Physical Therapy 0-16 Week Protocol

This is the sheet I came home with from the hospital that the doctor instructed me to give to my physical therapist so they can follow the proper protocol regarding rehabbing my new ankle replacement.

You can see that it's all wrinkly...this is the sheet that I was given from ankle #1.  My therapist, at the time, made a copy for herself and gave this back to me.  For ankle #1, it was hard to judge where I should be in the timeline since I was in a cast for 7 weeks.  This time around, it's a bit easier to judge.

I just hit my 8 week mark, so I'll be moving into the "Weeks 8-12" box of instructions.  I'm hoping to see some real improvement in the next 4 weeks!

Anyone else come home with a set of instructions?  Did you find it helpful?

Wouldn't it be nice if everyone came home with a set of instructions? :)

8 Week Update -- Ankle #2

Wow...has it been 8 weeks already?  It doesn't seem that long to me...but it does seem like forever since I've been doing normal stuff...probably because once I started feeling kinda normal after ankle #1 I was having surgery again.  What can I say...I'm a glutton for punishment.

Anyway...things are a bit slower this week.  If you read my post from Monday, you'll see why.  Not much has changed...or I should say improved.  Actually, I feel like I'm where I was about a week and a half ago.  I have physical therapy tomorrow and it will be interesting to see what she has me do.  I don't know if I'm ready to go back on the treadmill just yet...but at the same time I feel disappointed in myself if I don't even try.  I just don't want to move backwards again.  I need to keep improving...not doing all this backwards shit.

I'm really getting a little stir crazy...yeah, it only took 8 weeks!  The very best part about this week was that I was able to get out this past Saturday...even if I had to use my crutches.  I went to Walmart (with the use of the wheelchair) and went to lunch at Panera.  Oh how I loooove Panera.  These two outings were the most “normal” thing I've done since the surgery.  Yeah, my life is so exciting...don't all be jealous at once :)

I've decided to clean out all the prescriptions I was given after the surgery since they've been collecting dust on my bedside table for a couple of weeks now...this is a lot of medicine!  I can't tell you how happy I am to be off of these.  Now I'm just back on my Celebrex (for my arthritis) and Soma (for my back spasms).  At least my medicine routine is back to "normal".

Have you ever gone through something and couldn't wait to get back to "normal"?  What was it that finally made you feel "normal"?

The Evenup -- The Accessory To The Walking Boot

Have you ever hurt or fractured your foot or ankle?  Or had foot or ankle surgery?  Did you have to go into the dreaded boot for some time?  Did your hip, knee, or back start hurting when you were in the boot?   If this sounds like you, then you are going to kick yourself that you didn't know about this little beauty.   It's called the Evenup.  And guess what it does...that's right...it evens up your leg heights so you no longer have to worry about finding the perfect wedge shoe that will match the height of your boot.

When I got the cast of ankle #1, the lady who fitted me for my boot gave me information about the Evenup.  My first thought was, “Genius!”.  I went home and ordered one a couple weeks later.  I figured that I had some time since I couldn't really put weight on my foot and walk yet.  Well, I should have ordered it sooner because by the time I needed it, I needed it right now.  It did come rather quickly, but still I should have anticipated better.

By the time it came I was so relieved.  My hip and lower back had already started hurting...and I wasn't even all that mobile yet.  For those of you who have never worn a boot...understand that even the smallest difference in leg height will throw off your gait just enough that it will wreak all kinds of havoc on the rest of your body.  Seriously, such a small difference can cause a ton of pain.

The Evenup will fit around any shoe (I imagine) and has two layers of foam in it (so you can remove one if need be).  It gives me about another half an inch...just enough to be even with my boot.  I absolutely love it and the minute I got the okay to wear my boot with ankle #2 I started using the Evenup immediately.

So if you ever have to be in the boot, or have a friend or loved one who does, this little thing is a lifesaver.  It cost me $35 and I got it in about 5 days.  I ordered directly from the Evenup website, but sometimes Amazon has it for a little cheaper.  Spread the word! 

One Step Forward...Two Weeks Back

The beginning of last week was awesome.  I was able to put a lot more weight on my ankle and my balancing had started to improve.  Because of these two things, getting around was easier, to the point where I had started using my cane.  I was really improving and was starting to feel more “normal”.

And then Thursday happened.

I had physical therapy on Thursday and did all of my regular exercises...nothing new.  And I ended up hobbling out of the PT office.  That entire afternoon was pretty sucky.  Even if I was just sitting with my foot up, it would just throb.  I tried taking ibuprofin when I got home and then later that night, and it did nothing to help the pain.  Ice didn't help either.  The only thing that helped was if I stayed off of it completely.  So I did.

Both Friday and Saturday weren't much better, although the throbbing was limited to only after I would try to walk on it...so that was a mild improvement.  I went back to using my crutches and tried to put as little weight on it as I could for a few days.  My ankle felt as if I had gone back two weeks.  And the bone that I had the screw put into was what was hurting.  It was tender to the touch.

I had acupuncture Saturday morning and by Sunday it felt a little bit better (usually acupuncture takes a day to “kick in” for me).  Today, Monday, it feels about the same as yesterday, maybe a slight bit better.   It's still tender to the touch...as much as a few days ago.

After explaining everything to my therapist, she said that it could have been how aggressive she was with the distraction last Thursday.  The weird thing is that when she did that, it didn't hurt.  Only afterward, when I tried to walk on it, did I feel pain.  She didn't do much hands on today...gonna give it a rest...and next session she will just go a little easier when distracting.  I'm hoping by my next PT appointment that I will be able to fully walk on my ankle again and can get back to the treadmill.

It's funny how you have to sometimes push your body past it's limits just so you know where your limits are.  The 'ole “I really shouldn't have done that” routine :)  How many of you out there have done something similar?  

7 Week Update -- Ankle #2

Ankle #2 is coming along really well!  I seem to be doing a little more every few days.

Most of my days this week have been spent downstairs in my reclining chair instead of upstairs in my bed.  I still have my feet up in my chair, but they aren't higher than my heart...which is what was necessary to keep the swelling down immediately following surgery.  I'm able to sit in a regular chair without my ankle up for a longer period of time.  This has allowed me to be able to have dinner with my family, at the dinner table, for the past few days :)

On Monday I started using the cane around the house when I have my boot on, and since then have found it easier each day.  I still took both crutches to PT on Monday because there are exercises I have to do with just my sneakers on and I need the support if I don't wear my boot.

I started back on my Celebrex this past weekend.  I was supposed to wait until Monday, but I rebelled and started two days prior.  I was at the 6.5 week mark.  If I remember correctly, I started taking my Celebrex with ankle #1 at the 7 week mark...so it's pretty comparable.

My biggest accomplishment this week...I did 5 minutes on the treadmill on Monday!  I had my boot on, and was slower than molasses, but I did it!  Really looking forward to doing more work on the treadmill as walking is kind of a top priority :)

From Pixabay.com

We had a nice size snow this week and I'm glad my PT appointments missed the worst of the storm.  I'm originally from NY and sometimes miss the snow...so it was nice to have more than a dusting for a change.  I hope that the roads are good for my appointment tomorrow.  One of my biggest fears during this whole ankle surgery experience has been falling.  I'm terrified I'm going to slip and fall!  This wasn't as much of a concern in the summer when I had ankle #1 done, but it's a definite concern now that we are right smack in the middle of winter.  Keep me in your prayers!

The Plant Died...But That's OK

Since I had my first ankle surgery mid-June and then my second ankle surgery in December, you can only imagine how much stuff has NOT gotten done in the past 7 months or so.  There was no spring cleaning...no going through the garage and throwing out crap...no dusting the top of the refrigerator... no cleaning and sorting through closets, etc.  You get the idea.  My family has been in a survival cleaning mode since June.  This makes my OCD mental-ness a little haywire.  Oddly, I can't wait to clean again just so I can sit back, smell the chemicals, and smile.

My husband has done a great job holding down the fort and I give him a lot of credit.  He's done so much...cooking, cleaning, laundry...and still manages to work a full time job and coach a team!  We've also been blessed to have some help from my mother-in-law...she's cleaned my kitchen quite a few times, watched my kids, and made us food.  Friends and neighbors have helped with meals, rides to appointments, and I even had a couple of my friends tidy up my refrigerator.  All in all, we've been lucky.

Still, there is one thing that has not survived these last several months... my african violet plant that I got from a catechist dinner a few years ago. It's now just a pot of dirt with some dried up dead plant in it.

RIP African Violet

Really, I have to be realistic and realize that things cannot possibly be the same as they "normally" are.  I'm recovering from major surgery...again.  And things will get done eventually.  It's hard for me to let some of these little things go, but if the plant is the only thing that hasn't survived over the last 7 months, then I'm considering myself and my family pretty lucky! 

Maybe you've had surgery too, or just had a baby, or are caring for a sick family member -- and you can't keep your house the way you normally do.  Anyone else have problems letting go of the little things that don't get done?  Any tips or suggestions for staying sane and letting go?

6 Week Update -- Ankle #2

One of my newest exercises this week is to stand on both feet (with my boot on) and try to rock up onto my toes and then come back to neutral.  This may sound easy, but this is essentially a calf raise, and I haven't been able to do this on my ankles for years.  As I mentioned before in another post, the last time I tried these exercises I hurt my ankle so bad that I couldn't walk on it for weeks.  Now when I try this exercise, I feel pain in my right ankle (#2), and I feel muscle strain in my left (ankle #1).  I'll probably start feeling muscle strain in my right once I start doing this with the boot off.  I think I start PT exercises with the boot off in another week or so, even though I will still have to wear it normally until end of February.

I can stand 50/50 easily now and can even “one-crutch” it around the house if I'm in the boot (but not for long).  Hopefully, I'll be able to adjust to the cane in a couple of weeks.  Without the boot, I still need the support of both crutches or the walker.  I use the walker upstairs and the crutches downstairs and when I have to go out.

This is going to sound like a weird thing to be happy about, but I can now cross my feet at the ankles...just figured that one out a couple of days ago.  Basically, this means that my incision isn't that sensitive anymore.  I meant to take a pic of my incision today, but I forgot...I'll try to remember and add it to my photos page by the end of the week.

Something about my incision that I haven't mentioned before...I definitely have some nerve damage to part of my foot....from the joint on my big toe to rest of that side of the top of my foot...make sense?  Yeah, I probably should figure how to do some photo-shopping or something for a visual aid.  By the by...I didn't have this with ankle #1.  Anyone else whose had this surgery...do you have any nerve damage?  I'm wondering how prevalent it is.  I hadn't mentioned it before because I was waiting to see if the numbness would go away.  I figure that since I'm at the six week mark, it's probably here to stay.

My big trick of the day... I stood today to wash my hands.  Again, this seems like a minor thing, but I didn't really have the strength or balance to do this just a week ago.  My bathroom in my room has the soaking tub right next to the sink, so I have a place to sit while I wash my hands.  And, if I'm on my main floor, that bathroom is so small that you can put the lid down on the toilet and sit and use the sink...it's a seriously tiny bathroom!  So, for the past 6 weeks, I haven't had to stand...but today I did...and it was magical :-)

Picture by Yinan Chen - www.goodfreephotos.com

A Pain In My Neck...No More?

I'm happy to report that my neck feels a million times better than last week.  Immediately after I had the shots on Friday my pain level went down even though I was still experiencing the pinching.  Saturday the pain was less than the previous day and Sunday was even less than that.  

My pain level was at such an acceptable level yesterday that I ventured out of the house and went to my in-laws to celebrate my mother-in-law's birthday.  Both my neck and ankle did reasonably well, although I was really wiped out by the time we got home and my ankle was aching a bit.  Nothing a little nap couldn't cure!  And I really needed it since I was sleep deprived.  As usual, the steroids gave me a bit of insomnia.  I usually can't sleep the night of the shots, but for some reason I didn't sleep Saturday night instead.  And my left knee started hurting on Saturday and is still bothering me today.  I swear this also happened the last time I had steroids....I'll just file that under "random weird happenings of my body" :)

So even though the pain was less, I continued to feel the pinching throughout the weekend.  Today, I have no pain in my neck and haven't really noticed the pinching.  My physical therapist did “the wand” on the spot where I was experiencing most of the pinching last week.  Hopefully that will help keep the muscles loose.  As far as medicine goes, I've been taking Flexeril 10mg, 3 times per day.  I took a Vicodin today...but that was because I was going for PT.

There is still a spot on the back of my neck where the skin is numb, and I'm still totally freaked out by this.  Anyone else with neck problems ever experience this?  Tomorrow my pain management doctor is back in the office and will let me know about the x-ray readings and we'll discuss if I still need to get the MRI done that I have scheduled for Wednesday.

Many thanks to everyone who kept me in their prayers...they worked :)

"Room At Arles" ~Vincent Van Gogh

A Pain In My Neck...Again

For the past week the right side of my neck has been hurting like crazy and my normal remedies (heat, massage, muscle relaxers) haven't been helping at all.  And the neck pain that I've been experiencing all week has been different than the pain I usually experience on the left side.  At first, I thought the pain was because of the weather since it started last Sunday when we had freezing rain, but after it didn't let up during the week I started coming to other conclusions.

In the past, the pain on the left side of my neck has been a burning pain that starts at the base of my skull and radiates down my neck, up my head, and across to my ear.  If you remember, I had tried an epidural injection and facet joint injections to help relieve this pain that was caused by the occipital neuralgia that I was diagnosed with two years ago.  (In case you missed it, you can read about why I have neck problems here).

This week, the pain on the right side has been very different than the left.  The right side has been a pinching pain and when it gets really bad it just feels like someone is stabbing me in the neck.  The pain also starts from the base of my skull (but on the right side) and radiates down my neck to my shoulder.  Also, my skin is numb at the back of my neck on the right side.  This numbness freaks me out the most.

The pain had gotten so bad mid-week that I started taking Vicodin Wednesday night.  I was kinda upset at this since I had just stopped taking pain meds for my ankle.  Oh well... I've also been taking a muscle relaxer since Monday to see if that would loosen it up.  By Thursday nothing had changed, and I had a physical therapy appointment for my ankle that day.  I was hoping that my therapist would have some answers.

I know that my neck muscles get tight and just assumed that I probably had some big knots that may need attention.  My therapist looked at it and said that it didn't feel knotty to her and that my facet joint felt a little off.  She was unsure whether that was “normal” for me, considering that I had surgery back there.  Instead of manipulating me too much, she did an ultrasound treatment on the spot where I felt the most pinching and told me that if the pain didn't go away I should see my doctor.

After coming home, I took a double dosage of muscle relaxers and a couple of pain pills (gee, I sound like a junkie!) and called the neurosurgeon that I saw two years ago to see if there was any way I could see him.  Instead, his secretary told me to see my regular doctor first, this way they could order any tests (x-rays, MRI's) and rule out if it is just a muscle spasm.  I had called my pain doctor for an appointment that morning, so I was already set.

I saw my pain doctor today and she shot me up with some steroids in the back of my neck.  It feels a bit better now, but the pain isn't completely gone and I can still feel the pinching.  She thinks that it's probably just a muscle related thing, but ordered an x-ray to be on the safe side.  She also said to keep with the medicine protocol that I had started...muscle relaxers and pain meds if needed.

We shall see how the next few days go.  I have an MRI scheduled for next week, but if I miraculously get better over the weekend than maybe I can cancel it.

Fingers crossed!

5 Week Update – Ankle #2

Last week my therapist gave me the exercise of standing on both feet and transferring my weight back and forth.  This week I can now stand on ankle #2 with about 40% weight without the boot.  With the boot on, I can stand 50/50...pretty even.  The biggest difference is that I don't feel like I want to die from the pain like I did just a couple of weeks ago.  As far as my theraband exercises go...I found my blue band that I was given with ankle #1, and have started using that instead.  It is a step more difficult than the green one I was given last week, so it's a bit more challenging.

The best news is:  I stopped taking all my medicines for my ankle...except on PT days.  The 24/7 pain I was feeling for the first few weeks has subsided and now it just hurts when I work it or if it isn't elevated for a while.  Oh, and the redness I was worried about last week seems to have gone nowhere...thank God!  My incision is a bit red all around, but in a normal, healing way.  Still, it looks gross :)

29 Day Update -- Ankle #2

Today in physical therapy we started weight shifting...oh happy day!  Weight shifting is exactly what it sounds like...you stand up and shift your weight from your good foot to your bad one.  It's pretty painful, especially when you first start.  Right now, I can put maybe 25-30% weight on my operated foot.  The ultimate goal is to be able to stand on my new ankle and balance for at least 20 seconds.

I was also sent home with a green theraband today.  A theraband is a resistance band that is very common in physical therapy.  The different colors indicate the resistance levels.  Even though the green is not too hard, it's still a challenge for me right now.  Doing the theraband exercises is really helpful for recovery and getting your strength back.

Coming home from therapy was tough today...my ankle was really sore.  Luckily it was time for pain meds!  I took one Vicodin and iced it again.  Right now, just a couple hours later, it's back down to a 1-2 pain level.  Not too bad!

There is a bit of redness on my incision that I will keep an eye on.  It looks like I have a bit of a blood blister on it, which may be normal, but I'll need to make sure it's nothing more than that.  I'll monitor it over the next few days and make sure the area of redness doesn't get larger and that I don't get any other symptoms of infection (fever, pain and swelling at the site, etc).

It just started snowing a little while ago and I'm really glad that it waited until after my therapy was over to start...the thought of going out in my crutches and sloshing through slippery snow is scary.

The view from my window is so pretty...I want to go out and catch snowflakes on my tongue!

4 Week Update – Ankle #2

I'm 4 weeks post-op and so far so good!

I am able to shower again...like fully, with no cast care at all!  This is so exciting!  We really take the little things, like showering, for granted.  But anyone who has ever broken a bone and had a cast on, you understand what it's like to take that first shower with no cast care.  Having the warm water run over my foot was pure heaven.  And taking a washcloth to it...oh Lord...thank you for the little things!

Of course, now that I can get my foot totally wet, the steri-strips that they put on a week and a half ago are starting to come off.  Some were hanging on by a thread, so I just pulled them off.  Today I pulled off the steri-strip that was directly over where my incision was leaking (where they had to put the medical super glue).  That was pretty gross.  Of course, I like gross stuff, so it didn't bother me.  Check out my picture page for some updated pics.

I've been lotioning my leg and foot like crazy since my skin is so dry.  And now that I have access to (part) of my incision, I've been putting cocoa butter on it.  Usually, I lather on the cocoa butter in the morning and at night before bed.  I did this with my last surgery, and the scar isn't too bad.  Plus, I like the way it smells :) 

I decided to stop taking my 12 hour release Oxycodone.  It's supposed to be for all day pain relief, and I realized that over the past few days I don't have any pain if I'm just sitting around doing nothing.  Like NO PAIN at all.  Like a big fat ZERO on the pain scale.  Do you understand how awesome this is?  I went from, just two weeks ago, having a 6-7 pain level all the time, to having nothing (I'm still blaming that stupid splint).  The zero pain level is only true if I'm not using my ankle at all.  Physical therapy, of course, counts towards the pain, but so does something simple like showering.  Really, if my foot isn't elevated, even if I'm not using it, it will start to throb.  Once I get my calf muscle back in action and strong again, this should subside.

I'm hoping to get to the point where I only have to take pain meds on physical therapy days.  I could probably do that now, if I was allowed to take my Celebrex (arthritis medicine), but I wake up so achy that I have to take something or I'm in pain all day.  I've been taking the Tramadol in the morning and then again in the afternoon.  And on PT days, I'll switch back to Vicodin because it works better for my ankle pain.  The Tramadol is harsher on my stomach than the other meds and I have to make sure I take it with food.  Even still, some days I just feel sick to my stomach...no matter what I do.  Yesterday I woke up with a headache and sick to my stomach, and went to bed the same way...nothing I did made any difference.

Tomorrow at PT I'll start weight shifting on my ankle.  That should be awesomely painful.  So far, my big homework has been to stretch it.  I use my husband's belt and put in around my foot, and pull towards me. This kills my achilles and I have to ice it afterward, but no pain no gain right?  I'm definitely ahead of the game with my range of motion compared to ankle #1.  Since I started PT at 3 weeks out with this ankle, my foot didn't have as much time to lock up and stiffen on me.  Anyone else who has had ankle replacement surgery...how long did you have to wait until you started physical therapy?

As we ring in the new year, I am reminded of all the hopes and expectations I have for 2014.  I'm not making resolutions, because I feel like that just adds anxiety to my life that I don't need.  Instead, I think of improving my life little by little...in my own time.  Currently I'm working on getting both of my ankles stronger, and I'm always trying to be a better, kinder person.

What are you working on or towards?  Either for 2014, or in your own time?