Bilateral TKR Got out of surgery at about 5pm 6/4/2013

[Roy Gardiner]

I did my stretching exercise today... The one I do not like.

Which one is that? There may be an alternative.

 

[gazelle7777]

Which one is that? There may be an alternative.

Hi Roy! I put my legs straight with just a wedge under my ankle. I put a six pound ankle weight across my thigh just before my knee. I let the leg just relax for 5 minutes to get a tendon stretch along the back of the knee. It hurts like heck!! It is what my PT person says is a good hurt...that the tight tendon needs to be slowly stretched.

 

[Roy Gardiner]

It is what my PT person says is a good hurt...

Yes, correct IMO (well it was the same for me, anyway). It's because the tendons at the back of the knee aren't, again IMO, damaged in surgery.

However. Here's a lot more IMO, although I have read a lot about this: if you do a stretch into pain, the body reacts against it and tenses up. This is not productive. A stretch should be perhaps 30sec long, to the point of pain but not into it, with multiple repetitions. You can see in my exercises thread (link below) pix of the extension stretch I did, or you can try this one, with a partner.

- You sit on the floor, TKR leg out straight.
- Rest the heel on a fairly thick book or similar, to get it may 2" off the ground

- partner kneels at right angles to your leg, placing one hand about 6-9" below the knee, one about 6-9" above.
- gently pushes the leg towards the floor until you feel a good stretch through the back of the leg
- holds for about 20sec
- eases off, waits 30sec, repeats.
- repeat 3 or 4 times.

It's effectively the same as the self-performed exercise pictured in my thread on the subject, but more effective IMO.

 

[gazelle7777]

DAY 45, Thursday July 18th

Thank goodness for the cooler weather here in Seattle! I never complain about out weather unless it gets above 80 degrees! So spoiled here! Pt went well yesterday. It was a hard workout... I used calf muscles that have not seen any action for years and they are talking to me this morning.... I am achy.. and will just have to rest today. Yesterday before PT I felt quite good, other than being tired from lack of sleep. My knees seemed less inflamed yesterday and it was easier to practice walking a normal gait. Today... not the case and my evil twin knee is not wanting to bend from the workout yesterday. It is so hard to know what to do when you have those people saying to take it easy and not push so hard... and then you have this PT person who says something else and just wants to see the measurements.... I go see my surgeon on this coming Thursday... are there questions I should write down to ask him at this meeting ( which from what I read it really just to let the patient go...) If anyone has gone through this post op meeting and can give me a list of questions that would be so helpful. I want him to know I would like to be able to get some pain meds for a while more... how do I approach him with this?

On the bright side, I am pretty much just using a cane for long distances... and nothing around the house. That is progress! Yesterday after PT I went to the grocery store, and when I got home carried all the bags upstairs... what amazed me was that before surgery I could not carry anything that had weight as the extra weight put pressure on my knees and it was so painful. With these new knees I can pick up and carry weight with NO PAIN. That in itself is a blessing!

Luisa I hope you are feeling better with your shots and the special lotion made for you! HARPLAYER, how you doing friend?, Roy I totally understand about stretching for a shorter time and not until crying UNCLE as I have to do in PT. It makes so much sense. Miss J how are you doing? Diana hope you are healing and getting stronger everyday! Hello Puffin! Hope your journey is going well! ski Girl, Ready, Bottomshallow and everyone who has posted good thoughts, helpful ideas and encouragement.....Thank-you for stopping by and saying hello! For now....On to another healing productive day!

 

[harplayer]

Wow Gazelle...you are doing fantastic!!!!! I am so happy to find your latest update!!!!

I am driving and swimming and my PT is so much more humane...but like you, I find that my under used muscles that are now being engaged talk back to me the day after PT.

Keep up the great work!
Harplayer
(Lee)

 

[gazelle7777]

Hello Lee! Glad to hear you are on the healing journey! Today I need to rest from a real workout PT yesterday... And I may try going to CostCo tomorrow if my swelling goes down. That is a lot of walking! Take care and keep in touch!

 

[Plexiburg]

Sounds like you don't need the opioids anymore, just ice and take Aleve. I took Oxycodone for my BTKR for three months and I should have cut them off easily by 45 days. I'm three days out from having a explant and again the oxycodone is a life saver but they only seem effective close to surgery after that they become a negative force in your recovery.

 

[gazelle7777]

Sounds like you don't need the opioids anymore, just ice and take Aleve. I took Oxycodone for my BTKR for three months and I should have cut them off easily by 45 days. I'm three days out from having a explant and again the oxycodone is a life saver but they only seem effective close to surgery after that they become a negative force in your recovery.

Thank you for your input on this issue. Don't the opioids help in stopping the achy bone pain at night so one can sleep? I do not sleep.

 

[Lmarshall]

Joan, when I went to the surgeon my list of questions included things I believe you already knew. I did ask specific questions about why I had more pain in a specific area and she cleared it up for me very well, explaining aboutmy valgus and the stretch my tendons ligaments and muscles are experiencing. It made me feel better understanding WHY I still had extra pain in that area.

You might want to explain to the dr you feel like you will need pain medication for at least a few more weeks. They may want you to step down to a different medication. For me, Vicodin works well, and bothers my head and stomach less. It does take alot of the pain away. This may be a downgrade strength for you but would still work I think. Again, I am going to a pain management clinic and I think they are much more understanding of the need for continued meds. If you are worried about the dr not continuing, start going to a pain management dr sooner rather than later. I feel like the surgeon just specializes in the DEED....the aftermath is better suited for people who understand pain and how it impacts our recovery...and this is what pain management dr's are for!

 

[new knee in June]

Dear gazelle,
You are doing awesome you are out & about more than I am & I only had 1 knee done
When you said you did groceries & had no pain, you made my day.
When. You go to your doctors app. Definitely make a list of questions....saves so much time....
Take the pain meds if you still need them...tell him you need another script, because you are doing therapy &
You are still in pain. He will not drop you...you will have app. Up until a year out.
Thinking of you,
Diana

 

[new knee in June]

Also, tell him you have not been sleeping...possibly you could get ambien or Ativan so you can

 

[kneeper]

If the pain is what keeps you from sleeping I would think it would be ok to ask the doc for a continuation of the pain meds for overnight for a week or two. I can't remember how long I did, but I think it was a couple of weeks after I was down to just tylenol during the day that I'd take a hydrocodone before bed. (I want to say that was at about the stage you're at.) If it's not the pain and is just the sleep disturbance many get post surgery, then you could ask about that.

 

[referee54]

Buying new shoes also give you a chance to celebrate your new life and new lifestyle!

 

[Ready]

Good job, Gazelle. So proud of you and your attitude and hard work. Just make sure you listen to your body.

Great advice from all those bonesmarties. Here is my 2 cents: At your appt., make sure to ask what you can and can't do with your new set of knees so if you want to resume activities (like skiing for Kelly) so you know what is safe. i.e tennis, kneeling, etc... Also, I had heard about dental appointments and infections, so I found out what the procedure was for getting an antibiotic through his office. At my appt. I needed to secure a signed return to work form. Also, you may not feel like you need too many more pain pills, but just make sure you have enough to go through that taper process. I really suffered with goofy withdrawl the first time as I just stopped the oxycontin and oxycodone. My mistake: I didn't really need them and I guess one can never be too careful about having such strong pain medication in the house, so I never refilled when offered. Then I had none to taper with. Yes, I should have read the article in the library. This time I am going more slowly. Do you have any questions about your scar? Also, at my last appt. I asked for a copy of my surgical report and xrays. They gladly gave me both.

but they only seem effective close to surgery after that they become a negative force in your recovery.

I would have to agree. They were a God send at first, but now they seem no more effective than Tylenol and obviously aren't helping me sleep. But, we are all so different.

Hope your rest today does your body good and you are ready to meet the world tomorrow with a spring in your step.
PJ

 

[Kavan]

I agree for me at five weeks I began lengthening the period between pain medicine does and by six weeks I was off them totally. Now I take Aleve and it seems to work as well as the pain pills and helps with the swelling. Gazelle you might ask about the sleeping issue perhaps another medicine would be effective in helping that problem.

 

[ednacate]

Ahem, you do. If it hurts you, don't do it. Flexibility may well worsen over the next few days as the body reacts, don't worry about it. In fact, don't worry about anything.

Gentle stretches are all you need. It will be enough effort to get to your feet and move around a few yards.

 

[ednacate]

I hope you have a better day tomorrow. I haven't had mine done yet, will be both knees too. But one thing I have read over and over on this forum is to not overdo PT. Will be watching with interest.

 

[gazelle7777]

Wow- thanks for all the great suggestions and encouragement everyone! You make me feel so good! I did something this afternoon which I am pretty proud about.. I got into the tub... BY MY SELF... soaked and soaked so deliciously.....lots of bubbles and hot water AND I got out BY MYSELF . My knees were even cranky today and stiff and I was able to manuver myself in and out. That was such a deal breaker for me as some people in other threads talked like they would never bath again.... I love my bath SO MUCH. So I can chalk that I got into and out of tub by self off my check list..... and those ideas you all gave for the Dr. Appointment are so helpful. I am going to ask for copies of surgical report and my xrays... and discuss low dose pain meds. I have been trying to substitute natural anti inflamatories for pain and I hope they will fit the bill. If anyone wants to know what I am taking naturally just private post me and I will send you a list.

Bye for now! I feel so much more relaxed taking a hot soaking bath!

 

[Dulcimer Diva]

Everybody and every knee is different. And everyone's response to pain meds, Last year with my RTKR I was off Norco except for a pill at bedtime by 6 weeks post-op. But I was taking the Bonesmart cocktail during the day. I can't do that now because I developed a gastric bleed and esophageal inflammation this winter from taking oral NSAIDs, so I can only use topical ones (and sparingly at that).

I have tried to lengthen the interval between Norco 10/325s but one every 5.5 hrs. seems to be my brick wall. In rehab I slept through the night, 7 hrs. at a time--but that was because I was taking two Norcos at bedtime and two before PT. Last year, I was allowed two of them every 4-6 hrs. for as long as I wanted; and I truly believe that because I was given the latitude to stay ahead of the pain I did recover faster and naturally began to taper at less than 3 weeks out. I was prescribed no other pain meds! By the night before my LTKR I was taking only half a 5/325 at bedtime, and occasionally at that.

This time after my LTKR, I was allowed only 6 pills per day total once I transferred to rehab, with 5mg. of long-acting oxymorphone twice a day for about three and a half weeks, plus Neurontin three times a day for about four and a half weeks and Tramadol 3 times a day for breakthrough pain. (At first I was allowed 9 Norco per day but when I questioned that, my OS doubled the oxymorphone to 10mg. and cut the Norco to 6 tabs per day; when I complained that the only thing the extra oxy was doing was causing my muscles to jerk and twitch, he cut it back to the original 5mg. but did not increase my Norco. I felt I was being punished or at the very least suspected of "drug-seeking;" ironic because I'm the kind of person who won't even drink a glass of wine if I don't love the taste, so strongly do I hate feeling out of control). When I felt that the Tramadol wasn't relieving my pain but only sedating me (and possibly contributing to those twitches), I was allowed to substitute Tylenol instead. Good thing--because since I take an SNRI antidepressant the Tramadol could have killed me due to excessive serotonin levels.

I feel that whenever I go longer than 5-5.5 hrs between Norcos the pain and stiffness get ahead of me. (Tried extending to 6-7 hr. intervals last weekend with disastrous results, losing at least 4-5 degrees of ROM--when I went back to 4.5 hr. intervals my pain took longer to surface and at lesser intensity; and I regained the lost ROM and then some). Am also getting occasional deep sharp zapping twinges now that I'm off the Neurontin (to be fair, I had them last year too). But last year I never had that deep achy pain.

I am about to start my third refill of 30 Norco pills tomorrow morning, and I know my OS filled it reluctantly. (The pharmacy expressed surprise yesterday that I'd need a refill after less than a week, but do the math: 5 pills a day will last only 6 days). I am firmly convinced that if I was allowed the same regimen as last year I'd be down to 4 or even 3 pills per day now. All those other drugs mucked up the process, and produced mostly side effects. I notice that more and more patients are prescribed this "palette" of pain meds when in the past they were allowed greater latitude with just one drug. I am firmly convinced that doctors are increasingly afraid to run afoul of crusading state licensing and law enforcement authorities--that law in KY requiring a patient to pick up a paper 'scrip from the surgeon and deliver it to the pharmacy in person is a case in point. Yes, there is an epidemic of prescription opioid abuse by those who'd prefer but can't afford street drugs, but we legitimate post-surgical pain patients have become collateral damage in this ill-advised and futile "war on drugs."

IMO it's wrong to be judgmental about others' ability to wean off opioids, based on projecting one's own experiences and pain threshhold. You have no idea how your body may react in the future!

 

[gazelle7777]

Dulcimer Diva

You are so spot on with the issue of pain meds...I felt so upset when I really needed them, and I could only get four days worth at a time!!

I know there are people who misuse them, but after major surgery, it is important to have them. This issue with meds would make me reconsider major surgery again.