Bilateral TKR La's new knees (recovery diary)

[Larosser]

Re: La's new knees (recovery diary) Staple free and walking!

Well, y'all, I'm happy to announce that, at last, I am CAUGHT UP! This post is about yesterday and today, so from here on out, most of my posts will be near real time. Today is my one week "anniversary" of coming home, and I'm feeling pretty optimistic overall.

Yesterday I went to my OS to get the dressing changed and the staples out, plus to get post surgical x-rays. The staple removal was kind of interesting - have y'all seen how those things work? They pinch the center with pliers and the ends spring up. They didn't use any local anesthetic, but it really wasn't bad at all. I've attached a pic of my legs. Still quite a bit of swelling and bruising, but I think the incisions look good!

The x-rays were more annoying. The nurse suggested that I leave my walker because it was just across the hall and kind of crowded. Unfortunately, the chairs were low and armless, and getting up was a complain. And they wanted me to climb on a box and balance on one leg for the x-rays. I had to ask for something to balance on. But, I managed. Jimmy (my surgeon) gave us a set of the x-rays. I am going to try to upload them to share if I can get to my scanner.

Overall, he was pretty pleased. He gave me two more weeks of in-home therapy, and says if I feel up to it, I can move to outpatient care. He did ask me not to screw up his beautiful work by over doing - told me firmly to stick to walking, stationary bike and swimming for at least the next two months. I'm good with that - I have been so restricted in walking that I feel that I can make a LOT of fitness progess just moving around on my pins.

My PT is progressing - my flexion and extension aren't bad for this early. Right knee is 108 to 8 and left is 98 to 5. There's still a ton of swelling so I think those numbers can get better. The extension doesn't hurt as much as it did on my previous ortho surgeries, so I'm hoping for quite a bit more in that area.

My strength and muscle tone are improving - standing up is getting easier every day, and yesterday, I walked all the way around the block AFTER coming back from the doc. Makes me happy!

Today, I was pretty sore all over, and TJ the Good Therapist warned me to take it a little easy. Just as well, it's cold as all get out, I'm sore all kind of places that have nothing to do with my knees,and slllleeeeppppppyyyy. I'm gonna call this a rest day, and if the weather tomorrow is as good as they say, I'll get McQ to escort me on a walk. I really, really want to improve, but at the same time, I don't want to overdo. Balance, balance in all things.....


La

 

[Ditzzeechick]

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

I'm so glad you're writing, hearing this stuff from a fresh perspective is really helpful to those of us not yet on the other side but close (surgery should be last week of Feb 2012) Even the chair incident (sounded harrowing) will benefit us, I'll have the husband measure all chair heights prior to sitting down anywhere!

 

[Josephine]

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 hamstring, and patellar manipulation. Some of these are intense, but

What on earth? You are 12 days out of MAJOR surgery! You should be resting and recovering not taking part in his boot camp!

Truly, all this will do is make your swelling worse and delay your ROM - big time. It's so counterproductive, I can't say it enough.

I see I should have given you my 'set' of articles from the Library about good recovery. To start with, do read this very short synopsis of my recovery (and also Roy's recovery thread) because we did none of that and have done excellently well, as have many, many others. It's a total myth about having to work hard to get good ROM, it truly is.

Here is the reading for you!
Work “Smarter” and not “Harder”
About recovering a knee - from one who knows!
Some suggestions for home physio (PT) and activity progress

How Long Does Healing Take ......
Chart representation of TKR recovery
Energy drain for TKRs

The importance of managing pain after a TKR and the pain chart
https://bonesmart.org/forum/energy-drain-for-tkrs-t12982.htmlElevating your leg to control swelling and pain
Using ice
Myth busting: The "window of opportunity"

MUA (manipulation under anaesthetic) and adhesions
It's never too late to get more ROM!
It's Worth the Wait for ROM
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it

 

[Larosser]

La's new knees (recovery diary). Too much, too soon?

What on earth? You are 12 days out of MAJOR surgery! You should be resting and recovering not taking part in his boot camp!

Truly, all this will do is make your swelling worse and delay your ROM - big time. It's so counterproductive, I can't say it enough.

Thanks for the articles and your concern, Josephine. I appreciate it, and I hope I haven't given you the wrong impression about my therapy sessions. Honestly, they don't feel boot camp-y at all. At each session, I probably spend 10 minutes on exercises like the ones I described and maybe stationary bike, 10 minutes walking and 5-10 minutes on stretching. The stretching is the the only thing that has been uncomfortable so far - well, that, and my encounter with Evil Chester. I don't seem to be experiencing an undue amount of swelling, either.

My OS (who knows me very well) has reiterated over and over that I shouldn't try to push myself right now, and I'm honestly trying to comply. Based on your comments, I'll give him a call on Monday (before the next scheduled PT session) and go over with him what TJ's had me do, and see if he thinks it needs to be scaled back.

I've already made by share of dumb recovery mistakes, re-injuring myself because I was more focused on "soon" than "right". This time, I'm not competing, I don't have any deadlines, and I definitely intend to get the most out of this surgery in the long run - even when that means taking it easier now. I truthfully feel like I am not pushing or being pushed (excluding Evil Chester), but It sounds like I ought to take a sanity check on that, and I will do.

Thanks again for your concern.
La

 

[Larosser]

Herbal teas?

It occurs to me to ask: Is there any reason I shouldn't drink herbal teas while I'm taking hydrocodone? I enjoy chamomile, echinacea, ginger, clover, and valerian. Any reason not to drink them?


Thanks
La

 

[Jamie]

Re: Herbal teas?

I didn't see anything about a reaction when I checked, but just to be safe I would ask your pharmacist. Sometimes there are reactions with medications and herbs. It's best to get a professional opinion.

 

[tashia]

Re: Herbal teas?

Jamie, You are so right. I do take them but I have't taken any since surgry because I don't want trouble. When I first got involved with taken them, a herbal speclist help me. I was told there are three classes of herbs. One is food which is just food, the second was food or medicine, and the third class was used for medical reasons. I found it very confusing at times to what herb fit into what class. The only tea I drink is chamile or green tea. However I was told because you could have interaction you should not take medicane with the tea as liquid instead of plain water.. its better to be safe than sorry. Then I was told that lot of today modern medication came from herbs so you could end up taken a double dose if you didn't know the background of the medicane. I hope I made sense. Tashia:flowerysmile::doggieshmooze:

 

[Roy Gardiner]

The x-rays were more annoying. The nurse suggested that I leave my walker because it was just across the hall and kind of crowded. Unfortunately, the chairs were low and armless, and getting up was a complain. And they wanted me to climb on a box and balance on one leg for the x-rays.

I think you're pulling our legs. First you describe some lunatic of a PT who want you to do multiple stand-ups on injured legs, now you want us to believe this. We weren't born yesterday you know.

:th_heehee:

OK seriously, what is going on? Those people are supposed to understand your situation and help you, not this nonsense. You couldn't, as they say, make it up -- stand on one leg indeed :hysterical:

At each session, I probably spend 10 minutes on exercises like the ones I described and maybe stationary bike, 10 minutes walking and 5-10 minutes on stretching. The stretching is the the only thing that has been uncomfortable so far ...

So we are all different, I find stretching the easiest. Could be this routine is correct for you, I'd've not been able to at your stage.

IMO the bike should not be for exercise, just resistance-free ROM practice. Walking is cool, mind you I didn't do anything except around the house until 25 days.

I've already made by share of dumb recovery mistakes, re-injuring myself because I was more focused on "soon" than "right". This time, I'm not competing, I don't have any deadlines, and I definitely intend to get the most out of this surgery in the long run - even when that means taking it easier now. I truthfully feel like I am not pushing or being pushed (excluding Evil Chester), but It sounds like I ought to take a sanity check on that, and I will do.

Spot on! Less is more! I am more and more certain as time goes on that pushing injured knees is very counter-productive.

 

[Josephine]

Well, imo, you should be doing almost nothing right now.

My surgeon told me no PT and no formal exercises for the first 3 weeks, just ankle pumps, gentle heel slides and a bit of walking around the house like to the bathroom and kitchen and stuff. Throughout my recovery I did about 5-10 heel slides maybe 3 or 4 times a day and sat on my exercise bike for about 2 mins twice a week tops! And I did just fine. There really is no need for all this activity. You are supposed to be resting right now!

 

[Dawni]

Please keep posting you are such a good writer good luck with your recovery

 

[Jamie]

Re: Herbal teas?

It makes perfect sense, Tashia, and you are correct about herbs being the beginning of modern medicine.

I did see that green tea can thin blood and therefore and should probably not be used if you are on any type of blood thinners or NSAID treatment.

It's always best to check! This is why we always recommend that you advise your doctors not only of medications you are taking, but also any supplements or herbs.

 

[Larosser]

Re: Herbal teas?

Hi, all. I checked in with the pharmacist regarding teas. She was fine with chamomile, ginger and echinacea. She reminded me that red clover can reduce blood pressure, so I not have more than a cup or two per day unless I'm monitoring my BP. She would prefer that I don't take any teas with valerian while I'm taking the Norco, because both can make you drowsy.

I'm seeing my PCP tomorrow and I'm going to check whether he thinks a valerian tea at bedtime might be an okay alternative to a sleeping pill. I've been having real troubles getting blocks of sleep larger than an hour or so at a time, so I would be fine with a little drowsiness!

La

 

[kneeper]

The regime you describe sounds like something to be worked up to. I think I didn't get most of those exercises for several weeks. And the PT added only a couple at a time. Also, iirc, I was only "assigned" maybe 4 at any given time.

 

[Larosser]

Re: La's new knees (recovery diary) Legs (to stand on, pulling, last, shaking, etc)

Good morning, Bonesmarties! First off, I just need to say: WOOHOOO! I slept from 4 a.m. to 9:30 a.m., deeply and without a break. That's five and a half hours, by far the longest stretch of uninterrupted sleep since the surgery. I am DELIGHTED!

Last night, Roy left me this message:

I think you're pulling our legs. First you describe some lunatic of a PT who want you to do multiple stand-ups on injured legs, now you want us to believe this. We weren't born yesterday you know.

:th_heehee:

OK seriously, what is going on? Those people are supposed to understand your situation and help you, not this nonsense. You couldn't, as they say, make it up -- stand on one leg indeed :hysterical:

Yeah, Roy, I have been wondering that myself. When I was in the hospital, the therapists and nurses were very compassionate and respectful of my limitations. They seemed perfectly happy with my level of progress and didn't push me to do anything that seemed crazy or impossible.

Since I've come out, I've had several incidents where people seem to expect that I can do things that just seem ludicrious to me. Upon reflection, it seems to me that those people don't really get the implications of "bilateral". Evil Chester went so far as to admit he hadn't evaluated a BTKR before, and while I'm not sure that timed sit-stands are a good idea for anyone four days post TKR, it's even more ridiculous when you've had them both done.

And the tech doing the xrays obviously wasn't thinking bilateral either. When I asked her to clarify her instructions, she said, "balance on your good leg, and raise the other one to rest on that block...." I asked her "which is my good leg?" and she said, "The one you didn't have...OH! you had surgery on both!"

So, I've decided that I just have to be kindergarten clear with such people. My standard response noe is, "I've just had total knee replacement on both legs. Please explain how I can do that safely and comforable." I've used that a couple of times, and I can see that it really makes them take the situation in. It puts the ball back in their court. If they can't tell me how to do it safely and comfortable, it ain't happening.

For example, when I went to get a new dressing on my knees, (after crazy x-ray lady) the tech asked me to "hop up"on the high examining table. When I asked her how I was supposed to do that she changed her mind: instead of me on the table and her on the chair, we did it with me on the chair and her on a low stool.

So since we are talking about legs, I have a few other observations / comments / questions.

One is about swelling. My knees are somewhat swollen in general, and that overall level of swelling seems to be slowly going down. However, they also seem to swell more and less during the day. I understand why they would swell more after I've been active, but why do they swell in the late evening? It seems that no matter what kind of day I've had, what position I'm in, etc, my legs swell more around 11 p.m. or so. Any ideas why?

Another observation: I have absolutely NO reserve of strength right now. NONE. I am always "on my last leg", and I need to remember that. Yesterday evening, I sat in my easy chair and chatted with a friend while we watched TV for a couple of hours. When she left, I thought that I felt a little tired and should move to the bed. This involves moving my water, my computer and my phone, setting up a wedge of pillows so I can elevate my legs in bed, refilling my ice packs and getting into bed, then strapping on the packs and covering myself up. McQ usually helps me with this, but he was occupied chasing the neighbor's dog back under the fence, so I decided to do it myself. It was almost more than I could do. My the time I was on the bed with my knees elevated, I was too tired to actually place the ice packs and cover myself up. For true! I had to just lie there and take a cat nap before I had the gumption to finish. So I need to keep firmly in mind just how easily I tire, and be ready for it. Right now, ambition is a bad thing.

La

 

[Roy Gardiner]

Re: La's new knees (recovery diary) Legs (to stand on, pulling, last, shaking, etc)

Another observation: I have absolutely NO reserve of strength right now. NONE.

100% spot on. And it's a continuous surprise, isn't it? Unpleasant surprise... It is of course the body taking all the energy it can for healing.

At 7 weeks I am just starting to get some physical capability and mental process back -- although still severely limited as the pig's ear of redoing my BMI calculator (if anyone's been following that) shows.

 

[Larosser]

The regime you describe sounds like something to be worked up to. I think I didn't get most of those exercises for several weeks. And the PT added only a couple at a time. Also, iirc, I was only "assigned" maybe 4 at any given time.

There's some truth to that. The first day TJ came, he had me do a different exercise and then "graduated" me to straight leg raises, and there are a few on the chart set that he doesn't want me to try yet (like hamstring sets). Also I don't do all of those at one time. There's kind of a group of standing exercises, another of sitting exercises, and another of on the bed exercises. Usually, when he comes, I will do one set (he picks) and then I'll do different set later in the day. So I usually only do two of the three types on any given day.

 

[karmigirl]

La,

That is exactly how I got thru my PT. ONe set at a time. A few times I would try all at once and that was not the best idea I had. As thing progressed and mor exercises added, one day I would do one type, the nest day a different type. It really seemed to work well for me and I only had one knee done. Just did not have the stamina to do more.

 

[GrandyGirl]

La,

Your PT routine sounds a kot like mine here at the Veterans' Administration hospital. No one was more surprised than me that I could actually do it but there sas never a drill sargeant/boot campish attitude. I was not rushed and did as much as much I could. These people are the best... They train our nation's vets who have been wounded in action and need nuch more than a knee or hip replaced.

But the real test is in the pudding. Already, I have measurable healing and recovery and recovery and I am not just talking abt degrees of fldxion and extension. I've regained a measure of indepence in self-care and mobility I could not have not have imagined.

I am in no hurry and my approach to healing is a gentle one. I'm very encouraged! I seriously doubt thqt I will ever call pt fun... Some of it hurts... But I'm really glad to have access to this expertise.

Dori
aka GrandyGirl

 

[Jamie]

Re: Herbal teas?

 

[efoltyn]

La and everyone else going through rehab/recovery,
I posted earlier this evening for the first time in quite awhile. I'm coming up on my 4th anniversary of BTKR. I wish when I read some of these diaries that I had put something together. However, my recollection of the early days is pretty clouded trying to remember through an Oxycodone haze (all I can remember is waking-up, potty break, take pain meds, exercises at home, watch TV, and doze off again; to be continued several times per day). I had rented a hospital bed so that I could set it up in our lower level family room for the first few weeks (I was able to get rid of it after 4 weeks). I started outpatient PT at 2 weeks and after 4 weeks I was able to get to the gym a couple of times as well (great retired brother-in-law as a chauffeur). When I was at the gym, I could get in 20 minutes on the stationary bike without hurting myself. When I got home I would grab something to eat and ice down for awhile while watching TV again, and then a nap.

During this first month, I was religious about taking the pain meds by the clock and not waiting until I had to overcome the pain...it really works. Don't chase the pain. Also be good about elevating your feet and legs and icing down anytime you do exercise. This is the best thing for swelling. I think I took the primary pain meds for the first 4 weeks or so and weaned myself off of them (I wanted to get cleared for driving as soon as I could).

I changed from a walker to a single cane sometime after 3 or 4 weeks, about the same time I started to go up and down my stairs at home by myself. Somewhere around 6 weeks, I was comfortable walking without the cane, but I continued to carry it for a few more weeks. At my 6 week follow-up appointment, because I could walk without a cane, I was cleared for driving again...that was a great day.

I flew across the country to present a paper at a conference in Maine in August. I was quite worried about a cross-country flight with minimal moving around. I definitely wore the compression stockings on that flight...it kept the swelling down in my legs (remember this flight was at about 6 months). Driving and walking around at the conference was fine, but I would still get tired. For me, the "total" recovery was about 10 months (I actually don't think we are ever totally recovered. You will need to continue exercising, especially those of us on the younger side of life).

Because I gave up some of my "impact" sports (backpacking and downhill skiing) I took a motorcycle class at 7 months, got licensed, and bought a bike the following summer. So you are never too old to learn something new.

In closing, remember to keep up the exercises (it is work but it shouldn't hurt), take pain meds (especially early on, and elevate and ice down often.