Tuesday, March 26, 2013

Keeping on the Move, Thanks to Physical Therapy

As the number of days to total knee replacement dwindle and my nervousness builds, I turn more and more to the instructions my orthopedic surgeon and his assistants provided me. Today, I began to comprehend just how huge a role physical therapy plays in the success of this operation.

My instructions are that in order to restore movement in my knee and leg, I will use a device called a Continuous Passive Motion (CPM) machine, which will (1) slowly move my knee while I am still in bed, (2) help decrease swelling by elevating my leg, and (3) improve my venous circulation by moving the muscles in my leg.

I am to begin using the CPM while in the hospital and will be discharged with "similar equipment" to be used at home. The next line I have read and re-read many times:

"It's important that you use this machine at least 6 hours a day."

Wow, 6 hours daily -- and that's "at least." Furthermore, that passive motion is just the start of the necessary PT. The instructions say that "regular foot and ankle movement is also encouraged immediately following surgery to help prevent leg swelling and blood clots." And in case there were any doubt....

"Physical Therapy (PT) is an integral part of recovery after total knee replacement surgery.

"You will have in-patient PT during your hospital stay followed by approximately 2 months of outpatient PT.  {Emphasis added.}

"The physical therapist will teach you specific exercises to strengthen your leg and restore knee movement to allow walking and other activities, by assisting you either at home or in a therapy center."

Wow, again. Two months. That's a lot of PT.

As I contemplated all this, I start thinking back to the beginning of my senior years (early 60s) when I moved to the Washington, D.C. area to fulfill a lifelong dream of being a writer in the nation's capital.

A few years in, I started experiencing severe pain in standing and walking from the Metro stop to my office. After walking just a block, I would have to sit down until the pain subsided. The diagnosis with the aid of a MRI was a moderate level of spinal stenosis, a narrowing of the spinal canal in the lumbar region. There was some talk of surgery.

 Fortunately, my doctor recommended that I first try physical therapy. That proved to be a Godsend. With aqua therapy and then gym work, my therapist Michele taught me to do the stretching and other exercising, with the result that I got in better shape and the severity of my stenosis lessened considerably. I still have occasional stenosis pain but I am better able to deal with it.

Soon after completing the back PT, my cardiologist popped the news that I would need open-heart surgery to replace a leaky aortic valve and an enlarged aortic root. Long story short, that operation was successful, and I went into 36 rounds of another kind of PT -- cardiac rehab. That, too, was an enormously productive experience for me. I shed some weight, got back in an exercise routine, and (maybe most important of all) had fun. Depression is a common affliction after heart surgery, and the camaraderie of patients and nurses helped stave it off.

In semi-retirement in western Virginia and then South Carolina, I had some additional PT for knee and back, but though each was helpful, the growing dysfunction of my cartilage-free left knee greatly limited what I and my therapists could accomplish. I was advised years ago that the day would come that I would need a replacement.

So now that I contemplate my next PT challenge -- probably the greatest yet -- I am realizing that fighting for continued mobility and quality of life as we age is largely a therapeutic process. And it is not just physical but mental and spiritual -- the whole package. Anything worth doing is worth doing well. And here's to being able to do it with gusto as long as the Good Lord has in mind for us to remain on this Earth.

© Robert G. Holland  2013

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