Letter of approval!

[Grammy211]

I received my letter of approval yesterday for the TKR! I was afraid I would be declined since I had just switched insurance companies. Now I can breathe that it's really going to happen! My surgery is Jan. 5 in Boston so the next couple weeks are busy! Time will fly by and then my day will be here!

I do have a couple questions: I've been reading The material given here and reading the posts. I am determined that this surgery will have a much better outcome than my first TKR. So question #1 has to do with PT. Am I better off refusing all PT from day 1 or do I participate in PT but not overdo it? How many days per week for PT? Should I do exercises at home whether I receive PT or not?

Question #2- I am at very high risk for developing blood clots. I had a stroke 10 years ago then developed 2 PEs with my first TKR and have been on Coumadin ever since & will be for life. So I'm wondering if anyone here has been in a similar situation and did you end up with clots again? I'm kind of nervous about this.

Thanks in advance!


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[Pumpkin]

Grammy211,
Happy to hear your insurance is approved for your TKR.
You will need PT for the first time getting out of bed, making sure you are safe walking, getting in and out of bed independently, and going up/down the same number of stairs you have at home. No need for an aggressive program early on, you are in recovery, rehabilitation can wait until your knee is healed. Most of us feel better in 3 months, but healing will continue for a year or more.
We recommend the following gentle activities for flexion and extension.
Heel slides and how to do them and Extension: how to estimate it and ways to improve it .

With your history of blood clots your OS and hematologist will need to coordinate how to handle your TKR to prevent blood clots this time around.

I am going to tag @Josephine our forum nurse about your history of blood clots.

 

[Want2hike]

Congrats on getting approval!

I personally enjoy PT (especially the massages) but both my in home and outpatient PTs have taken a gentle approach. I just tell them "no more" if I am reaching my threshold of what I can do.

I had a prior PE (15 years ago) and was on Coumadin for 2 years before my doc took me off. My doc didn't think I was high risk for one this surgery so just had me on baby aspirin as a blood thinner. This made me a little paranoid, so I was hyper vigilant about doing the ankle pumps and trying to get out of bed and at least stand for a couple of minutes every hour. My doc also sent me home with inflatable calf compressors. I wore them overnight for 3 weeks plus often had them on during the day while I was icing and elevating. They gave me a bit more peace of mind and made my legs feel better. I was actually sad when I had to send back the pump. Ask your doc whether he will be giving you something similar.

This is what they gave me
http://compressionsolutions.us/products/triple-play-vt-dvt-ez-home-care-kit/

 

[KarriB]

PT isn't necessary, but some enjoy getting out and going to PT after a month or so. Much about PT depends on individual therapists, as the client you need to set ground rules. The key is do nothing that hurts, don't let anyone push or pull on your knee, no weights, and don't give in to taking pain meds before PT as it will mask any pain you have which can be dangerous. Pain is a signal that what you're doing isn't good for your new knee. I enjoyed PT, but my OS prescribed non-aggressive PT and the therapists followed the orders.

 

[newlybionic]

When did you have your original TKR? Is that TKR that is planned for January for the other knee or are you doing a revision to the original TKR?

Make sure your OS knows your past medical especially with regards to your previous PEs and that you are on Coumadin now. He might Wang you to stop it a couple of days before surgery but it will be resumed immediately post op. That's up to him to decide.

PT can be helpful but only if they do not hurt you and you are and let to speak up if they do. I wentb2 days a week's starting 3 weeks after my surgery but refused to do some of the exercises they wanted me to do. Eventually I stopped and just did my day to day activities.

 

[Josephine]

I am determined that this surgery will have a much better outcome than my first TKR.

That's actually not in your hands. None of us have any control (or very little) over the mode of our recovery.

So question #1 has to do with PT. Am I better off refusing all PT from day 1 or do I participate in PT but not overdo it?

Refuse it. I did.

How many days per week for PT?

None at all.

Should I do exercises at home whether I receive PT or not?

No but this does NOT mean you should be inactive. Just walks to the bathroom and kitchen on an 'as needed' basis and maybe walks around the house in the first few days, just for 5 minutes a few times a day.

As for the clotting issue, it's possible that you will be okay will on the coumadin but that's really in hands of your doctor. He will know all the details and blood tests you've had and I don't. However, if he thinks there is a significant risk, it is possible to have a prophylactic filter, called a Greenfield filter, inserted into your ascending vena cava to stop clots from reaching your lungs.

 

[Grammy211]

Thank you again for all your help in answering my questions! @Josephine my prior OS did mention the filter but my primary doctor said I didn't need it. My new OS did say that he would talk with my primary doctor regarding the PEs. They both seem to feel that I will stop the Coumadin a week before surgery and just continue with aspirin then resume Coumadin immediately after surgery. I have an appt with my primary right after Christmas so I'll know the plan then I guess.

I will take the suggestions of walking every hour, ankle pumps, and the suggested light exercises.

@Want2hike I will ask about the calf compressors for home use. I did have them on while in the hospital with my first TKR and I actually liked them! I know I'm strange .

@newlybionic my firs TKR was on my left knee 3.5 yrs ago. This time I am having the right knee replaced.




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[Josephine]

my prior OS did mention the filter but my primary doctor said I didn't need it.

In which case I would take that as a positive and not worry about it.

 

[Grammy211]

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[referee54]

am determined that this surgery will have a much better outcome than my first TKR. So question #1 has to do with PT. Am I better off refusing all PT from day 1 or do I participate in PT but not overdo it? How many days per week for PT? Should I do exercises at home whether I receive PT or not?

You will most likely need some PT to help you get things going while in the hospital---but you can set limits even there as to what you will allow them to do to you.

After my BTKR, I had PT only twice a week---and there were times that I would cancel a day or two---anymore than that will not allow your knee and yourself to get the appropriate rest---and again, remember---you set the parameters as to what is acceptable and what is not.

My PT's also took the gentle approach, so you had better make sure ahead of time that your PT's are all on the same page---do not be afraid to let them know ahead of time that you (and your knee) are in charge.

I also was one of those folks who enjoyed going to PT to get out of the house as well as to enjoy the camaraderie of other joint replacement patients.

 

[Grammy211]

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