Bilateral TKR Big Bend goes for bilateral big bendy knees!

[BigBend]

I got in to see my GP this morning. She thought the rash looks like folliculitis. Had her assistant take photos and send to dermatologist. Dermatologist thinks contact dermatitis. They prescribed a topical corticosteroid (triamcinolone) with instructions to get back to the dermatologist if not cleared up in 3 weeks.

Thanks for the push @Josephine to see my GP. Though I get the sense that GP/dermatologist are guessing, at least the medical professionals are on alert and the prescription may cure the rash, no matter the cause! @suzzee2000 , I will let you all know if it clears. I do appreciate your concern.

On a recovery note, since I'm not in PT and have no one measuring my ROM, I look at activity based progress. A few weeks ago when I saw my GP for my first post surgery visit, my friend drove me and I was in agony because I couldn't sit in the low chairs in the waiting room. Today I drove myself and sat in the low chairs! I still need the arms to help hoist myself, but I'm not afraid of low furniture anymore!

While I was waiting for the GP to consult with the dermatologist, I did knee bend exercises using the step on the bed in the exam room. It helped keep me loose and occupied. I'm pretty sure I have more than 90 ROM in both knees based on my stretching, though it doesn't always feel like it lasts when I get up and down from chairs. But I remain positive that each day will bring improvement.

 

[Josephine]

Dermatologist thinks contact dermatitis. Though I get the sense that GP/dermatologist are guessing

No kidding! There is an old saying in 'the trade' that no dermatologist ever lost a patient!
Hence you will find that dermatologists also never do on-calls!

Today I drove myself and sat in the low chairs!

Yayyy for you!

I'm pretty sure I have more than 90 ROM

If you like, you can post photos of your knees and I will measure them for you. Won't be entirely accurate but will give you an idea.

For this you need to get someone else to take the photos or do them yourself in a mirror.
I need to have the hip and the heel in the photo.
I also need a decent pixel size, about 1500 wide or more.
Perhaps best either on a bed or settee with knee bent up as far as you can get it - here's an example but preferably more of the hip and the foot!

 

[BigBend]

I may take you up on your offer, at some point, @Josephine , to estimate my ROM. I'm trying to be focused on performance based recovery and not worry about numbers..(not that I don't worry - I just try not to!) I'm walking well, can handle all ADL's and am confident I can get back to gardening. My one outstanding goal is to be able to get up and down from a toilet without using grab bars. I think I'm close, but not there yet.

Six weeks ago tomorrow was my surgery. Unless I can't move the bend any further (and I've read the ROM articles so I don't think I'm done!), I should get to my goal: doing the things I did before surgery, but for longer periods because I won't be interrupted by pain!

 

[Josephine]

My one outstanding goal is to be able to get up and down from a toilet without using grab bars. I think I'm close, but not there yet.

It's unlikely you'll get much farther with that at 6 weeks. It was fully 12 weeks before I was able to do without my 'assistive devices'!

 

[BigBend]

@Josephine , that it was 12 weeks before you could do without assistive devices is both encouraging (plenty of time for me to improve!!) and confusing. I've been assuming the reason I need the grab bars is because I don't have enough ROM to position my legs to stand. But your ROM was significantly better immediately after surgery than mine is now. So now I'm thinking the reason has to do with the actual healing of the knees. If that's the case, I need not to try to force myself up from a seated position using legs only. Can you confirm?

On another note, about a week before I noticed my knee rash, my OS prescribed Celebrex as an alternative to ibuprofen for pain relief and to bring down the swelling in my left knee. My GP just renewed the prescription as "excellent pain control." Frankly, I don't find ibuprofen or Celebrex to provide any pain relief and, though my left knee swelling came down, I'm not sure I'm getting any further benefit. Anyway, since my rash has continued to spread, even with the topical corticosteroid and because I've learned rash can be a side effect of Celebrex, I took myself off it today. I'm hoping to see the rash resolve. We'll see!

 

[VancouverUSAgal]

My one outstanding goal is to be able to get up and down from a toilet without using grab bars.

Do you have a raised toilet seat or are you trying to get up from a regular height toilet?

 

[BigBend]

@VancouverUSAgal , I put my bedside commode frame on my comfort height toilet. So I'm higher than comfort height but, more importantly, I use the frame to ease myself up and down.

 

[Josephine]

If that's the case, I need not to try to force myself up from a seated position using legs only. Can you confirm?

Absolutely not! There are no 'shoulds' and 'oughts' about this. Use your grab bars! Just share the load between legs and arms or you might find yourself getting pain in your shoulders!

Frankly, I don't find ibuprofen or Celebrex to provide any pain relief and, though my left knee swelling came down, I'm not sure I'm getting any further benefit.

I have always said - repeatedly - that NSAIDs are rubbish as pain meds. Gram for gram they have about 40% of the pain killing properties of Tylenol. So you not only get pathetic pain management from them, you also run the risk of serious side effects as explained in here Medications: NSAIDs, acetaminophen (Tylenol, paracetamol) differences and dangers. I won't take them any more, not orally or via gel, and I advise anyone and everyone that crosses my path to follow suit. There is much made of the potential liver damage that can be caused by acetaminophen (Tylenol) but it pales into insignificance when compared to those from NSAIDs. The significant difference being that with Tylenol, you're safe as long as you stay within the safe limits. But with NSAIDs even a few occasional doses can cause stomach bleeds.

As for the swelling issue, this isn't the kind of swelling that's suitable for NSAIDs as first and foremost, it's caused by pain. Ergo, treat the pain and the swelling will also be treated. In short, I would recommend you use Tylenol 1,000mg 3-4 times a day.

 

[BigBend]

Your conclusions about NSAID's is confirmed by my experience. And add to it, a day and a half off Celebrex and my rash is much diminished! It's acetaminofen for me only, from here on out!

 

[VancouverUSAgal]

I put my bedside commode frame on my comfort height toilet. So I'm higher than comfort height but, more importantly, I use the frame to ease myself up and down.

Oh good - I was afraid you were trying from regular low toilet and thought this was too early for that. Actually, even though I'm short, I don't plan to ever remove my toilet seat riser. I don't understand why adults should use toilets that are child-heighth! Some day I will replace my toilet with the taller ones they make now. I don't have any grab bars or place for them in my tiny bathroom, but I use the towel bar on the shower door in one hand and then used my cane in the other hand to help me up at first. Now I can manage without the cane and just hold on to door frame.

I have been working in PT at rising from a sitting position without using hands but it really depends on the height of the seat and how tired, sore and stiff I am at the moment.

It seems to me like your recovery is going just fine (your date was more recent than mine) and I don't think you need to push too hard. For me, every week is different and it sometimes feels like 2 steps forward and 1 step back, but we just have to focus on the long-term picture. My flex is coming along but I need to build quad strength - I get pretty shaky after I climb stairs and walk the equivalent of more than a couple of blocks. I'm about ready to quit PT because I think the rest will come thru movement every day instead of intense workouts twice a week at PT. I know I have to keep working at the bend so I don't get stuck.

I hope all is coming along great for you and the rash is all gone. I'm still taking some hydrocodone and Tylenol. Let us know how you're doing.

 

[BigBend]

Sheesh, I think the so-called comfort height toilets are too low! @VancouverUSAgal . And I have short legs!! I don't mind leaving my commode frame on my toilet forever, if necessary. I'm more worried about needing to use the facilities elsewhere when I try to get back to normal life. I tried the other day to raise myself up using mostly my legs and it just sent a shockwave through my knees. They are not ready for that kind of stress. I've been icing and elevating hoping I didn't do damage. And I took a Narco for the first time in awhile.

My rash is going away. I'm pretty convinced it was an allergic reaction to the celebrex. Most importantly, I'm no longer worried there was a potential infection in the implants.

You are 100% correct this is an up and down process. I did really well immediately after surgery. My PT was impressed how easily I did leg lifts, got in and out of bed etc. So much so that she said I didn't need in home PT. And I was able to get off narcotics pretty easily after only 3 weeks.

But, I'm not sure I've managed my own PT that well. I got my extention but don't feel I am progressing well in my flexion. I think the strain I put on my knees trying to get up caused some swelling. Maybe when it goes down I won't have regressed.Maybe today is just one of those discouraging days and tomorrow will bring progress!

 

[VancouverUSAgal]

I know how you feel. So far all my trips away from home have been short enough that I've been able to avoid the possibility of not finding a raised toilet but that's definitely a consideration.

I got off to a difficult start but now I'd say I'm about at a slow/average recovery from what I can tell reading other's stories. Whatever . . . it really doesn't matter does it? If you think you need some more help with PT or just an assessment of where you're at, I'm sure your surgeon would probably order a few sessions of PT. I never look forward to going but do feel better (though tired) after and think it has probably pushed me further along than I would have been on my own. I'm good at doing my home exercises but don't have the equipment they have at PT and think riding the bike, climbing stairs, etc. has helped. Anyway, just something for you to think about if you're feeling frustrated. Some days are just not good days with extra stiffness and even pain. I guess it's just part of the process. Hope tomorrow is better for you!

 

[BigBend]

Seven weeks out today. Like you @VancouverUSAgal , I judge my recovery as slow to medium. I definitely have much to be thankful for as I've read so many stories of more difficult recoveries. It is up and down. Sometimes I'm doing exercises and I really feel progress. Other days I feel stiff and wonder when that part will be over! Now that I can drive, I may join a gym just to do water exercises. I won't ask for a pt referral as the nearest facility is 30 miles away.

I'm finding a few more comfortable positions in bed, instead of just lying on my back. But even with pillows, my knees don't like to be on their sides.

My rash is gone. I had a phone consult with my OS. He said it was probably a reaction from something they had on me during surgery. Whatever. I'm just glad not to worry about it anymore! He scheduled no further appointments. I'm to contact him with any questions.

At first I felt a little abandoned. But mostly I feel free. I don't have to worry about what a PT or GP or OS has to say. I only have to worry about achieving my goals. I'm heading out for a walk on a beautiful day after some stretching exercises. Then I'll ice and elevate and rest and expect to be one day closer to the day I wake up and forget I had both legs sawed, hammered and glued! More and more I can tune in to the lack of arthritic pain because the surgical pain (stiffness only now) is diminishing.

Next weekend I will go on a road trip (passenger) with some friends and test my car/fun endurance. Still a little worried about finding useable restrooms....but there are always ways!

 

[EmptyHands]

As someone who has been more derailed by skin problems post-op than with knee issues per se, I'm thrilled to hear that your rash is gone! While your transition to greater independence can seem a little scary at first, I love your positive take charge attitude as you walk confidently toward a wonderful new life, free of arthritis pain.

 

[VancouverUSAgal]

He scheduled no further appointments.

I saw my OS yesterday (at 9 weeks) and waited over an hour again so I was not too excited that he wants to see me again in a month. He seemed satisfied with my progress so I don't know why. Anyway, I think you're lucky to be free of any appointments.

I know what you mean about worrying about restrooms - it's hard to know what places will have a handicapped toilet and which won't. I hope you have a great time on your road trip.

 

[suzzee2000]

I'm heading out for a walk on a beautiful day after some stretching exercises. Then I'll ice and elevate and rest and expect to be one day closer to the day I wake up and forget I had both legs sawed, hammered and glued! More and more I can tune in to the lack of arthritic pain because the surgical pain (stiffness only now) is diminishing.

That is sooooo true!!! It's such a process of recovery! I can't wait to wait for that day when I wake up and forget that too!!!
When people said the surgery was the easy part....how right they were! I am 10 weeks out tomorrow and still waiting to really turn the corner! I know it's a process but sometimes I'm just burned out and want normal....whatever that is! Anyway so glad the infection you had is gone! That was scary I am sure as I worry about infection in my new joints as well!

 

[BigBend]

@EmptyHands , I try to be as upbeat as possible, even if underneath I have the same fears and pains as everyone else. I take much comfort in reading other people's stories because even the tough journeys always end in success. So I know I'll get there...on my knees' schedule!

@VancouverUSAgal , my two week visit with my OS with all the travel and waiting was the single most miserable day I had after surgery. I'm not even clear what we accomplished. So when he set one phone consult, I was happy not to repeat the experience. I'm looking forward to traveling a little for pleasure - expecting my knees to behave - but I'm glad to be done with doctor's waiting rooms!

@suzzee2000 , I know you are waiting to turn a corner, but I wonder if you know how many corners you have already turned?! You are still an inspiration to me in all you have accomplished and continue to do. I'm thinking in two weeks, when you have 12 weeks of recovery behind you, you will be amazed at how good you feel. It's coming!!!

 

[VancouverUSAgal]

Every step of this recovery process has its difficulties. The beginning is SO hard but then we start making a lot of progress quickly. After a few weeks, the progress slows and we just have to be SO patient and wait as we gradually get better and able to do more and more. Others can often see our progress more than we can. We just want to be completely healed and that takes a long time. Interesting that my OS who never said much before surgery about recovery spent quite a bit of time at my follow-up appt. telling me how long total healing really takes. Fortunately I already knew that from this site, but I thought to myself that he should really tell people that ahead of time. Well, maybe he doesn't want to discourage folks but they really should know what they're getting into. This isn't something most bounce back from quickly. Thank goodness we have each other since others don't really understand. I appreciate everyone who has taken time to write on this forum.

 

[BigBend]

Did I turn a corner today? The last week or ten days, I've had more knee pain than when I was three weeks out. Part of it might be from trying to sleep on my sides and pushing myself a little harder in my exercises. Anyway, each morning when I get out of bed, I have unhappily anticipated stiffness and pain. This morning, I was surprised at how little discomfort I had. It felt like a turning point. I still have some swelling/tightness stuff going...just not as bad as it has been. Another day toward being healed!

ROM is still disappointing, but I have enough to do the things I want to do. I'll keep working at it.

 

[VancouverUSAgal]

I think that stiffness in the mornings or after any period of inactivity may be with us for awhile and doesn't necessarily mean you are doing anything wrong. I try to go thru my series of stretches and exercises in the mornings even though I don't feel like it because it makes me less stiff and more able to move. We still have lots of healing to go so remember to be patient. You're doing well and I'm sure you will continue to do so. We just all wish it could happen sooner!!!