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How do you know what is enough or too much?

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skigirl

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This weekend, the nurse told me that I was doing "too much". too much is easy to find, because I ended up in level 9 pain. But, how do we know what is not too much?

Everyone says to walk as much as we want---but, what do you do when you are a block from home and you start to l
limp? How can 5 min. on the bike be fine and 15 min be too much?

My pt says to just exercise in pt--but, that is impossible. When you get home, do you weed your yard for 10 min or 30? Do you do laundry or wear dirth clothing? Do you clean your house? If my knee gets stiff, then I ride my bike to loosen it up---but, It seems silly to ride for 5 min and then get off. Do I ride for 15 and see if there is pain? And, isn't this a time consuming way to live our lives.

I can see that my surgeon has a disconnect with reality. When I asked about gold he told me two weeks and I could chip and putt then at 3 weeks, I could start to play. The reality is that it is even hard to walk over to the putting green across the uneven ground to get there.

He told me I could return to work in 3 weeks---reality, the nurse tells me that I can't stand for more than 30 min. then sit
, then stand---and that I am supposed to ice the leg 4 times a day. This is not compatablile with working in an artist's studio.

He told me not to take the Percoset past two weeks--unless it was at night. His own nurse tells me to take the Percoset until the pain is completely under control. and what does that mean? Until every ache and pain is gone?

right now my pain is a 4, but I am not going to take Percoset and get all groggy again. I took 4 Aleve which should do the job eventually.


So, what to do? I am going to work in my studio--will try to ice once or twice---will sit down when I can---if I get really big pain again, I guess I will have to keep on trying until I can do it without pain. There is no book or list which tells us what we can do---each person is different---but, how can we know?
 
Skigirl
Bless your heart. You are trying so hard. My OS says one thing and his nurse says another. But not as far apart as yours seem to be.

I am not sure because I don't take Aleve but are you suppose to take 4? I take advil and asprin (not at same time) that works better for me. Aleve does nothing for me.

I know what you mean about getting on the bike when your knee goes stiff. I do that too. But I know it sounds silly, but only do it
for about 2 mins. not 5 or more for a few days. That way you can do it several times a day and 2 mins is enough to loosen up the knee at least mine.

Do as your PT says, do not do any more exercises when you have PT. You can still do your house work but pace not all in one day.

I don't think you can walk as MUCH as you want. You do have to gage it. Then work your way up. I don't know what you are walking now, but cut it in half and see if that works. (I am talking about just walking not walking around the house or studio)

I think you need to cut way back even to the point of maybe feeling guilty you are not doing enough. Because a little goes a long way.
The old saying "Less is More" is true esp. now.

I do hope you can get some relief soon.

By the way what kind of art? My son has a degree in Art and is very good. My mother in law was an artist and my kids are all really good including my hubby. My son was offered to have some of his paintings in a magazine and he was offered a showing, but he declined. He only does work for family and friends.
 
Skigirl,
Please refresh my memory as to when you had your surgery.
Did you have one or 2 done?
How long were you under anesthesia?
You need to remember for every hour you were in surgery under anesthesia, your body will require 2 full weeks to recover just from the anesthesia, never mind recovering from any surgery you had done! Your body is telling you, you are doing too much with such a high pain number!
I took pain pills for 3 months post op during the day. I took the pain pills another month and a half at night after I stopped them during the day. Ice should help alleviate your pain as well. Maybe icing once a day is not enough!
Your body is rebelling....... Sorry to be so blunt. Now you have to give it some time to rest and recover from too much too soon. Almost like starting over and finding out how much you can and should do during the day.
I will be interested to see how far out from surgery you are because if I remember correctly you are not far out at all! This recovery takes time and if you try to rush it you will develop problems you don't want to have to deal with. JMO
I am one year out and I did return to work 12 days post op as I run a child care business out of my home. I had 9 children in care last summer and did have the help of a parent client who worked with me for 7 weeks. Having her here with me enabled me to ice when necessary, take my pain medications, nap in the afternoons with the napping children, and gradually get back on my feet and take over my own business on my own 9 weeks after surgery. I was able to do it, but still went to bed early in the evening, did my exercises, soaked in the hot tub and iced when necessary.
Give your body a chance to heal, it will tell you thru the pain if you are doing too much. If your body lets you know you have done too much, the following day you must rest.
 
Skigirl yes I think he was a lil under estimating the surgery. I work at home as well. I do what I can but I do know it will get better. To push yourself a lil with excercises is ok but I dont think we need to scream and cry...I stopped pushing so hard and I dont have those days were I cant move. I do what I can and seem to be doing well....I do my own PT at home ( was costing 90 a week was easier this way ) and I am 117 Im ok with that improving all the time...Do what you can if your knee says stop, stop........You will be fine if you believe that you will go far....really!!!!!!!
 
Oh Ski g......what are you doing to yourself? You better NOT be cleaning the house YET! Everyone heals at different rates, all our OS's seem to have different advice, so it makes it even MORE confusing! There is SO much individual healing! Only YOU can moderate at YOUR pace! You may have a few good days and then a setback..but with major surgery....that seems to be the norm! Just reading all the posts you can see recovery is just as different as each of us! Please don't be so tough on yourself......there's no rush! You'll get to your destination....its always an uphill battle! But once you make it to the top of the mountain....STOP, look all around and marvel at your stunning achievements! Think POSITIVE!!! Every day may be a challenge, but wait til those milestones keep coming at ya! Be kind to yourself! You'll get to the top, for sure!!! :)
 
Great post Judles I ditto all of it...Good girl !!! Ski - I really think you are doing very well I think you just had yours done not that long ago I would have to look it up but Im sure of it....I see your post and they are very strong...............YOU ARE REALLY DOING GREAT JOB.....I did look it up you had it done middle of may and you were driving in 2 weeks..Thats pretty amazing,....I still dont drive...I still dont feel its strong enough...Please give your self alot of credit.......................alot
 
Looked up the date of your tkr and I believe it was 5/13 that would make it a month today.

You do need to cut way back. You are so early in recovery with all the things you are doing you are defeating the purpose of exercising
by over exercising and stressing the knee.

Please take it easy so you will feel better real soon
 
Skigirl, you are only about a month out of MAJOR surgery. I'm not sure who told you that you could "walk as much as you want to"...but it just ain't so. Also, most people are not even CLOSE to going back to work (or doing house chores) at 3-4 weeks. Quit beating yourself up, hon! Your body has LIMITS at this very early stage of knee replacement recovery. That's a fact you know all too well, it sounds like, because you find yourself in pain a good bit of the time.

Please try to readjust your thinking and allow yourself time to heal. You cannot rush it. If you try, you'll get what you are having happen now....serious pain.

At one month out if you find yourself limping, that means you need to use a cane for a while until your leg muscles get strong enough so you don't limp. It's possible that walking one block is ALL you should do right now. Gradually work up to longer distances. If you can do 5 minutes on the bike okay, do that for a day or two. Then up it another minute each day. Don't go to 15 minutes....that's THREE times the activity and (as you have found out) it's more than your body is ready for right now. You have to do this recovery thing gradually for the best result.

Listen to your PT. Right now maybe you need to just let the weeds in the yard go. And the cleaning. And whatever other home chores don't absolutely HAVE to be done. If you live with someone, they should be helping you!

Like you I found that my stationary bike worked to keep my knee loose. But it only takes a few minutes to do that....then STOP. More and you're not loosening, you're working out.

Right now your main job in life is to be a knee patient in recovery. It IS what is going to consume most of your time for maybe even a couple more months.

Be sure you are following the directions on the package for your Aleve or any other medication you take. Even though you can buy these pain relievers over the counter, there are serious side effects if you take too much of them. And if you take 4 at a time, that is WAY too much.

Skigirl, I'm really not trying to beat up on you here, but I am worried about you. For some reason your posts sound like you are pushing so hard to be back to a high level of activity right away and I don't understand why other than you think you should be. Please consider that you might need to take things a whole lot slower and be kinder to yourself. It will hurt a lot less that way. Your posts also reflect anger directed at your surgeon and the other medical personnel you've talked to. Has the doctor done something to make you feel this way? These folks really do have your best interest at heart...except for ANYONE who tells you that you can do the golf course in any form in 2-3 weeks after a knee replacement. If your doc told you that, he DOES have a disconnect with reality.
 
Skigirl --- Jamie has it oh so right!! The others also but Jamie's advice about 5 min on the bike for a few days then gradually push it up -- not jump from 5 to 15 is absolutely correct. My PT had me pushing my time on the bike up by one minute at a time. And that is exactly what I did -- staying at one level for a few days... then going up to the next etc. untilk I hit 20 min. After that it was up to me. It's like weight lifiting. You find a weight you can lift, ight? And then you work with that weight for a number of sessions -- doing one or two more reps when you feel you can. Maybe in a 3 weeks or so you work up to a bigger weight with fewer reps. And so on. And walking is the same. The "walk as much as you like" advice is always coupled with "when you get tired rest and then walk some more later". My PT told me that unlike most of his patients he had to hold me back ..not push me to do more. You sound like me and as I've said before on this forum -- for once in my life I actually listened to the PT and to doc and others writing here. We ARE all different in our recoveries. But some things are common and it DOES take time to get over the surgery itself. As in ALL surgeries there is a basic 6 weeks healing period. Get through that without pushing yourself too much and you'll see a major improvement....
Can't you perch on a high stool or even a ladder when you are working in your studio instead of standing all the time?
 
Crystal, I guess by now you can see that my surgery was on 5/13--and it was my left knee. How do you guys get those little numbers at the bottome of your posts? And Texas, what is a MAU and a KIM?

And yes, my doc did tell me that I could play golf in two weeks. He is also the one who told me to walk as much as I want to walk. I feel anger because what he said before the surgery is no relevant after the surgery. He is very stingy with pain meds and keeps telling me that I don't need them during the day after 2 weeks. I feel like a drug addict asking for more percoset.

One plus of seeing the Nurse Practioner on was that I asked her for a script while I was there.

When I first went to pt, they told me that the first two weeks were important, that I would spend a lot of time with my leg up. My doc told me that I could be up or down as much as I wanted, that I should walk alot.

I know that some of the early pain came from fixing the 10 degree bow in my leg and from lenthgening the MCL. Also Jo is right too--my ITband has always been tight--we ski in the mid position---and now is giving me a lot of grief.

After the first two weeks, I found out that there were even more weeks to sit around the house and do nothing. I am going crazy from lack of activity. and, I have stuff to do---if the doc had been more honest in the beginning, I would not have had the surgery. So, now I am in charge of a quilt show on July 3, 4 and 5. And, this is the time when I make money selling my art quilts. I have galleries calling me asking when I am sending their orders to them and have two friends having babies, who want quilts, etc, etc.

All along I have thought that I would be okay after 3 weeks. It was such a shock to be in so much pain on thursday night---and then to loose the weekend to more sitting---although I am making one quilt by hand, since I am so desperate to have work ready. I should have waited till next year to do this when I could have scheduled my work differently.

I did buy a stool to put in there so that I can do some work sitting, and I moved my sewing machines---normally I sew standing up so that I can sit to sew.

But I come home from Pt feeling like I have not exercised----two hours of stretching and doing quad sets is not exercise. The one advantage to the pool is that I can move fast from one side to the other---it feels good to be flying along again. Today I went to the gym for an extra hour and did all upper body and core stuff. I am going to do that every day---the leg can sit there and vegetate.

But this evening, i have a meeting to go to and then will be back in the studio--another compromise --until only midnight. But, since I cannot sleep at night, why can't I work in the studio? I sleep for one or two hours at a time, then wake up. It is impossible to be comfortable at night---I toss and turn by the damn leg just hurts. At least when I wake up I am working on the hand done quilt. I tried knitting, but I cannot concentrate enought to keep the pattern going!!!

I just want to be done with all of this, so that I can live a life again. Sitting in the house with my husband is stressing me. Yesterday someone asked me how I was doing, and I almost burst into tears!! Yikes I have to get off those Percoset. today someone called me up to ask about TKA---I had to tell her to call someone else, that I was not in a position to talk about it with anyone. My husband thinks I am mean---but, seriously I don't want to drop a lot of negative stuff on someone else---and I sure cannot recommend this surgery to anyone.

I think I should have waited---I had such a severe bow in my leg, it was causing me to thrust my leg with every step. I had pain, but nothing like some of you talk about. My OS convinced me that I had to take care of this early before it got worse---and I am really angry about that---I could easily have waited a year or so. He tried to schedule my other knee and I just laughed at him---I said I would be sure to schedule it right after hell has a big freeze. Luckily for me, it is doing better since the surgery--and probably won't need to have a TKA.
 
Ski G....YOu sound so angry and frustrated! Why would you EVER want to WAIT to be relieved of your PAIN! No lectures, but why wouldn't you even want to take advantage of all the opportunities open to you with any replacement surgery! The reason you should NOT be working around midnight in your studio is that you have to learn that your whole BODY has to REST,,,,,or else you are good for nothing or to no one!!!
 
Skigirl,
You are still early in recovery. I am very sorry your OS treated this HUGE surgery like it is nothing. He in not even conscious of how much you truly do need, require, the medication. I am happy you got a script from the NP.
Now, you are only 1 month out. VERY EARLY in recovery. You should take your pain medication and keep it on schedule.
You also need to have someone come and help with organizing this quilt show! There must be others you know who have done it in the past, have experience in organization of this sort who you can call and explain you desperately need the help due to having this surgery. Tell them the recovery is much longer than your OS lead you to believe.
I truly feel badly about that..... Did you ever purchase the book on Total Knee Replacement & Rehabilitation? It was a life saver for me. The week by week, month by month exercises and expectations for an entire year is covered.
I am an active person and did have help from a friend who I could trust to follow thru on all that needed to be done with the children in my care while I was recovering.
It is very hard for some people (me included) to ask others for help. I like to be organized and have all my ducks in a row. I like to know what is happening and what to expect next. It sounds like you are a similar personality and you got side swiped by the OS telling you, you will be fine in 3 weeks. That is so wrong and unfair to you.
It is done, now is the time to make the lemonade and make the best of this unhappy situation for yourself. By the middle of August, you will feel like a new person. However, you have to allow your body to heal and recover from Major Surgery.
Your bones were cut in 5 places on the end of your femur. The metal component was cemented and hammered into place. The top of your tibia was cut off and then a hole for the post was drilled and hammered then they filled it with cement and hammered the platform into place. They also cut your patella back off and implanted a plastic component with the button on it that rides in the groove of the implant.
That is a lot of work done at the bone level. Then they had to sew up the layers of skin and staple it shut.......
Now do you see why you need to take it easy? Your body needs time to heal the ends of the bone, the cement is hardening in place and the skin and nerves are trying to heal themselves. Your body is in overdrive trying to repair itself and that is saying nothing about recovering from the anesthesia! I was out for 4.5 hours which meant my body required 9 weeks just to recover from being under the effect of anesthesia. It is not normal for your body to not move for that long.........
So, please, help yourself out by asking others for help with the quilt show, get plenty of rest, exercise in small quantities, and ice and elevate. The time will pass faster than you know and you will begin to feel better one day at a time if you allow yourself to heal........
Remember, last year I was 1 month behind you and had both knees done. I was skiing on snow at Loon Mt in NH on February 1st! That will put you on snow by Jan. 1st!
Look on the bright side.......
 
Skigirl
The sleeping only a couple of hours is normal. And several folks
here had the same reactions of almost crying.


I bet you do beautiful quilts and someday put a picture on so we may see them.

Jo or Jamie will be able to tell you if going to the gym everyday for
the upper body will bother you. I don't know.

The stretching exercising is very important. Your are right it does
not feel like you did any exercise, but it is a very important part of recovery for the rom. You need the quad sets. I do those all the time to help with my quad, which is pretty strong.

Sorry your doctor was not more forth coming with you so you would have known what you were facing. This is not an easy surgery and the recovery is not quick. We can not hurry it up by over doing exercises as that will just knock you back.

Hope feel a little better soon so you will be able to get some more work done.
 
But I come home from Pt feeling like I have not exercised----two hours of stretching and doing quad sets is not exercise. The one advantage to the pool is that I can move fast from one side to the other---it feels good to be flying along again. Today I went to the gym for an extra hour and did all upper body and core stuff. I am going to do that every day---the leg can sit there and vegetate.
See here, lassie! You're confusing exercise with PT. It's NOT the same. You don't do PT to maintain your body fitness, you do it to help your ROM and your knee to recover from the major surgery Crystal just described.

I think I told you before that there is one immutable, inescapable fact in all this .... your body has
only one 'pot' of energy at any time in your life. Let's call it 20 points worth. In normal activity, like your sewing, you probably use up about 5 points, say 5 for housework and another 6 for your other activities. The remaining 4 are for underground things like digesting food, working your heart and vascular system and etc. If you indulge in, say, a marathon run, then you're going to use maybe 18 of your 'energy points' for the race alone. And as a result, you're totally trashed for a couple of days after until you restore the balance with some rest. Right?

Now you have had this very major operation. During the recovery your body has to heal - 10 points, cope with the pain (yes that takes energy too) - 6 points and engage in physical therapy from time to time - 6 points. At a peak moment, that's 22 points. Something has to go without. It's like a pregnant woman who doesn't have a healthy diet. Her baby is not going to go without, nature has seen to that. So baby will get the nutrients and mom with go without - result, mom gets ill.

Same thing happens with a joint replacement. You use up all your 'energy points' and something else has to go without. In this case it's
the healing of the wound, muscle, and ligaments and your body's ability to manage the pain by utilizing the pain meds you take. It happens but a LOT more slowly than it would had you reserved your energy for your recovery instead of wasting it in fruitless attempts to regain your athletic prowess which, like it or not, is not going to be achieved yet awhile.

Therefore, you do need to cut back and veg out. We all had to and so do you! And you need to take those pills. You are not going to get addicted in a few weeks. Research has shown that where pain exists, drugs can be tolerated (from that point of view) for some weeks. When you stop taking them, then tail off over a few weeks. Just means your body got a bit accustomed to them, that's all. Not that you were addicted! There is a difference! And if your surgeon won't be co-operative about the percs, go and see your PCP instead.

And for pity's sake lassie - go easy on yourself! It was the tortoise that won the race, you know! :wink:
 
Well said, Jo!!! That's what I always say...Slow and steady wins the race,,,,,well maybe not THAT slow!!! :)
 
WOW,
Thats all I can think of to say. I wish I could make it better for you I really do. But I can't make mine better either. I thought I would have my life back by now too!!!
I really thought I would be able to enjoy my 40th Anniversary without loading myself up on pain pills and margaritas but is was not to be. But I sucked it up and had a wonderful time. My Children put their hearts in to making it nice. I thought I would be able to get myself up and out of a armless chair by now but, I can't. I thought I would be able to put the yearly Flag Day Event on but, I couldn't I have to much pain to stand too long.
But my Town said that ok we will have a bigger Flag Day next year!!! MY MVA did not stop me from having Flag Day but my Knee's DID.
So The Doc's make it sound easier then it is, that life. So you wish that you had not had your knee done!!! ME TOO I wish I did not have my knee's done either. But I did so now I have to suck it up and deal with it!!! I know it is not easy but there are no promise's life will be easy. Sometimes you just have "To Put on Your Big Girl Panties and deal with it". It does seem unfair I agree but, what is done is done now we have
to learn to live with it. SO BUCK UP LITTLE BUCK-A-ROO and find something positive
in your new Knee.
 
Skigirl. I appreciate that you posted the details about your situation. I better understand your frustration and anger at the doctor who led you to believe that you could pop back in a couple of weeks after a knee replacement.

Crystal gave the BEST advice about what you need to do to meet your quilt show requirements. You need to ask for help, as difficult as that might be at this point. You simply cannot will yourself into getting all this done AND recover at the same time. And Jo was on target with her description of the "points" available to you. There is only so much "you" to go around. You have had the surgery (which, by the way, I think you will eventually come to be happy about once you get a little farther along in recovery) and you can't change that fact. Now you must go forward.

Maybe it would help to make a list of all the tasks you have to do. If you're like me, you probably already have the list...:D. Then go down the list and honestly ask yourself, "What would be the worst thing that would happen if this doesn't get done?" And if the outcome is not major (like loss of income that prevents your from making payments or if it would cause HUGE problems for someone else or result in something else that is really major), cross it off your list and let it go mentally. You have many more great years ahead of you to make up for these small cutbacks in activity. For the remaining items, go through each again, and ask yourself what could be done differently or who could help you with the task. You make beautiful handmade quilts, so you are creative....put that creativity to work figuring out different ways to do the things that must be dealt with. Get your friends, co-quilters, or (most importantly) your husband to help!!!

If all else fails, and you don't mind sharing some of the things that remain on the list, post them here. We have so many helpful folks that may be able to suggest ideas for you.

All of us want to help you get through this difficult time. Please allow your husband, your friends and us to be there for you. We really do care about you!
 
Skigirl
Wow I do understand where you are coming from but also know that we have to ask for help sometimes. When I do anything I
have a list and it is so well planned. My kids say I turn into a drill sargent. But I like things orderly.

However, as much as I hated it sometimes I had to ask for help.
It did hurt my pride, but at least the event went off OK. I am only telling you all this so you will know it is OK to ask for help and I do want you to get well soon.

If I read your post correct you are committed to make quilts yourself. You are the artist correct? I do not know how many quilts you are needing to supply, but have a feeling it is more than you are going to be able to complete. You do need to contact another quilt maker and ask for their help. I am sure they will be glad to.

You do want the event to go off ok, so you will have to swallow your pride and ask for help for the sake of the event. Because there is no way you will be able to do all by July 4th. That is with out causing further problems with your knee.

I looked at your profile and saw your age. I am impressed you are doing so much.

As far as being an athlete and embarrassed over this injury. Why???
My sons were all athletes, one was a well know track star, one an athletic director and head football coach and many of their friends were in the NFL and the olympics. They have all suffered injuries and some knee injuries. That is the cost of being an athlete.

Folks are going to see your knee scar and they are going to ask.
Why not just say it was time due to your athletic life and in order
to continue it you decided to have the surgery. You don't have to say anything else.

If people talk let them. I have never cared what people say, I am to busy to pay attention.

Hope all goes well for you, but you need to take a long hard look
at what is coming up and how is the best way to handle it.

Good luck take it easy on the exercising so you can get well.
 
The MAU is a manipulatin my leg would only bend 65 to many surgeries and scare tissure even though I busted my butt with excericse. So you go back under anesth. and he rebends the knee to the fullest till it pops and bends again. Just breaks all the scare tissue. And the Kim is me my name.....How long have you been skiing? I bet you are terrific. And a great teacher.............
 
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