeks, I saw the surgeon again and he said my knee actually looked very good and that things were coming along as expected.  I had had some painful clicking and popping with flexion and extension, but he said that was normal and it would go away as the swelling gradually subsided over the next several weeks.  He also said I could progress my activities as tolerated per the physical therapists, but cautioned me that my knee would continue to remain quite tender for at least another four to six weeks.

At two and a half weeks postoperatively, the therapists had put me on the stationary bike for the first time and what a humbling experience that was.  It took me over ten minutes simply to get the pedals to turn over just one revolution and even then it was excruciatingly painful at the top of the stroke when my knee was flexed the most.  I rode for four additional minutes after that, and it seemed like hours.  I was crushed emotionally, having come from competitive endurance cycling to this - barely able to turn the pedals on a stationary bike at zero resistance.  But I kept at it, even though I still can't use the right leg to push that pedal down first to get the bike started, and have to start with the left pedal for now. 

They said I could ride my own road bike at home on my trainer, but for no more than ten minutes at a time.  It sounded so pathetically short a time, until I got on the bike and found myself watching the second-hand of the clock tick off those slow and painful ten minutes.  Now at three and a half weeks, I'm still restricted to ten minutes on the bike at a very slow pace, but it is gradually becoming easier. 

I've had physical therapy twice every week since surgery, on Mondays and Thursdays.  The therapists have gradually increased the intensity and quantity of my workouts, but it has been slow going.  We're still using the electrical stimulation under a heating pad with the quad sets, and still doing hamstring and calf stretches, along with the indoor bike.  They also have me doing an extension stretch with the exercise band, step-ups on the aerobic step, heel slides to increase flexion and straight leg lifts to help regain quad strength.

Today I additionally got to use the leg press and leg curl machines, using with both legs together.  Granted it was at the lowest weight resistance, but I did it and it actually wasn't all that bad.  The biggest surprise came when the therapist gave me the go-ahead to get out on the tennis court this evening to practice my swing only - at my request, of course!  So this evening Steve brought out the bucket of practice balls and hit some easy ones right to me so I wouldn't have to really move and could concentrate solely on my swing, since I absolutely cannot pivot on my knee at all yet and really can't move very quickly yet either, even though I have been off the crutches for a couple of days now.  After so many weeks off regular exercise, I was pretty well fatigued after less than 30 minutes, but it was so mentally therapeutic for me to be able to get out and do this today.  I did ice and elevate the knee immediately upon returning home to help keep any swelling down.

Anyway, I know it's not even quite been a month yet and I still have a very long way to go, but I am starting to see some progress, and Dr. Gollehon said that based on how easily the kneecap snapped right back into the proper track once he did the lateral release, he is convinced the surgery was a success and that I will see dramatically positive results once the healing process is complete.

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