Post-op Activity Levels

I think it’s really important to clarify a bit on what the expectations are about post-op activity levels.

I had my own DS coming up on 6 years ago in Spain with Dr. Baltasar. I was one sick girl – my doctors had told me I’d live no more than 6 months without drastic intervention. Hence, the DS!

I was wheelchair-bound, and had been for a couple of years. I could stand for maybe 30 seconds. My BMIwas 64. Dr. Baltasar said to me, “the goal is to walk one step further each time you walk.” I was up walking to the toilet within 4 hours of surgery.

Within 24 hours of surgery I’d walked from my bed to the doorway of the room and then one step further to just out in the hallway. That was a banner day! I had (and still have) big time orthopedic issues. I have degenerative joint disease. I’ve got bilateral grade 4 degeneration of my knees and need both knees replaced. Last August I had my right hip replaced- I’m 44 years old. Right now I’m in a cast because they’re trying to immobilize my ankle long enough to decide if I’m a good candidate for ankle replacement. You get the idea – a mess!

By the time I was 1 week post-op from my DS I was able to walk 1/8th of a mile. May not sound like much to anyone – but to me it was a MIRACLE! I walked that far standing behind and holding onto my wheelchair. By the time I’d flown home to Oregon and was alittle more than 2 weeks post-op I was able to walk nearly a mile – I had to have my wheelchair with me for the trip back from wherever it was that I’d walked to, but hey – amazing!

By the time I was 3 weeks post-op I’d given up my wheelchair and was using 2 canes. By the time I was five weeks post-op I was down to 1 cane.

By the time I was six weeks post-op I was using no canes and was finally brave enough to get rid of the wheelchair.

For me, it was baby steps.

I guess one thing that I should clarify is that within just days some of my constant high-level chronic pain had begun to subside some. I know for certain that the constant swelling I experiencedwith both knees had decreased dramatically by the time I was a week post-op.

Part of the reason I was able to stand longer and walk further was that my pain was so much improved. The other reason was that I went into it determined to NOT sit on my fanny and feel sorry for myself. I also have a history of having had blood clots (five different instances since my teens)- I knew for sure I didn’t want to have a DVT or PE or any other kind of complication, and everything I knew from my work (I worked in health care)and research told me I needed to be disciplined about moving. So I did.

I’ve now gone back to Spain ten times as a support person to lots of other patients. There are some basic things that we have to have an understandingon before I’ll ever agree to be someone’s support person:

  1. You have to do what I tell you.
  2. You have to do what I tell you even if you think I’m obnoxious and a pain in the butt.

And the things I tell them:

Never stop doing pedal exercises. (Seehttp://www.bodybybaltasar.com/html/travel.html – click on the In-Flight Exercises link.) From the moment you board the plane you keep doing the exercises – even when you’re waking up after surgery – keep doing theexercises. Whenever you’re sitting anywhere – keep doing the exercises.

Sitting up is way more comfortable than lying down.

If you’re having discomfort – try moving before asking for pain medication.

Get up and walk at least one step further each time – once an hour during waking hours.

No bending at the waist to pick up stuff from the floor, or to tie shoes, orthe like.

No lifting anything heavier than 10 pounds the 1st week post-op.

Once they’re cleared to drink – take a sip (teaspoon sized) every five minutes during waking hours.

Once released from the hospital – continue the walk once an hour during waking hours thing.

After released from the hospital – one two hour nap a day, or two one-hour naps a day. The rest of the time stay out of the bed, get off of the couch, etc.

Use pain medication as needed – but stay alert, remember the more you move,the less you’ll hurt.

Make sure to adhere strictly to the post-op diet (we do 2 weeks of liquids after surgery with Dr. Baltasar).

Be certain to get calories in at least every 2 hours – that’s probably too long those first few weeks.

It’s basic stuff, but it really and truly does help and make a big difference.

That all being said, I’ll add that I carry a pedometer in my pocket everyday – whether I’m at home or abroad. My goal is always to try and get in 10,000 steps a day (which can be a challenge now that I’m in a cast!). When I’m in Spain I make note of how much a patient walks each day. On average, most patients are able to walk a mile by the third or fourth day post-op. It’s not about doing it quickly or all in one stint.

We often go down tothe Mediterranean (Benidorm, Alicante, Altea, Calpe, the general area of the Costa Blanca – which, incidentally is endorsed by the World Health Organization as one of the best places to recover from an illness or surgery!) and stay in one of the little towns along the Coast. Virtually all of the little towns have beautiful beaches and lovely tiled promenades running along the beaches – with benches every so often. I always encourage patients to walk as long as they feel they can do so comfortably, then find a bench, plant yourself, watch the ocean, watch the people (always fascinating!), close your eyes and soak up some of the lovely sun. Then, after a brief rest, get up and walk a little further – until you need to rest again. It’s truly not about walking miles – or even setting any particular distance record – it’s about the motivation behind it. Do I want to have a blood clot? Do I want post-op pneumonia? Do I want to be on meds for pain for a long time – or free of them sooner? Do I want to heal faster? Do I want to be able to step back into my life sooner?

Every patient’s condition – is of course – individual and unique to them, even though we all share some common things that we’ve suffered from or gone through. I’ve been to Spain three times with a patient who was wheelchair-bound – but every single one of them has been willing to get up and at least try to walk a few steps if it was at all physically possible.

This most recent trip to Spain (mid-May 2008) I had a patient who had been pretty significantly immobile due to a number of health issues. This same patient is the one who walked 2.5 miles the third day post-op. I, frankly, was blown away at the level of dedication and honest assessment that was made by that patient to stop and self-assess (at my urging) periodically and say,”Am I in pain? Experiencing growing discomfort? Short of breath?” This patient continued the rest of the trip in this same mindset – the day we walked the most we covered 3.5 miles. We flew home on the 13th day post-op. During the last three days alone we saw the Prado, The Royal Palace, took a tour of Historic Madrid, took in a midnight Flamenco show, among other things!

I truly believe that a patient’s frame of mind and willingness to be disciplined those first two weeks post-op have a HUGE impact on how the rest of recovery will go.

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