Knee Infection* CABLAND's 11/13/2023 LTKR Recovery

[CatieViv]

Merry Christmas!

 

[Layla]

I love your Christmas message, cabland!
May you have a lovely day and many blessings in 2024!
@cabland

 

[cabland]

Just a quick update on my progress:

Pain Levels - Still struggling here, but saw my surgeon this past Tuesday (6 weeks from surgery) and can now add NSAIDS so I am easing that into the mix (and trying to ease off the oxy). I forgot to ask about topical NSAIDS like Voltaren gel, but as my scar looks good, I am assuming I can try that out as well. We'll see.

Physical Abilities - I continue to progress (albeit slowly). I gave up the walker around the stat of week 5 and am on to the cane now, but around the house I walk without it as often as I am with it. I started outpatient PT 2 days ago and the therapist was actually happy with where I was at. She indicated my surgeon was more focused on range of motion and felt "strength" would come as it comes...so that was good to here. My PT will run through January. I did manage to take out the trash today and took a shower without the shower chair - baby steps! I am trying to add more of the ADLs (Activities of Daily Living) to my mix - particularly walking - vs. just stretching and PT exercises. Got up to 2500 steps yesterday (not much compared to my normal, but much higher than the last few weeks where I hadn't even broken 1000 until about a week ago.

Infection - Drum roll please.... I completed my 6 week course of IV antibiotics yesterday and the picc line was removed...praise the Lord! Yes, I have to do the oral antibiotics for 6 months, but it is a huge milestone. I see the infectious disease doc again in a week so he can gauge my reaction to the oral antibiotics. After that, it will be monthly (along with accompanying blood tests).

 

[mendogal]

Oh what a heartening update!!!!! No IVs and no shower chair going into the new year... may 2024 be your year of full recovery!

 

[Layla]

I completed my 6 week course of IV antibiotics yesterday and the picc line was removed...praise the Lord!

Yes, PTL! This is wonderful news and a great milestone.
Wishing you good health and perfect healing in the New Year!

 

[CatieViv]

What a great way to end the old year!

 

[sistersinhim]

Yippee, no more PICC line! What a wonderful update!

 

[cabland]

OK, so today is the 2 month anniversary of my knee replacement. It is definitely a rollercoaster of recovery. Current status:

Infection
As noted in my last post, I am no longer taking IV antibiotics (hooray), but have transitioned to oral antibiotics (100mg of doxycycline, twice a day - for 6 months). I think I am having some GI side effects, but so far am managing (note: am trying out various pro and pre biotics now). The reality here is that I simply won't know if the infection is fully gone until AFTER the antibiotics are stopped. It is a bit cringeworthy to think that 6 months from now it might come back, but I can't really dwell on that (at least not today!).

Physical Therapy, Progress, and Issues
Because of my infection, I started outpatient PT "late" (at least relative to "common" U.S. standards) - his was after doing 4 weeks of relatively mild in-home PT. I began on 12/28/2023 and am scheduled to finish on 01/25/2024 - basically 4 weeks, 3X a week. My comments:

• Physical Therapy
  • Late Start (maybe not such a bad thing) - My late start may not have been such a bad thing. It pushed me further into the healing cycle. Indeed, I had a full week gap between the end of in home PT and the start of outpatient PT. When I stopped in-home PT, my extension was pretty mediocre at +10. However, even with little focus on it, it seems to have almost "fixed itself" and is a lot closer to zero.
  • Primary Focus is on Stretching but recovery still a bit rough- So the primary focus has been on stretching, with a few other items added in. The regimen has included:
    • Stationary cycling, balancing (standing on piece of foam), quad sets, heal slides, slide on ball, extension stretch with strap, clamshells, bridges, manual manipulation (push leg down, push knee back - generally to the point of mild discomfort but tolerable), and graston technique mobilization around scar area,
  • I would not say this is strenuous, and in session it all feels tolerable enough, BUT that evening and much of the next day and night I am pretty sore and hobbling. I can, however, sort of self-throttle on some of these exercises as they are often TIME measured vs. quantity (i.e. 2 minutes of bridges as an example). I actually did that a little bit on my session yesterday (i.e. I can simply slow down and do less in that window of time). The same is true on manual manipulation...I just push back a little sooner. I am still sore today, but perhaps a little less so. In reality, I think twice a week might have been a better cadence as would give me 2 or 3 recovery days in between sessions. Regardless, my therapist is pretty good at listening to me (i.e. she has not ramped anything up based on my feedback), and isn't one of the "we must hit zee number!"...although she is pushing to get to 120 on flexion...but I won't sweat it if I'm not there at the end. I am at 113 now (for the record) after a lot of warm-up and a "hero" pull!
  • Ultimately, it is a balancing act to try to make progress while not continually taking 2 steps back (so much of the Bonesmart way becomes obvious here). I do think that I am making progress, but also feel the next big step will happen AFTER PT is done and I'm left to just my daily activities and a chance to recover from it for 4 or 5 days and then just start walking a lot more....I hope!
  
  
• Issues - The biggest issue I continue to have is simply PAIN. This occurs even when at rest unfortunately. The most significant area is right as I move off of full extension into flexion or as I approach full extension from flexion - unfortunately, that's the classic use range for walking! The 3X weekly PT cycle likely isn't helping, but as I do see some progress in capabilities from it, I am pushing through there (only another 2 weeks left). I have cut back considerably on the oxycontin and am taking it primarily at bedtime and maybe one other time in the day. I did have to force myself to do this and still "sit" in some discomfort as a results. I am taking a decent amount of Acetaminophen and NSAIDs though to fill the gaps. I have also started applying Voltaren gel. Icing is my friend and I am forcing myself to elevate on my lounge doctor (I'm on it as I type this!). Stiffness of course is the norm!

What about the right knee?
So, if you recall from the beginning of this thread, I was SUPPOSED to have both knees done in November (2 days apart), but an insurance delay caused the right knee to be denied (which turned out the be a blessing in disguise given my knee infection). My surgeon has indicated he would do the second knee as soon as mid-February. I. however, will need a number of things to be true before I proceed with it, including:

• • Left knee pain needs to be much reduced
  • Left knee mobility and strength needs to be "fine" for daily life and able to handle what my right knee did for the last 2 months!
  • I need my infectious disease doc to give the OK (note: there will definitely be some risk here, but hopefully minimal).
  • Ultimately, I need to be convinced the surgery has worked to make my knee better before proceeding with another...as of today, it is still materially worse.

Thanks again to all the Bonesmarties here. I continue to find the stories of others to be encouraging in the face of all the "people who were doing great in 4 weeks" which many of us know can be discouraging. I also appreciate the Bonesmart philosophy on recovery a lot. I don't think it is always a recipe for "achieving max gains as quickly as possible", BUT it's core just appears to be so sound. My recommendation is to listen to your own body. If you feel you can take more...go for it. Back off if it doesn't work out. In my case, I KNOW I am overdoing it (for ME) in PT right now, but am electing to push forward (and sometimes regretting it!) as I see some gains and am managing the downsides (mostly...see the comments amount self-throttling in PT, etc.). As proof that I am pushing it, my wife asked how I was feeling the other day and I commented that I felt like my surgeon was Tonya Harding and I was Nancy Kerrigan...Whyyyyyyyyyyy, Whyyyyyyyyyyy! Too soon?

I am looking forward to my own next update to see where I'm at. IF I HAD TO PREDICT, I am hoping that the 3 month mark will look considerably better from a pain and walking front (but with a long way to go) - a bold prediction and one I hope the Lord will help me out on!

p.s. sorry for the excessive bolding. tried to correct, but no luck.

Administrative note: We corrected the coding in your post to remove most of the bold type.

 

[AnnYo]

Hi @cabland--I had to write because you and I had a left TKR on the same day. I just wanted to tell you that from my perspective, the things you are able to do after having your terrible infection are AMAZING! You have come so far! My recovery has been more uneventful than yours, but I still deal with some of the nagging issues you describe. I think you have a great handle on how to both push yourself and pull back when you need to. I wish you the best and look forward to further updates from you.

 

[MSuki]

For me there is nothing that drives me crazy more than waiting on an outcome. Hope you get good news on the infection front.

I can relate to the idea of self throttling. On more than one occasion I have thought to myself on timed exercises that I could just go a little slower, only to forget to follow through! Maybe I’ll do it next week. As to visits, I took myself down to twice a week after Christmas and I like it better. 3 times was getting to be too much as I think my PT feels obligated to make progress at each visit. I felt like I was having trouble keeping up.

 

[mendogal]

On my first TKA, nearly a year ago and without benefit of BoneSmart, I kept myself to once a week PT because of losing a whole day after each session (swelling, pain, fatigue).

If the next day you have pain and hobbling, it's your new knee's ONLY way to tell you to back off. Pushing through will not assure a better outcome .... and might actually delay things.

 

[cabland]

On my first TKA, nearly a year ago and without benefit of BoneSmart, I kept myself to once a week PT because of losing a whole day after each session (swelling, pain, fatigue).

If the next day you have pain and hobbling, it's your new knee's ONLY way to tell you to back off. Pushing through will not assure a better outcome .... and might actually delay things.

Maybe I'll get a "snow day" on Monday!

 

[cabland]

On my first TKA, nearly a year ago and without benefit of BoneSmart, I kept myself to once a week PT because of losing a whole day after each session (swelling, pain, fatigue).

If the next day you have pain and hobbling, it's your new knee's ONLY way to tell you to back off. Pushing through will not assure a better outcome .... and might actually delay things.

Maybe I'll get a "snow day" on Monday!

Snow day confirmed...

 

[Layla]

Awesome, cabland! Enjoy your snow day. Here...catch!
Pretty pic, beautiful neighborhood!
@cabland

 

[MSuki]

Oh it’s beautiful!

 

[raylo]

Snow is beautiful only in a picture or for about 5 minutes in real life. Then comes the cleanup and living with the remaining mess for days or weeks. We have it here this morning for the first time in over 2 years and I am NOT happy. I'd rather be riding my bike!

Oh it’s beautiful!

 

[raylo]

My 5 minutes of beauty are already over. Now we have this... and it only keeps getting worse until it is gone. On a positive note, my new knee handled the shoveling just fine.

Snow is beautiful only in a picture or for about 5 minutes in real life. Then comes the cleanup and living with the remaining mess for days or weeks. We have it here this morning for the first time in over 2 years and I am NOT happy. I'd rather be riding my bike!

Oh it’s beautiful!

 

[Layla]

Living in the frozen tundra myself, I agree. Fresh fallen snow is the prettiest, then it gets dirty and the beauty fades, it lasts for months and it gets old, then you slip and fall and hate Winter, lol
Not funny, but certainly Debbie Downer sounding, lol
May your snow remain pristine, the temps in your neck of the woods tolerable, and the pavements you navigate dry and free of ice
Happy Healing guys as you continue the journey. Thanks for sharing your progress with us!
@cabland
@raylo

 

[MSuki]

I live in Houston. My brother lives in Vermont, and I just don’t stay long enough to see it melt.

 

[EalingGran]

Beautiful pictures but agree that it is awful from the practical point of view- such as shovelling and falls risk.
Thankfully we seldom get much snow in London- but we have got patches of black ice at the moment. I was out last night and saw a large icy patch on the pavement where some water had been spilt. It reminded me of last winter just after my surgery when I was so terrified of falling that I used a stick for months. Good luck!