I have not been blogging for a while- for a good reason. I had total left knee replacement surgery on March 8th. I postponed the surgery for as long as I possibly could because I knew that, even though I would love the outcome, it would be difficult, especially the physical therapy part. I thought that I was very well prepared about the surgery and the physical therapy afterward. As it turns out, I was not as well prepared as I thought. I had the worst bruising and swelling in the operated knee that my physical therapist has ever seen! I followed all of the instructions that were given to me by my physician. I did all of my physical therapy- both at home and twice weekly in an outpatient setting. I had such bruising and pain in my leg, that I was sent to the hospital to get an ultrasound to make sure that I did not have a blood clot. Thankfully, that was not the case. But why all of the swelling and bruising? And why am I making such slow, or sometimes no, progress? I know that every person is different, but my physician, my physical therapist, and even myself, had all expected a different outcome for me.
I have put a lot of thought into what factors may have caused such slow healing, swelling, and to be honest- pain. I have researched this, and I did find some possible answers from a few medical abstracts. Here is what I found out.
First, and my physical therapist talked to me about this, I have lymphedema on my left side from breast cancer surgery that I had done in 2015. Lymphedema is a chronic condition and is defined by an article in " Wound Care Advisor", written by Erin Fazzari, MPT, CLT, CWS, DWC, as: " a condition of localized fluid retention and tissue swelling characterized by high-protein edema caused by a compromised lymphatic system. All exterior regions of the body ( for example, face, neck, torso, extremities and genitals) can be affected. "
I will translate that a bit, and put it in my own words. Our lymphatic system is like our internal vacuum cleaner. Everyone has " trash"in our bloodstream from our bodily functions that needs to be removed. We all have hundreds of lymph nodes that are connected by lymph glands. Within the glands, there is a fluid that passes through the nodes and picks up, sort of like a vacuum cleaner, all of the waste products from cell destruction, bacteria, and viruses, among other things. This " trash" is filtered by the lymphatic system before the fluid is dumped back into the bloodstream. Our lymphatic system is a very important part of our immune system.
When I had breast cancer surgery, I had a few lymph nodes removed. I also had eleven lymph nodes removed when I had thyroid cancer surgery. My lymphatic system is now a little challenged, to say the least. This fact probably accounts for some of the excess swelling and bruising that I had after my knee replacement surgery. But I wondered, could there also be something else going on? How about my hypothyroidism? Even though I am on thyroid replacement hormones, I do not have a thyroid gland, and my thoughts are even if one has the best combination of thyroid replacement medications, and one's dose is correct, this still does not make up for a healthy, functioning thyroid gland!
I was able to find one study on the possible link between delayed healing and hypothyroidism. It is from the journal PLOS/ONE, and is titled: " Impaired Hair Growth and Wound Healing in Mice Lacking Thyroid Hormone Receptors.", published, September 25, 2014. Author, Constanza Contreras -Jurado, et. al. Keep in mind this was a study on mice, but I learned some very fascinating things. I already know that the thyroid gland affects every organ and cell in the body. But here are some very interesting facts from the study.
First, the skin is a target organ for thyroid hormones, and changes in thyroidal status can lead to skin alterations. Secondly, having thyroid receptor deficiencies can affect the regulation of collagen deposition during wound healing. Thirdly, the data from this study showed that cutaneous wounds heal more slowly and show reduced collagen deposition in the mice lacking thyroid hormone receptors. The author concluded that thyroid hormone administration accelerates wound healing in mice.
I have saved the best for last. The author concluded that topical treatment with thyroid hormone accelerates wound healing in mice. In another study that I came across, there is an ongoing trial of topical T3 solution that has shown promise in wound healing( in mice at the present time.) This is exciting news to me! I am looking forward to the results of this study, and the possible positive impacts this may have on wound healing in humans.
So, I have had a bit of a rough go in the healing process with my knee surgery. I am starting to make a little progress in the four and one-half weeks since I had the surgery. It helps me a bit to understand what may be impeding my progress and somehow this keeps me from being so discouraged. So, I am not the hare in the race, I am the turtle. But I will get there.
