TKR Cflower's recovery

[Josephine]

Yes I did read everything in the beginning I should have printed all the information so I had it on paper in front of me so I'm not asking stupid questions r things that have already been posted to the board. Sorry for getting everything so spread out. You can delete if needed.

It's okay - I just added all your threads together! No harm done.

Laying in bed with CPM up to 75 and I think if I pushed it any higher my one would pop.

Do remember (as if you could forget!) that you are not yet 2 weeks out.That feeling is because your knee is grossly swollen so forget trying to ramp up the CPM. For the first three weeks you should be doing as little as possible anyway to get the swelling under control. Remember - rest, elevate, ice and take your pain meds!

Kind of messed up on the hydrocodone today.

I thought I had a good system. I had alarms set on my iPhone to alarm at appropriate times so the following morning I just reset timers again. I forgot to do that this morning.

Better yet is to have a note pad and right down the exact times you take a pill. Then you have a permanent record of your usage. I have a palm-top and did that from the moment I got back from theatre! Even including the times I used the morphine button!

 

[jancat]

Cflower- What Referee and Roy said!
I am 14 weeks out and have been back to work 2 weeks and I feel GREAT!
From weeks 1-3 I laid around and did nothing but ice, elevate, take pain meds, putter to bathroom and kitchen once in a while, did cpm machine a few times a day, ankle pumps and the very early PT exercises that home PT gave me (leg lifts, heel slides, etc-easy and gentle). Had a near breakdown which I attributed to pain meds, but luckily found BoneSmart at the end of my 3rd week, read the 'post-op blues' article, and knew that was my problem, got myself straightened out and followed the advice here.
I did not have to use compression stockings at all; in the hospital I had those wrap around pump things when I was in bed.
I was taking Coumadin for 5 weeks post-op and did endless ankle pumps while laying around.
In week 4 I started OP PT, which was always gentle and just to my limit, never painful. I stopped OP PT the day before I returned to work. Now I do 3 exercises a day: balance, flexion stretch, and quad strengthening.
I think you would do well to follow the advice on this forum- do not push yourself now, keep the PT very gentle. Doing more/harder PT does nothing but hinder your progress.
It seems counter-intuitive to just sit and do almost nothing for several weeks, but that is what needs to be done, especially in the first 3 weeks post-op. Enjoy it!
So there it is: ice, elevate, pain meds, very gentle exercises, and read Bonesmart. You will do great!
Happy Healing!

 

[Cflower]

Today while going through papers I have accumuated from hospital stay I found this letter from the anesthesiologist. He had given it to my husband after surgery. I freaked out. Hub had not told me because he was going to wait until I felt better. Anyway subject of letter was difficult airway and goes on to say I have a small mouth and stiff neck. Etc etc. class 2 mallampati,grade three direct laryngoscopy, used glide scope, difficult but successful. Also said I should place the letter with medical records for future surgeries and was imperative that I give anesthesiologist copy for future surgery. Also recommended getting medical I'd bracelet. I have had at least four surgeries that I can remember where I have been put to sleep with no problems.

Now if the knee isn't enough to worry about I have this. Josephine; Help. Is this something i should fret over. Is there anything that can be done about stiff neck which would help this problem in the future. I don't need anything else on my plate right now.

 

[Josephine]

Of course not! The Mallampati classification is simply a means for anaesthetists to classify various oral accesses and not really indicative of anything serious. It's actually not an uncommon condition but does help if future anaesthetists are aware beforehand but the "grade three direct laryngoscopy, used glide scope" description isn't that uncommon either. It just means he had three goes with the standard laryngoscope and then used a guide (a kind of flexible stick) to slide the ET tube over. I've seen it done numerous times. It's a standard fall-back procedure when intubation is difficult.

Look in post #4 of this article Anaesthetics - spinals, femoral blocks, GAs and everything else and you will see what I'm talking about.

Actually, if he'd used a laryngeal mask in the first place, he wouldn't have had the problem in the first place! As for you having a medical bracelet - Jeeze! Forget it all until/unless you have another surgery and then just hand the letter to the anaesthetist who, if he has anything more about him that this chap did, will just read it and say okay and give it back.

In my opinion, this chap has been a bit of a drama queen!

 

[Cflower]

Tomorrow I go get staples out. I'm nervous for two reasons. One because its probably going to hurt like heck and second I'm afraid the doctor will think my ROM shoud be better. Tomorrow I'll be thirteen days from surgery. I have been icing, elevating, doing my exercises twice a day, pt three times a week. I don't think I have 90 degrees yet. Pt today gave me some extra exercises and showed me a couple my husband can help me with where he puts his arm under my bent knee and gently pushes down. I was really sore today after pt. I do not want to be one of the people who has to have the manipulation (??) I don't mind the progression of flexing going slowly as long as I know I'm going to get there in the end. Doctor told me after surgery that this wasn't a race but a marathon. Hope he remembers that and does scold me tomorrow.

Moving a little more today in the kitchen. Can't wait tonget back to cooking again. A friend brought eggplant Parmesan wonderful salad, bread and a peach and blackberry cobbler. Wonderful meal which gave my husband a break. Looking forward to another good night sleep. I do hope I Continue to sleep well.

Will be glad to get tomorrow over with.

 

[Debbie_joints]

I called a medical supply place and they have foam wedges 7 inches 10 inches 12 inches high is the 12 inch high enough to elevate leg? My pillows keep wanting to slip and I would rather have one piece.

Wondering what kind of wedges everyone uses. I know the doctors don't want you to sleep with your knee bent very much. Looking up leg wedges I see triangular ones and ones that have like a platform, but there it looks like the knee would be bent more. Does anyone have a picture of one? Also, do any of you use body pillows in bed? Another question, did any of you sleep in a recliner, how long? I want to be prepared. Thanks

 

[bottomshollow]

This is the type of wedge one should get. They can also be perfectly straight without the curvature this one has. I fear they are a bit pricey--but well worth it.

Quite a few Smarties use body pillows. I lived in my recliner and slept in it night and day for the first 2 months. I made myself get in bed at night and stay there for at least 3 hours, but usually had to get up after that and hit the recliner.

 

[Cflower]

I had my two week check up today (2 weeks will be on Thursday). Staples were ok coming out. I worked myself into a tissy worrying about it. It barely stung. I had 92 rom the day I was dismissed from hospital and I wasn't at 90 today. I didn't have the cpm machine the first three days I was home so I probably let myself slip back. Have I really messed things up not getting to 90 by first two weeks. I'm doing pt three times a week may see what they think about me going four times a week. Suppose to get on bike for the first time tomorrow. Don't see how leg will make that first turn on bike. Doctor gave me two more exercises to do. Sit in tall chair. Dangle legs, take good leg and push bad leg down then use good leg and pull new knee back up. Three times a day 10 repetitions.

I'm really hard on myself when I dont think I measure up to what's expected of me and I really don't want to walk stiff legged the rest of my life. I can bend it probably to 80 but not much more than that. Doc says I need to elevate and ice to get swelling down. I bought the wedge, 12", and ice all the time. We did put a folded quilt under the wedge to make it even higher.

I guess with all this rambling I want to know if others maybe did not have the 90degrees at two week check up and did you finally get the rom.

He took me off warfarin and since I have the protein s deficiency he put me on Xarelto for 14 days. At least with this thinner I don't have to have the blood test, watch eating vitamin k vegetables and on top of that I can start back to my two baby aspirin, fish oil, coenzyme q10, meloxican for the other bad knee and the vitamin d. I had to be off all that while in the blood thinner

Sorry for the rambling. I just dont know how hard to push myself to get the bend. Do I push until it hurts and stop or push a little more or. Push way more than I think I can handle. Thanks for listening to someone who at the present seems afraid of everything.

 

[Janet2012]

I was 88, 92, 85, 90, 95, 90 and - tada - 110! A single reading means nothing. It's the trend over time. The flux and flow of activity and fluid retention will make it more or less on any given day. You don't need to worry about anything at two weeks, and in fact, being around 90 at two or three weeks is just where they would hope for you to be!

 

[Josephine]

I had my two week check up today (2 weeks will be on Thursday). I had 92 rom day I was dismissed from hospital and I wasn't at 90 today. I didn't have the cpm machine the first three days I was home so I probably let myself slip back. Have I really messed things up not getting to 90 by first two weeks.

So what - you're only 2 weeks out. You shouldn't even be thinking about ROM. It's much too soon for all that. You are just at the stage where the swelling is really ramping up. Nothing much you can do about it - it happens to everybody. Just follow the mantra rest, elevate, ice and take your pain meds by the clock!

Now I know somebody gave you links to all the articles - you don't seem as if you read any of them otherwise you wouldn't be saying all this. I'll be giving you them again so this time please read them.

I'm doing pt three times a week may see what they think about me going four times a week. Suppose to get on bike for the first time tomorrow. Don't see how leg will make that first turn on bike.

At two weeks you shouldn't be doing ANY exercises or PT. Just gentle heel slides a few times a day, leg raises night and morning and walks to the bathroom and kitchen as needed. The bike riding should wait until at least week 3, the full rotations one to two weeks after that. Most people are 4 weeks out before they can do that.

The only thing you NEED to do right now is try and get on top of that swelling as that's all that's stopping your leg from bending. read Swollen and stiff knee: what causes it? and Some suggestions for home physio (PT) and activity progress

Doctor gave me two more exercises to do. Sit in tall chair. Dangle legs, take good leg and push bad leg down then use good leg and pull new knee back up. Three times a day 10 repetitions.

Read my previous comments - do them later, like in week 4!

I'm really hard on myself when I dont think I measure up to what's expected of me and I really don't want to walk stiff legged the rest of my life.

You won't. You have plenty of time to get that ROM. Has somebody told you that if you don't get to X flexion within 3 weeks, your leg will never bend again? Because that's utter rubbish, lies and just plain scaremongering. Do not listen to it. Myth busting: The "window of opportunity"

Doc says I need to elevate and ice to get swelling down. I bought the wedge, 12", and ice all the time. We did put a folded quilt under the wedge to make it even higher.

Well, that's okay but mind you don't lay with your leg bent. The proper ways to do it are in here Elevating your leg to control swelling and pain

I guess with all this rambling I want to know if others maybe did not have the 90degrees at two week check up and did you finally get the rom. I just dont know how hard to push myself to get the bend. Do I push until it hurts and stop or push a little more or. Push way more than I think I can handle.

You bend it to the point of discomfort and no more. Never ever make it hurt and don't let anyone else do that either. And if anyone starts spouting that "no pain, no gain" rubbish, you tell them that's not right either. The correct saying is "no pain MORE gain"!

Here are the articles, please read them carefully and memorise
The importance of managing pain after a TKR and the pain chart
How Long Does Healing Take ......
Chart representation of TKR recovery
Energy drain for TKRs
Using ice
Progression of activity for TKRs

Knee Replacement - Where Am I in Recovery?
So What Is It Going to Take? The Five “P’s” of Knee Recovery
Work “Smarter” and not “Harder”
About recovering a knee - from one who knows!

MUA (manipulation under anaesthetic) and adhesions
It's never too late to get more ROM!
It's Worth the Wait for ROM
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it

and finally, you should read the potted version of my recovery and see how much exercising I did!
Knee recovery - UK style

 

[bottomshollow]

Please Cflower, step back and take a very,very deep breath and stop beating up on yourself. Your flexion is fine and it will get better, but not instantly.

As long as your knee is swollen you are not going to increase bend. So cut out all the excessive PT on it. Do a lot of elevating and icing. Do gentle, easy stretches and bends---only to the point of slight discomfort---NEVER, NEVER cause yourself pain. This just make the knee swell up again---and you're back to square 1.Sweetie, you're just starting week 3 of a 52 week recovery---you have a long, long way to go and plenty of time to get there.

Go back and read the Library articles on ROM and stop stressing over it. And don't let your doctor or you PT cause you to stress over it. It will improve as the swelling in the knee goes down and stays down.

The name of this game is TIME & PATIENCE---TIME & PATIENCE---TIME & PATIENCE---and then some more TIME & PATIENCE. You are going to have to dig down deep, deep inside yourself and find the PATIENCE to take the TIME to move slowly and deliberately through this recovery and do things the BoneSmart way. If you do this, things will all come together and you will be able to move pretty smoothly through this recovery. But if you try to force things--the knee is going to make you pay and pay and pay.
Please take care of yourself and keep us posted. We care.

 

[Cflower]

Josephine, believe me I reread the articles. But I start getting scared when I think I'm not in line ith where I think I should be. I will read again and again I promise. You said stay on top of the pain killers. Maybe I'm doing this wrong. I'm taking 2 5-325 hydrocodone every four hours. That's the way I took it in the hospital. Today the pa told me that by two weeks some people are off meds all together. Then the doctor told me the prescription says 1-2 every 4-6 hours as needed. So if I wait or the pain then it s too late and it will take me at least an hour and a half to have pain ease up. I have refilled my third bottle 50 pills each. Have one more day left of that third bottle and he wrote another prescription for 50 pills NO REFILLS. So. My question is should I keep taking them every four hours and take only one pill or take two pills and try and push it out 5-6 hours OR wait until a nagging pain starts then take the pills. I know eventually I need to taper off and I guess at the end maybe extra strength Tylenol will have to be used. Am I taking too much I guess is the question.

I definitely appreciate all the advice from people who have been through this and I will read and re-read all the articles. Thank you.

 

[Janet2012]

Have one more day left of that third bottle and he wrote another prescription for 50 pills NO REFILLS. So. My question is should I keep taking them every four hours and take only one pill or take two pills and try and push it out 5-6 hours OR wait until a nagging pain starts then take the pills. I know eventually I need to taper off and I guess at the end maybe extra strength Tylenol will have to be used. Am I taking too much I guess is the question.

I definitely appreciate all the advice from people who have been through this and I will read and re-read all the articles. Thank you.

the fact that he wrote it as no refill (here, there are no refills, must get a new script), does not mean he wants you off the pills, only that he wants you to tell them that you need more. He doesn't want to prescribe pills that will not be used. As long as you have pain, which likely will be a while, he will want your pain controlled. If he says no more of a particular drug, ask for an alternative.

 

[RunA42K]

Josephine, believe me I reread the articles. But I start getting scared when I think I'm not in line ith where I think I should be. I will read again and again I promise. You said stay on top of the pain killers. Maybe I'm doing his wrong. I'm taking 2 5-325 hydrocodone every four hours. That's the way I took it in the hospital. Today the pa told me that by two weeks some people are off meds all together. Then the doctr told me the prescription says 1-2 every 4-6 hours as needed. So if I wait or the pain then it s too late and it will take me at least an hour and a half to have pain ease up. I have refilled my third bottle 50 pills each. Have one more day left of that third bottle and he wrote another prescription for 50 pills NO REFILLS. So. My question is should I keep taking them every four hours and take only one pill or take two pills and try and push it out 5-6 hours OR wait until a nagging pain starts then take the pills. I know eventually I need to taper off and I guess at the end maybe extra strength Tylenol will have to be used. Am I taking too much I guess is the question.

I definitely appreciate all the advice from people who have been through this and I will read and re-read all the articles. Thank you.

If you hurt, then take them! Mine were even stronger 7.5 - 500. Two every 4 to six hours. I needed them for 8 weeks. I got 40 in each refill. They would come with one refill, then the pharmacy would have to call the doctors office every other refill. I think that they put no refills on because maybe some people won't need them, but if you do, then they should refill.

Please don't worry about your ROM, I was the worst for worrying about my ROM. I used to complain all the time that I'd fear that I'd never bend my knee again. I was told the same that they are telling you now. I never went to PT more than 3 times a week. Working too hard slows you down. At 2 weeks I was 72 ROM, 4 weeks 88 ROM, 8 weeks 104. It took me two months to be able to pedal a bicycle, but at 7 months I was at 137 ROM. Be patient, it will come.

 

[jerseychick]

I had my two week check up today (2 weeks will be on Thursday). Staples were ok coming out. I worked myself into a tissy worrying about it. It barely stung. I had 92 rom day I was dismissed from hospital and I wasn't at 90 today. I didn't have the cpm machine the first three days I was home so I probably let myself slip back. Have I really messed things up not getting to 90 by first two weeks. I'm doing pt three times a week may see what they think about me going four times a week. Suppose to get on bike for the first time tomorrow. Don't see how leg will make that first turn on bike. Doctor gave me two more exercises to do. Sit in tall chair. Dangle legs, take good leg and push bad leg down then use good leg and pull new knee back up. Three times a day 10 repetitions.

I'm really hard on myself when I dont think I measure up to what's expected of me and I really don't want to walk stiff legged the rest of my life. I can bend it probably to 80 but not much more than that. Doc says I need to elevate and ice to get swelling down. I bought the wedge, 12", and ice all the time. We did put a folded quilt under the wedge to make it even higher.

I guess with all this rambling I want to know if others maybe did not have the 90degrees at two week check up and did you finally get the rom.

He took me off warfarin and since I have the protein s deficiency he put me on Xarelto for 14 days. At least with this thinner I don't have to have the blood test, watch eating vitamin k vegetables and on top of that I can start back to my two baby aspirin, fish oil, coenzyme q10, meloxican for the other bad knee and the vitamin d. I had to be off all that while in the blood thinner

Sorry for the rambling. I just dont know how hard to push myself to get the bend. Do I push until it hurts and stop or push a little more or. Push way more than I think I can handle. Thanks for listening to someone who at the present seems afraid of everything.

You are really being too hard on yourself and you are only 2 weeks out, just starting your recovery. At 2 weeks I could only bend my knee 30 degrees and my doctor said I was doing poorly. At 6 weeks I was at 90 degrees. Everyone progresses at their own rate. Besides, you can't bend a swollen knee, it's just impossible. Make sure you elevate and ice your knee as the doctor said...toes above your nose.

I took pain meds for 5 months till my PT was over. If you need them, than take them, that is why they are prescribed. When you are nearing the end of your bottle of pills, call and get a refill. That "no refills" left means you have to call the doctor for more pain meds.

Believe me you will NOT walk stiff legged the rest of your life. You are still healing, it takes time, at least a full year for recovery. This is not something that happens over night. Please give yourself a break. You just had major surgery and now have to take time to recover.

 

[Cflower]

Thank you all so much. I find myself crying at least once a day and now for all the support you are giving. My husband is the best at taking care of me. He is so protective and is there every time I need a leg rub, ice pack or even a snack. He's a keeper for sure. I'm going to pt tomorrow with A new attitude and plan on telling the therapist that I do not believe in no pain no gain but a little pain more gain is more mt style. Started Xarelto tonight so hoe that works out fr next 14 days.

I have four grandsons I need to get in shape for (2under 3 months old) and two under 4 years old so I need to be in shape to get in the floor with them. Thanks to everyone for all the help. This journey is just beginning.

 

[kneeper]

the fact that he wrote it as no refill (here, there are no refills, must get a new script), does not mean he wants you off the pills, only that he wants you to tell them that you need more. He doesn't want to prescribe pills that will not be used. As long as you have pain, which likely will be a while, he will want your pain controlled. If he says no more of a particular drug, ask for an alternative.

Exactly. They just like to keep track a bit of the pain meds.

And the best way to get in shape for the grandkids is taking care of yourself now. One of the hardest things is getting over the comparisons and the "I should be at x stage by now."
Your husband sounds like a keeper indeed.

 

[Cflower]

Had pt today. Actually felt kind of good even though it hurt. Started recumbent bike today. Could not make full rotation. Didn't matter to therapist. She said if I couldn't Just to rock back and forth as far as I could. My favorite stretch is where I'm laying on my back and she puts her arm under the bend of my knee then lifts it up and presses down on lower leg to stretch and bend. Sounds like torture but I feel good by the time I walk out. Good thing I had pretty strong leg muscles before going into this. Also did a stretch with step stool. I step up with bad leg and push into it kind of leave other foot on ground. I'm walking a little better with heel toe movement. I could probably walk without the walker but right now it offers a lot of security when I feel kind of dizzy. Hoping for another good day tomorrow.

 

[Cflower]

I don't know. If this has been covered but since I'm not wearing teds can I use the wide ace band adage that my knee was wrapped in out of surgery and wrap my swollen leg in place of the stockings. If so can I sleep In it. I want to try something else in addition to the ice and elevating

 

[bottomshollow]

Sure you can. Sometimes a little compression is good for swelling, and if it allows you to sleep better, fine. A little elevation along with it is good--also ice if you wish also.