TKR 9½ weeks means something totally different to me these days

[Josephine]

Wolfy, you have to realise, understand and accept that stiffness is a form of pain - along with soreness, burning, stabbing, throbbing, aching and swelling. They all need medicating.

So my next questions are

I'm going to ask you some questions and it would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine)

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how often are you icing your knee and for how long?

4. are you elevating your leg, how often and for how long?

5. What is your ROM - that's flexion (bend) and extension (straightness)

6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

7. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)

Note:
If you're not familiar with this, it goes like so:
1 lift of a 500kg bell bar = 1 rep or repetition.
Doing 5 reps and then a brief rest = 1 set of 5.
And doing 5 sets and finishing = a session.

 

[Josephine]

Oh - almost forgot to mention: Jamie has been trying her darndest to get me over there for almost 5 years. But though I love flying, I am also rather claustrophobic. Which isn't a problem with the flight or the airplane but it is with the teeny tiny loos they have on board! I've never been further than Malaga which is a 1hr flight and that was bad enough. Sounds like a lovely idea but it's not on, I'm afraid. Besides which, I shall be here to guide and advise you!

So sorry to hear about your mother. That must be awful to watch her dying. My prayers are with you both.

 

[wolf woman]

@Josephine

1. what are your pain levels right now?
Variable pain, between 2 and 5 with no particular average. Sometimes I think to myself "Wow, this is great! Think I'm on the other side of this thing!". Then all of the sudden, here it comes again.

2. what pain medications have you been prescribed, how much are you taking and how often?
I have some hydrocodone / acetaminophen 5-325 (generic for Norco). I have not taken any pain meds for a good while. It took me a good while to figure out it was the meds causing my nausea. I am super allergic to most all NSAIDs, I can take Aleve. The NP gave me some Voltaren Gel on Monday. Keep your fingers crossed, the last time I took diclofenac, I landed in the emergency room. My insurance doesn't cover the ER, so let's hope it isn't a problem using it topically.

3. how often are you icing your knee and for how long?
Every night I fill my ice pump around 9 PM and go to sleep with it. If I don't wake up till morning, it's still running.

4. are you elevating your leg, how often and for how long?
I elevate only in the late evening unless time allows me a break during the day.

5. What is your ROM - that's flexion (bend) and extension (straightness)
ROM is 115/2-3, depending on who measures. The 115 is with a lot of coaxing and stretching on my part in one of those exercise machines.

6. what is your activity level?
I am not doing super heavy housework. I do dust mop and run my small vac. I have cleaned my small aviary, changed cages, washed windows, but took my time and spread it over two days. I do laundry, lots of laundry, for hubby, mom, myself. Only light cooking. Sometimes when I shop, I ride around in one of those carts if I am in a really big store. I am at the nursing home at least every other day with Mom. it's a nice little stroll to her room.

7. what kind of PT/exercises are you doing? How much and how often?
Have not been regular at gym for 1½ weeks due to cold and bronchitis. Have only been twice since, but normally there 3 times a week.
Use NuStep machine for 10 to 20 minutes at workload 4, moving seat one click closer every 6 minutes or so to get a little more bend. No pain involved there.
Use inner and out thigh machine with some weight resistance, but the weight is on my chart at gym, so I don't know how much. Two sets of 15 reps each machine.
Another machine I use (I don't know the name of it), I sit with a back rest in a half reclining position, put feet on plate and push plate at about 120 lbs resistance for 2 sessions of 15 reps, each foot is on independent plate.
I walk on the padded track at my own pace, my guess is about a quarter mile.
There are two other machines that I sit on and adjust to my body then push down with my calves, this is about 30 lbs and I do 15 reps twice. The other I pull up with my legs. On both of these machines I hold for about three seconds each rep.
On the days that I see a PT, she has me do different things, like standing against a wall while pushing a ball against wall with back of knee. I sit on knee wall and come to a stand with no hands. There are many little things she has me do and I tell her if it hurts too bad. We are careful because my right knee is so bad.

I am wondering if the fact that both of my knees have been really bad for about 40 years is part of the problem?

 

[wolf woman]

@Josephine Solution to tiny airline loos: catheter!

 

[Josephine]

Variable pain, between 2 and 5 with no particular average.

Okay

I have some hydrocodone 5-325. I have not taken any pain meds for a good while. It took me a good while to figure out it was the meds causing my nausea. I am super allergic to most all NSAIDs, I can take Aleve. The NP gave me some Voltaren Gel on Monday. Keep your fingers crossed, the last time I took diclofenac, I landed in the emergency room. My insurance doesn't cover the ER, so let's hope it isn't a problem using it topically.

You don't mention Tylenol (I think I asked you this before)

Every night I fill my ice pump around 9 PM and go to sleep with it. If I don't wake up till morning, it's still running.

Good

I elevate only in the late evening unless time allows me a break during the day.

But for how long? And is it 'toes above nose' or nearly?

ROM is 115/2-3, depending on who measures. The 115 is with a lot of coaxing and stretching on my part in one of those exercise machines.

Don't do that, it's not good for your knee. And your ROM is okay. You're only 14 weeks out so plenty of time to get more.

I am not doing super heavy housework. I do dust mop and run my small vac. I have cleaned my small aviary, changed cages, washed windows, but took my time and spread it over two days. I do laundry, lots of laundry, for hubby, mom, myself. Only light cooking. Sometimes when I shop, I ride around in one of those carts if I am in a really big store. I am at the nursing home at least every other day with Mom. it's a nice little stroll to her room.

Okay

Have not been regular at gym for 1½ weeks due to cold and bronchitis. Have only been twice since, but normally there 3 times a week.

hmmmm ....

My comments in bold
Use NuStep machine for 10 to 20 minutes at workload 4, moving seat one click closer every 6 minutes or so to get a little more bend. No pain involved there. - but still rather a lot
Use inner and out thigh machine with some weight resistance, but the weight is on my chart at gym, so I don't know how much. Two sets of 15 reps each machine - hmmm ...
Another machine I use (I don't know the name of it), I sit with a back rest in a half reclining position, put feet on plate and push plate at about 120 lbs resistance for 2 sessions of 15 reps, each foot is on independent plate.
I walk on the padded track at my own pace, my guess is about a quarter mile - FAR too much! Too much reps, too much weight and too much activity.
There are two other machines that I sit on and adjust to my body then push down with my calves, this is about 30 lbs and I do 15 reps twice. The other I pull up with my legs. On both of these machines I hold for about three seconds each rep - ditto!
On the days that I see a PT, she has me do different things, like standing against a wall while pushing a ball against wall with back of knee. I sit on knee wall and come to a stand with no hands. There are many little things she has me do and I tell her if it hurts too bad. We are careful because my right knee is so bad - you haven't told me how many reps you do of these

I am wondering if the fact that both of my knees have been really bad for about 40 years is part of the problem?

Well it might be but my overall impression is that you are simply doing far too much. At 14 weeks you should be reducing the activity not increasing it. Your ROM is pretty good so you've got there. All you need to do now is some walking - in moderation - and some bike riding. All that other stuff is responsible for at least 95% responsible for your stiffness and pain.

 

[wolf woman]

@Josephine Wow! And I have been feeling like a slacker! As for the reps of the things I do with the PT, she let's me call the shots. I will do them until I become a little shaky or it starts to hurt. It's really hard to explain. The gym where I am a member is where I go for PT. It's a beautiful, very well equipped place, and they have a large therapy pool. I was released to go in the water at 7 weeks, went back in once, and haven't since. There was something that just didn't feel right to me. As much as I love the warm water, I felt so insecure it was scary. So, I am going back to the pool tomorrow. Hopefully I will be like a duck again!

About the bike...every time I have gotten on the bike, my knee has hurt so bad that I simply quit doing it. I may try it again in a couple of days if I move the seat back further. I really feel like I set myself back with that darn thing. The NuStep doesn't hurt and I feel like I get pretty close to the same benefit as a bike. Your thoughts?

Last night after doing more reading on here and answering your questions, I went to bed with ice pump, put my leg on top of pillows as the illustration shows (well, darn close to it) and elevated the foot of my articulating bed. When all was said and done, I was in fear that I was going to stick my toes in the ceiling fan! Well eureka! When I woke up early this morning in the same position, the swelling was down in my ankle!!! However, after being up for a couple of hours, it started to swell a bit again. This too shall pass. I am wondering if you think the little bit of swelling in my foot will ever go away? It's really not a lot, but enough to make my left shoe too snug.

As for Tylenol, I am okay with it and will try it. Do you prefer that over Aleve? In thinking, I may have some tramadol in my cabinet, but isn't that pretty strong stuff?

I failed to tell you that I started a Medrol 4mg dosepak on Tuesday. Having asthma and a history of other lung issues, there are times when needed. Hopefully this will also assist my knee. I did get permission from the surgeon's NP on Monday before I started it.

Thanks for being here and all of your concern and input! Mary

 

[Jamie]

Tramadol is a step down drug from narcotics and it would be perfectly appropriate for where you are in your recovery (about 3 months out). If you take Tylenol, be sure to take a 1000mg dose each time. You can have up to 4000mg in a 24 hour period. You need to be sure to count any acetaminophen in over the counter medications like cold and sinus meds in that 4000mg total.

If I were you, I'd think twice about using the machines you describe with weight until at least 6 months out. The leg press (plate you push on while sitting/reclining) can be especially bad if it's not done just so. It is hard on your knees if you don't place your feet properly on the plate or if you push through the balls of your feet instead of your heels. It's also not good if you straighten your knee too much when you push.

 

[Josephine]

Yes, Jamie has it perfectly. It matters not if the exercises aren't causing pain, you're still doing far too much!

As for the Tylenol vs ibu, did you not read the article I left you? All my thoughts and notes are in there.

And you might like to read the potted version of my recovery to see how little exercising I did! Knee recovery - UK style

 

[gr82cu2]

@wolf woman Wolfy (I laughed when Josephine called you that.....too cute!) I'm finding this all very interesting. I think I'm feeling much the same as you and doing many of the same exercises in PT so I feel much of what you have been told applies to me also. Thank you for asking Josephine. I'm just struggling with feeling like I (we) are doing too much strengthening exercises for this stage. For the first few weeks I didn't feel I had lost much strength but that is no longer the case. At times, when I'm up for too long, not only does my leg hurt but BOTH legs tend to get the shakes, from weakness I assume. I only do outpatient PT twice a week for 30 minutes each session and I've slacked off on home exercises quite a bit. I do use my NMES daily though, on both legs. I do take Tramadol, usually one or two a day. Maybe 3 if it's a particularly painful day. I also take Aleve twice a day since I turned allergic to Celebrex. I know Josephine feels it isn't an effective pain reliever but it does decrease inflammation which causes pain and many of us who have other forms of arthritis are inflamed in joints besides our knees. You are 6 weeks ahead of me and knowing how frustrated I feel I can't imagine how it feels to you. Can we get this recovery over already?

 

[kneeper]

I use the NuStep but I don't use level 4--usually 2 or 3 depending on the machine and how I'm feeling. Once I'm more recovered I'll ease up to 4.

 

[wolf woman]

@kneeper Our surgery dates were very close. Are you having issues like mine? When you mention NuStep workload, it made me wonder. I really don't feel any kind of pain or strain while on it. Maybe I will lighten up a bit on it, see what happens.

Mary

 

[kneeper]

It doesn't feel particularly bad when I'm on it, but I'm playing it careful. I developed chronic tendonitis in the quad of my first knee, possibly from over aggressive pt and overdoing.

 

[wolf woman]

@kneeper Oh my goodness! I never considered a possibility like that! Thanks for the heads up! I will be slowing down, that's for sure.

 

[wolf woman]

@gr82cu2
@jul
@marmora
@Nana moon 27
@tiredwife
And to all others who may be reading this post!
Just to let you guys know, I am having trouble staying on this site when using my iPad. It's possibly due to my downloading IOS8 on the day it was released. Since I am leaving for Indy early in the morning, the only access I will have is the iPad. Maybe I will be able to get on, maybe not. So, you guys will not be forgotten if I'm not posting!

This has been a tough week. The weather is changing and my knee is giving me fits. Oh does it ache! I am taking Tramadol periodically and thinking that will be stepped up to a regular dose while I am away for the weekend. Also, the walker is going with me. The event hotel will be large and a lot of walking required. While I hate taking that darn thing, I know it's best. Thank goodness my roomie had the intelligence to book us a handicapped room! Can you guys see me getting stuck on one of those super low toilets? I laugh about it now, but it would not have been funny!

Hope everyone has a fabulous weekend and little or no pain! Will post when I return if I can't get on!

Mary

 

[tiredwife]

@wolf woman Have a great trip, hope you are able to get on BS to let us know how you are doing. Be careful and remember to elevate when you can. Don't get stuck on the toilet, that could be awful, take your walker in with you, that way you can us it to help stand up.

 

[jul]

@wolf woman Hey Mary I no its a pain taking your walked but as you say you will be greatfull you did once you start getting around. Sometimes I think if we had a big bandage or something you can see on our knees we wouldn't feel so bad and also people wouldn't look at us thinking why are they using a walker or crutches. I no it's also a pain using them but myself going to work I am glad I use them just for the support for the long walks.

Those dam toilets I'm not a tall person but there either to tall or to short lol.

Hope you have a great trip and try to rest when you can.

Julie

 

[gr82cu2]

Enjoy your weekend here in Indy The weather is supposed to be really nice this weekend. We are having outdoor family pictures done on Sunday. It's supposed to be a 90 minutes session (arranged by our daughter in law). Hope I can stand around that long. Don't want canes and walkers in the picture, LOL. Have fun!

 

[wolf woman]

@jul Julie, you are so correct on all levels. If I had something to show besides a well healed scar, I might not feel so weird about the walker. However, it's easier to take it and use it than to suffer. As for the toilets, well, I wear a 34" inseam in pants. Can you imagine me getting off one of those low toilets?

Don't know if I ever told you guys, but a couple of months ago, I hurt myself pretty bad trying to get off a super low toilet in a restaurant. Well, I reported them to the ADA and the are making that restaurant put in an accessible stall. I hate being the toilet police, but hate even more hurting my knee and back just because I have to go!

MAry

 

[marmora]

Hello Mary @wolf woman

Hope that your journey from Kentucky to Indy is comfortable- are you flying or driving ?

I have usually been catching up with you in other forums, but decided to catch up on your forum and it's been good to see what has been happening with you.

Your three times/week session at the gym is much more that I would be able to cope with and as Josephine and Jamie say, may need to be looked at and paced a bit down.

I sit here writing in pain & stiffness, think it is from sitting from 7:30 pm to 10:30 pm for a Bridge Class last night. Wakeful night and my two Solpadeine at bedtime and again at 5:00 am along with elevation and icing in bed doesn't seem to have hit on the pain.

Your TKR was about 1 month before me and hearing that you are still experiencing pain and stiffness this week,confirms how long this recovery can be for us.

Janet @gr82cu2 You're about 2 weeks after me and waiting for your next TKR in November. And was interesting to read how your LTKR is reacting at this stage. Like you, Just started using the NMES on my left knee twice/day for the 20 minute cycle about 10 days ago, as was told that my VMO(inner quad muscle) was weak and needed an extra boost to help with my extension.

I think from reading your post and Mary's post, we three are having one step forward and then Bang- one or two steps that stop us in our tracks.

Mary, enjoy Indy and time with your friend.
Heading out for my morning walk with one cane,
Cathie

 

[wolf woman]

Oh my goodness! Arrived in Indy after a pleasant drive and checked in to our hotel. Well, so much for the handicapped room! I got on the toilet as soon as we hit them room then realized how low the darn thing was. No rails, nothing! So I yelled for Charlene to bring my walker and it wouldn't fit through the bathroom door. Ugh. Major confrontation with the hotel. We had to take a room with only one bed instead of two, but at least I can use the bathroom!

I cut my time short tonight in order to elevate and ice. I'm super tired, almost wish I had stayed home. Tomorrow will surely be better!