Full Version of “The Very Patient Knee Replacement Story by Jenny Meehan”

Warning!  This is VERY long.  For the abridged version of  “The Very Patient Knee Replacement Story by Jenny Meehan ” follow this link: https://jennymeehan.wordpress.com/abridged-version-of-the-very-patient-knee-replacement-story-by-jenny-meehan/

 

 

 

No Problem/Moving On abstract art print by Jenny Meehan jamartlondon.com bright bold motivational art for physiotherapy experience personal mobility challenges, jenny meehan,

No Problem/Moving On sign of the times series jenny meehan

 

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Introduction to “The Very Patient Knee Replacement Story” by Jenny Meehan

Before I start, or should I say finish, bearing in mind that this post at the beginning, is the post at the end of the story, even though it is not the end of the story, because it is also the beginning…

You are clear on that, yes?  !!!

Never mind! It depends which way round you choose to read this!

You will need patience to read this story.  But I am needing so much patience myself, and it’s a good thing to cultivate.  So it might be useful for you to bear with me.    “The Very Patient Knee Replacement Story” will be added to, probably in a couple of months time, as I am still writing it periodically.  So, here is the full version of “The Very Patient Knee Replacement Story” as it stands on 4th April 2017.   If you want a much shorter read on a patients experience of knee replacement surgery and recovery, then I have posted some extracts from my story as part of a post I made for April 2017. And there is the abridged version!

Warning! This present version is VERY long! (Around the length of a PhD!) It has some text in a different colour, so that if you are not interested in exercises or mental meandering, you can be aided in your reading by knowing which areas to skip over with ease. Information I’ve found in the expanse of the internet will often be in sea green. Text related to physiotherapy and exercises will be in orange, and mental meanderings will be in blue. You can then jump right over those in your reading if you wish.  Even if you do that, it’s still a good two hour read! But I couldn’t bear to cut the text out, and didn’t think it right to, even if not of interest to the majority,  because if you are considering a knee replacement, I can tell you now, you will need to make yourself interested in exercises and mental meandering, because it is likely you will be doing a fair amount of both! And you will need patience.

If you do prefer a shorter version then follow the link to the abridged version: https://jennymeehan.wordpress.com/abridged-version-of-the-very-patient-knee-replacement-story-by-jenny-meehan/

I have called this “The Very Patient Knee Replacement Story” as it features a chapter of my life which, while it is still ongoing, (my knee replacement surgery was recently carried out on the 8th March 2017), was one of those experiences where time takes on a new dimension, and patience, as a virtue, does come into its own. The story as it stands at present, covers the time period from January 2017  to a couple of weeks after my knee replacement surgery,  but  it alludes back in time, (rather a lot!) as I recall the past, and try and make some kind of sense from it.

I think I have realised that what often happens in life, is we are very patient, but not out of choice, rather out of desperation, and a hope that something will change.   In some situations, patience is not a virtue.  Sometimes we wait, hoping, wondering, worrying, and being passive, but could be taking some action ourselves. We can wait too long for a change to happen and in the process of doing so, cause ourselves and others, a lot of distress.  We sometimes have some control over what happens, even if only a small amount, and we need to take it.  It might be the smallest of actions. A change of mind, or of direction.   A few questions asked.  An attempt at trying some new venture, or seeking any small thing which might help, clarify, or educate.  We might need to question something, and challenge it, rather than accept it.  We might need to raise our expectations both of ourselves and of how others treat us.  We may need to find faith in the process, where we currently harbour only doubt.  Just sitting there and waiting, while sometimes the right thing to do, isn’t always the right thing.

Waiting is not the same as patience.  Sometimes you can be patient, but choose not to wait.

I have been patient, but I did not want to wait, because I felt the timing for having knee replacement surgery on my very arthritic  (I prefer the term “screwed up”) right knee was ripe.  Now the knee replacement surgery  is done, and the story and journey continue, and indeed, I know in my heart of hearts, it was right to have this surgery now.  I’m a “young” knee replacement recipient, at just 52,  so in the decision for a knee replacement at this point is also embedded the prospect of revision surgery in the future.  It will take a long time to reap the benefits fully, but I am already reaping them now, just a few weeks post-operatively, and all the distress of the last two years can fade into the background.  This hasn’t happened quite yet, as you will see from my narrative, but it is happening, and it is happening in the light of me having a life which I can now walk through, with some chance of regularly being able to walk for an hour, and probably even more.  If this expectation seems a little low, and it probably is, it is because my expectations with respect to my quality of life shrunk before my eyes, and this alarming experience was made all the more alarming by the thoughts which were sown in my mind that it was reasonable simply to accept what was happening and live with it.  I did not accept these ideas in the end, though I toyed with them for a while,  and felt a certain amount of pressure to accept them.

I hope my writing about my experience, and sharing some of the thought processes I went through, will help someone else in some way.  Every person’s situation is different and everyone’s knees are different.  The knee is the largest load bearing joint of the body, and this, for me, is as well as being a simple fact, is also profoundly resonant psychologically.  Because my story is one not just of the problems with this load bearing joint, but the psychological load bearing which my knee has brought me into. The struggle involved in  making a decision to have elective knee replacement surgery, and the need for determination and faith at a time  when I was  already pretty discouraged and distressed.  (Anxious and depressed, at times, in the end!)  And it is a story of patience.  When feeling the pressure.

Patience is power.
Patience is not an absence of action;
rather it is “timing”
it waits on the right time to act,
for the right principles
and in the right way.”
― Fulton J. Sheen

Patience is  born from our inability to control much in our lives, and while we by our very natures, like to be in control, the reality is that while we exert control in some areas, we find ourselves in this vast pool of life, subject to all kinds of forces, influences, situations, people,  and experiences which we do not have any control over at all. Or very little.   Sometimes we did have control of an area of our life, at least in part, but did not see it, either because we were unwilling or unable to. Sometimes we were simply subjects, and didn’t have the power or ability to change things. We are broken, and lack insight at times to recognise what is going on. We misunderstand others and we misunderstand ourselves.  I think often the hardest person to understand in our life is ourselves, and we are also often the hardest person to get along with!

In this quest for understanding and getting along with ourselves, we  encounter our broken parts…our injured internal limbs, which stop us from moving as freely as we would like to move.  This “The Very Patient Knee Replacement Story” which orbits around my personal experience with osteoarthritis of my right knee and the decision for getting my knee surgically treated, is a personal narrative, first and foremost, which might be of interest to other obese 52 year olds who are considering elective surgery.  Or others, of other ages, who are not obese, but who are considering knee replacement surgery! It might be interesting for anyone working with patients having knee replacement surgery, or “TKR”s, as they are often termed.  (Total Knee Replacements). It’s not the usual type of patient account/diary/story of TKR, as I let myself dwell in waters deep; a little theological here and there, a bit philosophical, a little bit practical, with some research and some emotional angst as well.  It’s long. You’ve been warned!  It has many extra miles in it, and like my life at the moment, cannot be rushed through!  Recovery is a slow process. But gives me a lot of time to write!

My experience of increased pain and disability due to osteoarthritis in my right knee was something which came upon me rather more suddenly than I could ever have imagined, and it changed my life dramatically from the beginning of 2015 onward.  With my knee replacement surgery in March 2017, the journey is not over, but it is significantly altered, as is my life, which is  already much better.  I am not sure how unusual such a rapid deterioration of a knee joint is, and I do not have the means to judge my own experience in a comparative way, with others,  but I imagine that my previous injury to the knee in 2010, no doubt contributed to the state of the knee being quite as dire as it was.   Well, whatever the whys and wherefores, this is my knee replacement story as it stands (rather nice and straight!) at the moment. I have kept my narrative centred on myself, and not included all the wonderful, lovely people who have helped me through this time.  I prefer to keep confidentiality unless specific permission has been given by people I write about, but one of the fantastically valuable aspects of my experience has been the way I have realised how much God can bless, work, and use people, working in hearts, minds, words and understanding, to knit together, in a healing way, the wounds we all carry and experience in our lives. It’s been a wonderful last few months.

I trust you’ll get something worthwhile from it, if you are patient enough to read it, that is!  Though I have packed it into some form of organisation, also strays this way and that, meandering, in the style of my usual blog “Jenny Meehan, Contemporary Artist’s Journal – The Artist’s Meandering Discourse”.    Written from my perspectives as a Christian, aspects of my faith are shared as they are an integral part of my life, and my understanding of my experience is that it has very much been a matter of me learning to trust God, to wait patiently, and to expect good things.  But trusting God, waiting patiently, and expecting good things, are not passive, and do not preclude taking actions or making decisions.  Indeed, the power and ability and strength to take action, comes from “Waiting on God”. The timing, the principles, the way.  As I quoted earlier, but will again, because it is of the essence of what I have learnt through this experience:

“Patience is power.
Patience is not an absence of action;
rather it is “timing”
it waits on the right time to act,
for the right principles
and in the right way.”
― Fulton J. Sheen

As a believer in a marvellously mysterious Creator, yet one also intimately involved in our lives, (if we wish this to be so), I can see how I muddle through things, often rather blindly, and in my stumbling around, often make things quite hard for myself.  However, through all this, God manages to work, and writing this story also means I can look back and be reminded afresh of this time.  Whatever happens with my knee replacement in the future…that great unknown… nothing can take away the rich and rewarding aspects of this experience.  Though it certainly has not been easy, this experience  is one through which I have made progress, and also gained more faith through.

Sometimes when writing, people dedicate their writing to others, and I dedicate this piece of writing to the wonderful people who have been part of this experience; the friends, family, and NHS staff, my surgeon, and all those who made it possible for me to get where I am at the moment.  Anyone who has helped me in any way.  You know who you are!  And I also dedicate it to my knee, which though it found the pressure too much to bear without some reformation, still continues to bear my weight, even while traumatised and healing.

It’s early days.  But I’ve come forward miles already.

Here goes…Be patient!

Most recent entry is first. “The Very Patient Knee Replacement Story by Jenny Meehan”  can be read either way, from the present backwards, or in chronological order.

 

Time to Catch the Last Post

This won’t be the last post, but I am calling it that for now.  Writing this has been wonderful, and a good task to engage myself in over this time period. For me personally,  having the focus of a writing project has been just right for me over these first few weeks in recovery from a knee replacement operation, and I will miss not doing it.  However, it is quite time consuming, and I probably should now devote a bit more time to other activities.  Because I am rather achievement orientated, it has been good for me to set myself a task which I can do and which isn’t hindered by my lack of mobility. It  also requires focus in the PRESENT MOMENT, rather than any future plans. And when you have had knee replacement surgery, you need to continually pull  yourself into the present moment, and live each day as it comes. Looking too far ahead becomes a source of frustration.  Mindfulness is a great asset!  The danger of me starting to get back into my usual art related activities is I will not be realistic about what I can do and get frustrated.  Anyway, the reality of the  matter is that I have simply been far too tired to do anything much at all, so writing is perfect.

I hope this “The Very Patient Knee Replacement Story” it will be useful in some way to you as you read it.  Even as you dip into it.  Reading the whole thing may be a little too much!  My patient journey has in reality only just began, because these are early days and there is a lot more to happen.  I have popped an imaginary sign post up at the one year point.  When I get there, I will look back and review what has happened. That may be the best time to write more about this.  I may be tempted to pop back before then though.  I have no idea of how things will go.  Complications can arise. Let’s hope they don’t.  But the most important thing for me, is a recognition of the need to trust  an eternal loving Creator with myself. With ALL of myself.  Including my knee!  This isn’t easy.

It involves faith, trusting other people, and receiving the ministry of love as it comes in its various forms.  Sometimes those forms are clear and obvious, and seem desirable and are much wanted by us.  Sometimes those forms come by way of difficulties, challenges and even hardships. But within all things, the careful eye and heart may be able to detect the hand of God, working diligently away, weaving together the discrete parts of our broken lives and healing all wounds with his/her own wounds.  Because, if we choose to believe in a loving, compassionate, and intimately involved Creator, who cares, loves us, and want the VERY BEST FOR US, then we can have faith, hope, and love, and trust that in ALL things God works for our good.  This is what I have learnt. And I  thank Christ for the work of the cross and the love of God, revealed so beautifully, in so many people who have been part of this journey.  A journey only just begun.

Looking backwards is better when you are moving forwards

With one, hopefully last look back, I can already appreciate how far I have come.

I am looking back on the review I made of my situation before the knee replacement operation. It does provide an overview. I wrote it because there was need of a review of my situation, but one was not being made by anyone else.  Shortly after it was written, my situation was reviewed, by several people.  And then things did get moving, very fast.  From November 2016 onward I had very little need for patience because the ball got moving.  Before then, I have never been quite so challenged in my whole life!

I quote just a portion of the review.  My awareness of the problem with my right knee started in January 2015 when though I could walk for three hours non-stop, my knee gave way a couple of times and I fell right over!  Then it gradually started its descent, getting progressively worse as time went on, particularly around August 2015.  The little improvements made, never stayed for long. But here is the most recent section:

“2016 September. physiotherapy  at …. hospital end of September and Lower Limb Rehab class . Also a Public Health “Better Bones” group twice a week and continuing with daily exercises. But situation deteriorating. Also moderate pain in left hip and left elbow. Walking distance lessened to ten minutes on average, then severe pain. Sometimes pain after a few minutes walking. Different types of pain in different places. Limping most of the time still. Pain often near constant.. .can be lessened but not obliterated. Meloxicam only thing which gets rid of it completely but not willing to take this medication too often because of side effects so using many other methods. Total standing time possible in day reduced to half/third of what it was before August 2015 (to just 3 or 4 hours per day). Impacts everything. Badly restricted, teaching, domestic work, painting. Struggling emotionally. My life has shrunk. Walking seems to have biggest influence on pain. Night pain more frequent, some weeks every night. Since April cannot lie on side to get to sleep as I used to which makes it harder to get to sleep. Waking up 4am not helpful. Keep bursting into tears. I really cannot tolerate this.

2016 October Though leg is stronger, all my effort hasn’t translated into improvements in function or pain apart from being able to walk up stairs normally. Often feel nauseous as pain more persistent and deeper. Willing to continue with the physiotherapy and will ask GP for referral to “Get Active” fitness programme so that I can continue non-weight bearing exercise on cross trainer and static bike, as well as continuing exercises for legs at home. Being unable to walk quickly, often or as far as I used to is making losing weight quite particularly difficult as this used to be my main form of exercise however I swim three times a week and do exercises every day plus adapted yoga. Completely committed to continued weight loss and continuing of exercises long term. I have no desire at all to delay surgical treatment as quality of life and fitness now most important. Understand issues regarding being overweight and having steady success with weight loss (lost three stone since the beginning of this year). Aiming for BMI of 25 (12 stone) and currently using mindfulness, portion control, cutting out most sugar and counselling in order to help. Currently on “Weigh to Go” public health programme for weight loss. “
Feel a burden and so restricted and frustrated. Social group is quite young and active, and feel terribly old! Husband also ten years younger than me, so restricted mobility extra negative. I rely on walking/ public transport for work related travel/tasks (cannot drive) and need to regain walking ability for work. Walking was valued leisure activity also. Impacts all of the family emotionally and practically. I cannot fulfil my domestic role even just adequately. Husband works 65 hour week so limited in ability to assist. Would be overjoyed simply to be able to walk around more freely.

I am at my wits end and want to be able to look forward to having the knee treated surgically and then at least seeing some kind of progress as a result of my efforts rather than basically being in the same situation that I was over a year ago. I am aware of the issues with respect to knee revision surgery but consider the adverse effect of being forced into a premature sedentary life most detrimental to my long term health and well being, and the deterioration in my quality of life experienced over the last year is causing me an awful lot of distress and sometimes depression. Has badly impacted my artistic practice which requires standing and mobility, plus the inability to predict how much I will be able to do and commit to is detrimental to potential creative opportunities. I believe that my own behaviour will influence the long term outcomes in a positive way.

Being disabled and experiencing severe pain over such a long time period as this is soul destroying, and even more so in the light that something could actually be done to potentially improve my quality of life. The thought I could have my knee treated surgically, while it entails risks as well as potential benefits, as well as a lot work on my part, is vital to me being able to cope with my situation. To start living my life again in a more functional way, is all I want at the moment. I feel currently that the state of my knee and the limitations it brings are effectually destroying all that is important to me in life. It’s as if someone has taken my life and run off with it, and I cannot even WALK to try and catch them up! Just walking freely would be amazing. While recognising that a knee replacement will not remove other symptoms of osteoarthritis which will continue to be a feature of my life, at least for the more immediate future, in this time when physical activity and creative ambition are so important to me, I will have some improvements. This thought/hope helps me in my current management of the situation but it is a struggle made bearable only in the light of the above thinking. I have twenty years of working life ahead of me, financial demands, family life and aspirations and ambitions which basically are the passion which drives me forwards in life.

Thursday 3rd November I discussed my situation with my GP Dr …. and we agreed that she would refer me to….   I am extremely relieved that this is being arranged. Steadily losing weight at 23/11/2016 at just under 17 stone (BMI 35) but committed to long term and permanent weight reduction.”

Things were hard to bear from August 2015.  Intolerable by June 2016.  I didn’t think things could get any worse, but they did! Oh dear!

What strikes me looking back, is that when I wrote this review,  I did see things very clearly, but it was a considerable process to get to that point.  When you are in the midst of things you don’t see them very clearly and a lot of unpicking your experience needs to happen.  It was such a horrible experience, and all the time I kept hoping the knee would get better (in terms of symptoms/pain).   I couldn’t quite believe that things were not improving. Because my work is self directed and I could adapt activities around my knee to some extent at least, I could mask the extent of the disability to a degree which may not be the case for people involved in some other occupations. We do not like to see our lives shrinking before us, and so consequently, it is sometimes possible to put the blinkers on.  It was mostly when I started to record the levels of pain, limitations on walking and standing over a period of a couple of months (the most useful suggestion made during physiotherapy treatment) that I realised I had been in a certain amount of denial with respect to how bad things were for me.  I also realised, that though I may have “ticked all the boxes” in terms of ability to look after myself, (ie being able to wash and get in and out of cars, or get up after a meal, as per Oxford Knee Score!)  this was due to my age, agility and suppleness, and the huge amount of work I was doing on my body.  Emotionally and psychologically I could not cope, and did not see why I should cope with an untreated knee, when treatment was possible for it.  Age, agility and suppleness, and even weight loss and physiotherapy, do not take away underlying bone deformities or destroyed cartilage, or the way that the whole body’s movement is thrown out of kilter.

I knew this.  My gut feeling is that my knee was screwed, basically, but it didn’t stop me trying  to improve things. I was willing to try more physiotherapy, but it worried me a lot that the expectation might be that I simply had to put up with my knee as it was. I did not want to go along with the vision I had at one point,  of a life which involved a cycle of more medications and more physiotherapy, meandering on into the distance, with a still severely limited quality of life.  All for the sake of delaying surgery.  For whose benefit? I kept thinking that if I had had an accident and had my quality of life affected in this way, in particular the not being able to walk for more than half an hour (ten minutes, reliably, at one stage!) there would be NO WAY it would be assumed to be in any way acceptable.  So why strangely was it acceptable now?  It took some time to sort my  thinking out on the matter, and it looks simple looking back on it now.  But it was not simple at the time.

I think it is possible that my high pain threshold, though quite an asset generally, did not serve me too well on this occasion.  If  pain experienced dominates as being the main indicator for referral for consideration of  knee replacement surgery, and a patient’s subjective assessment of their pain level is used in a somewhat abstract way (I am thinking of the Oxford Knee Score here.) in  order to indicate referral for a surgical opinion/appointment with a specialist/consultant more than anything else, (ie quality of life) then it puts those ABLE to manage their pain well, but also physically disabled,  at rather a disadvantage.  It assumes that if pain is managed, somehow, (at whatever cost to the person as a whole… including how long term medication and lack of mobility will  affect them) there is no need to explore the benefits or/and need of  surgical intervention.But there may be. 

Managing pain, long term, is a challenging situation on all levels. And VERY wearing.  It is not just the knee joint which gets worn down.  It is the person and their will to live. Nothing in the Oxford Knee Score about that.  Some people experience a lot of pain but don’t tend to moan or even speak about it much. It’s a constant mental effort to divert the mind away from pain.  It doesn’t mean someone is not suffering because they do not complain very much. Pain is often managed by avoidance of certain activities, and may be silently expressed in this way in a less obvious manner than singular complaints.   It is also the case that one person’s “moderate” pain will be another person’s “mild” pain or vice versa. Terms like this and exactly what they mean, need to be very clearly defined in a standard way.  While pain experienced is related to how it is perceived,  the interpretation of the terms needs to be clearly spelt out if questionnaires are filled in. I made the mistake of answering questions about my pain levels without getting a clear and specific definition of the terminology used.  It took me a while to realise, as I did in time,  that I would never pick “severe” as a description for my pain even when it was, because for me the meaning of “severe” was complete agony.  While “moderate” pain  (moderate means average in amount, intensity, quality, or degree) is a strange middle grounded word which most people will settle with even though what an “average” amount of arthritic pain actually is is rather hard to know as a singular patient.    

It is a hugely challenging situation to find oneself  entertaining long term disability in the knowledge that something CAN be done to treat a key component of your problem (knee surface/bio-mechanical factors), but that” something” is  presented to you as needing to be avoided at all costs.  Maybe for an older patient, in their 60’s, the thought of needing to delay knee replacement surgery for five years in order to possibly get away with just one surgical procedure may not seem quite so daunting, and might be worth weighing up say five years of suffering in order to balance it out with a possibly avoided second revision surgery later on.  Just possibly.   But for a 52 year old, the prospect of waiting takes on a rather pointless aspect. Knee replacement surgery, though a major operation, is routine, tried and tested, and effective for the majority of people.  If someone does not want to delay the surgical treatment of their knee joint, as long as they understand that the prospects of further surgery are likely to be part of their experience, then there is no reason why surgical treatment in the form of knee replacement should not be presented to them as positive move in the right direction.  It is not an emblem of final defeat.  Or something negative. It is a wonderful surgery which can give people back their lives.  Even if it does need to be re-done.

It is also the case that at whatever age, the knee replacement might fail.  This can always be the case. At whatever age. So you could wait, and then find that you needed it redone a couple of years later. Things can go wrong, and it doesn’t come without risk of complications.  But does life come without risk of complications generally? I think not.  Surgery, like everything else, is not fallible. For me the decision all hinged on this line, which was what I came to articulate with a great deal of passion;

“It is insane to endure this amount of disability and pain when something can be done about it.”

Sometimes you just get to the point when “That’s Enough!”

© Jenny Meehan DACS All Rights Reserved That's Enough Digital Print by Jenny Meehan for sale to buy at Chessington Court Cafe and Garden Centre This ink-jet print is laminated and mounted on Foamex. It can be purchased with or without a frame. Bold, bright, geometric composition from British female fine and applied artist Jenny Meehan jamartlondon.com

That’s Enough Digital Print by Jenny Meehan  Bold, bright, geometric composition from British female fine and applied artist Jenny Meehan jamartlondon.com © Jenny Meehan DACS All Rights Reserved

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“Limited clinical value” versus  the 2012 Biggs report

I wanted my knee joint/right leg  seen by a specialist a long way back in September 2015,  but I made the mistake of not insisting on this.  I should have.  I was not sure about it, but the pain was so bad, I thought it likely I had a small fracture somewhere. I did complain to one GP (not my regular one) about being in agony all night and being unable to put any weight on the leg, but their only comment was that according to the X-ray the arthritis “didn’t look very bad”.  It was the same doctor who, when I first injured the leg in 2010 and visited him a week after the fall, didn’t examine it “because it was too swollen” and told me to come back a week later.  And who recorded in my records that I had fallen on the left knee. What had actually happened to the left leg, as I found out a month later,(after being referred to a physiotherapist by my usual GP) was that I had torn the quadriceps tendon on the left leg, and several ligaments on the right). So unfortunately my confidence in that particular GP was at a low level. Probably wise to just not see that one in future!

It’s strange this error happened, as I  explained very clearly exactly how I had slipped on ice and that I had pain in both legs but it was the right one which had taken the impact.  The other mistake I  made, of not going to Accident and Emergency, is something I have kicked myself about a fair few times.  However, I do recognise that I was in shock when it happened.  My leg was so huge afterwards, and so painful,  I couldn’t think straight. But I am very surprised that the GP didn’t even send me off for an X-ray. I am sure that would have happened if I had gone to Accident and Emergency.  However, I did accept far less than I should have at that time. You never quite know what is going on inside your joint, or your brain!  Both legs were injured, (the left developed cellulitis later) but  the physiotherapy I was referred for by a different GP about a month later was very good and helpful for both legs.

But the right leg was never quite the same.  And when things started to go downhill in January 2015,  and particularly in August 2015,  there’s always the hope that, in time, things will get better.  I hoped  things would improve.  In time. Several visits were made to my GP surgery as the months went by, for things didn’t get better.  I was surprised to discover,  when I saw an Extended Scope Physiotherapist in June 2016, that I would need a knee replacement.  I had guessed  I would need the knee treated surgically at some point,  but I hadn’t quite imagined a full blown TKR (total knee replacement).  When presented with the statement “You don’t want a knee replacement do you?” my answer was at that point  “Not really”.  I did decide to give some more physiotherapy a good go, even though I had been doing daily exercises for over a year,  and also to continue to lose weight, in case that helped.  But I had a horrible feeling that my knee had decided for itself that it had had enough!  Major surgery isn’t something to be rushed into, and there is no doubt at all, that the person having the knee replacement surgery must be as prepared for it as possible.  And this preparation takes time.  It took me some time to get my head around the idea of having a total knee replacement.  But when I did get my head around the idea, I decided it was something I wanted.  A person needs to be ready for surgery psychologically and it certainly needs to be something they definitely want,  because they  need to be ready to work very hard afterwards in order to gain the  maximum potential benefits.

The time period from around January 2015 up until being able to consult with a surgeon in November 2016 is without a doubt a very challenging time of  my life.  23 months of gradually increasing experience of pain and disability.  Worse even more so from August 2015 onwards, which counts as one of the most difficult times of my life!   I hung in there.  By the grace of God, I was able to get to where I needed to be, and the timing of my surgery worked out well.  It’s not easy to say that, because I would have personally liked things to happen much sooner than they did,  but I will always be grateful to my GP  and the  surgeon who did hear me,  and did effectively  help,  by putting things into action in the direction that I wanted them to go in.

I had reached the end of my ability to cope, that is for sure.  Suggesting the right course of treatment and taking the appropriate actions in a timely manner, when it happens, is something to celebrate, and no amount of previous frustration can take the shine off this.  I did feel  as though it all happened much later than I would have liked it ideally to happen, but I did use the extra time I had to lose more weight, so it didn’t go to waste completely.  Having less of a burden to bear physically, may be a benefit which, though I suffered for it psychologically, on balance made the extra waiting worthwhile.  I do not have any bitterness or sense that I have not been able to benefit from this journey in patience.  A lot of wonderful things have been opened up to me through it.  A new found appreciation of the support and care offered by other people.  A new realisation that if I put my mind to it I can achieve beyond what I expect.  An increased recognition of the need to trust my own instincts and body, and to invest time into looking after it better.

I cannot deny I found the psychological and emotional aspect of being a patient with  osteoarthritic knees negotiating my way through our healthcare system  much hard to accept. All the questions and insecurities. I began to wonder if I was seriously expected to accept the changes in my quality of life. Was it seriously realistic to plan my life around my right knee to such a degree? Was it right that I should be expected to do this?  Did I have a choice in the matter?  In theory, the answer was yes.  But in practice, was this the same?  Being obese and 52? Did this change my situation? Is the knee replacement procedure really a procedure of “limited clinical value” or is it rather that my life, which could be potentially  transformed by accessing knee replacement surgery, is of limited value?  Because if it mattered, surely knee replacement surgery would be being presented to me in a more positive light? As an option for my problem to positively consider.   No one I spoke with involved with my healthcare said anything positive about getting a  knee replacement. The only people who had something positive to say were a few people I know who had had knee replacements, or who knew someone else who had had one. Later on (or earlier on, depending which way your read this), I include a quote from the 2012 Biggs report. I am asking myself now if the “limited clinical value” idea has a leg to stand on.* Ho Ho!  If it does, I trust, that if unable to stand, it might at least be presented with knee replacement surgery in a positive light.  Actually, second thoughts, let’s not afford it that opportunity, and just cut the blasted thing off!

*“Procedures of Limited Clinical Value” (PLCV) is a term NHS managers have applied to a range of elective surgical procedures that they no longer wish to fund.

Looking back on the review now, I am very aware that the  psychological distress of such an experience is a very important part of it.  Feeling that you will have no option but to carry on with such a reduced quality of life, for me, was THE worst part of it.  Why I felt that so acutely may have been due to my own lack of self esteem and little real confidence that I would be able to access the surgery I needed.  I am a fighter, and I worked through the experience, for which I am grateful and glad for.  I am grateful to all the lovely people who helped me and grateful for this surgery I have now received. Thankfully it now looks like the tide may have some chance of turning in the other direction though whether it will remains to be seen:

https://www.rcseng.ac.uk/news-and-events/media-centre/press-releases/nhs-england-warning-over-rationing/

“Limited Clinical Value” ??????????????????????Why, it hasn’t got a leg to stand on! 

Even though frequently involved in the process of looking backwards, at the moment, thankfully,  I am also internally jumping, running, leaping, and dancing,  all over the place.

The body has not quite caught up yet, but it will.

(I will leave off the running and jumping in order to look after my knee as best I can.)

But the dancing will come.

It is very early days.

The future is unknown,

but the door is open.

Twelfth day at home (Day fifteen – Wednesday – Post knee replacement surgery)

Oh, that doesn’t quite make sense…Wednesday to Wednesday.. Should be fourteen days, but I counted my days from the actual operation day, rather than the day after.  Oh well.

Today is the “Great Reveal” and how lovely the incision looks. Removing the dressing is simple…just a matter of peeling it off like a plaster.  There is a big arrow pointing upwards at the base of the incision.  I am very fond of the arrow and look at it affectionately.  A significant mark I will never forget.  And treasure.  I am very pleased with my knee and its progress.  I never want to get rid of that little arrow…It says to me “The only way is up!” and as for that incision, it is very short!   Amazing to get all that done through such a short incision. It’s just five and a half inches long!  I cannot quite believe it!  So neat! Looks like a scratch! I’ve put this image in black and white for you, as dried up blood doesn’t look very nice.  There isn’t much blood on the Steri-Strips though, and the dressing was completely spotless.

wound dressing after TKR

wound dressing after TKR and that is a swollen leg!

 

TKR incision photograph

TKR incision photograph showing Steri-Strips and glue

 

steri-strips after TKR

steri-strips after TKR

Above, my little caterpillar! Steri-Strips are called “Butterfly Closures”!

Here’s an image taken a few weeks later:

 

TKR incision at five weeks total knee replacement incision at five weeks

TKR incision at five weeks  Well, that IS a transformation!

 

When I saw the Community Physiotherapist yesterday I told her how I was feeling rather dizzy even when seated, how extremely shattered I was often in the morning, (even though I am getting very good sleep) and how now I am taking less medications I expected to have a little bit more energy than I do.  The extreme tiredness and also feeling quite faint at times has made me slightly worried with respect to falling  over though I am very good on my crutches.  I want to increase walking and the amount of exercise I am doing.  But I just do a few exercises and my heart is pumping away and I feel exhausted, so I am wondering if my iron levels are too low.  She advised me to see my GP so a friend takes me in the car, and indeed, I am rather anaemic.  So I now have a prescription of Ferrous Sulfate which is used to treat iron deficiency anaemia (a lack of red blood cells caused by having too little iron in the body). I am pleased about this because I am feeling very motivated to do the exercises, but find that my pumping away heart is just thudding that little bit too loud and strong after even the smallest exercise session.  My feet are also very cold.  So hopefully soon I will both have hot feet and a lighter beating heart!

Hopefully when this is sorted I can gradually increase my activity.  Feeling great inside.  Very happy with knee.  Gave it a nice massage again today and still icing and elevating for 20 minutes every two hours, at least.  Exercises are dotted around the day.  I don’t have the energy to simply work through the whole lot, so doing in short bursts works well for me.  And there are sensible times to do exercises, for example, just before the next ice and elevate session, or before the massage, or around an hour after taking medication.  I am pushing myself just a bit, but not too much.  It is easier on all fronts to persevere with gently working on an increase in flexion (bending) in small but regular bursts rather than forcing things and then making my lovely knee unhappy.  A little bit of swelling, a small increase in warmth, and a certain amount of pain to a moderate degree at the most, is something that doesn’t bother me as long as I address it quickly.  So I may be irritating my knee a little sometimes, but it also knows it will get the love and attention afterwards.  I don’t push it at all unless it is going to be iced, elevated or massaged afterwards.  My flexion is 90 degrees and each day this feels easier.  The swelling does make it tight, and so getting the swelling down or at least keeping it under control feels as important to me as making any progress with bending it.

I have found it very good to use a cooled ice pack to massage the front of my knee, rubbing backwards and forwards.  The soft gel and the cool temperature are very soothing.   So ice packs are useful even when not doing their intensive icing duties!  They are good for cooling use for at least an hour after they have been used for icing, and can be moved around the joint in a way which is very soothing, even if it isn’t effective in the way that is is for the first 20 minute ice and elevate treatment. I keep writing about icing, but there is a good reason for that, as most of my time is spent doing it.  Indeed, there is a considerable amount of repetition in the days as they go by, because the activity is very repetitious!   This may be a little tedious to read, but it gives a good taster of what things are like!

ice pack on knee

ice pack on knee

 

With respect to using the laptop, I do not sit at a desk and work on it, but have it slightly to the side of me on a pillow on the bed, if sitting up, and if icing and elevating, I have it on a soft pillow on my tummy.  I can do some exercises at the same time as working then, and I understand that sitting at a desk for long periods of time can increase the risk factor of DVT, so not a good idea!

Patterns of movement (more interesting word than exercise!) are now falling into place very naturally.  It takes a little bit more determination to stick at the exercises I find hard, and I do need to make special slots of time to do those, which I am managing to do at least two times, and sometimes three times a day. Hard exercises are best done in their own individual slot, with some kind of reward after them!   I am keen to increase exercises that involve standing, and to get into the habit of doing them every time I get up from the bed.   I have also combined doing them with singing my favourite hymn, as this is on the wall near the bed.  I stand up, sing the hymn, and change the exercise I am doing as I move onto a different verse.  This works a treat and is very good for the soul!  Makes it more interesting.  Also, as I am  feeling quite faint and a little dizzy at times, it helps that I can hold onto two very solid side units which happen to be just the right height.  I am more attached to the bed than I thought I would be, but this is mostly to do with how I feel after I have been standing up for a while or have exerted myself a little.  As long as I am moving around regularly, changing position, and alternately bending and straightening my knee, plus getting up each hour for a little walk, I guess I am doing enough for now.  I can’t do any more.  Even with what I am doing, when I sit or lie down, my heart is bumping away to the extent it would if I had done some vigorous swimming!   Oh well, should improve with time!

Here is my favourite Hymn.  Great for doing exercise to!

What a friend we have in Jesus,
All our sins and griefs to bear!
What a privilege to carry
Everything to God in prayer!
Oh, what peace we often forfeit,
Oh, what needless pain we bear,
All because we do not carry
Everything to God in prayer!
Have we trials and temptations?
Is there trouble anywhere?
We should never be discouraged—
Take it to the Lord in prayer.
Can we find a friend so faithful,
Who will all our sorrows share?
Jesus knows our every weakness;
Take it to the Lord in prayer.
Are we weak and heavy-laden,
Cumbered with a load of care?
Precious Savior, still our refuge—
Take it to the Lord in prayer.
Do thy friends despise, forsake thee?
Take it to the Lord in prayer!
In His arms He’ll take and shield thee,
Thou wilt find a solace there.
Blessed Savior, Thou hast promised
Thou wilt all our burdens bear;
May we ever, Lord, be bringing
All to Thee in earnest prayer.
Soon in glory bright, unclouded,
There will be no need for prayer—
Rapture, praise, and endless worship
Will be our sweet portion there.

“What a Friend We Have in Jesus”  was written by Joseph M. Scriven as a poem in 1855 to comfort his mother who was living in Ireland while he was in Canada.

In prayer, I invite the presence of God into my heart and look to my Creator for supplication, revelation, and wisdom.  Also to receive into my soul all that is good, and cast out all that works against the love of God.  Singing this hymn always reminds me to depend on God and trust in him.  The only line I take issue with is the “We should never be discouraged”  because we can and will be discouraged.  So I always change that to “I will sometimes be discouraged”.  God knows our humanity. Recovery from knee replacement surgery does include discouragement. When feeling discouraged, it is all to easy not be be patient and all too easy to just think about what I cannot do.  I keep reminding myself of the little improvements I have made. They matter a great deal.  And when I feel discouraged, I can just accept that too.  It’s part of life.  It’s part of moving forwards.

My friends are rather brilliant too.  Not much despising and forsaking going on as far as I am aware!  However, it is always the case,  though we can share very much with friends,  no one is fallible. We cannot expect people not to let us down at times.  We do have our “own cross to bear” as the phrase goes, and we do find ourselves in a place, sometimes, of needing to accept the limits of what we can get from others in the way of support.  This doesn’t mean we are not supported, but rather that we will find ourselves in a place of loneliness unique to each one of us. From time to time.  At these times,  prayer can have the ability to open us up to a great source of solace and, if we believe in a loving God, also to  a great source of compassion beyond limitation.  Having said this, it’s worth noticing also, that even though in the New Testament Jesus Christ had to bear the weight of the cross bar on the way to crucifixion, it’s also recorded that  Simon the Cyrene was ordered to carry the crossbeam from outside the gate to Golgotha.  Never underestimate the importance of God using others to help you when you are weak and heavy laden. This  has been something I have learnt  to a new level from this experience of TKR.  I tend to be over independent.  God works through people “His wonders to perform”.

Patterns of Movement/Exercises

Here are some of the Patterns of Movement/Exercises I am doing at the moment.  As the day’s go by I am finding additional movements and different places to do them at, which all integrate into my daily life.  So it doesn’t feel like hard work, even though it most certainly is! I haven’t included all I am doing here, and being a creative, I am constantly trying out variations.

Patterns of Movement/Exercises for Working on the Laptop/While in Bed.

Crawling around on the bed on all fours – I plan to gradually work this into Child Pose and work on my knee flexion in the process

Ankle pumps

Quad Sets

Gluteal Sets

Straight leg Raise –  Erm, well. Attempt at.  I try this when I am elevating the operated leg because it is encouraging to see the pillows the leg is on moving, even though I cannot see any lifting of the leg taking place!  There must at least be a little lift, even if I cannot see it!!  It seems to be slightly easier if the leg is not just flat on the bed. Yes, STILL not able to do it!

Heel Slides in Bed –  I started using a board on top of the mattress as this made it much easier

Knee Hangs –  Good to do at the same time as elevating.  I pop a foam roller underneath my heel.

Bridge Pose – Again, nice to do a Yoga related posture as my body is used to doing it.  I also find I want to exercise my whole body, not just the operated limb! My top half is getting slack!

I also put my feet up on the headboard in a bent position and try to slowly walk the feet down and up the side of the headboard, as it is rough and has a good grip on it.  But this is very hard!  My quads don’t like it at all.  I can do for a tiny bit!  I will carry on and hopefully when they get stronger it will be easier.  I can try to lift the leg in the air this way, just a bit.  It is easier than a straight leg raise which I cannot do at all.  Rather like the “Seated Knee Extension” exercise but done lying on my back.  Good when too tired to sit upright, which I am quite often!  VERY hard, so only doing a tiny bit at the moment.

Patterns of Movement/Exercises for Standing Near the Bed

(Not usually all at the same time, but two or three at a time)

Heel raises

Standing flexion backward (Standing straight and bending operated knee as far back as you can)

(I do this with BOTH legs, alternating)

Marching (of a sort!)

Standing flexion backward, but holding it still – My bed is just the right height for a 90 degree bend

Knee flexion  (moving and still)  Standing with my foot on the bed, bent knee, and leaning gently to and fro which gives a nice gentle stretch.  I also try holding it and just leaning into it and relaxing.

Cat Walk pose

Single-Leg Stance (Standing on one leg) (for very short period of time!)

Mini squats (OOOOOOOOWWWWWWWW!) And they are VERY mini!

Church Pew Exercise (reference for this later, if reading from the top!)

Patterns of Movement/Exercises for Making a cup of Tea

Standing Plank leaning into corner of kitchen units.

Just one “Downward facing Dog”…Lovely stretch at the back of the legs!

VERY mini squats… Hardly seems right to call them squats, rather knee bends.  Even knee bends is pushing it a bit!  This is my “hard” exercise! As I pray for my quadriceps to cease their strike, I manage a very small bend! Just perceptible!   After doing some of these standing up straight, I at least can look forward to the cup of tea “reward”! My husband is instructed NOT to talk to me when doing this exercise.  It is likely that he would get an unsavoury mouthful of verbal abuse coming his way.  He wisely takes note.

Prayer pose.  With prayers thrown in! (Very much needed after the squats)

Mountain pose.  With grateful thanks for having got this far, by the Grace of God!

Chair pose (Yes, I would like to sit down, thank you! )

Church Pew Exercise (I have my exercise bike face on, so I can hold onto the handlebars, as I sway backwards and forwards, as I do feel a little bit dizzy!  I have the chair pressed against the wall. Can feel the quadriceps working in a very pleasing way…slightly more gentle than mini squats but just feeling it there is great!)

Seated Knee Extension ( Pull up toes, tighten thigh muscle and straighten knee.  Heel will lift. It WILL lift.  Even if just a little bit!)

Single leg stance (generally called standing on one leg!) I like to turn mine in the best I can do of the Yoga pose “Tree” as it feels so great to do this with a straight leg!

As before, I don’t do all of these at once.  And I do enjoy a cup of tea!

Even going to the loo, up the stairs, is a major expedition.

Patterns of Movement/Exercises  for Chatting with Friends

It’s great to see people, and good to exercise at the same time.  While the jaw is being very well exercised, the hours whizz by, and it seems good to use the time for moving as well as chatting.

Seated Heel Slides

Seated Knee Extension

Static Bike (Sitting on chair facing it, and pedalling as you go….Nowhere!)

Marching feet while seated.

Elevating (I have a lot of flexibility, so put my operated leg right up on the handle bars of the bike!)

Massaging while elevating the operated leg.

Icing.  Never goes amiss.

It is all rather enjoyable. Well,  there are some moments of misery, but just moments.

I throw in some other random movements as they take my fancy.  Feeling rather free and liberated!

Best encouraging thing to do is “Warrior One”…As I bend my operated leg it GLIDES into place.  Let’s just do that one more time…

Thinking about patterns, I love playing around with making them.

crystal cluster surface pattern design uk jamartlondon© Jenny Meehan DACS All Rights Reserved

See more surface pattern designs by Jenny Meehan at Redbubble.com:

https://www.redbubble.com/people/jennyjimjams/works/15687294-crystal-cluster-surface-pattern-design-jenny-meehan?p=art-print&rel=carousel

For a shorter version of “The Very Patient Knee Replacement Story by Jenny Meehan” follow this link: https://jennymeehan.wordpress.com/abridged-version-of-the-very-patient-knee-replacement-story-by-jenny-meehan/

 

Eleventh day at home ( Day fourteen – Tuesday – Post knee replacement surgery)

There is a LOT of material on the internet on the subject of knee replacement surgery.  I have picked out random things here and there, as you do. All very random.   I am a person who enjoys researching very much.  I love it!  But looking here, there, and everywhere on the internet,  can have its flip side if someone is even just a tiny bit anxious about something.  Nothing can take the place of personal conversation, advice and experience, shared through that wondrous being…THE HUMAN BEING.  And if doubts and fears reside, then an internet search will not help allay these most of the time.

Ever, really. They may be allayed, for a short while, until the next piece of alarming information appears,  but the ability to allay them is something that a person gets the power to do through trust and faith, confidence and reassurance.  Internet searching  may just bring some additional perspective, approach or idea which might add another dimension to your experience and get you to think about something a little differently.  It can be very helpful like that. It can be very useful in helping you to decide what questions matter to you and which ones you want an answer to.  Also, reliable and/or professional internet sites, for example, The Royal College of Surgeons, or Arthritis Research, are quite clearly going to merit more attention and carry more weight than others. The most reliable websites are often set up by official organisations and businesses. They can often be identified by their web address.

Suffix Example Descriptions
.com The “standard” ending to web address often used by commercial organisations
.org Generally used by not for profit organisations
.co.uk A company’s website based in the UK
.gov A government organisation, eg local council
.ac.uk or.sch.uk University, schools and colleges

Even while information abounds, and is there for the taking,  there is no replacement for trusting your own instincts about your own body and trusting the right people.  The “right people” are people who God  can, and will, bring to you in order to help you.  They will come from all kinds of unexpected places, and won’t necessarily be the type of people we expect.  Invite your Creator to bring you the help that you need, and make sure you receive it when it comes.  If you can believe that God is a loving being, and cares for you, while our Creator does not control things in a puppet on a string kind of way, it is not beyond the realms of belief to accept that both an all powerful and yet completely servant-hearted Creator, filled with love and compassion, may want the very best for you and your life. It’s worth being open to the possibility.  I do believe in divine providence. Not everyone believes God is personable in nature, but I think even if someone didn’t, they could possibly still embrace benevolence as existing towards them.

Continuing on my theological musings, the saying “God works in mysterious ways” does has some foundation to it.  Though this phrase is not found anywhere in the Bible as quoted, it is a wisdom which runs all the way through it.  There are several ideas about where it came from, and the one I like is that it comes from the 19th Century hymn by William Cowper in the 19th century that says, “God moves in a mysterious ways; His wonders to perform; He plans His footsteps in the sea, and rides upon the storm.”  There are several verses in the Bible which also suggest this concept, one of them being  Romans 11:33: “O the depth of the riches both of the wisdom and knowledge of God! how unsearchable are his judgements, and his ways past finding out!”

There is so much within us, but so much beyond us.  We try and contain and comprehend what is happening to us. We try and make sense of it.  Yet all this information, while it can help, can also hinder.   It can also become angst fodder for the already anxious mind!  So tread with care.  Everyone is different.  Lots of little bits of information need to be gathered with care and thoroughly sorted.  Every person is different and what is right for one is not right for another.  General ideas, principles, risks, perspectives.  I have thrown my own into the vast pot.  I hope it is useful to others. My work has been sorting out what was right for me. It sounds simple. But often it isn’t!

As with the main part of my blog  “Jenny Meehan Contemporary Artist’s Journal – The Artist’s Meandering Discourse” on WordPress,  I have indulged myself in the writing process with little regard for the reader in terms of restricting the length. I think that in these current times, where there is so much available to read on the internet, we all get used to skimming around and dipping in and out of things we read.  So no need for me to make this pool of words any shorter for your benefit!  And I wonder if, in allowing the type of meandering I enjoy so much, that there might be something gained for me in the writing process which I would not glean if I were constantly attempting to summarise and shorten things in a more concise manner.  It may be for the “dipper” and “skimmer” reader, (I am one of these, incidentally!) that allowing the descent into the depths of my mind and experience,  while boring and tedious for the uninterested reader, might make for a more satisfying read for the interested reader. I remind myself that while I feel I have to write this – So strong is my inclination and desire to do so – I am not forcing anyone to read it, or to read it all.  With devices, we now have the blessing of scrolling! Scrolling is the key.  Scrolling along on the screen has brought a new dimension to reading without a doubt.  As the Scientific American observes:

“In contrast, most screens, e-readers, smartphones and tablets interfere with intuitive navigation of a text and inhibit people from mapping the journey in their minds. A reader of digital text might scroll through a seamless stream of words, tap forward one page at a time or use the search function to immediately locate a particular phrase—but it is difficult to see any one passage in the context of the entire text. As an analogy, imagine if Google Maps allowed people to navigate street by individual street, as well as to teleport to any specific address, but prevented them from zooming out to see a neighborhood, state or country. Although e-readers like the Kindle and tablets like the iPad re-create pagination—sometimes complete with page numbers, headers and illustrations—the screen only displays a single virtual page: it is there and then it is gone. Instead of hiking the trail yourself, the trees, rocks and moss move past you in flashes with no trace of what came before and no way to see what lies ahead.”

text quoted: https://www.scientificamerican.com/article/reading-paper-screens/ 

Information, and more information

On the subject of information, often one piece of information balances another, and so on.  The more you have can be useful depending on what you do with it.  And sometimes you are better off not knowing! Different people want to know varying amounts of information. Because of the restrictions on time, it is not normally possible to have all the questions you want answered.  Just some.  So sometimes finding the key questions which matter to you is the art.

I was interested in getting a basic idea of the procedure for fitting a knee prosthesis mainly  because I worked as a dental nurse for many years, and having seen lots of dental crowns being fitted, I wanted to know how it was done. I found this to give me an basic idea:

http://www.healthline.com/health-slideshow/total-knee-replacement-surgery-step-by-step#promoSlide

Having seen that, and also having watched the operation on a You Tube video, there was no way that I was going to have surgery and expect it NOT to be painful or to involve a long rehabilitation process, bearing in mind the knee joint is the main weight bearing joint of the body!  While people are all very different and many factors affect their experience, it can be helpful to look at others experiences and expectations, and it may help to temper ones on experience this way or another.  So the following is also interesting:

“2. 3 months after Total Knee Replacement 37 % of patients rated their pain as worse than expected. The average Total Knee patient needs 9-12 months of healing time so this survey result is expected.

3. One year after Total Knee Replacement 90 % of people believe the surgery met their expectation and 10 % have not had their expectations met. This is better than most scientific studies that report 80 % of patients had expectations met.
Posted by Stefan D. Tarlow MD at 11:09 AM
Labels: knee osteoarthritis, knee specialist, knee surgeon, total knee replacement”

http://blog.tarlowknee.com/2016/07/total-knee-patient-experience-survey.html

Patients expectations must be a whole area of interest in itself.   I simply want to be able to walk for a couple of hours, continue yoga (in the way I was doing before, which was already very adapted in consideration of my knees) and continue to enjoy swimming.  Standing in order to paint without pain is also an expectation.  But nothing more than that.  Anything more is a bonus. With respect to pain, what I am experiencing at the present time is better than I expected it to be.

On the matter of pain management, the Royal College of Surgeons website says:

“You should expect to need to take painkilling tablets for up to 12 weeks after your operation.”

Which is quite a long time. Three months.  So I am not rushing to get off of mine, but gradually reducing and playing things by ear!

Progress is Being Made!  Slow and Steady Wins the Race!

A few of my “Get Well” cards include the words “Wishing you a speedy recovery” but I doubt that recovery is a speedy matter in this case.  I think a steady recovery is probably more apt.  Speed is not of the essence in this experience.  Gradual and careful progress is more of the aim.  As the days go by, little things change. But the sentiment is not something I am picking at.  I love all of my cards, and the people that have given them to me! I guess no one wants things to take longer than they need to take.  Lack of speed has been something I have had to embrace for years.  Apart from when it comes to swimming!   The wish for speed is something we all grab at.  For me, if I am simply moving forward, I am more than happy. The art is is finding the small improvements and changes, and being mindful of them.  For example, today, I do feel I have quite a lot more energy, and that it is possible for me to do far more of my exercises (or patterns of movement!) than I have been able to do up until now.  My  difficulty with doing the exercises has not been  because of lack of inclination, but simply because of the energy drain on my body as it heals the knee area. So I did quite a lot of exercise today.  But not too much!

Another little milestone is that I have stopped needing to inject the blood thinner! Glad about that.  I am re-starting the routine I was in (which I stopped a couple of months before surgery) of taking one heaped teaspoon of turmeric, along with some black pepper and a bit of grated creamed coconut in my coffee. (Helps you digest it). I like it a lot.  You can just do this with milk without the coffee. It is also very nice in porridge.  I use one of those instant porridge pots and put the ingredients in there.   Turmeric is a good anti-inflammatory and I started taking this about a year ago.  I found it did have a positive effect on the inflammation of the soft tissues in the knee area.  I wasn’t sure, but when I stopped taking it I noticed more swelling would appear from time to time.  I think that the amount I was taking is a bit less than what is often used, but I was taking it for a generally beneficial effect rather than a conclusive answer to a problem. I kind of work on the principle of many little things may help, and there is no harm in trying.  As I was also massaging the knee, it is probably the two combined which helped.

So now I resume this routine, plus making sure that I have vitamin C, multi vitamins, iron and vitamin D as supplements.  It is now possible to have an additional iron supplement as I am less constipated since reducing the amount of Co-dydramol I have each day.  I enjoy a nice cup of rose hip tea each day and also enjoy the carbonated water drink (just chop up some ginger root and leave it in the water overnight) which I  also enjoyed over the last year. I usually munch a bit of the ginger when I have finished that water!   Both turmeric and ginger have blood thinning properties, and so I feel probably good to have at the present time particularly as the risk of blood clotting after surgery seems, according to some research, to be longer lasting than just one month.  A retired orthopaedic surgeon I know said that the risk was increased up to a whole year, though much less so than in the first few months. That seems a long time. But it seems logical.  I would rather be aware of that than not.

Found this: https://www.ncbi.nlm.nih.gov/books/NBK44181/ which says:

“Trauma and Major Surgery

Any injury to body tissues, whether due to surgery or trauma, increases the risk of a blood clot, because the injury stimulates the body’s clotting processes. Blood clots due to trauma and surgery occur relatively quickly, with most developing within two weeks of the event, and some happening much more quickly (within a few hours or even during surgery). DVT/PE also can occur up to several months after surgery or major trauma.”

Still got the TEDS on!  Have one bit of paper telling  me to keep them on for six weeks and another which says two weeks. I will need phone and check.

The bruising on the operated leg is now fading away.  I did not have much, just a bit at the back.  It’s looking good.

bruising afterr TKR,

bruising after TKR,  Not bad, nothing around the front

 

 

Massaging the leg with olive oil and frankincense daily and pulling towards the direction of my heart.  Inhaling the wonderful smell and doing the massage is lovely and relaxing and you only realise the tension you hold in your body often when  you let it go.  So the massage is a very nice daily routine!  I elevate the leg when I massage and take the TEDS off the the half hour it takes, massaging right down from the bottom of the leg and up to the thigh.   Pretty similar to what I used to do before the surgery.

Swelling

swelling after TKR

swelling after TKR

 

You can see the difference between the right and left knee!  I have no swelling around my ankles or feet at all.

I am constantly working on trying to reduce this.  Constantly.  Though it’s normal to have swelling for around six months I read somewhere.  I have no swelling around my ankle or foot, but just around the knee which is kind of understandable bearing in mind what has happened to it.  However swelling does make it harder to move the knee.

“Swelling – Swelling is a very common problem after a knee replacement, particularly affecting the ankle and foot, and may last for up to three months or so after the operation. The ankle swelling usually settles as your walking ability improves.

Swelling of the knee itself is also common over the first few months after surgery. Applying ice can be very helpful for a swollen joint, but make sure you protect your skin from direct contact with the ice pack. Ice can be applied for up to 20 minutes at a time. Raising your foot above hip height (on a footstool or similar) is another good way of reducing swelling, but make sure you get up and walk around for at least five minutes every hour to help reduce the risk of a blood clot.”http://www.arthritisresearchuk.org/arthritis-information/surgery/knee-replacement/looking-after-your-new-knee.aspx

I have numbered my days from the actual operation day, but as I am now two weeks away from the operation day I will be making one or two last posts and then popping off for a while.  I will probably come back and write some more but  I wanted to focus on this phase of my patient journey rather than go beyond it.  I have plenty of other creative projects to start in  a couple of months time, and I do need some time to watch daytime TV and waste a bit of time. This is  not something which comes naturally to me, but it is  probably beneficial in unusual way.  I will do a short update just before I publish  “The Very Patient Knee Replacement Story” no doubt. And after that, will just keep a paper diary of significant milestones, which I can insert later on down the line.

Physiotherapy after Knee Replacement Surgery

The community physiotherapist came today and is very nice.  She tells me I am doing very well and reassures me with respect to my quadriceps going on strike.  They will come back.  She shows me an exercise where I do little squats.  It is amazingly hard work but feels great because I can feel the inner quadriceps muscle in a very obvious way.  Possibly mild pain, but feels more like a burn and a strain.  A strong pull.  To me this, while it is not pleasant, does offer a reminder of the presence of the muscle, so this is quite motivating.   Certainly not agony. (I did take my pain medication a couple of hours before she came).  When I try the seated  I am pleased with the visit.  She checks various movements and gives me lots of useful information and advice.  I am very grateful for this input.  Left to my own devices,  it would be very easy for anxiety to set in, and the encouragement is needed at such a time as this!

Doing stretches (flexion and extension) dotted all over the day.  Really helps to have an ice pack (even a not completely icy ice pack!  The cooling is still helpful) handily.  I stick it on after doing a few stretches here and there.   ICE was one of my main methods of pain management before the knee replacement operation.  After it, ICE application is a constant task!  Every two hours or near enough for a full blast ice pack.  And after that I still use the pack when slightly thawed about 20 minutes later.  It is still cool and effective.  I have plenty, around six, so I can do this no problem.  I do push the knee a little bit, so there is an ache when I bend and extend it. But I only press into it for a very short while, and I don’t push into it more than three of four times, and then, just a bit. Then stick the ice pack on, and ache is gone.  I wouldn’t call it pain exactly. Well, it is really, but I choose not to think of it that way.  It would be pain if it hung around for ages, bothering me and popping up at the most inconvenient times.  That was a pre-operative experience.  Pain is frustrating and tyrannical.  Ache is work, and worth the effort because it will get me somewhere.  There is a slightly stingy pain along the incision, which feels a bit like a zip, but it’s no worse than the sting I had when I cut my hand when washing up.  That kind of stingy scab healing feeling! It’s kind of numb too. Very strange feeling!

 

Tenth day at home (Day thirteen – Monday-  Post knee replacement surgery)

Good.  Today I do not feel as if I have just been run over by a bus when I wake up in the morning.  And the other good news is the first thing I do is go to the toilet…for a poo.  A nice soft one.  At the usual time I do one.  These little things are a cause of great celebration. It’s the little things in life which make all the difference. My apologies to anyone who likes to avoid bodily functions, but my whole life is about bodily functions of one kind or another at the moment, and it is all I have to write about!

I have altered my medication schedule a little bit.  I am not in a rush to get rid of the medication, but I do gradually want to cut it down.  So the new plan is,

C0-dydramol x 1,  at 5/6am  (if needed in early morning, which it was today)

Ibuprofen x 1  7am (400mg)

1pm   C0-dydramol x 2

7pm Co-dydramol x 1 (or 2 if need be)

10pm -ish Ibuprofen x 1  (400mg)

So basically I have increased the anti-inflammatory  from just having one at night time to having two each day, and have increased the gaps between the Co-dydramol, just taking three times each day, rather than four,  with possible reduction in dose also.  Before now I was taking the Co-dydramol every 5 hours roughly, four times a day.   When I came out of hospital I  stopped taking the Ibuprofen, which I was having three times a day when in hospital.  I did not find Ibuprofen effective for me before surgery, and used Meloxicam if unable to address pain through other means.  I thought it would be good for my body to deal with the inflammation in its own way, but now I have changed my mind and I am keen to cut down on the Co-dydramol, mostly because of the constipation! I am taking two senna tablets and some Lactulose Solution, just once a day.  I have not needed to crack open the bottle of Morphine, and it does not seem I will need to. I plan to replace the Co-dydramol with Paracetamol (either 1000 or 500mg) and make the Ibuprofen doses 200mg, but will be responding to how the pain goes in terms of exactly what I take.

pain management after TKR

pain management after TKR

It is VERY important to write down what medications you are taking and when and how much.  I cannot quite believe how easily I take something and then ask myself afterwards, just a short time afterwards, if I remembered to take it!  It is also helpful to do this so that when you gradually start to adapt your medications and slowly reduce them.   You can then gauge much better if you are reducing too much or not enough by listening to your body and monitoring what is happening in relation to your pain and how much you are moving about.

I am not in a rush to stop taking medications.  My main objective is to keep moving, but also resting as I need to.   So I want a good night’s sleep and to be able to move in as many ways as possible, and also be able to do my “patterns of movement”.  Oh, I mean, exercises.  The main thing I am doing is icing and elevating.   The knee needs to be above the heart for a properly effective elevation.  Often mine is not quite that high but depending on what I am doing, it isn’t always possible! And I am regularly changing position.  As I sit here typing,  I have been elevating, icing,  doing a few “Quad Sets”,  bending my knee and keeping it there, “Knee Hangs” “Hamstring Isometrics” and a few “Heel Slides” on the bed.  I can do the “Heel Slides” without needing to put a board on the bed, which I needed to do up until now, because the drag of the mattress made it too difficult.   So every little thing is progress.

Unfortunately, when I try to lift my operated leg it in a “Straight Leg Raise” it feels like someone has glued it to the bed and also as if it has a large elephant sitting on it as well.  However, the operated leg does feel a little bit lighter when I move it around in daily life, and I tried side lying leg lifts yesterday, and I was able to lift it that way, which was reassuring.  I think if I wasn’t making progress in other areas I would be more worried.  I AM a little bit anxious about this, but I will telephone the “Discharge Line” at the end of the week, because there are a couple of other questions I have, and it might be possible for me to speak to a physiotherapist hopefully. Have not heard from the local physiotherapy service as yet, but I am sure I will soon.   Keeping  on with the “Quad Sets” and I am now speaking and praying for my Quad muscles. “Come On!  Wake up!  I need you!”

Pain

There is a certain amount of pain.  Sometimes it is a sharper type…Along the incision and something like feels like it is on a medial ligament.  Sometimes a deeper, dull ache. Which can be rather wearing if left for too long.   But to be honest, this is nothing worse than I have experienced before the knee replacement surgery,  and it feels much better.  It has a kind of sense and logic to it, and what is more it comes with a lovely resurfaced knee!  It is not a wild, crazy, untreated, tyrant of a pain.  A pain which is screaming out from deformed bone, and annoyed surrounding tissues, who are being thoroughly irritated by the whole state of affairs.  Or from a leg struggling to cope with uncomfortable alterations in the way it has to deal with the forces placed upon it.  Unable to move as freely as it was designed to move.   No, the pain experience is a matter of something needing to be managed,  but no more than that.  It is not unpredictable.  It’s just making adjustments to it’s new situation.  The pain needs to be accepted.  But it is a lot easier to accept pain when it has some good purpose, which you can appreciate.  It is not as bad as I imagined it might be.  But keeping on top with medication makes all the difference.  Pain which is purposeful is not the same as pointless pain.

Night times:

I think it helped that I had to get into the habit of sleeping on my back before the knee replacement surgery, (no option then, as it was the only way I could sleep!) because sleeping on your back, I should imagine, is probably the “easiest” on the soft tissues of the knee.  Though that is rather off the top of my head.  The leg can just rest without any major pulls or pressure on it.  It helps to have some of those beloved firm pillows to the side, so that the covers do not weigh down on the operated leg.  I am surprised how well I am sleeping.  I certainly need it.  I am not napping in the day, just resting.  I have wanted to keep my old pattern of sleep.  And it looks like I have.

sleep after TKR

sleep after TKR… bliss. When I wake up, I think my body has been very busy though, because I still feel very tired!

Target Setting

My surgery was on the 8th March, and now it is the 20th March!  12 days if you count it from the day after surgery.   I find myself wondering about setting some longer term targets, but I am also aware that I don’t want to frustrate myself.  I cannot believe the energy drain, and I realise my body has a massive task of healing to do. It is immense, but does make sense.  All my body’s resources have a mission based around my knee.  Don’t I know it!  I am praying for more energy and praying for my recovery process to go well.  I have an active part in the praying, as by acting wisely, I will make a great deal of difference one way or another.  I will make mistakes I am sure.  I think the expression “treading carefully” is very apt.  An I will need a lot of grace from God towards myself.  Kindness and compassion.  Applied. In the most frustrating and disappointing moments.  There will also be days, not just moments, I am sure.  When I feel that I SHOULD be able to do something, but I cannot, or I am too tired to do it.  I know I will need to be very patient.   And though this discourse is called “The Very Patient Knee Replacement Story” it only touches on the beginnings of the matter.

I have set myself some targets:

Practise going up and down steeper steps and do more steps in general, as energy allows.

(working towards being able to get in the swimming pool after 6 – 8 weeks!)

Practise getting up and down off the floor

(working towards being able to get in the bath and to get on the floor for yoga)

Practise going for a short walk each day for 10  minutes.

(working towards being able to get up to London on public transport)

I don’t intend to rush.  The amount of energy things take is going to be the hardest thing to accept I think.  Especially as my mind starts to imagine what I could be doing.  So I need to constantly shrink my ever expanding world. However, it feels much better to shrink a world which is ever expanding, than to watch a world gradually shrink before your eyes, as is the case before knee replacement surgery. What I mean, is the world now potentially much bigger than it was before, because I know I will be able to walk around in it, and I will be able to make plans and arrangements which involve walking, travelling, and being able to make commitments which I can be certain, ahead of time,  I will be able to meet.  The things I want to do, I can now expect to do.  However long it takes.

I will not be carrying heavy things.  I will need to look after my knees. I will need to continue to loose some weight (aiming for 12 stone) and  I certainly won’t be able to put it on again.  But my world has already expanded before my eyes.  I want to rush out into it.  I feel like jumping, bouncing, running and leaping into it.  So it will be all the more hard to pull back.  All the more hard to accept limitations. Harder to be patient. So I need to constantly shrink my ever expanding world. Correction:  My expanded world AND my ever expanding world.

Kneeling in Prayer

I am grateful.

On my knees

In prayer. 

Short poem.

It is possible to kneel with a knee replacement.  The bed is a good choice for the time being. Knee pads later on I should think!

I found this:

Don’t sit with your legs crossed for the first six weeks. You can try kneeling on a soft surface after three months when the scar tissue has healed enough. Kneeling may never be completely comfortable but should become easier as the scar tissue hardens.” http://www.arthritisresearchuk.org/arthritis-information/surgery/knee-replacement/looking-after-your-new-knee.aspx

But I am needing to clamber along my bed on all fours, as a matter of getting about.  As the surface is soft, and I don’t do it much, I don’t feel anxious about doing this.  I remember before my surgery that I used to find pressing down on the knee a bit helpful for pain relief.  It often made the knee feel much better at times of extreme pain.  I am thinking that for the soft tissues a little bit of compression, plus the bend that happens as I crawl across my bed, is probably pretty good for my knee.  It does not hurt at all. I want to feel that in time I will be able to put pressure on to the knee.  I don’t want to push it, but I do need to develop confidence in my new knee.   As for sitting with legs crossed, I don’t think that is good for anyone at any time!  Not sure how my scar tissue is.  Have not taken the dressing off yet.

The Centre of the Exercise Universe!

Ultrasport F-Bike Home Trainer!

This is the centre of my exercise universe!

exercise bike TKR rehab

exercise bike TKR rehab

So glad I purchased this.  It was less than £80!  Made in Germany, and very well made in Germany too.  I keep looking at it and cannot quite believe that they have been able to make it for the money!  The advantage of this piece of equipment are many.  Here are just some:

I can hang my Thera -bands on the handlebars so they are all in one place. (Not that I have started using them yet!)

http://www.thera-bands.co.uk/resistance-bands/34-top-resistance-theraband-multipack.html

I hang my small weights on the handlebars and a towel. (Again, not that I have started using these yet!)

I will, in time, be able to use my large, thick light grey heavy duty Thera-band (1.5 metres) looped round my foot to increase the resistance on one side when pedalling.  The resistance settings on the bike are not offering a huge amount of resistance, but this does not matter for me one little bit.  However it will be good to be able to increase the resistance on my operated leg sometimes and yet have the control of movement which comes from the pedalling motion.

I can stand face on to the bike and use the handlebars to support me when I do other standing exercises.

I use the handle bars for elevating my leg and stretching it also.  Nice and high, and good when I have visitors to be able to elevate it so easily and quickly.  Also very good for sitting on a chair opposite it and pedalling away while chatting!

Patterns of Movement, Rather than Exercise

Something I found on the internet preoperatively , which caught my attention, and I decided I wanted to try, was the “Church Pew Exercise”.  I thought it would be good to incorporate it into my own patterns of exercise, so as I can straighten my operated leg so nicely, it seems good to start that now.  Here is some information on it:

“Church pew exercises consist of having the patient in erect stance, closely positioned in front of a standard folding chair (or any device having an edge at the height of the patient’s upper calf, hence the name “church pew”). The patient then rocks forward and backward. The forward motion is arrested by a rapid contraction of the plantar flexor muscles; the trunk extensors also become active at this time. The backward motion is arrested by the calf making contact with the chair. This creates a sudden flexion torque at the knee and an extension torque at the hip, facilitating a rapid response in the quadriceps and hip flexors, respectively. “

As my quads are clearly unhappy with me, and I with them, I thought doing this while singing some choruses would be just the ticket.

More on it here;

Church Pew Exercise, Further Quote from: Church Pew Exercise Integrated With Conventional Physical Therapy Following Total Knee Arthroplasty (TKA): Case Report 7
© The Internet Journal of Allied Health Sciences and Practice, 2015 

As a consequence of the swaying motion of the CPE, the quadriceps, hamstring, and triceps surae muscles are stimulated to rhythmically vary their contraction pattern in response to the shifting balance of the body and the torques at the hip, knee, and ankle joints. Facilitation of the hip flexors and extensors and plantarflexors will contribute to improved muscle control during gait. However, of particular importance is the activation of the quadriceps, which occurs very rapidly due to the sudden arrest of the backward movement by striking the chair edge just below the knee. This facilitates neuromuscular activation of the quadriceps and prepares this muscle to function appropriately during heel strike when quick response is required to avoid collapse or falling.
In addition, the postural patterns used with the CPE are very similar to the lower extremity patterns during the mid-stance phase of the gait cycle. During ambulation, the transition from heel strike to mid-stance is the period when an individual with compromised quadriceps function is most at risk of losing control and falling. Therefore, facilitating these activity patterns immediately before an individual is about to walk may augment lower extremity function and provide a greater sense of confidence in that person.”

I find it all rather fascinating.   Might as well be interested in my leg, and give it the attention it deserves.  The surgeon does his work, and I must do mine.   I am doing this exercise, even for the fact that a gentle reassuring pull on the quads is indeed a gentle reassuring reminder that they still exist!

I called this subsection “Patterns of Movement rather than Exercise” because I am an artist and “patterns of movement” sounds so much more interesting than “exercise”!   I will have an appointment with a physiotherapist in a couple of weeks time and I will let them use their  experience and expertise to address any matters of concern. If I start worrying about my quad muscles,  I achieve nothing whatsoever.  I tell myself.   I just get anxious. That is it.  I keep reminding myself that the “impossible” exercises in the booklet (Straight Leg Raise,Inner Range Quads, and Knee Extension) Were VERY hard preoperatively.  Well, the Straight Leg Raise lying down flat was fine, I used to do that in Yoga all of the time, but I found it very hard to do sitting up.  The line drawing in the booklet is torturing me again… The figure is sitting up, and the operated leg is lifted a whole foot off the ground!  Because there is no expression on the face, they don’t look bothered at all.  And the “Repeat 10 times, three times daily” alludes to a standard and structure I cannot meet!  I HATE that line drawing!  I HATE it with all my heart! I would like to graffiti all over it, but restrain myself.

But  when I tried these exercises out preoperatively they were very hard indeed (with the “Inner Range Quads I could often not lift my foot of the ground at all, and when I did, just to a very tiny degree) and I need to keep this in my mind.  While I can do the “Inner Range Quads” (The towel under the knee and lifting foot up one) with my non operated leg very well, I could NEVER do it very well, if at all, most of the time, with my now operated leg. So to suddenly expect to do it now is ridiculous.  It doesn’t mean I never will be able to do it.

I am  VERY glad I did try out the exercises in the booklet before surgery, as at least I am clear about the “impossible”ones being very, very difficult to do BEFORE surgery.  Otherwise I might not be clear about that, and feel I am “failing” to achieve a standard even more than I do already!  I do not need to blame the surgery (what has been done to my knee!) for the fact I cannot do them.  Even before the knee replacement operation, my leg could not manage them well at all.  Though it will be hard going for a long while, if I do persist in my effort, with a nice smooth joint, in theory, my muscles over time will have more of a chance of success with their efforts.  This kind of self talk is essential to me!  I will be glad to talk to a physiotherapist soon though!  In an ideal world, it would be good to see one right now…But no news of appointment as yet.

A very little “Something” in the right direction

While it is tempting to avoid these “impossible” exercises entirely, I am not doing this, because I cannot avoid them for ever, so I might as well try to do a very little “something” in the right direction.  When working on  the laptop while sitting in bed I have my legs slightly raised on all those fantastic firm pillows, and so I can periodically attempt to lift my operated leg up now and again without it becoming something I fixate on. There isn’t much “lift” going on, but I can feel I am doing something.  I do find that the operated leg being already raised at a slight angle from below on the pillows does seem to help.  The only way I can tell it helps is that the leg does not feel quite so heavy.  It MAY even be lifting a fraction.  A fraction.  I need to change the phrase “If it feels good, do it” to “If it feels like you are doing anything at all, however small, do it”! And “something” is better than nothing.

As I mentioned at the beginning of this post,  I can also do the “Quad Sets” exercise while working on the laptop.  I have my laptop balanced on my tummy if I am lying down flat. Or on the top of my thighs if sitting slightly upright.  I use a fairly lightweight foam pillow to stand the laptop on, as I am conscious of not pressing down on my thighs too much.  (The laptop table I was thinking of using is a little bit too heavy to use in this way).   “Knee Hangs” also and “Hamstring Isometrics” also fit in well to this pattern of exercises.  If I occasionally bend my knee pulling it towards me and hold it there for a while every now and again, I guess I am doing a VERY slow kind of heel slide.  So, a little pattern of movements for working on the lap top has emerged.

Taking this approach does  not mean I will not dedicate a twenty minute slot of time here and there to do the exercises in a more focused way, ever. In time, as I get stronger, I might well have two or three well defined exercise sessions each day.  But this way, doing things in very short phases, it all feels much more do-able, less boring, and feels generally more relaxed.  I am less likely to feel a failure if I cannot stick to the standards I set, if I just take things in VERY small stages. Standards, real or imaginary, can still have a very discouraging effect, even if they are not completely unrealistic. They are still expectations.  And post knee replacement surgery, all expectations have to be put aside on a regular basis. As do comparisons.   With respect to range of motion though, I feel I can afford to be a little relaxed because I have managed to straighten my leg fully  (AND DOESN’T THAT FEEL WONDERFUL! FIRST TIME IN YEARS!) and bend it to 90 degrees. That seems to be a good foundation to start with, and then all the rest will hopefully follow, along with further increase in flexion.  One day it will meet the other leg for a nice mutual bend!

I will save the imaginary one hour long exercise sessions, where I work through all of the exercises to the number of repetitions and do them perfectly, as per the diagrams, with a smile on my face for…Well, not even for later.  I will relegate the image to the dustbin and get on with reality.  In terms of my quad-angst (new word!) I will be seeing a physiotherapist hopefully soon, and  I will also go back to the British School of Osteopathy  at some point, when I can travel to London,  and receive support there.  My surgeon will also no doubt be able to help in some way if the quadriceps are still on strike in a couple of months.

All these things will be able to help me. This is a LONG process.  I have to keep that in mind.  Things are not how I imagined they would be, but I am not quite sure HOW I imagined they would be when I think of it.  Apart from the image of the perfect exercises sessions with the perfect results, that is.  And that really DOES need to be binned.  The time after knee replacement surgery is not something which anyone can ever be fully prepared for I don’t think, because it is a totally unique and individual experience for every person. As is the individual recovery and rehabilitation process.  Hence the danger of comparison with other people.  I do think that whatever a persons personal weaknesses and struggles are, psychologically and emotionally,  they will be challenged. Mobility, and lack of mobility, really hits a person to the core.  But in the meantime, I know I need to enjoy what I am doing, because that way I will do it.  

Ninth day at home  (Day twelve – Sunday – Post knee replacement surgery)

Last night I woke up at 2am.  Not quite sure why.  I did not feel uncomfortable, but I think it may have been that strange point where pain relief wears thin…though not completely off, and so with this in mind I did take 200mg Ibuprofen “just in case”. I have a lot of protein snack bars and mini malt loaf type snacks, so ate one of those as well. I went back to sleep quickly.   I don’t like taking a lot of medication, and before the knee replacement surgery I only resorted to taking Meloxicam if it was impossible to manage any other way, preferring ice, movement, and TENS.  But the whole experience of recovery is very demanding, and pain on top of it would really make things needlessly difficult.  Plus my main objective is to keep moving and this is very do-able with small amounts of pain and discomfort.  It is not do-able in a lot of pain, and loosing the will to live is not a good idea.  It’s all about saving my mental stamina for what matters and not making things harder than they are.  A positive outlook is essential.

When I wake up in the morning, I feel like a bus has just run over me!!  Yes, I don’t think I have ever felt so exhausted in my life.  Thankfully the feeling does not last and half an hour later I am feeling a little more perky and up for the day, even though still very tired.  It is strange, it is as if though I have been asleep, my body has been running a marathon in the night without me knowing anything about it.  I guess all this healing does take a lot of  energy and effort.  I am glad I have the sleep.  Indeed, apart from one other night, when I woke up at 3am and was in pain, my sleeping is fine, lovely, delightful. Very comfy.  I am used to sleeping on my back, so nothings changed.

I am trying to work out what this experience is like compared to when I had my Cesarean Section with my first child.  I think this is going to take a lot longer to recovery from physically.  However, I do not have a baby to look after.   Just a lot of ice packs, pillows, and constant re adjusting of my operated leg as I move from here to there.  (Here to there does not mean very far!)  I think, in terms of tiredness, this would be like having a Cesarean section once every two weeks and having two babies to look after! I do not joke!   I think having had an operation before is helpful to me, as I did remember being “up for nothing”for a couple of weeks.  I have a distinct sense that this is a longer lasting and a rather more heavy weight affair.  However, I have not felt one tiny little inkling of “I wish I had never had this done.” I would rather have big challenges in pain and mobility for three or even six months, and then make, hopefully, if all goes well, gradual steps to a long lasting mobile future.  Better this, than to endure constant frustration and the  never ending reduction of plans and aspirations for the sake of delaying surgical treatment which can address issues of a deformed joint.

When I feel that pain is a bit too much of a pain, I think of my newly surfaced joint,  and stand up straight.  STRAIGHT!   I then bend it backwards and forwards for a bit and feel it GLIDE! I imagine the surface of my knee prosthesis  and then compare it mentally with the most horrible image I can think of of a worn out bone.  It works a treat.  I really wish I could see a photo of what a badly worn out bone looks like,  but my imagination does a pretty good job. I am sure I could find an  image on the internet at some point.  But in many respects I do not need an image, because I know what it feels like.

I am not going to church today.  It is tempting, but it is this energy matter which concerns me.  I want to stay active and stay afloat emotionally.  In order to do this I cannot afford to get over tired. Instead I go for a little “Praise Walk” in the garden.  Indeed, this is easy, for I am very grateful indeed!  It is a very short walk…up and down the garden a couple of times.  And the garden is not very big.  But in the sunshine and fresh air, it feels great!

In what became my favourite blog before surgery, “mykneeyourknee” https://mykneeyourknee.com/2016/09/22/a-view-down-the-line/ Ira Kirschenbaum writes:

I am now at 4 weeks after the surgery. The journey of healing is really amazing. Its not a straight, linear experience. There are quite a few ups and downs- during the ups, everything feels great and during the downs even I, as a surgeon, was getting worried. The ups and down are either in function, motion, general vitality, and pain.”

It is rather helpful to read this.  It is going to be a up and down kind of experience.  I am feeling quite fresh faced this afternoon. But in the mornings I feel shattered.  I have realised how easy it is to get despondent and how patient I am going to need to be.  Before surgery I mentally struck out three months of my life. This did not seem too hard to do.  But now I am actually in the experience, I am realising that already my mind is starting to leap ahead of my body, in  terms of thinking what I could be doing.  I have to pull it back and  take one day at a time.  I have to accept this is a different chapter in my life and it will be different to anything I have previously experienced.  I will have to “go with it” and that involves more than anything being kind to my body.  This sounds simple, but there is a balance that needs to be struck with exercising and challenging myself and resting enough which is indeed a balancing act.

This brings to mind my painting “Debris/Balancing Act”  So here it is!

Debris painting by Jenny Meehan

Debris Painting by Jenny Meehan © Jenny Meehan DACS All Rights Reserved

The Royal College of Surgeons advice for a speedy recovery

The Royal College of Surgeons advice for a speedy recovery:

3 Golden rules for a speedy recovery:

Stay active
Keep a normal daily routine
Keep social contact with people

“Your new knee will continue to improve for as much as two years after your operation as the scar tissue heals and you exercise your muscles. You’ll need to look after yourself and pay attention to any of the following problems:

Stiffness – Sometimes the knee can become very stiff in the weeks after the operation for no obvious reason. Try placing your foot on the first or second step of the stairs, hold on to the banister and lean into your knee. This should help to improve movement and flexibility in your knee. It’s very important to continue with the exercises you were working on in the hospital.”http://www.arthritisresearchuk.org/arthritis-information/surgery/knee-replacement/looking-after-your-new-knee.aspx

I am keeping the above in mind.   I find I am getting up and going to bed at the same time as I used to, and however tired I feel, though I do have a bit of a lie down in the afternoon, I am not sleeping in the day, just resting.  I find it best to only have visitors in the afternoon, rather like they do at hospital.  And one person at a time is best. Every other day, not every day.  This gives me time to do all the necessaries, teeth, wash, exercises, writing, etc in the morning and not worry about using energy up for talking.  Talking, while wonderfully enjoyable, does use up energy!!!!

It is helpful to keep in mind that this is a long rehabilitation process, and I do not need to rush it.  Rushing things is BAD BAD AND BAD after a knee replacement operation on all levels.  I am finding that having my writing project of writing this ” The Very Patient Knee Knee Replacement Story” is very helpful to me personally, because I am able to focus on something, and as quite an achievement orientated person, while the writing is demanding in once sense of it being something I need to make sure I do each day,  this is keeping me very engaged mentally. I like to be occupied.  The wonders of computers mean that it is possible for me to continue with quite a lot of my work.  This is better for me than doing thousands of crosswords, or reading magazines I do not find interesting.

When I cease writing this “The Very Patient Knee Replacement Story” I will start to read some books.  I have lots of books, mostly art and psychology related, which I have been wanting to read for a long time.  I will also resume a bit of work on the computer only.  I certainly cannot start doing anything physical apart from my exercises for a while!  My lovely husband has all the domestic work in hand and in two weeks time it will be the Easter holidays which is the time I have in mind for starting to venture out and about more.  I could probably try doing that earlier, but I am stunned with how much effort it takes to move around even in the house, and I know that the minute I get over tired things will steadily descend and I don’t intend to risk making things any harder than they need to be.

Well, I say that…I still have my silly “making things harder for myself” mentality.  As I look at the exercise booklet, it is so easy to feel that I MUST do that particular exercise (straight leg raise!) and I MUST do it now, and I MUST do it excellently.  But what I realise I MUST do is keep moving, keep active and keep resting.  My main focus is to include some movements which I enjoy (ie yoga) and try and do a little bit more walking around the house each day. Walking is not hard with the crutches, but it is tiring.  Exercises could become a trial if I did not enjoy them, so I am starting to put some music and and to devise little sequences.  Almost dancing! Almost.  I am also making range of motion a priority.   I regularly make sure my day is dotted with a mixture of bending my knee and straightening my knee as far as I reasonably comfortably can do it.  Sometimes the bending involves a low level of what I will term ache-burn sensation.  I won’t call it pain, because as long as the pain is being managed,  it is more of a just hint of pain.  Think of the following:

“A delightful blend of bending the knee, with the gentle addition of stimulating rich ache at the centre”

If it were a chocolate, this is how it would be described!

It is best to choose not to call pain pain if possible.  However, while diverting the mind away from suffering, we all have our limits, and when it feels too much, it probably is.

I think my most important aim needs to be to keep my spirits up. Because after that, everything follows.  Part of this, for me in my own faith tradition,  involves ingesting scripture and the spiritual succour I get from faith in a Loving Creator God.  So prayer, meditation, and reflection on scripture are all part of my recovery package. I am sure that others from different faith traditions  would also find a lot of strength from their faith and their faith community.  People to encourage and help are much appreciated and I think it is important to feel supported.

I have no doubt also that the initial ELATION of the wonderfully positive experience I had in hospital (not just down to the morphine!) is something  also hugely helpful to me and I know this is helping me in this recovery process at home.  I look back on it and feel quite inspired.  It was quite healing in itself, as I have had some negative and upsetting experiences in hospital in the past.  However, on this occasion, I was so well looked after and so well cared for.  The  staff were all so lovely, that is is quite a joy to be able to look back and remember it now.  This helps encourage  me spiritually, emotionally and psychologically.   While the initial high is wearing off a bit,  I am certain that having such a positive hospital stay in my mind, as a positive memory, is helpful to have, as I can look back on it and feel very blessed indeed. Having a good hospital experience to look back on is a very powerful source of strength.

 

 

Exercise À la carte

Just as I would not expect to be given a menu and  then to eat everything on it, I am keeping this thought in mind as I look at my exercise booklet several times over the course of the day.  Though I have seen post knee replacement surgery exercise schedules with tick boxes on the internet, that is not my style, and I cannot imagine being able to do all of the exercises, three times a day, in the amounts suggested, very well,  or even very badly, each day, bearing in the the amount of time I need to simply rest.  Not at this point, anyway.  Maybe in a couple of weeks time.  Thankfully the booklet I have from the hospital does not include a schedule and just gives the exercises and how to do them.  With “AIM FOR” being the key words in relation to how much I might actually get to do.  Apart from the exercises which I find quite easy to do, the others take a lot of effort, energy and determination, and while I make sure I do them, I certainly am not doing the amount of repetitions suggested.  I simple don’t have the energy to do ten of each, three times a day.  Or the time.  But this is not something I think I need to feel bad about.  It is very early days.  The amounts suggested ARE suggested.  And they are not attached to any specific stage in the rehabilitation process.  EARLY DAYS.

My main concern with the exercises is that I don’t get discouraged and that I continue to do them.  Continuing to do them means that I am careful NOT to wear myself out, and careful to make sure when I do them I do them to the best of my ability.  It means that, though I am a very sociable person, I am restricting my visitors, as I mentioned earlier. Otherwise I will get too  tired.  I can also some of the exercises at the same time as seeing people.  Seated heel slides and sitting in front of my static exercise bike while pedalling are the ones that most lend themselves to conversation without drawing a grimace on my face.

Rather than have distinct exercise sessions of a long duration, I am tending to organise the exercises I do around the usual activities I need to do.  I am also grouping them now into bed (lying down) based exercises, chair based exercises, and standing based exercises.  When I get into the different basic positions, I then have a string of exercises I can do from my location/position/necessary activity.  This works well.  It is piecemeal, but does have a nice informal pattern to it.  Sometimes I just do one exercise.  Sometimes a string of three.  Still working out which ones are best where, and when.  But I think it will come.  I am only doing a few repetitions.  And I have noticed that as I gradually move around more, just every day movements involve me using my operated leg in ways which stretch and challenge its strength.

The one thing I  AM doing religiously is making sure I am alternating  my knee regularly from bent to straight.  Icing and resting it.  Getting up each hour, or near enough.   And now having a short walk in the garden.  The operated leg is still quite swollen around the knee area, and this does make it hard to bend.  I am so pleased with the straightness of it.  I have to put my mind to remembering to work on the bend also.  It often feels very stiff because of the swelling, but does seem a little easier to move than it did last week. At hospital, the physiotherapist’s last words were something like “Make sure you reduce the swelling” and I have that hanging in the air.  Hence the considerable efforts of ice and elevation.  It seems that exercises are pretty much all I have to write about currently. That’s the main focus of life at the present time!

Breath…

Feeling like writing a little ditty…Won’t call it a poem, as I reserve that title for more careful and painstaking efforts! This is in the way of personal entertainment.  I have given it a grand title though, as add some kind of weight to it! Though why I want to add weight to it I do not know.  My arms are aching from lugging all these firm pillows around and manoeuvring them all over my nest.

© Jenny Meehan DACS All Rights Reserved yoga chakra colours opening painting art, chakra art, chakra dance, yoga exhale yoga breathing inspired abstract painting by jenny meehan

© Jenny Meehan DACS All Rights Reservedyoga exhale yoga breathing inspired abstract painting by jenny meehan

 

 

© Jenny Meehan DACS All Rights Reservedchakra colours painting, chakra colours art, chakra movement opening, yoga inhale yoga breathing inspired abstract painting by jenny meehan

© Jenny Meehan DACS All Rights Reservedyoga inhale yoga breathing inspired abstract painting by jenny meehan

“Yoga Inhale” and “Yoga Exhale” paintings are available as the original fine paintings on canvas or as an adapted print available through Redbubble.com.  Not signed or numbered, but as part of a very good quality open edition.

https://www.redbubble.com/people/jennyjimjams/works/21645465-yoga-inhale-print-from-yoga-inhale-painting-by-jenny-meehan?p=canvas-print&rel=carousel

https://www.redbubble.com/people/jennyjimjams/works/21645538-yoga-exhale-print-from-yoga-exhale-painting-by-jenny-meehan?p=art-print&rel=carousel

Open edition prints are available on various substrates; canvas, metal, paper, framed, poster prints and selected merchandise.  By purchasing them you help support my creative practice as I get a royalty percentage from any sale.

The life-breath of the saviour’s love brings lightness everywhere

A little bit of yoga,

in mindful prayer

Helps the soul to feel

the Holy Spirit near

(even though my leg is heavy and

the trauma quite severe!)

Pausing in the moment

I’m attentive to the Love

incarnate in being

both within, beyond, above

This time, it is a passage

(and it does seem VERY long)

but with the indwelt Spirit of God,

My soul is very strong.

quote from Daniel Fulham: 

“..You can use breath control during physical activity….During that knee rehab session, picture your breath filling your legs, stretching and relaxing your ligaments.  As also mentioned earlier, exhale on the difficult phase of the exercise and inhale on the relaxation phase”  quoted from pg 105 Knee Surgery – The Essential Guide to Total Knee Recovery by Daniel Fulham O’Neill, M.D, Ed.D

Breathing in this way does help!  Especially with the exercises I find more difficult/impossible!

Washing the body after knee replacement surgery

Today I had a shower.  It has been a week since having one in hospital, so now is the time.  I have been just strip washing each day.  Here is my set up:

bath and shower after TKR

bath and shower after TKR

 

I could kill for a bath, but cannot get into ours.  I am thinking also of the swimming pool which I already miss a lot and pining for immersion in water.  It looks like I will need to be satisfied with just a sprinkling of water for quite a long time.  As we do not have a shower, I fixed this hand shower to the wall in the run up to surgery.  I should correct this.  I just about fixed it to the wall.  It is a little bit loose!  But good enough. I did try out showering in the bath before the knee replacement operation and the shower head is in a good position for hitting my body but not going outside the bath.  As we do not have a shower curtain this is quite important!  I can go to a friends for a shower, and will do this also, but it is nice to be able to have a shower at home.

It goes well.  I ask my husband to be there just in case.  I am not sure which leg I am meant to put in the bath first but because of the way round the shower is in relation to the bath I have to put my operated leg in first.  I have this stool which I got very cheaply from Argos and it is perfect as it is narrow enough for our narrow bath.  Lots of the shower stools I looked at on the internet were too wide and would not fit. Also, they were rather expensive!  Tentatively I put the leg into the bath and fortunately, though there is no rail, there is the tap to the right of me to hold onto, plus the unit, which is fixed firmly in place to the left hand side of the bath.  I could hold onto the sink,but though it has been fixed there recently, I am not confident I will not pull it off!  And there are some things in life you do not want to pull off!

Next manoeuvre, after grabbing the tap and unit, is getting onto the stool. With pulling from the right side and pushing from the left, it is possible.  I don’t think anyone could do this unless they had good upper body strength and very strong muscles in their unoperated leg but I manage it.  Then the heaven of water descends and the risk and uncertainty is all worth it.  I am not sure how I will get out again but who cares.  I can shave my legs and underarms, wash my hair and dream of the swimming pool.  I am dreaming of the swimming pool. Though I cannot imagine how I would get into it.  It is a good incentive to think of the need to climb up and down the steps of the swimming pool.  That might just be the thing which helps me to keep on going in terms of the need to strengthen my operated leg.

After doing all the above, I have a re-think and realise if I get the small step ladder from the toilet, which has a handle bar across the top, I can use that as a support rather than the tap and unit.  I can also use my unoperated leg to get in the bath, which bearing in mind the quadriceps weakness of the operated leg is a better bet. Then just turn around!

On the matter of swimming, I had a visit from one of the ladies at the swimming pool a few days ago and she told me that other people (we all know each other!) are swimming in the lane I normally swim in “for me”.  This is so lovely; they are such a lovely bunch of people.  I miss them very much!

Eighth day at home  (Day eleven – Saturday – Post knee replacement surgery)

It is natural to wonder how I am getting on.  But recovery and the whole process is so individual.  More than thinking about how things are right now, I am wondering how they will be in a couple of months time.  I am enjoying the time right now, but also wondering when I can realistically think of resuming some painting, framing, sorting and other work related tasks.  There are lots of things I can do on the computer, and I lots of preparation for this year’s  Kingston Artists Open Studios Event to embark on.   I did take a look at this though:

The Royal College of Surgeons has a handy Recovery Tracker.  It is described as “Helping you to make a speedy recovery after arthroscopic operations on your knee for meniscal tears”  but it is useful as a reference for knee replacement recovery also.  It says that, at six to eight weeks, I “should have no difficulty with activities like walking, cycling or swimming. Activities that have a high impact on the knee – such as running or heavy lifting – should be avoided.”

 https://www.rcseng.ac.uk/patient-care/recovering-from-surgery/total-knee-replacement/recovery-tracker/

In my head and heart, I am running and jumping!  Which IS a good feeling, even if not translated into action.

Some of my exercises remind me that I have a long way to go.

This rehabilitation process certainly is a hefty one.

You need to really want the surgery and you need to realise that the surgeon does their bit, and starts the process, and you have to finish it.

I am young (ish) fit and healthy, and this is still hard going.  WORTH IT though.

A bit like psychotherapy, it wouldn’t be for everyone.

You need to work at it and you need to believe that it is worth working at.

Exercise À la carte

Because the exercises are hard work, it is good to have a cup of tea as a reward.  I am not going for biscuits as a reward as I don’t want to put on weight just by being careless at this point.  My body just wants blueberries, yogurt, banana and celery more than anything else. Plus a few nuts. And cups of tea and water.

Having something nice waiting for you when you have worked hard at your exercises is good.  And along with a cup of tea, massage, TENS or ice and elevation go down well.  I massage my operated leg with olive oil and frankincense every day for half and hour.  When I ice and elevate I have my leg sometimes straight and sometimes bent, and I try and alternate between the two.  Various arrangements of pillows are possible and I have both the ice cuff from the hospital (which is very good as it holds two ice packs) and a smaller one which includes an elasticated strap.  This is very good as it adds an element of compression into the mix.

pillows for elevating after TKR

pillows for elevating after TKR during daytime. An alternative arrangement for a bent knee elevation.  Useful as it’s good to change from straight leg to bent leg as much as possible!

 

pillows for elevating after TKR

pillows for elevating with a straight leg during the day  after TKR view from side

 

pillows for elevating after TKR

pillows for elevating with a straight leg after TKR view from above.  You can also put something under your heel.

I have now just started to have what could be called exercise sessions.  Just one in the morning and one in the afternoon for 20 minutes.  I pick one exercise I find hard and focus on it.  I have chosen the heel slides on the bed, as it is hard, but not too hard.  This focus includes trying related types of movements.  Though I am doing other exercises at other times, and I am finding little patterns emerging, (as I think I wrote earlier, as I do certain exercises in certain places), it is all rather random.  What this rather laid back approach does give me is plenty of variety and creativity.  I try out little bits of Yoga moves and other parts of exercises I did before the surgery.  I am working on the principle that my body remembers things.  It is not about me trying to do what I used to be able to do but cannot now.  It is more about introducing my new knee to ways of moving that the old knee used to do.  Bit like someone taking over your job. A hand over period!  Whatever I try out I do it with a lot of care and in small amounts.  I make sure my body is always well supported because my quads are rather inebriated and I don’t want to fall.

I felt very despondent today. Fine for most of the day, but very tired.  It was the end of the day, my pain medication was wearing off, and I decided to try to do something very difficult with my operated leg at the moment by trying to lift it up and down off the two pillows I was using to support it while icing.  It was a case of wrong timing, wrong movement (trying to do something which I already feel demoralised with) and bad pain management, as I had forgotten to take my pain medication on time.  This meant that the whole experience has left me feeling low. And slightly anxious, worrying that my quad muscles will not return to action as they used to. As I tried to lift the leg, supporting it with my hand, it was just that little bit too painful and unhappy to tolerate. But still I insisted on doing it ten times.   I have to ask myself why I thought this was a good idea.  What am I trying to do here?

It was because I thought I SHOULD be able to do it, but at this early stage, and not yet having had my physiotherapy follow up appointment, what would I know?  Who says I should?  Why did I insist on giving myself a hard time with it at a time which is the least optimal time of day for me?  Why did I try and do it at all?  It is far out of the range of things which I can do “just a little bit”.   If I want to do exercises or movements I find more challenging, I should choose something that I can do to a small extent, and work on that.  And I have to bear in mind what my leg has been through.  It is so tempting to think that things should be easier and happen more quickly.  But it will take a long time for my leg to get back to full working order.  And I have completely discounted all the things it can do, and am just focusing on what it cannot.

I would be better off simply sticking with lots of quads sets and not worrying about things.  There is also a “Discharge Line” which I can phone with concerns.  I will see how things go, but I can phone this if need be.  That is what it is there for…patients with concerns.  This is NOT something I need to deal with alone.  I will wait for a week or so, but will call in a week or so if no improvement at all, providing  I have not been contacted by the community physiotherapy service.

Sorry leg.  Sorry knee.   I will try and be nicer to you. I will give you some things you can do well tomorrow, with a little bit of challenge, but not too much.  I need to keep myself positive, and in order to do that, at what is a difficult time for my whole being, I would be wiser to take things a little more gently.  As long as I keep the range of motion in order, I am sure the strength will come back in time.  My whole body is very tired and recovering.  My quad muscles were struggling BEFORE the surgery. I must not forget that.  I really must be patient.  And everyone is different.  Just because the exercises are in the booklet, it doesn’t mean I should be able to do all of them at this stage.  It is VERY early days.  I think tomorrow I need to resolve to give myself a bit of a “day off” apart from a few very gentle exercises.  Because I am quite fragile, and it is amazing after surgery, how what would have been a little discouragement, turns into something quite heavy, which can make you despondent.  And how easy it is to start becoming anxious when tired and despondent.

Really important to keep on top of the pain.

Really important to rest and not stretch myself too much.

Really important to leave any concerns about rehabilitation to the professionals.

Really important to be patient, patient, patient.  And if any hint of frustration, more patient!

Tomorrow I will have a bit more of a focus on the walking, as I am VERY good at that, and STAND up nice and tall!!!!! With my VERY straight operated leg.  I will have a celebration of LEG STRAIGHTNESS DAY.

And also work on flexion a bit too.

I am exhausted today.  Yesterday my husband was at work and I needed to do a few more things for myself.  Only a few things but it did make a difference, which brings me nicely onto the next sub heading!

For a shorter version of “The Very Patient Knee Replacement Story by Jenny Meehan” follow this link: https://jennymeehan.wordpress.com/abridged-version-of-the-very-patient-knee-replacement-story-by-jenny-meehan/

Having Someone to Look After you After Knee Replacement Surgery

I have found it  ESSENTIAL to have someone to look after me after knee replacement surgery.  Certainly for the first five days after coming out of hospital.  I am “young” and very supple, which means I can do lots of things, for example, picking things up off the floor and putting my TEDS on without any problems.  I also have very good core and upper body strength.  I think this is making things a lot easier for me.  But if someone was less fit in the rest of their body, it would make things much harder.  Either way,  fit or unfit, you have very little energy after a major operation as all the energy goes towards healing the knee. This means that you do not have the energy to go backwards and forwards getting ice packs, food, drink, or anything else you might need.  It is important to have someone at your beck and call!

Ideally it would be good to have help for two weeks,  if possible.  Even if just part time for the second week.  It is not that you would not be able to manage on your own.  It may be possible, though I think unwise.  It is rather that it would be wrong for you to have to.  Every  little thing is very tiring, and even if you can physically do things in respect of being able to do them with your body, it is wiser for all the energy you have to go towards your knee healing.  Your body needs all of your attention and you need someone to help you care for it.  I spent a lot of time organising things before the surgery and made sure I had everything I needed to hand and near the bed, as much as possible.  Lots of little baskets and hanging containers, with snacks, medication, essential clothing, small cartons of drink, vitamins, reading material, tablet, and electrical sockets all within reach. This made my second week, when my husband was back at work, much easier. And I certainly utilised his assistance when he got home at the end of the day!

I am spending a lot of time writing, but  I am making sure I keep moving, change position, do a bit of exercise here and there, and going for little walks every hour.  I would rather write than feel I am whiling the hours away.  When I stop writing this there will be plenty of time for day time TV. Have not got to that point yet!

PS  As with all my ideas and thoughts, bear in mind that I am an artist and creative, and NOT medically or professionally qualified in any of the things I write.  I am writing because I love writing, loved having a knee replacement, and wanted to share my experience in case it gave other people ideas, questions, and thoughts which they might like to explore.  Check everything you do out with the relevant professionals.  DON’T take it from me. Just read away here and there, if it interests you. Then do your own research and seek your own advice. And don’t contact me for advice. I won’t give it. 

Seventh day at home  (Day ten – Friday) Post knee replacement surgery)

WEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE!

Fluid intake.

Fluid outlet.

In hospital I kept the nurses very busy with bedpans.  Jesus washing the disciples feet has changed into Jesus changing bed pans.   Ministry of love.

The “Hydration Station” was a highlight of the day.  Love that: “Hydration Station”. It really was called that!

I was very thirsty in hospital and drunk lots of water.  Nothing has changed at home.  I just have a bit more tea now as well.

I am very thirsty, and as I cannot swim in water at the moment, drinking it is the only way I can enjoy it.

I understand it is good to have good fluid intake  after surgery.  Fortunately my body agrees and it has been calling out for water very regularly.

The flip side is, well, the other end.

POTTY

Very good.  Toilet upstairs.  Me downstairs.

With the amount of trips I need to make (fibroids on my uterus pressing in, as they do), I think I would be exhausted if I did not have a potty.

To make things a little more pleasant, it is a container with a lid, and I put some camping toilet sanitizer (Elsan Blue Loo) in it, so it is very un-potty-ish.   A few squirts of a perfume I no longer use around the area, and you would never know!

You would never know, but I have told you now.

Sorry about that.

You probably didn’t want to know!

 

tea after TKR

tea after TKR  My lovely husband has prepared things!

 

tea after TKR

tea after TKR.  I don’t normally wear slippers, but got these for wearing in hospital.  Lovely sexy TEDS on!

 

Infection

“KneeReplacementSurgeryMaximizingYourNewKnee”  PDF at http://www.ortho.ufl.edu says:

Signs of infection are:
• Swelling
• Increased pain or tenderness
• Redness and heat
• Drainage (other than clear reddish yellow)
• Fever
When your incision has no open areas or scabs, you can massage with a water-based lotion
(approximately 4 weeks after surgery).

 

My incision is still under cover as the dressing is not due to come off until two weeks after the surgery.  If I rub my fingers over the dressing I can feel it.  I quite like the feeling.  I am glad my stitches are dissoluble though.  They feel very neat.  Makes me think of my “Mending” painting, so I will post that up here with this post!   I gave my leg a gentle massage this morning, which is something I have meant to do more of, but have not.

Infection is something worrying to think about.  Probably best not to dwell on it.  There is good reason to be aware of it, though I don’t think being aware of something and then choosing to think about it more than you needs to is helpful. This is one of the problems with the internet I think.  There is so much information about, that if inclined, someone could feed their anxiety for weeks and find more and more reasons to be concerned.  Even reading the extract I quoted above, I can see how even a healthy knee might translate into someone’s mind as an infected one.  Because there IS swelling, there IS tenderness, and sometimes you do feel a little bit hotter occasionally. The area has looked a little more reddish at times to a slight degree.  However,  I remember the cut on my hand which I did a week before the knee replacement operation, and how closely I looked at it then, to make sure that it did not have any signs of infection.  As I observed it, I did see swelling, redness, and tenderness.  But in a gradual and not extreme degree.  Nothing sudden, nothing major, nothing strong.  They are all part of the healing process. More internet input can be helpful, as in reading this:   https://www.advancedtissue.com/6-signs-you-have-an-infected-wound/ but nothing can replace a professional opinion.

Because I was concerned that my surgery might be postponed, I kept a very beady eye on the cut in my hand. I did a fair bit of searching on the internet, and this was a good thing, because I wanted to find out more about how wounds heal.  It turned out that the cut was providential.  Because it made me look a little bit more carefully at how my body works.  The healing process is amazing and inspirational.  We have a wonderful Creator.  Quite miraculous.  As I looked into the biological process it was rather encouraging to see what the body does when wounded.  So that little “Baby” cut, was the introduction to its rather big “Mummy”!  I cannot see  my incision at present, but have no reason to believe that  anything is amiss. I am going to keep my incision completely dry even when the dressing comes off. For three weeks. On the theme of healing, here’s one of my paintings titled “Mending”;

lyrical abstraction contemporary artist british, female artist jenny meehan london based, lyrical abstraction process led painting,collectable abstract paintings for collectors, jenny meehan jamartlondon uk, art historical relevant significant art british,exploratory innovative paintings, british women artists current today,affordable original paintings to buy uk, collectable paintings original british contemporary a

abstract lyrical expressionist british paintings jenny meehan

SO Tired!

It is very surprising how tired I feel.   I do feel quite perky, and then I do a very little thing like go and have some breakfast and arrange some flowers and I can feel my heart pumping away and I feel like lying down!  Though I have my repeating pattern, mentioned in the last post, of REST, EXERCISE, ICE, ELEVATE (not necessarily in that order and can happen in lots of different combinations!) It is certainly the case that I am not doing as much exercising as I imagined I would be doing.  I did not imagine that doing a tiny weeny bit of a challenging exercise would be quite so exhausting either! Or that I would feel so discouraged when I try one which is hard for me, and I can only just do it fractionally.  I have to keep choosing to look LONG TERM.  It actually helps me to look back and see that I had to work very hard for a long time to keep my knee functioning, and even then, it turns out that it didn’t function adequately enough for me to have a happy life.  So I have had my ups and downs, so to speak.  I have already pushed through difficulties.  When faced with current difficulties, it can be helpful to look back and recognise past challenges which you have managed to get through.

Something from the Royal College of Surgeons:

“Tiredness and feeling emotional”

Your body is using a lot of energy to heal itself, so you will feel more tired than normal – sometimes it can come upon you suddenly. If you feel upset or emotional in the days and weeks after your operation, don’t worry – this is a perfectly normal reaction which many people experience, particularly when your blood haemoglobin level may be a little lower than normal in the post operative period.

https://www.rcseng.ac.uk/patient-care/recovering-from-surgery/total-knee-replacement/what-to-expect-after-the-operation/

Nice Bright Flowers are Good for the Soul

Thank you to my lovely friends who have given them  to me!  The ministry of flowers is seriously under rated!

Highlights and lowlights

A highlight today was suddenly realising, as I did Warrior One by the sink (holding onto the edge of the unit, rather than with raised hands….just to be cautious, though I can lift my hands and balance) was that it was EASIER and more of a pleasure to do!  Instead of the usual “clunk, clunk, clunk” and uncomfortable feeling and my panic stricken leg pulling itself with extra effort in order to hold things together, I simply bent the knee, and SMOOTH AND SURE, with previously unknown grace (or not known for many years) we glided into position!  AMAZING! As well as the improvement when the operated leg is at the front in the bent position, when it is extended to the back I can feel the pressure from the floor smoothly right along it, from the heel, in a way which is guaranteed to make me feel very happy.

A low light, on the other hand,  is the degree I need to go to to do the “Seated Knee Extension” exercise. Still.  This was very hard pre-op and I needed to  lie back on the bed, rather than do it sitting up.  So I do it the same way.  A nice firm pillow behind my back is good because it is very tiring.   I also do use the other foot and my Thera-band looped around it.  Even then it takes a huge effort.  But I have to keep telling myself that this really IS ALL ABOUT PATIENCE.

 

IMage from the hospital rehab book. and hook and loop image?

Other Exercises on today’s Menu are:

Knee Flexion/Extension. Standing nice and straight and holding onto my exercise bike, I bend my operated knee as far back as I can, hold for a count of six and then relax. I can lift my toes about five inches off the ground with this one, which is quite encouraging.  As lifting the leg seems to be my most challenging area and the one which makes me feel most quickly discouraged, this exercise is one I think I will focus quite a bit on because it is hard but not to the extent I feel demoralised.

Hamstring isometrics. Lying on my back, I bend the operated knee slightly, and then push the heel into the bed. Hold for a count of six and relax.  I like this one.

I am seriously missing swimming.  But the yoga I  have started now already, which I did not imagine would be the case.  Very adapted yoga, I hasten to add, and only in small portions.  Good for the upper body and to just make me feel back to “normal”  Though the great thing is, of course, that the “normal”  I had before is not nearly as good as the “normal” now!  I am thinking positive.   It is not about trying to do what I used to be able to do.  It is simply about moving and moving and moving. With my new knee!

I need to be kind to it.  It is doing very well.  Can  you give  your knee a pat on the back?

Before the knee replacement surgery I watched a video of the procedure, which I found very interesting

It has some very exciting music at the  outset, and is in high definition!

I don’t mind this kind of thing at all.  I am rather interested in surgical procedures.  I used to be a dental nurse many years back, and this must have been where I got my taste for such things.  One of the surgeons at a practice I worked at was training in oral surgery, and used to take a lot of wisdom teeth out.  He took mine out. Popped them out like peas.  They are not always like that.  But mine were. The surgery was always interesting to watch.  Opening up infected abscesses was NOT nice to watch though , and stunk a great deal.  Gracious, I used to need to take a good inward breath before the dentist cut into the skin with the scalpel, and try not to breath for a while after until everything with well and truly sucked up through the aspiration tube.  But mostly  oral surgery a joy to be part of. Very interesting indeed.

Anyway,  back to the knee replacement operation.  Don’t watch it if you are someone who does not want to know what will be done.  I am the opposite.  I can be kinder to my knee and my leg when I understand what it has been through.   Though knee replacement surgery is obviously a far greater trauma to the body than having a dental crown fitted, and is major surgery, the similarities in the process for me are something quite comforting and interesting.  I certainly have seen many dental crowns fitted over the years, and don’t have any concerns about my total knee replacement prosthesis coming loose, or at least, hopefully not for a respectable while (unless there is some specific complication, for example infection.  Let’s certainly hope I miss out on that.)  And in time, I may, of course, need revision surgery.  I know this, and I factored it in to my decision to have the knee replacement operation. It depends on how long I live, and how my knee replacement fares.  At 52 now, if it lasts 25 years, I will be looking at further surgery at 77.  But I might not even get to that age.  Hopefully, if I do get to that age, I will be able to look backwards and see the wonderfully active 25 years I have been able to enjoy, and which would not have been possible without having my knee surgically treated. I am hoping for 20 years. 10 would be a tad disappointing.  But still worth it. It’s impossible to know how long it will last.  This is the risk you take.  A calculated risk.

I will also do my best, more than my best, to look after my new knee. Now I know what it is like to have the potential for so many good things in my life stolen away, because of not being able to walk very well at all, I can certainly count, even if the knee prosthesis only lasts 15 years, the choice to be a most excellent one.  I remember thinking quite clearly as I was considering surgical treatment, that the state of my knee (before knee replacement) could not be far from what an unsuccessful revision surgery might produce for  someone. And that even if I did need revision surgery, it would be worth it just to have 15 more years of life in the slightly “younger” age bracket of 50 – 65.  I was not ready to join the part of my life which, as life may well do with time, gradually shrinks in some ways.  Or in terms of mobility, at least.   And I need to be careful when I mentally consign anyone over 70 at restricted in mobility.  There are many elderly people I know, including the late Reg Driver, who were gallivanting around in their 80’s with gusto.

Well, back to what I was about to share:

Mmmm.  Meaty! How I miss the sound of a drill!

But not everyone likes watching surgery, and if you are interested to get an idea of a basic outline of the knee replacement procedure, then this video gives you an idea.   The internet is loaded with videos… I did a little bit of a skim over them.

Sleeping after Knee Replacement Surgery

At the moment my sleep is fine.  But I think people often find it harder later on in the process.  My pain is under control at the moment.  I think if it got out of control things could change.  I had to manage pain at night before the surgery, and I was expecting it afterwards.  But it is still early days.  The thought of it, in itself, does not freak me out. As long as I am sufficiently rested over all.  One of the reasons I am banning myself from going out for the two week post operative period, is I know how easily I could get over tired, and I will get more emotional and become stressed if I let that happen.   I want all my energy to go into my knee.

The text below is quoted from: http://www.aahks.org/getting-a-good-nights-sleep-after-hip-or-knee-replacement-surgery/

“Getting a Good Night’s Sleep after Hip or Knee Replacement Surgery

One of the most common complaints after total joint replacement is difficulty sleeping. The most common cause of sleep disruption is pain. It has been reported that more than half of patients wake up with pain after joint replacement. Many factors can affect the quality of sleep after a major surgery including anesthesia-type, narcotic use and discomfort due to pain or restricted leg movements. As sleep is crucial to the recovery process, it is important to follow appropriate pain management protocols.

Contemporary pain management protocols are designed to be multifaceted and inhibit pain in a multitude of ways. Many protocols use a variety of injections and nerve blocks for localized pain, as well as employing narcotics and anti-inflammatory medication for several weeks after surgery. As such, pain protocols should be fully followed to ensure an adequate recovery.

Usually around the second or third week after surgery, you will start to increase your activity levels while at the same time decrease your narcotic use. This often coincides with having a difficult time sleeping. When this occurs, you should take your pain medication an hour before bed to achieve better comfort and help restore your sleep cycle. A few days off from strenuous activity or physical therapy will not inhibit your recovery, but can have a tremendous effect on your ability to fall asleep and stay asleep.

Overall, sleep deprivation after total joint replacement is manageable through pain management, the occasional use of sleeping pills, and activity modification. If all else fails, it is advisable to call your surgeon who can help you manage sleep disturbances during the postoperative period.”

It is easier to sleep at home than in hospital!

I am not taking any morphine, as I was in hospital.  Still on the  Co-Dydramol four times a day.  Don’t take the maximum strength Ibuprofen at the moment, though I took one last night before bed with a snack.  If I do get significant night pain, the plan is to take the Ibuprofen at night time, with food, watch something on the i player, and use the TENS machine I think.  The bottle of morphine is only for dire emergency, if one should occur!

St Patrick’s Day

As it is St Patrick’s Day today, I include this:

http://www.independent.ie/videos/entertainment/watch-irish-dancers-stole-the-show-in-temple-bar-as-thousands-celebrate-st-patricks-day-35540728.html#play

This is pretty much what I feel like when I think of my “new” knee!   I am not sure any jumping would be a good idea, but in terms of my heart and body feeling light, all that bouncing around is very much in line with my feelings.  I remember at the British School of Osteopathy the senior osteopath saying that I would be “bouncing around in no time.”  Well, I am inside!

PS As with all my ideas and thoughts, bear in mind that I am an artist and creative, and NOT medically or professionally qualified in any of the things I write. I am writing because I love writing, loved having a knee replacement, and wanted to share my experience in case it gave other people ideas, questions, and thoughts which they might like to explore. Check everything you do out with the relevant professionals. DON’T take it from me. Just read away here and there, if it interests you. Then do your own research and seek your own advice. And don’t contact me for advice. I won’t give it.

For a shorter version of “The Very Patient Knee Replacement Story by Jenny Meehan” follow this link: https://jennymeehan.wordpress.com/abridged-version-of-the-very-patient-knee-replacement-story-by-jenny-meehan/

 

Sixth day at home  (Day nine – Thursday – Post knee replacement surgery)

I do remember the lady at the Open Day mentioning that many patients find the pain increases around this time, and true to form, mine has. (It is not nearly as bad as I expected “bad” to be though).  However, even though this is the case, there is a big difference between pain with a purpose and pointless pain.  In the day when doing exercises or gently mobilising the joint, it is easy enough to breath through it, and there is always ice and TENS.  What I will not tolerate is the pain stopping me from keeping on moving. That’s the reason, or one of them, I wanted to have the knee replacement surgery in the first place.   So I do keep, very gently, pushing on into the pain when I am exercising.  Just for a bit.  It doesn’t need to last long. No forcing.  Just patient application of movement.  Because I have additional pain management methods of ice and TENS, I have not needed to increase the pain medication at all.

using TENS after TKR for pain relief

using TENS after TKR for pain relief

I did find myself in what I call “deep pain”  last night at 3am.  It is more than a nag.  It is a bit like when you are swimming and you suddenly find yourself out of your depth.  I took some 400 mg Ibuprofen and asked my husband to get me some ice.  I elevated the leg for 30 minutes. I didn’t bother trying to get right back to sleep, but read a bit of my favourite book at the moment “Knee Surgery – The Essential Guide to Total Knee Recovery” and after an hour of being up, I settled back down to sleep.  It was fine.   I think one of the reasons it was fine was that I was not over tired in the first place, and also, when I found myself getting slightly anxious about the pain, I put on some relaxing music and did a bit of whole lung breath breathing.   Though the Knee Surgery book is not focused on knee replacement surgery specifically, but covers other surgeries, I am finding it a very good read.  It has a lovely tone about it and as I like books which I can dip in and out of, it is perfect for middle of the night reading!  It is the mind that often goes out of control with pain.  It is not that the pain is not there.  But there needs to be a certain amount of acceptance, along with the appropriate pain relief medication.

 

© Jenny Meehan DACS All Rights Reserved "Slow Motion We Get On" Digital Print by Jenny Meehan for sale to buy at Chessington Court Cafe and Garden Centre This ink-jet print is laminated and mounted on Foamex. It can be purchased with or without a frame. Bold, bright, geometric composition from British female fine and applied artist Jenny Meehan jamartlondon.com

© Jenny Meehan DACS All Rights Reserved “Slow Motion/We Get On” Digital Print by Jenny Meehan .Bold, bright, geometric composition from British female fine and applied artist Jenny Meehan jamartlondon.com

https://www.redbubble.com/people/jennyjimjams/works/23189740-slow-motion-we-get-on-abstract-print-design-by-jenny-meehan?p=photographic-print&rel=carousel

Open edition prints are available on various substrates; canvas, metal, photographic paper, framed, or as poster prints or greetings cards. as well as selected merchandise. By purchasing them you help support my creative practice as I get a royalty percentage from any sale. It’s safe, quick and easy to order. Also see my website jamartlondon.com for original paintings.

Nothing is moving very fast at the moment!  But I am  “getting on with it!”

Exercise À La Carte

The trick is,  I think, to  think “Slow and sure wins the race” and take things day by day.  Celebrate what goes well and if things don’t go well, accept them, and move on as best you can.

I was given by the hospital a rather handy “Your Rehabilitation and Exercise Programme following Knee Replacement Surgery” booklet, which included the essential exercises which I need to do every day, and it is these which form the core of my exercise programme. Days are basically: EXERCISE REST EXERCISE REST ICE ELEVATE EXERCISE REST,EXERCISE REST EXERCISE REST ICE ELEVATE EXERCISE REST,EXERCISE REST EXERCISE REST ICE ELEVATE EXERCISE REST,EXERCISE REST EXERCISE REST ICE ELEVATE EXERCISE REST,EXERCISE REST EXERCISE REST ICE ELEVATE EXERCISE REST… etc. Anything else that happens is a small add-on!  I find it important to take the pain killers half an hour before the exercises, generally speaking. It varies, but it is helpful.  It is not that I cannot do the exercises without having taken the pain killers before.  It is just if I am doing the exercises at the tail end of the effective phase of the medication, it does hurt,  and I am less likely to both persevere and more likely to avoid the exercises I find harder.

Now, exercises became a way of life for me quite a while ago.  This is no bad thing.  I have been doing a lot of exercises for a very long time. It was September 2015 when my GP prescribed me some quad strengthening exercises.  In 2016 taking part in the  “Better Bones” public health programme introduced me to some more, and the Physiotherapy Lower Limb class gave me a few more to try out.  I have been doing various other exercises, as well a Yoga, for a couple of years now. And the swimming.  I have experienced pain of different levels and duration as part of my application to exercise, and yet I always felt it worth it, as I simply did not want to descend into a cavern of inactivity, which seemed to be the only other option.  In the end, doing the exercises, as a mode of treatment, wasn’t definitive enough for me. My gut instinct has always been “my knee needs fixing”.  I have been willing to keep an open mind that things MIGHT improve sufficiently symptom wise, but I have never, deep down, believed it.

Now it has the beginnings of the future in place. I can work with it and believe it has some longer lasting chance of improvement.  I think knee replacements can take around two years to settle in comfortably.  So if it takes ages to improve, I am still very happy. The present time involves exercises, and I would have thought I would have had enough of them.   But, do you know, this is so much better than before.  Because now my work will have lasting effect.  It is hard right now, and easy to be discouraged, but I have this knee joint treated and I can and will work with it.  I invested myself into the exercise before the knee replacement and I will do the same afterwards.

Exercises I am doing: (three times a day, unless otherwise indicated is suggested.  Cannot truthfully say that I am doing all of these three times a day but they do get done at least twice a day.  Also bear in mind that I can do some of them and others not, ie Straight leg raise)

Ankle pumps  10 times …Kind of whenever I think of them.

Quad sets 10 times,  lying on my bed, this is the exercise of choice! Can do when icing knee which is handy.  Not sure if this is the best thing to do, but multi tasking is helpful to me.

Gluteal sets,  done lying on my back and pretty much anywhere else.

Straight leg raise.  I do this lying on my back.  Sorry, correction:  I TRY to do this exercise.  Still working on it! For I do not have “lift off” as yet!  The idea is that I WILL BE lifting my leg up as straight as possible, about 12 inches off bed.  Holding for count of six and then lowering.   I am doing with both legs by hooking the unoperated one under the operated leg for now.  Hoping that one will help the other!  This was one I did a lot before the knee replacement operation, and I was surprised how hard it was then.  Keeping that in mind is helpful now.

Inner range quads.  I do this sitting up with straight legs out in front.  I put a rolled towel under the knee and then lift up the heel.  Hold it for five seconds.  Sorry, correction: I am LYING.  I don’t like this exercise at all.  I have relegated this one for LATER. MUCH LATER.  Cannot do everything.  This was one which was VERY hard before the knee replacement surgery.  I sometimes could hardly lift the heel off the floor then.  I have to accept defeat with this one, FOR THE TIME BEING.  We do not like each other.

Heel Slides. Can be done on the bed or on a chair.  Chair is best. Correction.  Chair is not best.  I am just saying that because Chair is EASIEST.  That is not the same thing.

Knee Hangs.  These help the knee to fully extend.  I do these on the bed.  Putting a rolled up towel underneath my ankle, I let the leg straighten.  I rest the leg in this position and try and do this as much as possible over the course of the day.  I like this.  So proud and pleased with my STRAIGHT leg.  This is MILES easier and more comfortable than when I used to try and do it before the knee replacement surgery. This is a great exercise for doing with a nice cup of tea and a very self satisfied smile on the face.

Lowlight of the Day

I am feeling rather discouraged when I try the Knee Extension exercise. (Seated, lifting operated leg up by straightening knee)  I have to think positively…

I start by stamping (but not hard!) my feet up and down.  This is a good start, because it reminds me that I could not even lift the operated leg up off the ground at first.  Then I try to tighten the thigh muscle and straighten the knee, and it does not move at all.  I am cursing the picture in the booklet with it’s perfect example and dynamic looking arrows.  I use my left toe just behind the heel of the right foot to gently encourage the right operated leg to go in the right direction and activate the quad muscles with all my strength.  It feels impossible.  But the fact that it feels such hard work is good, I am telling myself.  I am working, there is no doubt about that.  The result is just a slight feeling of it being not quite so heavy.  But that is something.  And when I had a visitor here this afternoon, for some odd reason I decided to lift both legs up at the same time a bit, with my hands tucked under my thighs, and I did lift the operated leg along with the non-operated leg up a bit.  So that was a surprise.  So maybe not such a low light after all.

knee hang after TKR

knee hang after TKR

 

Highlight of the Day

Well, it has to be my lovely visitors.  Won’t go into detail as I respect confidentiality, but some more lovely flowers and even more beautiful than that, marvellous friends.

The Royal College of Surgeons website is an excellent source of information:

“Discomfort

The initial pain of surgery needs to be addressed with fairly strong painkillers for the first few days. You should expect to need to take painkilling tablets for up to 12 weeks after your operation. Your surgical team should be able to provide you with a leaflet about pain management.”

https://www.rcseng.ac.uk/patient-care/recovering-from-surgery/total-knee-replacement/what-to-expect-after-the-operation/

Yep…12 weeks.  Not surprised about that.  But pain CAN be managed.   And when you have prior experience of doing this, it does come in handy.  The pain feels very positive.  It is what it is, and you chose it. It will improve.  Even if it doesn’t completely go away (I believe some people find this), at least you know you have done all in your power to makes things POTENTIALLY better.  That is what I hold in my own thinking on the matter.

Falling Over Myself – Walking in the Early Days after Knee replacement Surgery

I like my crutches very much. In hospital I found them easier to use than the walker.  I think because of the height, there is a little bit of a lift when I use them which feels more natural.  I did use one I borrowed from a friend a few times, prior to the knee replacement surgery. I found it helpful  if I had a day in London which involved a lot of walking and if my knee seemed particularly cranky. The  hiking stick was normally enough but did not give the level of support. Being able to borrow some crutches beforehand also meant  I was also able to have a bit of a practice with them prior to the surgery. So I feel quite at home with them.  Well, I am quite at home with them, as I have not ventured out the house as yet.

Still very tired, and yesterday, as I was chatting with a neighbour at the door, using the crutches for support, after about ten minutes I was completely exhausted and realised yet another little thing which I have previously taken for granted.  So though I feel brilliant, and am surprised with how much I can move, I realise that I need to curb the internal enthusiasm and keep holding back a bit. I need energy to go to the healing process. And, I need energy for talking.  That is essential.

As I tried out using just one crutch for a short while in the kitchen, I  accidentally placed the left crutch on my left sock which had come a bit loose, and lost my step, falling forwards.  Luckily I am flexible at the hips and just ended up in an unexpected downward facing dog (yoga pose) so no harm was done. But certainly a timely reminder on the importance of being careful.  I am used to walking around pretty slowly anyway, but this adds a new level to walking carefully!

As today is the first day I have been home all by myself, with husband at work and teenagers at school, I decided that when I came down the stairs I would go on my bottom and make my way down that way as no one else was in the house.  It turned out to be quite a good exercise for the knee, as I needed to keep bending it.  I do find I can feel slightly light headed fairly quickly. It is not much, but not worth risking anything when alone in the house.

So with respect to walking… I am doing a bit.  Short little walks around the house. It IS tiring!

love my walk socks. But not doing all that much walking at the moment after TKR

love my walk socks. But not doing all that much walking at the moment after TKR

 

Walking  from arthritis research

“It’s important to use crutches or walking sticks at first because the thigh muscles (quadriceps) will be weak after the operation, and falling could damage your new joint. Don’t twist your knee as you turn around. Take several small steps instead. 

After two weeks, or sooner if you’re confident, you can go down to one crutch and then a walking stick. After about six weeks, if your muscles feel strong and supportive, you can try walking without aids. This process may take less time if you’ve had a partial knee replacement or longer if you’ve had a more complex operation.

You should be able to walk outside within three weeks of having surgery but make sure you wear good supportive outdoor shoes. After three weeks, try to take longer strides so you can fully straighten (extend) your leg.”

Well, that is handy to know.

I have decided to stick with two crutches, whatever.  I want to give my knee plenty of support, and it is a more balanced way of walking with two.  It has lots of healing to do.  I will be putting pressure on it with various standing exercises.  I am treating it with the greatest of respect.  Looking at the video and seeing what it has been through, it deserves a bit of a break!  (of the holiday kind!)

RICE

I found this text below:

R stands for REST. In the initial stage after the knee surgery, your body has been through significant trauma from both surgery and anesthesia. Therefore, you should let your body rest well and promote recuperation. This is especially after rehabilitation as it helps your muscles to repair themselves before the next work-out.

I stands for ICE. An ice bag or other icing methods should be adopted regularly in the first few days after your knee surgery. It is recommended to ice your knees for 20 minutes in every 2 hours and repeat the process throughout the day. Cold therapy helps to reduce both pain and swelling.

C stands for COMPRESSION And Massage. The stockings or Ace bandages not only hold on the bandages but also helps control swelling. Ideally, you should wear them for the first 2 weeks. Besides, you can massage your knee comfortably right over the dressings.

E stands for ELEVATION. It is essential to keep your leg elevated above your heart as much as possible to allow the excess fluid and blood to exit the knee. At least 15 minutes of every waking hour, you should combine elevation with passive extension.”

quoted from : http://www.jointessential.com/what-you-need-to-know-after-a-knee-surgery/

On researching this I found the text is the same as in the most excellent second hand book I purchased before the knee replacement… must be related… The book is “Knee Surgery – The Essential Guide to Total Knee Recovery” by Daniel Fulham O’Neil, MD, Ed.D  It is not a new book but I love it.  It is written by a man who is both a knee surgeon and a sports psychologist and I like the mix!  I like the attention paid to the psychological aspects of the recovery process and the way he places special focus on the mind-body connection. His suggested rehabilitation schedule is rather beyond me at present,  and a little too military for my liking, but there are some good additional standing exercises and I don’t have many standing exercises in my rehabilitation booklet from the hospital. As I haven’t seen a community physiotherapist yet, it’s helpful to have some additional information to hand.

 PS  As with all my ideas and thoughts, bear in mind that I am an artist and creative, and NOT medically or professionally qualified in any of the things I write.  I am writing because I love writing, loved having a knee replacement, and wanted to share my experience in case it gave other people ideas, questions, and thoughts which they might like to explore.  Check everything you do out with the relevant professionals.  DON’T take it from me. Just read away here and there, if it interests you. Then do your own research and seek your own advice. And don’t contact me for advice. I won’t give it. 

 

For a shorter version of “The Very Patient Knee Replacement Story by Jenny Meehan” follow this link: https://jennymeehan.wordpress.com/abridged-version-of-the-very-patient-knee-replacement-story-by-jenny-meehan/

Fifth Day at home (Wednesday – Day eight – Post knee replacement surgery) With a little bit of a news item

Wow!  I had this up near the bed last week:

That seems a year away!

I think I slightly over did it yesterday.  Far too easy to have a rush of energy and start forgetting you have had major surgery.  I am constantly trying to pull myself back a bit.  Because I am getting all over excited about my “new” knee.  Though it is not new, but the old one with a beautiful crown on! However, I will call it “new” because the addition of a prosthesis  has given it a new lease of life.  And me.

I need to ensure I have an afternoon nap, I think, and elevate the leg for a good two hours then.  I am elevating the leg over the course of the day but it is easy to forget to do so.  I am still in the course of linking up different exercises with different places and positions I will be in in the house.  For example,  I can do quad sets with my leg elevated while working on the computer. I can plug myself into the TENS machine and (gently) work on my flexion as I sit on the dining chair while watching TV by gently rocking my torso forwards and backwards.  Looks mega strange, but gives a firm, but still gentle, stretch to the leg.

I am going on the firm but gentle route I think, in approach.  Because it does tighten up pretty quickly.  It is still moderately swollen and I am needing to put more effort into reducing this I think.  I am also, (while having fun experimenting will what I can do), bringing myself “back to basics” and MAKING myself keep on trying with those exercises which are currently producing rather disappointing results.  Having said this, as I think I might have said earlier, even when I notice the leg feels a little lighter, I need to remember to acknowledge this as progress, because it is.  It show’s that my dozy quads may be starting to stir from their sedated sleep! It’s just exercise, exercise, exercise at the moment.  If it’s a bit boring reading about it, you are at least getting a taste of the process involved, because it does take some will power to stick at the exercises, rather than just opting for not doing anything.

I am starting to see the odd visitor now.  I have lovely odd friends.  It is so lovely to see them.  I have inwardly confined myself to not going out for another week.  My choice.   Apart from going in the garden.  I still feel VERY tired and need to keep breathing deeply and resting.

looking at my sock a lot while resting.

looking at my sock a lot while resting.

“Knee News” Not So New!

As usual, I am writing far too much.  But it is a good opportunity for me now, released by virtue of my rehabilitation process, to indulge in more and more and more writing!  As I point out often on my blog, the option of skimming is so much easier when you can simply scroll down and stop only where you will!  So I need make no apology.

When I started writing this personal account of the run up to, and first couple of weeks after,  my knee replacement surgery (and it may possibly be longer, as I may add some posts later on) ” I did not quite appreciate how topical it was.  Though holding in my mind a pretty strong, but slightly vague sense, of my pathway to getting a knee replacement being somewhat uphill (Going up hill is a good phrase to describe heavy going, when you have osteoarthritis, and have one particularly dodgy knee) the news items which then  soon started to splatter across the screens had not quite surfaced, and it was easy to tend to feel a little isolated in feeling doubts and fears about if I would get access to the surgical treatment of my knee.   However, since that time, all kinds of opinions and reports have been published. Though not a new matter, for the matter of rationing elective surgical procedures is not new, it has risen to the forefront of our consciousness again in recent times.  And I do wonder, though over the moon about my own experience, (which I can be,  having got where I am now)…I do wonder if my sensors were quite rightly alerted to a general drift, let us say, maybe even  a tide, which runs away from elective surgical procedures and more towards patients having to manage without surgical interventions.  And this, even when their lives with all probability, would be greatly improved if surgery and it’s benefits and advantages were highlighted more and the possibility opened up for consideration, at least a little earlier, for those very disabled by their knees.  Presenting surgery to people in a more favourable light doesn’t mean they are going to rush headlong into it.

The Royal College of Surgeons, which is ” Committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care.”  has had a fair bit to say, of late, and it is heartening to read some of the recent press releases made.  There was this press release regarding suspension of non urgent surgery:

Kent CCG announces unprecedented suspension of non-urgent surgery

03 Feb 2017

As The Guardian is reporting today, NHS West Kent Clinical Commissioning Group (CCG) has immediately implemented a policy to suspend non-urgent surgery such as hip and knee surgery until the end of its financial year in April 2017 in a bid to make financial savings of £3.2 million. The CCG covers 463,000 residents. The announcement came to light in board papers published this week.

Commenting on the proposals, Miss Clare Marx, President of the Royal College of Surgeons said:
“West Kent CCG’s suspension of non-urgent surgery until April is unprecedented and unfair. Patients, some of whom may be in severe discomfort or pain, should not be made to wait longer for treatment because the CCG has run out of money and surgical patients are perceived as easily postponed.

“The CCG is trying to make short term savings which may have major consequences for patients. While patients wait for treatment, their conditions could deteriorate, sometimes making treatment more complex and costly in the long term. In addition standing down surgeons and their teams is inefficient and a waste of scarce resource. Clinical decisions must not be made purely on a financial basis.

“Over the last few months we’ve consistently seen NHS financial pressures impact negatively on patients and policies like this indicate the situation is worsening. It’s time for the Government to be realistic about funding levels.”

https://www.rcseng.ac.uk/news-and-events/media-centre/press-releases

and this one, which I found particularly interesting, having realised that the use of the Oxford Knee Score had particular pitfalls for a supple “younger” patient already engaged in a lot of muscle strengthening exercise. (Anyone in mind, Jenny?)

RCS responds to CCGs’ plans to ration hip and knee surgery using Oxford score

27 Jan 2017

Redditch and Bromsgrove, South Worcestershire, and Wyre Forest CCGs are planning to decrease the eligibility threshold for patients requiring hip and knee replacements. The CCGs are using a scoring system, the Oxford score, designed to assess patients’ illness to reduce hip operations by 12 per cent and knee replacements by 19 per cent. They suggest the restriction could lead to 353 fewer surgeries and savings of up to £2.1m a year.

Responding to the CCGs’ plans, Mr Stephen Cannon, Vice President of the Royal College of Surgeons, said:

“The CCGs’ policy decision to restrict access to NHS care, based on arbitrary pain and disability thresholds, is alarming. It is another example of how the huge financial strains the NHS is currently under are directly affecting patients. It is right to look at alternatives to surgery but this decision should be based on surgical assessment, not financial pressures.

“Although the CCGs claim this will save them £2million a year, this overlooks the longer term impact on patients of delayed treatment, prolonged pain, and potentially higher costs of treatment. For example, patients affected by these changes may require additional pain relief medication, and may still require surgery further down the line, which may be more complex.

“Over the last few years we have heard of more and more examples of policies designed to restrict access to hip and knee operations to only those who are in higher amounts of pain or immobility. We are concerned that this is now happening up and down the country affecting thousands of patients. We fear that this latest policy is just the tip of the iceberg.”

https://www.rcseng.ac.uk/news-and-events/media-centre/press-releases

I think it IS just the tip of the iceberg.  I don’t live in the above areas, so maybe things are better where I live, but I don’t have the data or evidence to tell me one way or another.

What I do feel sure of is that if surgery is presented to patients as to be avoided at ALL COSTS, it is probably worth the patient seriously considering if the person bearing the cost will actually be them, and also considering if they want to bear the cost, if they are able to do so in terms of both their mental and physical health. In terms of bearing the financial cost, while some people have private health insurance or the money to pay, many do not.

Let me indulge in yet another retrospective narrative!

My GP referred me to an ESP (An Extended Scope Physiotherapist is a clinical physiotherapy specialist with an extended scope of practice) though my Oxford Knee Score was, at that time (May 2016) “borderline”.  I’m glad she did. I do wonder if the score  I had at that point, later on  then ended up working against me though.  I wonder if my Oxford Knee Score was worse (and it would have been worse if I had had a more realistic assessment of my situation myself at that time, plus a lower pain threshold and a less supple body,) whether I might have got to see a surgeon straight away.  However, even if I did, I am not sure it would have made much, if any, difference to what happened in terms of the direction of my treatment.  I believe I would have been sent in the direction of physiotherapy and loosing more weight, whoever I saw.  This was not a bad direction, in itself. But bearing in mind I was already at the end of my tether, it demanded a lot of me,  at a time when I had already come to the end of my ability to cope with things.   It just felt like more of what I had already been doing, for over a year.  It WAS, with some small variation in terms of the exercises I was doing, more of what I had already been doing for over a year.

Looking back, the main positive for me when I look back to that point in the journey (June 2016) was to see on the X-ray what I had felt to be the case.  The knee had got a lot worse (I could feel that!) and I would need a knee replacement.  That may sound like an unusual “positive” but it is good to see the evidence for your distress in front of you.  Your knee tells you it is knackered and the X-ray agrees.  As simple as that. Well, for me it is. The additional dimension to the situation of being 52 and obese, is something which throws all kinds of questions into the atmosphere, and how these questions meet the factors and circumstances in which they find themselves,  is far to complex, and probably pointless for me to entertain.

Though I may entertain them a little. Not for my own benefit, but out of an interest and concern for others.  I am a strong character with a lot of resources, which not every patient has. I DO feel concerned about those in a similar situation to myself, who may not have the support to make a stand for themselves. I have to balance this  unease with the solace I can take in the knowledge that, even if a knee replacement had been offered to me on a plate at that point, it is a big decision to make and shouldn’t be rushed into. It’s not just about being told you need something.  It is also about wanting it.   I found it hard to continue trying any other course of treatment because I was already at the end of my tether.  I was told I would need a knee replacement.  Indeed, I did. Probably, in consideration of the way my knee was impacting my life and my walking, sooner, rather than later, would have been better news for me, particularly if it also came with the reassurance I would access one and that my age and weight would not adversely affect that access in any way.

This wouldn’t have meant I would not have continued with my weight loss efforts.  But it would have removed a lot of fear and doubt from my mind.  I wonder, for example how different the experience might have been if I had seen a consultant at this point, been assured I would be placed on their list, for certain, if I wished to be,  even if this had the caveat that I would need to loose a couple of stone before doing so.  I think this would have been preferable to the uncertainty and made a great deal of difference to the experience.  Walking “the extra mile” is especially hard when you cannot walk the first mile.   But it was an “extra mile” which while it tested me personally, in a way I would naturally choose to avoid, it was one which paid off in the end. For ME.  But this would not be the case for everyone. It was exceptionally hard.  I do believe God uses all things for our good if we let him.  If we are ABLE to let him.  It is not an easy thing at all.   I wanted to hear “Being 52 and obese won’t affect your access to surgery” but this was not said, and it could not be said, with any degree of assurance, by anyone.  I don’t believe in the current situation, with the NHS as it stands at the moment,  it could be said with any certainty. It was not said, and it was not, NOT, said. Which leaves the distressed patient to their own devices in terms of expectations!

So even now, at this point, I look back and ask myself if it needed to be quite as hard as it was.  I’ll get over it.  But I don’t mind allowing myself to think it through. For me, I am simply trying to make sense of how my instincts about my unfolding experience may actually relate to reality.  I clearly needed a reassurance which could not be given for very practical reasons. The lack of that reassurance meant I felt a great deal more anxiety and distress than I needed to, because I became fearful that I would not be able to get the treatment I wanted and needed. For me it worked out just fine. I am thankfully a self motivated person, and faced with the prospect of needing a knee replacement at some point, I decided I wanted to do all in my power to make that point sooner rather than later.    I met a surgeon who understood me well,  and he decided to perform the surgery, for which I don’t actually have the words to express thanks for. (Well, that IS something…Stuck for words!)

The Pesky Oxford Knee Score and the Younger Patient

I don’t like the Oxford Knee Score. That did not serve my interests well at all.  Full stop. Not when used as a tool to assess  supple “young” patients suffering from osteoarthritis with a high pain threshold who cannot walk very far or straighten their leg properly. Or patients with a positive outlook who tend to underplay their ever increasing restricted quality of life. (Anyone in mind, Jenny?) Oxford Knee Score problems I can think of:  The score time range is “in the last month”.  Four weeks is no time at all! Especially not with knee osteoarthritis, the symptoms of which vary immensely depending on  your activity levels.   And the Oxford Knee Score relies on the patient possessing an accurate picture of their situation.  Which they may not have. When someone becomes slowly and gradually disabled and their pain increases and their mobility decreases, all kind of coping mechanisms come into play, and one of those is DENIAL.  So when filling out an Oxford Knee Score, it is easy for a patient to put something which is more optimistic than their experience really is. Because you want to believe it!  Looking back I can see that I did that.  The Oxford Knee Score is too limited in scope to be used to make important decisions about if someone merits surgery or not.

Clinicians themselves wouldn’t just take it as it is and use it in an arbitrary way. Well, some might, others not.  They use their professional judgement and experience. But time is short and it is quick and easy to use. But systems designed to save money would use it in an arbitrary way. Because then the more subtle aspects of patient care and accurate assessment of an individual situation can easily fall by the wayside.  There are many confines and restriction on what is possible in life.  That’s just the nature of things. We all live within them.  I think my experience has been one which has brought much closer to me the value of the NHS, and given me intimate personal experience of how much it does matter that it is given the funding that it needs.

I am not at all alone in my experience of feeling that I was expected to carry on longer than I felt able to in managing my situation without surgical intervention. The desperation I felt before being placed on a surgeons list is something I will never be able to accurately put into words.  I am thankful for the experience now, but  this is because I can look back on it and glean some wisdom and knowledge from it.  It has certainly made me more patient as a person. Patient with myself, with others, and with my knee!   I can feel thankful because I have received the treatment I needed which I was not able to access through any other means.  And when all is said and done, I think the surgical intervention was timely enough. It was just in time, for me.  When the ball got rolling, it rolled very quickly, which was a huge relief.  The hard bit was getting it started.   When you look back, and see the hardship, it does not seem quite so hard from the present vantage point, at least.  I lost out on a few opportunities and found the experience challenging and difficult.  In the light of potentially being able to walk for two hours, (though this is still a very long way away), it seems worth going through anything to open up the possibility of long term improvement.

This press release got me thinking:

Harrogate CCG targets overweight patients and smokers to make financial savings

06 Oct 2016

NHS Harrogate and Rural District Clinical Commissioning Group (CCG) have today announced that as part of measures to address a £8.4m black hole in its finances, patients with a BMI of 30 and over, as well as smokers, will be denied non-urgent operations for six months until they have completed a weight management programme or a stop smoking service. In July, NHS England rated the CCG as one of the few ‘outstanding’ CCGs in the country.

In September NHS England intervened to stop neighbouring NHS Vale of York CCG from imposing a similar policy after the Royal College of Surgeons raised concerns that proposals went against clinical guidance and made smokers and overweight patients soft targets for financial savings. St Helens CCG was also recently forced to abandon plans to save money by stopping all non-urgent referrals for four months.

Commenting on NHS Harrogate and Rural District CCG’s plans to delay surgery for up to six months for smokers and patients with a BMI of 30 and over, Mr Ian Eardley, Vice President of the Royal College of Surgeons, said:

“The policies for smokers and overweight patients that Harrogate and Rural District CCG intend to impose ignore the public outcry that surrounded similar plans announced by neighbouring Vale of York CCG in September. They fly in the face of the intervention made by NHS England to prevent those plans from going ahead.

“The Royal College of Surgeons is very supportive of encouraging patients to join programmes that help them lose weight or stop smoking before surgery. However making it a condition of receiving that surgery, no matter how sick they are or how much pain they are in, is wrong. NHS England has already said that denying operations to a particular group – such as smokers – is “inconsistent” with the NHS constitution. (2)

“NHS Trusts and CCGs are desperately looking for ways to save money in very challenging times but singling out groups of patients is not the way to do it. We hope NHS England will now step in to prevent Harrogate and any other CGGs from targeting patients in this way.”

https://www.rcseng.ac.uk/news-and-events/media-centre/press-releases

I think, in reflection of my own experience,  I feared that being obese was effectively going to mean that I could not access knee replacement surgery.  I had realised that my excess body fat was basically stealing away my mobility several years back, and had already sought to try and increase my activity levels which, ironically, then highlighted the problems with my joints.  I did have a kind of personal revelation that I didn’t want to be restricted from fuller mobility by my physical body, and the diagnosis of osteoarthritis in  2015 was helpful in this respect.  A definite reality check.   You overload your joints with too much to  carry and this will make things worse.  So relieve the pressure and lose some weight.  That was an important place of realisation and logical and sensible in every way.  That is when my desire to work on losing weight started.  I did my research, and had a fairly full appreciation of the clinical reasons why being overweight and having knee replacement surgery, both during surgery and with respect to the longer term outcomes, is something that does need to be addressed by a patient.  It could, quite unsurprisingly be argued, that in my case, the fear and anxiety were put to good use.  I really could not bear the thought of not having my knee treated surgically because every fibre of my being was telling me that this was the treatment I both wanted and needed.  My anxiety  was something which helped to cement my own application to weight loss, and helped to focus me in that direction.  However, I am very aware that for another person, this fear and anxiety could plummet them into despair, and they may not have the resilience and persistence that I had.

People need a lot of support to lose weight.  I certainly had a lot.  Not everyone has that support available.  For some people, having the surgery and understanding the need to look after their “new knee”could be something, (if properly educated and then supported after their surgery) that could potentially motivate them into continued weight loss and greater activity levels.  Some people will simply not be able to loose sufficient weight before having knee replacement surgery.  It would not be realistic for them.  Their pain and disability will stand against them just that little bit too much for them to make progress.   Even with my weight loss, which I am very pleased with, my symptoms did not improve.  I swam three times a week, accessed various public health programmes, and brought myself a stationary bike.  These options may not be there for many people.  I am still technically (just) in the obese category.  But I am mighty sure that it is going to be much easier for me to continue the weight loss I have started, once I can walk around for a few hours at a time!

The BIGGEST POO I have ever done in my Life!

The other significant news of the day, is that today is the day I just did the biggest poo I think I have even done in my life!  I think it is certainly bigger than the one I did after my C-section.  It was a fine thing.  But not in girth, I hasten to add.

Remember the plasticine you maybe had as a child?  When it needed softening, and it was so frustrating to try and mould into the shape you wanted it.  Used to need to warm it on the radiator…

I was seriously tempted to measure it.  I wish I had now.  Could of done it in two sections.

I was also tempted to take a photo of it and include it on this blog.  Regret not doing that too.

But now it has gone to the place beyond the toilet bowl.  Not without some difficulty.

A useful tip might be, DO it in sections and flush between each section.

Apologies for the detail. But in the realm of TKR recovery, as anyone who has been there will appreciated, this is a news worthy event.  It needs to be celebrated.  However base and basic it is!

Thought it might be fun to google “biggest poo in the world” to see if I had done something significant.

Then changed my mind, as really had quite enough.

I did find this on dinosaur poo though, which is rather a fun read:

http://www.guinnessworldrecords.com/news/2016/11/fossilised-poop-collector-enters-guinness-world-records-2017-book-450591

After these unpleasing thoughts have now entered your mind, let me wipe them away with something more fragrant!

west dean gardens jenny meehan flora foliage jamartlondon

west dean gardens jenny meehan flora foliage jamartlondon

west dean gardens jenny meehan flora foliage jamartlondon

west dean gardens jenny meehan flora foliage jamartlondon

For a shorter version of “The Very Patient Knee Replacement Story by Jenny Meehan” follow this link: https://jennymeehan.wordpress.com/abridged-version-of-the-very-patient-knee-replacement-story-by-jenny-meehan/

 

Fourth day at home (Tuesday – Day seven – Post knee replacement surgery) with a lot of subtitles

This is a long post!

Generally I am feeling less tired and brighter by the minute.  I do have to be careful, as it is very easy to overdo things.  My heart starts pumping away madly, and I realise that the effort involved in healing the knee and in getting all those muscles into action again is considerable.  I get very excited about something I can do, and then the temptation is to do too much.  I was practising walking with the crutches back and forwards and made my OWN cup of tea, but then when I started walking backwards and forwards again I started to feel a bit dizzy.  Not worth the risk. One of the good things about fainting twice in hospital is knowing how quickly a slight feeling of dizziness can become a very large feeling of dizziness. Then, before you know it, you have fainted.

I am using the laptop quite a bit, but the laptop table I kindly brought for my husband for his Birthday (which I thought might come in handy for me!) is too heavy to put on my legs.  So instead, if I want something on my tummy to perch the laptop on, I just use a foam cushion  or one of the firm pillows I brought. This is another instance of when having plenty of firm pillows is a great benefit.  I will be writing my paper “The value of plenty of firm pillows in the post operative phase of knee replacement surgery” very soon.  Seriously, they ARE very important.  I have FOUR.  I use them in various arrangements in my “nest” (otherwise known as a bed).  I use them to raise up the laptop on the small fold out table near the bed, and for leaning back on.  Or for propping the lap top up to a good level if it is to the side of me. Or to make the bed, if I am sitting on it, a little bit higher, as it is rather low. And for throwing at people.  (I wish.  In reality, I don’t have the energy!)  Even moving the pillows around is wearing me out!

I am gradually working out which exercises are good to combine with other tasks which need to be done.  It is handy to multi task, as time whizzes by.  The necessaries must be done, ie wash, hair, teeth, eat.  Rest must be had.  Icing must be done.  Elevating leg must be done.  Writing must be done. There is a lot to do.  But EXERCISES and REST are the most important things at the moment.  I have not got into a routine quite yet, but patterns are starting to appear.  For example, I have found that doing Quad Sets are good for when I am sitting in bed using the laptop.  In the morning, when I get up, the leg is very stiff, and so I do what can best be described as a standing Plank leaning against the chest of draws followed by some very little knee bends with arms outstretched at the front… little Chair poses.

To focus the exercises around CUPS OF TEA (!) is the most effective method for me to make sure I do them!  So I have my first trip to the chair in the living room, for A CUP OF TEA, and to go with it, rather than a biscuit, I have a session of seated heel slides instead.  Or my venture to the sink to clean my teeth will involve a few Chair poses and a Warrior One.   My second CUP OF TEA might take place in bed, where I place a board on top of the mattress and do the sliding the leg out to the side exercise (not sure what that one is called?) and Heel Slides.  And so, as the day progresses, each CUP OF TEA becomes a marker for another exercises session.  I don’t do all the exercises at each session but just a few, whichever are best suited to my location.  The static exercise bike is the centre of the exercising universe, with Thera-bands and weights hanging from it in all its glory.  (Not that I am using the weights as yet). This arrangement works well for me.

The exercises I find easy, are easy to ensure I do.  Ones which are harder ARE much easier to avoid.  No surprises there.  But rather than try all the hard ones every day, I pick one more challenging one  each day, and try mega hard on that one over the course of the day.  Sometimes with no distraction, so I focus on the muscles, and sometimes with distraction; maybe some TV or music.  Because it is easy to get discouraged when things are tough.  Some I can hardly do at all, but even then, if the leg feels just a fraction lighter, or if I can lift it even just a couple of millimetres, this is still improvement and progress.  It will take time and effort.  Everything in life takes time and effort.

I have found a VERY handy item to have is a small shoulder bag, which you can use to carry those small items which get left around the house.  It is  very annoying to have to walk back and forth all the time  because you thought you had something near you, but actually you left it somewhere else, and you cannot remember WHERE that “somewhere else” was.   Generally, though I am sure I can walk about more,  I am putting my energy into the exercises.  I really want to get my quadriceps livened up more.  They have certainly gone on strike.

It's great to touch my toes with a much straighter leg!

It’s great to touch my toes with a much straighter leg!

Making Life More Pleasurable When You Have Pain After A Knee Replacement Operation

This subsection  focuses on pain management and pain relief after a knee replacement operation.  Looking backwards I  glad that I had plenty of time to experiment and try out different things which could bring the “feel good factor” into play.  I belief pain management is not simple a matter of physical pain but also what is happening in our minds.  This makes a great deal of difference to our experience of pain.  Before this knee replacement operation I used, for pain relief:

Mindfulness

(Often when doing yoga and praying)  I don’t know what professionals would recommend, but I would try breathing deeply in and out with full lung breaths for generally relaxing my body, which tends to get very tense when there is pain anywhere in it. I would also, when doing Yoga, send the breath into the area of pain and accept it, which isn’t easy. I didn’t force my body to do anything that was too painful, but there is a point at which the pain can be gently worked through,  or at least born with. If there is just some pain, but not too much.  Dwelling with the pain, as long as not too much, was quite confidence boosting because I came to the understanding that I could live with it.  And also, I was often surprised how, when not allowing the pain to stop me from moving, I was able to do, over time, much more than I expected. Well, certainly where Yoga was concerned.  Not the case with walking around sadly.  Or the periods of continuous pain. Pain at night is also harder to manage than during the day. However, learning to manage at least some of this pain in this way was helpful to me.  The more methods one has of managing pain the better.  I also used distraction techniques and redirecting my mind, as well as giving attention to the knee when it was hurting a lot.

Post knee replacement I am finding, (at the present time, at least), that I am using the same techniques during those times when the effect of the medication starts to wear off, and yet it is not quite time for the next dose.  It is also  handy  for the times when I am exercising and feeling pain, but it is at a pretty low level (mild) and I sense that it is not quite yet time to stop the exercise because of it.  I have a handy app called ” “Just Relax” which was free from the internet and it has different pieces of very relaxing and repetitive music on it.   The inviting titles on offer are: “artistic”, “autumn forest” “convent” “fresh morning” “heaven” “inspiration” “meditation” “om chanting”.

I am also meditating on pieces of scripture. I did this prior to surgery, in particular Psalm 112 verse 7 (because I am somewhat prone to “catastrophic thinking!”)
7 They will have no fear of bad news;
their hearts are steadfast, trusting in the Lord.

My lovely husband read this out to me and it was very helpful.

Post surgery my favourites are:

Acts 17:28 New International Version (NIV)

28 ‘For in him we live and move and have our being.’[a] As some of your own poets have said, ‘We are his offspring.’[b]

Footnotes:

Acts 17:28 From the Cretan philosopher Epimenides
Acts 17:28 From the Cilician Stoic philosopher Aratus

Psalm 147 v 3

He heals the brokenhearted and bandages their wounds.

(I chose this one as I meditated on the vocation of nursing and how divine love may be expressed towards us through the care and attention of people who choose to serve in this way)

1 Peter 5 v 7

Cast all your anxiety on him because he cares for you.

Movement

I am certain that my work to develop strength, maintain flexibility and basically keep moving, before the knee replacement operation, has helped a lot, because the soft tissues around the joint were  as good as they could be ready for surgery.  As well as using movement to ease the pain, the general strengthening of the leg must have helped too.  The problems came with weight bearing mostly…standing, walking… You know, those things you need to be able to do in life. Essentials! When it got to the point that I began to seriously think I may not be able to continue to keep moving, because of the pain levels and the duration/continuous nature of the pain, (which rather insidiously began to slip into play), that I realised that the pain was simply too much to manage, even when using a variety of techniques, longer term.

Post knee replacement I am finding that the emphasis on keeping on moving, whatever, is obviously balanced out by the need for REST as I have just had major surgery.  But it is certainly a useful mindset to have, and using the static exercise bike, while seated on a chair in front of it, for around twenty full rotations, does help loosen up the joint a bit.  I do this VERY slowly and gently. I did not expect to be able to do this at this stage, though I am sure this, as with all things “knee replacement recovery” are completely individual.  I understand it is very important to realise that everyone’s recovery is unique to them.  I’m pleased about having and being able to use the bike at this stage, because it is an enjoyable exercise which I did before surgery.  Looking forward to returning to swimming too at some point.

Tens Machine

Not everyone finds them helpful, but I used a tens machine when having my second child and all I can say is I knew when my doula stopped pressing the button for me, as I snapped at her and told her to “Keep pressing the button!” So before my knee replacement I would use it a lot.  Not when sitting down so much, but I used to plug myself into it and use it when I was working on some paintings and I needed to stand a lot during the day.  As my standing time decreased over time each day,  it was very helpful to know that I had something to enable me to continue standing. Quite a relief. I am glad I tried this method of pain relief before the knee replacement operation and I stocked up on plenty of batteries.

Post knee replacement I am finding it a very handy addition particularly for the sharper pain at the front of the knee if it starts to become too tiresome and it makes a good change from ice.  It’s easier to walk around with a TENS machine on than it is to walk around with an ice pack. It’s a pleasant feeling, and good to have as another option.  Variety is the spice of life, even at times like this!

Massage

Before the knee replacement operation I used to use massage a lot, practically every day and sometimes more than once a day.  I used to massage my knee with frankincense diluted about 50/50in olive oil mostly, though I used other essential oils also.  The act of massaging was helpful, in tending to my knee, rather than getting cross and disappointed with it.  Frankincense is just one of many essential oils meant to be good for the purpose.  I felt the smell itself was also very beneficial and did lift my mood a bit, which is also very helpful in pain relief.  The smell of the oil itself is uplifting, or I found it so. It seemed to work down swelling and my right knee, pre-op actually looked better than the left one, which I did not massage.  The left one also is affected by osteoarthritis, but is much more spongy and bulky looking around the front.  I just used the frankincense for massage rather than taking it orally, but did use a pretty strong concentration.  Here is something from arthritis.org  http://www.arthritis.org/living-with-arthritis/treatments/natural/supplements-herbs/guide/indian-frankincense.php

“Frankincense, Boswellia, Boswellin, Salai Guggal] Boswellia serrata

Origin: Gum resin from the bark of the Boswellia tree found in India.

Claims: Reduces inflammation and treats rheumatoid arthritis (RA), osteoarthritis (OA) and bursitis symptoms. It may also be used to treat symptoms of ulcerative colitis and Crohn’s disease.

What we know: Boswellic acids – the active components – may have strong anti-inflammatory and analgesic properties. They may also help prevent cartilage loss and inhibit the autoimmune process, making Indian frankincense/boswellia a potential therapy for RA in addition to OA.

Studies: In a 2004 study, Indian frankincense/boswellia was tested as a treatment for knee OA. Researchers recruited 30 people with knee OA and gave half the group a daily supplement containing 333 mg of Indian frankincense/boswellia; others got placebo. People who took Indian frankincense/boswellia reported less knee pain, better mobility and an ability to walk longer distances than those taking placebo.

A 2008 study in India, where Indian frankincense/boswellia is a traditional remedy, found that a supplement called 5-Loxin significantly improved OA pain and function within seven days and slowed cartilage damage after 3 months.

A 2008 British review found Indian frankincense/boswellia safe and effective for both OA and RA, though results of RA trials have been mixed.

Dosage: Capsule or tablet; typically 300 mg to 400 mg three times per day. Look for products with 60-percent boswellic acids, the active ingredient.”

Do you know, the essential oil SMELLS so divine, I think that itself, is worth using it for.

Post knee replacement I am not currently using the Frankincense to massage as I will leave that till a bit later on.   But I am taking the occasional sniff of Frankincense, as this is very relaxing and lovely!  I look forward to massaging my lovely limb later on though, and I know my knee and leg will thank me for the positive attention.  Breathing in the smell is very relaxing.  Releasing mental tension, which does build up when experiencing pain, has got to be a good thing.

Pharmacological Management of Pain

Before the knee replacement operation I tried various types of pills and lotions.  There are various gels which contain Ibuprofen or Diclofenac sodium and many people rub them on their joints to help manage the pain of osteoarthritis.  I tried these from time to time but did not find they made much difference.  I think when my knee was inflamed it was probably past the point where these gels would make much difference.  I found the massage with frankincense more effective for my knee.  I tried the Capsaicin cream which I liked the sound of.  This did seem to make a bit of a difference to pain in the patella area at times, but not to any other area. Paracetamol was useful in the respect that it could be taken easily with other things like Nurofen, but both of those were only any use for pain which could be manged through other methods anyway.  I avoided the use of drugs if other options would  be sufficiently effective.  I have to say that I did find Meloxicam pretty wonderful.  That was the only thing which really worked when things were getting to the agony point.  And though there were some side effects, they were worth it just for the peace of mind of knowing that I did have something in my possession which I could take if I could not bear the pain any longer!  Amazing substance.  But bearing in mind the side effects of longer term use/constant use were rather concerning, I kept my use to only when really needed, and also I asked my GP to half the dose so that the Meloxicam did not get rid of all the pain but just knocked it back sufficiently for me to manage it using other methods.  There is no way I would want to take Meloxicam long term, but I was mega grateful for it used with care. Naproxen does not agree with me at all, and when I tried that I got flu like symptoms and very, very itchy skin. It was not effective for me either. I considered having a steroid injection, but I decided that I did not want a steroid injection, as I felt the risk of infection in my knee (though small) for the reason of  a pain relief method which was still short term, was not something I wanted to take.  Also because my pain was so bad, and I started to want a knee replacement sooner, rather than later, having a steroid injection,(from my limited knowledge), can make infection in the joint more of a concern for a surgeon.  I think some may not even want to do knee replacement surgery if close to a steroid injection in the knee joint.

Post knee replacement, I am finding the way my pain was managed at the hospital inspirational and encouraging.  There was a lot of regular medication given, and  part of the process involved frequent self assessment. Is the pain mild, moderate, or severe?  The main thing is to get control, and keep control. To be just one step ahead.  So I have taken this lesson home with me, and while no one likes to take too many pills, there is a time and a place for plenty.  As in my previous post, I am adjusting things slightly as I see fit.  I won’t be knocking back any Morphine for the fun of it.   (I have already done that on my last day at hospital, as it was a special occasion!) And there is always an element of try and see. I have the liberty of being a bit more flexible with the timing of medication at home, while in hospital it has to happen at certain times for practical reasons.  It is early days yet, and I do remember on the Open Day visit, that it was mentioned that around 7 – 12 days post op could be a difficult time for pain.  Well, I don’t want to expect that, but I am certainly thinking that as my activity levels go up, I may need to manage the pain differently.  And I shouldn’t feel bad if I have to take more pills.  I am not getting some kind of pain endurance award.

If I wanted that, I wouldn’t have chosen to have surgery. I would have just left the bloody knee joint to continue to deteriorate and make my life a misery.  

Anything Else That Might Reduce Inflammation

Before the knee replacement operation I sought anything that might generally have any effect on reducing inflammation and also tried to include various things in my diet which could be beneficial.  This was good to do because lots of things are worth a try.  Even feeling that you are doing something, even if it doesn’t make a difference, can be helpful in it’s own way.  And different people find different things helpful. For me, my top two were ginger root, which I put in fizzy water to make a very refreshing drink, and turmeric in my coffee. (One spoonful of coffee, or a bit less.  One teaspoon of turmeric.  Black pepper and some grated creamed coconut which makes it slightly oily).  Not to everyone’s taste but the pepper and oil help the digestion of the turmeric, I understand.  Turmeric is very good in lots of ways and is a natural anti inflammatory.  It is very nice in porridge too. Well, I think so. With the honey, pepper and creamed coconut.

ICE was something I used a lot before knee replacement surgery.  The use of ice can be termed cryotherapy. It works by reducing blood flow to a particular area, which can significantly reduce inflammation and swelling that causes pain, especially around a joint or a tendon. It can temporarily reduce nerve activity, which can also relieve pain.

Post knee replacement surgery I am on blood thinning medication, so though the amounts of ginger and turmeric were very small, I am leaving off that routine for a while as I think they do have blood thinning properties.  It is ICE that has really come into it’s own, and having used this very frequently prior to the knee replacement surgery I know how effective it is.  ICE is my friend.  ICE is wonderful.  I LOVE YOU ICE.  I ice when there is an obvious need, ie more red more heat.  But I am icing even if things are calmer.  The knee is currently still moderately swollen.  But it is 20 minutes every two hours for me.  And a slightly lesser degree of cold, by using the used packs which are still cool, for massaging or for placing in different areas of the need.  I often leave the ice packs on for longer than 20 minutes, and just move them around a bit.  I have a tea towel placed between my leg and the ice pack cuff I was giving at the hospital.  The cuff is great as it holds two ice packs at a time.

Anything Else Which Makes Life More Enjoyable After Knee Replacement Surgery is Worth Having!

 

My thoughts on any advice I might give, from my own personal perspective, to someone planning for knee replacement surgery would be BE POSITIVE and make your recovery a mission.  YOU play a vital part in this, in terms of finding what makes you happy and doing those things particular to yourself which make life more pleasurable.  Make sure that each day you have something to look forward to.  It might be just watching a TV programme you enjoy and reading a bit of a good book.  I thought I would have plenty of time for watching TV and reading, but so far I haven’t.  This is mostly because of writing this story, and the amount of time it takes to do the most basic things.  But whatever I do, I am focusing on enjoying myself.  Because if you feel pleasure, pain becomes more bearable.

Yes, it’s easy said, not so easily done. It’s very important to be kind, patient and gentle with yourself.  For me, spiritual sustenance makes a world of difference to my life and as a committed Christian I find this sustenance in my relationship with Creator God, who is loving, compassionate, and ever present. So post knee replacement surgery, I have put a great deal of attention into my times of prayer, contemplation, and reading small quotes from the Bible and other devotional matter.  But that might not be your thing.

I also love people and company.  Though I am having a quiet week at the moment, which I wanted, next week I will start to have visitors.  I already have the delightful company and care of a lovely husband and two teenage children. I am an extrovert and I am looking forward to friends coming over for a natter and drinking lots and lots of TEA. Tea and company are two of the greatest pleasures in my book.  So they are on my list of things to do.  In my experience, the love of Christ is expressed through many avenues, and God gifts us with the people around us, who may potentially be used by him to bring blessings and love into our lives.  We may choose to recognise the presence of Christ,  at work in the love of those around us…If we are Christians we will give credit to Creator God for those blessings which we receive as through him.  Other faiths will also have their own contexts of recognising the grace and love of God in their lives.  But whatever faith or none, or be you introvert or extrovert by nature,  to have a positive expectation is very helpful indeed, but not always easy to maintain in times of like this.  So we need those people around us very much, and to get the support you need after a knee replacement is very important indeed.

Nourishment comes from love and is very good for any kind of recovery!

For me, I have devoted a lot of time to writing, as you can see.  And writing TOO much has always been a great pleasure!

Making Exercises Fun When You Have to Do A LOT of Exercises After Having Had a Knee Replacement Operation

Play lots of music.  Silly and Funny music is best.

Move all the part of your body, not just your legs.

Make up motivating rhymes to help encourage your soul, for example:

“Moving my knee, is really not so easy,

and when I move my knee cap, it makes me feel quite queasy

but though I find this difficult, and sometimes hard to take

the long time goal in mind, is long walks I may make”

It’s an appalling rhyme.  But fun to bend my brain in that direction!!!

 

PS As with all my ideas and thoughts, bear in mind that I am an artist and creative, and NOT medically or professionally qualified in any of the things I write. I am writing because I love writing, loved having a knee replacement, and wanted to share my experience in case it gave other people ideas, questions, and thoughts which they might like to explore. Check everything you do out with the relevant professionals. DON’T take it from me. Just read away here and there, if it interests you. Then do your own research and seek your own advice. And don’t contact me for advice. I won’t give it to you, as I will be busy painting!

 

Third day at home  (Monday – Day six – Post knee replacement surgery)

I have cut out the Ibuprofen for a bit to see what happens.    But I am  keeping the Co-Dydramol in place, though taking it just three times a day rather than four. (In principle only…This means I am not holding myself to this idea rigidly!)  Taking a “softly softly” approach to reducing pain relief.  But very aware of needing to maintain a certain standard.  It is handy to have a TENS machine to use if a little bit of extra assistance is needed.  I am very glad that I decided to look into using TENS for pain relief prior to surgery.  Indeed, I used to use it a lot when needing to stand and paint mostly.  And I got used to using ice for pain relief too.  It is good to not just rely on  pharmacological management of pain, personally I think.

It is good to have plenty of drugs available though, after a knee replacement.  There is no need for a “either” “or” mentality. I am looking back now laughing at the first game of Scrabble I had with my husband on day one at home.  It involved me spending more time counting up the letters I had, than managing to think of words. And also a considerable amount of me repeatedly asking my husband the same question.  Which, come to think of it now…I cannot remember, even now, what that question was!  In the end I chose to abandon the game, because I realised I wasn’t quite up to it!  It was related to the fact I had had a couple of doses of Morphine at the hospital that day.  I didn’t quite realise how “out of it” I was until that point!

I have to confess that I don’t think the second dose of Morphine I had in hospital was, strictly speaking, necessary.  I was asked about my pain levels, as per usual,  and first said “Mild”.  Then when I moved the leg about things jumped up a level, but not THAT much of a level.  However, I thought, as I was going, it might be good to celebrate, and as I don’t drink alcohol, the morphine seemed a fitting toast.  Of course, my blasé  approach to medication is no to be recommended, but I don’t mind admitting my careless approach.  I did just ask for a small dose. However, I think as one is rather drugged up anyway, it possibly makes a great  deal of difference.

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© Jenny Meehan DACS All Rights Reserved “Funky/Wonderland” print.  Seemed rather fitting to go with the morphine experience!

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What I do want to add is that, drugged up or not, the experience and elation that day I felt as  walked away from the hospital was certainly not drug related.  There is a distinct difference between happy feelings which are drug induced and real, pure joy.  Because one is just a temporary fix, and the other is a permanent move in the right direction.  As I was telling one of the physiotherapists at the hospital,  I didn’t want my life to slowly but surely become one of taking increased pain medications in order to “treat” something which could be addressed surgically.  For the sake of delaying surgery.   I have never felt that long term medication use was the course of action I wanted to take in my life, if there were other options available which could have positive effects. I think this about all areas of life. Rather it is better to try and get to the root of the problem and take positive actions to resolve underlying issues.  This is pretty much my motto in life!  This is one of the reasons why I am such a fervent advocate of psychotherapy for those who are suffering psychologically, rather than management with medication alone.  Because to sort difficulties out we need to get to the root of them.

Exercise Delights of the Day

Now the hospital menu card is no longer available, I have what I will call the ” À la carte Exercise Menu”.

I am tending to try (apart from the ankle pumps, quad sets and buttock clenches) and keep things spiced up a bit by trying new ideas out and experimenting with what I can do and cannot do.  As I said before, it is easy to AVOID those exercises which are more of a struggle, but rather than do that, I am making myself do them, even if just one set of them once a day. The extent to which they are hard, and the patience needed to keep on doing them, is a challenge (I am thinking of the inner quad exercises and straight leg raises). Lack of success does make you feel very discouraged.  But if you make sure you focus your mind on the unexpected achievements, however small, and pop on a bit of music, do a little dance with the top part of your body, and join in with the bottom part in whatever way you are able…All this does help.

I also tried out some Yoga.  In the book I have used “Knee Surgery – The Essential Guide to Total Knee Recovery” Daniel Fulham O’Neil writes;

“Movement patterns, which should begin right after surgery, are the second prong of my three pronged attack on knee rehab.  This is one of the main facets of my program that sets it apart; I do not want you to wait until you are “all better” to get back to your favorite activities.  Re-creating some of the same movement patterns immediately after surgery that you made prior to surgery – whether they are gardening, loading a truck, playing second base, or dancing – will help keep your muscle memory alive, speeding recovery.  From a surgeon who also happens to be a sports psychologist, I believe this is a vital aspect of a healthy mind-body approach to rehab.” 

I agree. While the book has a pretty rigorous rehabilitation programme suggested, which I cannot imagine being able to do the way I feel at the moment, (I am exceptionally tired), it is very inspiring to read and I love the whole “movement patterns” approach.  I want to try and do movements which I did prior to surgery as much as possible so my  traumatised limb remembers how it used to move!  This time around though, it has opportunity to move even better, eventually!

And with the idea or not mind over matter, but mind WITH matter, I tried some yoga today:

I wedged the exercise bike against something so it wouldn’t tip over.  That is good for a support.

I used the corners of the kitchen unit as support too, which was even better.

The Warrior One FELT AMAZING!  I could really feel my quad stretching and I know it liked it.  So will do that again. As I have a pretty dead leg feeling in the operated leg, and it appears to weigh a tonne, feeling the quad do something is a good feeling.

Mountain pose also FELT GREAT!   I cannot tell you how amazing it is to stand up straight in mountain pose now.  It feels completely different to the way it did before.  My right leg is straight, and don’t I know it.  It matters to me a great deal that I can feel confident in the way my body is moving, because it promises that, with the necessary work from me,  I can make progress into being able to walk properly, efficiently, and for longer periods of time.  Which basically means I can have my life back!  The surgeon has done his work, and I can now get on with doing mine.

From the age of 5 years to 15 years of age I trained in Ballet.  While those days are long behind me, freedom of movement is essential to my happiness as a person.  When I used to dance, I danced from the centre of my being.  To be able to move and express oneself physically is a great joy. The art of ballet was an important part of my life.  In this respect, though in the past, it is still very much with me. It is part of who I am.   To be able to direct ones movements, to develop and refine them, and to  appreciate all the bones and muscles working together in harmony is a wonderful outlook to have.  In Yoga too, this mind, body, spirit connection…a matter of self expression (to my understanding anyway), affects how we feel greatly.  It is something which can apply to someone with no limbs at all, but as I do have limbs, the way they carried me well (or not…as has been the case) and the way  I carry myself, vastly affects how good I feel.

The years go by, and I am now a 52 year old lady, who does not prance about (well, not quite in the same way), cannot balance in the way that I used to, and isn’t foolish enough to think I will be as I was then.  But what I do have now is the potential to function much better physically without a deformed knee joint -.the main load bearing joint of my body – and believe me, a whole weight has just been lifted of my shoulders.  It’s  not going to be easy, and who knows how long it will last, but I have not denied myself at least the opportunity for significant improvement.

I now need to carry on losing the excess weight, doing the exercises, and watch life open up again.

Sounds good?

It is.

“In him we live and move and have our being”

Thank God for knee replacement surgery.

Thank God for love, and for nursing…A wonderful vocation.

Thank God for the art of surgery and surgeons.

Thank God for people, who motivated by love, “walk the extra mile”

Thank God for hearing…which is a greater skill than listening.

Thank God for humour, which adds the lightest touch.

Thank God for Christ, who abides inside the hearts of all who open up to their Creator.

 

Found this, and I am singing along with it.  My son is learning to play it on his keyboard, so it’s been around in the house in a somewhat depleted form for several months.  I can sing it with gusto!

Yes.  I am a wreck from the aftermath of major surgery, but I AM FEELING GOOOOOOOOOD!

For a shorter version of “The Very Patient Knee Replacement Story by Jenny Meehan” follow this link: https://jennymeehan.wordpress.com/abridged-version-of-the-very-patient-knee-replacement-story-by-jenny-meehan/

Second Day at home, (Sunday – Day five – Post knee replacement surgery)

Clenching my buttocks as I write this.  As I am sitting with bent knees on the side of the bed, this exercise also involve working the knee in what feels to be a slightly different way.  Feeling pretty chilled out with all the ice about.  The hospital gave me some wonderful Steroplast ice packs and a sleeve to use with them.   The Physio’s said to ice for 20 minutes every two hours so I am going with that as best I can.  It is also good to use the cooled ice packs as well for a bit of gentle massaging of the whole leg,  or just pop them behind the knee when doing quad sets.  I think they are most effective for 20 minutes when fully frozen, but I find they also have their uses after that.  As long as there are breaks of about half an hour in between usage, it seems that as long as you are not using fully frozen ice packs you can use them intermittently a little bit more.  Just my experience and choice though.  As with everything  I write here in this patients knee blog, I am just explaining my own method of muddling through the experience!

There is obviously a bit of pain when exercising but it is not much and I know I have my TENS machine which helps me press on through without worrying about if I will pay for it later. I am not proceeding in a military fashion.  I know some people do with a “on the clock” schedule but I am taking a little bit more of a “play it by ear” approach.  The main thing I am doing is making sure I have a mixture of exercise, rest, and ice.  Getting up every hour or two for a short walk.  I had to work out when I will take the medications as this is the main thing which happens by the clock.  The general idea in the post operative exercises booklet given was to aim for three times a day and basically DO THEM!  I am not fretting if I don’t get to do every single one three times a day.  I have to listen to my knee and go with that.  As I have a couple of years experience in listening to me knee, it is rather lovely to listen to it with the knowledge that if we continue our nice relationship, now it has it’s resurfacing done, we should get along very well together.  I have said it before, and will say it again…Now the FORM of the knee bone is sorted out, the FUNCTION can hopefully follow.  To simply have the confidence that things can improve is a delightful experience.

Deciding to write this patient knee journey blog has been a good decision.  It is good to have a little writing “mission” to do each day.  The four large firm pillows I brought are coming into their own.. I am using one on top of a little portable table to raise the laptop up to a comfortable height.  They are good for generally getting comfortable and raising the leg above the heart on a regular basis.  It seems there is no need for a recliner chair or anything like that.  Some people may buy them, but pillows are much cheaper and more versatile.

I have given my husband some helpful hints on what to do if I should feel faint. It probably won’t happen but useful none the less I think.   My blood pressure did have a low phase in hospital so I know he needs to keep talking to me, open the window, and fan some air towards me if it happens.  My blood pressure is fine now as far as I know, no problem at all,  but I lent over for a little too long earlier today while trying to sort out a problem with the boiler and that did make me feel rather faint for a short while.  Rather funnily, the boiler is also suffering from low pressure…low water pressure!  We will need to get someone out to sort it out as we don’t have any hot water at the moment!

Things I learnt today include using a long flat board on the mattress to do the exercises where I push my leg out to the side really helps.  I did not realise there was such resistance in what I thought was a firm mattress, but using the board makes  a huge difference.  I also did some standing heel raises which I just tried to see if I could do them, and I could, so that was pleasing.  It actually felt easier than it did when I was doing them before the knee replacement operation!  I also have done a little bit of stepping up and down on my step. With supports, I hasten to add.  Variety is the spice of life!  And the static bike, when used with a chair in front of it, is a great way to loosen up the joint which feels very stiff.  Very pleased indeed today.

I am keeping the Co-Dydramol in place as it was at hospital, but have dropped  the maximum strength Ibuprofen 400g down to twice a day rather than three times.   Tomorrow I might just try keeping the morning one, and leave the second to happen if I feel it is needed, rather than automatically taking it at in the middle of the afternoon.

Before I left hospital I made sure I gave the staff a thank you card with this design on it.  Thought you might like to see what I was working on before having my knee replaced.  I had to do something to celebrate the forthcoming surgery!

angles and edges knee replacement TKR design artwork © Jenny Meehan DACS All Rights Reserved

angles and edges knee replacement TKR design artwork © Jenny Meehan DACS All Rights Reserved

In the middle of the day , just to encourage myself, I tied a red Thera-band around my foot in bed while it was raised on the pile of pillows and lifted it up and down a few times to remind it what it used to be able to do. It is flatly refusing to do a  “Straight Leg Raise” at the present time.   It makes it a bit easier lifting from an already raised position I think and the rubber band has a nice spring to it so, I can push down into it as well as letting it pull my leg up.  I am certainly a VERY long way away from a straight leg raise.  But doing it this way, I did manage to move it up a tiny bit.  Even though it was rather pulled up by the band! There was a tiny bit of a lift.

 

I have to confess to completely avoiding the inner range quad exercise.

It IS quite a challenge to fit in the exercising and eating and resting as well.  Cannot work on everything all at once. So just doing what I can.

I also did about 20 rotations on the static exercise bike.  Though the knee is still swollen it did feel less stiff.

Right at the end of the day I manage to lift my right leg an inch off the floor completely independently for the first time. (Seated knee extension exercise)  I am mega pleased about this.  My quads are not happy at the moment and have gone on strike for a bit.  The physiotherapists did reassure me that the weakness is normal and I just need to keep activating them.  Bit by bit they will get back to work again.  I hope so.  I am missing them a lot!

Day four – ( Saturday – Post knee replacement surgery) – The time between walking out of the hospital and walking in the front door…Plus the rest of the first day at home!

chakra colours, yoga design, multicoloured, yoga products, geometric abstract design products to buy, new era rainbow coloured abstract design by jenny meehan

new era rainbow coloured abstract design by jenny meehan

 

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It is a very bright and very sunny day! Walking away from  the hospital on my crutches today, was one of the most wonderful things that I have done for ages. I could actually feel the positive difference in the way I was walking on day two after the operation!  And felt the difference in the leg, even when not walking, in  the post-anaesthesia care unit.  Obviously a lot of pain killers came into play, and still are.  But it is the way that my walking has changed which has affected the whole way I am holding my body. It’s an amazing experience!   I can straighten my leg properly and it has changed the way I move forwards… I thought this would be the case, but actually experiencing it is fantastic!  It feels better and easier to walk (obviously with crutches!) than it has for TWO years! If I could fly I wouldn’t…it is better to walk! THANK YOU! everyone who has helped me,  for getting me started on my journey. Now a lot of rehabilitation, but walking in the right direction now! At last!

I worked very hard on my extension, even on day one, by pushing my knee back into the bed.  And I have carried on, of course, with increasing the flexion.  I really did not expect it to be so good so early.  On discharge my extension was 0 and my flexion 85.  At pre admission my flexion was 110 and extension 10.  Amazing!  I now need to continue with all the exercises I have been given and develop strength in all the necessary parts! It is a full time job but worth investing in! It was amazing to see the post op X-ray.  It was heaven to look at the now very good joint space.  Which is nice and even! Now the exercises are likely to be more beneficial to me walking.   Completely different from the the X-ray in November 2016, with the tiny gap between bones on the medial side.  That was dramatic too, but in the wrong way.

It is easy to get slightly over excited and do too much and so I am doing my best to pace myself and make sure there is also plenty of resting going on.  The physiotherapist I saw on before leaving today reminded me to reduce the swelling as much as possible and ICE… so the freezer is ready and rearing to go!   I have sat down and worked out when I plan to take the various medications I am on, and am considering saving the morphine for “special occasions” if desperate.  I feel much better about using the Co-Dydramol and  Ibuprofen without the morphine if possible.  I did have a couple of small doses of morphine today, but though the very drugged feeling is undeniably VERY pleasant, it seems better to take a  path of avoiding it and managing pain in other ways, as I have been used to doing so often prior to the knee replacement operation.

 

It certainly pays to prepare.  Very handy to come back to things like there being a stair rail and an electrical socket by the bed for charging appliances like computers and phones.  All these little things count a great deal.  My husband is being wonderful and it is great to be in the home environment.  In the evening I tried out things like using the stairs and even tried out my exercise bike.  I wasn’t expecting that on my return home.  I sat a chair directly in front of it and did several rotations of the pedals all the way  around!  Did about 20!  I am also surprised with how strong the leg feels.  I did make sure my legs were in pretty good shape before surgery, but it is clear that the surgeon has done a most excellent job, because, among other things,  knee doesn’t feel like it has been very disturbed.   I am sure if I had watched the operation I would have seen the sawing, drilling and hacking, (!) and known other wise, but quite clearly I have been in the hands of a very skilled and artful surgeon with a great team.  The knee is pretty swollen now, but it was quite shocking to me how LITTLE it was swollen on day one of the surgery.  It looked like no one had touched it! It swelled up rather a lot when I put the TEDS on.

 

I have adjusted the timing on my medications to fit in more with the home timetable, but the Fragmin has to be at the same time, which handily, is six pm.  I did buy myself some topical anaesthetic which does make the injection painless.  I am sure I could brave it but when you are managing pain as part of the rehab it is rather refreshing to have something so simply and charmingly rendered painless!  I am currently, as I write this, plugged into the TENS machine and this is great at dealing with the pain I now have which is rather refreshingly surgical in nature but still needs a bit of attention.   I would like to keep the night time as well managed as possible and so am having the medication which used to happen at 10 pm a bit later at 11 pm.  Gosh, it reminds me of when you have a baby and need to think about the feeds you give to try and get a good night’s sleep!   The knee hurts right now because it is bent to 90 degrees or near enough. I have  not checked it, I’m just going by appearance.  When I finish writing this I will go and ICE it, elevate it, and give it a rest.   I think I will try and keep any morphine consumption, if it happens, for the night time.  Because everything often gets more desperate at night and can seem worse.

My final sentence has to be, that without good form, good function is very limited. Now I have some opportunity for walking around as I once used to.  I will need to work very hard.  But at least I will get somewhere.

Day four in hospital – ( Saturday – Post knee replacement surgery)

Bye bye, I'm not in a rush to go because it's very nice here but will be good to get home!

Bye bye, I’m not in a rush to go because it’s very nice here but will be good to get home!

I will do two entries for this day.  One for the time in hospital and one for the time at home.  It is a special day for me, and the beginning of my new adventures in life with a newly resurfaced knee joint.  I am hopeful all will continue to go well.  There could be complications later on, but let’s not expect that.  I will do all in my power to help things work out well. It’s a step of faith.

This is my paper diary entry for the day:

10am  I didn’t have any morphine yesterday but am thinking I might have some today possibly.  I would prefer to try seeing if elevating and icing is enough but decide to wait and see how the day pans out as it may be that if I am a little more active the pain levels may increase.. They are very good at managing pain and I am regularly asked if my pain levels are 1, 2, or 3.  Most of the time it has been moderate which I am used to anyway.  To be honest the pain is, while certainly part of the package, much better than the pain experience preoperatively because  preoperatively you know that the pain is going to get progressively worse while this pain experience will get progressively better.  Even if you still had a little bit of pain, it would still be better than living in expectation of a worsening state of knee joint and steady decline, with expectation of further decreased mobility and increased pain.  It may be I think that I could go home today.  My operation was Wednesday and now it is Saturday which would make it four days.  My day of fainting twice was the day when I felt the most “out of it”.  I am pleased that I experimented before the operation how to get my leg up in a raised position using pillows and with the hospital bed it is even easier.  Shame that I cannot take the hospital bed back home with me!   I have found that after the initial ice pack application it is very pleasant to take the ice packs out of the sleeve and use them to gentle massage the knee upwards towards the heart.  The “Hydration Station” is naturally the highlight of the day as it brings a lovely cup of tea.   The routine of the hospital is something I find quite pleasant and the staff changeover times are the busiest. It is actually very nice to wave bye bye to one lot of smiling people and welcome another, and they really are all very smiley which is important and does make a very big difference.  

1 pm It is one o’clock on Saturday and I will be going home at some point later on today. WOW!  Amazing!  I am walking on crutches  to the freezer in the Physiotherapy room to collect my ice packs every 2 to 3 hours.   It’s a great mixture of a bit of exercise, a bit of rest, and more exercise and more rest. The rest is very important – I can feel my heart pumping away and the blood pulsing in my neck.  I do feel quite dizzy and get tired pretty quickly.  It certainly is important to pace oneself.  Even as I sit here writing I feel extremely tired.  I did also have a small dose of morphine today which does help push me through the time when the pain gets too close to the edge, however it is basically under control and feeling  it is under control is FANTASTIC! 

The Physiotherapist said yesterday that the surgeon said it was “Definitely worth doing”.

“Definitely worth doing.” This helps a lot, because my gut instinct was correct.  My Asda nightdress was a good choice for the hospital stay! On the front it has:   “MRS” noun/miss-us/def: always right”.  It’s good to know once the surgeon got in there, that my knee was clearly in need of it’s crown! I wish I could see a photo of it.  Or even watch the whole operation. I seriously would, if I could.  I’d love to know exactly what was done!

very happy with my new knee in bright red Asda nightdress

very happy with my new knee in bright red Asda nightdress.   This photo was taken on day two or  three.

My time at hospital finished at around 3 pm.  My husband picks me up, and I walk out of the building in crutches. Annoyingly I have forgotten to get him to take a photograph of this significant moment!

I can tell you this…I have more potential walking out of a hospital with crutches than I did walking in without them.

Because, though the rehabilitation and recovery process for knee replacement is a long and hard one, compared to years of pain and disability, even one or two years to get things sorted is relatively short.

Hey! Now I am in good form!  My knee joint is in good form!

Now all this exercise has a chance of paying off!

See the next post for the rest of the day!

Day three in hospital – (Friday – Post knee replacement surgery)

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The paper diary entry for day three is, as follows;

Mmmm, yes, realising that the initial day one was a bit of a high.  At first I just had a bandage on and not the TED. When the bandage came off ( I wrote this referring to the day before) and the TED went on and I think various drugs are wearing off and all of a sudden the knee is huge.  I was so impressed with how little it was swollen before.  Now the swelling makes it very tight and stiff.  Still moving it as much as possible.  The surgeon popped in to see how I was getting on yesterday and just at the exact time I fainted.  It was lovely to see him though, even in the middle of a faint and he looked pleased with how things were. – regarding food.  I started off ravenous but now – bearing in mind I haven’t been to the loo for a while the appetite has gone a bit.  The physios I saw yesterday on day two are lovely and it’s great to have their support.   I decline the morphine I was offered last night.  I am wondering if that may not have helped with the fainting though it might not be related.  I asked for some ice and I elevated my knee several times last night which is a better way of managing the situation rather than just using pain relief alone, The pain I feel at the moment is surgical pain which at the present time at least is fine. I am still taking Co-dydramol  and Ibuprofen and this seems to be enough. I would really like to see the xray at some point. My bed is in a great place right by the window.  I have a fan and a breeze comes in through the window – I feel a lot more comfortable with it being so cool and breezy.  I put some relaxing music on my tablet when I iced my knee last night and that was very good for relaxation.  Did a poo today – Well done! Really lost all dignity now!  And what is more, not only the commode but the actual toilet.  Walking to another room has been the most exciting thing that has happened to me in a long time.  Physio told me to ice every two hours for 20 minutes at a time.  4.30pm  Feel so much better now I have got some  ice packs and plenty of them.” 

 

in the rather too short nightdress.

in the rather too short nightdress.  In this photo, thankfully the addition of shorts makes it respectable!

Other features of the day which I remember looking back:

The awful moment I realised that my night dress was rather short.  And was quite possible exposing a very small amount of my bum when walking.  Not much.  But even a little is far too much.  I only needed to lean forward a tiny little bit!  (Which you do with a walker!)  Oh dear!   I put my shorts on when I realised!  Possible now I no longer needed the beloved bed pan! Rather awkwardly I realised this when the patient opposite had visitors. On my return journey from the toilet.  Having already exposed my rear end on the outward journey!  Oh well, it could have been worse.  I would not to have liked to be a visitor when I used the commode.  There are some things you just don’t have control of in life.  Your response to laxatives is one of them. Thankfully my commode experience does not happen during visiting hours.  Now I understand why someone might want a private room.  Never occurred to me before!

 

Another key moment:

The wonderfully fit moment of putting on my bra. Suddenly felt very active! I think earlier on I mentioned the importance of knickers.  Bras are also very important for a woman.  I thought pretty carefully about this beforehand, and went for an active wear sports bra.  Yes, I know I won’t be jumping up and down on the bed quite yet, but they are very comfortable and easy to leave on all the time.  No digging in or itching or catching.  And, as always, the psychological aspect is important.  I FEEL active in my sports bra!  I knew I would feel pretty knackered and I was wondering if this choice of bra would make me feel more active.

Ho Ho!  I know I am pushing it a bit there, but even a tiny weeny little sporty inkling of a feeling can go a long way when you are bedridden.  I am not sure in retrospect, if the sports bra did make any difference to efforts at moving my leg, but the top half of me did feel more sporty as a result.

I found a very funny video on You Tube in the last few days, which did crease me up.  All about “active wear”!

My version:

Lying in the hospital in my active wear!

Walking on the walker in my active wear!

Got a knee replacement in my active wear

Yeah!  Active wear!

Getting there!

I’ll  walk a mile in my active wear! 

Give me six months in my active wear!

With a knee replacement,

and a bra

Yeah! 

I’ll just keep on walking 

in my active wear!

And there was also the heavenly moment of having a shower.  This was amazing!  Wanted to stay there all day.

And the food is great.  The mashed potato is lovely.  The spotted dick is delicious.

I don’t particularly want to go home.  Happy to stay a few more days!  It’s great!

 

 

For a shorter version of “The Very Patient Knee Replacement Story by Jenny Meehan” follow this link: https://jennymeehan.wordpress.com/abridged-version-of-the-very-patient-knee-replacement-story-by-jenny-meehan/

 

Day two in hospital – (Thursday – Post knee replacement surgery)

 

 

It appears my main preoccupations in hospital are the food and cups of tea, which are very good, and what comes out “the other end”. Let me apologise for this in advance.  All I can say is that at times like these, we are reduced to our most basic level, as rendered dependent on others, with very little else to occupy our minds.

The paper diary entry for day two is, as follows:

“I have done a lot of wee – getting quite good at using a bed pan – I didn’t sleep that much in the night but dozed on and off while doing some of my exercises -foot pumps and bottom clenches.  I am so pleased with the way my drip has been put in.  It is very comfortable.  The unfortunate lady across from me is very constipated and it all sounds very awful.  I decide that I will take a senna tablet which I have in my bag as soon as I get up in the morning even though it says you take them at the end of the day.  I do remember from my Caesarean Section that the drugs can make you constipated – I might just restrain myself with the food so that my bowels don’t have too much work to do – at least I have been to the loo – I did eat quite a lot yesterday – I can feel my stomach moving – Neil did a great thing yesterday and brought me a pack of various cut fruit; melon, strawberry and mango.  Surprised I have not seen the physiotherapist yet – really keen to be able to go to the loo by myself, for pretty obvious reasons. “

Then the physiotherapists do come! Just after I have written the above!

Whoops! The physiotherapists do come and when I try to use the walker I faint.  Apparently this is quite common – Still taking the morphine and other drugs. Bit disappointed I cannot get up to go to the loo myself” 

This is all I write for my second day. I faint on both occasions when I attempt to use the walker.  My blood pressure is low. I do feel pretty washed out. Both fainting occasions are kind of mixed up in my mind, as I look back and I am not sure exactly what happened when.  So the bits I remember here may not be in the right order!

When the surgeon kindly comes to see how I am doing, it is at exactly the time that the physiotherapists are with me, and I have just tried to stand up using the walker. Then  I start to feel dizzy and begin to faint! Again!  And the “Hydration Station” lady is there, offering me something sweet to eat! It is rather enticing, with some unusual colours in it…Very odd.  Green and orange. It is valiant attempt to keep me in the land of the living.  I say to the surgeon “I don’t think being sick on you is a very nice way to thank you for what you have done”   I also say “Thank you so much I am very grateful”. But I don’t quite finish the sentence because as it tails off,  I have fainted!  When I come round I have a little oxygen mask on my face for a bit.  I gradually perk up. The other two patients in the section of the ward I am in look worried.  I think they are more worried than I am.

I don’t feel great.  But, I do feel grateful.

I can also remember the physiotherapist telling me at one point that the surgeon said the operation was “Definitely worth doing”

Yes, it definitely was.

I can feel the difference already, and I cannot even walk yet.  But I can stand up straight! My body knows things are better, even with the trauma of the surgery to contend with. I cannot quite believe how obvious the difference is. My legs feel the same length for the first time in ages. It’s a great feeling!

I am a sensitive soul.  Horrified by the experience of having my walking ability so dramatically reduced prior to surgery.  Not quite able to believe that from walking for three hours non stop at the beginning of 2015, I was reduced, for large periods of the last two years, to a walking duration of between ten and thirty minutes. Latterly, just ten minutes of what I would term “reliable” walking time, meant that I begun to need to shut down vast areas of my life. Yoga and swimming kept me going activity wise. But this is not practical in terms of mobility. And certainly not possible to be a busy household manager, artist, counsellor and teacher with such restrictions.  Even my standing time each day steadily reduced.  That was quite devastating, as I need to stand to paint.

So, “Definitely worth doing” it was. Even without seeing inside the joint, which I would love to see, there isn’t a shadow of doubt.

Thinking about walking now, come to think of it,  I cannot remember if I did any walking on this second day.

I guess I must have later on in the day.  I did feel pretty dizzy and not too good.

But inside, I am elated, and over the moon.

Sorry about the muddle of tenses!

I am still over the moon as I write this, retrospectively!

The time between coming round and the rest of the time in hospital.  Which is a long time, even though not that long. Or is it? I am not sure, as I am too drugged up and “out of it”!

© Jenny Meehan DACS All Rights Reserved sign of the times series jenny meehan “Gentle Touch”

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Open edition prints are available on various substrates; canvas, metal, photographic paper, framed, or as poster prints or greetings cards. as well as selected merchandise. By purchasing them you help support my creative practice as I get a royalty percentage from any sale. It’s safe, quick and easy to order. Also see my website http://www.jamartlondon.com/ for original paintings.

Rather pleasant as waking up goes.  I am sure that Monday mornings seem a lot worse sometimes.  I am in PACU and a very lovely nurse is making sure I am OK.  The staff are so caring and lovely, and I feel very well looked after. I have some air tubes in my nose which is rather nice having fresh air streaming right where you want it the most.  I feel quite out of it and the lower part of my body is numb but the nurse explains what is happening very clearly and explains the different reasons for why I am feeling the way I am.  This is very helpful and I feel very relaxed indeed.  After quite literally lying around for a while, I begin to feel quite perky and even have some brown toast and marmalade about 3 pm.  Amazing!  Nice tea too.   I think the operation took around an hour and a half but I did not check exactly.  Just lying there knowing it is all done is fantastic.   It is all very restful and quiet, and resolved.  I have had my surgery.  I wanted knee replacement surgery and I got what I wanted.

But I got more than that.  I was treated in a wonderful place by brilliant people who showed dedication to their vocation in life and did their work most excellently.  This is worth a huge amount, and for me as a patient, is a very positive experience in itself, because it is a wonderful feeling to be well cared for.  And this in itself can make the whole recovery process a million times more successful, I am sure.  Because the way you feel about things affects how you feel about yourself and how you feel about yourself makes a big difference to how you treat yourself.  You are kinder, more patient, and more caring, if those around you are also kind, patient and caring towards you.  It is just easier for your body to respond positively to an experience if the positive input is there.  I saw so many smiling faces I couldn’t quite believe it.  And it was FUN to ask the porter to drive the trolley just that little bit faster, and maybe do a few swerves through the corridors.  Unfortunately he did not oblige, and it was not a patch on Chessington World of Adventures.  This is my only complaint about the experience.  The trolley ride, which I thought would be a highlight, was most disappointing!  I was hoping for a little bit of screaming!

I did write a few small entries in my diary while I was in hospital.  I can just about read it!  This is what I wrote on this day:

“I am in PACU and it is a dream – not quite sure how long it will go on for because the pleasantness is lots to do with the pain relief I am sure – So doing foot pumps and buttock clenches – Everyone has been lovely – My leg doesn’t look nearly as swollen as it did when I injured it in 2010.

4.pm Just done one litre of wee – very pleased with myself- pain is making a gentle entry – at 3.30 pm I took 2x Co-dyramol plus Ibuprofen.  It is very peaceful and restful here.  I have made a few texts and Neil my husband phoned – I am glad I did not have a catheter.  Looking back on when I went to the theatre it all feels very relaxed – they sedated me very gently and I felt like a baby.  The surgeon popped in PACU and told me it had gone very well and definitely needed doing as the bone was very worn which is quite helpful to know because X-rays and symptoms don’t tell the whole story and for the surgeon to say that is a good piece of information to have.

(slowly and gradually more  feeling returns to the leg)

 I can actually straighten my leg better than I could before and I can feel the difference already which is encouraging – It is also surprising how natural my leg feels – it feels quite strong – I wasn’t expecting that. It doesn’t look that swollen though admittedly it is all covered in bandages!  All the staff here are lovely and all kind, caring and contented. I have felt my temperature rise a few times but feel fine.  The anaesthetist was amazing at putting the drip in – I told him that a wasp would cause more distress. “

The amusing thing about what I wrote here was, I completely forgot the bit about the surgeon coming in.  It was only when I looked in my paper diary when I got home and read it that I remembered that it had happened.  That kind of shows you how “out of it”  I was!

I then continue:

” 17.00  I am now in …….ward.   I can smell the dinner cooking and I had some tea and toast at around 2pm and I am feeling quite hungry. “

That is it for that day! My further account which though I wrote it when I was home, I have kept in the present tense:

When I get to the ward I find I have a lovely bed right next to the window.  It is fresh and breezy which is very helpful.  My nurse is fantastic, and rather handsome, which always helps.  He is surprised that I have already had something to eat, and I get an unexpected dinner which is very tasty. The rest of the day involves lots of people with very smiling faces being very nice to me.  I was slightly worried about the possibility of death,  ( a very small risk, but there none the less) and wonder if I have died and gone to heaven, (I jest).  So it is rather a bonus to find myself in the land of the living, but having a rather pleasant time.

Things do take a downward term when introduced to weeing in the bed pan.   It takes considerable nursing skill to manoeuvre mine as I am “weeing for England”.   I have to agree.  Having large fibroids (I have three, one the size of a small melon at one point)  does press against the bladder, which kind of contributes to the need to urinate as well.  I am drinking lots of water because I am VERY  thirsty. I am very glad I do not have a catheter, very pleased about that indeed.  Worth enduring the bed pan and a rather wet bottom for the freedom to do something independently.  Well, erm, a little bit independently.  However little, that little bit is worth a lot when you cannot do anything at all.  This is quite a humbling experience.   Someone collecting your bedpan for you has replaced Jesus washing the disciples feet for me in my imagination.  It has now become Jesus emptying your bedpan.  Makes washing feet look slightly upgraded in the humility stakes, though it had its context too, which I don’t fully appreciate, no doubt.

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Open edition prints are available on various substrates; canvas, metal, photographic paper, framed, or as poster prints or greetings cards. as well as selected merchandise. By purchasing them you help support my creative practice as I get a royalty percentage from any sale. It’s safe, quick and easy to order. Also see my website http://www.jamartlondon.com/ for original paintings.

The time between the journey to hospital and lying on the trolley.

I want my husband to take a photograph of me on the trolley before being rolled into theatre which he cannot understand.  But here it is!  As you can see, I got slightly confused…Had the lilo for the swimming pool on top of me.   No, it isn’t a lilo, but a rather lovely inflatable blanket which keeps you all warm and cosy.  It really was rather lovely. Indeed, the matter has caught my interest.  I am told the operating theatre is very cold and indeed, every now and then I feel an icy breeze not far away.  My cubical is near to the theatre. How exciting!

I did a bit of research at home, as I found my entry into an unexpected polar region fascinating.  I used to be a dental nurse years and years ago, and so do have an underlying interest in medical matters, underneath all the arty business!  So the “Laminar Flow” operating theatre I was about to star in was something to look into, even though I would never actually see it myself, being “out of it”.

Up until the 1950s in the UK (and elsewhere) Surgical instruments were usually “sterilised” in boiling water baths either in the operating room,  or in a room next to it. Powerful extract fans would remove the steam. In doing so, they would create a negative pressure on the operating room and air from nearby areas would flow in to replace it. That air could be contaminated with whatever was colonising/infecting nearby patients.

Then they began to realise something…

Shooter RA et al. Postoperative wound infection. Surg Gynec Obstet 1956; 103: 257-62. Contaminated air was being drawn into a theatre from adjacent areas. When this inward flow was reversed “This was followed by an immediate reduction in the bacteria in the air and by a striking fall in the incidence of wound infections from 37 out of 427 clean operations to 5 out of 532”. There are other, similar papers from that era.

Getting very into things now…

Aerobiologically, the things that generate most airborne contamination in an operating theatre are the staff. The most common unit of contamination (colony forming unit – “cfu”) is a microcolony on an airborne skin scale. That microcolony will contain between 1 and 1,000 bacteria. (Microbial numbers are a critical factor in initiation of infection). A significant purpose of operating theatre ventilation is to prevent airborne bacteria from settling-out in “the wound”.

(and also, obviously, the instruments!)

There is a big difference in the microbiological standards achievable with Laminar flow:

Microbiological standards for working ORs • Conventional – less than 180 colony forming units per cubic metre of air • Laminar flow – less than 10 colony forming units per cubic metre of air.

However, just when you thought everything was simple conflicting evidence appeared, showing that there were increased levels of infection with Laminar flow,  with various theories as to why this was the case.   (Gastmeier/Hooper observations) They then realised that patient body temperature was key, hence me being wrapped up so warm and cosy.  (As an aside, being so warm and cosy is very nice for the patient and makes you feel all warm and snuggly inside!) (Much better than “Ready Brek”!

Maintenance of patient body temperature (“normothermia”): There is an established link between perisurgical hypothermia and infection. The high level flow of air in a laminar flow canopy will reduce patient body temperature far more than the airflows at the same temperature in conventional ventilation.

Another aspect:

There is currently uncertainty about whether laminar flow is better or worse than conventional ventilation 

I imagine this is one of those ongoing debates which is, by nature, ongoing and up for opinions either way.

All the above italics are from:

http://theific.org/wp-content/uploads/2014/10/016.pdf

Anyway, back to the day itself, and away from my interest in the operating theatre:

I am DELIGHTED to find I have charming pair of shortie style pants to wear.  I cannot tell you how pleased I am about this.  I think I mentioned in an earlier post how important it is to have a pair of knickers on.  There you are about to be rolled into the operating theatre, at your most vulnerable point in life (or one of them) ready to meet the surgeon’s knife, WITHOUT A PAIR OF KNICKERS ON!   We have all had dreams of going to school or work and suddenly finding to our dismay we have no pants on.  This is a classic nightmare.  There must be a reason for it being a classic nightmare.  Hence, the joy at meeting an unexpected pair of knickers at this point in my life cannot be stressed enough!  They were quite nice.  Enough of them to be there, but no more.  I need to go to the loo twice…I was told I could drink water in the morning, as long as it was before 7am, so I did…six glasses. I will be pumped with drugs and I don’t want to be dehydrated.

So here I am, ready to roll.   Let the show begin. I am warm, cosy, and happy in my knickers with a nice warm heated lilo on.  What could be better!  I am doing a crossword with my husband.  The nurse, surgeon and anaesthetist all come and go.  When the surgeon pops in, the only question I can think of is “How long will it take?”  He says it will take  an hour and a half.  I feel strangely peaceful.  I can thank God for  peace at this point,  as I have not been drugged. I am glad to be here, and very grateful for surgery. This is quite clearly a well oiled machine.  But not any sense of lack of human care, I hasten to add.  As the wheels get rolling….Off I go! Into another room with several very relaxed looking people who smooth talk me along very nicely.  I don’t feel worried and am told that I will be breathing in some air which will make me feel as if I have had a few too many drinks.   I’m out of it, completely!

 

 

 

Pre-Op Telephone Call Two Days Before Surgery

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© Jenny Meehan DACS All Rights Reserved “Niche Painting”

The weekend has passed and I want this phone call.   I want to know if my wound on my right hand is going to be a problem.  I keep worrying about my surgery being postponed.  I think deep down I am overreacting but still, when you don’t know for sure, it is easy to worry.  So I am glad when I get the phone call in the morning, and find out that the wound on my hand is not going to be a cause for the operation being postponed.  It is healing well, but itching like mad.  However, it looks good and itching is normal. No signs of infection. I am looking at it carefully! It was seven days ago, and must be in the latter stages of the healing process.  I look at it and then think about the somewhat BIGGER wound I am about to receive soon.  However, if little itty bitty wounds heal nicely on me, this is an encouragement, of a sort. Over the telephone various matters are checked and instructions given.  It is going to be hard not to have a cup of tea in the morning.  Normally this is the main reason I get out of bed.

I don’t eat after 7 pm in the evening, so it is very unlikely that I will be munching away at anything after midnight.  So no hardship there. Lots of lovely people have written me reassuring messages in emails, on Facebook, in cards and in texts.  It does help a lot.   As does feeling confidence and trust in both the surgeon and the hospital I am going to.  My husband is taking me and will be with me prior to surgery, but I have asked he doesn’t come back until the end of the day.  I think I would prefer to recover by myself and I am aware that I will be encouraged to be mobile as soon as possible which I think would be best done with just me and a physiotherapist rather than any onlookers. Apart from a friend who happens to be a nurse and will be at the hospital on the day anyway, I am not expecting any other visitors apart from husband and kids right at the end of the day.

Today is the day of LAST bath for ages… LAST walk with old knee.  LAST cup of tea for far too long.

I walked with my stick to the Bankside Gallery for a look at the Contemporary Watercolour Exhibition and made a note to enter it next year.  In the evening my knee is now reminding me of how I pushed it so, and though I have certainly improved my leg and my knee has done well, I do feel that though it is unimaginable to me at the present time, to be able to walk around without it actually being either a fantastic achievement or a disappointing disaster will be quite strange.  To simple walk around without the constant thought of how far, how much, how long, is going to be odd.  Though it will take some time in coming . Presently I am thinking a lot about the  rehabilitation period, which will mean that I am constantly assessing performance.  It seems like a distant dream to simply walk around.  I may even make the church ramble one day.

There are too many things at the moment which get struck off before they have happened.  I have been very cautious of late to reduce activity, (apart from my exercises, swimming and yoga), and though the pacing I do is too restrictive for me long term, as a short term approach before surgical treatment it doesn’t seem so bad.  As does pain, when it happens, not seem so bad as pain which promises to run endlessly ahead of oneself.  But to return so some semblance of what life used to be like will be interesting.   As I walked along the South Bank, stick in hand,  I remembered when I could walk much further along the river without even thinking about it. Right up to Vauxhall and further if I wanted. Three hours or more…No problem.  I cannot believe it has been over two years since I did that. I cannot believe I am getting the knee replacement surgery. But I am. And that’s amazing.  I’m so grateful for it. However challenging the last two years have been.

I had my LAST bath for a while.  I did put a bit of Savlon in the water.  No one has told me to do this but it was kind of ceremonial.  Getting ready for surgery is a whole body experience.  They will clean my leg up but it is all of me going in there, and it is a leap of faith and trust, for sure.  I like to feel I am helping in some way, and so a gentle all over disinfect feels kind of helpful.  It’s very diluted and the smell is very nice.  My daughter says “OH, that smells nice, what is it?” and is very surprised when I tell her what it is.  Thankfully the smell does not remind me of the school sick room or anything unpleasant.  It is a nice smell.  And I use my favourite soap which is “Wright’s Traditional Soap with Coal Tar Fragrance”. It is with Coal Tar Fragrance because  Coal Tar is now banned from use in cosmetics in the EU and so consequently the original Wrights Coal Tar Soap is no longer manufactured as it was. I think this is because Coal Tar is understood to photo-sensitise the skin making it more vulnerable to sunburn and consequently the risk of skin melanomas (cancer).  So with the new version the coal tar has been substituted with Tea Tree oil as it’s anti-bacterial agent.   However it feels all clean,  and a bit surgical too.  Gosh, I am so surgical. The only thing I lack is a trolley.  And yes, I may be off my trolley right now, but as long as I a rolling in the right direction I really don’t mind one little bit!

I work hard in the evening on an artwork submission, which is great because it helps me to focus on something other than the rapidly approaching next day.  I feel a mixture of excitement and anticipation sometimes, and then  anxiety at others.  But in the end I just have to trust myself into the hands of those who care for me, and that includes God, all the people concerned, and even myself.  For wisdom, peace and assurance.  Confidence. I pray for the surgeon’s hands to be VERY very blessed.  Bless his work and bless the art of surgery. Bless him and his team, and may I be part of a very good day.

I am going to make myself a much needed cup of tea.  Maybe two.. to make up for the one I will miss tomorrow morning.  Nothing to drink but water tomorrow.  BEFORE 7 am!  Good job I am normally up at SIX anyway.

I have insisted we leave at 7.30 am to get there for 9.am  I cannot cope with the worry of being late on such an important day.  And I like hanging around. I have got quite good at waiting!

Another post before knee replacement surgery!  Not the incision I was hoping for!

 

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© Jenny Meehan DACS All Rights Reserved”No Fear” painting by jenny meehan abstract lyrical expressionist british paintings jenny meehan

Well, why not pop in another post?  It is sunny outside but I cannot do any gardening.  Too much of a risk, because I certainly don’t want a scratch or cut on my leg.  My lovely pre-surgery leg.   I am not sure if cuts anywhere on the body are a problem before joint replacement surgery.  I am waiting to find out.  Horrendously  seven days before my surgery date, I was hastily washing up some plates and glasses and one of the glasses cracked and sliced into my right hand.  Thankfully, as I don’t generally wash up with my legs, it is my hand which is the affected limb! I am hoping that the location of the wound means it is not going to be a problem before the knee replacement surgery, but as I write this I do not yet know.  The water was not dirty, and I quickly ran a lot of cold water from the spray attachment over the cut for a few minutes, so I am certain there is nothing left in there.  The glass cut into the skin layer horizontally and scraped away a few layers of skin, but it IS just still skin deep, so I am hopeful it will heal up pretty quickly.  It bled a lot.  AAAAhhh!   I do not want my surgery postponed!  I am completely ready for it, and have no cold, or anything else that could stand in the way.  I have been so determined to get this surgery I cannot bear the thought of it being delayed.  I am waiting to hear back as I write this and though I am telling myself that it shouldn’t be a problem, as not on the leg to be operated on, I am not certain of the reasons that open wounds are a problem before surgery, so I cannot tell myself anything well informed about the matter to ease my angst!

A few days later:

When that wretched glass glided across my skin it left a flap which I snipped off with some scissors I had disinfected, and I am glad I did this because it has left a nice edge which is clearly helpful in terms of scab formation.  I am looking at the wound now, and feel quite amazed about my body’s ability to heal.  While the wound is very small, it  is making me think of my forthcoming surgery wound and it is quite encouraging to see the body working away at this little baby cut.  It does seems to be doing a very good job.  Just two days down the line and a thin layer of skin is already forming at the top.  I am hopeful this means it will be all sealed up nicely by the knee replacement operation date next week.  I have not heard back from the hospital yet, but it IS the weekend.  They might leave it till Monday I guess, which is when I would be due to be phoned any way.  I am thinking that “no news is good news” in that if they thought it was a real concern I would have heard back by now.  I certainly feel confident that it is not infected and is healing marvellously.  Let’s hope the forthcoming surgical wounding follows the admirable healing process happening in my hand.

Now I AM NOT DOING ANY WASHING UP!  (That’s handy!)

In fact I am now constantly being VERY careful.  All the time, things come up where I need a knife to cut things.  (Golly, maybe this is a deep psychological awareness surfacing in the light of forthcoming surgery!) I do use knives a lot.   There are the knives in the sink which need washing up.  There are my vast array of cutting knives, including a scalpel which I use for my art working.  I received a delivery of tool boxes one morning and realised as I automatically reached out for my Stanley knife, which I use to  open up packaging that I would need to be VERY careful. I thought I would make some onion soup, and changed my mind because of need for cutting up the onions.  I was going to do some framing, and this would entail handling sharp edged glass, so I changed my mind on that one.   I have done some drilling of holes in frames!  I am wearing shoes in the house rather than walking barefoot in case I tread on anything sharp. (This is quite a wise thing to do, because I do often drop sharp things on floor, frame fixings of various kinds!).  I am NOT manicuring my nails and I have decided NOT to shave my legs the week before the knee replacement surgery.   I will look bristly but I have decided I don’t want to risk cutting my leg.  Even though it has not happened for a very long time, after my glass experience washing up, I am thinking now, that chance might have it that I did nick a bit of skin, and it is simply not worth the possibility being opened up.  And not worth my skin being opened up in any other way but by a surgeon’s knife!  I am, well, I won’t use the word paranoid, because I don’t feel fearful, but I certainly determined to make sure I don’t scupper things in this week before surgery if I can possibly help it.

I feel mega positive and “ready to roll” into theatre.  I am making sure I am well hydrated and making sure I drink plenty of water and not JUST tea, which I tend to drink a ridiculous amount of.   I am taking vitamin C and a multivitamin which includes iron.  I am doing my exercises.  I have packed my bags.  SO hard not to put a whole wardrobe of clothes in there.  I remind myself that it will probably be just three days, and I don’t need a selection of attire.  But then I think…How nice to wake up in the morning and think about what I will wear that day.  To have a little rummage in the bag and select something that matches how I feel.  Will it be a “blue day” or a “brown day” post surgery?  Will I feel like patterns or something plain?  Maybe I won’t care.  But just choosing something nice to wear can really lift your spirits.  Is it possible for me to fit a small SELECTION of tops in my small case?  Hence the need for TWO bags.  I rationalise that they are not very big.  They are small.  And stuffed. They do also include dried fruit, to ease the constipation I am told will be part of the experience, and a couple of books, tablet, sketch book, note pad, etc etc. I have a terrible reputation, which has been a long term matter, as reputations normally are,  of always packing too much.  I don’t think this trip to the hospital is going to be any different.

The Weeks Whizz By…Not the Journey to Hospital, Quite Yet!

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© Jenny Meehan DACS All Rights Reserved Rush Hour – Jenny Meehan Signs of the Times Series

 

Open edition prints are available on various substrates; canvas, metal, photographic paper, framed, or as poster prints or greetings cards. as well as selected merchandise. By purchasing them you help support my creative practice as I get a royalty percentage from any sale. It’s safe, quick and easy to order. Also see my website http://www.jamartlondon.com/ for original paintings.

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Please, don’t sneeze on me!  I want my surgery!

On the train I am praying that people with colds are not nearby.  Someone sitting  a couple of people along on the long seat on the train emits the most horrendous, chesty, loud and unhealthy sounding cough I think I have ever heard in my life.  Someone just to the right of me, facing me, coughs into her hand, I think.  I dare not look up in case I see the hundreds and thousands of droplets spraying from her mouth head towards me with vicious facial expressions of the kind you get in toilet cleaner adverts,  which want to make you fearful of placing your posterior on a toilet seat without pouring lashings of disinfectant down it.  A man on the opposite seat coughs in a more self contained way.  Gracious, this journey in the rush hour is a dangerous venture.  I think I should be wearing a surgical mask myself.  I MUST NOT GET A COLD!

Back at home, the risk of being sneezed and coughed on has gone down from how things were a month or two ago.  I am just thinking of little jobs which other people are not able to do…Things like cleaning out the fish tank.  Sorting out my studio space.  Pre-packaging art work which need to be sent places.

I tried to do a bit of a long walk when up in London recently, optimistic with respect to the fine state of my legs in terms of muscle and reduced body weight.  But it yielded the same relentless pain.  Which, while bad on one front was also a timely reminder that my knee is not in a good enough state for me to live my life in the way that a 52 year old should be able to.  It is tempting, once you have surgery on the horizon (and feel so much better psychologically because of the fact it is coming up), to forget what life was like with a never ending sentence of pain and disability.  Pain feels better when you know it will be addressed.  So, though I managed a quite lengthy 30 minutes walk, which I was very pleased about, I also had an even more lengthy reminder that I had had that walk for the rest of the day.  And the more I do,  the longer, more quickly, and the worse the pain is.  So I push it a bit, and sometimes imagine what it would be like to do what I am doing with a “New Knee”.  I will be more disabled at first, and that will be hard.  BUT, and it is a big BUT, longer term, I should find myself strangely liberated.  To be able to walk freely, and do what I need to do freely.  That will be different, I am sure.  I could wait a whole year for that, no problem.

Keeping up the exercises and moving on.  It is easy to get anxious from time to time but in the end, while this is a major operation it is also a routine one.  So everyone has had plenty of practice.  There’s no other option but to trust in the end.  So it’s a waste of time being anxious.  That is easier said than done.

I am getting my usual February/March Buzz.  I always feel like starting new projects at this time of year and investigating new opportunities and making new contacts.  To a certain extent I can still do this, but always in my mind I have at least three months struck off my action packed agenda.  However I am choosing to think about the time I am out of action as a time of retreat.  Retreat is good for the soul.   In a retreat I can focus on spiritual matters without the focus on doing.  Well, I will have plenty to do in terms of rest and rehabilitation.   But my other choice will be retreat.  Retreat, rest and rehabilitation.  How contemplative I am going to feel I am not sure.  I have loaded a few apps on my tablet for example, “Pray as you Go” http://www.pray-as-you-go.org/home/  which is a spiritual aid to helpfully bring the opportunity for some guided prayer.  I also have a Yoga for knee pain, which seems to be lots of different Yoga videos.  It might add a bit of variety, though I have a feeling I will have enough on my plate with my rehab exercises.  Even bearing this in mind, it may be psychologically good for me to gradually incorporate some aspects of the Yoga I have been practising into my rehab exercises when I get to the point where they are easier to do and I am further on in my recovery.  My Yoga teacher has said I am welcome to come along even if I don’t do much at all, and I think I will consider this at six weeks post-op..  I think the body remembers what it has been doing and even if I am very limited, as long as I am accepting and don’t do the silly thing of getting achievement orientated, if I am wisely moving it would be good psychologically I think.  Because though it will be a long long time, the main thing is I will be going in the right direction.

© Jenny Meehan DACS All Rights Reservednew starting out geometric abstract design jenny meehan

new start geometric abstract design jenny meehan© Jenny Meehan DACS All Rights Reserved

 

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Open edition prints are available on various substrates; canvas, metal, photographic paper, framed, or as poster prints or greetings cards. as well as selected merchandise. By purchasing them you help support my creative practice as I get a royalty percentage from any sale. It’s safe, quick and easy to order. Also see my website http://www.jamartlondon.com/ for original paintings.

I am working through  lists of what needs to be done (Ideally) before the knee replacement operation,  but trying to keep a balance of not wearing myself out.  My under the surface cold seems to be improving.  A bit of reading here and there around the subject is something I still indulge in.

The National Joint Registry is always a good read:

http://www.njrcentre.org.uk/njrcentre/NewsandEvents/Latestjointreplacementpatientguidesto13thAnnualReportoutnow/tabid/1434/Default.aspx

They have some excellent patient guides. And lots of interesting statistics.  Seeing the data on obesity and outcomes was very useful for me personally last year.  Certainly a reality check on the need to loose weight and to maintain a healthy weight. I like to see things in black and white. My BMI is now currently 31.5.  I want to get that word OBESE out of my life for good.  I have four weeks until surgery, so I might just make it down to a BMI of under 30.  I would like that for my own sake.  No one has told me it needs to be that.  My weight loss is not something I have ever wanted to be particularly rapid.  Rather than that, it is important for me that it is slow, gradual, and long lasting.  It’s a matter of health. But as the surgery date approaches, it is very tempting to make a little more immediate target.  The long term target is for my weight to hover around the 12 to 13 stone mark.  This is still more than recommended, but I feel it is realistic and would place me on the right side of the overweight category!

The Royal College of Surgeons also has very useful patient guides:

https://www.rcseng.ac.uk/search/#SearchTerm=knee%20replacement

I am too busy trying to get things that need to be done done.  Because I am not expecting to do anything much for three months after the knee replacement surgery.  That way, if I do get anything done, it will be a bonus.  It will be all rest and exercise and a bit of writing and reading. It will be good to use the forced confinement in a positive way and attempt to give myself an injection of..not blood thinners, though that will be happening too, but rather of spiritual succour.   My blood group is B+.  I pray that I will be positive.  So part of my rehab will be the lovely company of people  I care about, lots of cups of tea, and regular spiritually up building inputs. I will write about that in more detail post knee replacement operation.  For now, I need to do a lot of cancelling and re-arranging, and move things around.  I have had two more phone calls offering me an appointment for the very next day…It must be that people unexpectedly cannot go ahead with their surgery.  One was with a different consultant, so I declined that.  Another was for the consultant I met, but it was too complicated to rearrange things.   Though it was VERY tempting. But I have other peoples schedules to consider and not just my own.  I also have a  residential course for SPIDIR over the half term, so I need to attend that as it is the last part of the course.

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Open edition prints are available on various substrates; canvas, metal, photographic paper, framed, or as poster prints or greetings cards. as well as selected merchandise. By purchasing them you help support my creative practice as I get a royalty percentage from any sale. It’s safe, quick and easy to order. Also see my website http://www.jamartlondon.com/ for original paintings.

For a shorter version of “The Very Patient Knee Replacement Story by Jenny Meehan” follow this link: https://jennymeehan.wordpress.com/abridged-version-of-the-very-patient-knee-replacement-story-by-jenny-meehan/

 

Psychological Considerations B+

I have popped this in as an “extra” rather than a “time between” entry.  I am glad of the time I have waiting for my surgery now, as it is an opportunity to settle my mind and emotions and start to invest mentally in the journey ahead as well as sort out the practical matters.  And so this “Psychological Considerations” is very important.  I have heard how important having a positive mindset is for a good recovery and I can believe that it makes all the difference. That and being able to draw on the support around oneself, and being kind to oneself, and patient.

It’s of interest to me that from the reading I have done on the post operative period of knee replacement surgery, it’s  a rocky road, with many ups and downs.  And the downs can be considerable.  It’s understandable to me that after any surgery the body and mind must have had rather a beating, and the surgery is a trauma to the body, even though it is one for healing intent.  All the energy needed for recovery must leave someone drained and feeling vulnerable.  I do remember after my C-section being extremely drained and sometimes very low in mood.   I think I will need to decide to be very kind and understanding to myself over the post operative period. I am thinking about all the surrounding tissues and the whole body, and what is involved in walking.  There is a lot of healing that needs to happen after a knee replacement. And a lot of different forces at play in the leg and the whole movement of walking.  While it has been a horrible experience to find my walking ability so badly messed up, I do not expect things suddenly to be problem free.  In some respects I feel I will need to start all over again.  But the good thing is,  I will have some opportunity for long term progress.  That clearly wasn’t an option before, and wasn’t going to happen without surgical treatment.

The realisation that my journey starts all over again, could be discouraging I guess, but I would rather take the experience so far as being a learning one in terms of patience with my knee.  And perseverance.  And persistence.  I needed persistence to get where I am at present for sure.  Psychologically I feel a world away from how I did before being placed on a surgeon’s list.  I was starting to dip into some areas of depression I think, though I would rather term the experience desperation, rather than depression.  The reason for the helplessness and powerlessness I started to feel was that it was a reaction to finding myself in what appeared to be a helpless and powerless situation. The situation of wanting and needing my knee treated surgically, but not having confidence that I could get treated.   The thought of spending years of my life on hold for a knee replacement IS an unbearable thought and is bound to contribute to low mood.  Just add an extra dollop of pain here and there, plus the general experience of chronic pain, and mix up an unpredictable knee which starts to monopolise every area of your life, and the anger and frustration, if turned inwards (which it easily can be) does contribute to depression, This sneaks in upon your life,  initially just as  little waves running towards you, but ones which can gradually start to feel bigger and bigger.

Though depression is rather more like a complete drowning experience, which I why I prefer to term my experience over the last few months as desperation, as it is more accurate!  (I am fortunate to have my own experience of moderate depression and anxiety seven years behind me now.)   Let’s just say that, before being listed for surgery, it was like standing at the edge of the sea, with water up to your knees, and knowing that when that giant wave comes crashing towards you, you cannot run away, or move very easily at all, because your ability to move is severely impaired!  You will get knocked down, and knocked back, by the very things which used to cause a certain amount of excitement and fun.  Because now, rather than leaping up in the air and screaming as you bounce through the water, and laughing as you fall down, you find you cannot get up when you fall,  and the games you used to play seem a lot less fun. You have to choose to make them feel like less fun, because, because of your knee, you cannot play them anymore.  And life becomes smaller.

If having your quality of life diminished by lack of mobility and pain is unavoidable, then you have to adapt.  If it can be treated in some way, it becomes torturous to suffer when you suffer needlessly. I think I realised the insanity of this situation…I did not want put my life on hold, or to delay treatment because I might need revision surgery later on.  I could never quite get out of my mind my years working as a Dental Nurse and I kept imagining the imaginary scenario of a Dental Surgeon telling a patient that they should think about not having their tooth crowned because it might need to be re-done ten or fifteen years later on.  “So, let’s just leave it, wait for it to get worse, and just eat soft food or eat on the other side of your mouth for the next ten years. You can have some pain killers and just make sure you eat more carefully.”  It never happened.    And though a knee replacement is of considerably more magnitude in so many ways compared to a dental crown, the basic principle is the same.  Knee replacement is major surgery, rather than minor.  I realise that, of course. Potentially serious risks and more invasive surgery.  I don’t minimise that. It should be very much wanted and needed.  But if it is… and you want a chance of living your life to the full again. WHY wait?

I think I recognised those little waves of low mood coming towards me, and I knew if I didn’t get my knee treated, those waves would simply get bigger.  I was struggling with accepting my situation because I realised it was fundamentally wrong for me to accept it.  Why should someone in their early 50’s not have knee replacement surgery when it is clinically appropriate and destroying their quality of life?  I really see no sense in signing up to stay in a situation which relentlessly steals away all that matters to me because I cannot walk as I need to.  There is always the possibility of complications and future problems.  There is no guarantee. But there is, at least, the possibility of progress.  A  chance of some lasting improvement, and after the long and hard rehabilitation process, the smallest whiff of being able to walk for even a couple of hours non stop!  Which is a dream at the moment.  So I reckon it is worth it. Many of my friends have commented on how much better, fresher, and happier I look since being listed for surgery, and they are right.  I do feel a lot better.  The huge burden of a sentence of several years of reduced mobility, reduced opportunities, reduced social and career activities and increasing pain has been lifted, in principle at least.  That itself is a huge relief. I am sure some post operative pain will wipe the smile off my face fairly regularly in time.  But at least I have some chance of working things forwards rather than letting my life shrink backwards.

british modern abstraction lyric expression painting acrylic detail from “Deluge”  jenny meehan © Jenny Meehan DACS All Rights Reserved

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Abstract Acrylic Painting/Markmaking with Colour. Instinctive intuitive process led painting, psychotherapy and art,psychotherapy and painting, British Contemporary female artist painter Jenny Meehan

deluge painting jenny meehan copyright DACS all rights reserved

 

The Time Between Being Telephoned with a Date for the Operation and Making the Journey to Hospital.

Yaahay!  Today (8th February) I was telephoned with a three possible dates for my surgery.  One was the very next day, but with a different surgeon to the one I met. Must have been a cancellation or similar.  Tempting though it is to whizz in there, I absolutely want the surgeon I met to do my surgery.  Trust and confidence is essential, and while the other surgeon I am sure would be excellent, I felt the necessary confidence in the surgeon who did my consultation.  This matters very much, as psychologically it’s a bit step offering your leg to someone to hack about…(Oops, sorry, I mean to perform an amazing operation on… the surgeon’s art…masterpiece, and fruit of labour!) I wish I could see a film of the operation afterwards.  I mean that.  I would watch it.  I may ask if photographs can be taken.  I am genuinely very interested in the procedure!

While the knee replacement operation is now then exactly one month away, I have started to get my bag ready.  It’s a nice feeling packing your bag.. Just another step in the right direction.  A month isn’t a long time away.  As I swim up and down in the local swimming pool, which is my place of greatest and most wonderful mobility, I know I will miss immensely being in the water.  It is probably the thing I will find hardest. I will just have to pretend I am under the water when I do my post operative exercises.

Yep.  I am dragging this diary out.  To all the “time betweens” I can muster.  No aim for the most succinct and summarised patient journey for me!  I have had to cut down many of my other more physical activities, so writing is just great for me to focus on at the present time.  It’s kind of handy to write for a bit, then  get up, do some non-weight bearing exercises, and then return to the computer. I am thinking that when I am in hospital it may be a little harder to continue to write in the same detail, so things might change a bit soon. I will take a notebook with me, and simply use a pen.

I am fine with waiting for my knee replacement operation now.  The amazing thing is I know for sure it will happen. That’s what I needed to know. And I have had such great training in patience.  As well at the mad rush (well, as much as I am able to rush!) to now sort out things that need to be done before the knee replacement operation,  I have time to bounce ideas around in my head.   It’s great being a creative person.  I love experimenting and exploring, and there isn’t one little area of my life where I don’t do that.  Just little but useful matters.  For example the discovery that I can put a chair in front of my stationary exercise bike (facing the exercise bike) and use the pedals on the bike that way, which I think might be easier for me in the beginning if I have not reached the point of actually sitting on the bike. (This is a bit of a clamber even now!)  I think people find it quite hard to do a full rotation of the pedals at first, and that it is easier to pedal backwards rather than forwards.  But everyone’s recovery is so different it is pretty hard to tell.  I hope to start on that a couple of weeks after surgery, just very gently, depending on how things go.

I have all the exercises given in my patient journey booklet and I am doing all of them and more.  I continue to swim three times a week and stretch in the pool in lots of ways…Mostly doing the things in Yoga which I find harder to do out of water.  I feel that the back is very important and I do a lot of stretching which involves my back, core, and the top of my body, not just my legs.  I remember in August 2015, (when everything suddenly got very bad for my knee and I found my mobility very badly restricted to the point of  some days not being able to walk even round the house ), that being able to move the other parts of my body had a very important part in keeping me motivated and focused on movement, rather than feeling immobile.  It is not good to feel immobile. If I ever cannot move my leg as I will, I can move my arm instead.  This is my attitude. With practice things will improve.

© Jenny Meehan DACS All Rights ReservedQuick Dip print by Jenny Meehan

© Jenny Meehan DACS All Rights Reserved Quick Dip print by Jenny Meehan. One of the Signs of the Times series

As said, I am sad I won’t be able to go in the swimming pool…Not until six weeks I don’t think.  But the risk of infection is certainly not worth taking. I can do exercises in the water once I have the all clear from the surgeon to do so.  I will miss my baths too!  I purchased a small stool from Argos to use in the bath.  I can put it there and then use the hand shower…rather pleased to find it. It took some searching.  Our bath is quite narrow, and a lot of proper bath stools are too wide to fit in it.

http://www.argos.co.uk/product/6003575?cmpid=GS001&_$ja=tsid:59157|cid:199887753|agid:17436842193|tid:aud-158518126633:pla-94468567473|crid:74692316553|nw:g|rnd:4691517210214475520|dvc:c|adp:1o1&gclid=CMa–frDg9ECFWYq0woddbMLhgd

bath and shower after TKR

bath and shower after TKR

I also have some large bubbled bubble wrap that came with one of my deliveries recently.  I think it will be useful when icing my knee, as it keeps the ice pack a bit further away from the knee but still transmits the cold.  This will probably be handy for when I first put the ice pack on.

I saw a video recently on you tube which suggested that  when injecting the blood thinners post op, it was a good idea to hold a little ice pack just below the area in order to numb it a little bit first.  I will try that too. You can buy an anaesthetic gel to put on the skin too.  I might try that.

I purchased some very firm memory foam pillows because I will need all the comfort I can get, I expect.   It is possible to arrange them on the bed either side of the leg, in order to keep the covers from weighing down on the limb, or I could arrange them so that the leg is slightly raised.   As long as the pillows are firm and the knee is not bent, but lies along the pillow so that both above and below the knee are supported, I think this should work well.  I only need three firm pillows to do this.  I use one for each leg (because it is more comfortable to have BOTH legs raised) and these are supported by one underneath at the end, plus one more right at the end which my feet rest on. I have tried this out and it is very comfortable.  There is a slight bend in the knee but it is very small.  Just a tiny bit different from the leg laid out on the mattress.  I think the very slight bend, as long as a make sure I am doing all my leg straightening exercises, should not be a problem. I won’t be sleeping at night with the leg elevated.

I continue to flit around the internet  from time to time. The website and forum “Bonesmart” is quite useful to look through.  I think it is worth bearing in mind that probably there are more negative experiences on it with respect to  long lasting pain , and sleep disturbance than conveys what the average experience is like. (I hope!)  People tend to turn to forums in their greatest times of pain and anxiety I think, which is understandable.  And I may eat my words.  But I have read plenty of other accounts where people experience less pain and have much better sleep than the overall impression I took away from my reading of Bonesmart.  However, the value of people sharing their struggles is very important, and  very useful when practical ways of management are suggested, and other people share what has helped them manage.  I skimmed through Bonesmart several months ago and gleaned many useful things from reading the forum and information sections. I feel I am better prepared as a result and have been able to sort out a lot of practical matters which will help me in my rehabilitation and recovery.

I am glad I looked at Bonesmart earlier on though, rather than at this point, as I think I ended up with rather negative expectations with respect to pain, which I have now had the chance to adjust slightly.  However, the adjustment in expectations is also partly due to having greater confidence in my ability to manage the pain and rehabilitation, and it is thanks to reading Bonesmart that I have taken some hints and tips away to enable me to feel I will be able to  manage.  So it is a double edged sword… Knowing what you don’t want to know, and would rather pretend won’t be your experience (though everyone really is VERY different) but at the same time realising there are things that can be done about it.  It is probably better to be prepared for the worst (well, not the very worst, but some considerable challenge!), and yet makes sure you don’t expect the worse, than not to have thought things through at all. There is a balance in that.

I am confident my pain will be well managed in the hospital which is very important.  Unfortunately my C-section with my first child was not very positive after the operation.  I got told off for ringing my bell repeatedly in the night and the next thing I knew I was screaming in agony and got a big shot of morphine in my thigh.  While this was welcome, it zonked me out so much that I couldn’t look after my baby.  It was upsetting to wake in the morning and have the nurse remove a nappy from my baby so full of wee it probably weighed far more than she did. But pain management is looking good from where I stand now, and I am confident that it will be managed well.  The open day was helpful in this respect.

My favourite words to dwell on at the present time are from the surgeon’s account of his knee replacement surgery. (Knee Replacement Surgeon Dr. Ira Kirschenbaum Documents His Own Outpatient Knee Replacement Surgery)

I have found the link to his blog now which includes his diary.  I did not quite clock before that he went home TWO hours after his surgery!   Here is his blog: https://mykneeyourknee.com/    It includes videos and is arranged in different sections.  I first found the diary through a different route, which I preferred, as it is just published in two textural accounts.  If you copy and paste: Ira H. Kirschenbaum, MD, chairman of the Department of Orthopedics at Bronx-Lebanon Hospital Center it is possible to access the medscape publication sometimes.  Or try   https://www.braceworks.ca/2016/09/17/treatment/when-a-knee-replacement-specialist-needs-his-own-new-knee/

In part 2 of his diary, He reports on  his postoperative pain management.

https://www.braceworks.ca/2017/01/21/health-tech/part-2-when-a-knee-replacement-specialist-needs-his-own-new-knee/

I am a bit concerned about what he says about needing a full time caregiver for the first two weeks.  I certainly need to do some organisation and ensure friends pop by in the day when I am home alone. And my husband could take a few days either off, or maybe working from home.

The Time Between The Patient Open Day and Being Telephoned with a Date for the Operation

© Jenny Meehan DACS All Rights Reservedsunflower digital image by jenny meehan jamartlondon colourful flowerhead

sunflower digital image by jenny meehan jamartlondon colourful flowerhead© Jenny Meehan DACS All Rights Reserved

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Look, if you want a short read, I need to disappoint you now.  I like writing far too much for my own good and for yours, and so I will write far more than I need to, and I will not edit it down one little bit.  This is my area for “going on” without just even one little interruption.  It is an indulgence far greater than chocolate, and does not add any weight to my already overloaded body.  That knee joint model was MIGHTY big.

On the weight front, things are good. I continue to drop pound by pound each week.  Weight loss is a very boring thing, but kind of rewarding too.  Not eating after 7 pm at night, cutting down sugar, mindful eating and some much appreciated input from the “Weigh to Go” public health scheme are reaping their rewards.

Oh, it’s “Weigh-2-Go”  Very clever.  Here’s the blurb:

Weigh-2-Go is a FREE 10-week programme for adults aged 18 and over who would like to lose weight and make lifestyle changes. Delivered by trained advisors in selected GP surgeries and pharmacies, you can choose from one-to-one support or a group if you’d like the support of others trying to reach their weight goals at the same time.

Each session involves practical nutrition advice, for example on label reading, portion sizes and healthy food choices when dining out. You’ll also receive ongoing support with setting personal goals to make gradual changes and a weekly weigh-in.

It’s very good.  I am grateful for it. Y…who had been facilitating my one-to-one session over ten weeks is fantastic and I am finding it very helpful and feel very supported.

I’ve considered in a past post if being overweight may have played a part in my own low expectations of getting access to surgery.  Was this a real issue, and something which would have prevented me getting to where I am?  Or did I feel it more than it was?  The NICE Guidelines are:

1.6 Referral for consideration of joint surgery

1.6.1 Clinicians with responsibility for referring a person with osteoarthritis for consideration of joint surgery should ensure that the person has been offered at least the core (non-surgical) treatment options (see recommendation 1.2.5). [2008]

1.6.2 Base decisions on referral thresholds on discussions between patient representatives, referring clinicians and surgeons, rather than using scoring tools for prioritisation. [2008, amended 2014]

1.6.3 Consider referral for joint surgery for people with osteoarthritis who experience joint symptoms (pain, stiffness and reduced function) that have a substantial impact on their quality of life and are refractory to non-surgical treatment. [2008, amended 2014]

1.6.4 Refer for consideration of joint surgery before there is prolonged and established functional limitation and severe pain. [2008, amended 2014]

1.6.5 Patient-specific factors (including age, sex, smoking, obesity and comorbidities) should not be barriers to referral for joint surgery. [2008, amended 2014]

1.6.6 When discussing the possibility of joint surgery, check that the person has been offered at least the core treatments for osteoarthritis (see recommendation 1.2.5), and give them information about:

the benefits and risks of surgery and the potential consequences of not having surgery

recovery and rehabilitation after surgery

how having a prosthesis might affect them

how care pathways are organised in their local area. [new 2014]

You can see I have emboldened the weight and age reference!

Maybe as an obese 52 year old (Far more than that…but for the above purposes, I will suffer the  description!), even with the theoretically reassuring presence of the guidelines, an awareness of the lack of resources and the rising demand, may have contributed to me feeling considerable doubt about my access to surgery. Just bearing in mind the current climate with the NHS,   this probably filtered into my mind.  Whether this feeling was based on reality or not, I cannot say.  One can only speak from one’s own felt experience.  I may have been over conscious.  But belief is a very powerful thing, and can affect patients expectations.  Let’s put it this way… No one at any point said  “Your age and weight don’t have any bearing on your access to elective surgery.” That would have been a reassurance.

I should have asked straight out, in retrospect. I really need to learn to be a little more blunt.   And not having the cash to simply have the operation privately…It kind of put’s you in a corner.  I must add that there was no felt resistance on the part of my GP or the surgeon.  Far from it.  It’s related to my previous hospital experience. I have always been a very motivated and pro-active person. Right from the start. That has always been clear.  I understand the real implications on surgery of being obese, both during and after.  Gosh, I hate that word.  I am slimmer than I have been for years,and still technically obese.  That’s a bit grim!  I don’t look obese.  I do look overweight! But even looking overweight may, for some people, signal up the idea that “this patient is not going to be offered knee replacement surgery on the NHS”, maybe? I have to wonder. There may be good reason not to offer optimism. They may have seen too many other people held back from surgery by not losing the required amount of weight. But everyone is different.

Losing weight didn’t, in the end, result in any improvements at all in terms of the pain or function of my knee.  But it is great to pop on some clothes which are FOUR sizes smaller than this time last year.   I still have some “Weigh-2-Go.”  (Ho Ho!).  And I feel great.  Most of the greatness is not due to just a lightness in body, but a lightness in spirit.  Because since I have been listed for surgery, I feel even lighter in spirit. I can look forward to walking freely (in time.)  If it takes a year, I will be happy.   Anything is better than the forced imprisonment of not being able to walk about as you need to.

Even as I sit here now writing, my knee is heavily painful, and just after three lots of ten minute walking, and a tiny bit of standing.  I could ice it, which works very well and is what I normally do.  But I am using my mind, as usual, to re-focus and breathing into it (Sounds a bit odd, but it is a Yoga thing!) and consciously relaxing the tension in my body which always seems to come when you have chronic pain.  I can resort to anti-inflammatory medication later (Meloxicam) if need be. That’s the only one which works for me.

By the way, my BMI is now 32.   Main things is,  I am going in the right direction.  I want my knee to last as long as possible.  So the aim is still quite a few stone more…around 13 stone is right for my height.  Three more stone to go.

Now, it’s off I go, as I need to do some exercises to help make my leg ready to run into theatre.  (Well, dream on!)

Since seeing the Osteopath (See earlier post)  the exercises have been easier and feel more effective. This is immensely helpful and important to me, as there was so much shaking going on I was worried…”If things are like this PRE – OP, then what the hell are they going to be like after the knee replacement!” I thought.

But I feel ready to roll.  Get that blue gown on me,  and wheel me into theatre.  I don’t have a knee like a Lidl Lamb Shank anymore, and that shiny prosthetic knee, though mighty bigger than a dental crown, is looking good.  It isn’t going to be easy, and I may regret what I am writing now, but I am steering myself in the direction which offers me a chance of some improvements…I am SO relieved I can start to look forwards, because before this opportunity for a “New Knee”, I was starting to think about marking the rest of the days of my life on the kitchen wall.  Prison cell, I mean. The biggest room becomes a cell very easily, if you sense a sentence of avoidable life reduction being whispered into your ears.

 

image of joint to put in

Avoidable Life Reduction

However long my recovery takes… I will have had my knee treated surgically and I will work and work and work to make the very best of it.  I will do all I can to help myself heal as best I can.  I know there will be highs and lows and I know it will be hard going.  But hard going with some kind of end in sight,  is quite different to endless lack of progress.  There will be a time in my life when nothing more can be done.  There will be a time of acceptance and acceptance of a reduction in my life in terms of mobility and what I might anticipate doing.  There will be a time when more of my friends have walking sticks, (just one has a stick, at present!) and maybe even a walking frame or two, and when we struggle all the time with lack of mobility, and moan together a bit about it, no doubt.  But that time IS NOT NOW,  for me in my early 50’s.  Or at least.  It will be for a time. But a time with an end.

I am very grateful indeed that I can have surgery.  Thousands cannot. And it seems (from the news recently), that though when I first tousled with my doubts about access to elective surgery, I was  thinking about people in more disadvantaged countries, or in troubled situations, it seems that there are also many people in this country who will find the barriers on the pathway to elective surgical procedures rather too high, and certainly very daunting.  Maybe even impossible to surmount?  It seems, even if my own angst was mostly rooted in my head, and I worried needlessly, (or more than I should have), that worry is justified,  if not on an individual basis, but on a much wider scale.

Anyway…Hello Quads…Here we go.  Get working.  Stand up. Sit down.

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Harbour Painting abstract lyrical expressionist british paintings jenny meehan© Jenny Meehan DACS All Rights Reserved

 

For a shorter version of “The Very Patient Knee Replacement Story by Jenny Meehan” follow this link: https://jennymeehan.wordpress.com/abridged-version-of-the-very-patient-knee-replacement-story-by-jenny-meehan/

 

The Patient’s Open Day Visit

It’s an anxious moment for L…  as one of the patients  opens the bowels of his experience at the centre…  Though he speaks highly of his treatment and care, things have been a little bit more complex for this particular elderly patient, with more complications than the average patient, and the group of at least 15 prospective patients all detect a slight state of suspension in the air; wondering what he is going to say next and if it is going to put us all off and lead us screaming in the other direction.

Erm, and there was some mention of problems in the physical bowel area…

I think….Prunes.  Put them on the list.

Thankfully, he has a smile on his face, even though his journey has quite clearly be rather more up and down than most.  He can only sing the praises of those involved in his care, and I reflect that indeed, this is what most of us really want to know.  We have no control of exactly what will happen as we stroll,  sometimes painfully and sometimes limping, into the future, and no one can predict how things will go, even with the reassuring statistics and wonderful reputation, plus outstanding results.  But the smiles on peoples faces do tell us something that we do want to know.

To put you in the picture, this is the Open Day for the prospective patients.    We are all in need of a hip or a knee, or even two knees, and as we pass round the models of both hip and knee in the introductory talk, the reality of having these implements in our own bodies comes that little bit nearer.  One lady is rather shocked about the size of the knee replacement components… horrified might be a better word.   Indeed, it is rather large.  Must be a big builder’s knee.  However, knees are pretty large being the main load bearing joint.  Putting my fingers on both sides of mine, I suddenly realise how large it is.

Another man asks a question about lubrication between the joint components.   Erm..  I don’t think it comes with oil or anything.  Vaseline?  I think to myself.  I don’t think that answer get’s picked up, as it isn’t quite directed to the person leading the session.  But I make a note of it.  As long as mine does not squeak I am fine.  WD40 not needed, I am sure.  As I manipulate the artificial joint in my hand,  it has a wonderful gliding action and I don’t have any worries myself about extra lubrication.  I sure glides a hell of a lot better than the current one inside my body.

Thinking about gliding, one lady asks about sports after the operation, and mentions ice skating, I think from memory pretty soon after the operation.  Silent amazement ripples gentle across the room.  Gracious, I think, I am aiming to be able to simply walk for an hour pain free.  Skating has not even occurred to me.  It is suggested that more gentle and less potentially risky sports might be a better idea. With less risk of falling!

As I sip my rather nice cup of tea, I am comforted.  The tea is good and this is VITAL to my recovery, I do know this for certain.  It was rather nice of it to be made for me, and I confess that I am not actually capable of refusing an offer of a cup of tea.

After the slide show, which is very interesting and informative and spattered with various questions from the group of prospective patients, it is time to do the tour of the centre.   Oh, I must add, the most amusing slide was patient satisfaction. Various different factors all included in this slide, all with very consistently positive score, with a funny, rather sudden drop in satisfaction when it came to the food.  However,  we are assured that is is pretty good, apart from the mashed potato, though some people like that.  Later on when looking around the ward, one patient says the food is horrible but another thinks it is pretty good, though lacking imagination.  Imagination is the last thing I would be expecting in hospital food.  She is quite happy with it though, so if she is, I am sure I will be fine. She obviously has high expectations.  It’s quite an achievement to get imagination in my weekly cooking, and I just cook for four.

As we trudge around, various types of stick in hand, we all squeeze together in the lift, going up, then down, then up again…or is it down?  Not quite sure.  But lots of lift.  I think “germs”, as we share the intimate air together,  Though I was a very good girl, and used the alcohol rub when we entered the centre.  I am relieved that my own cough, which threatens to surface along with its friend, the sore throat, has quite clearly hidden itself deep down in my chest.  Maybe the alcohol rub and the hospital environment scared it and forced it into hiding.  I was worried that I would cough as we walked around, and responsibly conscious of the need to keep any kind of infection away, I took with me a large cotton hanky to whip out, if need be.

The lift reminds me of the one at Borough tube station, and I think how much easier it will be, eventually, to travel around London.

It’s nice to be writing and focusing on the present and future.  I probably WAS a bit unrealistic to expect a Physiotherapy Department to help me on my way towards a knee replacement.  But that is looking back, again.  I have made you listen to my internal angst for long enough.

Smiling faces.

A little less smiley in the Pre- op area.   I do feel sorry, for as we all stand there, just at the entrance of that section, taking just a brief peep inside, there is a couple in one of the curtained areas. One of whom, a somewhat hairy man, is dressed in a theatre gown.  An amazing blue.  Both he, and the lady who is with him, are looking a little tense.  The curtain swishes around them, as they don’t appreciate the audience, and neither would I.  It’s nice to go to the theatre, but there are limits.  I don’t think they wanted quite such a crowd or to be quite such the centre of attention. Not before the show has actually begun.

I ask, as we get back in the lift,  if I will be able to wear my underwear in theatre.  “There is a great feeling of safety and security when you have your pants on.”  I add.  But, I find it is NOTHING at all.  The reaction of the man in the blue gown suddenly makes even more sense.  It is the stuff of nightmares… Having no knickers in public.

As we funnel from corridor to corridor, talking to a few patients here and there, one does stand out.  A man sitting in a wheelchair in the corridor looks young and fresh faced, though he is probably a bit older than me.  He has had his knee operation and says with great conviction;  “It’s the best thing I have ever done.  Don’t worry about it.” He smiles confidently. “You’ll be fine.  You are in good hands.  They are marvellous here.”   I can tell he means it.  He continues on with positive after positive.

That’s a good thing to hear.  He is a great PR man.  I am reminded of the caution about pain when you get home, but, even in the face of that, there is a certain amount of courage to be gained from that man’s conviction. I wonder if he is not really a patient at all, but maybe one of the surgeon’s planted there, pretending to be a patient.  What fun that would be.   It’s silly, I know. And no one would have time for that, however amusing it might be.  But this man is SO positive, so well placed, and such an evangelist for the place, that it wouldn’t be a surprise to find out that he was doing a job, because he was doing a most excellent job of making me feel very confident, and gifting us all with positive expectations!

On a different note, the Wi-Fi is not very good, we are told, unless you pay for it from the unit near your bed.  I make a note to download some things to read.

The Patient’s Open Day visit was well worth it, and a very good use of time.  There was plenty of opportunity to ask questions, and it is always good to meet other people anticipating the same thing as yourself.   Some people had dates for their operation, and others not. The biggest impression I got was that everyone was very well looked after.  “And that IS what you want to know…More than anything else!” I said to a couple of people I was chatting with. “You want to know that the staff will look after you really well, and that you feel cared for.”  They agreed.  As we waved each other “Bye bye” and walked off into the car park, the thought of moving on, just that little bit more easily than before, did promise everything very good indeed.  Even with the pain.

No Cares/Take Courage print from Signs of the Times series by Jenny Meehan

No Cares/Take Courage print from Signs of the Times series by Jenny Meehan

https://www.redbubble.com/people/jennyjimjams/works/13790986-no-cares-take-courage-leap-of-faith-design-by-jenny-meehan?c=231599-geometric-abstract-prints

 

The Time in between the Pre-Operative Assessment appointment and The Patient Open Day.

© Jenny Meehan DACS All Rights Reservedabstract lyrical expressionist british paintings jenny meehan

© Jenny Meehan DACS All Rights Reserved abstract lyrical expressionist british paintings jenny meehan

 

I have not arranged any art teaching or tutoring for the coming months.  I have not arranged anything in the way of my professional art practice which involves commitments to other people either.   The uncertainty over dates is almost exciting,  apart from the obvious wanting it done sooner rather than later.  I am fortunate that my work is self organised and I am in charge of my own schedule.  Domestic and household management is ever present, as always. I hope the rest of the family manage without me!  With respect to exhibiting, people are normally  very kind in being flexible if I am physically unable to deliver/collect work due to my knee. (Well, some are! Unfortunately there is one exhibition that though I was selected for it I was unable to show in due to my current disability not being accommodated).  I am getting used to asking for favours.  I don’t like it particularly. But my whole life has been impacted in such a way over the last 17 months that my expectations with respect to what I am able to achieve/plan for have already taken such a battering that the additional adjustments for post surgery don’t seem quite so significant.  Things will go down a level or two, but they have already gone down significantly.  I have learnt to accept a lot less for a long time.

I am not expecting some sudden resurrection post surgery.  Just a long, slow, road ahead, but happily one which should result in me being able to walk freely at some point in the future.  And also offer me a chance to, (instead of watching my whole life disappear down a plug hole) hopefully, gain  some opportunity to continue to develop my life. To work with less restriction on freedom. (Hear… walking = freedom)

There are several things I was aiming to do this year which are off the agenda, but for the time being, there are plenty of domestic tasks which need to be done, and can be done, “as and when”.  Clambering up into the loft, while I can (with a bit of foam for padding) and sorting out the devastation is one top priority job. Rather difficult and a bit dodgy for me to do that, as last time the power in my legs diminished to the extent I wasn’t sure I would be able to get down again.  None the less, tempting.   Various DIY tasks, as usual.  Usual domestic work.  Being a mum…All of that. What will it be like when I am out of action?    Best not to think about that too much.  I am sure they will manage without me.  (Well,  I hope so!)

My training course in Spiritual Direction (SPIDIR) has now finished and it looks like I will be able to make the residential session, which is good.  I have a few people to see, but have warned them that I may need to adjust dates. I am thinking now, rather optimistically,  that if I can walk eventually for some distances, I will be able to look into a few training opportunities which I had had to discount because of my current limitations.  That’s quite a prospect.

It feels a bit odd not knowing when the knee surgery will take place.  I have gone through my patient preparation resources and now am starting to organise some things in the house in a helpful way. It is great to have my care managed in the new setting of another hospital, without the memories of the past still hanging around.  It is wonderful to have the peace of knowing that my knee joint is going to be treated, and that though this will be the start of a considerable rehabilitation process,  I have managed to get where I am with this situation.

It has not been easy. Quite an achievement in itself.  To be honest, the BEST thing about this present time is that I do not feel I am engaged in a course of treatment which, for this time, in this situation, is essentially futile,  (physiotherapy) in respect of the fact it is not something which has the power to enable me to reliably walk for more than ten minutes.  Don’t mistake me,  I put more than 100% in the my treatment, and am grateful for it.  I still exercise (with some of the exercises) every day in preparation for surgery, as well as some new ones from the booklet I have been given.  Indeed, I am positively looking forward to any physiotherapy input in the future, (Smile…I could regret saying that!!!!) because I feel I will be working at it with some real, tangible, positive results… However long that takes.  Unfortunately, the bottom line for me personally, in reflection, as I said before,  is that I was listened to, but not understood. Yes, I am still mulling things over.  Still. But in order to sweep away the dust, I do have to take a look at it, and see what it meant for me.

I was heard in the end, after writing my own review of the situation and making it clear that no alternative way ahead was an option,  but when things finally were put into action in the direction of seeing a surgeon, several failings in communication and administrative shortcomings  resulted in me feeling well and truly messed about. It was simply too late for me to have any belief in that particular system. I’d lost all patience,  faith and confidence.  The communication and administrative shortcomings would have been bearable at an earlier point, but proved just that little bit too much.    I’d been hanging on just that little bit too long, and when  you are suffering and nothing helps,  but things just get worse, (and rapidly), you know without doubt something needs to change if the problem isn’t being addressed.   Somewhat over-stretched, I took my leave from the hospital because it did not appear to have my best interests at the centre of it.  I simply wanted my knee treated surgically and I wanted to talk to a surgeon about this option.   I didn’t want to wait any longer and I didn’t want to put up with things how they were any longer.  Knee replacement surgery, it appeared, was some kind of taboo word, which shouldn’t be spoken of… introducing the thought that it may not be an option at all, for someone like me, being “young” in knee replacement terms, and also with a BMI of over 30.  That’s a bad feeling… A very bad feeling.  A feeling which suggests  the one way you might be able to experience some increase in liberty in your life, is not going to be something you are able to access. It was a quite distinct feeling.

I think I had been too patient early on, and then, as time went by, my tolerance rapidly decreased!  It did indeed take some time for me myself, to get to a point where I knew what I wanted, without any question of doubt. Denial of how bad things are seems to be a survival strategy. But when you do get to that point, articulate it, and find yourself with still no definitive pathway ahead of you. That’s  hard to bear.  When you are waiting, with no idea when you will hear about an appointment, and understanding that you will be referred back to the person who referred you for physiotherapy in the first place, with still no guarantee that you will get to see a consultant…  I can see why I gave up then. We all have our limits.   Having given up hope in “limbo land”, and not having been informed of an internal referral being made,   I had gone to my GP, and with no resistance or delay of any kind, the ball was moving in the direction I was going in, finally. And that direction was fast in the direction of a different hospital which I hoped would be a little more responsive to my particular situation.

It was more responsive.  Consultant appointment.  No problem.

Am I sore?  I keep needing to turn things over in my mind.  Maybe still just a bit.  Just still accepting what happened. (Apologies for the repetition!  I am aware it is there.  I will move on soon.  Very soon). With my “new” knee I will be able to move on a lot more effectively in the physical realm too.  I have already moved on in so many respects. That’s great!  But still I look back.  I learnt, and trust other people will learn too.  I invested the time to put across my experience and perspectives as a patient, and I do feel confident that note will be taken of it.  I am hopeful that in some way my experiences, and the way I shared them, do benefit someone else in the future. And for me, though I found the whole process of getting where I am now hard, I do recognise that the one main benefit of it is that I do know for CERTAIN that I do WANT a knee replacement! There is some doubt about many aspects of my experience but there is no doubt about the fact I want a knee replacement! I am desperate for one!

I can understand the need to send patients away from hospital successfully “treated”.  “Treated” in  knee osteoarthritis terms means that you are happy to carry on and self manage your condition with pain killers and exercises.  This assumes that your pain and function have improved to a reasonable degree.  That “reasonable” degree is something which needs to be worked out yourself.  That’s not as straightforward as it sounds.  But  “reasonable” in basic terms, I think,  needs to be that you are in a place of experiencing  substantial benefits from the physiotherapy and exercise regime in your daily life, and your life is not closing in on you to the extent it is making you miserable.  For many people, the physiotherapy may improve things to a level they are happy with.  They may be happy to have several years of maintenance physiotherapy and take a lot of pain medications.  Or they may be willing to accept a less mobile and less active life.  But I am not one of them.

The need to send people away happy, or at least, accepting,  with non surgical management of their knee osteoarthritis may, many times, not present any problems at all. But if someone is like me and things are NOT working out in the usually expected way, then the pressure is on.  The “pressure”  is felt both ways,  in an increasing felt need that something more definitive needs to be done from the patient’s perspective, and probably a pressure on the physiotherapist (put on themselves) to “succeed” in managing to avoid the surgical route.  It may well be that the need to successfully treat a patient without then a referral for consideration of a surgical intervention being made is governed by the demand on resources. Also, it probably doesn’t look good having too many people moving from physiotherapy treatment straight to surgical consideration, rather than from physiotherapy treatment to walking out of the hospital door.

But I kept thinking, if someone breaks a bone, then they would not be told to manage their condition of pain and disability, but the bone would be treated surgically.  They would manage, as needs must, but they would have also been surgically treated.  The structural issues are addressed as best they  can.  Which is a wonderful thing. Box is ticked, and off you go. Pain, yes.  Disability, yes. Risks, yes. But some positive direction forwards in terms of mending.   But if  the joint problem falls under the umbrella of osteoarthritis, (though this is a big umbrella)  then it is, for some very good reasons, a problem which needs to be managed, rather than surgically treated UP TO A POINT.  I think my struggle was realising that this illusive point was something best to be ignored, because this point is one at which someone cannot be sent away to manage. Which is not convenient at all.  The Physiotherapy department haven’t been able to do their job, if their job is to make sure you can manage your osteoarthritis without having a surgical intervention.  Though, there is a big IF there.  Because, however major surgery is, with its risks and complications, as well as success stories,  if a patient wants and needs it, and a surgeon judges surgery is appropriate and  a good/wise course of action in the circumstance, based on the X-rays and symptoms, then the arrival AT THIS POINT is a very positive and life changing one.  Not a failure, but a success.  Not a matter of  “knee replacement” (=money) or  “not knee replacement” (save money) but what is best for the patient in the circumstances. IS the objective of  physiotherapy  to dissuade someone from surgery which they both need and want? No, of course not.  But I have been  left with the impression that it is.

I can laugh a bit about this now, even though I am stomping about in the mire of it somewhat also. It probably would have been a lot easier for me if I had not happened to come to that POINT at the same time I was being treated in a Physiotherapy Department!  If I had gone away happy, and arrived where I did later on, I guess I would have just plodded back to my GP and got things moving then.  Maybe.  But one is not in control of how much pain and disability one experiences. I’d been pressing on for a very long time.   However well you manage it, it is what it is. And you are who you are.  You may reach your limit.  I had already reached mine in June 2016, but chose to be patient again.  But there was always the risk of getting to the point at which one totally looses heart.  You cannot put a timer on that. It just happens.

Being philosophical, I got where I wanted to in the end.  So a big sigh of relief, and my needs and wants were acknowledged, even though the process was rather more rigorous than I had expected.   But I cannot quite believe, even now, how hard this felt. Though investing myself into the physiotherapy offered to me, I could not deny the reality of severely restricted mobility and severe pain on my own life, (though I did try!). This was not convenient, but I am mighty pleased I didn’t settle for less than I deserve.  Things got steadily worse, not better, for me symptom wise, and gut instinct told me that knee wise, staying in the previous hospitals’ care  was just another step in the wrong direction.

I know the direction I am walking in, even though I am limping most of the time!

Physiotherapists working with patients with osteoarthritis should, I think, be very careful to ensure that if a patients quality of life has deteriorated to the point where the patient is beginning to suffer from anxiety and depression, they reflect on if another direction might be appropriate, regardless of age or BMI.  And feel free to suggest this, regardless of their own desire to get a successful outcome from the provision of physiotherapy. Maybe they are not free to suggest a surgical route may be worth considering?   Even if surgery is delayed because of BMI,  for the patient,  knowing they are at least working in the direction of surgical intervention can be a great relief and a huge burden off their shoulders.  Any burden for someone with osteoarthritis is likely to be felt quite heavily!  Especially if it has rather rapidly progressed in a short period of time.  A physiotherapist’s own desire to help the patient, is very admirable, but may need to take second place to what will actually serve the patient better in terms of long term effect and improvement in quality of life.

Fat and in your fifties, but needing a knee replacement

The moral of the story, (if there is one), for me is that, even if someone is in their early fifties and obese (improving here…I need to add!) their pain is still pain and their lack of mobility is still lack of mobility.  It could be argued that one’s quality of life is actually MORE adversely affected if one is younger, because of ones peer group and of the expectations one has at this point in life, ambitions and aspirations.   Presumably these don’t simply stop at 50. However, it seems a bit mean to make an argument in favour of the “younger” aged group, because there are also issues in terms of access to elective surgery with older patients, who also deserve treatment, regardless of their age.  No age group should be viewed as being either too young or too old.   It may be that if you fall either into the very young or the very old category, rather than the more acceptable middle range, that accessing elective surgery may demand more determination.  Being fat and in my fifties and in need of elective surgical procedures, has in my experience, been rather more of a challenge than I expected.

Whatever age, loosing weight is very important to do. This is true. For minimising risks, for recovery, for ensuring the knee prosthesis lasts as long as it possibly can. There is no argument about that. I have found my journey so far much too long for my own comfort, and it’s had a very negative effect on my work, among other things.  I have suffered, and it’s been a struggle.  No one ever told me I would not be offered a knee replacement unless I lost weight. I almost wish they had, because I think this was probably the case in the previous NHS trust, at least.  Put it this way, it is the only explanation I have been able to come up with for the mysterious assumption that my knee problems would be addressed with physiotherapy alone.  I don’t see how any physiotherapist can know for sure that physiotherapy will always be enough. What if it isn’t? Isn’t that a possibility?

Though it makes no real difference, that things were not bluntly spelt out, because I sensed it anyway.  I don’t think I am wrong about it either.  Losing weight was recommended in June 2016, and I am grateful for that, because it was good advice. To think that it might help in some way gave me some impetus to work very hard at losing weight.   I had already started, but it was another reason to keep working harder.  And I do take some responsibility for adding to my burden, quite literally, and the situation I found myself in.  I have overloaded my body and made it much harder to move as a result. I am desperate to loose the excess, ALL of it, eventually.  And I think some will come off before surgery (I have already lost a lot) and some will continue to come off after surgery.  The surgery is an important part of me gaining increased mobility and leading an active life. It’s a key part, because without it I cannot move on, however much weight I lose.

© Jenny Meehan DACS All Rights Reserved Put Your Point Across by Jenny Meehan, Signs of the times series abstract prints geometric, jenny meehan fine artist print, uk female 21st century artist,

Put Your Point Across by Jenny Meehan© Jenny Meehan DACS All Rights Reserved

 

I am feeling more settled about the past months of brain straining my way through this experience of knee osteoarthritis, which did just come upon me that little bit too suddenly for my liking.  I also feel in a better place with respect to the pressures I felt in getting to the point I am at, and I feel I can move on now…not feeling sore about the past but working towards what I will be able to do, with not just my own effort, but the help of others.  The surgeon’s art is something I will appreciate, and it will put me in a place which I can work forward from. The only type of soreness and pain I want, now will be firmly located in my flesh, and not in my mind.  I am not going to edit out my angst and my turning over of my experience from this narrative, because it is an important part of it.  There’s an amount of repetition, but I am moving on!

So it is FORWARDS.  No need to look back now.   And one day, I might be able to walk freely, at last.  That is all I want.  More would be great, but that is my main aim.   I don’t know how long that will take.  But if it takes me a year, I will be over the moon.

THANK GOD my knee is going to be surgically treated.  I am over the moon already.  Just thinking of it.

Risks.  Concerns.  Rather worried about the rehab process.  Yes.  But nothing can take away the relief of getting to this point.

I am dipping into various knee replacement experiences written by other people from time to time, as I find it so interesting! One of my favourite reads around a knee replacement journey  is that which I referenced in an earlier post. It’s a diary of a knee replacement experience written by a surgeon who has performed many knee replacements on other people.  I like it because it is very well informed, as it would be, bearing in mind it’s author.  But I love the honesty and the way some quite difficult experiences, which I can identify with, are summed up so well.  Here is an extract:

August 17, 2016

Once you truly need a knee replacement, there really isn’t a lot you can do to avoid it. The only people, in my experience, who can avoid a knee replacement by trying a particular exercise regimen or injection product don’t really need a knee replacement in the first place. Once the bone on one side of the joint touches the bone on the other side and you begin that terrible painful slide down into arthritis pain, it is unlikely that you can avoid surgery. You can definitely do some maneuvers to temporarily relieve the pain, and as long as you continue to do these things, you can postpone the inevitable for a few months or maybe a year.

As in any situation, there are some exceptions, and everyone has a unique story. Some people say that they derive pain relief from Synvisc-One® (hylan-G-F 20) or glucosamine, even though such results are not based on hard science, but these products do nothing to lubricate the joint or build cartilage. Nevertheless, I tried them.

I did physical therapy focused on strengthening my knees. I took glucosamine. I did Synvisc-One injections. I did cortisone injections and took 600-1200 mg of Aleve liquid gels daily. The Aleve worked in bringing the pain down from a high of 8 to a low of 5 on the visual analog scale. Everything else was no-go. I still intend to recommend to my patients all of the modalities that failed for me. Even if a small percentage of patients do well, these modalities are so minimally invasive that there is no harm in trying. So go for it. But if your x-rays show that your knees are done, then they are probably done.

Denial works, though. “Who needs to run or even walk quickly anymore?” I thought. “There are more than enough Netflix and Amazon TV series to avoid ever needing to leave the couch.” So what if it takes me 15 minutes to walk across the street.

This line of thinking begins to run thin. Life is motion, and motion is life. But being in denial helped me hold out for 4-6 months, until nearly everyone I knew was saying, “When are you finally going to do something about that knee?”

This is quoted from: When a Knee Replacement Specialist Needs His Own New Knee
Ira H. Kirschenbaum, MD
Disclosures | September 07, 2016

(Ira H. Kirschenbaum, MD, is chairman of the Department of Orthopedics at Bronx-Lebanon Hospital Center, Bronx, New York.  When Dr Kirschenbaum needed a new knee himself, he kept a diary from a perspective he had taken for granted that he understood: that of his patients.)

For a shorter version of “The Very Patient Knee Replacement Story by Jenny Meehan” follow this link: https://jennymeehan.wordpress.com/abridged-version-of-the-very-patient-knee-replacement-story-by-jenny-meehan/

23rd January Pre-Operation Assessment Appointment

In the dark and early morning the car is covered in glitter…Well, not glitter, but it is good to think about it that way!   You can see I have my positive frame of mind in place.  This is important.  Because ice reflects light and makes things look beautiful, even in the darkest times.  Though the time is not nearly as dark as it appeared before the nice consultant orthopaedic surgeon not just listened to what I was saying, but actually heard it.  There is a bit difference between listening to, and hearing someone, I have discovered.

I’m dropped off at Macdonald’s in Epsom, and will get a bus from there.  The bus which goes right through to the hospital gets there a little bit too early, and the next one is too risky and would possibly mean I get there too late. Timing is everything.  I still feel sad that to get to the point I have feels like it has been “walking through fire”  It is hard being just 52 with osteoarthritis of the knee which makes a sudden, disabling and painful entrance into your life. It is made harder by negotiating a system which basically dictates that at my age I will be treated with physiotherapy and that will work and I will not be needing to see an orthopaedic surgeon or be needing to talk “knee replacement”. (at previous hospital). I am rambling on about this, in order to get it out of my system so that I am in a place where I can move forward without looking back.  So apologies in advance for any repetition. I need to harp backwards a bit from time to time. It’s still early days.

Having worked with exercise and pretty much everything else I can think of on my knee since August 2015 I have tried to go along with the general drift away from surgery.  And it is the case that one needs time to get one’s head around the situation.  But when pain and disability completely dominate your life, start robbing you of the things you love, and you realise your self that things are steadily getting worse and not better, it dawns that if the choice is between carrying on as you are (which involves not being able to walk for longer than ten minutes reliably, among other things) or having your knee TREATED….It’s then that suddenly clarity dawns, and you realise that it is insane for someone my age with my activities and aspirations, to decide to live such a restricted life unless there is no other option.

The problem is felt rather intensely when you realise this, and then need to start putting it across to others,  in order to change the direction of your treatment.    I struggled with this, because of a sense of swimming against the flow…Because of my age I think, (too young for a knee replacement?) and because of my awareness of policies which, (rightly, in one respect), are in place to ensure that people do not have knee replacement surgery that they do not need.  The difficulty for me has been putting across my own need for definitive treatment, (surgical!) and believing that it may actually be met.  On some ears my plaints have been heard, and very well indeed, and on others, some strange thing has happened which seemed to take what I was saying and pop it off somewhere else, in a more convenient place.  A place which did not include the surgical treatment of my knee. Hence the feeling of not being heard at times I think.  And the feeling that my quality of life has not mattered quite as much as it does.  I am STILL mulling it all over!

However, I got through in the end.  It has been frustrating at times.  Some people “get it” straight away. Most people, actually.  Normally, the people who know you well, and who see how your life is affected by pain and disability, who care about you, and are able to say what they think (without any other obligations or responsibilities which need to be met) will be very helpful to listen to, because they will speak common sense.  So, while I feel things have been a struggle, and possibly harder than they needed to be in some respects, I recognise that I have learnt a lot about listening to others, listening to myself, and the need for perseverance and assertiveness, if you happen to be in your early 50’s and needing (and wanting!) knee replacement surgery.  I have learnt that people can be very compassionate, but are often also very restricted by external factors which they have no control over.  The most important people involved in decision making with respect to my care and treatment didn’t have any hearing problems, which is something to be very grateful for.

Well, I have digressed, as per usual.  The Pre-Op Appointment was fine…Nothing very exciting.  I did a “naughty” thing by putting my urine sample tube on the patient reception desk (Oops!  I should have known better)…not good for infection control. (Don’t worry, I only used to be a Dental Nurse and it was a VERY long time ago!) I did offer to wipe the surface afterwards.  (Well, it’s nice to know infection control is so tight. Very positive).

The waiting room is full of people much older than me.  That’s good.  Makes me feel younger.  And such fellowship with all those walking sticks everywhere.  Rather novel.  Suddenly, instead of being the only one in a  room with a stick, I am among fellow stick bearers, and what is more, some bearing sticks far more impressive and medical looking than mine.  Even a WALKER!  Wow!  The business.  (I do not mock.  I will have my walker time post op.)

I had chosen my distinctly non-medical “Leki Wanderfreund” walking pole for the trip to the hospital, as I did not have much walking to do, and so the crutch was not necessary. So feeling elegant and as little disabled as possible, under the circumstances.

Filling in the Oxford Knee Score as I wait in the waiting area, I do my usual thing, and end up realising I have slightly under reported the effects of my knee, but this is the effect of a positive disposition I think.  I am an optimist, rather than a pessimist, at heart. I focus on the positive, realising I need to do this naturally, because the brain itself tends to graduate to the negative, for some annoying reason.   I completely forget that for a lot of my journey to the hospital I have been worried about my knee giving way (because it has been in it’s “out of joint”mode for a couple of days) and I also mysteriously forget that frequently it does not feel stable.  Regardless of this,  under the question “Have you felt that your knee might suddenly �give away� or let you down?”  I tick the box  “Sometimes or just at first”.   Which is generous of me.  (Well, you know, I love my old knee, decrepit as it is.)

As for the “Let you down”…Yes, it lets me down all the time, however, I don’t think it means that!  Knees “Let you down” when you have to organise your whole life around them, and they don’t promise to take you anywhere without moaning and complaining, with threats of punishing pain in the evening if you don’t abide by their rules.  Think… tyrannical child, and you will get my flow. Think, you need to change (or better, just forget) the plans of your life, or you WILL be let down, because you will have to either come home early, or simply cancel what you have planned. A few  “Days Out” which last just one hour or two at the most, end up being memorable for all the wrong reasons. And realise that whatever you do,  your knee might just say “I don’t feel like it today.” and so you cannot predictably tell what you will be able to do, either in respect to work or leisure.  You can go ahead and aim to do what you can regardless, which is pretty much the best thing to do, but the adjustments in your expectations gradually fashion your life which you notice over time is basically shrinking, simply because you are completely fed up of your knee “letting you down.”

Does it mean that?    I don’t think so.  But this is what it means. REALLY means

But this is an interesting matter. The Oxford Knee Score, as far as I am aware, was designed as a post operative measure/tool.  I am not dead certain, but I think so.   There also seems a great deal of difference between assessing a person’s situation over a period of ONE MONTH only and before they have had an surgical procedure,  and how things are longer term. Or shorter term after an operation.  It certainly is not a quality of life assessment tool. It should include something along the lines of “Has your knee made you feel depressed and is it dominating your life in an unreasonable manner” maybe!

I think there must also be issues for younger patients as myself, in the respect that our bodies may well be more supple, flexible, and able to adapt than that of a more senior person.  This can  render some of the questions (I am thinking of the  washing one!) a pretty invalid waste of  time.  Bear in mind, I can do more than touch my toes.  (very supple and super hips!) I don’t need to involve my knees very much at all in getting down on the floor if I use yoga moves to help me.   The Oxford Knee Score probably needs a little attention to improve it I think.  It is a patient perception gauge questionnaire also.  Subjective.  I can appreciate it’s usefulness on one level.  But also it’s limitations.

I expect I will be needing to fill one out after my knee replacement surgery, but I know one thing for sure; it should certainly not be used to judge the success of the surgery or if it has improved my life or not.   It shouldn’t be used to assess if the surgery is worth having.  It doesn’t have anything about desperation, frustration, depression and anxiety in it, for a start!  It does’t have anything about desperation and frustration in patients who fall through the net of it’s questions, even though surgical treatment  makes a lot of sense and needs discussing positively.

As part of my experience, I have done a little bit of surfing the internet.  It is the only surfing I am able to do.  So if I find things which catch my eye, as this narrative unfolds, I will be posting snippets now and again.

“procedures of limited benefit”  What????????????? A knee replacement.  Are they sure? What on earth is that all about?

This is an interesting section of the Biggs Report:

“However, to date there has been no formal approach to
the British Orthopaedic Association (BOA) the Orthopaedic
Specialist Societies, or the British Orthopaedic Directors
Society, who are ready to engage fully and help solve these
problems.
Procedure lists have been generated by PCTs and circulated
to GP practices with advice on “procedures of limited benefit”.
Again lists vary and demonstrate very little consensus or
joined up thinking. These include procedures such as THR
and TKR, two of the most effective surgical procedures
in all the surgical disciplines. Again these lists have been
generated without discussion with the orthopaedic community,
leaving some patients, especially the elderly, confused and
disadvantaged.
In April 2009 the DOH introduced Patient Outcome Reported
Measures (PROMs) for a number of surgical procedures.
These included THR and TKR as well as surgery for inguinal
hernia and varicose veins. PROMs are measures of a
patient’s health status or health-related quality of life and
are typically short, self-completed questionnaires, which
measure the patient’s health status or health related quality
of life at a single point in time. They contain both condition specific
(Oxford Hip and Knee Score) and general health
questionnaires (EQ-5D). Using the results from these
questionnaires it has been suggested that THR and TKR are
not as effective as they clearly are. Much of this was derived
from selective use of the EQ-5D data results. What must be
clearly understood is that patients, who suffer from multiple
co-morbidities such as multiple joint degenerative arthritis, or
heart disease and diabetes, may not see a huge increase in
their overall quality of life following these procedures. However
when asked specific questions about the joint replaced,
patients find the results very satisfactory indeed. Spinning
disinformation about joint replacement in this way confuses
patients and puts them at a disadvantage in the future for it is
well known that earlier intervention for osteoarthritis of the hip
and knee using THRs and TKRs results in better outcomes for patients.”

http://www.gettingitrightfirsttime.com/downloads/briggsreporta4_fin.pdf

Back to the Pre-op Assessment.  All went well.  Lovely ladies seen. Blood, urine, swabs, heart, blood pressure, weight, height.  All of that.  Then off back home.  Done.

Diary of a Patient’s Experience of a Knee Replacement Journey…

This “The Very Patient Knee Replacement Story” is something written for me to look back on more than anything else.  Bit of a liberty to put it here.  However, my knee is my knee, and the art of a surgeon is surely art.  People often refer to a person getting a “new knee” but the knee is not new… It’s resurfaced, with a post and some other bits!  It makes me think of my days as a dental nurse, and all those crowns we used to do, though of course, it is more complex in lots of ways.  It is major surgery…and not just a minor operation.  I am very aware of that. A lot more complexity, and a lot more disturbance all round.

I have realised that if I want to write anything more about my knee, I might as well do it now, before the forthcoming knee replacement operation!  I have done a fair bit of reading around the subject, and I will try and include links to interesting articles on knee replacement matters as well as rambling on about my own experiences! I am writing this part now (I am in January 2017 at present) but will publish it later, probably well after my knee replacement.  So it will be written in the present tense but published at a point when then, technically,  it should be written in the past tense.  It is more like a diary then. And old news!  Yet the present tense is nice and fresh, so I won’t change it.  But I also like to write with a little bit of distance between my experiences, rather than right in the midst of them.  So even these dated entries, written in the present tense,  are likely to include some writing in the past tense, as I tend to enjoy a  retrospective narrative.

There is a fair amount of looking backwards going on. Sometimes we have to look back in order to move forwards.  The main notable event which I don’t cover in this story is my consultation with the surgeon, with whom agreement was made and on whose list I was firmly and very happily placed in November 2016.  Then the nature of time changed for me, and it flew by.   Before then, it dragged.   It’s amazing the difference between the four months from November to March 2107 and from June to October 2016.  The former seems like no time, but the latter seemed like eternity.  I think many patients in need of treatment could  relate to this experience of time in relation to waiting.  And also to many of the emotions I have shared here. It’s cathartic for me to express myself.  Though I will re-cover some areas again and again!

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“The Realm of Inbetween/Pushing it a bit” abstract lyrical expressionist british paintings jenny meehan© Jenny Meehan DACS All Rights Reserved

So, for January 2017  “How is your knee?”

I am keeping any  knee aggravation and inflammation down as much as I can, but the cost is that I cannot walk very much at all.  I can do ten minutes, and sometimes more.  Some days are quite good, and other not.   But both standing and walking, even just round the house, demand payment at some point.   It is just too restricting.  Ice, TENS, Meloxicam, massage, breathing, relaxing, Yoga, Prayer, Mindfulness.  All are very good.  And now I still continue to do my exercises, but have become a little more gentle and selective about what I do, the symptoms are a lot more manageable.  Exercise is very important, but there is a delicate balance to be kept in the process I think. I am not walking much at all in terms of walking being a form getting anywhere!  The good part of this is that when I do, in five and ten minute stretches,  I am able to walk very nicely, unless some random lapse occurs (which does happen…Hence sometimes needing even a crutch, rather than a walking stick!) At other times I can walk without a stick even, for a little while at least.

I have given up trying to make sense of what is happening to the knee day by day, which is helpful! I am at liberty to do this because it does not bode any drastic further deterioration, I  imagine.  I think the relief of having forthcoming surgery has made the world of difference.  It has taken away the biggest pain, (well, in the chronic sense, at least)  which was that of what felt like a life sentence  of severely restricted mobility, with the added torture of the fact it could actually be treated, sandwiched between the distinct impression that, as far as possible, I should endure it needlessly for the sake of avoiding surgery.  Yuck.  I did my research.  And weighed things up. This didn’t seem right at all.

I am keeping things down in terms of aggravating my knee, but getting as much non weight bearing exercise as I can. Walking around the house is necessary, but does get very painful over the course of a day and sometimes even right at the beginning of it.  I can swim for an hour, which is pretty much keeping me sane and happy. Because it is great to move swiftly with no pain. When anyone asks me about my knee, I just say “it’s fine”.  I don’t need it to take up any more of my life and focus, as it has done that already.  And going on about pain and disability is mega boring when you have been experiencing it for a while.  I have no interest in that at all.

However, I guess it may be slightly confusing for someone to hear, when asking about my knee, (knowing that it is causing me problems),  “It’s fine” and then be told I am having a knee replacement!  The reality is, though, that even though I am wonderfully supple, (thanks to ballet at a young age and yoga later on), have worked on my whole body, which has done a fine job of compensating for the knee issues in many ways, and have, (though it has not been easy at all), psychologically worked my way through paths of pain reasonably well…The reality is that my life over the last 15 months has been restricted and affected in a way which is unbearable for me.  And I feel a lot better now knowing that the bone aspect of my knee will be addressed. The progression of osteoarthritis in my right knee has been very rapid, and this may be unusual. But X-rays along the way have clearly shown the rapid decline. It seems foolish to hold some vague optimistic idea that things will improve long term.

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I realised, after going through various stages of thought, emotion, research and understanding, that is it insane for someone of 52 years of age, with ambitions and aspirations, responsibilities and the activities which I am involved in, to watch that all sink into stagnation because of just one knee.  Not being able to walk as I used to (walking is my main form of transport) has been the most distressing part.  Though this varies, and a stick or sticks can help,  the reality is, that a person needs to be able to walk reliably in life.  If this is not possible at all, not treatable, not realistic, then acceptance must be the path.  However, I realised that for me personally, it is insane for my joint problem which CAN be treated surgically, not to be treated. In my case, I think any aspiration of wanting to hold off surgery for as long as possible is very misplaced.

For someone wanting to avoid surgery, then things may be different.  They may want to, or be content to accept, (or be forced to accept),  a more restricted life.  There is nothing wrong with that, if this is something which doesn’t destroy your soul.  But the major cause of difficulty for me has been the fact I have wanted my knee joint treated definitively for many months,  and yet I have felt that the necessary treatment was not available/going to be offered to me. I can only base my review on my own perceptions and experience. It’s possible I may have had more doubt about my access to surgical treatment of my knee than was there, but it is pretty hard to make a judgement about that, not having access to all the relevant sources of information. It was just a distinct impression.  Sometimes those are quite useful.

I wanted my knee joint/right leg  seen by a specialist a long way back in September 2015, but I made the mistake of not insisting on this.  I should have.  I am not sure about it, but the pain was so bad, I thought it likely I had a small fracture somewhere. I did complain to one GP (not my regular one) about being in agony all night and being unable to put any weight on the leg, but their only comment was that according to the X-ray the arthritis “didn’t look very bad”. It seemed a bit too extreme for osteoarthritis alone.   But I adopted a “wait and see approach” without a specialist opinion, which resulted in more anxiety and doubtless more pain than was probably  necessary.  When I did get one in June 2016 (Extended Scope Physiotherapist), the need for a knee replacement at some point was identified.  I thought long and hard and decided that I did want my knee treated in the way deemed most fitting by a surgeon.  Once coming to this point  the need to  see a consultant to talk about the surgical treatment of my knee arose very decisively  in October 2016.  It had been six months since seeing my GP and three since being referred for physiotherapy, but my knee was continuing to deteriorate and still impacting my life in an unreasonable way.  I’m a good communicator but somehow was not heard.  In the end I lost patience with the hospital I was at, and sought a fresh start at a different hospital under a different NHS trust, hopeful of being heard a little more clearly.  I do not have the financial resources to pay privately, or I would, because it would have been a lot easier a path to walk along. I can only find solace that in the difficulty of pursuing what I wanted, I gained a lot of very useful inner strength, which is an asset to have, and useful experience.

I am not unhappy now, because after consulting with a surgeon in November 2016, and being heard, as quick as lightning,  I am now listed for surgery, for which I am overjoyed.  People keep referring to it as “The light at the end of the tunnel”…This has been used four times!  However, I do not see it like that at all.  For me it is simply a beginning.  It will involve hard work, again, on my part.  There are risks… I don’t know what the outcome will be.  I am simply relieved that I have been able to work my way into a place where surgery has been offered to me.  The thought of being able to walk around for a whole hour is what I hope for.  At the beginning of 2015 I could walk for three hours, non stop.  This seems a world away from me right now.  In chronological time, my journey from rapidly deteriorating knee function and pain (from August 2015) to surgery has been relatively short. (19 months) Well, not short exactly, but short compared to how long some people endure the pain and disability for.  But it doesn’t feel that way to me. It feels long.  VERY long.  When you are distressed, desperately trying to improve things, and hoping like mad they will get better, but this does not happen, every month feels like a very long time!

I need to make sense of what has happened so far.  Even though I look forward to a new kind of start and the past  seems a bit miry now, I do finding writing about it helpful. I believe I was patient, and reached the end of my tether in June 2016, ten months after my knee symptoms kicked off in style. I think a big factor in the rapid deterioration of my right knee is related to it’s past injury in 2010.  I slipped very badly on an icy pier but didn’t get it treated at the time.  I never quite felt this past injury was taken into account as much as it needed to be in relation to the likelihood of my knee condition getting rapidly worse, but my gut instinct told me that it had a lot of bearing on the matter.    I “went the extra mile” and choose to persevere further, exercising more patience, even though this was difficult.  But I lost it in the end, and that wasn’t a bad thing! Sometimes patience is not a virtue.  And patience is not passive.  It has an element of waiting to it.  But you can be patient and active.  I think that my time of “hanging in there” did turn out to be positive in the end, because I wasn’t just passive, but did engage in everything I could possibly do to improve the situation with my knee.  But with the patience, also comes the need for good sense, and wisdom.  My knee joint was struggling, and so was I. Things were not getting better, and could not get any better. There were short phases of small improvements, but they were always followed but a further, and more noticeable decline.  This meant that any “better” never had a chance of ever being good enough!

Knee replacement surgery was not something I expected to be part of my life, but it is something I am very glad of, though of course  there is some concern, because I don’t think surgery is to be taken lightly at all.  I am mostly (still) sad and upset about how difficult it has been to be a patient with a chronic long term issue, ie osteoarthritis,  who simply wanted an aspect of the problem (my knee joint) treated in a definitive (surgical!) way, but who felt this could not be possible because of the current elective surgery rationing which clearly is happening. I suspect it is happening more than most of us are conscious of.  Feelings are not always reliable, but my instincts normally serve me very well in life, and I do not think that they were incorrect. I had to fight very hard with my own expectations, and make sure I moved them from what I felt I could not expect to get, to what I wanted and needed mattering enough for it to be taken seriously. “Taken seriously” means being given the opportunity to have a knackered knee treated surgically, in my book.

My own instinct and feelings have, possibly, both helped and hindered me..  Aware of being both a “young” and “obese” patient, I felt it was likely that deferring me away from surgery might be something I would have to quite literally come up against.  The deterioration of my joint was more rapid than I expected, and I was aware of the long term nature of osteoarthritis, and the fact that many people trudge on through their lives with it for many years without wanting, needing, or expecting it, to be treated surgically.  I think the battle, (and it has felt like one), has been not just external or internal but both.  It has been with myself, in terms of expectations, faith, and just the encounter with disability and pain, and also with my experience of finding myself within a health system which is overstretched just that little bit too much, and therefore needs to send as many people away from it as soon as possible. When you start swimming against the tide, and start expecting more than the system is designed/managed to give, you feel the pressure.  When you realise what you want is not on the wider agenda, even though you need it, it does then start to get rather worrying. You do feel the pressure. And things are harder anyway. When you cannot physically get where you want to go all of the time!  You don’t want extra grief!

This pressure,  is itself,  something for both patient and clinician to manage. It cannot be easy for either.  I am sure that the current state of affairs within the NHS health service must be exasperatingly difficult for all those  who work in it.  I don’t feel surprised I found things so difficult, this “being a patient” matter, because things are always harder for you when your life has suddenly changed in a way you did not expect.  It’s devastating.  And all the good intentions in the world, from individuals themselves, do not actually change the general flow of the system, or what it can and cannot offer.   The reality is,  for someone who is  (comparatively!) “young” in terms of being a knee replacement patient (I think the average age for knee replacement is around 65 years of age -ish), but whose knee has steadily deteriorated at quite a speed, (and who therefore has, clinically rather more of an “old” osteoarthritic  knee), the feeling that you MAY be expected to grin and bear it for another few years,  does creep up on you with reliable certainty, especially in the current climate. And a FEW years for a 52 year old, isn’t really a few years if the objective is to avoid revision surgery, and have say, 8 years of your life severely affected by  pain and lack of mobility.

So it all starts to feel very uncomfortable, this delaying knee replacement surgery business.   It does not make sense to my way of thinking. If I want to loose  years of active life to pain and disability, I would rather have that at the end of my life, than at this point of it.    I understand there are important surgical considerations, and surgical treatment does bring dilemmas for both patient and surgeon. There are  financial cost implications for CCG’s.  (I cannot miss that consideration out, can I!)   However, I do not think that these dilemmas should be a reason to dissuade people from knee replacement surgery if that is what they really want and there is sufficient clinical evidence, plus disabling/pain symptoms, which merit it.  Last year I was dissuaded from it in fairly subtle, yet very present ways.  But, whatever other considerations come into play, it is my  knee, and I am the one who has to live with it.

Quality of life is a pretty major thing. Correction.  It is everything!  In the end, it is the patient themselves who has to take a very good look at their quality of life,  and decide if they can accept the effects of their knee on their life, or if surgery is the right way forward for them.   It may not be logical or possible to encourage people like me (fat and in their early fifties!) in the direction of surgical treatment of their knee, even if it could potentially transform a life. Well, not within the NHS system at least.   Because knee replacement is an elective surgical operation but also costs the NHS money. And money is too short.  Oh, I do now feel more passionately that the NHS needs investment in! I have learnt how much it matters to me!

But money matters aside, if you choose knee replacement surgery, you do need to want it.  REALLY want it. It’s pretty demanding recovery and rehabilitation wise.   And you may need a lot of persistence and determination in the process.  With stretched resources, the provision of  elective surgery, for example, a  knee replacement operation, for a 52 year old female, with BMI over 30,  is bound to be something which attempts will be made towards discouraging.  Not everyone will be discouraging. But there may be a general climate of discouragement. Put it this way:   I understand a little of the funding restrictions and different policies.  They exist, and are in place.

I started out with avoidance of knee surgery on my own agenda also.  For a short while.  Yet, as things began to change, and my knee condition and symptoms deteriorated, the gravity of daily pain and never ending disability became clearer and I  began to get more of a grip on the reality of my situation. I was very grateful for the physiotherapy input I received. But doing everything in my own power still was not enough.  So then, the general flow away from knee replacement surgery began to feel rather insidious.  If my knee joint needs treatment, which it clearly does, based on the X-ray, among other things, then why am I being steered in the opposite direction?  Is this because having a knee replacement is really not going to be a good decision for me, or is this because resources are so stretched?  Why, when I tell the physiotherapists at the hospital about how my life is impacted,  am I strangely heard, but yet not heard?  Why am I communicating that I am at the end of my tether, and insisting that I want to see a consultant to talk about knee replacement surgery, yet more physiotherapy, (though I have been doing daily exercises for well over a year) is proposed?  Or why is it suggested that I wait a few years, (as if I had the liberty of effectually wasting two years of my life, putting all my creative activities on hold, just for the sake of I do not know what?).  Why am I basically told by someone else, who knows nothing about my life, work, and normal activity levels, that my knee “does not affect my work”?  Or that I could “take a taxi to deliver” to pick up art work, or that, though I cannot sit without pain with straight legs (to do the Yoga I love so much), that the simple answer is that I “just don’t do it.”

Maybe I would like to be able to sit with straight legs, and no pain?  Maybe, at only 52, it would be nice to have my knee treated in a way that it can potentially yield some improvements? Maybe it would be good to be able to walk around as needed each day.   Maybe that matters to me. Crossly, I wonder if the basic idea is that 52 year old women don’t actually  have much of a life worth bothering about. It is the logical conclusion. I am slightly dazed with disbelief when I look back on it.  At the time, I simply felt I did not matter. There is some room for my anger to exist here.  I can still be patient and have feelings of anger!

I have no doubt of the good intentions, and as I said before, was willing to try out some more exercises.  But these responses are not realistic answers for someone who cannot walk for longer than ten minutes reliably, and whose life is now blighted with  (avoidable) pain and disability. Even though I am disappointed about some of the responses I got, there were also positives, and I appreciate the help I did receive, and the input I received which it was in my power to effect, I did so, and most gratefully.  I can appreciate If I were working within the system, I would possibly  say the same kind of things if it was my job.  Anything said was intended to be helpful and certainly wasn’t a case of lack of care.  I think my experience was simply because of limitations. One has to work within the system and the system is too much stretched. And, though I was not prepared or willing to accept certain limitations on my quality of life, it may be that many other people would accept those limitations.

Anyway,  in the end, because of my  own abilities with communication and analysis, I was able to put my situation across in a way that got heard, in the end.  But this was not easy at all, even for me.  I needed to produce my own review of the situation and make my own assessment as to what was really going to serve my own health and well being in the best way possible. It was not right to accept how things were. I feel concern for those not able to do what I could do. To disregard, or even underplay,  quality of life, is certainly  convenient in the service of cutting down the availability of knee replacements offered on the NHS.   At least I did get  where I was coming from across in the end, but it was hard work.  The general experience was, regrettably unduly difficult, I feel. However, I did learn a lot through it.  Sometimes that is what happens when situations are challenging.  We find something inside ourselves that we did not know we had.

It is significant, I think, that neither my own GP, or the surgeon to be, have in any way been un-supportive of my own choice and experience, and I have felt they completely understood my perspective and respected it. I feel they both have a good measure of where I am coming from.  Boxes must be ticked and forms filled in, and some delays come through crankiness in the system, and little things  do go wrong from time to time, making more delays.  But as I practically fell onto the desk of both of them, (one in tears of desperation and the other time grimacing with frustration!)  there has been no discouragement or lack of receptivity with respect to the impact of my knee on my life.  The sticky mud I encountered really does appear to be something which is related to the previous hospital.

That past hospital experience (not  the hospital I am under the care of now) did not work out for me.  I lost faith, trust, and patience, in the end.  When resources are stretched,  the rationing of knee replacement surgery comes into play in a big way. I understand this.   I also think it worth tempering my words with the consideration that it does take some time too open oneself up to opting for knee replacement surgery.  Though I found my experience  unnecessarily difficult, and  would have appreciated some encouragement towards getting a knee replacement, rather than discouragement, I think, all things considered,  the struggle was worth it. I learnt a lot through it.  Knee replacement surgery isn’t something to rush into.  But surgical options of treatment shouldn’t be denied to people who do need and want them.  And quality of life is VERY important.  That is pretty obvious really.  But it does not appear to suit the system at all.

I feel I may have already gone through the hardest part of the process, which is getting to the place where surgery is offered. But I may need to review that thought in the future! If you have read this, then thank you for bearing with me, for I need to turn it over in my mind.  I found it hard. Life was a struggle.  I might need to turn my experience over a few times before I can finally completely let it go!

For reading today, I read this…Could not resist!

http://www.medscape.com/viewarticle/868379  If you cannot get to it via the link, just copy and paste the title and you can read it.

When a Knee Replacement Specialist Needs His Own New Knee
Ira H. Kirschenbaum, MD

Here I quote the Editor’s Note:

Editor’s Note: Ira H. Kirschenbaum, MD, chairman of the Department of Orthopedics at Bronx-Lebanon Hospital Center, Bronx, New York, has performed over 3500 total knee replacements. When Dr Kirschenbaum needed a new knee himself, he kept a diary from a perspective he had taken for granted that he understood: that of his patients.

Despite being an expert on the procedure he was about to undergo, much about the experience leading up to the surgery was unexpected, which Dr Kirschenbaum recorded in his diary. Part 1, presented here, offers his thoughts before and immediately after the procedure. Part 2, coming soon, includes his reflections on postoperative pain management.

And the wonderfully irresistible title is: “My Knee Is Now Your Knee”!

Part two is here: http://www.medscape.com/viewarticle/869491_3

The link does not always seem to bring you straight into the article, but you can access it in other ways, either by copying and pasting some of the editor’s note above or try this link:

https://www.braceworks.ca/2016/09/17/treatment/when-a-knee-replacement-specialist-needs-his-own-new-knee/

I also enjoyed (if that is quite the word!) reading this blog diary of a knee replacement:

http://www.barder.com/3942 Brian Barder writes delightfully…

© Jenny Meehan DACS All Rights Reservedlyrical abstraction contemporary artist british, female artist jenny meehan london based, lyrical abstraction process led painting,collectable abstract paintings for collectors, jenny meehan jamartlondon uk, art historical relevant significant art british,exploratory innovative paintings, british women artists current today,affordable original paintings to buy uk, collectable paintings original british contemporary painting jenny meehan river journey christian spirituality contemplative art, jamartlondon collectable british female artists 21st century painting, affordable original abstract art to buy, process led abstract painting, romantic expressionist abstract lyrical painting modern art, uk mindfulness art, meditation art, contemplative prayerful art, christian art london, experimental painting, art and spirituality,

“River Journey” abstract lyrical expressionist british paintings jenny meehan© Jenny Meehan DACS All Rights Reserved

 

For a shorter version of “The Very Patient Knee Replacement Story by Jenny Meehan” follow this link: https://jennymeehan.wordpress.com/abridged-version-of-the-very-patient-knee-replacement-story-by-jenny-meehan/

First Visit to an Osteopath – What to Expect?

Well, that is the question. There are lots of answers to that, but for me, the “What to expect” is, rather than the actual  encounter,  if I should expect any kind of improvement or result from the visit.  My agenda in going to see an osteopath certainly wasn’t anything to do with avoiding knee replacement surgery.  The bones are grating and banging against each other in a way which clearly isn’t going to be changed by anything at all.  I have been exercising and working on the muscles of the whole leg, and the rest of my body, since September 2015, starting with GP prescribed quad muscle exercises, gentle yoga, swimming, and then individually tailored physiotherapy from September 2016.  It was hard to imagine that any thing further might change in any way at all. Even with trying something new and unexplored, and having an appointment with an Osteopath.

I was not looking for a reduction in pain either.  I have got used to pain being part of my daily menu in life.  I am getting the knee surgically treated because the knee needs to be treated, and the problem addressed in this way.  I am not a medic,  but it has become increasingly clear to me, as I experience the steady and rather rapid deterioration, that things are not going to improve.  The fluctuations in symptoms which do occur, only belie the underlying reality that I cannot walk very far at all, and the I am turning down opportunities left, right, and centre, because I am now disabled and my life is restricted in a soul destroying way, and in a way I cannot accept.   And I don’t want to sign up to an experience of pain and disability any longer than I need to. I have been very patient in it all.  I have given it plenty of time.

But, as an artist, I have a strong appreciation of the importance of balance.  In an abstract painting, the constant alterations to the balance of the work, which are to do with the form/structure of the painting, make all the difference.  So it is simply logical that the same should apply to my own body.  I have been aware of being very “out of kilter”  and also of how a problem/alteration in one joint affects the whole body.  It affects the way I move, hold myself, and the experience of pain also needs to be managed and negotiated somehow.  The whole body tenses up when in pain.  So I did not go along to an Osteopath to relieve any pain.  Maybe that might be an objective after surgery though!!!

Here is a link if you want an answer to the question “First Visit to an Osteopath – What to Expect” in terms of the general experience of a visit to an Osteopath, the examination, diagnosis, and treatment, plus ongoing care: 

http://www.osteopathy.org.uk/visiting-an-osteopath/what-to-expect/

 © Jenny Meehan DACS All Rights Reserved cutting edge knee replacement design

© Jenny Meehan DACS All Rights Reserved cutting edge knee replacement design

Re-Posting of previous post on osteopathic treatment prior to knee replacement surgery

© Jenny Meehan. All Rights Reserved, jenny meehan, jennifer meehan, jamartlondon.com,germination seed image,new life,creativity image, black and white graphic image germination,jenny meehan woman female contemporary british artist 21st century,

germination print jenny meehan jamartlondon© Jenny Meehan. All Rights Reserved;

I am going to re post this, though I originally posted it in the “Jenny Meehan Contemporary Artist’s Journal” , as it falls aptly in “The Very Patient Knee Replacement Story”

So here it is:

My Personal Experience of Consulting an Osteopath on 17th January 2017

As part of my knee journey, I felt some time ago it would be beneficial to visit an osteopath.  I walk past the British School of Osteopathy quite regularly.   http://www.bso.ac.uk/   One of the things I had felt surprised about was that at no point in my experiences of physiotherapy had any direct manual work been done on my knee/leg and that this was something which might be beneficial.  It just seemed logical.  All those exercises did make a difference to the muscles around the knee joint, and I guess an appreciation of the importance of all the soft tissues and how they are involved did make me think that, even though I will have my joint addressed, it is also important for everything around it to be treated.

I don’t have any great expectations attached to my interest.  I don’t wish to avoid a knee replacement, as my quality of life is too badly affected.  I am fortunate in that I have worked, and continue to work very hard, on my body… The yoga is beneficial, the swimming is beneficial and the physiotherapy was also beneficial.  I have been pulling, stretching, massaging and moving both in and out of water.  I have been working hard for  months and doing all I can, including weight loss, to improve my situation.  I am managing the pain pretty well, though it has to be noted that it has been a lot easier to manage with the forthcoming knee replacement operation well and truly on the horizon.  The thought that I do not have a unnecessary sentence of more years of avoidable pain and disability is a very significant point to make.  I now realise I might miss my “old knee” to a certain extent… It has been with me for a long while.

Anyway, back to Osteopathy and why I thought I would bring myself along to the British School of Osteopathy and see what happened.  As said, I wondered about the lack of physical manipulation.  The total lack of physical manipulation. I am going to digress here a little bit… Into the past I go:

When I was treated with Physiotherapy in 2015 and 2016, it was initially through GP prescribed exercises (from August 2015) and then later on,  through an individually tailored programme of exercises at a hospital (from September 2016).  I did my exercises very conscientiously every day, and I  realised they could have a part to play in improving symptoms.  I was grateful for the input for a while.  But something about being treated was missing.  People with a long term chronic condition  are in a very different place to someone with a more immediate trauma injury.  The whole experience of knowing that your life will be affected in a  long term way,  is a big matter to get your head around.  And even when you have done your best at getting your head around this,  constantly experiencing pain and disability, and knowing this is your daily lot, (if it happens to be beyond what you feel you can bear), is depressing and anxiety provoking.  Your WHOLE life is impacted, not short term, but for a long time, in all likelihood,  and it therefore becomes more important that your troublesome body part is not dealt with in isolation to the rest of you, or detached from a consideration of how it affects your daily life and the quality of it, your self-esteem and your mental health.  It may be that delaying surgery is NOT in the patients interests at all, even if they are on the “young” side of “old”, and obese.  The patient should come first, over and above any other agenda. And good treatment involves hearing the patient, understanding their experience, and if a change of direction is indicated, being sensitive to that, even if it means accepting that physiotherapy is no longer appropriate.

Treatment can never be deemed a  success if it is not actually appropriate for where a person is.  That a person can do certain exercises or can walk around the room, doesn’t  mean that their mobility is adequate for their daily life. I guess for me it took quite a short time for me to realise I was somewhat misplaced in the Physiotherapy Department of the hospital I was at.  It took me from being told I would need a knee replacement “at some point” in June 2016, to me realising that point was just four months down the line! (This point being when being told you will need something becomes desperately wanting it more than anything else in the world!)  Things got worse, as they had been getting steadily worse before, and no amount of exercise was going to change that basic trend!  So though I started my Physiotherapy treatment thinking that exercises might possibly offer some sufficient improvement in my right knee joint,  in the process of having the treatment, I realised this was not the case.

I have digressed!  The relevance, in this story, is  I recognised myself that I needed a more holistic approach to the state of my health and well being.  Full stop. I felt that I wasn’t in the centre of my treatment because my change of mind and change of direction did not fit into that particular context very well, and I was not being heard or understood sufficiently.  Going to see an Osteopath was me looking for a different way to be treated, not in an attempt to delay or avoid surgery in some way, but simply to find something of physical benefit which could embrace my change of  direction, and also be beneficial in respect of preparation for surgery. I  felt my knee was affecting the whole of my body in the way that I moved, and I wasn’t happy to allow it to go untreated.  I wasn’t interested in managing the symptoms alone. I wanted my body to have some chance of moving more effectively, and in listening to my body, I felt I was simply punishing my knee, and my self, by persisting in exercises which basically were not yielding any functional improvement.

So what happened when I went to visit an Osteopath?  Things had deteriorated with my knee at such a pace which did have the overall effect of making me willing to try anything, even if I had not thought about it before.   So I was ready for anything potentially beneficial at all.  I do confess to having dismissed osteopathic treatment, thinking it was probably something not REALLY worthwhile. However, I am pleased to say that the session of osteopathic treatment I had WAS beneficial.   Someone who knows how to pull and push your limb around, and manipulate the soft tissues in theory should be helpful, and it was with this in mind that I went along.   I can now straighten my right leg more than before…  I felt the difference last night lying in bed, and was suitably impressed.  I also noticed some change in how the leg felt when I was swimming this morning.  It does feel more comfortable somehow. It feels straighter.  I did not ask about the details of what she was doing/had done because I did not want to involve my brain and my thinking, or my belief process in the treatment but I just wanted to simply have the limb manipulated and see what happened.

Bearing in mind that I have been working on my right leg for months, and have done what I am able to attempt to increase how straight it can be, including stretching it in the sauna, , plus yoga stretching and standing, and various other activities (with straight leg pressing the back of back of  knee into bed,etc) I am suitably impressed.   The fixed flexion deformity was only slight when noted last year, but all the same,  as far as I understand, it is not a good thing for the knee joint not be able to straighten well, as this I think puts more load on the patella. I must affect the way I walk significantly…It certainly feels like it does!  From my perspective though, it was simply rather impressive and encouraging that it is possible to manipulate the limb in this way and I wasn’t expecting anything at all. Simply curious and interested.  So it was a positive experience and I plan to come back when I have got the “all clear” after the knee replacement operation, and offer up my leg for some manual treatment.  I do confess to being very keen to ensure that I make the best possible recovery, and that I make the most of my rehabilitation process and get a good outcome from the operation.

As said, I had not considered going to see an osteopath.  But, as I massaged my knee, for pain relief mainly, I felt not only that there had been nothing practically done in the area of physical manipulation, which I was surprised about, (because of the importance of all the surrounding structures), but also that my experience with my knee was effectively a whole body experience. The osteoarthritis, while the right knee has taken centre stage, is part of what is happening for me all round.   The knee joint itself is one part of that.  The best way for me to tell you the outcome is by posting some extracts from the feedback letter I posted…As I have already written it!

“I just wanted to say how pleased I feel after deciding to come along and see what an osteopathic approach might offer me and to see if I found it beneficial.

I had no particular expectations with respect to any treatment, but my own instincts from massaging my own knee and to thinking about the body in general (in relation to art, in fact…as a mechanism which needs balance in order to create harmony) and also my experience of doing Scarivelli inspired yoga over the last year prompted me to come along. I have walked past the other BSO building many times and had never thought about osteopathic treatment up until then.

While I have certainly appreciated the Physiotherapy I received at hospital, I was surprised and disappointed with respect to the absence of any physical manipulation. This just seemed logical to me. I ended up feeling that my knee was not actually being treated. While all the exercises, (which I have been doing for rather a long time) have improved my leg, it was important to me that when I have the bones of the knee treated surgically that I had an optimal state of leg!

After my treatment my leg felt fine, but I wasn’t expecting anything much to be different. However, I am pleased to say that my leg does feel more aligned…and more like the left one. I had noticed that their was something a bit different about the right one in terms of alignment but couldn’t quite put my finger on it… it was to do with the way it moved. I also am pleased to say that indeed, something has been released at the back and I can more comfortably straighten it.

It is a much better feeling to do the necessary exercises having had the structure of the leg adjusted. I have noticed that when I do my sit to stands there is less shaking in the quads…They are still shaking a bit of course, because weakened, but there is certainly less shaking. When I am swimming, it feels I am swimming more efficiently. I was getting a lot of “out of joint” ness (cannot think of a way to put it) when swimming “doggie paddle” which stopped me doing that style, and had just been sticking to the crawl, but so far I can now doggie paddle too.

I am most pleased about the way it can now lay straighter though. It might seem a small thing but it really bothered me, because I felt this cannot be helpful for the knee, and though my walking is much better than it was last June…All in all, when I do my exercises the whole leg feels stronger and more efficient, and this is a really great experience for me, in the respect that I can now go and have my surgery knowing that things are as good as they can get in the other structures of my leg. I realise that the surgeon will upset things with the surgery, hopefully as little as possible…and that I will need to start all over with the rehab. But it makes sense for things to be as nicely in place as they can at the start and certainly the way the exercising is more effective is very encouraging. It worried me that even some of the simple post op exercises where so difficult for me pre-op, (ie lying down with left leg bent, then doing a low straight leg lift with the right, involved an awful lot of trembling!) and now they are easier, I feel more confident about my body’s ability to work through the whole experience successfully.”

Some general information gleaned on Osteopathy:

Osteopathy is a system of diagnosis and treatment for a wide range of medical conditions. It works with the structure and function of the body, and is based on the principle that the well-being of an individual depends on the skeleton, muscles, ligaments and connective tissues functioning smoothly together.

To an osteopath, for your body to work well, its structure must also work well. So osteopaths work to restore your body to a state of balance, where possible without the use of drugs or surgery. Osteopaths use touch, physical manipulation, stretching and massage to increase the mobility of joints, to relieve muscle tension, to enhance the blood and nerve supply to tissues, and to help your body’s own healing mechanisms. They may also provide advice on posture and exercise to aid recovery, promote health and prevent symptoms recurring.

The above is quoted from http://www.osteopathy.org.uk/visiting-an-osteopath/about-osteopathy/

and, a small extract quoted from

 OSTEOPATHIC PRINCIPLES AND PHILOSOPHY
by
Raymond J. Hruby, DO, MS, FAAO
Copyright 2000, 2007, 2014 by
Raymond J. Hruby, DO, MS, FAAO

We can define osteopathic medicine as a complete system of medical care with a
philosophy that combines the needs of the patient with the current practice of medicine,
surgery, and obstetrics; that emphasizes the interrelationship between structure and
function; and that has an appreciation of the body’s ability to heal itself. Based on this
definition, osteopathic medicine defines a distinctive set of tenets which osteopathic
physicians use to formulate their approach to patient care.5
These tenets are:
 A person is the product of dynamic interaction between body, mind, and
spirit
 An inherent property of this dynamic interaction is the capacity of the
individual for the maintenance of health and recovery from disease
 Many forces, both intrinsic and extrinsic to the person, can challenge this
inherent capacity and contribute to the onset of illness
 The musculoskeletal system significantly influences the individual’s
ability to restore this inherent capacity and therefore to resist disease
processes
From these tenets the osteopathic physician derives certain principles for patient care.
These principles state that 1) the patient is the focus for healthcare; 2) the patient has the
primary responsibility for his or her health; and 3) an effective treatment program for
patient care is founded on the above-mentioned tenets.
Thus the osteopathic physician uses a health-oriented and patient-centered
philosophy to implement the principles of osteopathic medicine in the care of the patient.
The osteopathic physician’s goals are to:
 Seek out and address the root cause(s) of disease using available evidence-based
approaches
 Optimize the patient’s self-regulating and self-healing capacities
 Provide an individualized patient management plan that includes emphasis on
health promotion and disease prevention
7
 Include palpatory diagnosis and osteopathic manipulative treatment to address the
somatic component of disease the extent that it influences the well-being of the patient.”

…………………………………………………………..

cutting edge knee replacement design © Jenny Meehan DACS All Rights Reserved

cutting edge knee replacement design © Jenny Meehan DACS All Rights Reserved

In your reading of my patient journey into knee replacement and out again blog please bear this in mind:

As with all my ideas and thoughts, bear in mind that I am an artist and creative, and NOT medically or professionally qualified in any of the things I write. I am writing because I love writing (without reservation!), loved having a knee replacement, and wanted to share my experience in case it gave other people ideas, questions, and thoughts which they might like to explore. Check everything you do out with the relevant professionals. DON’T take it from me. Just read away here and there, if it interests you. Then do your own research and seek your own advice. Also… Please don’t contact me asking for medical advice! To put it politely: You’re not getting it here!  Consult the professionals! 

This writing project “The Very Patient Knee Replacement Story” is part of my creative practice, albeit rather an unusual strand of it!  I usually put my energies into painting lyrical, abstract, romantic and expressionistic paintings but as my standing and walking ability is rather restricted, I have turned my hand to this.  Hopefully soon I will be able to return to more standing, more painting, more teaching, more walking, networking, and  generally getting myself and my work out there in the world a bit more effectively.

My usual blog page: Jenny Meehan  Contemporary Artist’s Journal: The Artist’s Meandering Discourses -Poetry – Painting – Spirituality”https://jennymeehan.wordpress.com/ continues to be written on a monthly basis.  My website jamartlondon.com displays examples of my paintings.  http://www.jamartlondon.com/ and you can purchase some of my imagery on the print on demand website Redbubble.com which helps me in a small way by providing me with a royalty percentage on anything you buy.https://www.redbubble.com/shop/jenny+meehan+prints?cat_context=u-prints&page=1&accordion=department

The link below leads you to my profile page, while the link above leads you to the page displaying my prints available at Redbubble.

http://www.redbubble.com/people/jennyjimjams?ref=artist_title_name&asc=u&SSAID=314743&utm_source=shareasale&utm_medium=affiliates&utm_campaign=banner

 

 

 

 

No Problem/Moving On abstract art print by Jenny Meehan jamartlondon.com bright bold motivational art for physiotherapy experience personal mobility challenges, jenny meehan,

No Problem/Moving On sign of the times series jenny meehan © Jenny Meehan DACS All Rights Reserved

 

No Problem/Moving On – Geometric Colour Abstract Print by Jenny Meehan jamartlondon.com

One of the “Signs of the Times Series” by Jenny Meehan

This artwork design conveys a positive attitude, and is the fruit of my interest in positive psychology and personal mobility challenges. A “can do” attitude in the face of resistance and difficulties is the only way to move forward. The design has something of my own experience of exercising in a gym with motion suggested through various formal elements, of varying speeds and a sense of progression.

Do you like this print?  You can buy it easily and safely through Redbubble.com, just follow the link:

https://www.redbubble.com/people/jennyjimjams/works/20507601-no-problem-moving-on-geometric-colour-abstract-print-by-jenny-meehan-jamartlondon-com?asc=u

For a shorter version of “The Very Patient Knee Replacement Story by Jenny Meehan” follow this link: https://jennymeehan.wordpress.com/abridged-version-of-the-very-patient-knee-replacement-story-by-jenny-meehan/

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