TKR beth1954's Recovery Thread

[Jozilla]

Hi Beth - so sorry to hear what you are going thru. My OS too will be stopping Percocet soon and I am four weeks out. I did take Norco for my spinal issues before surgery and will go back on it shortly. It does help with the back and bone pain though definitely not as good as Percocet. I don't know what prescription strength your Norco would be but for me 10 mg Norco is almost as good as Percocet. Hang in there and keep us updated. We are here for you.

 

[beth1954]

Jozilla, I'm just a big ball of crazy emotions right now. I was diagnosed with "major depression" decades ago and it never really lost its grip on me. Times like this are very difficult. I know that post knee replacement is a difficult time even for an emotionally stabile person. I know I will work through this but I just get so stressed over everything.
I'm pretty sure that my OS will prescribe Norco 10's.
PT is coming today and she is not gonna be happy w/my elephant knee. That's my main worry right now I guess.

 

[Jozilla]

Hi Beth - thanks for sharing with me. I too have been where you are and still take medication to help. Hope your PT as well as mine goes good today. - JoAnne

 

[Josephine]

PT is coming today and she is not gonna be happy w/my elephant knee

That's not for her to criticize. It is what it is and that's not your fault. However, it will be her fault if she pushes you through exercises that hurt as that will make the swelling worse, the pain also.

Remember that you are not yet 4 weeks out and shouldn't be doing heaps of exercises and PT anyway. Read this article Progression of activity for TKRs and make sure she complies with it as well as you. She is also NOT in charge - you are. You pay for her services and therefore you call the shots. Don't allow yourself to be intimidated or threatened with the old chestnuts of The "window of opportunity" and MUA (manipulation under anaesthetic) and adhesions. Read the activity schedule and make sure both you and she sticks with it, okay?

 

[beth1954]

Ok when she got here today she had me flex my knee and she didn't measure it but she said "good-that looks like a 90!" That's about what I thought also. She brought with her one of those little pedal things (like bike pedals, the contraption just sits on the floor.) She had me just rock back and forth with it and then asked if I could make a full rotation. I did, and it didn't feel too bad. But I did it longer than I should have. Then she wanted me to show her how I was doing the exercise in bed- the one where you slip a pillowcase behind your thigh then gently pull toward you so that you get flexion. She pushed a little on that.
Here I am tonight with a horribly swollen knee and in pain. I am taking my Percocet every 4 hours again. I was going to try to at least wait 5 hours but that didn't last long.
She comes back Wednesday and I am tempted to just cancel it or something.
I am such a weak individual. I shouldn't have done so much. This may sound weird but it seems like my eagerness to "please" takes over and sticking up for myself flies out the window. You would have to understand my relationship I had with my mother to really comprehend that.

 

[saltyal]

Beth, you & Sportsgurl have the same surgery date & went down similar paths... check out her thread & see what you think!

 

[beth1954]

You are absolutely right, Saltyal! We do have some similar experiences with our knees! I am suffering today because of the excessive stretches I did yesterday. I am swollen up--HUGE knee!

 

[chestnc]

Hi Beth you are still just a few weeks post op. I would take my pain medication before I encountered the physical therapist. It is a lot for you. This was you are on top of the pain before the pain arrives.

 

[beth1954]

Yes I always take pain meds before the PT arrives, but the swelling is just unbelievable this time (after Monday.)

 

[Mazza]

@beth1954 I could hardly believe what I read about the treatment you received both in and out of hospital. I was discharged with a flexion of 90 deg and my extension was no where near as good as yours, but that in itself is all down to swelling and we are all individual in the outcome of our surgery.
I wished I had got hold of a proper wedge cushion before my surgery, but did get one after four weeks and it really helped. Even now I know it sometimes feels uncomfortable as the position is entirely alien to the rest of our body, but icing in that manner is the best way to do it.

I had just two appointments for PT at our local hospital and although some of the regime was tough, the PT always stopped when I was gritting my teeth and he was very empathetic. I only had the two sessions because he felt I would progress fine by doing my own exercises at home and only at that point did I have a flexion of 123 deg and he thought that was excellent at 5/6 weeks. I don't even bother with "numbers" now; I just do some stretching and bending when I feel like it and generally keep as active as possible while moving as normally as I can. I am approaching ten weeks post-op, but the memory of the excruciating pain of the first 2/3 weeks will never leave my mind. At least I will know to expect it next time! I went through several days of crying and also had those night twitches which nearly sent me through the ceiling.

Keep writing about your progress and take advice from the Forum but most of all stay in control of your own comfort and ability taking it one day at a time.

Best wishes for your recovery.
Marilyn

 

[Josephine]

Even now I know it sometimes feels uncomfortable as the position is entirely alien to the rest of our body

Mazza, do you have a wedge that keeps your leg out straight like this?

Because that's not only unnecessary but certainly does cause stress pain in the back of the knee. It's perfectly okay to have a little bit of a bend while resting like so - just enough to take the stress out of the back of the knee and be comfortable

he felt I would progress fine by doing my own exercises at home

at that point did I have a flexion of 123 deg and he thought that was excellent at 5/6 weeks

I'll say! Fabuloso!

 

[beth1954]

Marilyn, thank you so much for your kind words!! Today has been rather miserable since my leg is so swollen. It hardly wants to bend at all. I've been icing several times today. It doesn't seem to help much.
I talked to my surgeon's assistant today about the swelling and she said that I definitely overdid it, and I shouldn't let it get that painful (gee, haven't I heard that somewhere before? Like all over Bonesmart??).......The assistant said that her dad had shoulder surgery awhile back and he said that he needed to learn to:
"Work up TO the pain, but not THROUGH the pain." Brilliant, huh??
I'm not going to let the PT do anything tomorrow if I still feel this way. I don't like feeling like I'm totally crippled!!
I'm glad to hear of someone else that had the "twitches" also! Mine have practically gone away, but I still get one occasionally. I'll be reading your recovery thread also to see how you are doing!!

 

[Mazza]

@Josephine About the wedge cushion - yes, that is the type I am using, but not very often.

I use it for a while when I am seated and use it more to do some subconscious stretching for the back of the leg rather than resting. The reason for not using it all the time is because it makes my back ache! I purchased it in good faith thinking it was a better alternative to stacking cushions which slipped about, but to be honest it is too hard and VERY uncomfortable to lean against for sitting up in bed. It's been an expensive piece of equipment but has served some of its purpose. The dog loves leaving against it when she's curled up at my feet.

 

[Mazza]

@beth54 - I'm pleased to think I can at last give somebody else some advice based on my own painful experience. Believe me, it really does get easier, but not quickly! Do only what you can bear to do and remember that what the PT's tell you should be a "goal" not an instant occurrence.

 

[beth1954]

I'm a little nervous about how my therapist is going to react when I tell her I can't do any flexion exercises today. So far my knee will only bend to about probably 70....then it just doesn't want to go any further. I had it elevated and was icing off and on yesterday and overnight. I can't really tell that it's gone down much at all!

 

[Mazza]

If the discomfort is too much for you to bend further than the PT desires, then that's all there is to it. You just tell them that the pain is too much and probably next week you will be able to do a little more. Given the amount of things that have been inflicted on your poor leg, it's not surprising that it doesn't feel ready to bend. Just do what you can and only when you can. I used to do little flexions, then slowly move to an extension, take a breather and then back again - S-L-O-W-L-Y. When my PT was in charge of my leg I used to let him go as far as I could tolerate, but the just said, "That's enough!" and he never pushed me further. After a short break he would then let me flex on my own and hey presto it did go further because it had time to calm down from the disturbance to the tissues inside.

Are things very different from your previous TKR? Maybe you don't remember that it might have been this bad at such a short time post-op. Don't despair, just care - for you. The rest will take care of itself and you'll look back like me and wonder why you were so scared. I was terrified that nothing was going right but it hadn't occurred to me that this was never going to be a walk in the park as my previous surgeries have ever been. This is major stuff.

You'll be fine; keep taking regular pain relief, move around in short trips to the bathroom, kitchen, etc. and try to smile at the thought that the worst bit is behind you and now comes the improvement process.

Best wishes and write by PM if you ever want to

 

[beth1954]

I have a question for all of you.....
With my first TKR the therapist used the Astym technique on my incision to break up scar tissue and I guess "de-sensitize" the incision. I may have asked this before and I apologize if I have...but what other techniques are used? The outpatient facility that I will be going to does not do the Astym technique and I don't want my scar to get thick or lumpy. Of course that is IF I choose to go to further physical therapy.

 

[Josephine]

It's a total myth about 'breaking up scar tissue'. Somehow the US PTs have this obsession with scar tissue and it's all nonsense. For one thing, adhesions, which is the correct word, is very uncommon and for another, Astym wouldn't break it up anyway. Also if it really was scar tissue, that;s the stuff that holds your wound together so the last thing you'd want to happen is to have it broken up! The key is that if you leave your wound alone, it will heal up perfectly well all on it's own. It really doesn't need any help from us. If you get any lumpiness, that will also go away if given time. Most lumps are due to internal sutures pulling tissues together anyway and one the dissolvable sutures have dissolved, the lumps will go away.

 

[beth1954]

Tell me then what the purpose of Astym is! I may have misunderstood the whole concept!

 

[Mazza]

@beth1954 I looked Astym system up on a website and really don't feel it would be appropriate for post-op, at least so early on in the healing process. There is a list of "appropriate uses" of the system and post surgery isn't one of them.

I read back through your Thread earlier on and noticed that you suffered with depression some years ago. I was diagnosed with Agitated Depression about 12 years ago and have been on a maintenance dose ever since. When I reached a critical point post surgery (complete meltdown!) I did up the dosage enough to get me through those bad days and it did help. At the time I was nearly tearing my own and everybody else's hair out as I was in so much pain and couldn't see that I would ever get through the dark days. Try speaking with your own doctor to see if he can suggest something to help lift your spirits just temporarily.

Well done you reaching the 90-ish mark; each visit to my PT left me in pain for a couple of days, but the outcome was worth it. He would support my ankle in a raised position, with me laying on the couch, then he would cover my TKR with the palm of his hand and do fast repetitive pulsing actions. That did make me grit my teeth and when he relaxed the leg back it felt awful, but after a couple of bouts, my bend was far better.

At 10 weeks post op, my scar isn't lumpy at all and all I did was massage it with body butter or any moisturiser. As you start to walk normally, the skin surface will gradually dissipate the lumps as you move about. I found that massaging the whole TKR leg felt strange at first, but definitely benefited from becoming my friend again!

Take care and stay calm.