Thursday, October 20, 2011

An Answer for Stephanie and Everyone

When to "Do" the Knees

I hurt my right knee when I was about 14 and my left knee some 40 years later.  I did not know until I hurt the left knee that my ACL was blown in the right knee.  That fact made my doctor and I decide I could cope with no ACL in my left knee as well since my right knee had been pretty functional for all those years.

So, I ended up having arthroscopic surgery on both knees within the last 10 years and various alternative treatments--prolotherapy and PRP (platelet rich plasma injections) that allowed me to continue on at a pretty good functional level.

My knees ached and there were many things I could not do. Climbing stairs could be hard on a bad day, and walking long distances was not always comfortable. I could not do anything that required movements similar to running or jumping, but I could ride my horses. I might be sore afterwards, but I was able to ride and train three horses in dressage, managing to train two of them to the FEI level.

But last year, a PRP treatment had minimal effect, and I was finding myself riding less and less.  Finally, this Spring, I took a short trail ride and the next day, I could hardly walk. My knees hurt and I was miserable.

THAT was my benchmark moment. I had long ago decided that when I could no longer ride, it would be time to consider knee replacements. I am now 62, so my age suits the profile as well. Generally knee replacements do have a lifespan themselves and it's better to wait until you are a little older to have one in hopes you will not have to repeat the surgery in the future. (I may be on the borderline there....)  However, I would not discourage anyone younger as long as they had reached the moment in their lives when coping with the pain, discomfort, and general disability of bad knees was no longer tolerable.

I had already evaluated the situation and knew what was going to trigger my decision. So, looking back and saying, "Gee, I should have done this sooner," as many people do, is not part of my thinking. Once my knees are 100% better--still in recovery phase--I may think that, but I honestly will have no regrets about waiting. My surgical decision was planned out well in advance and, as I noted, I did have treatment options that were keeping me relatively sound despite everything.

All that being said, my surgeon told me my knees were "really bad," which does add to the equation. Perhaps I am more tolerant of pain or better able to cope with physical problems and limits than other people.

As you all know, I also spent the summer swimming nearly every day, building up my cardio system and body fitness in preparation for the surgery.  Since I could not do much in the way of good leg exercises on land, being in the water allowed me to use my leg muscles to build them up as well.  Swimming also helped build my upper body strength, which was also a plus in my recovery, as I was easily able to push or lift myself with my hands and arms to get out of chairs or use walking assist devices.

I will not tell anyone that my recovery was pain free. The surgical incisions cut through muscles as well as skin and the new joints are inserted into my bones.  For the first couple weeks, my thigh muscles ached and burned in various places and with varied intensity.  Again, I may be more tolerant then some people are regarding pain.  Pain meds in the hospital certainly helped but they did not make me pain free.  My level rarely went below a 4-5 on my pain scale.  However, to be honest, most of the time, it was no worse than the aches and pains I suffered in my old knees after a day of too much exercise.

I was determined to have a fast recovery.  According to all the professional around me, I have.  I spent four days in the hospital immediately after surgery--the standard for two knees--and then less than a week in the rehab center.  In rehab, I only had four days of physical therapy before they decided I was well able to cope at home on my own.

The key? I was fit before the surgery. I already had learned skills to "coddle" my bad knees, so sore new ones were not a problem. And, above all, I kept a positive, cheerful attitude about the whole thing. So many people in rehab were depressed and obvious about their pain. I found that laughing and trying to lighten everyone's spirits was some of the best medicine I could take--and offer.

If you need replacement surgery yourself, here's my advice:  First, set some kind of benchmark for yourself so you will know when it's truly time. Second, DO NOT wait until you can't walk or function anymore. That will only make recovery much harder. Third, research to find the right doctor. I ended up with only two consultations but was so blown away with the attitude and approach of the surgeon I selected that there was no question in my mind at all. Fourth, prepare yourself. Get your body into as good shape as possible. Eat right and exercise as well as you can within your limits. Do not neglect cardio vascular fitness either as heart and lungs are an important part of a good recovery. And do upper body exercise to build strength there. Fifth, plan ahead as much as possible for your hospital time so you will not be worried about what is going on at home with family and pets while you are gone. You will need to be selfish while you are recovering and totally consumed with yourself and not other problems. Sixth, learn all you can about your own care, medications, etc. so that while you are in the hospital, you can watch out for yourself. If you have a close family member who will be your care advocate, that's great, but if not, you will need to be ready to speak out on your own behalf if there are any issues regarding your care or treatment. Seventh, keep a positive attitude. The whole idea of replacement surgery is to make your life better. The road to recovery may have a lot of potholes and rough spots, but the end is well worth the struggle. Keep that in mind and learn to smile through the difficulties.

Yesterday, as I was walking in from the barn, for about five strides, all the stiffness in my knees vanished and I felt what it's going to be like an a few more months when I am further along in my recovery. All I can say is "Wow! That's what good knees feel like!!"  It was more than enough to put a brand new smile on my face.


  1. Anonymous11:24 AM

    People who are fit do much better with any type of surgery and recovery, and that has to be even more true of knee surgery. Glad the recovery is going along well.

  2. Great post on detailing what to expect and how to know when it's time.

    Glad you're recovering so quickly. I do think a positive attitude really helps too.

  3. I didn't realize that all your swimming this summer had a particular goal--kudos to you for taking such excellent care of yourself. I'm hoping for the best in your recovery!

  4. Very good advice. I agree that staying fit is the secret to a quick recovery. I think it's also the secret to staying young. You were doing more at 62 with two bad knees than most people half your age and sound!

    I'm trying to put off my inevitable surgeries for as long as possible, for the same reasons you stated. My benchmark is the same, too. When non-surgical therapies don't help anymore, and I can't ride anymore, then I'll go for broke.

    Your quick recovery and good results give me hope, though. You're truly an inspiration!

  5. You took a lot of time to think about and write this blog. It's good advice for all of us should we find ourselves in a similar situation. I love the finish - five pain free steps as an indicator of the future.

  6. Yes you are truly an inpsiration fro your determination, and your self-control. not once did you think to give up the responsability of your health to somebody else. And when that horrid Doctor gave you a mean diagnostic you changed him. It shows so much respect for yourself.

    I wish I understood it younger. It took me a while to understand that my health was my sole responsability. I f you did not care and respected myself, nobody would.

    You must have greatly influenced your students!

  7. Thank you!! Such a great post. I agree with it all. I guess my biggest challenge is coming up with my own benchmark. I am so glad that your recovery is going well. :)

  8. And being young helps, too.
    After I had my own ACL replacement surgery I met a young man of about 18 yrs old at the grocery store who had just had the same surgery I'd had 3 months prior, the injury caused by playing football.
    While I was still wearing a brace and not able to put too much force on knee or walk too quickly for fear of it giving out, this young man was already planning to play football again when it started up again in another month. He was already running and working out and was all healed up!

    Anyway, after reading this post, I finally understand where you are coming from when I'd only read your most recent post, after re-injuring your knee.
    I actually considered not having the ACL replacement surgery but the pain was too intense and even after 2 weeks, I wasn't even able to walk without crutches, so it was time.
    I hope I never need a knee replacement, though, but my knees are always creaking and making strange noises, especially when I'm walking up and down the 2 flights of stairs to my bedroom. Thankfully I don't have any pain while riding or just walking and hiking, though. I turned 45 yrs old a few months ago, so time will tell I suppose.