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abnormal lab results after ltkr

Glad you're getting it checked out.
 
Glad to hear your having some lab work done. TKR is an energy drain alone, you don't need anything else draining your energy. I'll continue watching your posts. I know everyone is interested in your outcome.
 
Tomorrow is my 3 week post op appointment. I've had pt at home the last 2 weeks. My ROM is slowly improving, 84 on Monday, 86 on Tuesday, and pt forced it to 92 yesterday. I Didn't sleep good last night from pain. In fact, My sleep the past week has been worse than the first 2 weeks. I'm not a back sleeper and my knee wakes me up almost hourly. Any sleep suggestions? I have taken a sleeping pill 3 of the past 6 nights, still woke frequently. I believe if I could sleep better I may feel like getting out of the house. Admin- can u change my header thread title to "sleep problems"?thank u. I could not figure out how to on my iphone.
 
'PT forced it to 92'
Don't let PT ever force your leg to bend. That can be causing you extra pain and swelling making it harder to sleep.

I am a side sleeper and found I slept better in my recliner with my leg elevated on three pillows.
 
J.A. Hag said:
My ROM is slowly improving, 84 on Monday, 86 on Tuesday, and pt forced it to 92 yesterday. I Didn't sleep good last night from pain. In fact, My sleep the past week has been worse than the first 2 weeks. I'm not a back sleeper and my knee wakes me up almost hourly. Any sleep suggestions?
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It isn't necessary for your PT to keep on measuring your ROM. It will only improve slowly and it can only improve as the swelling goes down. It's not the exercises that improves ROM. It's the decrease in swelling. So, spend less time exercising and more time resting, icing and elevating your leg, to help decrease that swelling.

Do not allow your PT to push on your knee or force it, ever. It's your knee and you have the absolute right to say STOP, loud and clear.
Saying no to therapy - am I allowed to?
Remember this, from the mantras:
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist (PT) - to do it to you.
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again

It's quite likely that you are suffering the normal disruption of sleep patterns, as explained in this article:
Sleep deprivation is pretty much inevitable - but what causes it?
You make up for sleep lost at night by taking daytime naps. Sleep where you can, when you can, and how you can - and try not to worry about it. This is normal.

However, it's also possible that you are under-medicated, especially after being hurt at PT. Your knee will hurt more at night, as the stress from the daytime has a cumulative effect. Do make sure that you take an adequate dose of your pain medications at night and during the night. That might help more than taking sleeping pills.
 
Thank u for your suggestions. I will speak up to pt and I'm getting dr.'s opinion on pt force. Wondering what motivates pt to push, do they paid or rewards when patient reaches certain numbers? I tried to take less Percocet because of the horrible constipation so at night I take one tradamol with one 5mg percocet at 10pm and 2am and 6am.
 
Make sure to take stool softeners if you are having problems with constipation. A lot of people prefer Miralax. It is a tasteless powder that can be added to any liquid. You can always check with your PCP or OS too for suggestions.
 
I don't P/T probably gains anything other than saying when asked by the O.S. or to write in their notes patient has a ROM of what ever. I do agree that any forcing the bend will lead to swelling and decreased ROM. Icing and elevation work the best at keeping the swelling down, plus that will help towards a decrease in pain, which could mean a decrease in pain medication, == less consitpation. (sp) a win/win combination.
 
J.A. Hag said:
Wondering what motivates pt to push, do they paid or rewards when patient reaches certain numbers? I tried to take less Percocet because of the horrible constipation so at night I take one tradamol with one 5mg percocet at 10pm and 2am and 6am.
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PTs get hooked up on the numbers because it is one way they can prove to the insurance companies that their ministrations are effective. That doesn't mean that what they are doing is good for your new knee. In fact, it's very bad for you knee, because when they push on your knee or overwork it, that causes increased inflammation and swelling, which can actually set back your recovery.

Some PTs have been taught two old-fashioned means of treatment - "No pain, No gain", and that you have a limited amount of time in which to gain ROM.
Both those beliefs are wrong. They are myths that should have died long ago:
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR

You do need to take adequate pain medication. Yes, it's true that the pain meds cause constipation, but you still need to take them.
Pain management: importance of managing pain after a TKR and the pain chart
This article might help:
Constipation and stool softeners
I had to ask my own doctor for a prescription for an aperient, so that I could keep taking the pain medications.
https://bonesmart.org/forum/threads/myth-busting-the-window-of-opportunity-in-tkr.6895/
 
Hi I went to 3 wk appt this morning and the Dr. said patients are at 100 ROM by now, you're behind. I was 90 today and 92 is my best. I was told when you come at 6wks if you're not 112 we will do surgery to bend knee for you. My swelling is why I can't bend and it's from doing too much. He said it's a challenging period and I need to push through. My husband went with me and he walked away with you need to be 120 in 3wks and I'm going to need to do better. How can I when knee swells so much which decreases my ROM. I did switch to a cane which is good need! Yay me!
 
"we will do surgery to bend your knee for you".
Well if that was talking about my knee I would fire him. 8 degrees is not a big deal.

Rest ice elevate . That is what gets rid of the swelling..
Are you doing that? That is your job now.
 
J.A. Hag said:
I was told when u come at 6 wks if you're not 112 we will do surgery to bend knee for u.
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Far too soon for this. Just say no! All the forcing is only adding to the swelling making it impossible to gain ROM. Ice, elevate and take your meds. And do not let anyone force your knee - including the OS.
 
J.A. Hag said:
Hi I went to 3 wk appt this morning and the Dr. said patients are at 100 Rom by now, you're behind. I was 90 today and 92 is my best. I was told when u come at 6 wks if you're not 112 we will do surgery to bend knee for u. My swelling is why I cant bend and its from doing to much. He said its a challenging period and I need to push thru. My husband went with me and he walked away with u need to be 120 in 3 wks and I'm going to need to do better. How can I when knee swells so much which decreases my Rom.
Click to expand...
It is important to remember that they cannot do anything to you without your permission. It is your knee and your recovery----and we all recover at different rates and on different schedules---not the schedule put forth by an OS.

I would not worry at all about the MUA----again, it is your choice, not his---and they cannot force you to do it. Don't let him threaten you.

Remember that (and I was very much like this after my BTKR) that some of us recover very slowly---and that our schedule (actually, our knee's schedule for recovery) was not at all on the same page as the OS's. Understand that a full recovery can take upwards to a year or more---and that you have a ways to go yet---

Ice, elevate, and rest and let that swelling come down. Cut back on what PT----this is not the time to push through it---it is not about working harder---it is taking things more gently and taking things slowly. Slow and gentle---not pushing through things.

You are not behind---you are right where you should be, according to your knee's schedule, and not your OS's.

Don't let them bully you or threaten you----take your time, take some deep breaths, and understand that things can take longer than we would like them to, but it is not anywhere near time to consider an MUA.

I am also going to tag @Josephine and @Jamie to give you their input.

Relax, and do not be frightened. Most of us were not prepared for the length of time that a TKR or a BTKR can go on for---and your knee is right on schedule---its schedule, not your OS's. His schedule means nothing.
 
Three weeks is far too early to think about an MUA. Your numbers are fine for 3 weeks, just say no.
 
J.A. Hag said:
Hi I went to 3 wk appt this morning and the Dr. said patients are at 100 Rom by now, you're behind. I was 90 today and 92 is my best. I was told when u come at 6 wks if you're not 112 we will do surgery to bend knee for u. My swelling is why I cant bend and its from doing to much. He said its a challenging period and I need to push thru. My husband went with me and he walked away with u need to be 120 in 3 wks and I'm going to need to do better. How can I when knee swells so much which decreases my Rom. i did switch to a cane which is good need! yay me.
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I disagree entirely with your surgeon. "Push through the pain" is a very misguided idea.

My surgeon does not expect 90 degrees until about 6 weeks. He also does not believe in any PT until at least a month after a TKR. He says that your knee needs that time, so that it can start to heal properly. His patients all do well (I did, too) and he hasn't had to do a manipulation to help with ROM (Range of Motion) for the last 4 years.

With a bend of 92, you are actually well ahead of what many surgeons expect, so don't worry about it.
Above all, don't frightened into doing more exercises, in a vain attempt to increase ROM.

My dear, this is your knee. You are in charge of what happens to it. No one can do anything to your knee without your consent. So, speak up. Say and do what feels the best to your knee. That probably means not over-exercising, and not causing it pain. Tell your husband that you will be kind to your knee and not allow it to be hurt.
Saying no to therapy - am I allowed to?
BoneSmart philosophy for sensible post op therapy
Remember, as I posted in this article, previously, that there is no deadline for gaining ROM:
Myth busting: the "window of opportunity" in TKR
ROM can continue to improve for a year, or even longer, after a TKR, so there's no need at all to rush.

So don't get scared by threats of a manipulation. Your surgeon can't do that without your consent. He can advise, but you have the right to choose. In any case, studies have shown that having a MUA early in recovery has no positive effect on the eventual outcome.
MUA: the ineffectiveness of early MUA (JBJS)

Do your best to help decrease the swelling in your leg (lots and lots of rest, ice and elevation) and your ROM will improve all by itself, without any forcing or over-exercising. At the moment, the swelling is making your leg act like a hose pipe that is filled with water. It can't bend easily. But, get rid of the water/swelling and the bend is much easier.

I think it might be a good idea if your husband read some of the articles we've posted for you. Hopefully, he'll then understand a little better.
 
After my revision I followed the one sentence his office told me. "If it hurts, dont do that". I took him at his word and follow that advice. I can flex to 130 degrees now but I'm sure I wasn't near 90 at 3 weeks. He also told me that further down the road "If I Thought" I wasn't progressing well enough to let him know. I did no painful PT at all. I did some stretches and increased my walking according to what my knee decided.
 
This is why I have such negative feelings towards P/T, mine claimed the surgeon expected certain numbers, yet when I went to the surgeon in the beginning he didn't mention much about it. About this same time period where your at, that is when that MUA became part of the conversation at my P/T sessions. One day I was so disturbed by the news I cried all the way home. You don't feel the greatest anyways, you make good effort to get p/t in, your mind is still mushy from surgery. My husband thought also I should push myself harder and I wasn't trying hard enough, this was put into his head by p/t when he went along for my appts in the beginning. In hind sight I needed to ice and elevate more and not try and do things just because I could and I would have been further ahead. My pain level has never been bad, my swelling and stiffness that has been what has held me back, but I didn't do as much icing and elevating in the beginning.........slow learner.
Don't let P/T dampen your spirits, it's such a burden to have hang over your head. I think we all want to do what's best for ourselves to recover, but I think our biggest recovery tool is time and patience.
 
When I discontinued PT it was like a weight leaving my knee.. My surgeon never really pushed PT. But it was in the bundle of service for the first three weeks ( at home) then the home PT's pushed outpatient PT.
 
J.A. Hag said:
the Dr. said patients are at 100 ROM by now, you're behind.
Click to expand...
These doctors and PTs who set timetables for their patients make me want to scream! There's no way the ROM at 3 weeks should be taken as an ultimate, much less threatening with an MUA because of it! You are perfectly correct when you say the swelling is blocking your ROM and there is NO way you can get more until the swelling goes down.

And I echo the advice and comments from others about the MUA. Read this post and see that you DO have control over this.

So I'd like to ask you some questions if you don't mind, 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 swollen is your leg compared to these?
[Bonesmart.org] abnormal lab results after ltkr


4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

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

8. what kind of PT exercises and exercises at home are you doing? How much and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home and how many sessions you do each day
enter exercise by name then number of repetitions of each
etc., etc.

At PT (how many times a week)
enter exercise by name then number of repetitions of each
etc., etc.
 
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