TKR BoneSmart Works!

[mendogal]

PT - **MY** way!!!
I decided that since 6 weeks, on my left knee, had marked the start of light strength training (which I felt was good for me), I would keep yesterday's appointment after having cancelled all except the first one post op.
I explained that as my knee from post op day 1 already had great ROM there hadn't been any point in doing more than recovering at home with walking and light ROM.
He wanted to measure to meet his computer metrics. My extension was to 20. I told him that instead of him stretching me, I wanted to do the gentle *relaxing* ROM I do at home. My extension was then to 10.
He told me I really needed to stretch the behind knee tendons and muscles. I told him they would be fine when the swelling was down.
He wanted to put a 4# ankle weight on me for strengthening. I said, "Nope, no weight, I need to establish my baseline."
I did some quad and some hamstring exercises, slowly and controlled, never to knee pain but to the point of target muscle fatigue. He also had me do side stepping down the hallway for weight shift and balance. Um, hello Mr. PT, meet tai chi budobabe
The good thing is I have scheduled 4 or 5 weekly appointments with the PT aide, a pleasant young woman who never measures, never stretches; she will warm me up on the exercise bike as tolerated and take me through the exercises at my pace. Then, having established a good home routine, I will see the PT and discharge myself.
I am so grateful for having found Bonesmart on a random Google query late one night! You validate our gut feelings and concerns, empowering us to self-advocate.

 

[sistersinhim]

You go, girl! Taking control of your PT will only lead to good things! I'm so glad that you found us, too!

I was blessed to have done the Bonesmart way after each of my 12 knee surgeries! I knew it worked well for me and I continue to believe that it will work well for most knee replacements!

 

[Layla]

I am so grateful for having found BoneSmart on a random Google query late one night!

Aww, we're happy you found BoneSmart too! Thanks for the support you offer and for sharing your healing journey with all.
@mendogal

 

[Jaycey]

He wanted to put a 4# ankle weight on me for strengthening.

What! Total rubbish! You are not in training! I'm so glad you were firm about this. So many members get totally discouraged when PT try this trick. Plenty of time for strength building once that knee is healed.

 

[benne68]

Great post, @mendogal! I hope all our pre-op members read it and learn from your example.

 

[mendogal]

Post op day 43 so here's a 6 week update!

Mobility: Outdoor walking is just under a half mile, using the walking stick.
I literally have a wrinkle creating an ache when walking: at the very top of the incision, there seems to be an interior suture catching which creates a small overhanging fold of thigh skin over it that is uncomfortable. I sent a photo to the surgeon's medical assistant who recommended massaging it but I see my surgeon next week and hope it can be addressed.
Tomorrow I have an appointment with my massage therapist so will be going up a full flight of stairs and then back down for the first time post op. I don't feel an urgent need to drive yet.

ADLs : Independent with all personal care, meal prep, putting up laundry, and just resumed scooping the cat litter in the mornings (MDH does evenings plus all meal clean up). Watering potted outdoor plants and doing a very little bit of weeding only a couple of times weekly. I accompanied my husband to the weekly Farmer's Market and once so far to our food co-op. Today I am meeting a friend for brunch and will sit in a cafe for the first time post op! I do continue to take frequent breaks to elevate and ice - easily six times a day, sometimes more. My sitting in a chair (to draw or eat a meal) tolerance is increasing slowly.

Pain: Acetaminophen 3000 mg/24 hours is effective. About twice weekly if there's nagging aches late in the day I take 1/2 an Acetaminophen with codeine (so 15 mg codeine) and reduce the plain Acetaminophen. It's overall more stiffness and aches than outright acute pain, though this time I have more skin tenderness than with the first knee.

Sleep: If I use the commercially available sleep tea (includes valerian) and 3 mg of sustained release melatonin, then put my devices on blue filter and stay in semi dark for an hour (yes, including brushing my teeth with the hall light on instead of the bathroom light!) I can sleep 8-9 hours, just waking once. Doing this a couple of nights in a row, then a night off to keep from getting habituated. On the off night I might use diphenhydramine (benadryl), or low dose codeine (15 mg) if discomfort is a real issue.

 

[mendogal]

I walked a bit over .6 mile in 20 minutes this lovely cool bright morning! (and got to practice my Spanish on the return portion with another early morning ambulator )

 

[Layla]

Trabajo genial!

I had to look it up.

 

[mendogal]

Trabajo genial!

I had to look it up.

LOL. It's buen trabajo

 

[Layla]

Oh well…I tried.

 

[mendogal]

I had my first postop massage yesterday afternoon - it was wonderful, she spent 2/3 of the hour on gentle work on both legs/hips, getting good release of unneeded muscle tension.
Also - after my earlier L TKA my first visit to her was at 8 weeks and I needed to do the stairs slowly with both feet on each stair. Yesterday was at 6 weeks, and without even thinking about it I just took the stairs sequentially, "regular style."
As happened a week ago, doing two activities in one day (I had a longer walk than usual yesterday morning) was a bit overtaxing. I slept well last night then took quite a nap in the recliner today (11 AM to 1 PM). Well my biggest "jobs" today will be a shower and making chef salads for supper so that's fine!

 

[Susie-Q]

This is a good update, @mendogal ! It sounds like things are progressing just as they should.

Congrats on doing the stairs sequentially!

 

[EalingGran]

Yesterday was at 6 weeks, and without even thinking about it I just took the stairs sequentially, "regular style."

That's amazing!
I couldn't do that until about 5-6 months.
Great report.

 

[mendogal]

@EalingGran - I was, as y'all say across the pond, gobsmacked. I realize there's still plenty of healing to do. I do have loose joints (yes, a loose woman...) which didn't become apparent until I challenged them doing martial arts in mid life; in the case of joint replacement it seems to be an advantage in that my ROM remains good.
@Susie-Q - thank you! Some of it is more self confidence on the second go round - on my first TKA I was sure I was going to weight shift badly and break it!

 

[mendogal]

Post op day 49 and my official office visit with the surgeon (saw his PA at week 3). He doesn't play the number game, is very happy with my demonstrated ROM, walking 1/2 mile, not needing the walking stick to go from the car into the offices and exam room. About the aching horizontal fold of skin above the incision: he says it's not caused by an internal stitch but by the fascia sticking to the muscle (this makes sense to me in terms of how it presents). As it is already slowly improving with my several x daily massages, he feels it will resolve.
I am cleared for swimming, hot tub, sauna (none of which I will be doing) and driving. Will do a short drive later this week or the weekend.
Still needing the low dose codeine 2-3x weekly and using valerian and/or melatonin for sleep. It doesn't help that our entire roof is being demolished (including rotten plywood and beams) starting at 0700 daily!
Oh! Did some brief errands with MDH without the walking stick; using it when solo.

 

[EalingGran]

Sounds like you are doing great. Good luck with the roof!

 

[sistersinhim]

How good to read about your continued improvements! You are an inspiration to others and with your sensible activities, you prove that you don't have to work your baby knee to have a good outcome!

 

[mendogal]

Why I love the PT aide ... I haven't seen her since graduating from my L TKA, when I told her I'd be back. She knew we were to be working now on strengthening.
I told her how 2 weeks ago I couldn't use the bike at my gym. She said, ok, let's see if we can warm you up our bike (much shorter rotational axis, suitable for 5'1" me).
I showed her the uncomfortable skin fold above the incision, caused by sticky fascia, and she said, ok, I can do some massage on that before you leave.
So I did 4 minutes, no resistance, slowly on the bike. Did 15 very slow short arc quads, no weights. Did 4 very slow leg lifts, told her the skin flap fascia issue was making it too difficult to engage the lateral quads well enough (not a lie!).
So the second half of the session was a wonderful gentle massage of the entire area around the lumpy knotted problem area. The knotted areas are a little softer and the surrounding area (about 2.5" away from the lump in all directions) relaxed.

 

[sistersinhim]

What a great 'workout' you had! It's nice to have a PT that knows how to rehab a knee replacement.

 

[EalingGran]

Sounds like a really good session! It's always reassuring when you work with someone who understands your body. It's good to see that kind of therapist regularly- because they can often see progress that you have missed, and encourage you.