Bilateral TKR La's new knees (recovery diary)

[Larosser]

Re: La's new knees (recovery diary) Things they make you take

La, you do know the daily maximum for Tylenol, don't you? It's 4,000mg per 24hrs.

Hi, Josephine. I know that now, wasn't something I'd previously considered as I did not take tylenol prior to the surgery. I am actually kind of surprised that you can't get the hydrocodone without some sort of NSAID - wonder is that required for effectiveness?

If you take 2 Norco every 4 hours, you end up with 3900 mg of tylenol every day. That's how most of the doctors apparently prescribe it. Mine did it "every 3 hrs, PRN" for which I was really grateful a couple of times, but it did mean you had to think a little more about how much you had, when.:rolleyespink:

Now that I'm home and starting to heal, every 4 hours is plenty adequate.

La

 

[Larosser]

One thing I would like to add is when in hospital and you are being given your meds ask what everything you are getting is and what it is for. As La said you can refuse anything you don't want to have but you must speak up for yourself.

Super good point. Always ask what you're getting, the nurse will tell you and it's good for you to know.

 

[Larosser]

Re: La's new knees (recovery diary) Ready, Set, Home

Okay, so I want to finish up the in-hospital installment of this diary, so we can talk about home - that's where most of the fun happened.

By the end of Post Op Day 1, I'd regained feeling in my legs, gotten my catheter out and walked to the end of the hall an back, all prereqs for getting released from the hospital. I'd also had an epically bad experience with getting out of a chair, but I don't want go back into that right now.

On the morning of Post Op Day 2, Corey the Wonder Therapist took me walking again and got me a less evil chair to sit in, and then it was time to unwrap my presents. The nurse came in and took off the miles and miles of ace bandage to reveal a foot long gauze dressing on each leg. The dressings were simple, looked like they'd been put on in a hurry and were oozing a bit. They came off easily and painlesslessly to reveal clean broad straight wounds over the top of each knee, held together with staples. A bit Frankenstien-y, but actually less dramatic than I'd expected, having looked at photos of the work involved in the actual knee replacement

My surgeon and the nurse seemed pretty happy with the wounds and assured my that the bruising - my lower legs were so discolored that they looked like the skin of a snake - was normal. At this point, I got to take a SHOWER (yay!). A tech helped me get undressed and situated on a bench in the walk in shower, and I was able to do the actual washing up myself. Got a bit of help with drying and dressing, and got to put on clothes - loose sloppy athletic shorts, a t shirt, and gripper socks. Stylin'! Shorts turned out to be the right idea - want to keep the wounds and dressing accessible. Loose is also good because there's quite a bit of swelling involved. Gripper socks are also essential to avoid slipping. One other note about clothes: I found that any bands of elastic - on shorts, socks, sleeves and underpants eventually became irritating. The harder and narrower the band, the more offensive. Just sayin'.

At this point, the nurse redressed my wounds, and told me that before I could go home, I'd need to get my blood count up and poop - in addition to getting my surgeon's okay.

Pooping was more of an issue than I expected - inactivity and hydrocodone really slows the system down. A few shots of prune juice and walks eventually got THAT box checked.

On the morning of Post Op Day three, my blood count was still going down. The hospital doc told me that they'd keep me at least 8 hours after the transfusion, so we decided to go ahead and get that underway so I could be released the next day. Glad we started early - had to order the blood from across town, and then taking on two units of blood took about 6 hours. It wasn't really unpleasant, just a little confining. I got a little chilled, and if I wanted to go somewhere (like the bathroom) the IV pole had to come with me.

After the transfusion was done, my blood pressure rose a bit, into the low normal range. I also started to feel a little more myself - less tired and woozy.

The next morning, my blood count was up, and everything looked good for my release. McQ had everything packed and ready in no time - he was sick of sleeping on a bed shorter than him, and he'd pretty much eaten everthing in the vending machines. I was ready to go as well....tired of having my finger stuck, sick of being woken up, and just generally ready to be back in my own space.

A nurse came and put on a water resistent dressing so I could shower, gave me my morning meds, and then all we needed was for my surgeon to stop by and okay the release. Um, that took a while. My advice on your last day: go ahead and order your meals, and don't be afraid to nap.

When my OS came in, he went over what meds I was taking home and why (hydrocodone for pain, inoxoparin for clot prevention), how to get set up with home health, when to come see him, etc. As soon as he gave us the thumbs up, we tried to bolt for the door. I will be forever grateful to nurse Doug for slowing us down for one last dose of pain meds before we headed out.

Of course, I was pushed to the car in a wheelchair. McQ brought the station wagon, since we had a walker and such to take home. I was able to get into the front seat, but it was surprisingly challenging, even with the seat pushed all the way back. Your knees really don't want bend much at this point.

The ride home was fun - I'd been in the hospital long enough to appreciate the scenery outside, and I was definitely anticipating being back in my own space. I also felt kind of triumphant - we'd done made it! Or maybe that was just the two units of blood. At any rate, I was pleased to be leaving.

 

[Josephine]

I'm not a great advocate of using anti-inflammatories for the immediate post-op period. That kind of swelling is not what NSAIDs are designed for. If you've had major trauma you would expect there to be swelling and this kind should be treated with elevating and icing.

However, when the acute post-op stage is over, then they are a good supplement to pain meds. NSAIDs are not a very good pain medication in themselves, no matter what the makers of Advil would have us believe! For many years I've taken a Tylenol/ibuprofen cocktail and we used it in recovery along with codeine for patients who were going home the same day and so couldn't have morphine. Interestingly, Reckitt Benckiser have just brought out a drug called Nuromol which is 500mg paracetamol(Tylenol) and 200mg ibuprofen which is exactly what I've always taken! I think they must have been hacking my phone! What I want to know is why on earth someone would pay about four times as much for this than when getting generic stuff from Asda (Walmart)!

 

[Larosser]

Re: La's new knees (recovery diary) SLEEP

Hi, all. Sorry to have gone dark here - hope to be back tomorrow. Ever since the surgery, my sleep/wake cycle has been awful - very little real sleep, lots of floating around dazed. Well, it's caught up with me. Except for PT, eating and bathroom breaks, all I've done for the last 24 hours is sleep. And now I'm going to go sleep some more.

La

 

[lreaves]

Hi La,

Thanks so much for your posts. I have to admit I chuckled through most of it. I had that blood sugar issue and did not enjoy the what seemed like continuous finger pricking and yes the lack of ability to time food intake with testing. I also had to be given blood and it seemed to take forever.

You're so right, if you can have an "advocate" with you in the hospital it's a great idea. I was so fortunate that my dear friend and tennis partner is a nurse Oh yea, she kept them in line. They delayed my pain meds once and she was on this poor guy like white on rice.

Good luck with your recovery. Look forwarded to reading more of your saga.

 

[Larosser]

Re: La's new knees (recovery diary) - Home (work)

When we got to the house, I really appreciated the "rehearsal" that Brian the Side-kick Wonder Therapist had given me on getting into the house. We'd talked through how to stand up out of a car seat, how to use a walker on grass and practiced going up stairs. By the time I'd done all three of those things and made it into my own bedroom, I was exhausted.

Getting into my own bed for the first time, I realized something I was going to miss: bed rails. And the overhead trapeze. And hefty techs to help you get in and out of bed. The bed at the hospital was foam as is mine at home, and Corey TWT had set the bed height to the same as my bed so I could practice, but I did not consider the differences between a twin sided foam bed with hospital railings and a trapeze vs. a frameless king size bed. Getting positioned on the latter is a challege and involves a form of locomotion similar to a seal on ice - if the seal wer flipped over and required to squirm on her back. I give McQ a lot of credit for not laughing at me - mostly, and even more credit for getting some wood and fashioning a headboard that I can use to wrangle myself around with.

Checkout and the trip home had pretty well exhausted me and I was looking forward to a nap from which no one would awaken me to prick, squeeze, prod or dose me. Shortly I found out that only about half the reasons that I didn't sleep soundly were caused by the hospital. I still had to deal with random aches and stabbing pains in my legs caused by bruises and staples, starting and twitching (I think caused by the hyrdocodone), stuffy nose and dry mucous membranes (partially surgery partially allergies), noise from McQ and the kids "tiptoe-ing" in to check on me, etc. And then, there was the home heath agency calling to send a couple of nurses and a PT evaluator to check me in. Well, FIE! Still no real sleep.

Also, my sister was in town for business and decided to come stay with us that night. A few words of advice to anyone planning a visit to a relative who has just had TKR: Don't expect to be entertained. Everyone will be too busy. DEFINITELY don't get on the wrong train heading for the other side of the city and expect to be picked up - people will yell at you. And don't be offended when the relative you came to visit drops off to sleep snoring lustily in the middle of your sentence. Once we got past the original trauma, it was nice having her there. Disjoint, unchallenging conversation was about all I was good for - too scattered for books or even movies at this point.

First night home, McQ cooked us a nice celebration dinner and I sat in my kitchen enjoying good food, good company and my own home. Well, same song, second verse. I sat too long, let my pain meds run down, couldn't get up from a new chair. *sigh* Just like at the hospital, I spent half an hour bawling and sniveling while ice, elevation and pain pills got me limbered and lubricated enough to go to bed. I've REALLY got to watch that one!!!

The next moring, McQ set to work on building raised platforms for my lounge chair, which he'd determined was too low for me to get in and out of reasonably. He's been pretty amazing this whole time - blazing around building, removing, re-arranging so that daily activities are safe and do-able for me. Bless him, this WOULD NOT have worked without him.

One word about coming home quickly: The first week or so is VERY challenging on the caretaker. Not only will you be doing everything you did at hospital, but everything that the patient used to just ring for as well. And often, you're going to be doing in without some facilities you took for granted. Where do you get ice chips now? Warm blankets? Do you have plenty of flat freezer space to chill ice packs? How do you feel about helping with baths and toileting? Take this into consideration when planning your escape. I'm VERY happy to be home, but I worry some abour running McQ to death.

 

[Larosser]

Re: La's new knees (recovery diary) Home Health and Physical Therapy

One of my first "at home" experiences was checking in with Home Health and PT, and they've been my mainstay of contact with the medical system since then.

As soon as I was released, they were all over me - when will you be home? What time can we see you? I responded to their urgency by scheduling my check-in appointments for about an hour after I expected to get home. In retrospect, I wish I'd told them to cool their jets. It's not unreasonable to plan for food, a nap and to get your prescriptions filled before the work starts.

The nursing check in wasn't too bad. Blood pressure, pulse, temp, questionaires. The only hitch was that we had to call the pharmacy for info on my scrips, since they were still in the process of being filled.

The PT evaluator came at the same time, and the good part of that is they both took their notes - I would have had to repeat if they'd come separately.

When the PT guy went to start his work, I told him that my pain meds were overdue and that we didn't have them yet. His response was "no big deal". McQ got up and left. (I found out later he nipped over to the pharma and arranged to have my scrips moved to the top of the fill queue - GOOD McQ!)

The first part of the PT eval was what I expected - measuring extension and flexion, push strength test. A little unpleasant in my unmedicated state, but tolerable.

Then he said, now we need to do a timed sit/stand test. He pulled my walker away (I was in a straightbacked chair) and instructed me to stand up and sit down as many times as I could in 30 seconds. I asked him to repeat that. (Remember, I haven't done an unassisted stand yet - I'm feeling pretty proud that I can get in and out of a seat with just McQ and a walker.) Yup, he confirmed, that's what you need to do. "The average person your age can to 11 to 15 of these". The nurses didn't object, so...I tried.

Without anything to lever up on, I made a couple of controlled attempts and couldn't get through the rising motion. I had to sort of throw myself up to get past the "pulling" part of the motion to the push. (I could hear Corey the Wonder Therapist cautioning me, "Don't thrust and flop. Control your motions, Use your leverage - WHAT frigging leverage? Evil Chester has my walker!) I managed to get into a standing position with a surge of about level 8 pain.Coming down was worse, and I yelped as I hit the seat. He still had that damn stopwatch out, so I gave it another go. This time, the pain was a solid level 9 all the way through and I was sobbing aloud. Chester was in the middle of saying "You still have nine sec-" when the door slammed open. McQ was standing there with my pain pills and a gatorade. He handed them to me saying "don't move". He pointed at Evil Chester and said "you're done" and went to get ice for me. As Chester was packing his bag, he commented, "It will be interesting to see if the next client has as much difficulty as you do. You're my first bilateral. It would have been almost worth the pain to leap out of the chair and bite his throat. Almost, but not quite. So I satisfied myself with glaring at him.

On Monday, my assigned physical therapist turned up. "Did you take your atenelol today?", he asked. I told him I'd taken it an hour ago. "Why is your pressure still so high?" "Because you're here," I snarled. "We need to talk." After some stern quizzing I ascertained that a) he had worked with BTKRs before b) he was familiar with my doctor, the hospital I had gone to and their therapy approach and c) he had no plans to do timed sit-stand testing.

I told him, "Look, I want to get well. I'm willing to work hard and endure some discomfort, but I need to know that you aren't going to ask me to do anything that's impossible, egregiously painful, or dangerous to my recovery. We pinky-swore on that, and we've had a good therapy relationship. He challenges me on the active exercises, and some of the passive manipulations are excruciating (he's made me cry a couple of times) but it's never become intolerable, and my progress is good. My flexion and extension have progressed into the "functional" range, and yesterday, I walked around the block. Yes, I had the walker, but I really didn't use it for walking, just for balance. I saw my orthopedist yesterday, and he said he's very happy with my progress. (More on that next post). So, TJ can stay. He's one of the good guys.

Here's a laundry list of some of the things he has me do:

On the bed:

- Quad/glute sets
- Heel slides
- Straight leg raises
- Side leg raises
- Bridges

Seated:

- Front leg raises
- Marching

Standing in walker:

- calf raises
- heel raises
- hamstring curls
- side raises
- marching
- mini-squats

He also does passive stretching for the knee, quad and hanstring, and patellar manipulation. Some of these are intense, but I'll take that for increased ROM. Overall, I'm pretty happy with my PT / Home Health experience. I've told everyone I've worked with about Evil Chester and the timed sit-stands, and no one has said he shouldn't have done that. On the other hand, no one has tried to justify it, or asked me to do those again. So I just don't know. But..next time someone asks me to do that, they'd better be prepared to justify why it's needed.

 

[kneeper]

McQ sounds great! Gradually you will be able to do more and more--so let him help now. Sounds like he likes helping.

Yeah, the trip home and visitors are pretty exhausting. Sounds like you've got that all settled down now though.

 

[kneeper]

Evil Chester is right. At this point those timed sit stands sound ridiculous. I can see having you show where you're at with getting up and sitting down, but one time should tell him what he needed to know. :hissyfit:
Glad you put your foot down with the new therapist.
(love the pinky swear :th_heehee: )

 

[Roy Gardiner]

Re: La's new knees (recovery diary) Home Health and Physical Therapy

... instructed me to stand up and sit down as many times as I could in 30 seconds....

I got to this point and was leaning forward in my chair almost shouting "Whaaaaaat the f..." because I know that putting force through damaged knees a few days after surgery is AGONY.

...so I gave it another go. This time, the pain was a solid level 9 ... when the door slammed open. McQ ... pointed at Evil Chester and said "you're done"

I am surprised he was so polite.

As Chester was packing his bag, he commented, "It will be interesting to see if the next client has as much difficulty as you do. You're my first bilateral.

You may not be familiar with English rhyming slang; Evil Chester is what we call a 'berk'. This has a common-or-garden meaning of 'fool' which lots of people innocently use, and another much more descriptive meaning...

...I need to know that you aren't going to ask me to do anything that's impossible, egregiously painful, or dangerous to my recovery. We pinky-swore on that,

Good it shouldn't hurt.

...some of the passive manipulations are excruciating (he's made me cry a couple of times)

Huh? It shouldn't hurt!!

He also does passive stretching for the knee, quad and hanstring, and patellar manipulation. Some of these are intense,

It shouldn't hu(am I repeating myself here?)

Stretching exercises of hamstrings and calves might be uncomfortable, but pain is the body reacting negatively. Exercises of the damaged knee I am 100% convinced should be pain free; mild discomfort only. They are damaged, not out of condition.

I do virtually nothing on flexion, a good bit on extension, but just lots of fairly gentle stretches. No PT with 3rd parties at all.

At 7 weeks my knees are still swollen, but going down. ROM maybe 120+. I can walk 1/2 mile and up and down stairs correctly, if slowly. Does me.

 

[Roy Gardiner]

Evil Chester is right.

:th_heehee:I read that several times before I realised you meant "Evil is the right word for Chester".

McQ sounds great!

Indeed he does! Is that his real name or is he nick-named after the John Wayne character?

 

[Larosser]

Re: La's new knees (recovery diary) Hard Things

Thanks again, all, for your encouragement. I'm glad y'all don't like Evil Chester either. I'm almost caught up to present day, so I can just post as things happen going forward. Before I do though, I want to say a few words about Things That Are Hard. I'm sure everyone is different, but here are the things that are tough for me, and what I'm doing about them.

Standing up This is the one physical activity that anyone expects me to do that creates problems. Part of this is inevitable, considering what's been done to my knees. Part of it is (I think) my own stress and worry about standing based on a few ugly incidents with wobbly chairs and evil evaluators. Nonetheless, getting out of beds and chairs and off toilets is something I just plain have to do. Here are some factors that contribute to how easy or hard it is.

- Height of the chair (bend of your knee). The lower the surface, the more your knees have to bend to get out of it, and the harder and more uncomfortable it will be. McQ actually built a platform under my fave lounging chair so it's not to low for me - I will post a pic of it later.

- Stable surfaces to lever up on. This can include the arms of your chair, if they are high enough and the chair doesn't rock or swivel, hand rails, and heavy pieces of furniture that are stable side to side, not just up and down. Your walker can be stable if someone braces it.

- Technique. There's definitely a trick to this. Move to the edge of your chair, plant your feet about shoulder width apart, feet/knees pointed in the same direction, lean forward (way more than you will think makes sense, and start the motion with your arms. You'll use your legs to push off as well, but let your arms start you off.

- Stiffness and swelling. If you haven't iced for awhile, or haven't had an anti-inflammatory, or have kept your knees in the same position, you may find it significantly harder to get up.

- Pain. In my first days, I didn't try to stand up except in the "sweet spot of my medicine cycle (from about 45 minutes after I took pain meds until about 2.5 hours after)

- Confidence and preparedness. I'm not going to harp on my "choking" experiences (enough wingeing about those elsewhere in the thread) but attitude does matter. Don't let people pressure you into trying to get up if you aren't ready. If you don't feel ready, don't like your levers, are having too much pain, whatever...get the problem fixed and wait until you DO feel ready to move.

Sleeping Still not easy for me. Little aches and pains, limited positions to choose from, limited physical activity, the strange way the meds make me feel all contribute to limited sleep. I don't have very good advice for this, except, get it when you can. Be at peace with cat napping when you elevate our knees, or after meals, or therapy. I try to get a longer period of sleep after the dose of medicine that comes around midnight. I turn off lights, turn on some low soothing music (this seems to help get back to sleep if I do wake up) and generally make myself as comfortable as I can. I don't set the alarm to take my next dose of meds, just do it when I wake. If anyone has more tips or suggestions, I'd love to hear them.

Pooping At the risk of TMI, my bowels still aren't working really well. I understand that the meds contribute to this, and the relative inactivity. My diet probably isn't helping, since what I want is MEAT. I am craving protien like nobody's business. I try to balance that with fresh veggies and high fiber cereal...but I still have an issue. I've had to resort to a laxative once already. Again, any suggestions are welcome.

Paying Attention Truely, no can do. I have the attention span of a six week old blonde chihuahua - on a good day. Hopefully, as my meds go down and my sleep schedule normalizes, this will get better. In the meantime, I'm just going wi- Look! A squirrel!

 

[Roy Gardiner]

Don't let people pressure you into trying to get up if you aren't ready. If you don't feel ready, don't like your levers, are having too much pain, whatever...get the problem fixed and wait until you DO feel ready to move.

I think this sums it up. Control is (a) knee(s) (b) yourself (c) hah, surprise, there's only (a) and (b)!

 

[Larosser]

Is that his real name or is he nick-named after the John Wayne character?

McQ is a nickname, based on his Mom's family name. And yeah, he's pretty great.

 

[bottomshollow]

Larossa---am loving your posts!:biggrin:

On the BM issue--which believe me is a real issue for all of us---I have found that taking a stool softener with the morning meds and with the evening meal meds and lots of fluids during the day took care of the problem long term.

I am now off the narcotics, so I am cutting back to one a day for about a week and then will try to get off all together.

Hope this helps. Judy

 

[Jazyb]

Great recovery diary; thanks for taking the time to write it and well done. As for the bm issues - have you tried prunes and prune juice - it does wonders for me. I am also eating a ton of grapes and I have not had to take any laxatives since leaving hospital. Good wishes to you.

 

[rubysue]

Superb diary! Very good information that will be quite useful for others.


I can recommend Miralax. It is not a stimulant laxative. After I had a horrible day from constipation about two weeks in (and I was taking Metamucil and a stool softener), my GP recommended staying on a daily dose of Miralax until I was off the narcotics. It worked like a champ and didn't create any long-lasting effects. I also added a daily dose of prune juice and prunes and found I actually like them.

I can really relate to the meat craving - your body really wants protein for healing. I had, and still have, lots of lean steaks and burgers (grass-fed beef and my favorite, bison) and also keep it going with chicken, salmon and other rich, fatty fish and the occasional pork dish. Bison is expensive, but it is a fantastic lean protein. My DH (a real gem, like yours) is the cook in our household and he makes a fantastic bison chili that is almost like a magic elixir because it imparts so much good nutrition and energy (yummy with cornbread on the side).

 

[Juliep]

You have done a great job with you diary and I for one can tell it will be a huge help for me once I have my bi-lats done. You have explained things so well and do it in a very great way.

Keep healing and getting stronger. Hope your sleep will get better as well. Been there and done that and I will be doing it again......

 

[helix-2000]

Love the diary and the snipets of humor as well. McQ sounds like a great chap to have around.