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[TKR] Greda's recovery story<<

Discussion in 'Knee Replacement Recovery Area' started by Greda, Aug 29, 2018.

  1. Greda

    Greda graduate
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    Hi everyone,
    I was on this forum back when I had my right PKR and just had a TKR on my left knee 8/22/18 and need support.

    While I was at the recovery center things were wonderful. Very little pain. Was able to do the exercises PT wanted. It seemed like a dream then I came home Friday afternoon. At the surgical center I was given 5 mg oxy pills about 3-4 times a day and 1000 mg of Tylenol a day doses given every 6-8 hrs. I just assumed since the pain control was working that was what I would go home with. Instead I was sent home with Norco 10/325. The Norco did not work my pain levels over the weekend were 7-10.

    I called the surgical center Sat morning (they had said over and over again call with any issues). I told the person who answered the phone about the pain and she gave me the number for the on call doctor. I called him and he said there is nothing I can do you would need a written script and that is impossible. Try urgent care but they will probably not write anything for pain.

    So this weekend I toughed it out adding more Tylenol. Monday morning I called my OS office and he was not in but the PA was. I have chronic pain and she did not feel comfortable giving me anything else I should call the pain clinic. I called the pain clinic and the nurse said they don’t get involved with surgical pain. One smart thing I did 2 weeks before my surgery I spoke with my pain clinic PA and asked if this happened would he be available and he promised he would. I told the nurse to go speak with him and she called back and he gave me 1 week’s worth of Percocet 5/325.

    Anyway got pain under control and went to PT. I have used this facility before and they always were gentle and never caused pain. I got a new guy. It was horrible - he kept doing things that cause me to almost cry and I told him to stop he had the nerve to say “your knee has been fixed so I can’t hurt your knee . I am just hurting your feelings:”. I was shocked.

    I kept telling him to stop and he kept saying it is just your feelings. He said this is easy next time it will be much harder and rougher. I have been miserable ever since. I am going to cancel my next PT appt but after that appt I have PT people I had before but I just don’t feel I can trust them.

    I have an appointment with the pain clinic Thur and will speak to him about pain control and I see my OS Tues. My wound is still slightly seeping. I thought after 6 day the seeping would stop. My knee hurts all the time. I use the Polar Care. Getting up to start walking is so hard. My foot and heel hurt. I have to walk on my tiptoe for a couple of minutes then can walk normally.

    Unfortunately my husband had to go back to work yesterday and it is hard being on my own. He has set me up before he leaves. He will be home tomorrow and then work Fri and be off for 4 days. I just need support at this point.

    My leg is aching from the thigh to the foot and so I tried one Percocet did not help after an hour so took a second one (script says 1-2 every 8 hours). I am just afraid they won’t give me any more. I take eliquis for a blood thinner and norflex for a muscle relaxer (took that already for other pain issues).

    Thanks for listening.
     
  2. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    :console2::console2::console2:
    That PT is required to stop anything you tell him to stop doing. If he doesn’t, technically it’s an assault, but you’ll probably never convince anyone but us that it is.

    Please don’t go back to that place.

    Also keep in mind, it’s not exercising that gets our range of motion back, it’s Time:

    Time to recover.
    Time for pain and swelling to settle,
    and Time to heal.

    Our range of motion is right there all
    along just waiting for that to happen so it can show itself.

    In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

    I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

    Knee Recovery: Guidelines

    1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now; they are almost certainly temporary
    2. Control discomfort:
    rest
    elevate
    ice
    take your pain meds by prescription schedule (not when pain starts!)
    don't overwork.
    3. Do what you want to do BUT
    a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
    b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​
    4. PT or exercise can be useful BUT take note of these
    5. Here is a week-by-week guide for

    The Recovery articles:
    The importance of managing pain after a TKR and the pain chart
    Swollen and stiff knee: what causes it?

    Energy drain for TKRs

    Elevation is the key

    Ice to control pain and swelling

    Heel slides and how to do them properly

    Chart representation of TKR recovery

    Healing: how long does it take?

    Post op blues is a reality - be prepared for it
    Sleep deprivation is pretty much inevitable - but what causes it?

    There are also some cautionary articles here
    Myth busting: no pain, no gain
    Myth busting: the "window of opportunity" in TKR
    Myth busting: on getting addicted to pain meds

    We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

    While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only
    ONE Recovery Thread.
    This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
     
  3. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor

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    I am not surprised
    :thumb:

    You do not need PT to recover. Good PT will help you along a bit, bad PT (i.e. if it hurts) will set you back.
    Sounds like if you shot this guy in the head you too would only be hurting his feelings, as he clearly has no brains.
     
    • Funny Funny x 10
    • Agree Agree x 4
    • Like Like x 1
  4. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    Yes, yes, yes! Exactly!
     
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  5. Greda

    Greda graduate
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    Roy
    I couldn’t believe he said that plus he has a doctorate in PT. Not sure where he got it. My biggest issue is my husband and family think PT is necessary. I had shown my husband the articles and he is kind of seeing it in a different way. He doesn’t want me to cancel all PT just with the guy from Monday.

    Thanks Jockette!
    I will look at the articles. My biggest fear is the pain meds. I hope my pain clinic will step up. I will know tomorrow.
     
    • Agree Agree x 1
  6. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor

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    • Like Like x 1
    • Agree Agree x 1
  7. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    My husband was very leary of me stopping PT also, because we are told we can’t recover without it. But he could see that by 4 weeks post op they added things that were taking me days to recover from and agreed that these things were counterproductive for me.

    That’s when I found Bonesmart. I backed way off on what I was doing at home, and said no to things at PT and cancelled some appointments and managed to get an honorable discharge shortly before my 8 week post op mark.

    I never had an arrogant PT like you did. Mine were pleasant and caring and always accepted my no, even though they nicely encouraged me to do more. But their pleasant personality didn’t make my pain any less. They were all fans of pushing my knee to the limit which caused quite a bit of pain. That was one thing I never had the nerve to say no to, because they got good numbers. And that early on everyone was happy with those numbers.

    However, now that I’ve been on Bonesmart about a year and a half, I feel very strongly that no one will push on my knee like that if there’s a next time. (and I have a partial that is not going well, so there’s every chance there will eventually be a next time)

    I understand pressure from a husband about PT. My husband has always been an athlete who pushed through the pain. It took many months of bringing him around to Bonesmart’s point of view and I’m not totally sure he’s 100% for it.

    But at the end of the day it’s your knee, not his, you feel the pain, not him, and you have to do what you feel is best for YOU. My husband respected my right to make the choice that I felt was in my best interest and we eventually agreed to disagree. He didn’t give me a hard time about stopping the exercises, but I know he felt I should continue at some level.

    After all, “everybody goes to PT and we know it’s going to be tough” and “you have to do your exercises “

    Well thanks to Bonesmart I’ve learned those statements are NOT true, everybody does NOT go to PT, and they recover just fine without it, and with less pain.

    Bonesmart’s approach is the one for me!

    Try it, I think you’ll like it. :console2:
     
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  8. Greda

    Greda graduate
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    My husband and parents have never had any surgery. I am going to trust myself with your help. It just doesn’t seem logical to have a straight leg at this point when I didn’t have a straight leg before the surgery. Have been up and down the stairs 4 times today and need to rest a bit. So happy my husband will be home tomorrow.
     
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  9. Roy Gardiner

    Roy Gardiner FORUM ADVISOR Forum Advisor

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    It isn't and you are right. Stretching exercises (walking is a good one!) will help you regain a straight leg now that you're not being restricted by the knee joint itself. But it'll take time.
     
    • Agree Agree x 1
  10. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    This is what we call Activities of Daily Living. Though 4 times at only one week post op is a lot, sometimes one has to do what one has to do.

    Especially in the early weeks, Activities of Daily Living are all the exercise your new knee needs! As you heal you will be able to do more and your leg will naturally strengthen by default.

    Hang out here with us.
    Bonesmart has a wealth of advice, information and support.
    We will offer helpful suggestions, :idea:

    Cheer your accomplishments :happydance:

    And send hugs when you are feeling down. :console2:

    Best wishes!
     
  11. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    I am going to tag @Josephine
    our forum director and nurse to address your concerns.
     
  12. Laurenkate

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    He's not hurting your knee, he's "hurting your feelings". What an outrageously (insert favorite expletive here) thing to say. :tantrum::tantrum::tantrum: Apparently he doesn't realize that replacing a new knee involves a lot of cutting into things like tissue and muscle?????? DO NOT GO BACK TO HIM!

    I'm sorry you're having problem with meds. FWIW, my in home physical therapist said trying to get pain medication now is becoming very, very difficult because of the opioid epidemic. She's had patients try to drive (or walk) to a pharmacy a day or two after surgery to try to get any kind of relief. Apparently it's becoming a real problem and like everything else, isn't properly addressing the problem of surgical patients. I feel a rant coming on so will stop....but good luck.
     
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  13. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    What an ignorant and unfeeling ..... thing! (can't use the expletive I wanted to!). People like that make me want to scream! :tantrum:
    I've never rated titles like that. His course obviously never included sessions on patient care!
    I agree with Roy. 100%! I never did any PT/exercises whatsoever. I recommend you read my recovery thread to see how little exercising I did for either knee! Knee recoveries UK style Parts I & II (Josephine)

    You stick with us, we'll guide you better than that!



    I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
     
  14. Greda

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    I will answer questions. Pain meds are up in the air until my appointment at the pain clinic tomorrow.
     
  15. KitKat64

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    @Greda, I am sorry you had to go through this at PT.

    I had a bad experience with PT for my right TKR (you can read about it on my recovery thread KitKat 64), so I stopped all PT after a couple of weeks. I went to the gym for gentle exercise and did some of the exercises at home plus walking. For my left TKR, I chose a different place for the PT and they were much more gentle when it came time for the ROM stretches. They never pushed me beyond my limits, and would stop when I asked them to.

    If you decide to continue PT I would try another PT place. Never let anyone bully you in regard to this. You have the right to say stop if it becomes too painful!! In my case, I let them bully me for a couple of weeks before I decided I'd had enough!! I only wish I'd found BoneSmart back then!! I've said this before, PT is supposed to be beneficial to the patient, not resemble torture!! I think all these over aggressive PT's need to join BoneSmart maybe they would learn a thing or two!! Ok, my rant is over, lol!!
     
  16. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    What a brilliant idea!

    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?
    ai63.tinypic.com_eta39s.jpg

    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.
     
  17. Greda

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    1.My pain levels today vary from 5-9.

    2. Percocet 5/325 1-2 every 8 hrs (only 1 week’s worth)
    Was taking before surgery they think will help now
    Norflex 100mg 1 twice daily
    Ambien 10 mg 1/2 at bedtime

    3. swelling: between moderate and huge

    4. Not sure. I was in so much pain with PT I don’t know what he said
    Could not straighten leg before surgery

    5. Almost all the time with polar care by Breg. Can’t function without it

    6. I elevate when I sleep. It is really uncomfortable but have been trying. The ambien makes the elevating at night tolerable. Using 3 pillows like you have in article.

    7. My husband went back to work so during the day I have to get ice for polar care (upstairs)

    Going up and down 2 sets of 8 stairs about 4-5 times a day
    Put clothes in washer
    Fix my breakfast and lunch
    Take care of cats

    8.
    At PT on Mon - 10 of each
    Sitting on table raise leg (could not do so he “helped”) x10
    Heel slides x10
    Quad sets x10
    Straight leg raise (again with “help”) x10
    Put a bolster under knee then suppose to raise leg to height of other bent knee. So painful and could not do it and he “helped” but told me to fire quad each time

    Since PT Mon only a few heel slides
    I get up and walk about every hour or two, when I first get up I can’t use anything but my tiptoes on that leg the gradually can walk
     
  18. Greda

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    A quick question —how much Tylenol can I take in a 24 hour period? The on call doc told me 1000 mg a day was all. However I remember the doses in the surgical center were 1000 per dose with 3 doses a day.
    Thanks
     
  19. Spex10

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    In support of all the others I have recent experience of 2 TKRs. The first I was a good girl and went to PT because I thought you had to. The PT would just sit and force my knee to bend (which it didn't!) My poor knee tissue became inflamed and I developed adhesions. Down to my genetics apparently. Needless to say I then needed a MUA. That worked fine. I saw a different and good PT after that for practical stuff like gait and stairs.
    My recent TKR - it's my 9 week anniversary today! - was very different. I was well prepared this time. I said no to any opiates as I hate the way they cloud my thinking and also refused PT the way the first PT wanted to do it. Eventually, as I was so awkward, I got the head PT. He was excellent. He gave me some hints and tips for the early days but accepted that I just wasn't interested in his exercises. I went home and just walked. Not long walks, just about the house, then grounds, then shopping. Stairs as I met them. Nothing forced or artificial in the way of exercise
    I was discharged 2 days ago by OS and PT with a good bend, good walking and generally incredibly better all round.
    Moral of the story - be strong, don't do PT!
    PS the OS's colleague, another surgeon, had a TKR and refused PT. He did fine too!
     
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  20. Celle

    Celle FORUM ADVISOR Forum Advisor

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    The safe total amount in 24 hours is 4,000 mg, divided into 4 doses of 1,000 mg each.
    That's assuming that there is no Tylenol (Acetaminophen) in any other medications you're taking. If there is, cut back one or two of your Tylenol doses, so you stay within that safe, 4,000 mg limit.

    In the US, you may be told that the safe daily total is 3,000 mg. That's because the FDA is being cautious and assumes you won't check what is in your other medications.

    About the PT: my surgeon doesn't allow any PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house.
    After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
    His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.
     

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