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TKR Hawkie's 2nd Knee

BBCG

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@hawk2go mentions a CBD/THC tincture and I also have used a locally produced one as well as a salve the same folks make, with the same ingredients along with other herbs in it. I used these to help wean myself off the heavier drugs so I could feel more normal, as those drugs don’t make me feel very good. The tincture and salve have no mental-affecting capabilities, but they do really help my pain be lessened…
 
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hawk2go

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The tincture and salve have no mental-affecting capabilities
Prefacing with YMMV (not trying to convert just inform)! This risk of affecting mental capabilities was the thing that stopped me from trying these products for years until my chiropractor rubbed a bit of CBD salve on my injured back. That woke me up to the relief these products can give, drove me to understand more and also gain awareness of the advances made since people got stuff from the weed man. The science these days is very precise and there are many strains bred to resolve specific symptoms - pain, appetite, sleep, anxiety, etc. I worked with a doctor and "farmacist" to explain my challenges (sleep, pain) and also to emphasize that I did not want to be high. The fact that it's all natural and easily recognized/metabolized by our bodies is a huge plus. I just don't mix with the pharmaceuticals because there just aren't enough studies about interactions.
 
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hawk2go

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I had my first outpatient PT session and it was good. At about 5.5 weeks down, my flexion was 104 without pulling and extension was 4 without pushing. My knee was sore and a bit swollen from working this week, so I imagine I lost a few degrees from last week. I'm ok with that, confident that as I build strength and stamina through walking, ADLs and light exercise, the reaction to sitting at my desk for a few hours a day will decrease. The PT and I agreed that I would work and push to some discomfort but never to the point of pain. I expect to be in her care for about 5 weeks. Side note: I've been consistently able to walk around without my cane and, more important, without a limp.

Question for the team - I've tried a few different positions to ease the strain of sitting up to work. Tried different office chairs at different heights, used an under desk footstool at different heights and angles and even switched from my standard desk to a portable/adjustable laptop desk. My conclusion is that it's the length of time that I sit, not the position. With that said, I'm open to suggestions - have you found a position that allows you to sit for 2 or more hours at a time without getting stiff or sore?
 
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FCBayern

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Unfortunately at ~5 weeks it's going to be very difficult to sit upright for any length of time comfortably. I know for myself I still needed to be elevated most of the time to remain comfortable at your stage of recovery. Hope you can find some relief @hawk2go.
 
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hawk2go

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Thanks @FCBayern. I realize it might one of those "time heals" activities. I'm able to use my rocker/recliner again, so may try that for parts of the day. That just means I'll have to kick everyone out of the living room while I work. :heehee: I moved my icing machine downstairs so I could ice when I relax but it may make sense to move it into my office until I improve sitting tolerance.

On a separate note, I've been using the rocker design of my recliner to do gentle pushes when I'm not elevating. It feels good and makes me think I'm working. Anyone else use a rocker to keep the knee moving?
 

FCBayern

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I didn't use a rocker but when I got back in the office I would plant my foot and roll the chair forward until I felt tightness, then I would hold it there. I didn't even go to the point of discomfort, just a feeling of stretching. Hold for a few minutes and then I could roll a little farther. I think it really helped my ROM.
 

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I went to breakfast this morning with a few friends to a restaurant for a friend's birthday and sat at the table for over 2.5 hours. What helped me was that I had a chair perpendicular to my left leg so I alternated putting my leg on the chair and having it bent and foot on the floor. Having the ability to change positions was key, otherwise I would have cramped up and had to get up. I think you are exactly right, it's not the position it's the time that your knee has to be in the same position. Being able to move it around is the best option.
 

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Hi @hawk2go ... with my first surgery I was still working IN the store we run, so on my feet alot. So, I did more desk work and propped my leg up on a stool with a thin pillow on it and had my ice packs with me, chilling in the freezer (we have one for products) so I iced at least once an hour, got up to move about at least once every 30 minutes, walked around the building 2-3x a day, and initially only worked 4 hours at a time. I still hurt later that day, so didn't cook, didn't do much else when I got home, but at that time, my husband was our chief chef and I was good with that! I had two of those gel-filled, 11" x 18" ice packs and took both to work and alternated them, each lasting about 30 minutes before needing back in to refreeze. It wasn't ideal, but it did kinda work okay... although, that entire healing period was far more difficult that this past one, and I had way more pain overall and less relief.

It seemed that icing and elevating my leg at least to hip level, and moving frequently helped the most, as I recall. This past time, I am now mostly working at home, as my husband's situation changed after he battled a few scary diseases!
 

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Hello @hawk2go yes, it is definitely about the length of time your knee is in the same position. I set the cooker timer for 30 minutes and when it goes off I take a short walk and then come back to a different position - i can get quite a lot done that way. Every 2 hours i take a 30min break and do the stairs a few times.
 
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hawk2go

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Thanks everyone. This is week 2 and I've moved the ice machine to my office. I'll add the reminders to get up and move about, as well as the 2nd chair or stool to elevate during meetings.

I also tried the floor pedaler last week with no negative effects and that will help with some of the movement.

On a separate note, I may have to cut back on PT. After Friday's session which actually felt good that day, I needed Saturday and Sunday to recuperate. It was an evaluation session where they took measurements, observed my gait/balance and then gave me a few new exercises to add to the home PT regimen. I completed those exercises in the session and then did 1/2 on Saturday after my walk, the 2nd half was hard to get through but it was my 1st solo walk. I had more pain, some swelling and I returned to dependence on the cane this weekend. I was relying on my walks for pain free progress, walking was the one thing that didn't hurt though stamina limited my distance. I'm better today but am uninterested in 1 day of PT and 2 days of recuperation for the next 5 weeks. Of course, the spouse thinks I should push through but relented when I mentioned I'll talk with the surgical team about the impacts. More to come.
 

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Prior to my TKR I was aware of the BoneSmart gentle approach to recovery as opposed to rigorous PT. I was lucky enough to find the site before my TKR. Even though I knew about the BoneSmart approach my OS was all about PT and "whatever ROM you have when your scar turns silver is all the ROM you will ever have." He was the trained surgeon that has done many, many replacements, he must know what he's talking about right? So off I went to my first visit to PT, about 2 weeks out from TKR. The next day when my knee was more swollen and I was in much more pain I opted for a BoneSmart recovery. I never went to another PT session. That was one of the best decisions of my life. Not only did I suffer less pain, but my ROM has continued to improve over two years. I've been hiking over rough terrain for good distances, scuba diving, and just living a happy active pain free life with more ROM than I ever thought I would have again after many painful years. I've now had a hip replacement with equal success following a BoneSmart approach. You don't have to suffer needlessly to have an amazing recovery.
 
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hawk2go

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Even though I knew about the BoneSmart approach my OS was all about PT and "whatever ROM you have when your scar turns silver is all the ROM you will ever have." He was the trained surgeon that has done many, many replacements, he must know what he's talking about right?
That really is the challenge, right? Also, I believe that insurance typically requires you to complete the standard recovery plan (because of that protocol, I had to fail the ever progressing treatment plans before I could get approved for TKA). If I run into issues later, insurance may not cover me if I haven't completed PT, so it's a delicate balance. I may get to the "no more PT" anyway because, truly, my most consistent progress has been when I take it easy with the exercise, walk daily and increase my ADLs slowly.

I've written to my surgical team and my PT, hoping for a conversation to determine what's best for me (vs. the standard patient).
 

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Yeah, they kind of did the same thing to me last Wednesday. I was going to see my OS the next day so she was doing a lot of assessments and trying to stretch me to get a higher number of ROM. Well, I had overdone it with walking, exercises and general "on my feet too much" the day before and my knee was swollen and sore so she wasn't able to get much more than the range I'd been on Monday (105). This weekend I'm afraid I did too much too and today is PT.

The funny thing is she faxed my assessment to the OS's office and when I was there I asked if he'd gotten it. He didn't know anything about it. All that work by the PT writing it up for nothing. He only cared that I was greater than 90, which is all they're concerned I be at by 6 weeks and he said he had no doubts I'd keep improving and if I didn't to let him know. I guess it can go in my file and sit there. :shrug:

I haven't done a walk for quite a few days because of too much activity going on. Maybe today will be good since I have PT and won't be doing exercises outside of that (it's enough!)
 
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hawk2go

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I talked to my PT who said she pushed me right into strengthening exercises based on my assessment. She mentioned that I was further along than most of her TKR patients at 6 weeks (thank you BoneSmart) but maybe not ready for that level. She'll back off those exercises in our next session and I should leave them out of my home work. I may still dump PT soon.
 
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hawk2go

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What is your ROM at this point, @hawk2go ?
104 and 4 on Friday plus I was walking, limp free, without the cane and was able to go from sit to stand without holding on (hands folded across my chest). I think my ROM had regressed from the week before because I started work last Monday and sitting for long periods caused some swelling.
 

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@hawk2go You're doing great. I think using your ice machine while you are working may help. Start with it elevated and then put your foot on the floor for a while and then do the same thing again. If you have time to stand then try that too. Take a quick walk when you are able.
 

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You and I are about the same, ROM-wise. I'm around 105 and a week ahead of you. I think I'm closer to 0 on flexion but not sure. Maybe 1-2.

My work, which is very part time, is mainly on my feet. I work at AR Workshop, where I help people create painted or stained wood projects and it's a 4 hour shift. I had to stop working around 1-2 months prior to surgery, my knee just couldn't take it. I'm not sure when I'll be able to go back but I don't think it will be before 3 months post-op. If she can start me off with very small classes (like 2 people) then I would have some down time to sit on a stool while people are working. A table of 5-6 people and I'd be on my feet the whole time. I miss working so hopefully by Dec I can go back. I feel bad as this time of year is the busiest for my boss but my knee was the boss this time and I had to get my surgery done when I did.
 

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