TKR Kayak59's Recovery Thread

[newlybionic]

You can just use the band aids instead when you go out as long as you have no drainage anywhere. I just had a coulee of steristrips placed where I still had a little drainage. I'm glad you found the cause!!

 

[KarriB]

Paper tape is great though, it eventually did bother me after a month of using it to tape my gauze bandages to my leg. I have to wonder if they have "paper" steri strips.

 

[newlybionic]

I've only seem one type of steristrips in my 20 years as a nurse. When my mom had cut her leg I found a tape in the local drug store that was for sensitive skin. You could ask the pharmacist at the local drug store for suggestions also.

 

[newlybionic]

I've only seem one type of steristrips in my 20 years as a nurse. When my mom had cut her leg I found a tape in the local drug store that was for sensitive skin. You could ask the pharmacist at the local drug store for suggestions also.

 

[New England Librarian]

Kayak, I know what you mean. While still in the hospital I agreed to an anticoagulation program of Lovenox (shots) for 2 weeks, followed by 4 weeks of aspirin. As you say, DUH! Years ago I learned that I can't take aspirin or most NSAIDs for more than a few days because they upset my stomach! I found myself on day 7 of the aspirin regimen wondering why I had such unrelenting tummy pains . Definitely a bad case of brain fog!

I hope your skin reaction as settled down and you are more comfortable today. A lesson learned for your next surgery in a few weeks.

 

[Timetolive]

Glad you figured it out before it got worse! Could you take a Benadryl for the itiching? I love paper tape! It doesn't stick so badly that it will cause damage to tender skin.

 

[kayak59]

@Josephine , Celle , newlybionic; question for you nurses out there.

This may seem like a silly question, but why do I have surface or skin pain all the way down into my foot? I can understand it just below and above the surgical site and because of the tourniquet, l but not all the way down to my feet. Yes I have bruising all the way down but that is just blood and fluid that went there, right? But it doesn't hurt where the blood pooled near the bottom of the heel. Its definitely surface pain, not tissue -- and the swelling near my ankle and calf is minimal -- but I don't remember this kind of pain, even after I tripped as smashed my knee into the wall damaging the meniscus and the whole middle part of my leg was the size of a football. Its not a problem; doesn't hurt unless I touch the skin, so of course "don't touch it, silly"; but I am curious. I assume everyone is experiencing this; its a normal after effect. Thanks!

 

[Celle]

@kayak 59
I've edited out two of the tags from your post above. We do ask people not to make lists of tags; the reason why is here, in the second part of the article:
How to tag another member; how to answer when someone tags you

Now, I'll try to answer your question, but Josephine may have a better explanation.
Firstly, it's still early days since your surgery and you're going to find you get aches and pains in several different parts of your leg.
Secondly, during surgery, your leg was handled a lot, people held your leg in several different places and moved it around.
Thirdly, your lower leg was painted with antiseptic, which your skin may not have liked, even though you didn't react to it.
Fourthly, some nerves were cut during your surgery and others were moved around. All the nerves in your lower leg are going to be irritated and that may be the cause of your pain.

You see, I don't think there's just one answer and I don't think the tenderness will persist. Maybe some icing of your lower leg will help?

 

[kayak59]

Thanks Celle, that does make sense. It does feel more like nerve pain -- perhaps emanating from the surgical site. Fortunately its not a problem, just more of a curiosity.

 

[kayak59]

Hmmm.... might be on the verge of joining the ODIC. I've been doing leg left variations using my left leg, trying to keep the quads strong for the surgery in 3 weeks and yesterday I started doing them on my right as well. Keeping leg straight but only as much as the knee wants to go, doing leg raises and side swipes. Yesterday evening and this morning, a couple staple holes were weeping a bit. Just clear fluid, no extra redness, doesn't look infected. Putting Neosporin on the weeping holes and covering with a bandaid to prevent rubbing on my pants. First time this has happened so I guess that is an indicator to back off. Overall though, the right thigh is getting steadily stronger. I am using the walker but not putting any weight on it -- its just there for "just in case". I think I feel confident enough to switch to the cane now and will ask the PT tomorrow. 13 days post-op, 18 days pre-op.

 

[Timetolive]

Time is moving along! When do you get your staples out? It certainly is easier using the walker in the house. I think I will have to go along all my doorways and repaint once this is over! I have run into all the door casing! Please watch those staples holes. I haven't been brave enough to put pants on yet! Shorts or my stretchy knit capris. I guess when I go to the doctor tomorrow and it is 45 degrees, I will have to rethink that!

 

[newlybionic]

Putting a bandaid is a good idea but just make sure it's big enough to cover the staple holes on both sides of your knee so the adhesive is not bothering those areas. I dragged my walker around just for security for about 3 weeks until I felt secure enough to make the switch. Make sure they instruct you had to use a cane if you don't know already and bring the cane with you.

 

[kayak59]

staples were taken out last Thursday @Timetolive and thank goodness! comfort level definitely increased. That is when they put the steri strips on and I had to take them off because of my skin reaction. That is almost gone, still putting hydrocortisone on the worse spots and now Neosporin on some of the staple holes.

 

[Celle]

Go easy on the Neosporin. It might be enough to just clean the clip holes with saline and then pat them dry with some sterile gauze or a freshly-laundered cloth.

 

[Josephine]

Please watch those staples holes.

That is almost gone, still putting hydrocortisone on the worse spots and now Neosporin on some of the staple holes.

DON'T get hyper about staple holes. They are extremely superficial and will almost certainly close within 48hrs at the most. The little leggies on the staples aren't even 3mm long so they don't even get under the skin!

And do not use any lotions, potions or similar on them either. It's totally unnecessary. God's good clean air will dry them up in no time and that's all you need.

why do I have surface or skin pain all the way down into my foot? Yes I have bruising all the way down but that is just blood and fluid that went there, right? It's definitely surface pain, not tissue

Well, bruising is painful for one thing. And it can make this skin sensitive. If I were you, I'd give it a little massage while you're in the shower or bath. The hot water and soap will be a good lubrucant!

However, I'd like to ask you some questions as well if you don't mind, and 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 compare this with the bone-on-bone pain you had before surgery!

) Also don't forget to include 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 often are you icing your knee and for how long?

4. are you elevating your leg, how often and for how long?

5. What is your ROM - that's flexion (bend) and extension (straightness)

6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

7. what kind of PT exercises and exercises at home are you doing? How much and how often?

Can you describe them like these examples ....

Exercises done at home: 3 sessions a day
Heel slides x10 (reps)
Straight leg raises x10
Steps x10

At PT
Squats x5 (reps) x2 (sets)
Wall slides x5 x2
Clamshells X5 x2

 

[kayak59]

Hi @Josephine

Thank you for the time you are taking to check up on me. I had a nasty reaction to the steri-strip adhesive so I had to use the hydrocortisone -- with PT's approval. I don't need that anymore, the rash is almost gone now. Have not used the Neosporin since last week; no more weeping.

Also, that pointy bone spur definitely damaged my quad but its no longer painful but still swells with use.

"Well, bruising is painful for one thing. And it can make this skin sensitive. If I were you, I'd give it a little massage while you're in the shower or bath. The hot water and soap will be a good lubricant!"
Will do and its getting better

However, I'd like to ask you some questions as well if you don't mind, and 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 compare this with the bone-on-bone pain you had before surgery!

) Also don't forget to include other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness

Accurately gauging pain level is hard for me since I am just so used to being in pain all over - my feet, knees, whole spine, neck, etc. My criteria is: easy to ignore/no impact on movement, (<4) too much to ignore but not affecting mobility, (5-7), hurts alot when I move (8+). Cry out loud is 10+ and I've been told that is a higher 10 than most people. Given that, PT's report last Wednesday (Nov 18) was "minimal swelling" and I'd agree with that - even more so now. Can't say below my knee hurts unless I touch the skin. Maybe a 1 behind knee, feels a bit stuffed - not as much as before. At rest (elevated or straight), knee and first 6 inches of knee feels stuffed, pain level 1. Pulling up for a heel slide, 3 -- and the knee and thigh feels more stuffed. Knee at 90 degrees sitting in chair, 1 at first, goes up the longer I do it. The more I flex, the more stuffed and uncomfortable the feeling is but I can't say the pain goes up more than a momentary 4-5.

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?
I am back to taking 400mg of generic Celebrex in the morning and for me, that works as a pain med. I take Tylenol ES (1000mg rapid release) during day as needed - always before PT and before bed Tylenol Arthritis strength (1300mg extended release).

3. how often are you icing your knee and for how long? I am icing and elevating continuously during waking hours. Stopped icing at night 2 days ago but will resume if needed. Am not being awoken by pain at night.

4. are you elevating your leg, how often and for how long? If I am sitting, I am elevating and icing.

5. What is your ROM - that's flexion (bend) and extension (straightness).
119/123/123 & 0/0/+3 last Wed/Fri/today. On Thursday checkup, Doc said to not go past 120 because bone spur area swollen and hot. Greatly improved since. PT says I do not need/should not try to increase flexion at this time

6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc.
Housework? Ha! I put the dishes in the dishwasher, that is it. Lots of trips back and forth to put the tea kettle on and to feed cats. .

7. what kind of PT exercises and exercises at home are you doing? How much and how often?

frequent PT directed lymph reducing exercise sequence (ankle pumps, quad sets, butt clenches elevated: 10/10/10 x 3, wait 15 minutes, repeat

Twice a day including PT session if scheduled:

heel slides x15, (she does not insist on going any further than I want to.)
terminal knee extensions,
abduction slide, x15
straight leg raise, x15
knee flexion, x15
long arc quad, x15
knee raises against walker, x15
press knee against walker, x15
sitting knee flexion against walker, x15
prolonged knee extension, 5 minutes
clamshell x 5
standing exercise against wall focusing on correct posture and leg position, hold 3 mins
standing knee raises holding onto walker, x15 (added Today)
standing backward leg kicks (slow) x15 (added Today)

I would like to emphasize that at no time has my PT encouraged me to do more or try harder, instead she just corrects my position or technique and cautions me against overdoing it. And if any of these hurt too much the 2nd session, I adjust as needed.

While I am highly motivated to being as fit as possible for my 2nd knee replacement in 2 weeks, I am acutely aware of how easily I could make things worse, not only for my knees but back and neck. Been there, done that, won't do it this time. I take all cautions, warnings, and advice to heart.

 

[Josephine]

The more I flex, the more stuffed and uncomfortable the feeling is but I can't say the pain goes up more than a momentary 4-5.

hm, okay

I am back to taking 400mg of generic Celebrex in the morning and for me, that works as a pain med. I take Tylenol ES (1000mg rapid release) during day as needed - always before PT and before bed Tylenol Arthritis strength (1300mg extended release).

okay

I am icing and elevating continuously during waking hours. Stopped icing at night 2 days ago but will resume if needed. Am not being awoken by pain at night.

okay - good

If I am sitting, I am elevating and icing.

Excellent!

123 & 0/

very good

On Thursday checkup, Doc said to not go past 120 because bone spur area swollen and hot. Greatly improved since. PT says I do not need/should not try to increase flexion at this time

okay

Housework? Ha! I put the dishes in the dishwasher, that is it. Lots of trips back and forth to put the tea kettle on and to feed cats. .

LOL!

frequent PT directed lymph reducing exercise sequence (ankle pumps, quad sets, butt clenches elevated: 10/10/10 x 3, wait 15 minutes, repeat - never heard of such things as 'directed lymph reducing exercises'!

Twice a day including PT session if scheduled:
heel slides x15, (she does not insist on going any further than I want to.) - I would suggest that doing sessions of heal slides twice a day is not productive. Read this to see that I'm talking about Heel slides and how to do them.
knee flexion, x15 - what kind of exercise is this? and you don't need a second flexion exercise
sitting knee flexion against walker, x15 you're already doing heel slides, you don't need a third flexion exercise

terminal knee extensions - what are these?
abduction slide, x15 - can't see these have any benefit whatsoever!
straight leg raise, x15 - let me tell you something about SLRs - once you can do them you don't need to do them any more!
long arc quad, x15 - this is the same as SLRS
knee raises against walker, x15 - same again
press knee against walker, x15 - don't see the benefit of these at all!

prolonged knee extension, 5 minutes - hm okay
clamshell x 5 - clamshells are teh invention of the devil and customized to case IT band issues
standing exercise against wall focusing on correct posture and leg position, hold 3 mins - :s
standing knee raises holding onto walker, x15 (added Today) - another invention of the devil! You'll get quad tendinitis!
standing backward leg kicks (slow) x15 (added Today) - very slow, I suggest and only 5 at a time!B

I strongly suggest you read my recovery threads to see what exercising I did!
First knee. Knee recovery - UK style
Second knee. Josephine's 2nd knee story - short version where I did even less!

 

[kayak59]

@Josephine

Thank you for your comments and advice. Here are a few comments about your comments.

frequent PT directed lymph reducing exercise sequence (quick ankle pumps, quad sets, butt clenches, elevated legs: 10/10/10 x 3, wait 15 minutes, repeat - never heard of such things as 'directed lymph reducing exercises'! Nor had my second physical therapist. She said that "lymph fluid reduction" was a specialty in its own right. My first Physical Therapist had had bilateral knee replacements and I assume she learned this at some time in her career or perhaps during her own recovery. All I can say is that I did not do this enough to hurt and within 48 hours, the swelling was 95% gone from my foot and ankle and at this point, 95% gone from most of my calf. By the way, I am also taking hydrochlorothiazide, 25mg once a day and that may be helping with the swelling too. My upper thigh still looks and feels like a half set jelly but I'm not complaining.

Some additional comments on the PT exercises below. I made some mistakes while recording them the first time. By the way, after my 2nd knee replacement, I know I'm going to reset and will probably have different and less exercises for the right knee. Will not assume I can pick up where I left off. Oh, and did I mention that I am hyper mobile/ aka "double-jointed"?

Twice a day including PT session if scheduled:
heel slides x15, (she does not insist on going any further than I want to.) - I would suggest that doing sessions of heal slides twice a day is not productive. Read this to see that I'm talking about Heel slides and how to do them. Will do and I don't try very hard the second time at all.
sitting knee flexion, x2, hold for 20 secs. - what kind of exercise is this? and you don't need a second flexion exercise Oops, only two times, slide heel back as far as I can and hold.
sitting knee extension (not flexion) against walker, x15 you're already doing heel slides, you don't need a third flexion exercise. Against walker to keep my knee raise straight up and control horizontal movement.
terminal knee extensions - what are these? This is the one where, lying down, you put a pillow under your knee and raise from the knee. (Its what the written instructions and picture calls them.)
abduction slide, x15 - can't see these have any benefit whatsoever! Works the inner thigh; similar to my Pilates exercise. Doesn't hurt.
straight leg raise (flat on back), x15 - let me tell you something about SLRs - once you can do them you don't need to do them any more! These were and will be a part of my regular exercise/Pilates routine. Doesn't hurt so will continue - carefully.
long arc quad (sitting), x15 - this is the same as SLRS Feels very different sitting vs lying down. Lying down requires use of abs too. The stronger my abs, the stronger my core and lessens likelihood of back pain.
knee raises against walker, x15 - same again This is more controlled, concentrating on vertical, no horizontal movement.
press knee against walker, x15 - don't see the benefit of these at all! Works the inner thigh; similar to a Pilates exercise and important for kayaking. Doesn't hurt.
prolonged knee extension, 5 minutes - hm okay
clamshell x 5 - clamshells are teh invention of the devil and customized to case IT band issues Doesn't hurt but will be very careful. Similar to a Pilates exercise
standing exercise against wall focusing on correct posture and leg position, hold 3 mins - :s
standing knee raises holding onto walker, x15 (added Today) - another invention of the devil! You'll get quad tendinitis! Similar to a Pilates exercise I did and believe me, I know when to back off.
standing backward leg kicks (slow) x15 (added Today) - very slow, I suggest and only 5 at a time! Will do but not difficult.

Again, thank you for your advice and comments. I have learned the hard way to be very careful in any kind of exercise program and after a "major body insult". If I have any concerns, I'll listen to my body and back off, also taking into consideration the recommendations made by those who have already gone through this.

 

[Josephine]

 

[kayak59]

16 post-op, 13 days pre-op.

Those numbers are very much in my mind these days but only looking forward to getting the 2nd knee done; feel like I'm in a holding pattern right now. Right knee is healing very well but my physical therapist wants me to continue using the walker and really concentrate on my gait. I had not realized it was so bad but I am sure my fairly chronic back and hip pain was affecting it long before the knee pain kicked in. She says she is seeing some new muscle development in the right quad so that is good. (And I didn't realize how atrophied that muscle really was, either.) Still having pain and swelling from the bone spur site. I don't put weight on the walker but its there just in case. I am shuffling around without the walker in the kitchen and bathroom where I have something to grab onto if necessary; but walking properly is work and takes a lot of concentration and different muscles groups. I am now allowed to walk outside up the mailbox -- whoopee! But I probably won't be allowed to drive before the 2nd knee surgery. :-( (Which doesn't mean I won't but I won't need to until the two days prior to the surgery.)

This is work day 3 and I am really glad that I can sleep in tomorrow. Its not physical but still very tiring. I don't know how people go back so soon when they actually have to go in to work. You have my admiration, people!

Went for my pre-surgery work at the Surgical Evaluation Center yesterday and found out that I left the hospital still quite anemic. Iron is supposed to be 12 something and I left at a low 8 something. The nurse checked it again and it was still in the low 10. I was not told to start taking iron when I left the hospital but the SEC nurse told me I should start now so I can get it back up to normal or higher before the 2nd surgery.

Happy Thanksgiving everyone!