Warning: things that make you go “yuck” follow.

As you can see from the X-ray image on this page, my replacement left knee is firmly in place and doing well at the moment. My surgeon was indeed impressed with my walking progress, saying that most people at my stage were still in a walker. He was concerned about the edema (swelling) that affected my knee, both lower legs, and both ankles, though, but he was able to confirm that the knee replacement hardware was not the source of my knee’s swelling. Thank goodness for that.

Since that appointment, the swelling has subsided slightly, but it has left behind a different and somewhat disturbing problem: an open sore that used to be a blister, which refuses to heal. You see, the entirety of the swollen areas makes me itch and rub madly. I was not scratching at my left inner ankle a few days ago, so get that thought out of your head. I was rubbing it instead, when I came across what I thought was a small blister that had popped. I peeled back the loose skin, only to find much more than a small area peeling away. When all was said and done, there was a bare, oozing spot about 2 centimeters by 3 centimeters above my ankle.

My wife came in, promptly declared it gross, and applied a gel-based “burn bandage” to it. The next day, it had puffed up almost 1 1/2 cm. above the surface of my skin. We removed it and found it was full of yellow gel fragments, while the spot it covered continued to ooze. We didn’t have any more of those bandages, so for the next few days we covered it with non-stick pads wrapped in gauze and ACE bandages. Each following day, the result was the same – the sore had oozed through the outer gauze and was still leaking. She finally bought another gel-based bandage (not specifically a burn bandage), which is on my leg now. It has puffed up to cover the entire dimensions of the sore, but it’s not very tall yet. Still, it’ll definitely need changing tomorrow – otherwise, it’ll start leaking out the bottom.

A trip to the doctor is definitely in order, unless this new bandage performs some kind of miracle healing action. Watch this space for updates.

Much progress has been made since my last post. The quad muscle exercises worked so well that I’ve first been able to ditch the walker and go on my cane indoors, then finally ditch the cane indoors and only use it outside of the house. And to think that all of this progress took place between October 14th and the 26th … my mind boggles, when you compare it to how long I was a literal post-op invalid, unable to do anything for myself from the waist down without the aid of a nurse or a therapist.

Speaking of a therapist, you should have seen the physical therapist’s expression when I met her at the door without my walker for the first time. Surprise would be an understatement. My latest surprise, during the session on Monday, October 26th, was to show her how well I navigated my house without my cane (and while doing left quad exercises at the same time). She was thrilled.

Yesterday, Tuesday the 27th, I had a session with the person she calls her boss. (He calls himself something else, but I couldn’t understand what he said.) I went through all of the exercises I could remember with him, plus a few that he taught me on the spot. He then pronounced that I was making “awesome” progress, and that my surgeon should be quite proud when I go in to see him for a follow-up next Friday. He also said that I need to go through another month of home therapy so that I can get my lateral stability and range of motion back to normal, and so I can continue strengthening my quad muscles.

If it seems like I’m going on and on about my quad muscles, remember: they cut through them to remove my old beat-up knee and reattached them to my shiny new knee. You could say they’ve been through quite a lot of trauma.

One last note: I’m still wearing the compression stockings and taking the high dose of Lasix for the edema in my ankles. I think that the swelling is pretty much gone by now, but I’m taking no chances. I’m getting it checked at my primary care doctor’s office this Friday.

I’ve figured out something since my last post; something that has made a difference in my recovery. I realized that a big part of my pain while walking came from the sensation that my knee was hyperextending, or letting the bottom half of my leg bend too far forward. One thing that could cause this would be weak quadriceps muscles, or thigh muscles, and I haven’t been doing much in the way of exercising those muscles.

A bit of thinking gave me a possible bit of help for my problem. The only problem would be that I’d wind up looking like a member of Monty Python’s “Ministry of Silly Walks” sketch. Well, to hell with that, I’m stuck inside my house, and no one’s going to see me, so I might as well do it.

The solution was to raise my left leg high on every step, flexing the quad muscles in the process, then lower it and do a “glide step” (see previous blog entry).  Do this enough times, and my left quads would strengthen. I tried it out starting late last Wednesday. I definitely felt a burn in my weakened muscles, but it was a good burn, along the lines of my quads saying to me, “Where the hell have you been all this time?”

I’ve stuck with the routine ever since, and the progress has been wonderful so far. I still have pain in my leg and knee area, but it’s a pain of use, not a post-op pain. I’m even able to walk away from the walker with renewed confidence.

While I’m talking about exercise, I should update you about physical therapy. I’m now seeing a home physical therapist every Monday and Wednesday, along with a home health nurse every Wednesday morning. A particularly painful PT session last Wednesday prompted me to do the thinking which led to the “Silly Walks” exercise.

Additionally, the PT brought me a pair of compression stockings for my edema-inflicted legs and ankles. (I traded her a copy of my Derivations album for them.) They seem to be helping, although I can’t be sure if it’s them or if it’s the 80mg of Lasix that’s doing the most work. Let ’em fight it out between themselves.

At this point in my recovery from having my left knee replaced, I’m not sure if I’m moving forward or backward. When I was in the nursing center, I had a physical therapist come by practically daily to assess my progress. Now that I’m home, I no longer have that daily visit to track my progress. In fact, I haven’t seen a PT since last Wednesday, and to be honest, I’ve felt like I’ve been regressing since his visit. My baseline pain level has gone up, and I’ve suffered from edema (swelling) that’s forced me to see my primary care doctor. (He doubled the Lasix diuretic I’ve been taking for chronic ankle swelling from 40mg to 80mg to treat it.) Walking has felt more painful, too, due (I think) to a gait adjustment the PT made to stop me from shuffling my feet – a good thing, but it hurts my left knee muscles.

Allow me to back up for a moment. Yes, you did read things correctly. I am in home health care. I had two nurse administrators confirm that I would be able to go from home health care into outpatient physical care as long as I had a doctor write a prescription for it. So, the last week has been a “getting to know you” week. I was discharged from the nursing facility on September 1st, spent the weekend re-acclimatizing myself to my home, then had a nurse and a PT come by on different days to assess my situation. They’re in the process of setting up appointments for next week and the weeks that follow.

Back to the present. If any of you reading this were in a corps-style marching band, you’re probably familiar with the concept of the “glide step.” It’s where you walk heel-to-toe, one foot after the other in a straight line. The PT that came by my house reintroduced me to the glide step and has me walking that way now so I won’t be dragging my feet and so the muscles in my leg will heal quicker. The only problem is that it hurts like hell when I’m trying to walk without my walker, to do things like move along the sofa or navigate the kitchen or restroom. I’m not ready to put 100% of my weight on my left knee yet unless I’ve got the support of my walker, hence the additional pain.

As for the edema, it hit me about the same time that the PT came by. He was mildly surprised when he saw it, but the edema hadn’t hit me in full just yet. The PT’s visit was at 1o:oo a.m. My visit with my primary care physician was at 3:30 p.m. the same day, giving the edema more than enough time to balloon up. Whereas the PT was only mildly surprised, the doctor was downright shocked. He had trouble getting my sock off of my left foot to see the extent of the swelling. Now you can see why he called for the doubling of my Lasix.

So, I’m now going to the bathroom twice as often as normal, which means I’m walking twice as much as before. Maybe the combination of Lasix and extra exercise will help with the pain. Stay tuned for more updates.