Wendy Keller is an occupational therapist who works with patients who have had knee replacements She also has had both knees replaced. Wendy says an occupational therapists focus on the IDAL’s: activities of daily living for independence. She talks about how her situation is unique in that she has been on both sides: someone who helps patients with knee replacements and someone who needed bi-lateral knee replacement herself. Wendy danced professionally but had to stop when she was 20 due to a congenital defect in her knees. Both as a patient and a therapist, Wendy stresses the importance of communication.
WENDY: My name is Wendy Keller. I’m an occupational therapist and not only have I worked with people who had knee replacements but I have actually had one myself. Actually I’ve had two. Both of my knees were replaced at the same time and this was an experience.
WENDY: I’m actually kind of glad I did both of them at the same time because it was a way for me to go ahead and do it and get it done. So I was not out of work quite as long. I’m a little younger so I was able to recover faster.
WENDY: An occupational therapist helps people to get back to doing those things that they are no longer capable of doing or they’re not able to do as well as they were able to before something happened. Whether they got sick or they got hurt or they had surgery; something happened that interrupted their ability to do something that is of great importance to them. So we and the government classify those things as bathing, dressing, transferring in and out of the bathtub, transferring on and off of the toilet. And then there’s IADLs which are the activities of daily living for independence. And those are things like being able to clean up around your home; not doing great big huge things; we’re talking fixing a sandwich, putting something in the microwave. The big one that most people want to do is drive. It’s such a huge thing for independence.
WENDY: So an occupation is defined as anything you do that has meaning. So it’s a different experience to be an occupational therapist and be that patient as well. It’s not something that most people would ever probably experience to need the joint replacement and to be recognizing hey, this is impacting my ability to walk up and down the stairs where I live. This is impacting my ability to get dressed. This is impacting my ability to get in and out of my shower and being able to do so safely.
WENDY: I was in pain and I needed to go ahead and take care of this problem so that I could be safe, so that I could be in s-significantly less pain. Now I can do almost anything. I was severely limited in my ability to go do things that almost all of my friends were able to do. When I can’t go out dancing and or I can’t go out and participate in the same things as my friends because gee, I can’t do that because my knees hurt and they’re looking at me like what are you an old lady.
WENDY: There were reasons for that. When I was young I was a dancer and I found out after my very first dislocation of my knee when I was 13 years old that I have a genetic defect in my knees; both of them. Prior to that I was in tap and jazz and ballet lessons. I actually danced professionally. I had my first knee surgery at 13 years old. Before I was 20 I had two more. And that is a problem but they sat me down and said hey at 20 years old if you want to be able to walk in 10 years you’ve got to stop dancing. And I was crushed. I mean just devastated. And they said furthermore you’ve already destroyed your knees to the point where you’re probably not going to make it to 40. I made it to 42.
WENDY: I’m glad that I have both of them then at the same time. It was challenging because it meant that I didn’t have a leg that was “Good Leg”. I had to use the walker just to get around and I was in a lot of pain.
WENDY: Pain management is huge; talk to your doctor’s, talk to your therapist’s. You’ve got to talk to everybody in when they say hey, take your pain medicine before we come into therapy you’ve got to do that. And it’s kind of speaking kind of both sides at the moment; both as therapist and as patient because if I hadn’t taken my pain medication I would have been able to participate in my therapy. And it’s frustrating speaking from the therapist point of view if they don’t take their pain medicine and we can’t work with them because they are in too much pain. So we can’t help them get better.
WENDY: I was able to get back to work in two and a half months and I think that was pretty fast given that a lot of times people take a lot longer just to recover from one knee.
WENDY: In the hospital the occupational therapist will help be focused on what you need to be able to do right before you go home. Most people nowadays are only in the hospital for two, three days tops and then they go home. And that’s when their Home Health occupational therapist will take over. And in the case of a-a knee replacement that Home Health occupational therapist is focused more on the lower body dressing if necessary and how are you able to get in and out of your own shower, how are you able to get on and off your own toilet. In the hospital those toilets are a little bit taller, there’s grab bars, they’re-it’s a little bit easier to do because there in hospitals, their designed to do that. At home your home toilet isn’t necessarily designed for you to be not feeling so good.
WENDY: We also try to teach you how to get in and out of your shower safely. A lot of people get very upset; they don’t want to have to put in grab bars. Oh my God I’m an old person I have to have grab bars now. Um, sometimes it’s a more of a this is my tile and I’d just add it done and it looks really pretty and I don’t want to put a grab bar there. In both cases I tried to tell people hey you know what they make a really nice looking grab bars nowadays, that you don’t have to put in the you know stainless steel ugly ones from the hospital. You can put in white ones, you can put in tan ones, you can put in something that goes with your décor but you’re going to be a whole lot safer if you start to wobble and you have something to grab.
WENDY: Some people try to take their walker into their shower which is also very dangerous because those walkers are not designed to be in a shower where it’s wet and uneven. So we try very hard to encourage people against doing any of those kinds of things. And if they absolutely will not consider it then we always try to encourage them to have somebody right there with them holding their hand, making sure that they are absolutely 100 percent safe while transferring.
WENDY: So we recommend that they have a shower chair. And with a knee it depends on how stable they are; they may or may not really need it for very long so they might be able to borrow one. Nowadays there having their knees done a little younger, people are a little healthier so there’s not as much oven need for the chair for some of the under people.
WENDY: There is something called a 3-in-1 commode that is often misunderstood as being just the bedside commode. But there’s a little bucket inside that you know comes out. If you take it out you can put the whole commode over the toilet and then it becomes something that can-you can use to get on and off the toilet and a can be a little higher. So you’re not having to actually install anything over that toilet for the short time that you may need it.
WENDY: The whole goal here, the whole point of having the knee surgery is that in a short time you’re not going to need these things.
WENDY: Because the hip takes much longer to recover from that and there are hip precautions that have to be adhered to for a longer period of time. There’s a posterior and an interior approach so it depends on how the surgeon did the surgery. But when they do that they tell the therapist and then there something called hip precautions. For one type you’re not allowed to bend over more than a 90 degree angle. And you’re not allowed to turn your feet like pigeon-toed. And you’re not allowed to cross your ankles. So when you’re trying to do something like put on your socks for example you can’t do that. I mean you just can’t get down there. So we have adaptive equipment that helps with that. We have things called a soft aid, dressings stick, grabbers; most people are familiar with what the grabber is.
WENDY: A dressing steak is something that doesn’t look like anything that makes any sense at all but it is very helpful for a lot of like pulling and pushing close around but it’s also great for when you’re in recovery, being able to pull those covers up and push them down and it actually because it won’t snag on clothes and that kind of thing.
WENDY: The sock aid you can put the sock on, put it on the ground, put your foot in it; it’ll pull up, it’ll pull your sock on.
WENDY: We want to give the hip the chance to heal up so we’re going to give you some things that will allow you to still get that independence back.
WENDY: We usually see patients right after they have surgery in the hospital and then we see patients when they go home for usually two to three weeks and we see them between one to three visits, one, two or three visits a week depending on the patient and how they’re doing. And the same is true for my cohorts in physical therapy. They’ll see them in the hospital, they’ll see them in home health and then they’ll see them in outpatient. So we kind of work as a team in tandem.
WENDY: A lot of times what I’m working towards is helping both the patient and the caregiver to understand how to best project this person towards health. They both have to do certain things in order to help the patient get to their optimal state of well being. And when I first go in for the eval I asked the patient what do you want to do, where do you want to go, watch your goal; are you trying to be able to drive race cars again? Okay well then let’s try to get there. What do we have to do? We’re going to start here, we’re going to there, let’s try to get there. And it’s not just about the patient it’s also about the caregiver. Each person has a role in that process.
WENDY: When I have to deal with a patient that is really resistant and they keep saying I can’t, I can’t, I can’t, I can’t I start going look can’t is a four letter word. I don’t like four letter words. We’re going to change to I’m struggling with this right now. Changing the words that are coming out of their mouths are really starts to put a worm it in their head and it stars changing their mind. It sounds very simple but it really, really works.
WENDY: It’s really important when dealing with a patient who’s had joint replacements that they use their-use their ice, use those things that they have available to them. Be ready for the therapist when their coming to see you. Be willing to do your exercises. Do your homework. We ask you to do these exercises, we expect you to do them. Not only do your exercises but I think outside the box a little bit and try to do things that are going to help you get better.
WENDY: The doctor has given you restrictions; whether it be that they don’t want you to bend your knee too far or they don’t want you to bend over too far or they don’t want you to cross your legs. They want you to use the walker; they want you to stay off it for a certain length of time. There could be other things that are going on in your health profile that are in addition to the knee surgery or the hi-hip surgery and you need to adhere to whatever those restrictions are.
WENDY: If it’s a walker they don’t belong in the air. So picking them up and walking around with them in the air is not useful; it’s not safe. Putting them in the shower; not safe.
WENDY: Don’t overdo it. If we ask you to do two sets of 10 of something to two sets of 10 not two set the 50. Because that’s overdoing it; you’re just going to make your muscles tired. You’re just going to make the ligaments tired. All you’re going to do is just a aggravate everything, it increased the swelling and that’s not good.
WENDY: Swelling is a really big problem. It creates a lot of pain and it can in the end actually lead two some creation of scar tissue. A can create a lot of other competitions which we don’t want. So ice, ice is huge. We’re asking you do these things because we have lots of experience and we’re not just saying it because we’re moving our mouths and doing it for our own exercise. I’m saying them for your health. And that’s why we’re here is to try and help you. Not to just do it for us. We’re doing it for you.