TKR Freedom works on recovery<<

[newlybionic]

I live by myself also. I had one daughter here from the Wednesday I came home to Sunday. After that I've been alone except for home therapy and my daughter coming buy to get me some groceries at the three week mark. It can be done. I have quick frozen meals and small bottles of Gatorade, water and soda.

 

[Josephine]

He insisted "it is a 2 way street, you have to push through the pain. When PT shows up and asks if you are ready to get up, if you say no you are in pain, they turn and leave. You have to say YES!"

That is an outmoded, heavy handed, dictatorial way to approach things! You know different - you've proved it to yourself. Stick with it and be unmoved!

 

[Freedom]

@newlybionic I don't have anyone to be with me for the first 4 days -- just my Baker's Dozen: 8 cats and 5 bichons.

 

[newlybionic]

I'm sure the OS and the social workers will have no problem justifying a stay for rehab.

You sure have a full house! I only have three dogs.

 

[Freedom]

Oh they have no problem justifying it. To themselves, to the insurance company. That is fine. He just feels I will recover more quickly if I could sort things out and work it so someone was here at least during most of the daytime and I could come home from hospital.

 

[Clipless]

Risk of infection is scary high in extended care facilities (rehab). How about hiring a home health aide/nurses' assistant for the first week? Maybe insurance will cover this.

 

[kneeper]

Maybe the doc is responding to the one in 1,000 tkr person who expects to be entirely pain free and waited on hand and foot. Most of us expect some discomfort and want to try to get up and about--we need to be encouraged to not do too much.

 

[Freedom]

@kneeper, all I know is, I had uncontrolled pain for the first 5 days to the point that I completely shut down -- I couldn't do a thing. I wanted pain managed better so I could do what so many others do: while in hospital get up and sit in the chair, get dressed, walk the halls with my walker. Spending 5 days screaming (and being told by a nurse to scream into the pillow as you are scaring the other patients in the unit) and telling people I feel like the top of my head is going to blow off with this pain, is not proper pain management. I just don't know what do on that point.

 

[kneeper]

True.

 

[Celle]

I need to address pain management. For the left, I had 5 days of uncontrolled pain. I attempted to discuss this with the OS this morning. He insisted "it is a 2 way street, you have to push through the pain. When PT shows up and asks if you are ready to get up, if you say no you are in pain, they turn and leave. You have to say YES!" If my pain on a scale of 1 to 10 is a 15, and I am screaming and saying the top of my head is going to blow off, there is no way I can say yes to any sort of movement, PT or otherwise.

Stick to your guns and insist that you need more effective pain relief. It's pretty obvious that your surgeon hasn't had a knee replacement himself, or he would know how much they can hurt.

There is no way that you have to push through the pain. That's a very old-fashioned idea and completely wrong. Effective pain management is necessary and not a luxury, and pushing through the pain is one of the worst bits of advice handed out.
Pain management: importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain

Frankly, you don't need to do any PT while in hospital, so stick tight in bed or your chair and refuse to do it if you are in pain.

I think we've told you plenty of times that it's not PT that brings about your ROM. It's time and reduction of swelling. Your ROM is there all the time, just waiting for the swelling to go down, so that it can show itself.

By the time that June arrives, your left knee will have healed enough for you to have your right knee done. I think you will be able to manage OK alone at home and I don't think that rehab will be necessary. There is no rehab in other countries and people do manage without it. You do need to plan ahead, to make things easier for yourself - cook and freeze main meals ahead, stock up on groceries, plan a "nest" for yourself, within easy reach of bathroom and kitchen.

You will probably have at-home Pt at first. You don't need to go to outside PT until you are ready to drive yourself, if at all. There's no reason why you can't do a few exercises at home, because you don't need many. All you need to do is walk round the house a bit and do a few Heel slides and how to do them
Not going to PT will not retard your progress - in fact, it may help.

Do you have a friend or neighbour who is willing to phone or call in for a short period each day, to see how you are getting on? You don't need someone there all the time.

Do you have a good relationship with your own doctor (PCP)? If so, he/she may be able to help you with pain control, once you are out of hospital.

Have a look at this thread, so some ideas about how to manage alone at home:
Home Alone After Surgery

 

[Freedom]

Stick to your guns and insist that you need more effective pain relief. It's pretty obvious that your surgeon hasn't had a knee replacement himself, or he would know how much they can hurt.

Frankly, you don't need to do any PT while in hospital, so stick tight in bed or your chair and refuse to do it if you are in pain.

Since I don't see the surgeon again until I am being wheeled in to the OR , I'm not sure what to do, how to pursue this.

The in hospital PT is mainly stuff I need to do to be home: get up from bed without help, take the walker to the bathroom and back, very basic. The only exercise they insisted I do was ankle pumps to prevent blood clots (also have oral meds for that), and I was fine with that. With the first knee, I needed 2 CNAs to help me to the bathroom and back those first 5 days (2 days in hospital, 3 days inpatient rehab). Initially I was trying to hop with the walker! Just extending the leg to get my foot on the floor hurt, and no way I was putting weight on that leg. Then I progressed to just needing 1 CNA with me mainly to be sure I didn't fall or need help, and finally Day 7 post op I was on my own for the bathroom trips. At that time I was at inpatient rehab and the bathroom was literally next to my bed. Here at home, it is a bit more walking to get to the bathroom. That afternoon PT ok'd me to walk around IN MY ROOM but not leave without aid. Day 9 I was finally able to take my walker out of my room on my own, so I could have meals in the dining room not in bed. Day 10 I was sent home. I still was not able to do steps, not even the 2 they have in the PT room, with hand rails on each side. My friend who came to pick me up had to help me get up the threshold into my house. Good thing I live in a ranch house (all one floor) and once I was in, no stairs to
deal with.

I have to say, there is no way I could have been home sooner. So when you say you think I will be OK atwith home, that does not relate to what happened with the first knee.

I only want to be able to do what others do in hospital:
- get dressed. I was in hospital room Wed 6 PM to Fri 1 PM. In a johnny the entire time.
Took 3 people to help me get dressed for ambulance ride to rehab. Once at rehab, back in johnny for another 48 hours. Then 2 CNAs started helping me dress for a few hours then back to johnny, we did this twice a day until I could dress myself.
- get to sit in chair. In hospital, only did this for a few minutes once dressed, while waiting for ambulance to arrive, I am crying in pain the entire time.
- walk the halls with my walker. Was absolutely not possible!

I don't think it is unreasonable to be able to do these things. THAT is why I want better pain management. Oh and when I asked Surgeon re dilaudid, he started talking about injectable pain meds. I think it also comes in pill form?


The Pet Sitter will be in twice a day once I am home so having someone check on me is covered. (They come in 4 times a day while I am not here, as the dogs are small > small dogs have small bladders. Once I can manage letting them out and in, I have the Pet Sitter cut back to twice a day, mainly for the cat care. Last time, I was home 24 hours and then had them cut back to 2 visits per day.)

As for having the PCP authorize meds, that is a good suggestion; I have to see her on May 12 to sign off my clearance for surgery, I will discuss this further with her at that time. I'm not sure what she is authorized to do while I am in hospital, and I KNOW the doc at the skilled nursing facility does not care what ANY other doc says, he does his own thing, it is 'his' territory. So this means I still have to get home before my PCP can help.

 

[newlybionic]

In the hospital the surgeon had ordered the pain meds but I wasn't getting enough relief. I had a hospitalist (since my PCP didn't work at this hospital) who upped my pain meds one afternoon so I could be comfortable. I made sure when I was leaving my meds were ordered that way. I'm not sure how to handle the rehab situation as far as pain meds but perhaps you could give them a call and discuss your experience the last time you were there.

 

[Freedom]

Oh wow this is great news @newlybionic ! I guess it will be up to me to call someone then. The rehab USUALLY continues on with the meds you have at discharge from hospital. The problem I hit in rehab was THAT doc decided on Day 5 post op it was time to taper off my opiate meds; even though I was still have bouts of screaming in pain!!!

 

[Celle]

All your early problems with not being able to get out of bed, put weight on your leg, walk to the bathroom etc relate back directly to poor pain control. Of course you can't do any of those things while your body is screaming out for pain relief.

Next time, take a notebook. Ask what pain meds are prescribed for you, and how often you can have them. Write all that down.
Write down the medication, the dose, and the time you have it. Ask what time the next medication is due. Write that down, too. Ten minutes before the next dose is due, ring your bell and ask for it - that will give them time to get the med to you when it is due. It is important to keep up a regular schedule of pain meds.

If the staff won't co-operate with this, ask to see a patient advocate - I believe that every hospital has one.

As for being told to scream into your pillow, so that you don't upset other patients - to heck with that! I would have screamed louder and told that nurse that I would keep on screaming until I received the pain relief that I needed.

 

[Freedom]

If the staff won't co-operate with this, ask to see a patient advocate - I believe that every hospital has one.

As for being told to scream into your pillow, so that you don't upset other patients - to heck with that! I would have screamed louder and told that nurse that I would keep on screaming until I received the pain relief that I needed.

Yes, I have been in contact with the Patient Advocate. I've put all the details in a separate thread. I probably short changed myself in terms of help from this forum by not setting out what happened right off. I only learned the end bit this morning. Until now, I've been wondering if perhaps I misunderstood some things which happened. HA! Nope, I sure didn't.

As for ignoring the nurse and screaming louder (you have me chuckling) remember this was my first time in hospital, I was following the instructions of the Authority Figure.

 

[GimpyGal]

@Freedom, I just caught up on your thread, from start to finish. What a wild ride you have had. There is absolutely no excuse for the lack of pain management you were offered and it's vitally important you go into your next surgery with a game plan for it.

I had poor pain management for my first knee and told my surgeon before the second that we needed to solve this problem before surgery. Frankly, he did not have a lot to offer me, since the problem with narcotics in on my end, but he said he'd do a few things differently before I even entered the operating theater. He gave me a cocktail of many drugs that worked together right from the start, he could now offer a longer lasting block, and we could try a couple of different narcotics along with anti-emetics to see if I could handle them. Even the nurses tried to find something to help. One said I was okayed for a muscle relaxer that might help me be a little drowsy and relax more through the pain. When that didn't work, she tried something else.

The surgeon told me enough that I gained confidence he was trying EVERYTHING, but if he had just dismissed my concerns? Well, frankly, I would have found another surgeon. I would not have gone into another surgery with him if he was going to just try what didn't work last time, just because it was his routine. I'm not fond of the nurses you were dealing with either! What is wrong with these people? Isn't their job b a lot easier when the patient is comfortable?

Every single time I was given a medication, the nurse wrote the medication on a chalkboard in my room. And next to the medication, she wrote the earliest time I could ask for it again. What a comfort that was to see that it was 3:00 pm and in my drugged haze, not have to calculate when I could have more.

Also, because of your anxiety, the entire ordeal was much more difficult for you. They can certainly help you with your anxieties - why do they just ignore it? People get anxious! Some more than others. Treat the whole patient - not just a KNEE!

I hope you can go into your second surgery with more confidence, less anxiety, a game plan for pain control and the utmost confidence in the hospital and nursing staff.

 

[Freedom]

GimpyGal, I only just learned the last part of the story this morning. I am seriously wondering what I should do re my right knee. I am so glad your OS worked with you for the second knee. That is what I would like to hear from my OS.

 

[Celle]

I know I'm bad and subversive but I always think of this: directly or indirectly, I am paying the surgeon. Whether it is through my insurance or I pay him directly, I am paying him. Therefore, he works for me. And he gets big money for it, too. He is the person ultimately responsible for my care. Therefore , if all else fails, I will phone him. Your surgeon probably would not like that, but it's part of his job to see that you get appropriate care.

I know that it's easy to feel that you have to obey the "authority figure", but really you don't. These people can advise you, but it's up to you to choose whether or not to accept that advice.

You are entitled to receive adequate and effective pain relief. It is part of the duty of care owed to you.

 

[Freedom]

I know that it's easy to feel that you have to obey the "authority figure", but really you don't. These people can advise you, but it's up to you to choose whether or not to accept that advice.

You are entitled to receive adequate and effective pain relief. It is part of the duty of care owed to you.

I am learning! A great deal.

 

[Freedom]

Here is the latest from my Lucy knee. Left knee; first of 3 implants. 3 years old this past January. Lucy has never been 'right.' Constant pain and swelling. There is a weird feeling in the center back of the knee, much of the time, not just when I am working out. I've been back to exercising at the Y 4 days a week, circuit training (weights), and bike. Started last November; so far I've lost 15 pounds.

Yesterday, Sunday, the knee was fine when I got up, but within about 2 hours the swelling was much more extensive, limited mobility, lots of pain. I was still home, didn't do a thing different. Not been that bad since about 4 months post op; and here I am over 3 years post op. I did not fall or do anything unusual, no idea where this was coming from. I did go to the Y because usually riding the bike will help loosen it up. But yesterday the swelling was so extensive that I could not make a full revolution on the pedals (upright bike). So I got scared, and went to the ER.

Xrays show all is fine. No signs of infection. Script for 600 mg Motrin every 4 hours for 4 days, and RICE. This morning, the swelling has gone down but not to the point I was at before this happened. ER doc said this is just the way this knee is. It is going to be cranky and act up now and then. He said some are like that.

(I am in 2 other support groups, and there are many folks who have a knee like this one, 3, 4 even 5 years out it swells and is painful, so I believe what this doc was saying.) He went on to say: Since I have much less pain than pre-op and can do so much more than pre-op, I need to be happy with that, and not expect it to ever be perfect like the other knee and the hip are. My discharge instructions also said to see my surgeon in 3-5 days. Just made that appointment for tomorrow.

When I do the weight machines as part of my workout, there is a glute machine. Pic attached, for those not familiar with it. My right leg (knee is perfect) can do 70lbs, 8 reps per set, 3 sets. That has improved since November and continues to improve. However this left leg can only do 15 pounds, 3 reps and that is it. This left leg is not strong and I've made little progress with it since last November.

I did have the left hip replaced also. So not sure if this issue is tied to that and nothing to do with this knee. The knee surgeon blames this on the hip; the hip surgeon blames this on the knee. Pfft. Thanks guys, nothing like a little rivalry to confuse the patient.