Good morning new friends

[susanw]

I had my knee done at Mayo Clinic in Rochester, Minnesota and stayed there for rehab for about 2 1/2 weeks. I had 115 flexion post op and on day three was able to climb stairs, so I only had 1 week of PT in rehab to instruct me in my own exercises (at the time I felt short-changed because I had not yet discovered bonesmart). My rehab was based on pain relief and building up my stamina (I went into surgery too late and was completely physically and mentally shot from the pain).

I live in Washington DC area and had seen an OS here but he referred me to a physiatrist (physical medicine specialist) because I also had spine issues. She keep me in PT and gave me all the knee shots that didn't work while I rapidly declined. So, barely able to walk, in a wheelchair and in so much pain that I could hardly think straight, my son took me to Mayo. I had been there before and knew I would see good doctors and did not have the ability to shop around locally for one.

So, the last 11 or 12 days in rehab at Mayo was without PT - the PT there told me it would not help me early after surgery, that all I needed to do were the basic heel slides and quad sets, etc. and walk, walk, walk to build up my general stamina and balance.

When I got back to DC I had enough ocxicodone to last for awhile so I continued to take that and started investigating to find an OS here. When I ran out of ocxicodone my family doctor gave me some more and also some vicodin, but he suggested that I find an OS as he was not comfortable treating post-op knee surgery. So, I found someone and he wanted me to start physical therapy - however, he did not suggest a clinic. I had a friend recommend the clinic I went to as she had been there for foot surgery and was very pleased.

I didn't want to go to PT while I had high pain levels and so I didn't start until I was off my narcotics and down to motrin and driving on my own. That had to be at week 9 or 10 that I started PT.

The PT clinic called this neurofascial therapy not myofacial. I am aware of myofacial massage and there was a difference, albeit small; the neurofacial with the PT was more gental than the myofacial massage I've had in the past.

Well, this has been long winded, however, you are only 3 weeks out of surgery. I was just getting out of rehab at that point and on oxyi and had only done a few days of PT to get me doing my own exercises. At your point, you should be concentrating on pain and swelling reduction. As I said above, I started PT at about week 9 or 10. Now I am nearly 8 months out and I still have some minor issues, but I watched as ever so slowly the swelling has gone away and the pain subsided. Now, I sometimes forget that it is there, it is stronger and I am able to get around pretty well. Currently, I am side tracked with my spinal issues and my left knee that is awaiting it's turn for the knife.

I should have named this "Susan's Story" as it is a lot of my history and I've not done much posting here at bonesmart - more reading and jumping from thread to thread.

 

[maryo52]

Susan,

The internet has provided me with a lot of my post-surgery entertainment as we have virtually no TV. So I loved that you wrote out all those details. Thank you so much for sharing. I'm from the DC area, actually, and at one point had scheduled my TKR at Anderson. I reasoned that I could spend post-op period at my mom's in Arlington and then return back to Maine. But I cancelled when the surgeon experienced the tragic loss of two family members, and actually with bike riding was able to get several more years out of my arthritic knee.

In our rural area we don't have a lot of options and so to find anyone knowledgeable about massaging a post-surg leg is a bonus.

Good luck with those other issues. I've got a little sciatica happening on the operative side but know that when I spend more of my day moving about that will subside.

 

[Josephine]

I'm about 80 flexion and it's not getting any better. When I stand up my leg feels tight and stiff. I'm in that week 4 every talks about as being when they turn the corner and I would think there'd be some change. It's hard not to wonder, even with all the reassurances from this forum, if something is wrong.

Could this all be attributed to inflammation (my good left knee is almost as unhappy as the right)?

Almost certainly. And the 4 week bench mark isn't set in stone, it's an average. What is a certainty is that you are only 4 weeks which is far too soon to be considering this is because of 'something wrong'. I still think that your flexion is being hindered by the swelling and pain. Manage the pain and swelling and your flexion will improve.

Did you read these threads I linked for you? You didn't say if you did. Here they are again.
The importance of managing pain after a TKR and the pain chart
How Long Does Healing Take ......
Elevating your leg to control swelling and pain
Discussion on managing pain in TKR surgery
Using ice

It's never too late to get more ROM!
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it

Once in a while when I feel hot I check my temp and it's 99.5. The knee feels hot. The wound is all healed. I see no visible problems.

Healing almost always causes a slight fever and heat around the operation site. Some experience it more than others and for a longer time. It's normal.

I got advice from a TKR friend to talk to my ortho, and also from a nurse friend. Both said things don't sound normal.

Do I call my ortho? Do I ask for a second opinion?

Well, what's normal?!
I'd sooner put it that you're having a rough recovery which isn't all that uncommon. But if it would ease your mind then you should call him.

But if you want a second opinion, the last thing you should do is ask your OS. He will send you to one of his colleagues/buddies who will tell you what he tells you. Such opinions are rarely truly independent. Find a surgeon who is totally unconnected with your present one, give him no information about what your surgeon has said and let him draw his own conclusions.

Sorry to be such a big baby.

You're not a baby. You have a problem that is worrying you. That's what we are here for.

 

[maryo52]

My surgeon is out of office until Tuesday. I talked to "Dr. So-and-so's assistant." In America that's what a CNA working in an MD office is called. I have read and re-read the items you listed, Josephine. Maybe today I could work on adjusting my expectations. Maybe also scheme a way of working with the PT I've been friends with for 30 years who is so much more gentle and encouraging.

 

[Tykey]

That sounds like a good plan Mary, just remember we're all different:thmb:

 

[Jamie]

I can tell you, Mary, that at 4 weeks I was still hobbling around the house with a walker. It was by NO MEANS a turning point for me! My recovery was slower as I had a lot of swelling....still get it if I push things. It's just "me."

I agree with Jo that you should contact your surgeon if it will reassure you to hear him say nothing is wrong. Heaven knows I called mine a couple of times when I was worried. Worry is counterproductive!

But I do think you are just fine and that you need to continue a program of rest, ice, elevate, and pain meds on a specific schedule throughout the day and night. You are still VERY early in recovery and have a ways to go before you would be considered "healed."

 

[maryo52]

I guess in my foggy thinking I need reminders of your wisdom. However, things happen almost daily that concern me. Today it was needing 2 percocet for the first time. I usually am fine with 1, or maybe an extra half. The knee is still very swollen. I'm icing and elevating religiously. The heel slides . . . I haven't done any. It's not that I cannot but I can only slide a short ways, and it hurts. Hard to not feel like I'm dropping the ball.

 

[Josephine]

Don't feel a loser for needing more pain meds. I was taking 150mg of Tramadol many times in the 4th-6th week. And I also had a look at my surgery diary and found I was just like Jamie - hobbling around at week 4. I didn't really get going until about week 8 and even then it was slow. And I was told I had a 'stellar' recovery!

 

[maryo52]

When I was expecting my firstborn, I noticed how much easier birth was for those who went early and signed up for that concept. Nature did not comply however. And what happens when you near you due date is people watch and ask basically the same question over and over. Lucky me, he came 3+ weeks late and he's a stellar kid. So I'm having the same kind of experience, people watching my numbers. Gotta remember I'm a late bloomer. I cherish the support I get here.

 

[Josephine]

Thank you - that was a nice thing to say. I cherish your comment!

 

[maryo52]

Yesterday I did a couple of gentle step flexion stretches but mostly babied my leg after Tuesday's rough PT. Today I've done some gentle stuff. The leg lifts go well. I didn't do the short arc quads because they are painful. I did some heel slides. How do you folks go about these? I'm less than 90 flexion so you can imagine my heel slide is pretty unimpressive. Even at 45 degrees the top of my knee hurts. I stop and let it stretch. Should I use a strap to help the heel come further back? Nothing I've done so far has increased flexion but I do want to keep things limber. I don't need lofty goals, just realistic ones, and a course that won't contribute to problems. Any help appreciated as usual.

 

[Just Judy]

Hi Mary. I am at 12 weeks and I still have swelling and pain. I have just now got my ROM to 100. Thank you Jo , Jamie, and Tykey who keep reassuring me that this is a different process for everyone. At 4 weeks I was still in alot of pain, barely walking with a huge limp, and swollen up like a balloon. Hang in there , it will get better but it will be when your knee is ready not you. Rest, ice, elevate is the most important thing for now. I just had my 3 month checkup and doctor says I am getting better but that everyone heals different .My knee is gonna be a turtle. Just try to get thru one day at a time and not focus on the end. I wish you all the best. I will be checking back on your progress. :cnsl:

 

[maryo52]

I spend 99% of my waking time with leg elevated, icing every 2 hours. Every time I try to do any form of PT I suffer a setback. The little bit I did this afternoon ramped up the pain so that I to pop a half dose of pain medication. It's a traumatic surgery and there's a range to that trauma. I know because I watched a bilateral knee. The first took longer and required more tweaking of components, the second was straightforward. I know that pt had trouble with the first (left) knee. Probably nobody told him why. Thanks for your caring, Judy!

 

[brs0660]

Mary,
You are not quite one month out from a surgery that required hammers, screws, and saws. I cannot tell you that that is pretty major!!! You are actually doing well.

My first month, I did knee slides with a strap (I used a dog leash). I held them no longer than a count of 5 especially if it was uncomfortable.

I would do these once a day! Ice afterwards. I did a lot of toe flexes, and the exercise where you press your knee downward with it extended.

I also tried to get up and walk for a little while around the house for a few minutes every hour. Keeps your knee from being quite so stiff.

Another comment you made concerned me that you are not taking your pain meds on a regular schedule. I think you will find that if you take them regularly, that you will see your progress improve. (NOTE: If you take them as prescribed, be sure to get a stool softener (not a laxative)).

One more thing, it is common to feel kind of blue through this period of recovery. It goes along with not getting enough sleep, hurting, and hating to be dependent on others for help.

Feel free to post here anytime. We have all been where you are right now! Hope somthing here helps you

 

[maryo52]

Thank you Barb. I'm headed to bed soon. Half hoping for a different day tomorrow. Half knowing it won't be different. After all, I'm old enough to know that sometimes when it seems you're going nowhere, things, important things, are indeed happening.

But I most definitely am taking pain med on a 4 hr schedule. Probably that and ice are my day's structure. Plus this forum!!! What a lifesaver.

It's hard not to compare. I guess I could count the blessings . . . no infection, no clots, successful surgery, a husband to wait on me hand and foot, warm house, no pressure. Have had lots of support from many good friends. But there's always those few who innocently mention PT, a sore (in more than ways) subject with me. As I said, the little I did today made me have to add a half a pain pill to what I had already taken.

Definitely on the stool softener (and prunes) as I am also on another med, Verapamil, to keep my cluster headaches away. Verapamil kinda turns you into a brick factory.

Many many thanks for your kind support.

 

[Tykey]

Remember, Mary, that the first step in recovery is to heal all the scars and bruises. Then the swelling and pain will reduce, and the ROM increase.

The healing will take it's own time, there's nothing you can do to increase the rate, but there are ways to slow it down, which is (yes, you've guessed it!!:hehe too much PT, too soon.

I can see from your posts that you are beginning to come to terms with it all, but keep checking back and keep up the good work.

IT WILL GET BETTER !!!!! Just be patient:thmb:

 

[maryo52]

Tykey, You're right, I'm coming around slowly. Let's see if I can get through the day without panic.

 

[maryo52]

Does anyone take pain medication a little more often, like every 3.5 hours? Just wondering because there definitely is some tapering off in the last half hour, and then a little time before the new pill kicks in. I'm not miserable or anything, but I notice the difference and keep the knee still and/or iced during that vulnerable moments.

 

[Tykey]

I could never remember what time I took the last one anyway, so I'm sure some were after 3 hours, some perhaps 6 hours. I just took some when I needed it. They always seem to hurt more towards the end of the day, because we've been doing things during the day.

I tried to make sure I didn't overdo it over the 24 hours. That wasn't difficult because I slept like a log (and no I didn't wake up in the fireplace!:hehe

 

[DebR]

Hi Mary,
I take the meds after about 3.5 hours. One of the nurses said to remember that it takes time to get into you system. Wait 4 hours, no relief for another 45 min.-1 hour. It made a huge difference. I also wanted to tell you, when you are having problems with the toe numbness, roll a pillow in half and put under the blanket where your foot is going to be, unbelievable relief! You really are coming along, and just keep telling yourself that. I am 5 weeks out and trying to get in "the mood" for Christmas. I love Christmas, but this year it will be on a much smaller scale, I just gave myself permission to ease up. It's really easy to get depressed going through this, but small tree, some lights, family and friends and a NEW KNEE for the holidays makes all things brighter ha-ha!! Just let yourself heal, the rest will fall in place soon enough.