We Need Personalised Numbers!

2,000 calories. 10,000 steps. These numbers float around and almost become related: subconsciously there can be a belief that if we do 10,000 steps a day we’ll be fine eating 2,000 calories a day! Will we?

2,000 calories a day is as much a myth as is the 10,000 steps a day. While there is always the caveat that the 2,000 is an average recommendation for the average person, etc etc, it is the 2,000 number that sticks in people’s minds.

Based on these rather wide, and self-reported, ranges, some pretty loose rounding happened, and the number 2,000 was settled on for a standard. In other words, not only was the calorie standard not derived based on prevalent scientific equations that estimate energy needs based on age, height, weight and physical activity levels, but the levels were not even validated to ensure that the self-reported ranges were actually accurate.

US News
From Samsung Health app

The 10,000 steps originally came from a marketing campaign.

The magic number “10,000” dates back to a marketing campaign conducted shortly before the start of the 1964 Tokyo Olympic Games. A company began selling a pedometer called the Manpo-kei: “man” meaning 10,000, “po” meaning steps and “kei” meaning meter. It was hugely successful and the number seems to have stuck.

BBC .
Garmin Connect app

Readers who know me on social media know I am very big on getting my movement every day. This website originated from my personal dedication to Movement IS Medicine. So am I against pedometers? Not at all, I highly recommend pedometers. Just forget about the 10,000 steps a day.

Let’s look at each of these aspects of our lives separately. First, the calorie conundrum.

2,000 Calories?

My favourite illustration is the car fuel tank versus the human body. My car’s fuel tank capacity is 60 litres. No matter how hard I try, I can’t put more than 60 litres of petrol in that tank. My body? Ohhhh, I can consume as much fuel as I like. I would just keep expanding to store it all!

I have several factors at play:

  • I’m over 65 – age reduces our basal metabolic rate
  • I’m short
  • I have a chronic condition which limits my fuel burn
  • I’m on medications – medications can affect metabolism.

It would take me an hour of weight lifting in the gym on top of my three walks a day and 7,500 total steps to burn slightly over 2,000 calories a day. My usual burn would be 1,800 on a good activity day. On that basis, if I consumed 2,000 calories a day I’d be storing 200 calories a day. A rule of thumb is one kilogram of fat on the body is 7,000 calories, so I’ll let you do the maths on that. Yes, I lift weights and I walk, but not at the intensity required to be building too much lean muscle with that extra 200 calories a day!

In the image above from my Samsung Health app 1,352 calories a day is recommended for me given my age, weight, height and gender. It doesn’t know about my medical conditions or my medications – if it did, it might recommend less! That is 648 calories less that the 2,000 number that gets thrown around with abandon.

My nutritionist recommended 1,400 a day for me, just for comparison.

Everyone is different and we need to tailor our intake for our particular circumstances and output (burn). We also need to be very careful about what we eat as we have less calories to “fit in” the needed nutrients. For example, I aim for 1.5 grams of protein per kilo of body weight per day. The extra protein chews into my calorie allowance.

Those of us with chronic conditions that have a boom/bust aspect do not have the luxury of “burning it off tomorrow” either. We can’t “do extra” or we end up with a flat battery. It is all interwoven.

10,000 Steps?

I aim for 7,500 personally, at this time. A pedometer is a good way of measuring how much we are moving. It is not the number itself that is critical, it is the consistency. Not moving leads to de-conditioning which is not what we want as it has negative impacts on our bodies.

de-conditioning

A pedometer is also useful when it comes to calculating our pacing up. It is an indication of what we have done and therefore helps us calculate what our 10% increase target is. It doesn’t matter if the number is 2,000, 3,000 or 8,000. It is the relatively and consistency that matters.

I talk about steps as part of my movement regime because it is what I and many other people use. There are, of course, also many chronic condition patients who use other movement modalities. The underlying premise remains the same.

Tracking and Recording

I track and record because let’s face it, even healthy people forget they had a muffin at morning tea. Add cognitive impairment on top of that and it is easy to forget what we ate during the day. I’d be hopeless if I didn’t keep track. With only 1,400 calories to play with, I need to make sure I don’t accidentally eat 2,000!

The same with activity/movement. It is easy to think we moved more than we have and over time we find we’ve paced down unintentionally instead of UP. Our pain levels may increase as a result of less movement and more weight. Not what we want at all.

Personalised numbers are needed. Know our BMR, know our limits, work out our personal parameters and targets based on our individual circumstances and bodies: age, gender, height, weight, medications, conditions.

Personal Energy Use

Early in my chronic illness life, I wrote an introductory article, Pacing for Beginners. More recently, I wrote about Pacing THRU, Pacing UP, Pacing DOWN.

Pacing, balancing my life, has become even more critical since starting a full-time job. The earlier articles talk about the spoon theory and the battery analogy. Today I’m going to stick with the battery analogy as we all understand what happens when our mobile phone battery dies. That’s it. The screen is dead. You can’t make a call. The only option you have is to recharge the battery.

I find energy difficult to write about. I can’t quantify it like I can quantify calories or steps or weights. Energy seems elusive, hard to pin down. Even though I am using the battery analogy, I don’t have a charge meter on my arm. I can’t tell how much battery I have left at any given point in time. So if it seems like I’m pondering as I write, it is because I am pondering as I write.

Many of us with chronic conditions are a bit like a mobile phone. The battery has a limited capacity. I’ve written about fatigue/lethargy before too, in When was the Last Time You Yawned? Working full-time hours again, I have had to revisit my condition management plan to ensure I avoid the dreaded Boom/Bust Cycle. So far, I’ve managed, although my weight training has taken a bit of a back step, sadly.

The difference between me and my phone is if my phone goes flat, I can plug it into power, turn it on and make a call. If my battery goes flat, that is it. Coffee is not going to help. A sugar hit is not going to help. In fact, either might make the situation worse. Imagine if that phone battery could actually go negative and had to be charged back up to zero before use, even when connected to power. THAT is how we can be (not how we can feel, how we can BE) if we are not careful, if we break the rules.

While I was working part-time, I had everything worked out beautifully for me. I got the exercise I needed, the sleep I needed, I did my job well. I never let myself get a flat battery.

While I was not working in the early part of 2020 my plan was to pace up my exercise to build physical resilience in readiness for a new job. With the success of my new treatment, I could do this. There were some interruptions! A knee put me in hospital, then Covid-19 lockdowns followed by a total knee replacement meant things were a bit stop-start, but I was way ahead of where I had been at, say, the end of 2016.

Working full-time has changed how I can arrange my time and also shone a light on the fact the boom/bust cycle is still very much a risk. There have been times at the end of the work day where I quite simply feel my brain shut down. It goes from 90 miles an hour to a dead stop. Nothing I can do about it. The battery is dead. It isn’t just about physical activity, this battery also runs our brain.

It is challenging for people who have no prior experience of these sorts of conditions to understand what happens. After all, many of us, myself included, LOOK fine! It took my daughter some time to come to grips with it, but she now asks “Do you have enough spoons, Mum?” when suggesting something.

I’ve become better at declining social invitations – no, not on an evening before a work day, or no, not two events on one day.

Every activity we do uses battery power. Showering, drying our hair, driving, working, exercising, cooking. In my experience some things use more battery power depending on the time of day: driving is a classic example. Driving for one hour in the morning is not nearly as tiring as driving for one hour in the evening after a day at work. It is almost as if once the battery gets low, it depletes faster. We have to be aware of all these things. I don’t want to cause a fatal car accident because I lose concentration because I haven’t paid heed to my battery level. Look at the pace column of my walks in the image above. the first walk of the day is the fastest, the last is the slowest. This is a constant pattern.

Early in my journey, I would have been unable to do a weight training session and grocery shopping on the same day. That would have used way too much of my battery. Even now, I shower in the evenings. Why? Because I can do it at a slower pace in the evenings and I am not using up vital battery life I need for the work day.

A good night’s sleep should recharge us, you say? We wish that were true. In many cases it is true – unless we have drained too much – then we end up in that negative charge scenario. Not good. However, disrupted sleep is often a symptom experienced by those with chronic conditions. Imagine trying to charge your flat phone, but the charger plug keeps falling out of the phone overnight. In the morning your phone battery is still at only 50%. That can be us.

Strength can fluctuate as well. I happily did 32 kilogram chest press sets one day with every intention of increasing next visit. Next visit I struggled with 25 kilograms. Why? No idea. By no idea, I mean no rational “healthy” explanation. Just that day my body said, “No, not today”.

Endurance is linked to our battery too. Some days I can walk two kilometres easily in one walk – other days I have to stick to three separate one kilometre walks. I’ll feel exactly the same at the start of any walk – then sometimes the body just says, “No, not today”. Part of this is linked to my not having the time available at the moment to consistently Pace UP. Between work and weather I have been limited to grabbing my walks in a somewhat patchy manner which breaks all the rules of pacing. Consistency is key. I’m not getting consistency. I suspect similar applies to the weights.

It is very hard to explain to people what this whole energy thing is like. How we constantly have to be aware of how much battery we’ve used. Healthy people would not, for example, think of having a shower as using energy, or should I say using any great amount of energy. I can assure you, many of the chronic illness community will attest to having to rest after a shower.

In my last article I raved, quite rightly, about the medication I am on. I also stated it hadn’t completely solved the energy/lethargy/fatigue aspect, or the “brain fog”. Despite my writing about energy today, these aspects are still much improved from where I was three years ago. To give some sense of measurement, three years ago I was working 24 hours a week and Saturday morning would always be a recovery morning – I’d do nothing until at least noon. Now I am working 38 or more hours a week and I’m actively doing something by 10 am on Saturdays. I might be at the gym, grocery shopping, doing laundry: I’m active. So a major improvement. And some quantification, which makes me happy!

However, I’ve had to cut my second weight session a week because the energy required to drive to the gym, do weights, drive back and then shower is more than I can manage at the end of a work day. I rarely write any more because usually by the end of the work day my brain has said, “No, not today”. I started this article on December 31, it is now January 16 and I still feel this is very scrappy writing. On the other hand it is a very scrappy topic: as I said I can’t quantify it very well. My thoughts about it come and go: after all, we learn, over time, to live with it. It becomes our new normal. At the same time we recognise that our healthy friends, family and co-workers can be baffled by something they have no experience of and it is not visible.

When I wake up in the morning, assuming I haven’t overdone it the day before, I feel perfectly “normal” just as I did before I became a chronic condition patient. The main difference is at the end of the day I will NOT feel as I did at the end of a day back then. Furthermore, depending how much “charge” I use during the day, I could hit that flat battery state earlier in the day. Other patients will not be as fortunate as I am, I am aware of that. So readers, just because I say I can do something, DO NOT, please do not, assume your mother, father, sibling, friend or co-worker can. They may be “better” or “worse” that I. I am simply n=1 – I’m not a study, I’m just one example trying to explain what it can be like!

As I write, at the beginning of 2021, I am very concerned for the long haul Covid-19 patients, many of whom cite fatigue as an ongoing issue. While the studies of this phenomenon may shed scientific light on ME/CFS, we will also have more chronic patients. My thoughts on society and chronic conditions are expressed in Society and Chronic Health Conditions. As communities, we have challenges ahead.

18 Months In – Thank You Science!

My clinical trial rocks! No other way to describe it! If you are unfamiliar with the backstory, there is a series of articles, the first of which is A Clinical Trial – Patient Journey – Part I, exploring how I came to be on a clinical trial and the initial phases. In summary, I am on a clinical drug trial for a medication for psoriatic arthritis (PsA), a condition that affects an estimated 24 in 10,000 people (0.24% of the population).

I am now 18 months down the track, so thought it time for an update on progress!

No sore entheses! This is fantastic. The enthesis is the connective tissue between tendons/ligaments and bone. PsA rather likes entheses, unfortunately.

At my last injections I had ONE, let me say that again ONE, toe joint that glowed faintly when all the toe joints were tested. That’s a major improvement from 20!

No sore finger/thumb joints. Not one. The base of my thumbs used to be really painful. I am also no longer splinting my fingers at night on a daily basis to prevent waking up with my hands locked into fists. I find I may have to splint them about a week out from my next injections, but not always.

Left and right index finger splints

My shoulders are fine. Admittedly I do a series of exercises to maintain my shoulders which have helped considerably, but the reduced inflammation is fantastic.

My wrists, which would flare regularly, have not flared for months. I can’t remember the last time.

There has been no progression to other joints. There was no hip or elbow involvement, for example, and there still is no hip or elbow involvement.

My skin in 100% clear. Yes, 100%, clinically assessed.

My finger nails are back to being perfect, although two toe nails persist in having white spots and and the tell-tale ridges across the nails. But they no longer crumble off.

No dactylitis (sausage fingers/toes) this year.

I have lost the 20 kilograms I’d gained with all the various medication changes prior to starting the trial.

Energy levels are much improved. I won’t say back to normal, but much better than previously. This is evidenced by the that fact I am back working full-time. No, I did not take on a senior management role, that would have been too much, but I’m working.

The dreaded brain fog is also much improved, as I have noted before. I don’t like the term brain fog, as readers may already know, but everyone is familiar with the term.

No adverse side effects! After my previous experiences, this is yet another fantastic aspect for me personally.

At my latest appointment, one of the staff commented, correctly, I was lucky I don’t have any joint deformities, especially of the hands. I put this down to early medical intervention – I was lucky to be diagnosed early in my journey.

I’m not cured. I am as close to being cured as I probably ever will be and that is a great thing. The medication, risankizumab, isn’t the only weapon in this war though. I am, as is well known, I firm advocate of Movement is Medicine. I keep my muscles strong. I still wear my “special” shoes to help my back. I had a total knee replacement this year, osteoarthritis – not something risankizumab can fix. Overall, I am very happy with progress.

Are You Moving Less While Working From Home?

Working from home is with many of us, perhaps for longer that we may have initially envisaged. It is very important for all of us, but most especially those with arthritic and other chronic conditions where movement is beneficial, to ensure we don’t fall into the trap of becoming more sedentary! Most of us working from home are sedentary enough already, bound to our desks and laptops as we tend to be.

The good aspect is we now have the opportunity to put the commuting time to better use – we just have to make sure that IS what we do!

I am now balancing being back in an accounting role with my medical need to keep movement levels up plus the continuation of post-surgery knee rehabilitation exercises. What have I learnt already? I let my rehab exercises slip a couple of days, I ate at my desk twice and one morning I sat for WAY too long without getting up! Not good. For some inexplicable reason I found myself drinking more coffee and less water, so I’m being more aware of that now.

My daily physical activity commitments currently are:

  • 40 to 45 minutes of formal walking
  • achieve a total of 7,500 steps a day (limited due to post-surgery)
  • 40 minutes of rehab exercises

Swimming and weight training aren’t in the list as the gyms and pools are still closed in Melbourne due to Covid-19.

There is the need to avoid that dreaded boom/bust cycle and pace all of the above accordingly with working hours. These are not necessarily considerations for people without underlying health conditions: even so, worth bearing in mind!

Although the rehab routine is not tiring, the walking can be; especially if one has worked all day. Fatigue IS a symptom many of us live with. Mine is now minimal (thank you risankizumab), but I remember the days when I suffered quite badly from the fatigue. So rest time is important, it has to be part of the routine we establish.

I’m still at the stage of developing a daily routine. Finding what works for me. For a WFH day, I eat breakfast, walk for 25 minutes, then get ready for work (do my hair, pop on the lippy etc – all those video meetings!). Watch out for those back-to-back meeting days! The sitting time can easily extend to three hours. If you don’t have a sit/stand desk (mine is arriving soon!) this can be a trap. Watch your calendar: suggest different times for meetings if you have too many one after the other. Remember to take regular breaks from your desk.

Make sure to take a lunch break. This is important: move your body, stretch, sit in a different chair, break the mental exertion too. Do not eat at your desk.

I’m still working out the best time to do my rehab routine. If I do it in the morning, I need to get up earlier. If I do it after work, I’m becoming fatigued and I still have another 15 to 20 minutes walking to do. I’m thinking lunchtime might actually work best and will try that this coming week. The second walk is important because the one thing we lose while WFH is incidental exercise. No campus to walk around, no walking to and from the car park or tram stop. Those activities all add to our step count for the day. But we do have that extra time from the commute we no longer do, as mentioned earlier. It is finding the right balance.

Catching up on activity on the weekend is usually not an option for those with chronic conditions. Catching up just initiates a boom/bust event and none of us need that. So consistency is our friend. It is finding the right routine for each individual that is critical. What works, what doesn’t work?

Consistency is our friend

Weather can also throw all our plans completely out the window. I walk in the rain and in the cold – I can’t manage the heat. The heat intolerance that came with the hyperactive thyroid does seem to be finally abating: I found it much less troublesome last summer. I hope that persists! For others, the cold could be an issue. Weather is not related to WFH specifically, but working does mean we have less flexibility to juggle our physical activities around the weather.

Walking in the Rain

On days I physically go into the office (few and far between) I know I will get more incidental steps walking around the campus, to and from the car park, etc, therefore I don’t worry about a second formal walk on those days as long as I hit the 7,500 step count.

It is important to keep moving, get outdoors (mask up!) and not become glued to our desk and laptop. And on that note, I am now going to move, because it is Saturday and writing this is enough sitting for today!

An Announcement

I have made the decision to no longer offer personal training services. I will still write and share chronic condition experience, research and information. I am available to participate in applicable research projects and very open to speaking engagements.

I’ve made this decision slowly over the last 12 months. The primary factor that drove my decision was my responsibility to clients. Personal trainers are required to maintain current first aid and CPR certifications. The last time I did my CPR certification I struggled maintaining the position required due to my knees and my back. Now I’ve had a total knee replacement kneeling is challenging (not impossible, just challenging).

I don’t want to paint a bad picture – my operated knee is fantastic and my back rarely bothers me except for certain positions, giving CPR being one of them. I am well aware that were I struggling to maintain a CPR rhythm due to my physical limitations, that could be disastrous.

In addition, recently I have found my physical strength is not what it used to be. Partly this is due to the limited strength training I have been doing myself, partly it is due to the simple fact I’m not getting any younger. I find loading a 20 kilogram weight onto the leg press a challenge and as a working personal trainer I should be able to do that for clients.

While I am a firm advocate of Movement is Medicine and exercise has done absolute wonders for me and my condition, I don’t feel I am strong enough myself to provide the level of service to which I aspire!

It is spring, the blossoms are out, time for new opportunities!

Keep MOVING! I will be!

Thirteen Weeks! (Knee Arthroplasty)

It seems like months ago, yet really it is no time at all! Thirteen weeks have flown by.

I kept up the rehab exercises every single day for twelve weeks. With the approval of my surgeon, I have now dropped to every second day but I have increased my walking. I was aiming for my first four kilometre walk today, but missed it by 120 metres – slight miscalculation on my part! It is important to keep up mobility work on your knee, so I do.

With the encouragement of my trusty physiotherapist, I’ve even managed to do single leg glute bridges. I was doing 30 glute bridges a day, now I’m doing 30 every second day. Unless I get super bored by Covid-19 lockdown and then I might still do sequential days.

What can I say? I. LOVE. MY. NEW. KNEE.

I think at thirteen weeks it is safe to say that! I’ve even knelt on it – not too often and not for too long as yes, kneeling on it does feel very odd. I don’t think I’d be out kneeling for long periods weeding a flower garden, for example. Plus the risk of kneeling on something sharp and not feeling it is always a possibility – to be avoided at all costs.

I can now walk down stairs normally, rather than the bringing the two feet together on one step method employed initially. My flexion was last measured (about week 10) at 145 degrees: I was very happy about that!

My right (the still natural knee) decided to be nasty almost a month ago. My physiotherapist said in her experience this is not unusual and should settle with some love and care. It seems to be settling down this week, possibly a load issue due to the operated knee not doing its fair share for a few weeks.

The only remaining issue I had at 12 weeks was a bit of pain around the kneecap getting on and off the toilet. However, even that seems to have resolved. I had adjusted one of the rehab exercises to strengthen the muscles used in that action and it seems to have worked. Plus the glute bridges, of course!

I recognise I’ve had a very successful knee operation. My surgeon is great, my physiotherapist is great and yes, I was dedicated to doing my rehab consistently and effectively. Between us we got a great result.

A word about rehab exercises. I used the word effectively in the paragraph above. From my experience, that is critical. It can be tempting to “back off” if an exercise causes a little discomfort (most don’t). Especially I found the stretches can really feel as if you are stretching! I’m not suggesting suffering pain, but at the same time don’t back off at the first twinge of discomfort either. Check with your physiotherapist if you are unsure.

One of the extra exercises my physio gave me was to lie prone (face-down) across the bed with a weight on my ankle and let my leg be stretched that way. Let me tell you, trying to take a photo of yourself lying face-down in this position is not easy, so I’ve drawn a little stick figure to give you the idea. CHECK WITH YOUR PHYSIO FIRST before trying this at home. Everyone is different!

I’m using this exercise to illustrate the discomfort factor. I started with one kilogram for 30 seconds. I can now do two kilograms for over a minute. Yes, it does hurt a bit this one. Not the actual knee, but the muscles. In my specific case we have been working on getting those muscles working properly again. I persevered. No, I didn’t let myself get into a really painful place (a martyr I am not), but I didn’t stop as soon as I felt a twinge either. The physio did warn me it would hurt a bit. The benefit is I have 145 degrees of flexion!!

We are all different, we all have different pain tolerances. Even so, we should feel as if our exercises are doing something.

The flip side of that coin, of course, is not to go to the other extreme and overdo things. When I was leaving rehab, I asked the physio how far was I allowed to walk, one kilometre, two? She looked at me and in a stern voice said, “I was thinking the end of the street”. One of her colleagues, who had worked with me on some days I was there, piped up from the other side of the rehab gym, “Just make sure she doesn’t live on Dandenong Road!” For those with no knowledge of Melbourne, Dandenong Road is very long, a major arterial road. I got the message.

I was splitting my walks, one in the morning, one in the afternoon. However with Melbourne in lockdown, where we are only allowed to leave the house once a day for exercise, I’m increasing the single walk.

I miss the gym, swimming and hydrotherapy pool. I was hoping to be back on the leg press by now! All in good time.

Oh, did I mention? I. LOVE. MY. NEW. KNEE. 

Previous:

My Total Knee Replacement
Home: Now the Willpower Kicks In

The Gods Brought to Their Knees by the Invisible

Humans are Earth’s chronic condition. We destroy at will. We see our species as the pre-eminent beings on the planet. Although many believe in a God or Gods in the heavens, here on Earth the human species is all-powerful.

This year the God-like species has been brought to its knees by something it cannot see. A tiny, minuscule, virus. So insignificant, it is not considered to be living. Yet this unalive molecule coated in protein has shut businesses, grounded air traffic, overloaded the health systems of several cities and killed nearly 700,000 people (at the time of writing). We wear masks, socially distance and in Melbourne we are now under a curfew. Many work from home, many are not working at all. The human worship of the great God Economy has been called into question most dramatically by the state of our aged care homes.

Despite great advances in science and technology, humans are losing the battle. The front-line defence, healthcare workers, are dying.

Some leaders are performing brilliantly trying to save and protect their constituents. Local leaders Dan Andrews of Victoria and Mark McGowan of Western Australia spring to mind. The New Zealand Prime Minister has achieved what many deemed impossible. Others are intent on using the virus as an excuse to denigrate these leaders and undermine their efforts. Tim Smith and Tim Wilson are two examples in Australia.

I am the beneficiary of advances in medical science. I have a prosthetic knee and I’m on a clinical trial. If I was living 200 years ago it is possible I’d be severely immobile, yet in 2020 I am lucky enough not to be. While I recognise the wonderful things we, as a species, are capable of, I also recognise how damn stupid we can be.

I don’t need to provide links, nor do I want to, highlighting the ridiculous conspiracy theories and “my rights” people. The inability of some to accept the existence of something they can’t see is one problem. The selfishness of the “it is my right to go maskless” brigade is another. The lack of numerical literacy, where people cannot comprehend growth rates and infection rates, is a problem.

At the moment there is much talk of vaccines. I hope as much as anyone that a vaccine is developed: I am also aware it will be the first coronavirus vaccine. To date we have not developed one, partly because coronaviruses have not previously been so contagious and deadly/damaging. Then there is the question of availability. Will only the rich be able to afford any vaccine, or will a vaccine be made available to all? The great economy, you see, would not like a free vaccine.

The human species has been brought to its knees. Not by aliens, not by flood or fire (yet, that’s coming) but by an unseen molecule. Humans are reminded despite our belief in our own pre-eminence, that we are vulnerable. Humans can, indeed, be on the receiving end of the same brutality humans dish out to other creatures on this planet. We steal and destroy their habitats, we shoot them for sport, we really don’t care if other species become extinct through our actions. Now we know how it feels. We’ve lost the freedoms we took for granted: the freedom to crowd supermarkets, to fly to the other side of the world on a whim, to get a haircut when we feel like it.

The fragility of nature

We ignored the beauty and fragility of our world because we did not feel fragile. We redefined beauty to be tall skyscrapers, fast cars and electric lights.

Human’s biggest enemy has always been other humans. Wars. Killing each other. Now humans have a new enemy. It isn’t the first and according to science, this will not be the last.

I wonder if this is the wake-up call we need. Time to re-evaluate our way of life. Re-evaluate our disrespect for the flora and fauna with which we share this planet. Re-evaluate our worship of the God Economy.

Managing the economic and social costs of the survivors suffering chronic illness is going to be a challenge. As I have written before, as a society we do not cope well with chronic conditions, I worry that many are going to suffer greatly in the years ahead.

How we cope with the aftermath of this pandemic is going to be a major test of the humanity of the human species.

 

Home: Now the Willpower Kicks In (Knee Arthroplasty)

While in hospital and/or rehab, others drive the recovery process. Essentially all I had to do was follow instructions. Food was provided, bed was made for me, physiotherapists ensured I did my rehab exercises, nurses delivered ice packs and heat packs as required at the press of a button. Medications were administered on schedule. If you are catching up, the hospitalisation part of this journey is found at My Total Knee Replacement.

Once home though, I’m the one in charge. I have to do all that stuff. While I write from the perspective of living alone, I am aware that partners are not always good at enforcing encouraging patients to do what needs to be done. While partners may cook and make the bed, when it comes to the exercises, these the partner cannot do for the patient!

There isn’t anything I’ve struggled with or been unable to do since arriving home. Having said that, remember I did spend time in rehab, I did not come straight home on Day 5. The physical action of getting out of bed is easier now that it was before surgery.

Full rehabilitation takes about six months according to the experts. I’m one month down the track today. It is my bionic knee one month anniversary!

Here’s a list of my tips topics, I speak about each in more detail below. Warning, there is a scar photo at the end – avoid if squeamish!

  1. DO. THE. EXERCISES. Every day. Just DO THEM!
  2. Continue seeing a physiotherapist or outpatient rehab.
  3. Sleeping, napping, coffee.
  4. Eat nutritious meals, you’re healing.
  5. Ice!
  6. Skin care.
  7. Establish a relatively normal routine, enables better rest and movement.
  8. Protect the knee (from falls, twists, etc). Get the shoe horn!
  9. Follow your medical team’s post-op instructions to the letter!
  10. Take a walking stick on public transport.
  11. Equipment.

Exercises

Whether you went to a rehab hospital as I did after the surgical hospital stay, or go to outpatient rehab, there are a set of exercises to do to get the best out of the new knee long term. I have a list of 10 exercises and some stretches. My physio keeps adding new stretches. My programme takes about 30 minutes, not a big chunk of the day.

In my experience it is easier to be inspired to do the exercises in the early days: the excitement levels are still high! By week three post-surgery I did find I had to push myself some days. Boredom: “Do I HAVE to do the SAME things AGAIN?”. Yes, I do. Tiredness: sleeping can be quite disrupted for a while – at one point I was exhausted from lack of decent sleep. Still DO THOSE EXERCISES.

While the rehab physio said I could do half in the morning and half in the afternoon if I wanted to, I have found doing them in the morning as part of a regular daily routine easier. I can’t guarantee I won’t feel tired later in the day, so best to do them when I’m fresh.

I started walking in rehab – I did laps of the ward. Small, regular walks are recommended by the experts and I’ve certainly followed that advice. I’ve increased in the same way I would for anything else, monitoring how I feel afterwards and the next day.

Here is my last week and you can see I dropped steps on June 16 – that was also the day I went to the physiotherapist, so a reasonable amount of activity already. I’m not pushing myself to get the 3,000 steps a day target I had set myself for this week, as I was warned (very strongly) not to overdo it!

The biggest issue I have found with the rehab exercises is not the actual joint itself, but the skin! The skin initially feels SO tight I was actually scared I might pop the wound open with one of the exercises (one where I lift my heel towards my bottom). When you are home alone and not allowed to drive, this is actually quite a scary feeling. Even now, one month post-surgery, the skin is still tight, but improving daily. Plus I’ve got used to the feeling.

Do any of the exercises cause pain? Everyone is different so there is no easy answer. In my case, one of the exercises causes muscular discomfort if I hold the position too long. This is an exercise to improve the straightening of my knee. I couldn’t straighten my knee properly before surgery, so I am undoing old issues, that’s why the discomfort. The only exercise that sometimes causes any pain is standing up from a dining chair. Some days I can do it without using my hands at all, other days I still need a little support from my hands. Essentially, the exercises are painless to do. Initially, of course, pain medications helped! I’ve not been on pain medications since June 9 and the only discomfort I have is as described above.

Continuing Physio

While I felt I was fine with the actual knee exercises on my own by the time I came home, those darn glutes were still giving me grief periodically. Six days after I came home I was off to see my physio for some glute help. In my case I was super lucky, as my physio also happens to do shifts at the rehab hospital I had been in, so she was already conversant with my case! I am seeing her weekly, although after this coming week we hope to reduce the frequency. This has been invaluable for me. Extra stretches to get the hamstrings and calf muscles (both very tight) back into good condition as well. Essentially these sessions are about working on the muscles involved with the knee to get them back into the condition they were before my knee troubles began.

As an added bonus she measures my flexion and extension so I can see I am progressing. I like to have those progress measurements as motivation to keep improving my flexibility.

Sleeping, Napping, Coffee

Sleep can be disrupted. According to the information provided pre-surgery, the length of time and the severity can vary considerably from person to person. I’ve had trouble getting a decent night’s sleep and I’m not even sure why. In the early days the knee did tend to ache at night – this wasn’t pain as such, just an annoying ache. If we sleep too much during the day, then it can be even harder to sleep properly at night. While a short nap maybe helpful, don’t sleep the day away!

For me, this is easy as I’ve never been able to sleep during the day at the best of times (unless I’ve got the ‘flu or similar).

If you do have a partner, my suggestion would be to plan a separate sleeping location for your partner before you leave to have the operation. I would not have wanted any poor person to try to get a decent night’s sleep with me of late!

I’ve made sure I don’t drink coffee after 3 pm. Like the napping, coffee can affect one’s sleep and that’s the last thing I need.

Nutrition

Have a good supply of eggs! If all else fails they are quick and easy to cook.

Easy Meal!

Have a supply of healthy frozen meals in the freezer. I also had long-life milk in the cupboard and preserved fruit, just in case.

There are times when cooking just doesn’t seem like something to be bothered about, but marmalade on toast is not really a nutritious meal, especially when the body is healing. Having a healthy frozen meal is a good option.

Hydration is very important. No-one wants a dehydration headache on top of a healing surgical site.

Ice

Continuing the hospital/rehab practice, I still ice daily at some point when I feel it necessary. After my exercises perhaps, or after walking. The knee swelling and heat hangs around for quite a while, so ice is my friend!

I ice the top of the knee first, then I later ice the underneath part of the knee.

This is my preferred ice-pack, but there are many on the market.

Skin Care

As mentioned above, the skin feels so tight and this is an area you bend! Bend constantly! Nothing much can be done re moisturising or Vitamin E oil/cream until the wound is healed and permission is granted, but once moisturising can happen – oh, the relief!

Quite a large area on the outer (lateral) side of the knee is numb. This is usual, but a bit disconcerting at first. The area reduces in size over time, I’m told – I am yet to experience that myself, but it will come!

Routine

Establish a routine. Get up at the normal time, eat at normal mealtimes, go to bed at a normal time. I hear stories of patients spending way too much time in bed. Not good. It was recommended to me to lie down for up to an hour, twice a day, to let the muscles stretch out. This I do.

A routine makes it easier to meet exercise needs, take any medications at the right times, eat appropriately and fit in rest breaks.

Healing is actually tiring. Add to that disturbed sleep. On June 12, which was Day 23 post-surgery, friends kindly took me to lunch. I was really quite tired after my outing and visitors. On top of the aforementioned lying flat on the bed, rests in an armchair/recliner after rehab exercises and walks are sensible. Each person recovers differently: listen to your body, don’t push it. If the vacuuming doesn’t get done today, it really doesn’t matter.

My routine is (flexible) as follows:

  • 6:30 – 7 am get up
  • Prepare/eat breakfast
  • Morning ablutions
  • 9 am “flat” rest
  • 10 am (thereabouts) rehab exercises (and COFFEE!)
  • 11 am walk
  • Noon – lunch
  • 2 pm walk
  • 3:30 pm second “flat” rest
  • 5:30 pm dinner
  • 10:30 pm SLEEP

In between I have little rests, ice the knee, do some laundry, the typical other living type stuff we have to do!

Walking to a local coffee shop and rewarding oneself with a coffee and a treat is highly recommended once that distance is achievable, plus that provides a little mid-walk rest!

A treat is allowed every now and then.

Protect the Knee

That may sound like an odd tip but I’ve learnt the (almost) hard way. The pavements in my area could do with some tender loving care in a few places and twice in my early first walks I almost tripped – that would not have been good. I keep my eye on the terrain now.

It is important not to twist the knee, yet it is surprising how much we twist the knee in normal day-to-day activity. Once my knee started to feel pretty normal, I found myself almost (caught myself in time) twisting the knee just doing simple things like getting stuff out of the fridge or a cupboard.

Don’t cross the legs. O. M. G. That is SO HARD for a veteran leg-crosser. I’m better now, but two weeks ago I’d have to uncross my legs every time I sat down.

Stairs. I live in a downstairs apartment (selected very deliberately because of Lennie, the bung old knee). I would not have liked to try to tackle stairs if I had come home on Day 5 after surgery. Stairs and crutches or walking stick are certainly workable, rehab teach patients the correct approach. I was already proficient from my time on mobility aids with Lennie. I would have been happier about the prospect of stairs, I think, if I did not live alone. The thought of possibly falling with crutches on Day 6 post surgery, alone, is not an appealing thought. I’m sure I’d have managed if I had needed to deal with stairs.

Now, one month after surgery I can climb stairs normally holding onto the handrail, but descending is still an “operated (left) leg down one step, right leg to same step” affair.

Follow the Medical Team’s Instructions

Do I really need to say that? I don’t, do I?

I haven’t detailed too many specifics because each surgeon and rehab team, although all quite similar, will have slight variations on the theme. Different surgeons use different components – there are lots of variations. Also again, each patient is different. The rehab physio crossed out one exercise on the sheet for me, saying, “Not yet, for you”.

They’ve done this hundreds of times, they are constantly updating themselves with research in the field. Follow the instructions for the best result. Even when that means not driving for six weeks.

If you are told to wear TED stockings, wear them! Yes, they are ugly, uncomfortable and annoying. Wear them.

Take a Walking Stick on Public Transport

I’m still taking a walking stick with me when I go on public transport. For two reasons.

First, many of our trams are not that easy to get on and off. Deep steps for one thing. The little extra support getting off and on the tram/train/bus is comforting.

Secondly, the walking stick is a badge. Without it, I look perfectly normal, yet I still need extra time and space to get on and off transport. I also don’t want to get pushed or knocked over. The walking stick encourages people to give me that bit of extra space, even on the pavement.

Equipment

The exercises prescribed for rehab do not require equipment, however it can be helpful to have some. I have foam rollers and they are easier than using two rolled up towels. I also have ankle weights which have proven very handy for one of the extra stretches I’ve been given. I rather wish I had a half foam roller.

Get the long handled shoe horn. I cannot stress this enough. Most important piece of equipment ever! Absolutely fantastic! I still cannot get my runner on the foot of the operated leg without the shoe horn.

I haven’t needed rails in the shower, but the raised toilet seat is definitely needed (and can be used as a seat in the shower if needed). I was VERY careful getting in and out of the shower the first time! I did get a non-slip mat for the shower, then realised it already has non-slip tiles.

Status

This was my knee a week ago. As you can see, the left leg is still swollen at this stage, but I’m walking around normally, just not as far as usual – yet!

You can see the shin bone on the right leg, not yet on the left. The knee is still larger. But it is much less swollen that the pre-surgery knee shown in the previous article!

The scar looks to be healing really well. I’m happy. Let’s see how I am feeling when the six months is up!

June 13

The worst part about being home is the boredom! Honestly, for me, that’s the hardest part. Not allowed to drive yet, so can’t go to the gym (for upper body), don’t have clearance to swim yet either. I hope the surgeon isn’t so strict the next time around!

One unexpected added bonus is my posture seems to have improved. I’m naturally standing straighter than before. I’ll see if that continues to be the case, but a positive plus.

My Total Knee Replacement (Knee Arthroplasty)

My early birthday present this year was a bionic knee. My surgeon will tell you very clearly it is NOT a bionic knee: the Australiam Orthopaedic Association clearly advises, “After knee replacement you cannot run, squat, kneel, crawl or play twisting, impact sports“. So not very bionic, but I like the idea.

Warnings re this article.

  1. It is long. Very long.
  2. Your experience may be very different. Each body is unique. That’s why the title includes “My”.
  3. I do try to inject some humour into the proceedings, otherwise it is a very dry topic.
  4. There are wound photos, but none of them are gory. I forgot to ask the team to take gory photos.
  5. This is written from the patient perspective (obviously) and no, not everyone gets praise (most do) – there are some bouquets and brickbats at the end.
  6. I do not name hospitals, doctors or medications.
  7. This article deals with the period of hospitalisation and rehab. I will write a second about being home (and continuing physio).

Background

We will call this knee Lennie (for left knee). Just to bring newer readers up to date with Lennie, back in 2014 it started being a little on the grumpy side. I had a Synvisc shot as an experiment and it worked well, but knee replacement was initially discussed back then. In October 2019 Lennie got really grumpy and I had fluid drained and a steroid shot. Temporary relief. By the end of January 2020, Lennie had me in hospital for five days. A cyst dissecting my popliteus muscle was discovered. At first it was thought that could be removed, but two eminently qualified orthopaedic surgeons said “No.” Mr T, the surgeon I went with, did explain a little more comprehensively. The view was the inflammation was so bad I’d simply develop more cysts. The time had come.

I was shocked. I had been expecting keyhole surgery to remove a cyst. NOW I was looking at rebuilding Lennie. Slightly more major event. Psychologically this was challenging for me – I WANTED to be able to manage the osteoarthritis (being careful here to distinguish from my psoriatic arthritis, different conditions) with exercise and strength and physiotherapy. Yet I had to admit this was not going to be a happening thing: Lennie was just a little too damaged. No matter what we did, Lennie would rage.

Once I made the decision, I was raring to go. Let’s get this show on the road. We had to time surgery around my drug trial injections. Surgery was booked for April 8, 2020.

Preparation

This is not surgery undertaken lightly, let me tell you! After the consult with Mr T to agree to let him cut out some of my bone and insert some metal and plastic bits and pieces I then had a schedule.

  • Consultation with a physician, Dr M
  • Blood and other tests
  • ECG
  • Visit with hospital staff re post-surgery planning
  • Another pre-op consultation with surgeon

Dr M’s job was to make sure I was healthy enough to survive surgery. He was also responsible for my post-operative welfare in hospital. I spent an hour with him, lovely guy, very thorough. Pulled prior medical tests from my various other specialists, including the cardiologist. More on THAT a little later – because I got a little surprise.

Dr M also ordered me to stop some medications I was on. This is very patient specific but I can tell any women of my age reading, it includes stopping (temporarily) HRT. Also verboten were anti-inflammatories. This is fun when you have a rather inflamed knee and are still trying to walk three kilometres a day and do exercises to keep your muscles “recovery ready”.

Then Covid happened and everything got cancelled. I did however still go and have the blood tests and ECG. The plus was I could go back on anti-inflammatories and HRT (temporarily)!

During this time my left ankle was becoming more and more painful until one morning I absolutely could not weight bear at all. I was convinced this was all tied in with Lennie’s misbehaviour, as from my January hospital excursion I had been unable to control that foot. Mr T was unconvinced, but I also did not explain to him (my patient oversight) the specific loss of foot control I was experiencing. The 4 second video below illustrates what I could NOT do with my left foot.

FINALLY and fortunately and I am forever grateful I GOT A NEW SURGERY DATE! May 20, 2020. Back off the anti-inflammatories and HRT. This however meant my knee was swollen and painful. My GP worked out a pain management regime so I could keep moving. As always, I was very nervous about this as I didn’t want to develop a tolerance to medications and have pain medications not be as effective as possible post-surgery. My GP assured me I wasn’t taking enough, or for long enough, for that to happen. By the last couple of days pre-surgery, I was in considerable pain and not a very happy person.

May 16 – not at the most swollen, but just a snap I sent to my daughter

Due to Covid, the hospital appointment mentioned earlier happened by phone. I also needed another (updated) lot of blood tests, which I had done at the hospital on May 8.

I had groceries delivered the day before surgery, changed the bed linen, did all the laundry and the dishes and cleaned the fridge. All I would need when arriving home was fresh milk and fresh fruit.

I was VERY happy to arrive at the hospital at 6 am on May 20, after starving myself from midnight.

Surgery Day

The very first thing I was required to do was have an antiseptic shower. I was first on the theatre list. The anaesthetist popped in to see me, the assistant surgeon dropped in, Mr T popped in to draw on my leg (the big black arrow from my ankle you will see in a later photo). I commented to him I’d love to watch the surgery. I think he was a bit surprised. His response was it was a worksite and I wouldn’t “want to hear all the swearing”. I figure I’d have talked too much anyway, asked too many questions: I’d have distracted them from the task at hand.

Dr M popped in at some stage, I forget exactly the sequence of events now, BUT he blithely informed me I was going to the HDU post-surgery. The conversation went a little like this.

Dr M: You’ll be going to the HDU post-surgery.
Me: What is the HDU?
Dr M: The High Dependency Unit
Me: WHY? I’m healthy as an ox, I just have a bung knee!
Dr. M: You have a nocturnal AV block.
Me: …………????????

I had no idea what a noctural AV block is, or that I actually had one. My recollection of my cardiological investigations was I was pretty damn good on the cardiovascular front, just every now and then my heart would miss a beat, nothing to worry about – I certainly don’t still see a cardiologist! Unless, it seems, you are having fairly major surgery. As I write I still do not know much about the mysterious nocturnal AV block, but I’ve been busy concentrating on my knee. I’ll find about the AV block later (that’s going to be delegated to my trusty GP).

By 7:30 am I’d seen four doctors, been drawn on and discovered I had something that was sending me to the HDU. I also mentioned to the surgeon and the anaesthetist that it had occurred to me I never research the anaesthetist, despite the number of surgeries I’ve had. Check out the surgeon, yes, but then just trust him/her to pick an anaesthetist that will keep me alive! I just found it interesting.

My daughter and I had agreed they would not visit on the day of surgery as I might be a bit “out of it”. As it turns out, the day of surgery I was fine, would have been a great day to visit! Day 1, when they did visit, I was “out of it”.

I woke up to be greeted by this.

Now when I say I could feel nothing, that’s exactly what I mean. Nothing! I could not move the leg at all, it was like a lead weight, seriously. It was also cocooned on a padded frame I did not take a photo of. Just holds the leg safely in position.

I thought if this is as bad as it gets, this is a walk in the park.

Mr T did pop in to see me and share with me the news that he had not been able to remove all the inflamed tissue as per his normal practice as that would have been just a bit too dangerous in my case. In my experience doctors use the word “dangerous” very sparingly so I’m guessing my knee was a little messy once it was opened up. Will find out more detail when I see him again in a couple of weeks.

Then My Glutes Went Crazy

At about 10 pm, so roughly ten to twelve hours post-surgery, I mentioned to the nurses that I was starting to feel pain and my glutes (the muscles in the buttocks) were spasming. This glute spasming thing had happened back in January too. Wasn’t fun in either January or May, let me tell you. I won’t go into all the detail of the next few hours, but those hours were not pleasant. The anaesthetist got a 4 am wake up call (although apparently he was already awake – do those guys ever sleep?). Dr M got in on the pain management act as well. I want to stress here, it really wasn’t the knee that was causing me the issues. It was everything else: the glutes and the ITB mainly (I’ll talk about the ITB later, at this point I didn’t separate the knee from the ITB pain, that dawned on me later in rehab).

The glute spasms came in waves, just as they had in January. Those wave peaks were intense. The great team did get it all under control fairly quickly, but the glutes continued to be an issue, reducing in severity over time, for nearly four weeks. In hospital the nurses would ask that great pain question “What is your pain on a scale of 1 to 10?” My answer would often be, “The knee is zero, the glutes are 6.”

I ended up with three drips in various locations on my right arm and I was on a cocktail of drugs Day 1 (surgery day is Day 0).

I’m an information technology person: we make ONE change at a time when troubleshooting. If that change doesn’t give the desired result, we roll it back, make another change, test. Rinse and repeat. When you have a patient in considerable pain, I can understand they don’t have the luxury of the time to try one drug, it doesn’t work, take it away, try another one, rinse and repeat. Hence the cocktail. To me, with my background, it was like “But which one worked/is working?” I’m a pain medication minimalist at the best of times, I make an exception for surgery, but I was staring at the IV pole in horror.

Yes, it was an unpleasant few hours but would not happen to every patient and was probably more specific to the state of my anatomy at the time. Nowhere in all the copious information are glute spasms mentioned as a possible post-surgery event! I’d got an extra five years out of the knee since surgery was first discussed, so I can’t complain too much if during that five years other tissues had suffered: shortened, tightened, etc due to coping with the damaged knee.

Preventing Blood Clots

Blood clot prevention is big these days! Compression stockings, daily injections of a blood-thinning agent and these intermittent pneumatic compression (IPC) sleeves. Apparently some people hate them, but I loved them. I would have stolen them if possible. Like a constant leg massage. The only problem was I would count the compressions. One leg was doing 17 before the rest between sequences, the other leg was only doing 5 compressions. Was something wrong, I wondered? Did I have faulty sleeves? As a patient, I expected them to do the same thing to both legs. No-one seemed to know, which worried me even more. They rebooted the pump, unplugged and replugged the connectors, still the same. I can’t remember now who did know the answer, but apparently these sleeves don’t work in unison, but have a pre-programmed variation. It is likely many patients would not sit there counting the compressions to compare, but of course, I did!

I still find it amusing that I had to stop anti-inflammatories before surgery because they thin the blood (don’t want us bleeding too much in theatre, after all) then as soon as surgery is over, we get blood-thinners daily!  I understand the logic and am very grateful for the level of care, but it still amuses me.

Dr M also gave me deep breathing and coughing exercises to do.

Day 2 Onwards

Day 2 it was suggested I go to rehab. By Day 2 I was feeling much better, but thought I’d be guided by the experts, so I agreed. I do live alone and thought perhaps this may be a wise choice. Transfer was scheduled for the coming Monday. The remainder of my hospital stay was reasonably uneventful. The glutes were kept under control, I gradually lost IV connections and started to move about. Had my first shower sitting in a chair (first time ever!). That was the only chair shower I had, all others were standing. Another issue was sleeping on my back. I have never been a person that sleeps on my back, but all of a sudden I was expected to. That was hard. My back didn’t like it overly either. As soon as I was able to sleep on my side using a myriad of carefully positioned pillows, I did.

I learnt how to hook my right foot under my left ankle and swing my still as heavy as lead leg up onto the bed. The monkey bars above the bed were a great assistance! You will of course note by then I had painted my nails!

Day 2 I also had an x-ray. Mobile x-rays are wonderful things, plus the lovely staff took photos of the x-rays for me. I could finally see IN my knee! I could see Mr T’s handiwork, even though I missed out on seeing it happen.

X-ray without moving from my bed!

The bubble wrap looking stuff is the dressing. But there it was – Lennie was replaced, no more angry knee. Yes, my patella got some attention as part of the whole deal, so it lights up as well. Apparently, yes, I will set off the airport metal detectors.

The actual knee itself looked pretty good, if somewhat swollen (as is to be expected). And there is the aforementioned big arrow the surgeon drew on my leg before it all started.

BEST OF ALL? I discovered I had control of my foot again! I could move it as demonstrated in the little video above! The nurses were a bit mystified at my excitement, but I was ecstatic. I had control of my foot back!

I swapped between a walker and crutches for a couple of days as I have to say the walker was convenient for hanging clothes and towels on moving from bed to bathroom. Other times I would use the crutches. I had little exercises to do in bed to start stretching and bending the knee.

Day 4 I was feeling pretty chipper, but was still in a nightdress. Still no haircut either.

Off to Rehab

Day 5 was off to rehab day. I got dressed!!! All by myself! The last IV connection came out and off in the ambulance I went (very squishy ambulance, just as an observation).

Rehab is mostly about physiotherapy, moving, functionality. The monkey bars are gone, for a start, as was the walker (although I’d not used that for a few days by then). I ended up with the start of abrasions on my elbows from dragging myself up the bed, so we had to cover my elbows at one stage to protect the skin. I did learn to use my hands more than my elbows, which helped!

Unfortunately, the glutes decided to spasm badly again once I reached rehab. That was disappointing and frustrating. I missed a physio session due to the glutes. The whole pain management process started again, but this was about the glutes, not the knee.

They have a gym! First trip to the gym is in a wheelchair, but most after that on crutches (even if the physio followed me with a wheelchair “just in case”). Some physio sessions were in the room. For example, I’d go to the gym in the morning, then in the afternoon the physio would come to me.

It was in the gym I had my ITB epiphany. Refer back to the above section about the glutes going crazy. At that point, immediately post-op, I hadn’t differentiated between my knee (the operated bit) and the ITB. As a patient you are still a bit foggy from the anaesthesia, it is all in the same area, pain is pain at that point. But in the gym, six days later, your brain is working a lot better. I was doing one of the rehab exercises and realised it wasn’t the surgical site that was hurting, it was my ITB. It was painful and restricting my movement.

The physiotherapist and I had a chat about what we could do. The rehab hospital had a clinical massage therapist so we decided to give that a go. ONE treatment and the ITB pain was gone. I have no idea what he did, but it was fantastic! He also worked on the glutes a bit too. I had two treatments with him. My own physio, now four weeks later, is still working on those areas for me.

I’d have a heat pack on my glutes and an ice pack on my knee. The knee wasn’t necessarily painful, the ice was more preventative and to help with the swelling.

The goal for release from rehab is knee flexion (bend) of 90 degrees. I reached 93 degrees on Day 11 (post-surgery day count, that is). That was also the day I found myself in the bathroom with no crutches – I’d just got off the chair and wandered into the bathroom. Hmmm, I thought to myself, perhaps I’d better get Mr T’s OK, because I don’t think this is the first time I’ve done this in the last couple of days. Mr T’s office said that was fine, I was close enough to two weeks. I could “potter about” without crutches or walking stick. I promised not to go to the supermarket (just yet) without crutches.

By the very next day, my knee flexion was 105 degrees. Day 14 I finally came home! Now, almost a month after surgery, I am walking about 3,000 steps a day and my flexion is 125 degrees (as of Tuesday this week) – more on that in Episode II.

I had an appointment to see my surgeon on Day 13, but because I was in rehab we agreed the rehab doctors could review me and so that appointment was cancelled. In hindsight, I wish I’d gone to that appointment, just for information and post-op guidance.

Bouquets and Brickbats

Mostly I have bouquets. Just three small brickbats. Overall the care and staff were fantastic.

Surgeon – wonderful work. What more can I say? Fantastic.

Physician, anaesthetist, assistant surgeon – as far as I can tell, all did a great job! Sorry about the 4 am wake-up call.

Physiotherapists – terrific. They were really encouraging, understanding and supportive.

Nurses – all bar one night nurse were wonderful.

Food – some was great, some was not so great, but hey, it isn’t a restaurant. I was happy to get home to a higher protein diet though.

Pillows – terrible. Next time I am taking my own pillows into hospital IF that is allowed (it occurs to me maybe that would be considered an infection risk).

One rehab night nurse – I was not impressed. Towards the end of my stay I avoided calling her at all costs. HOWEVER, given the number of wonderful nurses over the 14 days, I think only one being not as helpful as I would have liked was not too bad really.

Release Process – oh, OK, discharge. I was sent home with various medications, two of them were pain medications. I was released just before a long weekend, so I was thankful for the coverage. It occurred to me over the weekend I had been given NO instructions how to get off these things. Remember I’m the pain medication minimalist – BUT I was also aware I’d had pretty invasive surgery, I didn’t want to change anything on a long weekend and cause a pain episode. Off to my GP I went to find out what I could stop taking and when. We stopped the slow release, kept some instant release up our sleeves IF necessary. I was happy. On reflection, I feel not enough information was given to me on discharge about the medications. Really, a small complaint very easily rectified by a visit to my GP.

Telehealth – Let Us Keep This Innovation!

The Covid-19 pandemic has brought sadness and pain globally: job loses, businesses closing, the high death toll in many parts of the world. The loss of family members, colleagues and friends is devastating for those affected, irrespective of the death toll of any given country.

One positive that has emerged is telehealth. In Australia telehealth was already available in certain regional areas: during the pandemic it has become widespread. The Guardian published a very good article from the perspective of the medical profession, “The genie is out of the bottle: telehealth points way for Australia post pandemic“.  Here I present my perspective as a patient.

Telehealth is fantastic! Especially for me and I suspect for many other chronic illness patients who see a collection of doctors. Apart from the obvious Covid-19 related benefits of limiting unnecessary contact and thereby maintaining isolation, there are other benefits.

  • Many chronic illnesses have a tendency to flare, meaning even without Covid-19 travel to and from a medical clinic can be an unpredictable physical challenge.
  • In situations like my current one, awaiting total knee replacement surgery, the main focus has been pain management (I’m pretty healthy other than the knee). My GP has been wonderful, keeping in touch, ensuring I’m managing, reviewing the pain management plan, faxing prescriptions to the pharmacy when necessary.
  • My endocrinologist really doesn’t do much with me physically during my visits – observations such as weight, blood pressure and temperature I can provide (although she didn’t ask – this may be an area where some practitioners have to develop a bit of patient trust!). Aside from my description of my health, in my case at this point, it is mostly blood test results that drive decision making, plus an annual ultrasound of my thyroid. Telehealth worked perfectly and saved my travel time, fuel and parking costs. She emailed me a pathology request for my next appointment in July.
  • My psychologist used Zoom, which worked really well. Again, saved travel time, fuel and parking (although that parking location is free in my case). For me it was clinically no different to sitting in her rooms, yet I was in my slippers and had a coffee on hand!
  • Hospital pre-admission appointment for surgery. Yes, my surgery is actually happening, next week! While I was to have a face-to-face appointment at the hospital to go through pre and post surgery planning and preparation when my surgery was originally booked for April 8 (then all surgeries were cancelled due to Covid-19), I had that appointment by phone yesterday. It worked well, everything was achieved as it would have been in a face-to-face appointment, including my being able to confirm I can take nail polish in with me to apply post-surgery.
  • I can see benefits for working people too. A 15 minute phone consultation is a lot easier for a working person than taking several hours off work to go to the doctor. Let’s face it, it does take several hours: travel to the clinic can easily take 30 minutes or more, wait time (minimal if your doctor runs on time), consultation time, maybe a stop at a pharmacy, travel back to work depending on the time of day. I suggest most of us would not return to work after a 4 pm appointment, for example, or go to work before a 9 am appointment.

I have long-standing relationships with my doctors: I’m not sure I’d like to have an initial consultation with a new doctor by phone, although video conference may be fine. I’d prefer my GP and specialists used video and I think that will come in time.

Clearly telehealth doesn’t work for everything: my surgeon is not about to slice and dice me over the internet. The physician couldn’t do his pre-operative physical examination over the phone. I couldn’t get the ‘flu shot remotely.

For on-going management of existing conditions it works beautifully from this patient’s perspective.

There may be opportunities for people such as myself to assist patients with technology in their homes. I notice the article linked above mentions this:

Dr Chris Bollen, a GP in Adelaide who cares for many elderly people living in their own homes, has spent much time recently teaching patients to use FaceTime and other digital platforms. He is excited by the potential for telehealth to help support older people to live independently…

The article also points out that the current arrangements are planned to be temporary.

These temporary arrangements are due to end on 30 September, and the health minister Greg Hunt has flagged his support for their continuation, although many questions are yet to be answered about the rollout and impact of these services.

I hope teleheath stays. It also has environmental benefits which are discussed in the above article. It works for many situations, it is now proven. Let’s keep it.