TKR And the Marathon Begins<<

[Celle]

I find that most PT seem to have a process they follow and they are not prepared to change their point of view unless there is some new data out there.

I agree Vonnie about their process. I think it’s ingrained in them.

I can’t wait to hear your PT’s response!

It doesn't matter what the PTs' response is, or that they don't want to change it, or what they say.
It is your knee and you are the only one with the right to say what happens to it.
Say what you want, what you feel your knee wants, and they have to respect your wishes.
Saying no to therapy - am I allowed to?
CONSENT: what it means and how it can be used

 

[nuttybrunette]

I hear what you’re saying Celle, I really do, but if we choose to continue with PT then it behooves us to foster a good working relationship. In doing that it helps us to understand their process, full well knowing we don’t have to agree to it if we don’t want to. My PT’s response was actually interesting because he said he doesn’t often see it in linear form like that, month by month by a patient. Thought it was cool and reinforced the fact that he knows we all progress differently. Him saying that helps us be more on the same page. All working out)

 

[Jockette]

Did you discuss with your PT the conversation you over heard your surgeon have with another patient as compared to what he said to you?

 

[nuttybrunette]

@Jockette I did, last week, but for the life of me I can't remember what he said about it. LOL Brain Fog and age!!!

 

[Jockette]

@Jockette I did, last week, but for the life of me I can't remember what he said about it. LOL Brain Fog and age!!!

Been there, done that!

 

[sistersinhim]

What's bad is when you have brain fog 2 years later! I call it a brain cramp!

 

[nuttybrunette]

Med question!!!: Need advice on how best to taper off Tramadol. Been taking 50 mg 4 times in a 24 hour period. Sometimes just 3. But after taking one before bed last night and nothing all day today I started feeling not so good. Stomach hurts and jittery. So, I just took one, it’s bedtime again. I don’t know what to do. I did fine pain wise today with just Tylenol. But how the heck do you get off Tramadol??

 

[nuttybrunette]

My night was just awful. Couldn’t sleep, had to move, was so jittery and crying. Was in and out of bed a dozen times. This is so bizarre. Does this happen to everyone or is my system way too sensitive? Lol. Would you suggest starting out by cutting each one in half and still taking the 4 a day/24hour period? Some days I’d forget it tho and it would be 8 or 9 hours of a span, and that was fine. Should I take less than 4 a day then? Who knew you’d need more than one kind of rehab: knee and meds! Lol

@Josephine do you have a written “schedule or plan” for this?? I was on it for about 5 weeks. Thanks!!

 

[kneeper]

If you have a good pharmacist they might be able to advise, particularly about if pill splitting is ok.

 

[Josephine]

I wouldn't think that a 5 week period on Tramadol would result in dependence. I doubt even 5 months would result in it! I doubt your problems were due to that either.


I'd really like to offer you some structured advice so I can advise you but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[nuttybrunette]

@Josephine Glad to think it might not be that....sure felt weird. So going off it "cold turkey" you think would be okay??

I'll be happy to answer questions.

 

[Josephine]

When I was taking Tramadol - which I did for about 4 months! - I was actually reducing them for about a month beforehand as the pain receded and I just stopped one day. But I think taking them for only a month would certainly be okay to stop it now if your pain is really that low.

 

[Josephine]

Here y'go then!

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. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

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?

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. are you doing any exercises at home? If so what 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
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[nuttybrunette]

@Josephine
1. Pain level 1 or 2

2. First I was on Percocet for about 2 weeks. Now on Tramadol 50 mg and Tylenol 1,000 every 6 hours - has been my schedule for 5 weeks. I've had many days where I skip the midday Tramadol and or stretch out the doses. Mostly felt the need for it in the evening, until recently where I don't feel the need for it at all. Would like to try just Tylenol.

3. Slight or none. Looks just like my other knee.

4. Flexion is 90, or was a week ago, could be more now. Extension was +10, meaning not bending down to 0 yet.

5. Icing 4-5 times a day for close to an hour.

6. Elevating every time I ice and whenever I'm sitting still, which I still do a lot. Also, elevated all night. Lounge doctor is my friend.

7. Activity: laundry, load and unload dishwasher, feed cats/dogs, pick up a bit, do one part of the dinner meal like just the salad part while hubby does the rest, but get my own breakfast and lunch. I've been to the store twice for a few things, but hubby still does the big shopping trips. Overall, I sit for most of the day, if you were to break it up into percentages of down verses up. I have a cool paint by number project I'm working on.Also various walks around my garden, pull a few weeds, cut a few dead flowers, throw a ball for a dog When its not 106 degrees I take a walk down the road for maybe 15-20 minutes once a day. I have a house cleaner that comes once a week to do it all, including sheets. Money well spent!

8. At home: (I've tried to mostly stick to the advice here about the ADL being enough and not overdo it. I overdid it on my last knee and that got me nowhere, so I'm trying to not worry about it this time).

-Stationary bike: Just started a week ago, about twice a day for 5-10 minutes. Feels good to stretch it. Have been just rocking back and forth. Can go all the way around with a little hip lift each rotation. Not sure if I should do the hip lift technique.....
-quad sets: 20 reps per day, some days I forget
-short arc: 20 reps per day, some days I forget
-try to work on extension by putting calf and foot on the ottoman in front of a chair, maybe 4 times a day for a couple minutes. Should I do more?


At PT 2 times a week:
-Stationary bike: 10 minutes-rocking back and forth
-quad sets: 30 reps
-short arc: 30 reps
-laying down, heels up on big ball and roll ball towards myself and bend knees, 30 reps
-stand on big foam cushion and alternate weight on each leg, like marching very slowly, but knees not up high-4 minutes
-alternating toe touches up onto an 8 inch platform while standing in front of it. Just touch, not a step up, 30 reps
-lots of feel good massage
-ice, elevation and is it the TENS unit with the 4 electrodes that pulse electricity? If so, then that. All for 20 minutes

 

[nuttybrunette]

@sistersinhim I just noticed your bike in your picture. I like the step thru part. Do you like that aspect about it? What brand is it? Do you love it? I use to ride a lot and really miss it. Rode in college with a group that did a lot of miles then my husband and I would take bikes on our camper vacations and try to get in some riding. Over the years I had to switch to bikes that were more upright, as it would hurt my arthritic neck to be in the hunched over position. Last bike I bought was after my last TKR, 10 years ago, but it is just too big, more bike than I can handle, so I never really got back into it much. I'd love to rekindle that though when this new knee is ready for it, but think a bike like yours might be the answer.

 

[Josephine]

1. Pain level 1 or 2

Oh - okay

2. First I was on Percocet for about 2 weeks. Now on Tramadol 50 mg and Tylenol 1,000 every 6 hours - has been my schedule for 5 weeks. I've had many days where I skip the midday Tramadol and or stretch out the doses. Mostly felt the need for it in the evening, until recently where I don't feel the need for it at all. Would like to try just Tylenol.

Then do so! Sounds like you're just prime for stopping it! Try taking the Tylenol 1,000mg 4 times a day.

3. Slight or none. Looks just like my other knee.

Good!

4. Flexion is 90, or was a week ago, could be more now. Extension was +10, meaning not bending down to 0 yet.

Yes, I know what +10 means! My advice is don't worry about it. Normal every day activities and walking will get the extension better.

5. Icing 4-5 times a day for close to an hour.

Jolly good!

6. Elevating every time I ice and whenever I'm sitting still, which I still do a lot. Also, elevated all night. Lounge doctor is my friend.

Excellent

7. Activity: laundry, load and unload dishwasher, feed cats/dogs, pick up a bit, do one part of the dinner meal like just the salad part while hubby does the rest, but get my own breakfast and lunch. I've been to the store twice for a few things, but hubby still does the big shopping trips. Overall, I sit for most of the day, if you were to break it up into percentages of down verses up. I have a cool paint by number project I'm working on.Also various walks around my garden, pull a few weeds, cut a few dead flowers, throw a ball for a dog When its not 106 degrees I take a walk down the road for maybe 15-20 minutes once a day. I have a house cleaner that comes once a week to do it all, including sheets. Money well spent!

All sounds good!

8. At home: (I've tried to mostly stick to the advice here about the ADL being enough and not overdo it. I overdid it on my last knee and that got me nowhere, so I'm trying to not worry about it this time).

Jolly good!

Stationary bike: Just started a week ago, about twice a day for 5-10 minutes. Have been just rocking back and forth. Can go all the way around with a little hip lift each rotation - that's good
Not sure if I should do the hip lift technique - which is what?
quad sets: 20 reps per day - stop these
short arc: 20 reps per day - stop these
try to work on extension by putting calf and foot on the ottoman in front of a chair, maybe 4 times a day for a couple minutes. Should I do more? - no - stop these too

At PT 2 times a week:
Stationary bike: 10 minutes-rocking back and forth
quad sets: 30 reps
short arc: 30 reps
laying down, heels up on big ball and roll ball towards myself and bend knees, 30 reps
stand on big foam cushion and alternate weight on each leg, like marching very slowly, but knees not up high-4 minutes
alternating toe touches up onto an 8 inch platform while standing in front of it. Just touch, not a step up, 30 reps

At 8 weeks you don't need these. I suggest you cancel the PT sessions altogether.

lots of feel good massage
ice, elevation and is it the TENS unit with the 4 electrodes that pulse electricity? If so, then that. All for 20 minutes

Those are fine.

If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?

 

[sistersinhim]

What brand is it? Do you love it? I use to ride a lot and really miss it.

It wonderful to be able to ride without a painful right knee anymore! It is a Diamondback Serene. When I was looking for a step through, there were very few available. Now, they are pretty plentiful. In October I rode 34 miles in 2 days and my knee was a little sore, but otherwise did great! Before my tkr I was lucky to be able to ride a few blocks. You will get back to it! Just take it easy and let your knee heal!

 

[nuttybrunette]

@Josephine Thank you for getting back to me so quickly. A couple things: The reason I explained what +10 extension was because I wasn’t sure myself if I was +10 or -10 and I didn’t want to tell it to you backwards. I know you know what it means, it was my insecurity about it.

The hip lift technique I mentioned is what I do to get full rotation on the bike. If I don’t lean to the side a few inches and lift my hip I can’t do the rotation. Is it wrong to do that? I’m thinking it might put a weird angle on my knee or at least mess up my back. I only do it for 30 seconds, just to feel like I’m riding a bike like normal people. Otherwise I just do the rocking the pedals forward and back.

I was thinking I didn’t need those PT exercises that you crossed off either. They seemed fine in the earlier stages but felt I was past their use at this time, too.

The extension activity of putting your calf and ankle on the ottoman was something I saw a fellow posting here. I thought it was endorsed by bonesmart. No? Not a good way to help extension? But I’ll certainly stop if not worth it.

Again, thank you so much for all your help and advice. This site helps so much. I still remember how useful it was for me 10 years ago, when Doug and Pattipoo were here. Their craziness was just what I needed to cheer me up and keep me going.

 

[Jockette]

I did that hip lift thing, too, on the bike at PT because it was the only way I could do the rotation. I was barely 4 weeks post op and I now know that for me, it was too soon to be doing full rotations, as they were so painful it took all weekend to recover.

 

[SusieShoes]

The extension activity of putting your calf and ankle on the ottoman was something I saw a fellow posting here. I thought it was endorsed by bonesmart. No? Not a good way to help extension? But I’ll certainly stop if not worth it.

It's not a bad exercise for extension, just that now may not be the best time for it. You can always do it later if the walking hasn't gotten your knee to full extension. The ottoman exercise (for lack of a better name) can be painful early on and contribute to knee swelling, and therefore less flexion. Walking is a gentler way to stretch those hamstrings.