TKR and PTSD

No, not THAT PTSD, although it could apply considering the "trauma" of having your knee replaced is considerable.

This is PTSD of a more positive variety designed especially for not only the "Kneebies" among us but for all TKR patients. As you know by now, I do these posts because I get tired of writing the same words over and over again. There comes a time when I type that one extra character, fall off the cliff and end up in a heap writing another BIG post. So here's my humble offering on our version of PTSD: 

Patience, Time, Strength, and Determination

PATIENCE

When we first come home, we're all faced with the question of how long this pain is going to last and how soon will we be "normal" again. Let's get the "normal" part out of the way first. You will NEVER be your old "normal" self ever again. You now have a 2+ pound mechanical device implanted in your body. That's not normal...except for a robot. You will never be able to play competitive sports, do a slalom ski run at 60 mph or even just plain run. Anything involving knee impact or twisting motions is verboten! (Check my other post on acceptable/forbidden activities.) My hip doc told me years ago that I could have a hip that lasted 25 years or go back to playing hockey and having it last only three. Your choice...except that having it done a second time is NEVER as good as the first...never as tight...never as strong.

Back to patience. We live in a world where the value of patience is completely discarded as we demand whatever we want NOW!  There's an old book entitled "The McDonaldization of America" which speaks eloquently to this point.  We want our food fast and healing faster. For us, patience cannot be a virtue...it must be a necessity. We cannot speed up a healing process that takes a long while to complete, no matter what we say, want or wish.  In other words, getting past a TKR is something mostly out of our control. Yes, we can do our PT and exercises without which we'd never get better; but the rest is not something we have any say over. Therefore, patience with the healing process is an absolute requirement for us to get past this.  Just like those car rides with our parents when we were kids ("Daddy, when will we get there?"  "When we get there!"), be more Zen: "I'll be better when I'm better."  

TIME

Lockstep with patience is time.  If you haven't noticed already, a TKR recovery is not measured in days or weeks but in many months, up to 18 or more in some cases. (Check my other post on The TKR Bell Curve.) If you think you'll be on your feet in a day or two, you're CORRECT! You have to be!  The best thing you can do is walk and exercise. However, if you think you'll be back to work in a month, you are flat out delusional. What else is there to say? Except for the extreme, rare cases, this is just not going to happen because a TKR recovery takes a lot of time.  At the beginning of mine, I slept an awful lot...actually, unconscious would be a better description. When I asked my GP why I was sleeping so much, she responded: "All the healing energy of your body is being directed to your knee."  

Expenditure of energy can lead to exhaustion and sleep. That's what's happening to your body too. You have to be prepared to give your body time to heal and recover.  We all know that you cannot push a knee...when you do, it slaps you back by swelling up, getting hot, causing pain, etc. Don't do that! Listen to your body...do your exercise work but give yourself time to heal. Don't push to drive again especially if you're still on opioids (absolute no-no) or don't have the motion/strength to depress a clutch. Very dangerous. And don't rush back to work. There's no way a nurse can run the halls, a construction or factory worker can bend and lift, or even a desk-jockey sit there for eight hours without pain and swelling.  Most people return to work around six months, some faster and a few slower. Give yourself the time to heal before resuming your life.

STRENGTH

This one involves three things, specifically, mind, body and spirit. Regardless of how your body feels, your mind has to be strong. Any depressive thoughts should be dealt with and discarded immediately. Post-Operative Depression is a real thing for people that have body parts replaced. The docs never talk about it so be prepared for those crying jags 10 days post-op. Know what it is and discard it. Any feelings of depression down the road are usually caused by having unrealistic expectations about your recovery, like "Oh poor me...I should be doing better by this time...". Bullpucky!!! Just a bunch of Jedi mind tricks you're playing on yourself. STOP DOING THAT! Focus your mind on the positive; distract it with other things like reading a good book, being with friends or killing zombies on XBox. Strong mind...do it!

Your body also needs to be strong. PT only gives you your range of motion back; it does nothing for your atrophied quads, glutes and core. After PT, you MUST do the gym (or home) gym work to regain your physical strength. This is the only way you're going to climb stairs unaided again or walk without a cane for the rest of your life. If you can't get to a gym, get a set of resistance bands and use them. Also: Eat healthy, lose weight (if necessary). hydrate a lot, eliminate artificial sweeteners and processed foods, eat good protein. You have to rebuild all the leg and hip muscles that will support your new knee.  

To get all this done, you'll need to look inside yourself and find your peaceful center. It's the place you need to go when you're all alone, times are tough and things might not be going as you thought they would. Pray, meditate, practice yoga, read from your favorite spiritual books or other resources. Do whatever you normally do to find some peace in your life.  Concentrate on bringing that healing, spiritual energy into your body.  Do not discount this source of strength...it is very important.

DETERMINATION

This is where you get to kick some serious a$$... This is all about motivation and focus. The hard part is that it all has to come from inside of YOU. Yes, there are great posters, books, t-shirts, coffee mugs and more that can provide inspiration but it really all starts and ends with you. The easy part is Physical Therapy, really.  Do you actually think you'd go back to your surgeon for your six-week alignment check and tell him that you skipped all your therapy sessions?  We all know that's not going to happen.  You have to break down the scar tissue that's forming or you'll never walk correctly again.  That's a pretty powerful incentive.  It's what comes AFTER PT that will make all the difference.

The only way to get your strength back is by exercising your quads, glutes and core that have atrophied over these past many months. You'll look down at your leg and see a toothpick where there once was a strong quadriceps muscle. Gotta fix that...and the only way is to get out of your chair and do the work. (See my post on Post-TKR Exercises, designed for us by a pro.) And the only way to get out of your chair is to make the determination that exercise will now be a part of your daily like. I won't be something you do occasionally or when you "feel like it"...instead, it will be part of your SCHEDULED daily activities. You have to keep your focus on getting stronger and not give into depressive thoughts and actions. See yourself better then MAKE yourself better!  My mentor for my master's degree had an old IBM punch card on his office corkboard containing five simple words that have guided me since I met him in 1971.  Those words: "NO EXCUSES. DO THE WORK."  Determine to do the work necessary to get well again...no mind games...do the work!

CONCLUSION

Just my thoughts on a lot of topics and questions that keep getting asked over and over again. Just an old guy musing about the past year trying to recover from what everyone calls the most "brutal" of all surgeries...and I concur. It can be life changing in many ways, not just the physical. You can really find parts of you that you never knew existed or had forgotten about for a long time. Recovering from a TKR is an OPPORTUNITY to find strengths that you never knew you had and make you a better person for it. Or...you can wimp your way through it...your choice.

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