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Indygo

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My TKR was on May 15th, so I'm day 12 or 13.

I've had deteriorating knees since my last pregnancy, 30 years ago. There's been nothing unusual (so far) in my recovery process, though I had a terrible time with the oxycontin and had to stop taking it after three days. I've continued with the oxycodone and Tylenol.
I still battle swelling quite a bit and of course the pain.

My question right now has to do with activity. I do the stretches three times a day and walk when I need to, but what about cardio health? As my knee heals, I'm worried now about the rest of me, particularly cardio health.

I'm trying to take a couple of five minute walks a day, but when I do that the knee swells so it's harder to do the stretching for ROM. And when there's swelling, there's pain and so I need to continue the oxycodone every four hours and would like to start cutting back.

Thank you!
 

Roy Gardiner

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when I do that the knee swells
The answer always is, 'don't do it then'. You won't suffer, healing goes at its own pace.
I'm worried now about the rest of me, particularly cardio health
Please don't worry; you can start exercising again when the knee is more on the road to full healing.

Knee Recovery: The 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 Activity progression for TKRs
6. Access these pages on the website


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 a 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 history before providing advice.
 

DLR

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Welcome the moderators will be along with suggested reading. For now you simply need to listen to your knee, the time for cardio will come later on. Right now, simply focus on rest, ice, elevate and medicate with shorts walks to the washroom or around the house. Knee surgery is a huge trauma and your body needs to heal. Wishing you all the best.
 

Josephine

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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?
 
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Indygo

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Absolutely, Josephine!
 
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Indygo

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I would also say that my concerns aren’t as much with fitness as with wanting to start getting healthier. I’d become so sedantary because of my knee and kept adding pounds. My blood sugar is borderline for type 2 diabetes. Part of my motivation for doing this is to find the strength to get healthier and I’m so afraid that this time I’m spending on the couch is going to make it even harder. My daughter is getting married in six months to a wonderful person and I want to be able to dance at least one dance! Thanks for any advice!
 

Roy Gardiner

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You can do any amount of upper-body exercise, no problem. A gym might help with that, although I can easily understand you might be a bit shy of going. Might there be somewhere near you offering weight training classes (or personal tuition, even) for seniors? I have bought a set of dumbbells for about £40 for arm exercise, dead cheap. I'd suggest ones where you can add/remove weight.

You could also invest in an exercise bike, great for both knee stretches and later for fitness.

Using a bike to gain ROM is pretty simple:
  • Set the bike to zero resistance
  • Set the saddle low enough so that a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
  • Gently turn the pedals, through discomfort but without pain.
  • Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
  • Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
  • Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
  • And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't
Here is a bit more chat and some pix and how 'healing' and 'training' are different

I am a T2 diabetic. I suggest you look at diet with a view to eliminating as much sugar and starch as possible (obviously chocolate, cake, etc but also white bread, white rice and similar). There's any number of books on the subject, and it isn't complicated.
 
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Indygo

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Thank you Roy. This helps a lot. I hadn’t even thought of doing upper body exercises. I belong to the Y and they have stationary bikes there, so I’ll add that to my regimen once I’m ready to go outside the house again. For now though, I’ve got my husband looking for my long-unused weights.

Speaking of going outside the house, is the an average day or week when people feel ready to face the world a bit? My PT is coming to my house until next week, so that will probably answer my question.
 

Jockette

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Speaking of going outside the house, is the an average day or week when people feel ready to face the world a bit?
If you go back to the Recovery Guidelines that Roy gave you, you’ll see an article about week by week activity guide.
 

Benay

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For me, 3 weeks out, when I feel normal I can't put the brakes on the overdo. I've been to the market a couple of times, done casual dinner for friends - with lots of help but think it sets me back painwise and recovery wise the next day or two. I'm really trying to curb the tendancy and take only baby steps forward. My mantra is patience. I've got 3 weeks under my belt and 49 left to go.
 
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Indygo

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Thanks Jockette and Julieskan. I forgot that the Recovery Guidelines mention going shopping. I won't rush it.
 

Josephine

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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.
 
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Indygo

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Here you go:
1. Pain level from 1-5

2. OxyContin 10 mg every four hours
Tylenol 1000 mg, 3 times a day

3. Moderate swelling

4. 88 (91 once!) and 2

5. Yes. I was doing it 3 times a day but just got a Polar ice machine so I can do it longer and more often, without having to keep freezing and refilling bags. I hope this will help with pain and stiffness

6. A lot! It’s elevated when I’m not doing something that requires walking or exercises. I feel like I’m doing this too much. I’ve listened to a lot of music and read

7. Making myself snacks and moving laundry from washer to dryer. See answer to question 6!

8. Three sessions a day.
Heel slide 10 reps
Leg raise 10 reps
Quad sets 10
Straight leg raise 10
Short and long arc quad 10
Heel prop 5 minutes

Same thing at PT, 3 times a week. Next week I start leaving the house for PT.

Starting two 15 minute walks a day.
 

Josephine

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1. Pain level from 1-5
3. Moderate swelling
Moderate swelling, being itself a form of pain, adds 4 points to your pain score. So I now make that a 9!
2. OxyContin 10 mg every four hours
Tylenol 1000 mg, 3 times a day
Sounds good.
Not too bad
5. Yes. I was doing it 3 times a day but just got a Polar ice machine so I can do it longer and more often
Good!
6. A lot! It’s elevated when I’m not doing something that requires walking or exercises
But are you elevating correctly, as per Elevation: the do's and dont's
7. Making myself snacks and moving laundry from washer to dryer
Good


Three sessions a day - once a day would be plenty and none at all at the weekends
Heel slide 10 reps - your ROM is good enough and will improve with the walking. You don't need these now
Leg raise 10 reps - once you can do these you don't need to do them any more
Quad sets 10 - same here
Straight leg raise 10 - and here
Short and long arc quad 10 - and here
Heel prop 5 minutes - and here - none of the supposed exercises that are supposed to improve extension don't work and may even worsen the swelling and pain so don't do them
Starting two 15 minute walks a day - that's good
Same thing at PT, 3 times a week. Next week I start leaving the house for PT - I strongly suggest you don't go to PT. Cancel it.

If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?

Don't misunderstand me - you are doing well. I just want to see/hear you doing even better but you're not going to if you start PT sessions. The walks are plenty for now..
 
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Indygo

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Thanks. Josephine. Today I didn’t do PT but walked more and iced and I felt better until right now, when I crashed—physically and emotionally. We had a large tree blow over—roof ball and all—and a leak in our basement so I was managing workmen by phone as well as dealing with work emails. My husband has been doing so much for me, and I worry about him overdoing it. Nice to have a place to vent. I can already tell that stress doesn’t help the recovery.

Would going to the Y and riding a stationary bike be better than PT?
 
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Indygo

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So it's the next morning. The tree removal guys are here, the dogs are barking, but everything seems better in the morning. I can walk a bit more without breaking out in a cold sweat and I feel like I can manage better. This feeling usually lasts until around 4:00.

It's funny, though, because I've always been a night person and part of this recovery seems to be that I get up at 5:00 and get in bed (though not to sleep for a couple of hours) exhausted every night at 7:00. This morning was one of the few times in my life where I listened to the birds wake up.
 

Jockette

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This morning was one of the few times in my life where I listened to the birds wake up.
I am not a morning person, either, but during a week spent on the Outer Banks, NC, sleeping in a room facing the east, I was up every morning to view and take pictures the the awesome sunrises over the ocean. It was the first time I had ever stayed someplace where I could see the ocean from the house I was staying in.
 

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@Indygo I thought it interesting when you asked about going to the Y and biking instead of PT....
I can still hear my surgeon answer my PT questions from my Pre-op appointment, as I was terrified he'd recommend aggressive PT like what I'd had years before.

My surgeon actually laughed and said the PT thing has gotten out of hand with TKRs. He proceeded to tell me he doesn't send all of his TKR patients to PT only the ones who obviously need it. For a complete recovery, he says all you need are 3 things: 1) to do the basic post-op exercises sent home from the hospital, 2) ride a stationary bike 5-10 minutes a day once you're able to get a full revolution, 3) your normal activities of life.

It's very similar to the Bonesmart way, except he does think a few basic exercises are beneficial early on. I've found few people who were ever advised this in my part of the USA, so I love sharing it with people. :)
 
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Indygo

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Thank you Rockgirl. That was really helpful! Going to the Y and riding a bike sounds so much better than someone pressing on my knee, which terrifies me.
 

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