TKR Barnmom22's recovery thread<

[KarriB]

Try some Miralax. It did the trick for me when softeners weren't helping at all.

 

[dianehelen]

Sounds like some encouraging progress. I understand your conflict between PT & Bonesmart. Maybe some midde ground? Push a tad more just past discomfort, but before pain, and work with PT on that compromise level?

As for the narcotic pain meds, someone will have to physically go to the office to pick up a paper rx. They will not call those into the pharmacy, just the way it is these days.

Hope your improvement continues exponentially

 

[sistersinhim]

For inviting a visit from the poop fairy I found that a handful of mixed nuts helped me more than anything. And second to that is craisons, which are dried, sweetened cranberries.

There are many of us on BS that have never had pt and are doing just fine. I'm one of those. I do not in any way consider BoneSmart to be a cult. For me it is an answer to prayer. There are many examples of painful, pushed therapy setting the patient back quite a bit verses the easy, self-controlled therapy increasing ROM and accelerating healing.

How can rough, aggressive, painful therapy help a knee that has just gone through this? All these layers need to heal before being moved and stretched, keeping them angry and inflamed. Please baby your knee and let it heal before hurting it unnecessarily.

 

[newlybionic]

I do understand about feeling a conflict between what PT is telling you and about what you read here. No one is telling you to do nothing at all here. The main idea is only to go to a point of discomfort and not to pain as that will set you back in developing your range of motion. I was at about the same place you are in my recovery. I did go to PT but no one ever pushed my knee at all to the point of pain nor did I do anything that hurt me. I continued to ice and elevating as much as possible. My range of motion is now 130,0 .

 

[Tabbycat]

Hi @Barnmom22
Well done, that's a good update, and you are starting to achieve those important little milestones. Try not to let the constipation become chronic, it's the meds that cause it mostly (and enforced inactivity doesn't help).
I couldn't find anything to counteract the constipation from the codeine until I tried a magnesium oxide supplement.
Don't forget you can have swelling inside the knee joint that's not obvious, but will affect how much you can bend it.
Good luck with your appointment.
Love, Tabby xxx

 

[Celle]

My home PT is terrific but she does like to try to push my knee for more ROM when she measures. This morning she gave me the talk about window of opportunity for ROM. I told her about Bone Smart, sent her the link, and asked her to take a look and let me know what she thinks. I was at 84 ROM. Now 88. she seems to think that's not very good for two weeks especially since there is not much swelling or bruising. It's hard for me to disagree with her because this is her specialty and she is overall such an excellent PT and a kind person. On the other hand I don't want to be so taken with my Bone smart Club (cult?) that I miss the best opportunity for maximizing ROM. I have no idea what my OS's philosophy is on this subject but will be sure to ask on Monday.

One other concern is in the poop area. Not much happening despite prunes, colace and seema. I drink a lot of water. When I pop a suppository I get a little relief but no unbidden relief. I'm inclined to just wait for my system to catch up. Any danger in that?

Hi, @Barnmom22
I can understand your concerns. However, I don't really think there is as much conflict as you think. I'd like you to keep working with your PT, who sounds like a nice person, but just try not to to get caught up in a race to get ROM quickly. Above all, don't let her do anything that over-stresses or hurts your knee.

Those of us who have actually had a TKR know from our own experience that the "window of opportunity" is a myth, because our own ROM has continued to improve long after that period. It can continue to improve for at least a year.
My own ROM increased for about 15 months. Your PT therapist was probably taught that there is a window of opportunity, but I have a friend who is a PT, who tells me that the refresher courses for PTs in her area are now teaching that the gentle, unhurried approach to recovery is better.

Your ROM, at 88, is actually very good for two weeks after surgery. My own surgeon doesn't expect 90 degrees until about 6 weeks and you are almost there! Your ROM will continue to increase, as your knee heals and the swelling goes down. Even if it doesn't look very swollen now, there will still be some swelling inside the joint. It's a very small, enclosed area in there and it only takes a small amount of swelling to "gum up the works", so to speak.

You won't be missing any opportunity for maximizing ROM if you exercise your knee gently and refuse to allow it to be hurt. You see, its not exercising that increases ROM. It's time and the reduction of swelling. Time to heal, time to allow your knee to recover from a major trauma, and time for it to start working properly again, without swelling or further irritation slowing it down. The bend is already there inside your knee, just waiting for the opportunity to show itself.

Please don't think of BoneSmart as a cult. It's not. Josephine has over 50 years' experience in orthopaedic nursing, including operating theatres, and she has had two knee replacements herself. She and Jamie attend orthopaedic conferences and Josephine has herself presented papers to the Royal College of Surgeons, in the UK.
BoneSmart's Board of Directors consists mostly of orthopaedic surgeons, who approve of the advice given here, and we also have an orthopaedic surgeon on staff, as well as a PT and a couple of nurses.
Here's a link to the page that lists the Board of Directors:
https://farmortho.org/bod/

Now, a change of subject :
The narcotics you take to relieve pain do have a side effect of causing constipation. It affected me badly, in spite of drinking plenty of fluids, eating a diet with plenty of roughage and taking stool softeners. I found that I had to resort to a mini enema initially and after that I had to ask my PCP/GP for a prescription of a laxative that I took every day until I stopped taking the narcotics.
While allowing things to take their course may not do any harm, I think you'll be more comfortable if you try something similar.

The first few weeks of recovery are the hardest, but you'll soon be through those. You're doing OK and lots of us here are wishing you well.

 

[KarriB]

There's a difference between aggressive and non-aggressive pt. Agressive PT means someone else is pushing/pulling your knee to gain ROM and not stopping when you say it's painful. I'd say do PT, but not to the point of pain.

I tried eating apples, nuts, salads, water, nothing helped me except Miralax. I wouldn't even have known about it except my wonderful nurse in transition care suggested it. I'll be forever grateful to him, because once I got started it wasn't a problem again.

 

[GA-Peach]

@Barnmom22
At 2 weeks out I was so frustrated and very confused about what was good for me. Oh if only I had found this group. I do want to say that getting what seems to be "conflicting" ideas about PT can seem frustrating as well. I know that at 2 weeks the PT (the one that I fired) was "disappointed" that I had not yet reached 90 degrees. Long story short, I went to another PT and they were great - BUT - I did have pain and tightness with my knee the next day after. The PT told me that was to be expected (similar to working out - the pain comes the next day) so I figured she was right. After reading Bonesmart - I cancelled two of my appointments and was very pleased with the reduction in swelling. The next week, I reached my goals with my ROM. My knee did need to rest and I have come to the conclusion that at 10 weeks - it still does. So I still do the mantra - even on the weekends and force myself to rest and ice. Yesterday - being a holiday - I was out more than usual, but nothing strenuous yet I did have swelling. You will eventually come to know "your knee" and have your tailored made plan to make it work for you soon enough. Glad to hear that you are so encouraged!!!

 

[Barnmom22]

Such helpful responses. Thank you all.

 

[Happydale]

That's an overall good report! You have come a long way, and are nearing completion of "The Dark Days of Recovery"! I just posted a long tirade on Bill's thread (anesthesia blew my mind) about how I reconciled the BS PT advice and that of my medical team. I am taking a bit of a middle ground, but only because that seems right for me. I am very firm that I will not have any PT pushing my leg, and I told my wonderful PT that right from day one. I was relieved my doctor didn't even want to try that. Next Monday I'll have to break in the outpatient PTs! Both my doctor and my PT told me 90 ROM at 2 weeks was exactly what they love to see, so I think you should be elated!!

Now onto my poop advice: My niece had to go to the emergency room one time after surgery due to severe stomach pains. It turned out to be constipation. It wasn't even that she wasn't going at all, but she wasn't going enough. They told her in the emergency room to take Miralax in every drink she has. You can't OD on it. It is nearly tasteless. When I got out of the hospital, my niece and sister started doing that to me. Soon I had diarrhea. My primary care physician called to check on me, and I told her this. She said that's better than constipation, and to make sure it wasn't too watery, or I'd be dehydrated. She said you're going for pudding consistency. (I apologize for being so graphic with such a gross topic, but this info helped me!). Josephine reminded me that even Tramadol can cause constipation, so I realized I should continue. Now I'm not still taking Miralax in every drink, but maybe 1x/day or 1X every other day, as I'm monitoring the situation, so to speak. My PT warned me of impacted bowels, and that tidbit of info really kept me motivated! Best wishes to you on this front.

May your recovery continue on a positive trajectory!

 

[uva55]

@Barnmom22 it sounds like you are doing really well overall, even at three weeks I slept thru one of my pain meds and I paid dearly for it, your doctor should be able to give you additional pain meds, mine gave me hydrocodone/acetaminophen 5/325 mg when I saw him at 2 weeks.

I started out patient PT today, not bad.

Please continue to keep us posted

By the way, the poop fairy has a mind of her own, I'm taking a little less meds and still have problems :(

 

[dianehelen]

Someone, I forget who, mentioned coconut water with pineapple. I take tramadol on a regular basis, deal with the missing poop fairy from time to time. I ordered a 12 pack of coconut/pineapple and I have to say, it has helped. And it's pretty tasty too.

 

[uva55]

@dianehelen did you find it on Amazon?

 

[dianehelen]

Of course is there anyplace else?

https://www.amazon.com/Vita-Coco-Coconut-Water-Pineapple/dp/B000LKXRNQ/?tag=ate362da-20

 

[Josephine]

I was at 84 ROM. Now 88. she seems to think that's not very good for two weeks especially since there is not much swelling or bruising.

That's very good for two weeks! What a pessimist!

It's hard for me to disagree with her because this is her speciality and she is overall such an excellent PT and a kind person.

It might be her speciality but she's more than a bit off beam!

On the other hand I don't want to be so taken with my Bone smart Club (cult?) that I miss the best opportunity for maximizing ROM.

It's not the exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all 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. Exercise as in strength training is counter-productive and does more harm than good. Normal activity is the key to success.

I do not in any way consider BoneSmart to be a cult. For me it is an answer to prayer.

Thank you for that! It touched my heart greatly!

 

[kneeper]

One of the valuable things of the PT for me was just helping me build my confidence and showing me the right way to do exercises. If you've got a good PT, you work with them collaboratively.
You know your body. When your knee is you know you've done too much or need a break. PTs are afraid people will sit like lumps and not try.Most of the trouble we see among posters here is overdoing, not underdoing, though.

 

[FlaGranny]

Josephine is right about the ROM being there from the start. I've watched several videos of different surgeons doing TKRs. Before they close the incision, they put the knee through a complete ROM a couple of times to make sure everything is working properly and nothing is impeding full movement. It's the pain and swelling that restricts movement after the surgery.

 

[Suz]

I remember so well being where you are now in recovery @Barnmom22. I promise you- you're about to turn a corner to feeling better. It comes slow at times- but at 5wks I was so much stronger, especially mentally, with less post-op symptoms. At 9wks today I feel I have my life back! I'm still patiently working toward improved ROM but when I watched my flexion increase 40*s in only 2wks, of not doing very much PT at all, it sank in that the BoneSmart way is the best most natural way to heal. Today I count it all blessings that I found this group of wonderful individuals who have blazed a path to a better recovery for me. And best of all my knee is responding well to my patience! Any PT confusion I had back at 2-4wks post op is gone forever! It is possible to find a middle ground with a good PT. It's the PT's who aren't willing to be further educated you want to watch out for. So glad you're seeing improvement and it will continue to come-!

 

[uva55]

@Suz you are so right, I think we have to find the PT.

I have to find a way to strengthen my quad, and my back, all my muscles are sore. Unfortunately I was not physically fit prior to surgery and I feel it now, I won't allow them to hurt my knee but I do want to get stronger!!!

 

[Celle]

I won't allow them to hurt my knee but I do want to get stronger!!!

Heal first, then strengthen.
It's best to wait until about 3 months before starting strengthening exercises. You can clench your butt and tighten your quads before that, but avoid anything that puts strain on your knee.