Lisa J Lafave

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Total knee replacement

Physical Therapy After Total Knee Replacement

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Physical therapy is really what it’s all about after total knee replacement. You really have to trust yourself and keep up with your exercises after total knee replacement. You want to get that flexion and extension to where it needs to be and it will only happen with hard work.

After my total knee replacement surgery, I had physical therapy the day of the surgery. I was up and walking the day of surgery. The surgery was in the morning and I was walking that afternoon around 4:00 PM. Heck, no rest for the weary! The next, day I was walking up and down stairs. That was fantastic! I was not going to be limited to one floor post op. On the fourth day, I went home to begin my long recuperation. For the first three weeks, I had a physical therapis come to my home to work with me. Then I had a driver escort me back and forth from treatment and by the fifth week, I was driving myself back and forth from physical therapy.

I am now about three months out and doing fairly well. I am having trouble with a suture reaction, but that will resolve itself overtime. It is seen frequently and is not much to worry about.

So the flexion and extension that is measured at every visit with the physical therapist as a marker of progress has to be achieved before your body shuts down and change can no longer occur. You see you have a certain window during which the exercises can affect your ultimate outcome from the total knee replacement. The more you work it, the greater your flexibility will be for the life of your replacement unit! So don’t forget to work it.

For extension, my primary tool is a rolled up yoga mat with the plastic wrap still on it. I lay in bed with the mat at the end of the bed with my ankle resting on the mat. I flex my quads and hold for five seconds, then release. I do this over and over while watching TV and taking care that my foot does not roll outward, like a duck. If anything, you want the knee to roll in toward the other knee. Then you press downward and try to get that knee as flat as possible. Having a leg that straightens out fully is important for walking.

For flexion, you start with knee slides. You will sit in a chair with a rag under your foot. On a wooden, or tiled floor you will slide your foot out and back. You can do this same movement while laying on the floor with your butt a foot or so away from the wall. Again with a rag or pillow case under your foot, you will slide your foot up and down the wall. If need be, you will use your other foot as a weight to help the operative leg to slide further down and then hold while you count to five. Then release and move leg and foot back up the wall. You can also do knee slides in bed, while lying down. Don’t forget you can use the non operative foot to press Your other ankle back, to give your operative knee a better stretch!

I also like to use my bar chair for flexion. I have noticed that with my non operative leg I can flip my foot around the back of the bar down below. So I feel like I should ultimately be able to do this same maneuver with my foot on the operative side. At first, it was quite a feat just to get my foot on the bar and hold it to stetch out the knee while watching TV. Later the job was to push my foot farther and farther backward; first to heel, then to mid foot, later to toes. The thing about this chair is the bar lets me know exactly where I am at with moving the process forward. I am sure you will find your own favorite techniques, as you approach your own quest toward greater mobility post total knee replacement.

Have you ever been through a round of physical therapy? What tips or tricks did you use? What advice do you have for others who are just beginning physical therapy?

If you think you would benefit from enlisting someone to talk you through the process and hold you accountable, contact me and we can schedule a time to talk.

All my best to you,

Lisa

Lisa J Lafave, PhD, MBA, ACC, BCC
CEO & Founder of Coaching Rocks, LLC
The Wellness Coach from Building Better Bodies Rocks
A Single Mom By Choice Raising Surrogacy Twin Boys
Written in My Little Brick in University Heights, Ohio

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When Should You Go Off Pain Medication after TKR?

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I’ve had quite a few surgeries to date. Generally, when I go home, I go off all pain medications straight away. I did the same with the total knee replacement (TKR) I had in January. But turns out, that’s not the way they do it! Shortly after being free and clear of the pain medication, I was told by the physical therapists that I needed to stay on the medication for the therapy to work. I was like, “Huh? You’ve got to be kidding me!”

I got with the program and went back on my medication as suggested. I then went off it a few more times just to be told it was premature and that I needed to go back on the medication. They had put me on oxycodone and hydrocodone and that stuff is just not to be played with! It’s highly addictive and just the type of opioid medication that has lead many to become addicts, even though that clearly was not their intention, at the outset. I was leery! But I got through it! I wish someone had explained this part of the process to me, in advance.

Clearly my modus operandi, of getting off pain medications ASAP, did not work in this arena. I too had to learn to be more patient. I had to go against what I thought was the best practice. In essence, I had to learn a new trick, and learn I did.

I hope you too are not too rigid to learn new things, when life necessitates it. I hope I remember this lesson, when I face total knee replacement 2 head on!

All my best!

Lisa J Lafave, PhD, MBA, ACC, BCC
CEO & Founder of Coaching Rocks, LLC
The Wellness Coach form Building Better Bodies Rocks
A Single Mom By Choice Raising Surrogacy Twin Boys
Written in My Little Brick in University Heights, Ohio

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Total Knee Replacement – What a Trip!

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It’s been 9 weeks since my surgery and I am beginning to sense that my new knee is my good knee! It used to be that my left knee was my good knee and my right was my bad knee, so don’t you know it that I replaced the right knee. Just after 2 months out, my new knee is becoming my “good knee” and my formerly good knee is becoming my “bad knee.” Crazy huh? Well that is rapid recovery after total knee replacement (TKR). They call TKR a super surgery! I had physical therapy the day of my surgery. You heard that right! The same day I had surgery, they had me up and walking and the next day they had me walking up and down stairs! It was truly remarkable.

There was plenty of icing too! The swelling was just what you’d imagine! The fact that he swelling takes 3 – 6 months to resolve itself was the true surprise! Consequently, the icing continued well after the 4 days in the hospital. Indeed the icing continued for weeks with concomitant nose of above toes 3 times a day for 20 minutes a pop! Having someone to drag the ice to me and prop me up was key in my recovery!

I had a few weeks of in home physical therapy and then had someone drive me to therapy for a few weeks, until I could drive on my own.

All of the therapy basically hurts. They hurt you to help you along. Trust me it’s not for the faint of heart! But it is doable! The more you push the flexion and extension, the greater the range of movement you’ll have in the end. At first, it doesn’t feel like anything is going to budge. You are just stuck at a plateau and seems like you’ve ruined yourself! Then all of a sudden your efforts pay off and you get movement! You move forward a little, and then a little more, and then even a little more! Altogether it makes a big difference. I will never forget when I could finally bend my leg in bed with my knee up and my foot flat. That was a moment. Never felt quite so satisfied with a simple positional difference in bed.

I’ll tell you I really didn’t sleep well until around the 8th week. I just couldn’t figure out what to do with my legs. It was rough! But I got through it!

Have you been putting off a surgery? What stops you dead in your tracks every time you think of the surgery? Is there anyone you need to consult? Remember the decision is yours! Just be sure it’s an informed decision! Do you have a trusted partner or friend who you might be able to confide in to discuss this topic and help you move forward in your process? If not, maybe you can discuss it with someone who had the surgery who might be able to share some insights that you might not be privie to. Just remember try not to be an island! Bouncing ideas off others often helps you to make good decisions!

All my best!

Lisa J Lafave, PhD, MBA, ACC, BCC
CEO & Founder of Coaching Rocks, LLC
The Wellness Coach form Building Better Bodies Rocks
A Single Mom By Choice Raising Surrogacy Twin Boys
Written in My Little Brick in University Heights, Ohio

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I’m Having Total Knee Replacement

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Several years ago, my rheumatologist told me that within 10 years time that I would require double knee replacement. Well, the first one will occur within the next week, and will be performed by Dr Peter Brooks at the Cleveland Clinic.

The surgery scares me a bit. They have this “Rapid Recovery” program, with an emphasis on education. Personally, I think they share too much. I nearly ran away and said, “Forget it!” Somehow, I pushed through and am having it done next Thursday.

So what scares me is the notion of a systemic infection causing damage to the unit, necessitating removal. In extremely rare causes, amputation has been the end result. Most people seem to do fine with the procedure, and most seem much more comfortable with the new joint, than their original knee. Our knees wear out and the replacement units do too. The average lifetime of the replacement units is 15 to 20 years, but some people keep them for 30 to 40 years. Holy moly do I ever hope mine lasts a long time.

The other thing that creeps me out is you have to take your advanced directives to the hospital just in case. That’s always unpleasant!

After my back surgery, my doctor, Elena Boruhk, MD, told me that many of her patients are too frightened to do a big surgery like this one. She told me, I was brave! Apparently, it is my bravery that allows me to push through.

Do you have any surgeries that you are putting off? Is there any cost to putting it off? What causes you to put it off? Do you think the surgery is in your best interest? Do you want to have it? What could make it happen for you, if you do indeed want the results that are likely with the surgery? Who needs to help you with this decision?

Best of luck, if you do decide to push forward.

Lisa J Lafave, PhD, MBA, ACC, BCC
CEO & Founder of Coaching Rocks, LLC
The Wellness Coach at Building Better Bodies Rocks
A Single Mom By Choice Raising Surrogacy Twin Boys
Written in My Little Brick in University Heights, Ohio

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Total Knee Replacement Yikes!

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I am having my total knee replacement, in a little more than 48 hours. Part of me just wants to hobble away and hide. Frank running has been out of the question for some time. This surgery seems so barbarric! I hope not to live long enough to learn that this surgery was definitely not the way to go, with this type of problem!

Every group of people, in every society, throughout time has had notions about how we should deal with various health concerns, and most clearly not all of them have been correct. My bones are telling me to run! They are screaming at me. However, state of the art surgery suggests this is the way. Seems like I am between a rock and a hard place! If I do nothing, I will continue to suffer, and there will be a point when the surgery will be much more difficult to perform. If I move ahead, there is reason to believe that I will feel better and lament not having moved forward sooner!

I hope when it’s all said and done, I am happy about my surgery, and have more functionality, as a result of the knee replacement. I so want to move about freely, with less modifications! I have had to change how I get along in the house, and out in the world! Although I can walk significantly further, than I could before my back surgery, I still cannot walk for long periods of time. Things have not been easy. I hope that the total knee replacement surgery, and recovery go well. Wish me luck!

Is there any health procedure you’ve been avoiding? How do you make decisions about procedures like these? Can you learn about the cost associated with forgoing the procedure, versus moving ahead with it? What factors keep you from moving ahead with it? Are these sound reasons for not pursuing the procedure? If yes, by all means, stay the course. If no, talk it over with your physician, and loved ones.

All my best to you and yours!

Lisa J Lafave, PhD, MBA, ACC, BCC
CEO & Founder of Coaching Rocks, LLC
The Wellness Coach at Building Better Bodies Rocks
A Single Mom By Choice Raising Surrogacy Twin Boys
Written in My Little Brick in University Heights, Ohio

Leap Into Action!

Non-Stress Stress Test

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Did you know that if you are unable to perform the stress part of a cardiac stress test, there is a non-stress stress test? Well there is! Instead of walking and then running on a treadmill, they give you medicine to invoke a state similar to that of exercise or stress and attach a nuclear tracer to it, so they can take images of your heart pre and post the stress produced by the medicine. I just learned this a month or so ago.

Today, I am finally completing my non-stress stress test at the Cleveland Clinic’s Cardiology and Nuclear Medicine departments. This stress test is also sometimes called a pharmacological stress test.

I tried to do the test last week, but it was a no go. While in the Nuclear Medicine Department, I was given radioactive Regadenoson, which is a vasodilator. This medicine dilates your blood vessels in a manner which occurs during exercise. Subsequently, images of my chest were taken by the gamma camera. I then went to Cardiologyy just to find out that my heart rate was 142, which was too high to perform the full test and cause further increases in my heart rate. Apparently, 140 is the heart rate they aim for on the traditional stress test with exercise, and without the vasodilator.

I had been asked to refrain from using caffeine, Acetominophen and Metoprolol, for 24 hours. I take the Metoprolol to minimize tachycardia, or high heart rate. I had stopped these drugs for 36 hours and that was just too long. Since the initial gamma images of the flow of blood through the heart are good for one week, I was able to reschedule within one week, and continue as usual. So here I am today, for the next two parts of the test.

I had the stress portion of the exam already today. Basically, they attach leads to monitor your heart, put the IV into your arm, put on a blood pressure cuff, inject the medicine, Regadenoson, for the test. They then monitor both your heart rate and blood pressure for 4 minutes, while you pump a soft ball and march your feet up and down, alternating left and right, to get the blood flowing through your veins.

Thank goodness the chemical stress test only lasts 4 minutes, because it made me feel really weird. First, I felt breathlessness, then dizziness, then I experienced distress in my stomach and lower abdomen.

Next up, will be the post gamma camera images of the blood coursing through my heart detected by the nuclear tracer, given to me earlier.

Tomorrow, I have a CT scan of my heart to rule out pulmonary embolism, as the cause of breathlessness, often referred to as dyspnea in the medical community.

So remember, if you are having trouble with your heart and having difficulty getting around, you can still have a stress test. It’s called a pharmological stress test or a chemical stress test or a non-stress stress test. Don’t be shy to call your doctor today, if you are experiencing breathlessness or chest pain.

If you feel really badly, do not hesitate to call an ambulance or go immediately to your local emergency room. It has been my experience, and I have more experience than I would care to share in these matters, that when you call an ambulance to go to the emergency room, you essentially jump the line in the waiting room, and receive more immediate attention. So if you think your need is urgent, for goodness sakes call 911, and have an ambulance, more safely, take you to the hospital.

I know I am out of shape owing to increasing back, knee, and hip pain, over the course of the last five years, with accompanying decrease in exercise. Prior to my boys being born, who are now 5, I used to walk 45 – 90 minutes, everyday for years, with my dogs, in the woods. During the last year, I have become woefully out of shape and have been hardly able to walk to the corner! No wonder I have been experiencing breathlessness.

This is really the story of on middle age woman’s journey from the brink of medical disaster, back to health. I am over weight, and at risk for diabetes. I have been fighting diabetes for some time, but now I am fighting off heart disease. I have a mandate from my rheumatologist to have total knee replacement in the spring.

After back surgery 4 months ago, I am now able the walk around the block! I can also swim for about 20 minutes.

I have a history of severe acid reflux and have experienced esphogeal spasm, which mimics heart attack. That could have been the cause of the chest pain I experienced last month.

After getting the results of the non-stress stress test and the CT of the chest, I will know if I am suffering from heart disease and what I have to do about it.

I hope it’s not heart disease for two reasons. First, I hope I haven’t gotten myself into that much of a health problem. I really don’t want to add heart disease to my list of health concerns. Secondly, I am on a roll with Dr Mark Hyman’s Detox Diet and don’t want to upset the apple cart. If I just have another 11 months to pursue this diet, unobstructed and as is, I think I can make some dramatic changes in my overall health.

I am wondering if this anti-inflammatory diet might be able to buy me some time with the total knee replacement. Technology improves with each passing year and I’d like to take advantage of that, as much as I can. Plus, it’s just a lot of stress on my boys to have their Mama in the hospital and then in rehab. After having gone through the back surgery this year, I surely would like to spare them the drama of having to go through it all again so soon. These things are especially challenging when you are a single parent!

What medical issues are you facing square in the eye? What can you do about them. Have you discussed these issues with your internist? Have you seen a specialist? Don’t bury your head in the sand and hope it will go away. There are things you can do about it to reduce the severity of your problems. Why not start by noodling it around with a trusted friend or family member. Ideas abound when your share your problems with others!

Why not take out a piece of paper or grab your cell phone or tablet and write a list of the three most urgent medical issues you have been sitting on. Below that list, write three names of people you would be willing to discuss it with. Then give yourself a reasonable time period to have that discussion. Actually write that date down. Next, stick with the plan! Then, write a similar list, after your discussion with each your trusted others, and put down another date. Follow through with this plan, as well!

Lisa J Lafave, PhD, MBA, ACC
The Wellness Coach at Building Better Bodies Rocks
CEO & Founder of Coaching Rocks
A Single Mom By Choice Raising Surrogacy Twin Boys
One Woman’s Experience Recovering After Near Medical Disaster
Written in the Nuclear Medicine Department @ Cleveland Clinic

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