I felt good enough to lead worship at Redemption Church this morning. This was a big step for me for a number of reasons. First of all, I am lately bored out of my mind, with the same old routine going on most days: lots of ice, elevation, TV, and sitting around. I am normally a busy guy. So now that I have my mental faculties back to normal, not being busy is quite unpleasant. It was good to get back to doing something I love – playing guitar, singing, and leading others in worship.

I have found that I must understand my limitations at this point. I can do something for an hour or two, then my knee begins to feel heavy and swollen, forcing me to elevate and ice, in order to feel comfortable again. I then feel surprisingly exhausted, since I really haven’t done all that much. I figure this is still a remnant of the surgery trauma on my body. My work at church this morning fit within those limitations.

Most of the energy during physical therapy at this stage is devoted to bending my knee in an attempt to develop normal flexion. I was at 111 degrees flexion at the end of last week. I do not know if that is good, bad, or normal. But everyone who worked with me seemed encouraged.

One of the things done at the beginning of a therapy session is work on a stationary bicycle. Initially, you are just warming up the knee and bending it at a level at which you are comfortable, since the amount of motion of the leg is controlled by the foot on the other pedal. During my last session, I had just begun working on the bicycle when a man at least ten years my senior sat down at a nearby bike and began pedaling vigorously. He saw me watching him and asked when I had my surgery. “June 7th,” I answered. “Same here,” he said. I felt a little twinge of jealousy, which was probably good for me, because I felt challenged to push myself a bit. I found that after a couple of minutes of concentration that I was able to pedal all 360 degrees. Progress!

I am at the end of week four. My surgeon stated that I would feel some sense of normalcy after six weeks. So I feel confident about where I am in the process of healing and rehabilitation. I anticipate substantial progress over the next two weeks!

If you’ve ever needed physical therapy, you may have made this same observation. It seems there are a disproportionate number of athletic young women that work as physical therapists. There isn’t anything wrong with that other than it makes the whole experience weirder for a middle aged guy like me.

• 

• 

Physical therapy is a necessary but unpleasant part of the recovery process after TKR. It is every bit as important as the surgery itself. The therapist helps to restore the proper motion of the body part, the knee in my case, and strengthen the muscles necessary to normalize the use the of that limb or other part. Therapists must do some things that, in some cases, can be quite painful in order to accomplish this end. So when one is greeted with, “Hi. My name is Alicia and I am here to torture you.” Smile. Giggle. It is all a little surreal.

Now I am not positive that is exactly what Alicia said. But I know that is what she meant. That first session of therapy is somewhat difficult to accurately recall and evaluate, because my mind was still pretty saturated with opiate painkillers. But this week has been clear because I quit the opiates this past weekend.

My third session was today. The main focus at this point is restoring the degree that my knee can bend. Apparently I am doing pretty well. The surgeon stated that the goal at this point is about a 90 degree bend. Mine has 103 degrees of flexion at this point. But this came at a price. It is sort of a “How much can you physically take” proposition. So Alicia has been taking my leg and bending it, pushing me to the limits of my pain tolerance, which is normally quite high. But that may work to my disadvantage in this case, because what you can take is what is afflicted.

I remember a similar experience when I was rehabbing my ACL reconstruction a decade and a half ago. I had another young female therapist. She bent my leg until I grasped the sides of the table with all my might, while sweating profusely, clenching my teeth, and trying to fight back wailing out in pain. This gal, however, mocked me, describing how well the twelve year old she worked on that morning took the same treatment. I dare not complain lest I lose all sense of my manhood.

Alicia is not so brazenly cruel. She is actually quite pleasant about it all. Though she is very strong and inflicts an amazing amount of pain without relenting. She asks frequently, “How are you doing?” What is different is that she makes me feel kind of guilty about complaining. I am not sure whether she actually cares about how I am doing or if that is strategy to make me think she does while she inflicts pain. To make it worse, Vicki was sitting beside the torture table, er, I mean, therapy table. And I did not want to embarrass myself in front of her.

Maybe the best part of what is happening, in spite of the pain, is that I am improving. My mind is now clear enough to consider it all. Getting off the opiates is important. They do a great job of alleviating pain. But I did not like how they made me feel emotionally and mentally. I am now beginning to sense that I can be productive in spite of my current physical limitations. I can have normal conversations with people. My emotions are under control. These are important advances.

I won’t pretend to know what you’re thinking 
I can’t begin to know what you’re going through 
I won’t deny the pain that you’re feeling 
But I’m gonna try and give a little hope to you 

Just remember what I’ve told you 
There’s so much you’re living for 

There’s a light at the end of this tunnel 
There’s a light at the end of this tunnel 
For you, for you 

After living pretty much the same day over and over again: wake up, take pain meds, put on stupid pressure stockings, ice knee, exercise, ice knee, take pain meds, stare, sleep, stare, take pain meds, sleep, you get the picture; I went to see my surgeon. Granted, Vicki has been taking good care of me, and I have had visits from a physical therapist. But I have been looking forward to this day.

I ended up seeing the surgeon’s assistant, which was okay. She pulled the dressing off of my incision and examined it, and was satisfied with my progress. The incision oozed in a few places, but she stated that it appeared as it should.

I asked a few questions about my progress. I still am in quite a bit of pain and have to take substantial doses of painkillers. She said that since my legs were quite muscular I was experiencing more pain. But that it still was not abnormal. We discussed a plan for reducing the painkillers that seemed reasonable to me. I also asked about popping feelings and sounds coming from my knee. She explained that since my knee still has quite a bit of fluid in it, the part of the prosthetic cemented to the back of my kneecap was likely not riding precisely in the track prepared for it. Besides, since my knee is now metal and plastic, this isn’t uncommon. It made sense the way she described it.

She then gave us the best news of all. No more stupid pressure stockings! Vicki was as happy as me.

I am, then, a few days away from the what should be the end of the most painful time in this process – the first two weeks. Then I will begin the more serious phase of physical therapy.

“Down around the corner, half a mile from here
See them long trains run, and you watch them disappear
Without love, where would you be now . . “

I am happy with my progress, as I begin my second week of recovery. My leg swelling has gradually gone down. Some flexibility is inching its way back into my leg as well. It seems like I have been at this longer than a week, as the specter of pain keeps staring me in the face. And it does not mock me with horrific laughter. It’s more like an evil smirk that infers that it is going to annoy me as long as is possible.

If I didn’t have Vicki loving on me and managing me, I am sure I would be in considerably worse shape. She is terrific about making sure I stay on schedule for medication, making sure I eat, managing the area around me, and putting those stupid hose on my legs. I’ve had some good friends bringing meals over as well.

I very seldom get bored. I just don’t generally allow myself to fall into that state by busying myself with some project, playing the guitar, reading, or some other choice of activities, and there are usually plenty of those. But right now I am bored. I really can’t do much but sit here. The narcotics I am taking make me kind of dopey, which I am sure is somewhat entertaining for Vicki, but I can’t concentrate on anything long enough to read, and TV just seems like mindless drivel or it makes me mad. And I cannot seem to maintain a train of thought long enough to support a decent conversation. So I find myself in unfamiliar territory. I appreciate your prayers for a speedy recovery, a quick transition off of pain meds, and for Vicki that I do not drive her nutty with my neediness.

It’s a beautiful day today. I am sitting out on our patio, soaking in a plethora of wavelengths of electromagnetic radiation from that great golden orb God uses to power this earth. I am hoping to get my body to generate some vitamin D to counter some of the pain killer induced fog gumming up my mental mechanisms. Laying around is definitely not good for me mentally. My intuition tells me I ought to try and start weaning myself off this stuff, but the nurse who visited me today stated that I should be worried if I am not winding down the pain killers when I am three weeks from my surgery. I am six days in. So we shall see.

I really like the physical therapist assigned to my home care. He is a father of seven, which in and of itself leads to some pretty interesting conversation. He is positive and encourages my progress. Since my leg is stiff, swollen, and generally uncooperative, it is no easy task to move it around and regenerate some of the flexibility necessary for normal function. But I am working on it and, according to him, making good progress.

I have been getting around, when necessary, with a walker. I balked at this at first, because I did not desire that geezer-like a persona in front of the kids and my smoking’ hot wife. But any notion of getting out of bed necessitated my rejection of this attitude towards this particular mode of transport. Yesterday, however, brought with it an important advancement along this path of progress toward moving from here to there. My PT directed me to use a cane.

My children’s great grandfather, Lonnie Mattingly Senior, left a stylish bamboo cane in the trunk of the car that was his and eventually belonged to my son, Jordan, and it is this cane that I chose to use instead of a more utilitarian aluminum cane. It adds a bit of style to this humbling task of walking with assistance. And when flourished properly, adds some class to my outfit comprised of pressure stockings and shorts. I also hope that I will absorb some of the toughness and class exhibited by that World War II vet. And so I say to you bum knee, you cane’t stop me now.

This morning brought with it a reduced intensity in the amount of pain I am feeling. Not that the pain has stopped, It’s just the I can feel a difference between today and yesterday. With the change in pain intensity is a slight change in appearance of my leg: a little more color!

• 

• 

• 

I have home health care as a part of the follow up to my surgery. I saw a nurse, a physical therapist, and an occupational therapist. The only one that is really necessary for me is the physical therapist. He gave me few exercises to do that had an immediate positive affect on my leg. He also reassured me of a number of things. The surgeon I chose was an excellent choice. There was nothing unusual about the appearance of my leg or any other aspect of my condition. He also helped me sort out what is normal with regard to pain management.

One of the odd things that is part of this whole process is that there are different hospitals groups that are a part of my treatment team. My surgery was done by a surgeon in the Wellington Orthopedic group. It took place at Anderson Mercy Hospital. And for some reason, my in home aftercare is being managed by St. Elizabeth Home health. The nurse sent by St. Elizabeth informed me that my pain management should come through my primary care physician with whom I need to make an immediate follow up appointment. He is a part of St. Elizabeth Physicians group. I complied, making an appointment, and leaving a question about my pain management for my primary doctor. Later that day, my surgeon’s assistant called to check on me, and told me that they are in charge of my pain management and that the surgeon would call in some additional meds. The physical therapist told me that I did not really need the follow up with my primary care physician either. So I cancelled that and am left wondering why all these other people are involved at all.

I think I would advise someone else going through TKR to ask questions about the aftercare. Who is supposed to be involved? What should I watch out for with regard to people who do not need to be a part of my treatment team, yet who will try to insert themselves into the process.

Apparently one of the worst side affects possible after having TKR is the formation of blood clots. To prevent these little nasties from forming, one is given a pair of really tight socks that are meant to extend from the foot all the way up to the top of the thigh. So imagine having an elastic tube that is too small to allow you to slide your leg into it, only you have to slide your leg into it, and you get the idea. This has been the biggest ordeal for Vicki so far, and she is an absolute angel with regard to her caretaker skills. She has wrestled these things up my tree trunk legs each morning where they must stay until I go to bed for the evening.

Pain management has also been an issue. I normally turn down opiates. But not in this case. I was prescribed oxycodone to be taken every six hours. The problem is that it wears off in about four hours and then it takes about thirty minutes to kick in once taken again. So there are some serious gaps in the whole pain management process that make me a bit grumpy. I am trying to maintain perspective here. I did have my leg sliced open, bone removed, and metal things inserted. So getting off pain free is probably not realistic. But I am not against testing the limitations of acceptable administration of pain relief medicines at this point. I would not want to be around me during that two and half hours of little to no pain management! Hopefully I am not saying mean things to Vicki. And for some reason, I was told by the nurse that visited my house yesterday, that my primary physician should be the one coordinating my pain management. I await a call from him with great anticpation!

It’s the day after surgery. I am trying to write something that makes sense in spite of the Oxycontin induced fog in which my mind floats.

A rough night preceded this morning. There were tests to be run and medication administered. Getting up to go the restroom was a bit of an ordeal. And at some point, during the early AM hours, a large man loudly entered our room, slamming the door, turning the lights on, and demanding my blood. I awakened startled and yelled at him, “Who are you and what do you want?” Turns out he really was there to get blood from me, and after Vicki calmed me down, he adeptly extracted a couple of tubes full from my arm and went on his way. We thought that he must be under great pressure to collect from all the patients on the floor in a short amount to time.

I was greeted a couple of hours later by physical therapists that got me to do some basic things. I lifted my leg, flexed my feet along with a few muscles in my legs, and they were quite pleased. In fact, it ends up that it was a good investment to do hard work outs to strengthen myself for a quick recovery.

Later in the day I was able to walk down the hallway, using a walker for support, and taught how to navigate a flight of steps. Then I was given clearance to go home.

Above all else, you really need to enlist some help, if you are going to do this TKR thing. Vicki has been tremendous, making sure I take my meds at the right time, and that I do what I am supposed to, using all five feet of her stature to keep me in line as is necessary. My daughter, Morgan, son Jordan, and daughter in law Faina also came along side me to help me go home the day after surgery.

The knee prosthetic was put in place early this morning. I had to arrive at the hospital at 5:30 this morning, which has some advantages since I didn’t have to sit around all day and think about it. My hope is that Dr. Lee is a morning person.

As with most happenings in life, when you go through them, you often find others in your circle with that experience. So I have been networking with others on the whole Total Knee Replacement (TKR) process. Vicki and I went to Dairy Crest to get an ice cream cone. While we enjoyed our delightful, cool, chocolate-dipped swirl of ice cream like wonderfulness, a familiar looking guy ambles up, and I recognize him as an old friend, Steve Aerni. Steve began to share his own TKR experience right off the bat: he had both knees done just a couple of years ago, feels like he is 35, went skiing and plays basketball, was in terrible pain for two months but now feels great. I then shared that I was getting mine done the next morning. He asked if I had an ice therapy machine, which I did not, then promptly went home, found his, and brought it to my house. What a blessing!

I experienced the normal pre-surgery stuff: signed a whole lot documents for which I did not know the purpose, was asked approximately 87 times my name, birthdate, and what I was getting done, stripped down so I could wear that obscene, open-back gown. And I was soon doped up and out of it.

I woke up in the recovery area, groggy, muttering nonsense to people, and having only a vague recollection of getting an epidural to allow Dr. Lee to do his cutting and grinding. A pressure wrap covered my leg from ankle to upper thigh along with an immobilizing brace. I don’t even recall being moved to another room, but found myself in a fabulous suite with plenty of space and amenities, characteristic of Mercy Anderson Hospital.

• 

• 

Vicki has been a fabulous helper and Morgan came up to help as well. My pain today was manageable, thanks to Percocet and morphine. I was able to get up, use a walker, and go pee without help, which is apparently a big deal. And I was able to do all my exercises well.

What I think really helped me in the above recovery steps was that I worked out vigorously during the last few weeks. It hurt a lot. But I want to recover quickly and I figured getting myself as strong as I as possible before the surgery would help. We shall see whether or not that is sound advice for others as progress continues on my recovery.