TKR 9 Weeks Post-op: considering MUA

[Jockette]

Tomorrow I am going to go to a small shopping center 2 miles away to walk farther than I can at home.

This is a good idea, but I think you should wait a couple of weeks, at least, before doing this. With your current swelling, you just need very short walks, like from one room to another. You need to get this swelling down first.

Yesterday after therapy, they told me to not elevate my leg, to let it drop to the floor and leave it down.

Worst advice ever! Even at 3 months post op most of us have trouble doing this.

I’m glad you cancelled PT for today. Consider taking a break from it for a couple of weeks. Seriously. Your mind and body need rest in a calm environment, and that PT office does not give you the calm feelings you need. Maybe even loook for another office, with a more updated philosophy of rehab for a TKR.

And I’m so glad you slept well! That alone will do wonders!

 

[benne68]

DH has said he will take the doctor and PA out of the room and let them know that I will NOT be following their advice on my goals and that he will not stand for their scare tactics like I'm a 4 year old kid refusing to eat all my veggies.

Cheers for DH! You've got a keeper there, @westiemom. So glad he understands.

 

[Layla]

So glad to read you're feeling better, westiemom!

I believe that you have the strength and courage within to advocate for yourself, with your husband by your side. I believe the medical professionals will have more respect for you if you speak for yourself explaining you'd like to work with them to establish realistic timelines and goals that you all agree upon.

Consider explaining to the OS, PA and PT that you feel pressured and uncomfortable when you're pushed to do exercises beyond what your body feels ready for. Explain that you want to recover at a pace that feels comfortable and sustainable without the need to recover from aggressive PT sessions as your body is healing from the trauma of joint replacement. Express what you're willing to do and what you're not willing to do. You have that right.
You can tell them you are willing to work with them, but you'd like to come up with a plan, collectively, that balances your progress with your comfort level. I have faith that you can do this if you remain firm, focused and calm. You're all adults in the room and you have no reason to feel intimidated by them.

I am going to relax about my recovery and not worry (too much) about how long this takes and how much ROM I get back.

Yes! Yay! Yahoo! Hooray! Please hold this thought.

Elevation is certainly still important. It helps improve blood circulation, reducing fiud buildup in the knee which results in tightness / stiffness and limited mobility. Less swelling usually means less pain, so get that leg up.

I am going to go to a small shopping center 2 miles away to walk farther than I can at home. We live in the country and have a gravel driveway and really cannot walk there. I'm tired of making circles thru the house so going out and walking sounds exciting.

I think this sounds like a great idea! We all need to get out and smell the roses, participate in and enjoy life and getting out in the world for a time will likely do wonders for your mental outlook also. It should be a happy and pleasant distraction for you especially as the stores / malls are decorated for Christmas and people are in the holiday spirit. A change of scenery and more space to walk, rather than circles around your home should be good for you, as long as you DON'T OVER DO IT. Maybe take a 5-10 minute walk, then a long rest, maybe over a snack or meal, then another 5-10 minute walk. Enjoy...then ice and elevate once you are back home.
I hope you sleep well again tonight!

 

[westiemom]

I went out today to a doctor appointment with my cardiologist an hour away. I managed to sit in the hour long drive with my leg on the floor, sit thru the appointment and then we went to a restaurant for lunch. I used my walker and walked uphill to the door of the clinic and back to the office. At the restaurant, I did put my leg up on a chair, then drove home an hour with my leg dangling to the floor of the car. Came home, am elevating and icing my leg.

Yesterday was the first day I actually had no pain, just discomfort. I rested all day, with elevating and icing. Took only 2 pain pills in the entire 16 hours I was awake. I'm going to PT tomorrow with a different PT and DH is going to be in the back with me. Everyone's comments about how worthless it is to hurt myself with the PT gives me so much courage to complain when it hurts too much.

I usually have enough guts to stand up for myself. I actually fired my cardiologist and walked out of his office after telling him he was the worst doctor I've ever seen. I have fired many veterinarians over my 45 years of having dogs that I can't even count how many. I don't know why this particular doctor feels me with such trepidation and fear. He seems nice, so not sure why I react to him this way. Maybe just all the pain I've been in for 3 months.

Thank you everyone for helping me by encouraging me, by sharing other's stories of recovery and just all your caring comments. You really make a difference in my life!

 

[Jockette]

After such a busy day today, take tomorrow off and rest a lot! I always did that, and I know @sistersinhim did also. And, no guilt! Don’t look at it as doing nothing, look at it as giving your knee the best opportunity in which to heal.

I don't know why this particular doctor feels me with such trepidation and fear. He seems nice, so not sure why I react to him this way. Maybe just all the pain I've been in for 3 months.

I think there’s something about a joint replacement that makes us feel so vulnerable this early in recovery. I felt it, too. I usually don’t have any problem ignoring medical advice that I don’t agree with, but not with my PKR. I think all the hype we get from everyone (at least everyone not connected to Bonesmart!) puts so much pressure on us, to work so hard lest we be considered a failure. (And I did feel like that my first year of my PKR recovery) 7 years later, and literally thousands of posts just like yours, I know we have to just go with what our body tells us.

You mentioned PTSD earlier. I definitely have some of this from my whole PKR experience. I can still get a little upset talking about my experiences during that first year. And it shouldn’t be like that. Our medical teams should be a source of accurate guidance and advice, and they should be comforting and our biggest cheerleaders. Unfortunately, some are not, and mine definitely were not. I am so very thankful I found Bonesmart!! Bonesmart is where all that accurate guidance and advice is, and is the biggest cheerleaders!

 

[Layla]

What a day...you did great, westiemom! How wonderful yesterday was a day of no pain. I hope the PT you have tomorrow turns out to be a good match for you. If so, are you able to continue seeing the same PT?

I hope you're able to be open and honest about the goals you wish to achieve and you feel understood. Remember you're the boss, they're working for you.

Please don't hesitate to let them know upfront about any exercises or movement that you're uncomfortable with.
They enjoy sharing their knowledge so you can build rapport by asking why certain exercises are important and how it will help you. If you don't like an exercise, consider telling them you're uncomfortable, or that it feels too challenging right now and ask if there is an alternative. Make it clear you don't want to push into, or through pain. They should understand. I believe if you get a good PT you can build a trusting relationship with it will be
a win / win!

I usually have enough guts to stand up for myself.

I believe you...and I have faith in you!
I'm sorry for the bad experiences you've had. Unfavorable experiences can feel overwhelming, especially in the moment, but we can't change them so we need to move forward rather than let them plague us for any length of time. Life is too short and your future looks bright. You're on the mend and you have a loving supportive caregiver in hubs it seems. Christmas is upon us and a brand new year in which you will grow stronger and steadier on your feet month by month. Good things to come! You are blessed, westiemom!

 

[westiemom]

I had my PT appointment yesterday with someone different. The way PT is set up here is that they try to keep you with the same 2 or 3 people to work with you. This person was a young man. I got thru the entire session, just once telling the PT that I refused to do something cause I hurt too much. I can't say I'm very impressed with this particular PT; he just seems to be going thru the motions and couldn't care less about ME. But I live in a very rural, backwoods area and this attitude is prevalent in a lot of areas.

I took my pain med right before we left for PT so hoping that helped with the pain during. We actually stopped at the grocery store on the way back and felt good enough to stay in the car with my leg on the floor. My bending is the thing I'm having problems with. I could only get to 70 degrees again today, but with less pain.

After realizing I am in discomfort, not "pain" per se, I am so much more relaxed about my upcoming OS appointment. No matter what he says, I'm just going to tell him that I am improving slowly and that will be that. If I don't progress as much as he wants, oh well.

I know my expectations from myself and if I don't get back to whatever is considered normal, I'm fine with that. The fact that my knee doesn't hurt with every step is a huge plus.

Once again, thank you for all the comments and encouragement from everyone. It's 60 degrees here and DH is going to drive me down to the nearby shopping center so I can walk and he can watch my leg and let me know how much I'm bending while walking versus walking flatfooted.

I love you all for every comment, advice, and encouragement. You are all the best!!

 

[mendogal]

Hi! I hope you have a great walk today! Yes, having your husband watch you walk will be a great help as you strive for a good heel-toe gait.

BTW, we caution folks against taking pain med before PT or exercise - we **need** to be able to feel our body's limits!

It's always a good a idea to premedicate when we can't avoid a problem (a long car trip or before bedtime, for example), but with PT and longer walks, etc it's best to medicate afterwards.

 

[ouchie!]

Bless you @westiemom I know exactly how you felt and are feeling. Those first few weeks were hell to be honest and I also felt like I was recovering from PTSD with some of the nursing and PT’s staff lack of kindness adding to it. I found overdoing it (sometimes just sitting on a chair for too long) would cause throbbing pain and swelling. I would ensure I raised and iced the knee a lot and resting like crazy the next to make up for overdoing things. Rest as much as you can. It’s just the swelling that’s stopping the full bending - it will come. I started driving at 11 weeks, I just didn’t feel ready before then. Just short journeys at the moment. I’m now at 12 weeks and by bedtime that blooming knee swells up so icing whilst I rest in bed. Sleeping is easier now and I now wake up and realise I’m lying on my operated side and it’s fine! Your body just knows what you can and can’t do. There seems to be an obsession in the USA with ROM and doing MUA’s but here in the UK they’re not so obsessed by it. There is a saying in the UK “Don’t let the people get you down!”. You will recover in your own time and it can’t be hurried. Wishing you well.

 

[Layla]

I can't say I'm very impressed with this particular PT; he just seems to be going thru the motions and couldn't care less about ME.

Sadly, they often run through a list of exercises, checking off the box.

I am so much more relaxed about my upcoming OS appointment. No matter what he says, I'm just going to tell him that I am improving slowly and that will be that. If I don't progress as much as he wants, oh well.

I love your attitude and outlook. I was reminded early on by the PA that the prosthetic, while getting pretty close, will never match our natural joint.
Slowly but surely you will get there. At only 25 days post op, you are in the early days of the healing process in the entire scheme of things. Lots of room for improvement!
I hope you had a nice walk at the shopping center this afternoon.

 

[Layla]

Happy One Month Anniversary, westiemom!
I hope you have a nice weekend!
@westiemom

 

[westiemom]

Hi! I hope you have a great walk today! Yes, having your husband watch you walk will be a great help as you strive for a good heel-toe gait.

BTW, we caution folks against taking pain med before PT or exercise - we **need** to be able to feel our body's limits!

It's always a good a idea to premedicate when we can't avoid a problem (a long car trip or before bedtime, for example), but with PT and longer walks, etc it's best to medicate afterwards.

Thank you for the info about taking the pain med before PT. I will keep them and take them as we're coming home from therapy now.

 

[westiemom]

I can't say I'm very impressed with this particular PT; he just seems to be going thru the motions and couldn't care less about ME.

Sadly, they often run through a list of exercises, checking off the box.

I am so much more relaxed about my upcoming OS appointment. No matter what he says, I'm just going to tell him that I am improving slowly and that will be that. If I don't progress as much as he wants, oh well.

I love your attitude and outlook. I was reminded early on by the PA that the prosthetic, while getting pretty close, will never match our natural joint.
Slowly but surely you will get there. At only 25 days post op, you are in the early days of the healing process in the entire scheme of things. Lots of room for improvement!
I hope you had a nice walk at the shopping center this afternoon.

I had a very nice walk at the shopping center. I feel good about how my leg felt afterwards too. Haven't been back as the weather has not cooperated with walking outside. Just boring walks thru the house numerous times till we get nice weather again.

 

[westiemom]

Happy One Month Anniversary, westiemom!
I hope you have a nice weekend!
@westiemom

Planning on having a nice one. First weekend after surgery with discomfort (mostly) and not "pain". Thinking of pizza as a way to celebrate!

 

[westiemom]

Bless you @westiemom I know exactly how you felt and are feeling. Those first few weeks were hell to be honest and I also felt like I was recovering from PTSD with some of the nursing and PT’s staff lack of kindness adding to it. I found overdoing it (sometimes just sitting on a chair for too long) would cause throbbing pain and swelling. I would ensure I raised and iced the knee a lot and resting like crazy the next to make up for overdoing things. Rest as much as you can. It’s just the swelling that’s stopping the full bending - it will come. I started driving at 11 weeks, I just didn’t feel ready before then. Just short journeys at the moment. I’m now at 12 weeks and by bedtime that blooming knee swells up so icing whilst I rest in bed. Sleeping is easier now and I now wake up and realise I’m lying on my operated side and it’s fine! Your body just knows what you can and can’t do. There seems to be an obsession in the USA with ROM and doing MUA’s but here in the UK they’re not so obsessed by it. There is a saying in the UK “Don’t let the people get you down!”. You will recover in your own time and it can’t be hurried. Wishing you well.

You have no idea how good it makes me feel to know that I am NOT crazy about the pain and not getting better faster! I did have my follow up with the surgeon and he just said he was pleased with my progress and to keep working at PT. Following that appointment, I went home and napped for an hour and then went to my PT appointment. And....drumroll.... I overdid it again. Today (the day after PT) was a lost day. My knee swelled up and I actually had to take pain meds in the middle of the day and ice all day and no exercises. I have a PT appointment tomorrow and I'm thinking about cancelling it. They are pushing so hard to get me to 90 degrees and I'm just not there. I was at 84 degrees at the PT and I made her stop from measuring. It really seems as though I do better with LESS PT than more. My knee is so swollen it will hardly even bend at all. I've been going M, W, F to PT and next week I am cutting back to twice a week. I don't think any of the therapists are going to be happy with me but I am so tired of a good day, then two or three bad ones, and around again.

I also think in the UK they have better mindsets about pain relief. Here our doctors act like we need to just tough it out. I had a pacemaker implanted two months ago and they refuse pain meds during recovery!!

 

[Jockette]

It really seems as though I do better with LESS PT than more.

That’s because you are getting inappropriate PT. Stop doing painful PT like many of us did. You will see much more progress by doing less.

Regaining our ROM does not require forceful bending or painful exercises. That is counterproductive.

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.

I did have my follow up with the surgeon and he just said he was pleased with my progress

This is excellent!

 

[mendogal]

I found it really helpful to NOT be measured and to let my functional milestones mark my improvement:
Things like going from walker to walking stick, losing the elevated toilet seat, losing the shower chair, putting up a laundry, making a meal, resuming cat litter duties (semi squats!), driving, going up stairs sequentially, etc.... Each thing is a distinct new level of healing.

 

[westiemom]

Well, I cancelled my PT appointment today. After Wednesday,s PT appointment, I was back on Oxycodone cause of the pain. I will do my exercises at home today. I found out that (because I am on Medicare), if I don't show improvement every time, if it looks like I am plateauing then Medicare will not pay for more PT sessions. So cynical me, I think that is why they push me so bloody hard to make the "measurement". I had 84 degree on Wed. and she wanted 85 so badly. Now I know why. This is such an American Healthcare scam.

If the weather cooperates I am planning on going to the little shopping center and walking around again. Right now it is in the low 40's and very windy so it might mean walking thru the house again and again.

I can tell I am doing better. I am doing so many more things at home - just daily living stuff - that I never imagined I could do when I first got home from the hospital. Even my dogs know I feel better; they're not as clingy as they were in the first few weeks.

Again, so many thanks for all the encouragement and advice. It makes me feel so much less alone in this journey.

DH COMPLETELY agrees with me about the painful PT appointments. He actually refused to drive me today cause he knows how much I backtracked in my progress since Wed. And believe it or not, PT requires a reason as to why I am not going today. Apparently "no way to get there" is an approved reason for not showing up. God knows what would happen if I don't have an approved reason for not going.

 

[mendogal]

Just to clarify Medicare @westiemom .... If you're on traditional Medicare, and your doc and the PT certify you for a specific period (4, 6, or 8 weeks is standard for initial PT), it's totally untrue that there has to be measurable progress at every single visit. The only time a plateau becomes a bar to PT is when there's a documented pattern over a course of therapy of no improvement. This has been litigated in the cases of longer term rehab for stroke patients.

There may be ridiculous documentation requirements at this one facility. And yeah, my PT provider always needed to write down the reason I was canceling.

And if you are enrolled in a Medicare Advantage plan I have no idea what Utilization Review rules you're subject to. They do go over everything with a fine tooth comb to find reasons to deny service because it costs them money.

 

[westiemom]

Just to clarify Medicare @westiemom .... If you're on traditional Medicare, and your doc and the PT certify you for a specific period (4, 6, or 8 weeks is standard for initial PT), it's totally untrue that there has to be measurable progress at every single visit. The only time a plateau becomes a bar to PT is when there's a documented pattern over a course of therapy of no improvement. This has been litigated in the cases of longer term rehab for stroke patients.

There may be ridiculous documentation requirements at this one facility. And yeah, my PT provider always needed to write down the reason I was canceling.

And if you are enrolled in a Medicare Advantage plan I have no idea what Utilization Review rules you're subject to. They do go over everything with a fine tooth comb to find reasons to deny service because it costs them money.

I have traditional M'care with a M'care supplement. Physical Therapist is the one who told me that after 10 sessions, if I don't show improvement each time, they will not get approval for any more sessions. They want to see at least a 5 degree improvement each session.

From reading more people's stories, it seems that my PT and surgeon are quite aggressive wanting me to be at 90 degrees in 4 weeks. My extension is still at 3 degrees but it is my flexion they are all concerned about.

I am on tramadol today and elevating and icing 30 minutes on/30 minutes off. I feel so much better than yesterday when even the oxy didn't take the pain away. DH and I will be working on exercises later today at home. It is too cold to go for a walk outside and looks like it may rain.

Thank you for explaining the Medicare thing. I have no idea what requirements this PT place has. I know it is very very busy and it's hard to get appointments. We only have the one place for everyone in our county and the surrounding one so they might just want to keep patients who are showing a good improvement each time. Who knows?