PKR 7 years, 9 doctors, and 6 hour drive

[Layla]

That's awesome, Grace...I mean lrj
Only kidding with you because if it looks anything like my first attempts getting up off the floor, it resembles that garden ornament of that bent over lady's bum and legs. Ugh...if we can't laugh at ourselves during this process, it would be sad.

Woohoo though, that is a big accomplishment and a good one! A PT once told me that getting up off the floor is a skill we need for life, so you're doing good!
@lrj

 

[mendogal]

YES!!!! Floor mobility is a huge functional milestone!!!!

 

[lrj]

Beautiful weather today. Went back to the zoo. I did go up and down the hill! But they have some construction going on so I couldn't complete the loop. I stopped at the bottom of the hill and watched the tiger for awhile. Stopped twice once I got back up. I think I'll do better with some compression socks, which I ordered today.

 

[mendogal]

Lovely day. I have to time my walks to "looks like the rain has stopped, where's my jacket?" And not an elephant can I find!!!

 

[lrj]

I've been reading many threads here for a few weeks. I agree with a good portion of what is being said here. There is one point I keep seeing that I have concerns with. That is how often I see it suggested to people to stop physical therapy.

PT is important. Can you heal ok without it? Yes. I do think it's important that people know that's an option, and this is the only place I've seen it discussed. My problem isn't with that. The problem is with how often people are conflating physical therapy with a bad therapist. A good therapist will tailor exercises to the individual. A good therapist is focused on all aspects of your healing; swelling, pain, strength, and your ability to function, not just ROM. A good therapist listens and asks for feedback. A good therapist wants you to balance doing with resting. A good therapist asks about your personal goals with therapy, not tell you what their goal is for you. A good therapist adapts depending on how you are progressing.

You can progress better and faster when you have a good therapist. Getting out of the house to go to PT can be a big morale boost. PT can also help let you know if something is normal, or you need to consult with your doctor. I know my therapist has helped people spot the early signs of infection or blood clots. These people got medical attention sooner than if they had to spot these problems themselves.

You don't have to go wherever the surgeon typically sends patients. You can request to have the orders sent to any therapist. I think there should be more encouragement to do research on therapists before surgery. Maybe there should be a list of questions you ask before picking a therapist. Read reviews. People love to post bad reviews. Fewer people post good reviews. If there's a lot of good reviews from people who have had joint replacement, it's probably a good sign.

It is a fine line between doing a good amount of work and overdoing. If someone is having problems, dropping all PT may not be necessary. Ease off, yes. Find a new therapist, yes. Dropping PT is an extreme. So is the therapist who pushes ROM. Both can be successful. Both can be problematic. But a middle ground does exist. Think of a normal population distribution on a bell curve. Most people fall in the middle. Some people fall in the extremes.

Each person is an individual. Each person has to determine the right level of work that goes into their PT. More people need to listen to what thier body is telling them, which is encouraged here on BoneSmart. I do agree and appreciate that.

 

[sistersinhim]

You can progress better and faster when you have a good therapist.

How do you know? Have you ever not taken formal PT? What about those of us who recovered alone and had to do all the household, yard work, and self-care. Aren't these also PT, PT that is natural movements. Many of us have recovered quite well without going out to PT. But, the key is to be as active as our new knees would allow us to be without adding to the pain and swelling. No one wants to join the ODIC!

There is one point I keep seeing that I have concerns with. That is how often I see it suggested to people to stop physical therapy.

What we stress is that aggressive, and/or forced movements are bad, and the member is better off not going to that PT. We are not against PT, we are against bad PT. That can slow down recovery.

A good therapist is focused on all aspects of your healing; swelling, pain, strength, and your ability to function, not just ROM. A good therapist listens and asks for feedback. A good therapist wants you to balance doing with resting. A good therapist asks about your personal goals with therapy, not tell you what their goal is for you. A good therapist adapts depending on how you are progressing.

Yes, that is exactly what we believe and suggest to our members.

I like your suggestion that you could 'interview' therapists and read reviews. That is how I found my OS. It took a few negatives before I found the one for me. That would be the same for a therapist.

 

[Jockette]

That is how often I see it suggested to people to stop physical therapy.

I only suggest this to members who are being hurt by their PT, not to members who are having a good experience with their PT.

I've been reading many threads here for a few weeks.

I’ve been reading many threads here since April 2017. I have over 35,000 posts, which means I’ve read about that many. There is a recurring theme about members who are hurt by their PTs, and/or are given inappropriate exercises for their stage of recovery, which causes them problems.

You can progress better and faster when you have a good therapist.

We have members who have great recoveries, whether or not they went to PT, or how long they went. While a good PT can be helpful, recovery is more about how your body responds to the surgery and how it heals. Many aspects of recovery are more about time, than PT activities and/or ministrations. Even a good PT cannot speed up that process, and it varies for each of us.

I think there should be more encouragement to do research on therapists before surgery. Maybe there should be a list of questions you ask before picking a therapist.

This is a wonderful theory, but in reality, I don’t think people know to do this, because, another recurring theme I read here is how often members are not given appropriate information about this recovery, let alone have information about researching a PT. And, what to look for in a PT would come from the opinion of who is writing the recommendation, which also varies widely.

We are sent to PT and trust that the PT does have our best interest at heart and will tailor their efforts to our personal needs. Over the last 7 years I’ve read posts where that doesn’t happen.

More people need to listen to what thier body is telling them, which is encouraged here on BoneSmart.

And this is exactly why I may suggest a member stop going to PT, if they are not being heard at the facility they are going to. I don’t suggest this to members who are happy and doing well with the good PT that they have.

PT is a personal decision. My goal is to help members through their recovery and let them know that they can choose how they recover.

 

[lrj]

How do you know? Have you ever not taken formal PT? What about those of us who recovered alone and had to do all the household, yard work, and self-care. Aren't these also PT, PT that is natural movements. Many of us have recovered quite well without going out to PT. But, the key is to be as active as our new knees would allow us to be without adding to the pain and swelling.

Scientific studies. They show that movement and weight bearing promote healing. That's why we don't keep people in the hospital in bed for a week after surgery. Now that is looking at the overall population, not individuas. Populations follow that bell curve. So yes, I agree, there are people who do well without going to PT.
Also, ability to function is a key component. If you are having to get up and take care of yourself and household, that does play an important role. It needs to be a holistic approach and be a discussion between the individuals and their care team.
I am not disagreeing with you. I am concerned with an oversimplification of a complex topic.

 

[benne68]

Scientific studies. They show that movement and weight bearing promote healing.

Would be interested in which studies you reference. The latest from the American Physical Therapy Association found that rehabilitation should focus on "achievement of mobility milestones, education, assessment and provision of equipment" rather than on traditional range of motion or strength exercise, "which we're finding patients don't need as much of."

 

[lrj]

The latest from the American Physical Therapy Association found that rehabilitation should focus on "achievement of mobility milestones, education, assessment and provision of equipment" rather than on traditional range of motion or strength exercise,

It's a complex issue that encompasses all of this. I don't see this as contradictory, but supportive of what I said. As with all medicine, it has to be individualized. Humans are complex systems with many parts working together. What affects one part also affects the whole. That's also why medicine, fitness, and nutrition are ever developing. And each person is different.
Yes, most people on here say to look for a different therapist or drop PT only if the therapist is causing pain. But I've also seen people jump to "drop PT" without full knowledge of the situation. Sleep is an important aspect of healing. If you can't sleep because of ongoing pain, it does need evaluated.
I'm not a medical professional. There are some great ones out there, and there are plenty that need to work harder on staying up to date on the latest research. Like I said in my intro when I first posted about my surgery, I went to 9 doctors before I was able to get answers. I also go to acupuncture, which I know a lot of people won't even consider, even though there are scientific studies supporting it.
Maybe I'm having a difficult time understanding why people would stop PT because I had an amazing therapist. I told her I wish I could hire her as a personal trainer when I finished PT. I hate that not everyone has had a good PT experience.
I wish everyone the best recovery possible and hope you have open, honest conversations with a receptive, understanding, and knowledgeable care team.

 

[mendogal]

Scientific studies. They show that movement and weight bearing promote healing. That's why we don't keep people in the hospital in bed for a week after surgery

BoneSmart advises walking and activities of daily living, not lying in bed.

The best PTs I've worked with - personally and professionally - were interested enough in how the body works to get further education, either in various forms of body work, kinesiology, or a subspecialty.

The newest PTs, now getting at least a MS if not a PhD are at least coming into work with deeper and broader grounding.

There are PTs who are distinctly mediocre, stuck in 40 year old methodologies based on stroke and polio paradigms, and who can and do hurt people.

 

[EalingGran]

only suggest this to members who are being hurt by their PT, not to members who are having a good experience with their PT.

It does seem strange to me how many people here have very aggressive PT. It seems to be more of a thing in the US than the UK. Perhaps it is an advantage that the NHS doesn't offer much free physiotherapy.
I got private pilates lessons which I did find helpful and I do credit my teacher with contributing to my excellent ROM. But it was very individually tailored and never ever caused me pain.

 

[Layla]

Hello lrj
Thanks for your honesty and willingness to have a healthy discussion on all. I think you may be onto something in wondering why some may not favor PT, since it sounds like you were blessed in finding a great match to work with. Given that, it will definitely make it more difficult to understand. There are some great PT's out there for sure, we've read many accounts here, but also read stories of PT's that have pushed members to the point of pain and suffering for days and sometimes even weeks afterward. Those are the type of situations that pull at your heartstrings and bring about warnings that possibly at times sound too alarmist.
Wishing you well as you continue the journey. Happy Weekend!
@lrj

 

[lrj]

I just received my explanation of benefits for both surgeries and the hospital stays. Both knees cost a total of $107,000. I know there's a lot of problems with insurance and the system needs some major changes, but I'm so grateful for insurance. Had a $4,500 max out of pocket and had already payed some for other things before hand. So, in total, I paid less than 4% of my medical expenses last year!
Only barely got both surgeries in last year. Had the 2nd one on the last day they were scheduling knee replacements. Had to have 12 weeks between. If they had called to set the schedule just a week later, I wouldn't have been able to get the first done in time to get the second one done too.

 

[mendogal]

Yes it's an odd system that has us scheduling tons of stuff at the end of a calendar year to get it covered during the period in which we've already paid our deductible and out of pocket!

 

[lrj]

Went on a hike with my aunt and dog yesterday! It was an easy about 2 mile trail. No problems.
Saturday, my niece was in a winter guard contest. I sat on bleachers in a high school gym for 4 hours (did get up a bit during that time). That was miserable. I believe bleachers were designed by the devil himself. I hurt for the rest of the day.
I had changed jobs about 3 months before my first surgery. They knew I had surgery coming up and said they were happy to work with me. I had to take off more time than I anticipated with the first surgery. 2 weeks before the second surgery, they let me go. They tried to give some "reasons" for it, but it was because I was going to be taking off again. Not protected under FLMA due to being at that job less than a year, and not enough employees within a certain distance of the office I worked in. Stinks that they get away with this, but it would cost more to get a lawyer than I would get from fighting it. Fortunately, I have family support. Today, I at least started part time work. Still looking for full time, but this will help fill the gap. This job also has a possibility of turning full time.
I've also been having some swelling in my legs. Not pain, just discomfort. I have some compression socks. They help my lower leg, but the swelling originates at the knee and can't move down. So my knees and thighs get quite swollen. I'm starting to look into compression leggings, but it's hard to find them in a plus size. Anyone have any suggestions?

 

[MSuki]

Sorry you’re having to deal with job issues along with your recovery! I hope this new job works out, or you find something even better.

I did a quick look on Amazon and found something listed as

beister Medical Compression Pantyhose for Women& Men, 20-30mmHg Graduated Support Tights, Opaque Footless Waist High Compression Stockings & Leggings for Varicose Veins, Edema, Flight, DVT
This has a 4.5 star rating and comes in different colors and sizes from small to 4x, but not sure if it’s what you’re looking for or not.

 

[Layla]

I am sorry about your work situation. I hope you find the perfect employment opportunity, at the right time.

I have a few tips to share as far as swelling goes -

It is our lymph system that rids the body of fluid (swelling). So you want to get the fluid to the lymph nodes in your torso area so your body can more quickly process it. The lymph system works rather slowly on its own and much more efficiently with the assistance of gravity. The fluid isn’t draining into the hips, but contained with the lymph system and moving to the torso and lymph nodes located there.

BoneSmart FA, CricketHip, is involved in Therapeutic Massage and has shared this exercise to assist in manual lymph drainage. This gentle, yet effective therapy will help prime your lymphatic system to move fluid and inflammation away from your leg, which in turn will help your range of motion and pain - you may want to give it a try and tag her if you have any questions, she’s very helpful.

While lying supine, take deep breaths...deep, as in breathing in to a count of 5, 4, or 3 seconds, whatever is most comfortable for you. Hold that breath for another count of 5, 4, 3 then blow out completely, still using the count that's comfortable for you. A series of at least 6 reps may help get the excess swelling to move. To ensure you are taking proper deep breaths, place your hand on your naval and watch while taking in your breath, if doing this properly you should see your hand move up. Repeat this whenever you feel up to it during the day or night. Lying flat (supine) is best as the lymph nodes seated in your groin are less restricted, allowing for better lymph flow.

In addition, after the breathing exercise, place your hands lightly on your upper thigh, at the crease in your groin and lightly stroke upwards towards your naval.
Be patient because it can take the body time to respond.

Give it a try…it can’t hurt. Best Wishes!
@lrj

 

[lrj]

I've ordered some compression leggings. Only found one brand that might work. I hope the fit.

 

[lrj]

Wow you had to go through a lot. How was recovery on the surgery. I believe it i used to be active and now limited in my mobility. I’m worried about other health issues now due to not being as active

Yes, it was a lot. The last year, I mowed my yard (flat, 40min with self propelled walk behind) and had to use a cane the next 3 days. Then had to pay a friend's kid to mow for me the rest of the year.
I've never been in shape or athletic. However, I have working construction for the past 10 years, so my legs have been quite strong.
My recovery has gone well. With the osteotomy with the first PKR, I was no weight bearing for a month, followed by 2 weeks of partial. Work said they would have desk work for me to do until I was ready for more. Original plan was one week off. Took 6 weeks off instead. I did get back to taking my dog on 1/2 mile walks.
2nd surgery was 3 months after the first. My job also let me go 2 weeks before this surgery. I'm sure it's because I had to take more time off than planned for the first. I'm 2 and a half months out now. I can take the dog on mile walks, and even did a 2 mile hike last week. Been going to the zoo to walk. And I've gone to the gym some too. And finally started with a part time job. Still looking for full time.
My goal is to hike the highest mountain in Australia. Got to get to the point of being able to go physically and financially.
Even though things have gone very well, there were surprises along the way. I needed a tall toilet seat with handles so I could get up on my own. With both surgeries, there was a point about a week out when I was in tears because it was too difficult to get off the couch, but I had to pee. Still have difficult standing up from lower chairs. But I also have surprise moments when I discover I can do something again.
Overall, very happy with my results. Using this as a starting point to work on getting in better shape. More exercise, mild changes to diet. Feel like I'll be able to mow the yard this year. I know I'm looking at TKR in the future, but I'll be in handle it because I did this now. This has literally been a life changing experience!