HerbM: Here We Go Again, Bilateral TKRs for late October/early November

[HerbM]

@HerbM our grandson is suppose to be autistic but I don't see it. He seems like any other kid too me. He was a little slow talking, but so was my husband and my dad, and my son in law (his dad). I have babysat him since he was a month old and would be hard pressed to say he is autistic, but he was diagnosed as such. A friend of ours has 2 autistic children and you can tell they are autistic. Really great kids though. Your grandson looks adorable!

Thanks, Andrew is definitely 'autistic' or something that is affecting his mental development whatever we call it.

He is truly adorable and a real lovey. What you see in the avatar is me at *my* best and Andrew at *his* normal happy self for everyday.

This is the reason I used this picture as my avatar on "health & therapy sites" much of the time.

He's talking some and making progress but it will be hard for him to really complete an ordinary education unless there is some new breakthrough.

On the other hand, he is not autistic in the typical TV/movie or other stereotype sense as he loves to be hugged, loves to be tickled ("tickle me"), loves to be with people and pets. Very lovey dovey.

 

[tiredwife]

@HerbM The state paid for some therapist to come work with our grandson and that helped his speaking. He is also very loving, loves attention, loves to make people laugh, smart as a can be (he has been using a computer since he was 2), looks you in the eye, and loves to have you play cars and super heroes with him. Now they say autistic spectrum which covers a huge amount of problems.

 

[HerbM]

I was wrong, exercise does accelerate wound healing, as does stress reduction (and perhaps in other ways).

Turns out the effects are clinically significant (as opposed to merely marginal).

I apologize.

The following Google search of Scholarly Articles [Exercise Accelerates Wound Healing] pops 17,000 scholarly references even when filtered for "since 2010".

"Exercise Accelerates Wound Healing Among Healthy Older Adults: A Preliminary Investigation" Charles F. Emery

"EXERCISE ACCELERATES CUTANEOUS WOUND HEALING AND DECREASES WOUND INFLAMMATION IN AGED MICE" Keylock, K. T.
“The key point of the study is that moderate exercise sped up how fast wounds heal,” Keylock said in a statement. “The thought is that the exaggerated inflammatory response slows the healing process. And if exercise can help decrease the amount of inflammatory cytokines put out by macrophages maybe that would help decrease the inflammation, and therefore, speed healing.”

Can Exercise Accelerate Wound Healing?
Home / broken link removed: https://www.advancedtissue.com/category/wound-healing/ / Can Ex ...
July 22, 2014https://broken link removed: https://www.advancedtissue.com/can-exercise-accelerate-wound-healing/

Various studies have been conducted to help cement this correlation. Researchers from Ohio State University first explored how exercise is able to accelerate wound healing stages. To their surprise, it was found physical activity can cause an increase in cortisol levels, a hormone that is often produced through stress and routinely considered an enemy to good health because of its association with lowering immune function and increasing symptoms of depression. Previous studies have reported that exercise can lower your production of cortisol; however, the researchers noticed a significant increase in cortisol levels in their participants who engaged in various exercises. The spike in cortisol production was also linked to subjects having a quicker wound healing time, with daily intervals of exercise leading to a 25 percent faster treatment process for the participants.

[RED Emphasis Added]

The Impact of Psychological Stress on Wound Healing: Methods and Mechanisms Jean-Philippe Gouin
broken link removed: https://www.advancedtissue.com/can-exercise-accelerate-wound-healing/
"This result suggests that the relationship between stress and wound repair is not only statistically significant but also clinically relevant. This review presents data and methods from observational, experimental, and interventional studies corroborating the impact of stress on wound healing."
[Emphasis added]

Exercise enhances wound healing and prevents cancer progression during aging by targeting macrophage polarity
Jorming Goh https://www.sciencedirect.com/science/article/pii/S0047637414000438
"Physical activity, which can include regular and repetitive exercise training, has been shown to decrease the incidence of age-related diseases. Aging is characterized by aberrant immune responses, including impaired wound healing and increased cancer risk. The behavior and polarized phenotype of tissue macrophages are distinct between young and old organisms. The balance of M1 and M2 macrophages is altered in the aged tissue microenvironment, with a tilt towards an M2-dominant macrophage population, as well as its associated signaling pathways. These M2-type responses may result in unresolved inflammation and create an environment that impairs wound healing and is favorable for cancer growth. We discuss the concept that exercise training can improve the regulation of macrophage polarization and normalize the inflammatory process, and thereby exert anticancer effects and enhance wound healing in older humans."


I am going to continue to exercise at my maximum safe and reasonably comfortable level and plan to do so as early and as often as practical for my BTKR.

 

[Roy Gardiner]

From the first article:

..if exercise can help decrease the amount of inflammatory cytokines put out by macrophages maybe that would help decrease the inflammation, and therefore, speed healing.

And

When engaging in physical activity, you will need to accommodate your wound with specific exercises that won’t hinder the injury. For instance, if you have an ankle or foot wound, running probably isn’t a suitable solution. Low impact exercises such as swimming and cycling are the best when dealing with lower limb or foot injuries, because minimal pressure is applied to the wound while still achieving cardiovascular activity. Rowing machines are an excellent source of physical activity that can build endurance and stimulate blood flow while dealing with a hurt leg or knee.

However, all of the survivors here know that if you walk/run/cycle/whatever too early you will increase the inflammation of the knees, increase pain, worsen recovery. Training exercise not involving the knees I'm sure would be helpful -- however I did Fanny Adams and still had an exemplary recovery.

 

[HerbM]

It almost goes without saying that if you are over-using it to the extent of significant swelling, inflammation etc. you are doing too much -- especially if ice and NSAIDs don't immediately resolve that.

The point being that exercise UP TO (or somewhat less than) that point is pretty much proven to speed healing.

My apology was for saying that healing time was (more or less) fixed. It's not.

 

[Jamie]

The study you cited has to do with wound healing. This is not the same as healing from surgery. This is a critical difference when you are talking about a major surgical procedure that involves manipulation of deep tissue, muscles, ligaments and bones. The surgical incision could be considered in the most strict sense to be a wound. But with surgery there is a lot more that goes on once the skin is incised.

In this study, please note the use of the word "cutaneous".....this is the surface of the skin...not deep tissue and bones. They are talking about wound healing from injuries, not a surgery.

So, yes, it's true that some activity is always a good thing for your body. "Exercise" will not make you heal any faster from major surgery.

 

[HerbM]

Go read a lot more of the Google search references, some of them are explicitly about surgery anyway but you are free to add 'surgical' or such to the search.

Also note that your body's healing process hasn't a CLUE whether the knife was wielded by a surgeon or a criminal except the surgeon probably causes less irrelevant trauma.

And yes, they call it a wound even when it is a surgical incision.

 

[kneeper]

I think your key point @HerbM is "constant monitoring." Here we call it "listen to the knee."

 

[HerbM]

I think your key point @HerbM is "constant monitoring." Here we call it "listen to the knee."

Absolutely. Both.

"Constant monitoring" is about not presuming the joint can do what you think it will do, and maybe it can't do what it did yesterday even.

"Listening to the joint" is about the process of analyzing the feelings and your level of effort to determine if you are staying inside the safe envelope.

We want to make as few excursion (and as small as possible) outside that "safe envelope" (e.g., a fall is almost always a serious excursion during joint recovery and for some people a fall is ALWAYS a serious excursion.)

We can feel the difference between good and bad 'pain' and also watch that even good pain doesn't tire or inflame the joint. Some of us are really experienced with this (even without a prior JR) others don't understand it at all and this requires them to be far more conservative.

To clarify, I am far more aggressive than most people here would RECOMMEND to someone else, but oddly enough, I agree with (most of) those more conservative recommendations for MOST OTHERS.

You won't hear me (generally nor very often) telling people to do more but you will hear me recommending they "listen to the joint" and "constantly monitor" the feedback it gives to both every step (or other movement) AND to any "activity" they undertake.

Also I am very adamant that no one should "try to do X" when "X" is a big or difficult thing.

What I mean is someone says, "I am not walking very well but tomorrow, I am going to try to make it to the mailbox" then likely my response will be a large CAUTION.

Figure out what you KNOW you can DO,
and KNOW you can do SAFELY
DO that
No more.​

If that works out well then consider doing more, but only what you are NOW confident must succeed.

No one should EVER try to emulate my ACTIONS and BEHAVIOR.

It COULD be appropriate to follow my philosophy and strategies and adoption of some of my tactics, actions, and behaviors when each is appropriate but that requires the "constant monitoring" and "listening to the joint" we discussed above.

 

[Jane B.]

HerbM, interesting stuff. My husband is a physician and researcher. He always says, "Show me the data!" It sounds like you are a "Show me the data" kinda guy. Me too.

I hope your surgery and recovery proceed as you hope. Glad you bought the recliners!

I had very little time with my orthopedic surgeon, but I asked if both knees could be done at once. My left is not bad enough to do now. I felt that going through this once is WAY better than twice.

Unlike you, I wish I could go to rehab. I am so darn independent and do not want to ask my kids for help. It's different with my husband, but he will be back to work and puts in long hours.

We do have different wants and needs, don't we? Makes people fascinating.

 

[Josephine]

Herb, you confuse the essence of healing with our views on recovery. Two totally different aspects. Maybe when you get your knees done you will understand.

 

[HerbM]

Quick update on my plans for Inpatient Rehab PT after the BTKR:

It turns out this hospital is 5 minutes from my house and it is owned by the same hospital as my surgery. I didn't know their excellent PT program also ran up here and it turns out it not only has the program but also has an Inpatient service.

I can stay 5 minutes from home when doing my knees so my wife will be right nearby all the time and won't have to go 30 minutes each way.

ALSO, the nearby one "has a pool" but it turns out the pool is OUR YMCA where we belong and it is 5 minutes away as well! If I am doing the pool from the Inpatient Rehab they'll have to drive (almost) by my house to get there and back.

I love it when a plan comes together.

 

[HerbM]

Herb, you confuse the essence of healing with our views on recovery. Two totally different aspects. Maybe when you get your knees done you will understand.

You could be correct. Maybe you will.

Not sure that I have seen a clean distinction or definitions of these words anywhere here.

I can imagine that what you mean is the same as the meaning of those words to me, but it would likely be incorrect (or at least incomplete) in some important way(s).

Surely you have an article or it would be worth writing one....?

 

[HerbM]

HerbM, interesting stuff. My husband is a physician and researcher. He always says, "Show me the data!" It sounds like you are a "Show me the data" kinda guy. Me too.

I hope your surgery and recovery proceed as you hope. Glad you bought the recliners!

...I felt that going through this once is WAY better than twice....

...wish I could go to rehab.
I am so darn independent and do not want to ask my kids for help. It's different with my husband, but he will be back to work and puts in long hour...

Glad you find it interesting and thank you for the good wishes.

Yes, I am a show me the data kind of guy, but data must become information, and works best when mixed with experience to produce wisdom. Still working on that

I am also fairly comfortable in the absence of the data when it just doesn't exist. You integrate what you have and make the best logical analysis possible, THEN you let your intuition and feelings choose.

(It doesn't work nearly as well in the other order, you end up trying to PROVE what you already feel is right or filtering so you only see and hear facts that supports your feelings. <----- BEWARE DEEP STUFF HERE)

Once is definitely better than twice (I hope and) in my estimation.

Well as you can probably guess my independence is very important to me, but I just won't let that desire to be self-sufficient put me in a WORSE position where I will need more help than originally.

And, I really can't afford to pretend to be independent while my wife acts as sherpa trying to carry *ME* up the mountain (Love that 'sherpa' word, stole it from another lady's recovery thread.)

So I will take ALL the help I need and some that I probably don't need.

I want it cushy ;)

 

[HerbM]

@rosietosie is doing a BTKR right now & suggested I read @Crow22 & @ljrfrm since they are had TKR this month as is she (rosietosie).

I was reading a BTKR recovery thread from a guy in Dec 2011 I believe when my browser crashed and I lost the reference -- it didn't get picked up in my Firefox tab history for some reason or it's a tree hidden in my forest of tabs so I'll find it one way or another.

If anyone has a reference to their own or another interesting BTKR thread, it would please me for you to add it here in my pre-op thread. (Thx in advance)

 

[Roy Gardiner]

I was reading a BTKR recovery thread from a guy in Dec 2011

Could be me, linked from my sig below.

 

[HerbM]

It WAS you @Roy Gardiner ; thanks for saving me the search to find it again. I had only started reading it late this evening and only gotten through a couple of days.

You and I haven't really chatted much (yet) so wasn't sure of the name. My plan is to read the ENTIRE log which is so far very interesting beyond just being about BTKR which I need to understand more fully.

I presume you and your new knees are doing well almost 3 years into the relationship? I sure hope so.

 

[Roy Gardiner]

Pretty much.

I can't sit on my heels (flexion is about 135), but then Mr Lazy isn't doing the stretching required to make it so. I can run a bit, although I look like a marionette with tangled strings.

But I can walk and ride my bike as much as I want, limited only by myself not my knees. Walk up and down stairs carrying cups of tea (demanding wife, what can one do ?) without spilling them. All in all a gazillion (roughly) times better than before.

 

[HerbM]

Great news. I am so happy for you (and for my prospects.)

I haven't sat on my heels in almost 50 years in any case (though I would like to do that since some martial arts training uses that seiza position and it would be nice to not ALWAYS be 'different' from the other kids. )

Probably couldn't have gone upstairs without spilling the tea either. It's kind of like the old joke (stop me if you heard this):

Patient: "Doc, after the operation will I be able to play the piano?"
Doc: " Once we fix you up I don't see why not, sure, you'll be playing in no time."
Patient: "Fantastic operation Doc, I never could learn to do that before."

 

[Roy Gardiner]

I haven't sat on my heels in almost 50 years in any case

Hmm, it depends on why that is. In my case it was firstly a long term injury (I fell over my next door neighbour's dog when playing with him; he wasn't hurt) followed by arthritis. Now there's no restriction - injured knee now in a bin somewhere, arthritic bone spurs removed) but that my tendons have shortened over the years. If it's similar for you, IMO you'll be able to gain full flexion, but I bet it will take a long, dedicated time. The doctors should be able to tell you - although in my experience they tend to be pessimistic.