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[PARTIAL KR] 4 hour ice pack myth

Discussion in 'Knee Replacement Recovery Area' started by Woodpusher, May 21, 2019.

  1. Rockgirl4

    Rockgirl4 senior

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    @Woodpusher I can't even imagine doing that at this stage. I was super strong/athletic before this surgery and can barely even put weight on my bad leg, let alone stand on it by itself. I'm shocked they're asking for this at a week out from surgery. :yikes:
     
  2. lovetocookandsew

    lovetocookandsew FORUM ADVISOR Forum Advisor

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    Just because a PT wants you to do an exercise doesn't mean you have to agree to do it. It's your knee, your recovery, and you call the shots-and no one else! If it's something you want to do, then do it; if not, decline. I refused any PT this time around as I think they are either pushing unrealistic numbers post TKR to justify their employment, or else that's what they were taught and won't sway from it. It's up to us, the patients, to let them know what we believe and want, and where their boundaries lie, if we agree to any PT. Even in the hospital I laid down my rules for the PT (he was not to touch my leg except to help me in and out of bed, I wasn't doing anything except walking the halls and the steps, I wasn't doing the exercise where they place a rolled towel under your ankle and have you lie there and let your knee fall to the bed, and so on.

    I allowed a therapist one visit to my house as my doctor has them also check your vitals and general well-being, so I agreed to a single visit. But I told her in no uncertain terms the moment she arrived what my boundaries were, and that that visit was all I was going to allow. I was not doing any exercises at all, just walking around the house and eventually the yard. When the PT dep't called to schedule another visit, I declined, and the woman on the phone told me she was going to message my OS that I refused PT, as if her tattling to my doctor would make me go along....lol. I told her to feel free, as not only did I not care, I happen to know my doctor's view on PT after a TKR. I didn't mention that to her, and I sure as heck wasn't going to be threatened into compliance! :snork:

    You have the same right to decline any or all PT that you choose.
     
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  3. Woodpusher

    Woodpusher junior member
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    Thanks all for your replies. The exercises I'm willing to do are no harder than some ADLs. Ok, flexion and extension exercises are in, load bearing on the affected leg are out.
     
  4. Woodpusher

    Woodpusher junior member
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    Well, thinking about this at 3:30 in the morning, it's not all my weight on one leg since some is being taken by hands on the counter. Probably more than half, too much.
     
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  5. Woodpusher

    Woodpusher junior member
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    1 week out I'm at 94/8 unassisted and 105/5 with minor assistance.
     
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  6. lovetocookandsew

    lovetocookandsew FORUM ADVISOR Forum Advisor

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    Any numbers you get while being "assisted" are not really your numbers. Only numbers you get on your own are real. But at one week out, you are still swollen, and the numbers will not be stable as your knee will swell more some days and less other days. I have not been measured for progress at all this time as numbers really mean nothing to me-only the ability to do normal activities matters to me. If I am able to walk, ride a bike, go up and down stairs, sit and stand, etc, that is what matters to me. I wish they wouldn't even measure people this early on as many people get measured at the hospital when the swelling hasn't really set in, then get discouraged a few days later when the swelling shows up and the numbers go down. Plus, too many people, IMHO, set up their recoveries by the numbers. If they get to a certain number by a certain (and artificial) date, they're doing great, if not, they're failing and either get depressed or go crazy trying to make their knees recover faster.

    In reality everyone is different, and everyone heals at a different pace; therefore setting certain points in a recovery to achieve set numbers usually leads to disappointment, feelings of failure, pain and more swelling when you try to push your knee past what it's ready for in order to achieve those numbers. At this point, my advice is to relax, allow your knee the time it needs to recover without pressure to get to higher numbers by certain dates. Your knee will bend when the tissues surrounding the implant recover from the assault that is a TKR. You can delay that recovery by doing more than your knee is ready for. Now is the time to rest that knee, ice and elevate it a lot and let nature take it's course in recovering from surgery.
     
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    Last edited: May 28, 2019
  7. Woodpusher

    Woodpusher junior member
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    @lovetocookandsew, it is a little strange that we're trying to manipulate this knee that's in the middle of healing. They don't want it to to heal in place and leave us with no ROM.

    Tell me about the spacer replacement. Is that the meniscus equivalent of the implant? I imagine that was real surgery.

    Ken
     
  8. lovetocookandsew

    lovetocookandsew FORUM ADVISOR Forum Advisor

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    If you do normal daily activities as listed in the activity progression article, you don't need to worry about not having any ROM. I read that article every day so as to make sure I didn't do too much, or too little, as I recovered.
     
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  9. kneeper

    kneeper FORUM ADVISOR Forum Advisor

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    Agreed. And I generally took breaks from the icing machine something like this: 1 hour on, 20 minutes off, all day.
     
  10. Woodpusher

    Woodpusher junior member
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    That's roughly the schedule I'm on. The material on the Polar bladder seems like a high quality plastic, not that different than an all in one ice wrap I have that goes directly on the skin. And since the bladder is cooled by water, by definition it can't be colder than 33 degrees.
     
  11. Celle

    Celle FORUM ADVISOR Forum Advisor

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    That's a pack of rubbish they've told you there. It doesn't even make sense, no matter how I look at it.
    Your knee will not set in one place if they leave it alone, and if you only exercise it gently.
    There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
    Myth busting: the "window of opportunity" in TKR
    The concept of a window of opportunity is just an old urban myth that should have died long ago.

    For the first month after surgery, your knee needs time and gentle treatment, so it can start to heal. There's no good reason why it should be stuck in one place if it's not manipulated. Right now, it's swelling that is stopping your knee from bending more. As the swelling goes down, your knee will naturally start to bend more. Pushing on your knee and forcing it to bend will just make it more angry and swollen, so it's counter-productive.

    It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.

    My surgeon doesn't allow any formal PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house. The walking is our exercise - and walking is very good exercise.
    After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
    His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.
     
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  12. Woodpusher

    Woodpusher junior member
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    Day 12 update: Put in a new air filter into our furnace. Ok, no big deal., mostly upper body work .

    80-85 percent of my work is walking and ADLs, the rest are exercises recommended by physical therapy. For now I'm giving my therapist just enough to keep her happy. We'll see what happens when I see my surgeon tomorrow for the follow-up.
     
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  13. Rockgirl4

    Rockgirl4 senior

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    Good luck with your appointment today. I think it's interesting most other American surgeons see their patients back at 2 weeks. Mine waits for the 4 wk mark. Maybe I'm assuming...
     
  14. lisabl

    lisabl member

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    Its 6 weeks before seeing the OS in the UK
     
  15. lovetocookandsew

    lovetocookandsew FORUM ADVISOR Forum Advisor

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    My OS sees me at two weeks, one month, 3 months, 6 months and one year (and any time in between if needed). Today happens to be my one year check-up.....:fingersx:
     
  16. tabbykit

    tabbykit member

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    Hi - can I ask those experienced with using ice machines, re the CryoCuff is it worth the difference to have the powered version? Just trying to decide before my surgery. Thanks!
     
  17. Woodpusher

    Woodpusher junior member
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    Does anyone know if the non-powered version of these machines circulate water back and forth? I don't see how if they're gravity fed. On mine, the pump does all the work, and I don't have to worry about having the cooler at a level above the knee.
     
  18. lovetocookandsew

    lovetocookandsew FORUM ADVISOR Forum Advisor

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    From what I understand, the non-electric machines are manually circulated by the patient. Personally, lifting and raising/lowering a bucket of water constantly at any time, but especially after a TKR, is not on my list of things I want to do. An electric one, to me, is the only way to go. It does the work so you can rest and recover.

    As it happens, I am about to buy another machine as I would like to be able to use it when needed, even now. @Pumpkln has a Breg Polar Care Cube that has served her well for a very long time, and that's likely the one I will get. I loved my DonJoy clear, but went through 4 or 5 of them as they all died in a very short time and I had to get them replaced, which was a hassle as I was then without a machine for days when I needed them the most. Even the one my OS was using after a shoulder surgery died on him-not a good ad for the product. If it's possible, get an electric one, IMPO a manual one is too much work. Think about just the nights-you can set up the electric one, go to sleep and it works all night while you get to rest and reap the benefits of constant ice water circulating around your knee.
     
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  19. lisabl

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    @tabbykit I was given a manual cryocuff last year by the hospital when I had my partial. Looking back I probably didn't ice for long enough especially overnight, but to me it was ok. Before surgery this year I bought a powered lid that jusr fits to the old bucket and it is definitely worth it, although it is noisy during the night and I need earbuds to sleep properly.
     
  20. Rockgirl4

    Rockgirl4 senior

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    @Woodpusher I used the non-motorized Cryo-cuffs back in the late 90's and '01,'02 with my first 4 arthroscopies. They handled the pain well for that and were convenient because I didn't need icing at night, but nope--no circulation of the water without our own efforts. With a TKR, I'm glad I have something motorized and hand's off, as I use my ice machine all night long--well, on and off. My incision is still too sensitive in one certain area to have the wrap on it constantly.
     

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