TKR A Lefty for kneeper
- Thread starter kneeper
- Start date
OP
OP
I know I told the PT but this was the assistant yesterday. I will be sure to remind the actual PT tomorrow. In her defense the assistant did say "can you try for 10?" and I, ever compliant,
did.
OP
OP
Thanks @71Beetle . I took a nice long doze with my polar ice cuff 
and felt much better. Had to go online for something else so decided to check in on BS right away. Left a message on PA's voicemail but didn't get a call back. I hope that's a good sign. I'll check in with the pharmacy tomorrow to see if they got an order 
.
and felt much better. Had to go online for something else so decided to check in on BS right away. Left a message on PA's voicemail but didn't get a call back. I hope that's a good sign. I'll check in with the pharmacy tomorrow to see if they got an order .
chestnc
big-cheese
Hi @kneeper, checking in to see how you are doing. Hope you are getting along well. Have you noticed that with the knee replacement being done you have required more pain medication or larger doses given your other diagnosis or do you seem to be golding your own? Great that you are getting some good rest. It is wonderful to go to sleep with an ice pack and wake up and feel better. I many nights sleep with one. Of course it doesn't stay on all night which is okay too. Stay well.
Jozilla
supremo
@chestnc if your health insurance covers it, why don't you ask your RA doctor for a prescription for an ice machine. It is so worth having. Or they can be found on eBay and Amazon at good prices. I believe I slept with mine for over 7 weeks and gave me so much relief. Also question for you and @kneeper - after you had your tkr do you still have RA issues with that joint? I have a friend whose Mom has RA and needs a tkr. I did tell her about BS and hope she joins to find some answers. Take care.
OP
OP
@Jozilla the RA issues with the knee go away after the tkr. I found after the first one that I still have some remaining soft tissue soreness at times though--either the RA which can affect tendons and ligaments or the fibromyalgia--hard to tell. The first knee stopped swelling once it healed--I hadn't seen a "normal" looking knee in years before that. Usually though, the right tkr knee I had done 3 years ago feels amazingly "normal."
@chestnc before the tkr my RA pain was not too bad. I could usually keep it at a manageable level with max doses of tylenol and an occasional vicodin when it got particularly bad. Right now I think I need the pain meds as much for the RA as for the tkr knee. :(
@chestnc before the tkr my RA pain was not too bad. I could usually keep it at a manageable level with max doses of tylenol and an occasional vicodin when it got particularly bad. Right now I think I need the pain meds as much for the RA as for the tkr knee. :(
OP
OP
Good news/bad news.
Good: I got my refill on the hydrocodone with no problem. They're not worried about me reducing meds yet. Extension is excellent & I don't need to focus on it at all.
The PT wants to focus on my flexion and leave the strengthening and endurance on the back burner for now. Seems sensible.
Bad: I'm still only at about 82 flexion. They are believers in the "window of opportunity" and say the OS could recommend an MUA or dynamic splint if I'm not at 90 by my visit on Tuesday. Therefore I should be working the knee harder to get the bend.)
Now I do believe I can work the knee a bit more than I have been now that the swelling's a bit better, but I don't want to work it so hard the knee blows up. (PT seemed to be advocating spending a good chunk of the day working on the bend)
My inclination is to keep steadily working on it but with lots of icing and elevating too. If can progress a little in the next week or so my thought is to say "not yet" if he says MUA or brace. I was a bit of a turtle last time too and did ok in the end. I want to say I didn't really start gaining flexion until week 5 or 6 when the knee started calming down.
I don't feel like I'm "stuck" because after some massage and loosening up, she got an extra degree or so compared to when we started the day. Also I feel like the bending to the limit I'm getting is smoother/easier feeling.
(btw: Again like last time the OS had to remove a lipoma arborescens as well as doing the other typical things.)
@Josephine I suspect I know what you will say to all this but I'd really appreciate your thoughts.
Good: I got my refill on the hydrocodone with no problem. They're not worried about me reducing meds yet. Extension is excellent & I don't need to focus on it at all.
The PT wants to focus on my flexion and leave the strengthening and endurance on the back burner for now. Seems sensible.
Bad: I'm still only at about 82 flexion. They are believers in the "window of opportunity" and say the OS could recommend an MUA or dynamic splint if I'm not at 90 by my visit on Tuesday. Therefore I should be working the knee harder to get the bend.)
Now I do believe I can work the knee a bit more than I have been now that the swelling's a bit better, but I don't want to work it so hard the knee blows up. (PT seemed to be advocating spending a good chunk of the day working on the bend)
My inclination is to keep steadily working on it but with lots of icing and elevating too. If can progress a little in the next week or so my thought is to say "not yet" if he says MUA or brace. I was a bit of a turtle last time too and did ok in the end. I want to say I didn't really start gaining flexion until week 5 or 6 when the knee started calming down.
I don't feel like I'm "stuck" because after some massage and loosening up, she got an extra degree or so compared to when we started the day. Also I feel like the bending to the limit I'm getting is smoother/easier feeling.
(btw: Again like last time the OS had to remove a lipoma arborescens as well as doing the other typical things.)
@Josephine I suspect I know what you will say to all this but I'd really appreciate your thoughts.
Phil75070
post-grad
That is very much the program my PT followed. Many weeks were spent doing exercises that promoted flexion and extension with only a little bit of work on strengthening the quad. The last few weeks of PT were spent on the strength exercises not only for the leg but also the upper body. By that time the initial swelling was way down and the knee held up and didn't swell as a result of the workout I went through.
71Beetle
post-grad
Hi @kneeper - well, the good news is good but the bad news is a real drag. You are still only 5 weeks out. I found that I improved greatly after the 5 week mark. You will get the flexion eventually. Remember they say that the recovery can go for a year or longer. I am not sure what to recommend. I was only at 106 at 8 weeks but I was okay with that as I was able to get to that number with less work than I did at 7 weeks.
What is a lipoma arborescens?
Hope things get better forvyou soon!
What is a lipoma arborescens?
Hope things get better forvyou soon!
busylizzie
post-grad
@kneeper , it seems early days for a MUA. Can you stall it for a while? I'm at about the same stage as you. At my appointment on Wednesday they said my progress would have been what they expected from a primary TKR. Don't overdo the stretching it only aggrevavates the swelling in my opinion and then you go backwards. I'm working on mine slowly letting my knee set the pace and it seems to be working. The number is slowly going up. We are only at just over five weeks out from major trauma to our knee. The first time around for me, they gave me very aggressive physio and it definitely was counterproductive all round and my knee went backwards from then on.
Josephine
NURSE DIRECTOR EMERITA
Actually, no it doesn't!
Well let them go whistle! The choice is yours, my dear, and only yours. They can recommend but then they have to get you to sign a consent form without which they cannot touch you, not even for the brace.
It's quite simple: your leg, your choice. NOT THEIRS! So tell them "thanks for your advice but if it's all the same to you, I'd sooner do it my way".
Intra-articular lipoma arborescens is an uncommon benign synovial neoplasm (tumour) of unknown aetiology. LA is characterized by villous transformation of the synovium due to diffuse infiltration of the subsynovial stroma by mature adipose cells. The Latin word “arbor” means tree-like morphology - very similar to PVNS: Pigmented villonodular synovitis
OP
OP
@Josephine Why not?
Unless maybe the PT is going to focus on the flexion and the assistant will focus on the exercise part? They alternate appointments.
How did I know that's what you were going to say?
That's my feeling too, but it helps to keep getting reinforcement. I feel like I'm just not going to be on an arbitrary "schedule."
OP
OP
Thanks @busylizzie . That is my feeling too. But it helps to have backup. I do feel a bit sore today in the quads & hamstrings.
I was able to do forward & backward rotations on the bike this AM. I'll take it a little easier today with gentle stretches throughout the day. I think they try to compress things into a PT appointment. :(
I'm so happy for you that you're doing so well.
OP
OP
Oh and another thing. I don't think the PT has much experience with RA patients. When I tried to tell her that it was acting up and I may have aggravated things last time with the steps etc. I think she thought at first I was trying to get out of doing stuff. I had to explain that it wasn't the new knee it was everything else that was the issue--such as the ankle.
I think she did eventually kind of get what I was saying, but people don't realize you can look "normal" and still have RA.
I think she did eventually kind of get what I was saying, but people don't realize you can look "normal" and still have RA.
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PT should have gotten a good overview of RA in school, not sure what she is thinking.Check out the library, there are some good articles on the downside of early MUA, to back you up if it is suggested.
You are way to early in recovery to even be thinking about a MUA..
You are also too early for strengthening and endurance exercises. You are injured not weak or out of shape.
If you can go all the way around on the bike, your ROM is adequate.
Take it easy, go slow, the @kneeper wins the race.
OP
OP
msmechanic58
post-grad
I do strengthening exercises first with the assistants and then ride the bike to loosen up the knees. After that we work on range of motion. I am there a good while since everything is doubled. It is working well so far for me.
chestnc
big-cheese
Hi @kneeper, I agree with the other folks in that MUA is too soon to be talked about. I think in due time you will reach the 90 flexion on your own. I think when you have other medical issues going on it may slow down the progress of any operation. I was at 90 in about one and a half week post op. But now at almost 9 months the knee is now sore to touch and still hurts at times more so than it did ub previ. I hope you are feeling better soon. 
@
@
I actually had RA and OA in the knee and was minus cushion. I don't have the same discomfort of bone on bone, but I have discomfort of having the TKR. I still have stiffness in the knee at itself at times which is a part of RA and could also be a part of having the TKR. I don't feel the pain of RA in the knee as before the surgery. But the knee is sore. It is sorer now than when I was 4 months post op. That is why I have an appt. on Thursday with the OS. When I take the pain medication the soreness and discomfort are not relieved by the pain medication I am on for the RA. I will address this with the OS doctor since I will see him first. I will address it also with the pain management doctor as well. Since I am so far out post op the OS doctor may not want to write me a pain med script since I have a pain management doctor involved. Especially with the difficulty now a day of controlling narcotics and people including prominent people in the media found over dosing. Also some folks will go to many different doctors for pain medications. This makes it tough for us folks who are post op or have a chronic illness or both to obtain pain meds at times. My Rheumatologist stopped writing pain medication scripts for me as soon as new Laws went into affect in NY. He referred me to pain management, but I had already referred myself.
chestnc
big-cheese
Also @kneeper
. You are so correct in mentioning this. The second visit with my PT person, she grabbed my leg and pushed it straight up in the air. I think I caught a cramp at the same time and I let out an elongated scream and she placed my leg back on the table and told the assistant to have me must continue with the rest of the exercises. The next visit I explained to her that I have RA (though she was the one who did my intake) and somedays will be good for me and some will be not so good. So after the chat she would ask me or I would be sure to tell what kind of day I was having before she touched me. We worked it out and by the time my last PT session ended, I did not want to leave. Kneeper you are correct when you are correct when you say that sometimes the therapist does have a clue about RA. many people don't. Most of the time I don't even mention RA to people because I know they don't have an idea at all and how it causes you to not feel well or incapacitated at times. At work only my close friends know. Most people may say oh what's wrong and I may say oh my back hurts and leave it at that. Anyway keep feeling well and glad you got the Hydrocodone. Use it as long as you need it. Stay well.
