TKR Coming along<<

[traceys]

Same rash brought out every time I used shower gel or lotion with scent or chemicals in them. Quite a few on here have posted identical experiences. Putting anything on to heal the scar or alleviate winter skin?

 

[Elad1002]

Thanks Traceys. I'm looking into Bio Oil. Do you have any suggestions?

 

[traceys]

Don’t use anything. Your scar shouldn’t have anything on it that soon

 

[Elad1002]

I used bag balm soap because it is so moisturizing. I also use bag balm on my hands and feet to prevent cracking but nothing on leg, sort of been avoiding the area. I understand bio oil is hypoallergenic.

 

[Elad1002]

Thank you for saying that, I've sort of felt the same way. I now see a black spot on the incision , wondering if it's a stitch starting to come through, time will tell.

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[Elad1002]

1. 4-5, factoring in newly acquired broken left 5th metatarsal bone.

2. I was originally prescribed Morphine, Celebrex, Gabapentin, Tylenol. Presently only taking Tylenol.

3. Swelling is moderate at this point 7 weeks po.

4. 0/115

5. Icing 2x daily

6. Elevating 1x day in late afternoon when fatigue sets in.

7. My activity level has decreased but still doing small chores, light cooking and cleaning and having husband help with pretty much everything because I fell and broke my 5th metatarsal on opposite leg (foot). I have a carbide steel insert for that shoe so I could still walk but need to keep foot flat. I

8. Exercises done at home
straight leg lifts 5 sets of x10 throughout the day
Leg extensions from a seated position x40
Walking 10 minutes 4x daily
Heel slides every day x10

PT twice weekly
Straight leg raises with 1lb weight x30
Leg extensions with 1lb weight x30
Standing knee extensions with bungee cord
Step ups, lowest setting x20
Bicycle no tension 10 min

PT will stretch me total tolerance, no pain

I am battling with severe anxiety which got triggered as a result of the TKR, not fun.

What do you recommenced for scar ointment, anything? I'm using nothing on scar but have very dry winter skin which as I explained in last email and photo, hair follicles look irritated on surgical leg below incision.

Thank you.

 

[maryo52]

When I do any bends, I go to the point of discomfort (2 on the pain scale) and sit with that a minute or two. Just 3-5 of those is enough. I'm attaching an article you might find helpful. In my previous TKR life I had a terrible battle with ROM so I can relate to how discouraging it can be. Read the article!

 

[Josephine]

Some detail you missed out!

5. Icing 2x daily
6. Elevating 1x day in late afternoon when fatigue sets in.

The question was "how often and for how long?"

Standing knee extensions with bungee cord

The questions was "number of repetitions"

PT will stretch me total tolerance, no pain

IN what way does she 'stretch you'? And for how long?

 

[Elad1002]

5. I ice for about 20 min at least 2 times a day, lately 3.

Standing bungee cord extensions are 3 sets of 10.

6. I elevate for at least an hour.

I also sit in a recliner throughout the day. I JUST realized that I may not have been elevating correctly. I've been using a straight wedge with a small pillow over it trying to simulate the curved wedge shown on this site. I just today, ordered the type of curved pillow you show on this site. Amazon states the pillow is intended for acid reflux, but looks to be the same curved design as the one you recommend.

PT has me lay down on back while he lifts then bends my knee so my foot is flat on table for ROM. He then pushes it by a few degrees. The process takes between 15 and 20 seconds. The last time he got between 115 and 120. I believe with this ROM there is no longer a need to do this.

 

[Elad1002]

We are recovering from an ice storm here in Connecticut, USA.
The internet has been in and out. Sorry if I posted twice, not intended.

 

[Josephine]

GAAAGH! Another one I missed! I am sorry!

2. I was originally prescribed Morphine, Celebrex, Gabapentin, Tylenol. Presently only taking Tylenol.

The question was "how much are you taking (in mg please) and how often?" And this should include what you were 'originally' taking!

 

[Elad1002]

I was originally taking 30mg of Morphine 3x D ev 8 hours ( no longer taking)
Gabapentin 100 mg 3x D, (no longer taking)
Celebrex 200 mg 1xD ( still take as needed)
Tylenol 650mg every 4 hours. Still taking every day 4 x Day, occasionally 5x day.

 

[Josephine]

1. 4-5, factoring in newly acquired broken left 5th metatarsal bone.

oh ouch! You poor thing!

Celebrex 200 mg 1xday (still take as needed)
Tylenol 650mg every 4 hours. Still taking every day 4 x day, occasionally 5x day.

I suggest you try taking Tylenol 1,000mg 4 times a day at 6hrly intervals. I think you'll find that much more effective than only 1300mg per day.

3. Swelling is moderate at this point 7 weeks po.

You did factor this swelling (which I said is a form of pain) in to your pain score?

4. 0/115

Okay, not too bad for 8 weeks out.

5. I ice for about 20 min at least 2 times a day, lately 3.

You accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day.

6. I elevate for at least an hour.

And about 4 times a day, I trust?

7. My activity level has decreased but still doing small chores, light cooking and cleaning and having husband help with pretty much everything because I fell and broke my 5th metatarsal on opposite leg (foot). I have a carbide steel insert for that shoe so I could still walk but need to keep foot flat.

Okay,


Exercises done at home
straight leg lifts 5 sets of x10 throughout the day - once you can do an SLR you no longer need to do them
Leg extensions from a seated position x40 - leg extension are unnecessary as you are at zero
Walking 10 minutes 4x daily - that's too much. Did you read the Guidelines in the second post of this thread (Jan 5th) specially this one? Activity progression for TKRs You're doing too much!
Heel slides every day x10 - you don't need these, you're already at 115 degrees

PT twice weekly
Straight leg raises with 1lb weight x30 - once you can do an SLR you no longer need to do them, certainly not with weights!
Leg extensions with 1lb weight x30 - extension 'exercises' are harmful so don't do them. Espaecially don't do anything that involves weight or straps
Standing bungee cord extensions are 3 sets of 10 - these are ill advised - don't do them
Step ups, lowest setting x20 - these are also ill-advised
Bicycle no tension 10 min - this is okay!
PT has me lay down on back while he lifts then bends my knee so my foot is flat on table for ROM. He then pushes it by a few degrees. The process takes between 15 and 20 seconds. The last time he got between 115 and 120. I believe with this ROM there is no longer a need to do this - I don't recommend this.

Summary:
Increase the amount of Tylenol you are taking as suggested earlier
Quit ALL the exercises and PT. You no longer need it.

If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?

What do you recommenced for scar ointment, anything?

The only thing I recommend is Scar Shield which you can see advertised at the top of this page though it rotates with two other ads.

 

[Elad1002]

@Josephine Ok- I canceled PT for this week. I have apt with OS this coming Monday, will tell him of my decision to discontinue PT. Think I will let him know that my numbers are good and activity level is good. He is a huge proponent of PT, so have to chose my words carefully. I will bump up the Tylenol, Thank you.

 

[Josephine]

A week won't do you any good. You need a minimum of 2 months.

 

[Jockette]

He is a huge proponent of PT, so have to chose my words carefully

It is your decision whether or not you go to PT. If my doctor didn’t ask me about it I would not volunteer the PT discussion.

 

[Josephine]

Nor me! Silence is very often golden! Or to put it another way (in the words of my grandmother) what the eye doesn't see, the heart doesn't grieve over!

 

[Elad1002]

@Josephine @Jockette
I do see the wisdom in not sharing my decision to discontinue PT with the OS. It actually makes no sense to continue with PT, now that I am also healing another broken bone!

I have a recumbent bike which I will continue to do for 10 min on 0 resistance.

I have Exerstrider walking/trekking poles.

I was not an extremely active person prior to this surgery, other than my daily walk, before it became too painful, that is. Post surgery is not a good time to become an athlete. Your recommendations all make perfect sense. It's crazy how many well intentioned people advise me to ,"Do your exercises, if you want your leg to get heal." I am fortunate that I don't have to return to work for 16 weeks. I think it will take all of that to be able to work an 8 hour day. Thank you for your wisdom.

@Josephine
I am 8 weeks po. Is it ok to begin using scar shield? I swear my incision line changes colors every day. Thanks.

 

[Jockette]

Post surgery is not a good time to become an athlete

Very well said!!!!

I have never been an athlete, either, though in my younger days I had a lot of daily activities which kept me fairly fit.