TKR Bionic LaxMom

[sandbar525]

@LaxMom Thanks for the link to article on TENS. Just got notification from Amazon that it should be delivered tomorrow. I'll let you know how it goes. Have a great day!

 

[LaxMom]

Tomorrow is week 3 anniversary of my surgery. The day started out poorly, but ended on a good note.

I did my first round of exercises around 9:00 am and almost immediately began to get stiff and swollen. I have no idea why. There was no change in meds, exercises, or even what I did yesterday. It was just one of those days. I spent the majority of the day in my recliner, iced, elevated and using the TENS unit for relief. I felt ok while sitting but did not feel good getting up.

About mid day, I called my OS office to get some questions answered. The first had to do with short term disability wanting me to go back to work on 12/22. From where I sit right now, no way do I think I will be ready. But, I got the impression that the doctor's office will just go with what the insurance company says. Not thrilled about that. Maybe I will feel more up to it by 12/22. Tomorrow, I have a phone call with my boss to see if I can use vacation time for the last 2 weeks and return on 1/5. I am hopeful that will work out.

I then asked about meds, specifically weaning off the dilaudin, driving, and outpatient PT. They said I can begin weaning off the dilaudin. I know that taking the tramadol every 6 hours will not hold my pain. I am going to move the tramadol to every 4 hours and then see if I can cut back one pill a day of the dilaudin. I am only taking 3. And, I like the effect of the tramadol, so hoping it is doable. Driving - they said once I get off the dilaudin I can drive if I want to. This did surprise me since it is my right leg. I spoke to PT about this and she suggested I get in the car, do not turn it on, and practice putting my foot on the gas and the break to see if I am comfortable. Once I can slam on the brake without hesitation, I am ready. And finally, outpatient PT. Once I can get myself out of the house, I can do outpatient PT. I think I am going to try to start that next week, even if I need rides for the first week.

I guess all this is good news, but I was feeling anxious all day about just not feeling ready to go to work. I do think I will benefit from outpatient PT because they have more resources. And I think the tramadol will work at the right frequency. I guess it just returning to work that has me freaked out. This surgery was so much more overwhelming to me than I anticipated.

At 4:30, PT came. That is when the day started to get better. I had a substitute for my usual person. The one I had today I actually saw the day after I got back from the hospital. It was great to get her perspective of seeing me then and seeing me now. Obviously, she was happy with my progress, since it has been 3 weeks, after all! In and of itself, that lifted my spirits. But the goodness did not stop there.

She did a lot of hands on manipulation, shoeing me how to massage my incision, which has some subcutaneous adhesions - this is what is causing the stinging feeling I get when I bend my knee first thing in the morning. She also did some manipulation to straighter my leg. I thought I had all my extension, but she was able to get more. She also was pulling my leg longer,which helped reduce the pain I have been having on the inner part of my leg.

Finally, she noticed that while my surgeon straightened my leg, I am still moving as if my leg is still knock kneed. The result of this is I am compressing that inner knee, which is causing me more pain. And, by moving this way, I am not building up the muscles on the inner side of my knee. As she demonstrated this and what I should be doing, I could really see and feel the difference. Through all this, I was also expressing my frustration and sadness about the day and my progress. She explained to me that since I had juvenile rheumatoid arthritis, I have had 46 years to create these patterns that I now need to change. I finally was able to realize why this is so hard - I have 46 years to undo. In some ways, that may seem overwhelming, but for me it was a relief. I have no doubts that I will be able to recover. I know I can. But understanding why I cannot possibly exceed expectations (ok, I admit it, I am that kind of gal - I expect that I will always exceed expectations and feel like a failure if I do not) made be relax and give myself much more realistic expectations. I expect this will be a really long journey for me, but now I understand what I am up against and what I need to do a little more fully.

That was my day. I am now elevated, having taken a warm shower to ease my weary muscles. Tomorrow is a new day. And now I know how to slightly alter my exercises to break old habits and be more effective. I am really hoping that will also result in less pain.

As always, I am greatful to have this forum as my outlet. I live in a world of healthy people who do not understand the fight I have fought my entire life. But you all do. Thank you for that.

 

[sandbar525]

Hi @LaxMom Sorry that thinking about return to work is causing you stress. I understand completely. I've moved my return date back from the 22 December date to 5 January 2015. OS has agreed to amend his form to short term disability insurance company. Hope you can also get the cooperation you need to move your date as well. It has given me tremendous peace of mind. Sounds like you had a very good PT. My PT does similar stretches at the beginning of each appointment and they really feel great. PT for me today was upped in intensity from last week but nothing that caused pain. I did sleep for about 3 hours after I got home though. I know that the fact you are dealing with JRA on top of everything else makes this more of a challenge for you but you really are doing great! Please try relax and concentrate on healing. You are doing everything right and will have the outcome to prove it. Hugs!

 

[LaxMom]

Thanks @sandbar525 for the nice message. Yesterday was not a good day but at least it ended well, with me having a better understanding of where I am and what the issues are. The hardest part for me it that trying hard actually accomplishes less that going easy. So hard to wrap my mind around that concept!

I did do a fair amount of massaging of my incision yesterday. I did not start my day with the stinging sensation I typically get when trying to bend my knee. At least something worked! Small victory. Today I am going to work on becoming very conscious of where I plant my foot and place my knee in an effort to break my knock kneed muscle memory and create better patterns of movement.

I speak with my boss at 2 pm and will ask if I can end the year with 2 weeks of vacation. He is a very nice and kind person, so hoping for the best!

I also upped my dosage of tramadol to every 4 hours. I want that in place before even trying to cut back on the dilaudin. When I read your report on meds, I can see I must be having more pain that you, since you are every six hours with no dilaudin - I would be out of my mind with that dosage. I keep telling myself that I had 46 years to build up to this level of pain. Helps me deal a little better! Trying to drop my over achiever personality. Not an easy thing to do!!!

That is the plan for the day, along with very gentle PT, and lots of ice and elevation. Trying to work smarter, not harder.

Thank you again for all your support. Hugs back at you!

 

[Jaycey]

@LaxMom you are doing great. And as you have discovered pushing yourself only results in a set back. Easy does it. I do hope you can get time off work as you are still very much in the healing mode. You'll get there! Time and patience prescribed in large doses!

 

[referee54]

The hardest part for me it that trying hard actually accomplishes less that going easy. So hard to wrap my mind around that concept!

That is a really, really tough thing to learn, as many of us---almost all of us---were taught that hard work put us in a position to be successful.

We have to relearn this and understand that, when dealing with a BTKR or a TKR recovery, it is contrary to everything that we have been taught.

 

[LaxMom]

@Jaycey it is so great to hear from you! You are so right and for whatever reason, this concept is so hard for me. I just finished my morning PT, being very conscious of foot and knee placement to avoid my knock kneed habits. What a difference it made!

Trying for a gentle day focused on form, ice and elevation.


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[LaxMom]

@referee54, I read your articles on this subject. Great stuff. It really resonated. Thank you!


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[referee54]

Finally, she noticed that while my surgeon straightened my leg, I am still moving as if my leg is still knock kneed. The result of this is I am compressing that inner knee, which is causing me more pain.

This is also having to relearn the mechanics of walking correctly---we have been dysfunctional in our gait and our mechanics for so long, that what is not normal has become normal---and we have to break those habits---and it feels very weird.

that I will always exceed expectations and feel like a failure if I do not) made be relax and give myself much more realistic expectations.

do not put any expectations or schedule on yourself---let the knee set the schedule and take the successes as they come along---if you set up a schedule or a calendar of expectations---it can result in frustrations. You are not failing at all---you are recovering!

I did my first round of exercises around 9:00 am and almost immediately began to get stiff and swollen.

Ah---you are doing exactly what many of us have done before you---"What happened to cause this----let's figure this out!"

The truth of the matter is that this recovery is very much like a roller coaster ride, and there is no reason that we can grasp that caused this stiffness or swelling to occur. It just does. I tried to think of reasons--to come up with reasons for these little issues and bumps in the road---and to no avail! It will happen---stuff happens, and yo will have ups and downs along the way. That being noted, though, it is important to understand that, as you progress through your recovery, these little speed bumps will become smaller and fewer in between.

If you ever truly find out what causes these little issues, you will be up for a Nobel Prize!

 

[referee54]

Finally, she noticed that while my surgeon straightened my leg, I am still moving as if my leg is still knock kneed. The result of this is I am compressing that inner knee, which is causing me more pain. And, by moving this way, I am not building up the muscles on the inner side of my knee. As she demonstrated this and what I should be doing, I could really see and feel the difference.

This again is very much like coaching or teaching one to officiate.

I have had QB's with terrible mechanics---their throwing motions was so convoluted and lousy, it was a wonder that they ever completed a pass. However, their motions felt natural to them, and when I taught them the correct mechanics---it really felt weird for weeks, and they had to make a mental and physical effort to not go back to what was wrong--and what was easier.

The same thing holds true in officiating---I have to teach umpires how to correctly get down behind the plate, and many of them have had no training in this at all, and their plate mechanics are lousy---but that is what feels natural to them. It may feel natural, but it is wrong, and what feels wrong, is actually the correct action mechanically to take.

Your years and years of walking in a certain way will take a while---and an emphasis on your part---to break, but you will be able to do it!

I had issues with my gait after my BTKR and it took some concerted effort on my part to take care of it---but I Got "R Done!

 

[LaxMom]

Thank you @referee54 for the excellent advice and encouragement.


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[PrincessTia]

being very conscious of foot and knee placement to avoid my knock kneed habits.

This is where the real hard work lies! I have found it very difficult to have to concentrate and THINK about every movement I'm making, when my body is pushing me to move in the old, unthinking ways. It can leave me worn out from all the energy used in this unfamiliar, conscious mode of thinking. After 15 minutes of practicing this way, I'm ready to rest and elevate. And maybe ice my brain!

You are working hard! Maybe we need to redefine what "work" is...

 

[LaxMom]

So true @PrincessTia! Thanks for letting me know I am not the only one relearning how to walk.

The good news is, this is causing me less pain today. Yay!!!


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[LaxMom]

Talked to my boss, who approved my use of vacation time when my short term disability is up. Which means I can return to work on Jan 5th. What a relief!

 

[PrincessTia]

Yay that you get your extra two weeks!

 

[kneeper]

Hi @LaxMom I hadn't realized you had JRA. Me too. I'm glad your PT understands your situation and has been helpful with retraining your walking. Walking "normal" takes a lot of practice.

 

[LaxMom]

Hi @kneeper - I did not realize you had JRA either. Mine started when I was 12 and about to start at a new junior high. It was not a great time in life to deal with that! For years I was taking gold shots and sometimes plaquenil. In my late 30's, my rheumatologist started me on sulfasalazine, one of the mildest treatments for RA, and from there on,I have mostly been in remission. But, the damage was already done by that time. The rest was a matter of time. JRA is certainly a disease that affects your entire life, and who you become. Perhaps any chronic condition is like that, but trying to cope with all that as a kid is a challenge, as I am sure you know!

I was fortunate that the substitute PT person noticed my gait and habits and made some suggestions. I think outPatient PT will be all over this issue, but now I know to ask about it.

Today was a very good day. I upped my tramadol frequency but did not start weaning the dilaudin yet - will do that tomorrow. I focused on the knee and foot placement all day, even while on the recumbent bike. I did not experience much pain today, more just pressure. The differnece In how the bike felt was amazing.

It will be hard work to change the way I walk, but just knowing there is something I can do to help myself is so powerful.

And, I can now rest easy that I do not have to face work until January. My boss also had some great suggestions regarding how to phase back Into work to keep things easy for me, and is fine with me working solely from home until I feel up to going into the office. What a weight off my mind! And what a difference a day can make.

Thank you all my Bone Smarties for the support and great advice today. I surely needed all of you. Hugs!

 

[LaxMom]

It is a good day. I have been focusing on knee and foot placement for the last 2 days. I notice less overall pain and no more sharp, stabbing aches in the inside of my knee. PT came today to go through the paces with me. I got to 0 and 115. Yay!

Today I start weaning off the Dilaudin - starting with the mid day dose. I called Outpatient PT and plan to start going there next week.

Now I am off to ice and elevate before I jinx myself!!!

 

[SuperSnapper]

@LaxMom great progress then. The stabbing pains are nasty! Ouch! Glad they are going.

Take it easy though.

 

[kneeper]

Yeah, the teenage years with JRA are kind of tough. I was diagnosed at 4, so I don't really remember not having it. Unfortunately when I was a kid they didn't have many drugs to give you. Fortunately I didn't get terrible damage. Though I do have 2 new knees and will need a new shoulder at some point. Luckily I've been pretty well controlled with various DMARDs and haven't had to go up to biologics.

Good to know you don't have to go back to work until January. Happy