Friday, January 18, 2019

My experience with knee replacement surgery

By BOB JOHANNESSEN | LDH Communications Director

With a family history of arthritis and bad knees, plus more than 40 years of high-impact sports (basketball, volleyball and soccer), I should not have been surprised when my doctor suggested I would be returning to him anywhere from a year to 10 years for a knee replacement.

The conversation occurred in 2005 after I injured my left knee in a soccer match, resulting in arthroscopic surgery to repair the meniscus. In a follow-up visit after the surgery, the doctor said my knee should be fine for another 10 years … but only if I stopped running and cut back on the amount of soccer I was playing at the time. If not, he said, I should just go ahead and schedule the knee replacement soon.

Therefore, I took the doc’s advice, giving up running altogether and limiting soccer to one game a week. Nothing more.

He was right: Everything was good, and I kept playing well into my 50s. However, about eight years after the surgery on the left knee, my right knee failed altogether and it was time for a total knee replacement. That was two years ago; and just two months ago, I returned for a right knee replacement.

My goal is to share my experiences in order that anyone else making the decision to get a new knee can be as informed and prepared as possible. Consider this the alternative to this article, 9 Things No One Ever Tells You about Getting a Knee Replacement.


When should you begin considering a knee replacement?

The best answer is to consult with your doctor. Although you might hear people saying, “I should have done this sooner,” the right answer is unique to each person and each knee. When I asked my doctor, he said, “You will know when the time is right.” With the right knee, over several years I went from pain relievers and physical therapy, to cortisone shots, to almost unbearable pain before agreeing to the surgery.

Two years later, I didn’t wait for the pain to get too severe. Instead, the prompt for the surgery came as I tried to traverse my daughter’s hilly college campus on her first visit, discovering I could not easily go up and down the many earthen stairs, or the stairs in the buildings. I also could not keep pace with other members of the tour groups and was the only parent who waited for an elevator.

How much will it hurt?

I believe this depends on your pain threshold as well as knowing that each surgery is different. As with any surgery, there will be pain as your knee is cut open and a replacement part is installed. It takes time for the wound to heal, the swelling to subside and the need for the use of painkillers to go away.

With my first surgery, I used a walker for two week, then a cane for another month. I was dependent on (not addicted to) to strong painkillers for a few weeks, then got my non-narcotic painkillers refilled about four times. I recall the pain being severe whenever the medicine wore off, with nights being most troublesome.

It was much different the second time. I ditched the walker almost immediately – just a few days after getting home. In addition, I didn’t use the cane too much, only for the long walks from the parking garage to my office. I did not need any narcotic painkillers, and I only had two refills of the mild medicine. My pain level was almost nonexistent, although it was still uncomfortable to sleep.

How long does it take to recover?

Although the knee will swell after the surgery, and can take anywhere from three months to a year to return to normal, isn’t so much about pain as it is about limited flexibility. With both of my surgeries, I scheduled in-home physical therapy, five days a week for two weeks. This PT was all about regaining my range of motion. The PT, plus regular icing, had me bending my knee enough to put on my socks and pants by myself a week after the second surgery. This was much different from my first surgery where it took about three weeks to do these routine tasks.

Following both surgeries, I was back at work after a few weeks. As for driving, I could do that after two weeks when it was my left leg. However, I needed to get a ride to the office for about a month following the right knee replacement, as this is the driving leg.

What about therapy –  how much does it hurt?

Following the two weeks of in-home PT, I have been doing outpatient therapy twice a week for a couple of months. Don’t be scared by people saying therapists are masochists or the pain is excruciating. Both are false.

Almost all of my physical therapy has involved range of motion, strengthening my core, quads and glutes, and strengthening the new knee. The therapist designs the program, teaches you the right techniques and times your intervals. Any pain is completely self-inflicted, as my routines never involved the PT’s hands on my body. Massaging of the affected knee to combat the scar tissue and inflammation are the only times that I’m touched by the therapist.

Tips for success

ICE WRAP: Invest in some type of Velcro cold therapy knee wrap. For less than $20, this makes it super easy to ice your knee on a regular basis.

TRANSPORTATION: If it’s your right knee, find a friend or co-worker who can take you to and from your work location. Plan on needing their help for about four weeks.

SHOES: Shoes can make the difference. On my third outpatient visit after my first surgery, my therapist looked at my aging Nikes and noted they were not conducive to a good recovery. “You need new shoes,” she commanded. “These have formed to your old knee and will keep you from progressing.” I went straight to the New Balance store and was fitted for a new pair.

Temper your expectations

The most frequent response I get when asked about my new knee is, “So, you’ll be running a marathon soon, right?” Nope. I did not run long distances before and I’m not going to begin now. Nor am I going to be playing soccer again. These were not the goals.

Instead, I’m glad to be pain free in the right knee and on the way to the same with the left. I’m counting on resuming my 2-mile morning walk (I’m halfway there today) and maybe even coaching a youth soccer team again. Finally, I look forward to visiting my daughter at college and navigating that hilly Samford campus with youthful vigor. 

Friday, January 11, 2019

Cold weather often brings strep throat


Few things are as painful as strep throat. Strep is a burning sensation that is there every time you swallow. It’s nasty, it’s irritating and just plain makes you miserable.

Just like the flu and the common cold, this dreaded illness is most common when the outdoor temperatures get colder. Strep throat, often simply called strep, is common among children ages 5 to 15, and always increases in late fall, winter and early spring. It is caused by group A Streptococcus bacteria, which live in the nose and throat.

The spread of strep

People infected with strep spread the illness by coughing or sneezing, creating small respiratory droplets containing the bacteria. Other people can become infected if they breathe in the droplets, touch something with the droplets on it and then touch their mouth or nose, share the same cup or plate as an infected person or touch skin sores caused by strep (impetigo). Rarely, a person may become infected through food that is improperly handled.

Strep can spread quickly wherever there is close contact or large groups of people, making schools and daycare centers a prime breeding ground for the illness. However, that doesn’t mean adults can’t get strep. It’s just more common among children.


Symptoms

Though it’s generally a mild infection, strep throat can be very painful. Infected persons will become ill two to five days after being exposed to the bacteria. Common symptoms include:
  • Sore throat that comes on very quickly
  • Pain when swallowing
  • Fever
  • Red and swollen tonsils, sometimes with white patches or streaks of pus
  • Tiny red spots on the roof of the mouth
  • Swollen lymph nodes in the front of the neck

Additional symptoms may include headache, stomach pain, nausea or vomiting, especially in children. Some people who contract strep throat also develop a rash known as scarlet fever.
Strep’s symptoms can mimic viral illnesses. If the illness also includes cough, runny nose, hoarseness of voice and/or conjunctivitis (pink eye), the culprit is not strep but a virus.

Diagnosis and treatment

Diagnosis comes from your doctor, who will perform a rapid strep test or throat culture. Upon confirming the diagnosis, your doctor will treat you with antibiotics – either penicillin, or amoxicillin if the patient has a penicillin allergy. The medication decreases symptoms and the length of illness, and prevents the spread of bacteria and serious complications.

Serious complications are uncommon but may include:

People infected with strep should stay home from work, daycare or school until they no longer have a fever AND have taken antibiotics for at least 24 hours. Symptoms should start to ease within a day or two after beginning antibiotic treatment.

Prevention

Practicing good hygiene habits is the best way to prevent the spread of strep throat.

Always cover your mouth and nose when you cough or sneeze. If you use a tissue, put the used tissue in the trash. If you don’t have a tissue, cough or sneeze into your upper sleeve or elbow. After coughing or sneezing, always with your hands with soap and warm water for at least 20 seconds. Alternatively, if soap and water are unavailable, you may use an alcohol-based hand cleaner.

Wash any glasses, utensils and plates after they have been used by someone who is sick. Once washed, these items are safe to use.

Friday, January 4, 2019

Learn the facts about birth defects


January is National Birth Defects Prevention Month, an effort to raise awareness of birth defects, their causes and their impact. March 3 is recognized as World Birth Defects Day. This year’s theme is “Best for You. Best for Baby.”

About 1 in every 33 babies born every year in the United States is affected by a birth defect, or about 120,000 babies each year. According to the Centers for Disease Control and Prevention (CDC), birth defects are structural changes present at birth that can affect almost any part or system of the body, such as the heart, brain or limbs. Birth defects may affect the way a body part looks, works or both and can vary from mild to severe.

Birth defects are usually detected within a baby’s first year of life and may be easily visible, such as a cleft lip, or found during testing, such as a heart defect. Some may be treatable, such as surgery for cleft palate, and some may be fatal, such as anencephaly.


Causes

A baby can develop a birth defect during any stage of pregnancy, though most occur within the first three months, a very important stage of development. Other birth defects may occur later in the mother’s pregnancy while tissues and organs continue to develop.

The cause of most birth defects is unknown. Some factors that may play a role in birth defects include genetics, behaviors and environmental factors. The CDC lists these factors among contributors to birth defects:
  • Smoking, drinking alcohol or taking certain illicit drugs during pregnancy
  • Certain medical conditions, such as obesity or uncontrolled diabetes before and during pregnancy
  • Certain medications, such as isotretinoin, used in the treatment of severe acne
  • Family history of a birth defect
  • Being an older mother, typically over the age of 34

Prevention

Not all birth defects are preventable. Some things a woman can do before and during pregnancy to lower the risk of having a child with a birth defect include:
  • Prenatal care as soon a woman knows she is pregnant and regular healthcare checkups throughout the pregnancy
  • Taking 400 micrograms (mcg) of folic acid every day, beginning at least one month before getting pregnant
  • Avoiding alcohol, smoking and illicit drug use
  • Talking with a healthcare provider about the medications she is taking or thinking of taking, including prescription drugs, over-the-counter medications and dietary or herbal supplements
  • Taking steps to prevent infections during pregnancy
  • Keeping any medical conditions, such as diabetes, under control before becoming pregnant
  • Eating a healthy diet that includes fruits, vegetables, whole grains, low-fat dairy and lean proteins
  • Maintaining a safe level of physical activity

Resources in Louisiana

The Louisiana Birth Defects Monitoring Network, part of the Louisiana Department of Health’s Bureau of Family Health, works to prevent birth defects and birth defect-related disabilities within the state, as well as providing support, services and resources. Visit ldh.la.gov/lbdmn for more information.