TKR Anxiety about TKR - now it's done!

[kneeper]

Pain levels of 9 at PT are totally out of line imho. What are they doing to you?
You're right that you will be happy later, but you can't rush to get there. Your body needs time to heal.

 

[jenng2003]

I am also out of pain meds and due to state laws, I cannot get more until tomorrow at my appointment. Let's just say PT doesn't believe in ice, elevation, and rest. I pulled weights off my leg today because it was too much. I am not even three weeks from surgery. But the level 9 pain has lasted all day. Even now in bed, I am at about an 8 with ice. I iced all day today to try to contain the pain. The hip flexor is also feeling a bit like tendinitis again (I've battled this since March). There are tears frequently throughout the day. I am praying my appointment tomorrow morning will make them stop. My goals are pain management and making my OS talk to the PT about the excessive force she uses on my leg, as well as what his protocol is for PT after a TKR. I knew it would be rough recovery, but this is enough. I've said more than once in the last week that I want this to just go away and for it to be normal.


LTKR. October 27th 2014

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[Ollie]

@jenng2003 So sorry to hear about your pain and PT issues. And the emotions are all part of the wonderful adventure you've embarked on. I didn't have near the issues that you are having, but if would burst into tears at the slightest stressor. . . Or if I was just feeling pitiful. It will pass and your sanity will return!

So - I know it has been said before, but why don't you just cancel your PT appts. until you get the pain and swelling under control? They shouldn't be running/ruining your sense of safety and wellness. If you are hurting - at not even three weeks out - something needs to change. Tell your OS what you want and that your PT has been hurting you. PT should be work, but not bring you to a pain level of 9!!

My PTs never touched my knee; I was lucky to have an OS who believes in pool PT and it was great. But I had to keep seriously icing for long stretches of my days clear up to 8-10 weeks. And not over do with shopping or whatever!! I couldn't be out and about for more than 15-20 minutes until about week 4 (PT being the only exception). OH, and I really don't like that your PT is threatening MUA at two weeks... So unfair!

Get on a pain med schedule - again, tell your OS or GP what you need. Don't let them tell you about fears of addiction, etc. I was on Dilaudid and didn't start to taper until about week 10 and never had any trouble. Now (I am at five months) I take Tylenol extra strength in the morning, after school only if I need to, and most nights a Tylenol PM at bedtime. Some days I feel good, some days there is discomfort, but it is getting better. More slowly now that it is colder, but still better!!

Go Get 'Em!!

 

[jenng2003]

I successfully got more pain meds. Unfortunately, the dr is concerned with my lack of flexion. He is giving me two weeks and then he is doing manipulation under anesthesia. He said there isn't much swelling. He was impressed with the way it looked. He thinks with my history that there is just too much scar tissue. I am working on massaging my leg hoping it will loosen. I don't know what to do. I'm outta sick time and I am frustrated. I can't just quit PT or my insurance won't cover anything else related to this knee. Gotta love healthcare!


LTKR. October 27th 2014

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[kneeper]

I can't give you medical advice, but given the fact that your pt has been overworking you, and that you are not even a month out, I'd think hard before agreeing to an MUA. Remember they can't do anything to you without your permission. In any case, I can tell you what helped me was to move the knee throughout the day but ice and elevate A LOT.

It is possible to tell the PT when something is too much. Mine would say "try 10" of something and sometimes I could just tell that when I got to 7 or 8 that was enough and I'd say so. The world did not come to an end. The PT knew I was trying. Maybe the next time I could do 10.

 

[jenng2003]

Yeah. I'm not sold on the procedure. I've been forcing it to bend myself today and I heard a pop and it bent a little bit. It didn't really hurt and nothing seems out of place. I would like to avoid it. I was surprised to hear my surgeon suggest it this morning. They say it works the best of done less than 3 months afterwards. I just don't get why it won't bend anymore. I did everything I was asked and then some (except the bio-whatever machine that force bends and made me scream). The pt tried to give me weights the other day and I took the right off. I said no way. I do cheat at times on exercises if my leg is not cooperating and is done. I freaked out this morning when he suggested the MUA. I am absolutely frustrated. I'm gonna try taking double dose (I am allowed to) of meds before pt on Monday and see what happens.


LTKR. October 27th 2014

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[kneeper]

If your knee is swollen it just won't bend. An analogy used sometimes is a hose set on full blast, it's just not flexible. That's why we talk a lot about reducing swelling with ice and elevation.

 

[jenng2003]

There's very little swelling. It looks normal. I have knee cap definition and everything. It's amazing. I heal quickly. I don't want them to force anything, so if I can gently stretch it out myself, it will be better.


LTKR. October 27th 2014

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[Josephine]

I am praying my appointment tomorrow morning will make them stop.

That is in your hands. YOU tell them to stop. Or you stop going. It's as simple as that.

Unfortunately, the dr is concerned with my lack of flexion. He is giving me two weeks and then he is doing manipulation under anesthesia. He said there isn't much swelling. He thinks with my history that there is just too much scar tissue.

All of that is hocum. If you have that much pain you can't possibly have no swelling.

They say it works the best of done less than 3 months afterwards.

The evidence is very much that they are ineffectiveness of early MUA (JBJS) if done before 12 weeks out. All that happens is that it creates even more swelling. And the surgeon tells you he got it to 120 or something so it looks like it's just you being lazy. But it's easy to bend it when you're under GA - dead easy. And you have NO ADHESIONS - trust me on that one.

Please note:
You should also bear in mind that in order to do an MUA he first has to have your written consent. If you refuse that, he cannot touch you. To do so without your freely given consent is an assault. You don't have to argue or be rude, just say "Thanks very much but I'd like to think about it for a while if you don't mind."

I can't just quit PT or my insurance won't cover anything else related to this knee.

You know that for sure? You can do your exercises at home. Or can't you take a sabbatical of sorts?

I've been forcing it to bend myself today

No don't force it - read this Heel slides and how to do them

I just don't get why it won't bend anymore

Did you ever read this? Swollen and stiff knee: what causes it?

 

[Ollie]

@jenng2003 I hope you are doing well today! And what Jo and Kneeper said about MUAs - please take to heart. I am so lucky to have an OS and PT who are NOT aggressive. I got to control every movement. If 10 was too much, I could say so. Of course I got to work in the pool - and still get in the water every chance I get!!
I also hated the CPM machine; the first time was fine but I was still numb, and the next time I lasted about 10 minutes and got it the heck off my knee. Neither the hospital PT nor my OS cared. They both said that it was good for some and not for others and research clearly showed no lasting long term advantage for being tortured by it. I did have a friend who loved it, would take naps while it chugged away. . . But for me...

Advocate for yourself - and I support what Jo told you - if you feel stiff, there is swelling, even if you can't see it.
Good luck with the Dr!!

 

[Clipless]

@jenng2003, sounds like you need a little more time off. Have you investigated FMLA (Family and Medical Leave Act)? FMLA doesn't pay the bills, but it's a federal law that protects your job and benfits if you need to take time off for a serious health condition, as in what you're having now. Check with your HR regarding eligibility.

Also, you ALWAYS have the legal right to tell your PT to STOP hurting you!!! Your doctor does not need to intervene at all. Change PT clinics if possible. And...i'm not a doctor but if you google MUA and/or read the above articles you will see that five weeks is crazy early for MUA. My friend had MUA at 12 weeks post op, which is much more typical.

I don't know what your ROM is now, but many of us don't even begin regaining flexion until at least three weeks post op. Even then, it can be a slow process. You had major surgery. There is swelling somewhere in that knee, whether you see it or not.

As others have said, give yourself time to heal. Doing too much too soon will only set you back.

 

[jenng2003]

Apparently I am not expected to get more than 100 flexion anyway according to the OS. I think one reason he threw out MUA as an option (it will be at about 8 weeks) is that I have had 8 surgeries on this knee and he knows there's a lot of issues with it. My swelling really is minimal. I do have bruising yet, which I think is part of the problem (not visible, but deep muscle/ligament/tendon). I have a normal looking knee. It is amazing. My OS was amazed that at 3.5 weeks I didn't look like I had surgery (minus the lack of flexion and huge scar). They are concerned with my pain level, but I have been researching and discovered in young females (50 and under) with the type of trauma I had, it is common to have high levels of pain for many weeks/months after surgery. And some of the pain can be permanent. When does the difficulty between bending and straightening start to get better? There's a lot of noises coming from inside me (not
just the clicking of the implant). I am thinking that I need the quad muscle to start kicking in to help with the motion. If I hold my muscles while bending, I get more of a range without increasing the pain. I'm thinking things are just not being held in place. Everything looked good on the xray. I was concerned that maybe there was an infection since I still have a low grade temp weeks afterwards, but the OS wasn't worried. It's not even at 100, so he said it's probably just all the trauma.

I hate the cpm. I will never do that again. I would rather force my leg myself rather than have it strapped in and have a machine do it. I'm thankful my dr is against it. The pt finally stopped asking. My husband is my greatest supporter. He told her to stop. The OS said it doesn't transfer to lasting results. That's when I asked how does the MUA translate into lasting results? He said it doesn't always. It depends why the knee is stuck. If it's adhesions, it should work. If it is another reason, it probably won't.

I am on fmla. Problem is that my short term disability is taking forever to kick in, and I am primary wage earner. I am hoping to go back after thanksgiving. If they would insist on the MUA, it would have to be done right before Christmas break since I am out of days. The dr said as soon as I hit 90, I can return to work. Although I am very close to 90 after this weekend, I plan on staying out until after thanksgiving. I am not sure though if not returning to daily activity is hurting or helping my recovery. I am still wiped out from pt and not sleeping at night (although the latter is less of a concern). I am getting by most days without meds, but lately my hip and back are aggravated from the extra stress on them (I am calling chiropractor tomorrow to see if he will see me). I know from other surgeries (one almost as intense as this) that I do much better once I get some sort of normal back. But saturday we went to see Santa come to the mall with my daughter. I walked for about two hours and then used my wheelchair for another 2-3 hours (waiting in lines to do activities stresses my legs/back too much yet), and by the time I got home, I was beat. I slept for two hours. I wasn't hurting...just an energy drain...I know it is normal. So I am thinking work would be too much right no.


LTKR. October 27th 2014

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[Clipless]

If you're close to 90° flexion already, you're doing fine! I've worried about "maybes" like MUA, but really it's better to stay in the present, don't walk much, and let others handle most everything. Your job is to rest a lot, ice, elevate, and do your gentle exercises. Last week I got wiped out just from having lunch with a friend and trying to buy a purse. :D

 

[jenng2003]

I'm at 70 passive and I can get about another 10 degrees by pushing. That was last week. I know that I was at 90 on Saturday because my wheelchair has fixed footsteps and I managed to get my knee to bend comfortably in the foot rest after warming it up slowly. It's hard to go through a full range though (extension-flexion and back again). I wish that would get easier.


LTKR. October 27th 2014

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[Clipless]

According to my physical therapist, as long as you're ~90° by six weeks post op you're okay. She's got a PhD and I've no reason to doubt her. And Yes, everything will get easier!

 

[jenng2003]

That's the OS's goal as well. I have until the 6 week mark to get to 90. They would like me slightly more than 90, so I don't slide backwards, but it must be at least 90. Pt wants me at 125-130. I cannot wait to inform her that her goals are way too lofty and we need to set some attainable ones first.


LTKR. October 27th 2014

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[appaloosa girl]

Hi @jenng2003
I was reading your thread and not having ROM at a 90 is ok. It'll come. Pt is uncomfortable at time can be painful. Especially when our therapists get to rough. And mine has.
You are still very early in recovery and to push hard can set you back. Especially with swelling and pain. My flection gets worse when I push to hard.
It's a one day at a time marathon we are on. And each day we try to go 2 steps forward and try very hard not to go backwards. Good luck at pt.


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[jenng2003]

82 at pt today. I didn't let her push to pain, but to stretch. I did stairs today pain free. Yay for small victories!


LTKR. October 27th 2014

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[Clipless]

Yay, jenng2003 !!! You are well on your way!

 

[kneeper]

Yes, it does sound like you're doing just fine.