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It's Done - 4 days post op

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Well, I had my staples removed today by the P.A. who was a jerk! I asked for more pain pills and he hemmed and hawed but will prescribe 50 more for me. I asked him about sleeping aid since night is the worst for me which then requires more pain pills. He asked me if I was sleeping during the day and I told him 15-45 min. on occasion because I was so tired from not sleeping. He then lectured me that sleeping during the day takes away from sleep at night. I wanted to slap him! I occasionally fall asleep during the day because I cannot function on 3-4 hours of sleep every night. I told him I had no plan to become dependent on pills or sleep aids, that I wanted to try to get sleep cycles in order so I could return to work. He suggested I could get back to work by not using meds....remember, I am 11 days post op. He finally said he would give me a few if I "insisted" and I did insist. To make matters worse, my husband I got home only to find someone elses name on the prescription. We live 30 minutes from his office, so it now will take at least 1 hour to get a RX to the pharmacy, and longer still to get to me. I've been out of meds since Wednesday and have been using some weaker meds from my arthroscopic surgery. I don't ever want to see "Carl" the PA again because I may scratch his eyes out! Sorry...just had to vent! Anyone else have to deal with a pompous physician's assistant?
 
Oh brother! He does sound pompous! Beside which, he's got his facts all wrong. You really don't want to be using sleep aids just yet as you are on narcotic pain meds. And sleep disturbances are part of the deal with major surgery. Your naps during the day are part of that deal and part of your body's needs during healing. So you should be catching naps during the day and whether or not that impacts on your sleep at night is beside the point. Actually, I'm of the opinion it doesn't.

It would be more to the point if you would resign yourself to some sleepless periods at night and just get up and do things like read a book or log into BoneSmart until you feel ready to sleep again. It doesn't last forever.
 
jeauix - you have raised several points, sleeping issues, ROM, PT. I had RTKR 12-21-10 so I can tell you that things will get better. On the PT issue: I stopped my PT "earlier than thr OS wanted simply because it was wearing me down once I went back to work (went back to work at 6 weeks.....WAY TO EARLY!). Anyway, I pretty much did the home PT stuff they provided me and my ROM had increased wonderfully. Pre-op I was 70 degrees. Today I am at 148 ! Takes only a small part of the day to stretch, stretch, stretch. I even stretch at work.

Sleeping was an issue for me as well. Actually my sleeping (everyone is different) did not come fully around to normal until about 2 months ago (6 months post-op or so). I went thru the sleep aid thing and it did not work really. My OS was correct - sleep issues are caused by pain - take the pain meds before you go to bed. That was his advice and it was better than the Ambien that I got from my GP.

I weas fortunate to have an OS that is also very pro pain management. I still have Tramadol avaialble and use only randomly. Takes the edge off depending on my activities.

My strength is coming along on my own schedule (no PT) with daily activities. I will likely join a gym to get some weights in there as winter comes. My bike is a great way to keep my ROM and some strength.

Everyone is different.....the road is long. According to my OS i should expect 5 more months until everything is "normal",

Good luck !
 
Sandi,

I am almost 9 weeks out and I can really relate about issues with the PA. read most thread and you'll see what I mean.
Question on Pain Meds ( 1 2 )
karmigirl

Welcome to the other side and keep us up to date on how you progress. Yes sleep seems to be everyones issue on Bonesmart. Just part of the journey we are on.

Rose Madej
RTKR 6-6-11
 
Today I started using a cane instead of a walker which is a small step to becoming more independent. I still use the walker first thing in the morning, when I get up at night and when I am feeling extra tired...just for added support.

I read through the articles mentioned and it makes sense to me (sleep, pain meds, etc.) and my husband and I have decided we will not see the PA again for a number of reasons.

I am continuing to stretch, ice, elevate, rest, and use CPM (although not the 4-6 hours a day they recommened - not even close) and I am still seeing gains in ROM.

Thanks for pointing me in the right direction!

Sandi
 
I am FOUR days out and around the knee its quite toasty. Good to know that this is a common occrance and won't be alarmed when weeks down the road it will still be warm..aka...HEALING

Great job on using cane only!!!!
Natalie
 
Also be aware, that after PT sessions the knee might be even warmer than normal. MT PT started each session with applied HEAT and electrical stimulation to get the juices flowing, then afterwards, icing for 15 minutes and sent me home for more icing.
 
Update: 17 days post-op and I am continuing to make small gains. Today P.T. measured flexion at 96 degrees today and extension at +6. I have very loose joints so OS put in an extra wedge (?) to keep me from hyperextending the new knee, so I wonder if that is making it slower for me to reach 0. I had to do exercises with 1 1/2 lb. weight today which was a bit taxing for me even with the pain meds prior to P.T. I am only seeing P.T. 1 x week for 2 more weeks. They are ready to move me to cycling but I know if I get a stand for my bike I can replicate it at home, too. I am starting to sleep more and I have been able to spread out the daytime pain meds. I was able to stay up quite a bit yesterday standing and sitting, but don't want to push the limits too soon either. Now I will ice the knee and put heat on my cramped muscles.
 
Do continue to not push too hard. The weights might be a bit premature, so if you have pain from that at therapy or afterwards, cut that back. You're right that the cycling will be an excellent exercise.
 
Thank you! I am paying the price with restricted ROM today, swelling, and increased pain. I am not ready to add weights as I have been pretty much off that leg since April. I'm not even sure my "good" knee could handle 1 1/2 lb. weights without pain and cramping. I think I will get an indoor trainer to put my bike on and do my own therapy. I've got several guides with exercises and may just go at my own pace. Not once has P.T. talked about stretching and relieving muscle aches which, if I work this hard, should have been discussed. I'm frustrated but appreciate your feedback so much!
 
The PT I had in the hospital was excellent. Demanding, but in a gentle, encouraging way. My outpatient PT is a little more tough, and I think I'll be having a talk with her this Tuesday. She is very concerned with measuring everything first, and then working on getting to the number she wants me to be at. When I went last Thursday, she immediately had me lie down and measured my heel slide. I didn't do well enough (as well as the previous Tuesday), and she immediately pushed me harder to get there. I think she should have started with me doing the slides, and then when I had done a set, measured to see where I was, and then try to push a little harder. At least I would have worked up to it! I'm hoping to clear this up so we can have a good working relationship!

KneedKnees

BTKA - August 5, 2011
 
KneedKnees.....YOU have the right idea. Now educate your therapist!!!
 
I was closer to 6 WEEKS when my PT did the weights to help me gain extension. But I'm bigger and he added more weight :( Not my favorite time in PT... Just make sure if you put your bike on a trainer, that you have someone help you on and off the first few times in case you have any issues getting on or off. I still enjoy riding the bike indoors sometimes. Don't be discouraged if you can't get the pedals around since real bikes have longer crank arms than the exercise bikes do. Still rocking back and forth never hurts.
 
Update: I will be 4 weeks post-op on Monday. I see daily progress and I have been able to reduce pain meds to 1 at bedtime and 1/2 Vicoden halfway through the night. 1/2 in a.m. and 1/2 mid-day. I now only wake up 1 time during the night for pain/discomfort instead of every 2 hours and stay in my own bed instead of wandering the house for something to sleep on. I will still take pain meds whenever I need them, but am also running low so hope the surgeon will okay refill when needed. I have been going in to school every day for 3-5 hours to set up my classroom and go back and forth between cane and mobility chair. I mainly will use mobility chair in hallway to shuttle kids as we have 1000 elementary kids in our 2 story building. There are frequent traffic jam and I don't want to get knocked over :) I continue to have the tight band above the knee which indicates it is still swollen inside and I continue to ice it throughout the day. After reading numerous posts I feel assured that it isn't anything I am doing wrong...it is what it is! Visually there is very little swelling noted on the outside. ROM hovers between 85-110 degrees depending on how tight that band is which is my biggest frustration. I have been able to walk around stores with my husband but still use a cane for stability and am increasing walking around the home without the use of a cane. This week I have been able to walk heel/toe with my new knee and there is much less of a limp! Woohoo! I still have not made my mind up about returning full-time to teaching in 2 weeks and will see how the next week fares for me. My goal for the next 2 weeks is to increase strength as well as ROM.
 
jeauix said:
Update: I will be 4 weeks post-op on Monday. I see daily progress and I have been able to reduce pain meds to 1 at bedtime and 1/2 Vicoden halfway through the night. 1/2 in a.m. and 1/2 mid-day. I will still take pain meds whenever I need them, but am also running low so hope the surgeon will okay refill when needed.

I continue to have the tight band above the knee which indicates it is still swollen inside and I continue to ice it throughout the day. After reading numerous posts I feel assured that it isn't anything I am doing wrong Visually there is very little swelling noted on the outside. ROM hovers between 85-110 degrees depending on how tight that band is which is my biggest frustration.
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Yes you are doing something wrong - your second paragraph tells me that you should not be reducing your pain meds yet. 4 weeks is still very early in recovery and you need to continue taking them until that tight band begins to recede. I'm sure your surgeon will give you a refill but if he doesn't you can always get them from your GP instead. Generally there's no problem about that. And it would seem that surgeons are sometimes restricted on how many refills they can issue but it doesn't mean that you can't get them from elsewhere. You need them so don't be concerned about that.
jeauix said:
My goal for the next 2 weeks is to increase strength as well as ROM.
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Don't have goals. Let it happen as it happens. And it's also too early to start thinking about strength training. Your knee is still healing - let that be your goal for the next 4 weeks or more.
 
I wasn't cleared for strength (weight) training until almost 10 weeks out. 4 weeks, wow... It was well worth the wait!
 
Almost 5 weeks post-op and saw surgeon today for the first time since surgery. ROM was over 100 flexion and with pressure I had good extension. Doctor thought I was doing great but wanted me to consider going back to P.T. I explained insurance only allowed 1 more visit and I didn't want to pay out of pocket for now. I explained that I was doing home exercises, stretching, etc. I have been able to make a full rotation on pedals and am able to do 5-10 min. slowly.

I told the doc that I had hoped to return to work next week and he agreed to a M-W-F schedule for 3 weeks and then we will re-evaluate. I don't like missing school for a ton of reasons, especially at the beginning of the year. I do trust the OS as he has had a knee replacement but I am glad he is willing to listen to me! I have been going into school 3-6 hours nearly every day since Aug. 15th to prepare my classroom (with husband's help) so have been progressing in stamina. That's all for now. Still looking for that light at the end of the tunnel when I no longer feel discomfort from the tightness/swelling. One day at a time :)
 
I agree wholeheartedly with Josephine's "no goals" point. When you set goals, you can set yourself up for frustration. While "we" like to be in charge, the :knee" is in charge. Let each day come and take it in stride.

While I believe that you should wait a little longer to return to the classroom, I guess the M-W-F setting is better than going back full throttle.

I know how you feel about the light at the end of the tunnel--i had a limp and tightness after my BTKR for quite some time.

Trust me, though---the light at the end of the tunnel will come and the tightness and frustration will be gone.
 
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