2+ year update

The Summit at Phoenix Mountains

In February 2013, Eric & I hiked for four days straight in the mountains around Phoenix. On the 4th day we climbed to the summit of the Piestewa Peak, a scramble type of a climb requiring, for me from time to time, hands-on rocks. The climb up took about 1.5 hours, down about 1 hour. It was a challenging climb, even for a fit person. Runners were running up and down the peak. Others were resting or turning back. We were both challenged mightily and were very happy to reach the summit.

This was the strongest test of the knee since the surgery. I took a picture from the top to honor Dr. Ghate.

from The Summit, Piestewa Peak

1 year update

L knee implant next to normal knee

I had my one year post-surgery check-up with Dr. Ghate on Friday, 9.9.2011. I was very excited to mark the milestone since I felt I had made tremendous progress since my previous visit 6 months out from the surgery. Ghate works very quickly so after the form filling, the xrays and the waiting, I got at-most 5 minutes with him and his trailing medical student. He asked how I was doing, wanted to see me walk across his small examining room, asked if I had any pain with the knee.

L knee bent showing 2-part implant and kneecap

For my part, I wanted to show off a bit. I told of my bicycle riding and the uphill climbing I was able to do this summer that I could not do last summer and of the many hour walking excursions every day for two weeks in London.

I am experiencing limited flexion in the L knee. I asked if that was a function of the hardware in the knee and how far I could expect to flex it after working it. On the exam table, Ghate checked my flexion estimating it at about 130 degrees. He said the hardware would allow up to 140 degrees flexion. I was released from physical therapy with 130 degrees and I know that I have made progress since then so my estimate would be higher but without an accurate measurement, I cannot refute his guess. He sees a lot of repaired knees.

I am still making progress at one year out; just today I could nearly sit back on my heels with 2 blocks under my butt. I could not get close to a sustained sitting position on my heels even one month ago. I have also noticed that I can bend my knee without assistance and grab the ankle to get a front of the thigh stretch. Definitely not the stretch I can get on the right side, but up until 3 weeks ago, I could not grab the leg without assistance.

L knee from the top

Lastly I said I had a few questions from my trainer, he rolled his eyes at the student. Tek wanted me to ask if we could do PNF stretches, a type of forced stretching with release. Ghate answered that I did not want to work through pain at this point in the rehab process. The time for painful forced bending was in the early days of rehab when the therapist would push and push to achieve more flexion and it was very painful. That was breaking up scar tissue and now pain is to be avoided. If I were to experience pain through flexion, that would be a bad sign at this point.

My bottom line: I am very happy with the knee and the functional progress that I have made since the surgery. The long and hard sessions with a trainer and on my own have been worth the effort because I have achieved great enjoyment from the ability to bicycle and walk distances that I had written off with the damaged knee. I hope I do not need to do my right knee and for now, I am satisfied.

6 month update

I haven't posted to this blog since January. I guess I haven't been thinking about the knee in ways that made me want to write about it. That is the good news! Actually, all the news is good.

For the past 2 months since I last posted, and a 4 month period prior to now, I have been doing a range of activities on my own and with several favorite instructors that have been keeping up my fitness in general, working on my knee flexion and upper left leg strength, balance and symmetry.

Come to think of it, I have even run for the bus!

Looking back over my posts, I see that at 4 weeks I was doing minimal yoga with assistance and understanding from instructors. At 5-6 weeks, I was trying to keep a regular yoga schedule and sometimes missing because of pain, discomfort and lack of endurance. Since the 6 week mark, I have been building, albeit slowly, strength, endurance, flexion, and a balanced walking stride.

At 6 months, I am adhering to regular schedules in four weekly yoga classes with 2 instructors, 2x per week personal training for full body fitness, left leg muscle strengthening and knee joint flexion. Three-to-four times per week I do a stationary bike workout for 20-30 minutes on low resistance, high RPM.

I am able to walk long distances, up to several miles, with very little new pain. If I feel like I may have overdone it, I will ice the knee after the walking to prevent night time wake-ups from knee pain. One walking experience that was very fun and very rewarding was a walk I took with E in the rolling hills of a Phoenix park. We walked 30 minutes out and then returned. It was free form walking, no canes or poles, at times rocky with slight ups and downs. I was able to use the knee and leg in a very different way from the work of any of my training exercises. I used slight rotation and quick, spur the moment decisions about foot falls. The first day of this was tiring and made me a bit sore. The 2nd day, one rest day in between, was exhilarating! The control was returning, the flexibility increased dramatically from that small change in actions.

One still to be accomplished goal is to get outside on my bike, ride from Ohio St. to Promontory Point on the lakefront and start to get some "real" biking legs. With any luck and some planning, that will happen soon. 60 degree temp promised for today, snow for the end of the week. After all, this is Chicago!

4 months out

Had my 4 month check-up w/Ghate this morning. All is well and he doesn't want to see me again until the year anniversary of my surgery. My next appt. Is 9/16/2011.

What I learned today is that I may never be able to sit back on my heels in a proper child's pose. Ghate says the knee has about 135 degrees of flexion. I checked out of PT with a flex of 130 degrees. Right now the muscles seem to be holding it back from fuller flexion but maybe there is more to it than that. Read article about flexion and TKA.

He also says that it is as straight as I need it to be even though when I look at my legs-up-the-wall in the side mirror, I see one slightly bent leg and one straight against the wall. He said that I should not try to hyper-extend the knee replacement. I thought I was only going for straight.

His outer range for loosening the muscles around the knee, for me the quad, the hamstrings and hip muscles, is 18 months. Luckily I am working with some very talented yogis who will help me get to my max, whatever that may be.

I mentioned a strange story I heard this week about a woman whose knee replacement twisted, dislocated I guess, and had to be taken out and replaced again. He said that my knee is glued in place and that would not happen to me. The only thing that could do that, in his opinion, is a car accident. I may have to ask how it happened to Elaine, wife of David in my building.

The side view in the x-ray shows my knee cap, my own on the outside and on the inside it has been coated with a plastic surface to make it slide easily against the metal.

release to water activities

Today I saw Dr. Ghate for my 8 week checkup. Next one is in two more months, January 5, 2011.

In his typical 2 minute visit, he released me to participate in water activities, submerging my knee in water, something prohibited due to risk of infection up until now. He also picked up on the point that I do not extend my knee fully when I walk. After years and years of walking with the damaged knee, there is now the possibility to extend my knee to fully straight. The only thing(s) holding back my knee from full extension are the muscles, and many of them; hamstring, quad, inner leg line, outer leg line, glut, a lot. This has been the working assumption but Ghate suggested that it may be sciatica rather than IT band pain. I will investigate with Natalie in PT.

He specified and demonstrated a walking style for me to practice: kick the knee out leading with the heel, strike the heel first upon the ground, roll the full foot through the step. I have been sort of swinging the leg from the hip and not straightening the knee. He wants me to practice daily walking in this manner.

Speaking of straightening, I attended the 'gentle yoga' class under the leadership of Gabriel Halpern at Yoga Circle. His mantra about knees is 'until you can straighten, you cannot bend'. I had forgotten although I had heard it previously. I will try to attend his class at least once per week although I find that other things vie for the time (12:30p-2p TU, TH).

From Natalie, who I went to immediately to share my news, I got five exercises to do in the pool:

• walk forward in the pool, extending the knee fully
• walk backward in the pool, extending the knee fully
• walk sideways in the pool, alternately leading from each side (like the band walking on land)
  
• stretch the hamstring on a step
• bend the knee in the water

So now my workout includes:

• 10 minutes on the stationery bike
• 10 minutes on the treadmill
• 10 minutes on the elliptical (resuming for cardio)
• 20 minutes in the water
• leg lifts (forward, back, each side -- forward with weight)
• knee stretch (hanging off bed with weight)
• hamstring stretch, stretch to each side, stretch out hip flexor and groin
• etc....
  

changes are happening!

but not without pain...

Walking is getting smoother and faster. Yesterday I walked one mile in about 20 minutes (I google-mapped it when I got home.) I was tired when I got to my destination, sat for a few minutes, spent the next hour or so on my feet. When I got to physical therapy later in the day, I told of my exploits and my therapist thought it might be a bit much. As we went through the exercises she could see the fatigue in the leg, it was shaking.

Today the whole leg is sore -- the hip, the IT band, the quad, the hamstring, the calf, the ankle...and of course the knee but not the overwhelming pain. It was the hip that woke me up.

My take on this is that it is a good thing to have tired the leg muscles through exercise and targeted work and that the pain is reflecting the use. In my limited understanding of the body, this should lead to strength. Unlike the pain I felt with the damaged knee, where the pain did not lead to strength but eventually atrophy of the supporting muscles because they were not able to engage due to lack of the supporting knee.

This pain caused me to miss a morning yoga class that is within my current abilities but I had gotten up for ice for the hip pain and fallen back to sleep. I hope to reliably get back to my regular activities soon.

Crutches are gone!

Sent my crutches and bath bench to the first responder on Craig's list. Luis wants them for his old parents who are in their 80's. You go Luis!

I am happy to have them in a good place.

My secret weapon has remained with me - that is my aluminum cane - which I can use to wave at buses when I need one to kneel down for me. It is a great tool when you are out in crowds and just want to make sure noone bumps into the sore part.