Bilateral TKR Luisa's road to recovery June 10th, 2013

[Josephine]

My R is at -8 and my left is at -10 My Flexion is doing well....R being at about 105 and L being 115. I am most concerned with my extension. VERY CONCERNED. I feel I should be better by now but in the past 10 days I have made minimal progress maybe 2 degrees on both legs. Am I lagging behind??

My dear good lady, you are only 4½ weeks out which is so very, very early. You are not helping yourself by fretting about this, being in so much of a hurry and trying to rush things. You cannot expect to get improvements this early, honestly. It takes time and patience and NOT using weights on your legs at this stage. Please don't do that again as you risk setting yourself back. I am telling you the facts here - gently does it is the only way.

For what it's worth, my extension was also about -6 at 6-8 weeks. Most people's are also around that. Extension is the last thing to come back and can often be a long time doing it. There's no problem with it, it just does take time. In no way is it indicative that you are never going to get a good ROM at the outcome. So calm down and let things take their time. In no way are you going to be permanently lacking in ROM!

MY OTHER CONCERN is I have external rotation on my L that is coming from the hip

Need I also remind you that it was your left leg that had the knocked knee deformity? That's been corrected and you cannot expect not to have some repercussions from that but it will correct itself in time. How long did you have that deformity? You cannot expect it to right itself in a few weeks, can you? Only common sense!



I am appalled to find that no staff member left you the recovery articles which might explain your misunderstanding of the proper way to recovery a knee! So here they are now and please read them. In the last few are some posts made by members who continued to get improvements in ROM even after one YEAR! Some are in bold type - those are the ones you should pay special attention to!

First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!

And here are some very crucial articles
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Activity progression for TKRs

Healing: how long does it take?
Chart representation of TKR recovery
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling

Home physio (PT) and activity progress: suggestions
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it

And wise words from members who have shared their experiences ...
Where are you in recovery?? (TKR)
Five “P’s” of knee recovery
TKR: work “smarter” and not “harder”
Recovering a knee - from one who knows!
It's never too late to get more ROM!
It's worth the wait for ROM

 

[Ready]

Luisa, Please heed Josephine's wonderful advice. Just relax and let your body adjust to it's new alignment. I hate to see you work yourself up, which will most likely cause more problems sleeping. It is easy to feel like it's your fault or you need to do more when you compare yourself to others. I think your legs are healing like YOUR legs should. My extension is moving a degree or so a week, so I have some work to do as well. I learned form #1 that it will get there. It took a few months, but now it lays perfectly flat, and when I flex my quads, my heels lift right off the ground. As far as the leg flopping to the side when I lay down, mine does that too, but I never thought about it before as an issue. I bet everyone's legs do that. Look at an infant or toddler sleeping on their back. Please try to go easy on yourself. As someone already said, "Rome wasn't built in a day."

 

[Roy Gardiner]

PLEASE HELP!! I a feeling on the verge of hysterical over this. I know it sounds dramatic, but I need to know I will be OK in the long run.

The first thing is, if you can, calm down. You are in the very early stages of recovery, everything will be up in a heap, ESPECIALLY your head.

Relax. Watch telly. Eat chocolate. Rest. Take it easy. Do some gentle stretches, don't worry if you don't get much ROM. Sit down. Sleep a bit. Get that telly watched, someone's got to do it. That on-line shoe shopping, that's essential too.

Don't panic, it will come. Ask me how I know.

 

[Lmarshall]

My dear friends and Josephine I am so happy to have you all. I mean TRULY grateful. I have received this list you you before Josephine, back in my pre op post, but am so grateful to have received it again and read each and every one of the links, again. This time with eyes wide open as I am in the thick of things. The thing that hit me the hardest was...WORK SMART, NOT HARD....and this is exactly where I went wrong today....all it did was upset me, upset me left knee, make me anxious, and doubt my recovery. Its so hard to think of 4 weeks as the beginning of my recovery, since I feel like it has been IONS since I had the procedure done. Looking at the charts, I realize how foolish I am being, looking at the chart of the healing process, I see now that my bones and ligaments in particular have such a long way to go before they are healed. My reading has opened my eyes again to the reality of things and where I am now.

The PT did NOT make me do these things, I asked her to push harder, and I realize now it was a mistake. I felt like I wasnt working HARD enough to see more progress, little did I know (even though I subconsciously knew and had read this already), I was setting myself up for failure. (Seeing my knees pop up when lying down really got to me for some reason, and seeing so many in earlier stages of recovery with extension at 0). Luckily, I dont feel I did too much damage to my knee. Yes, my left knee is alittle sore, more than usual after PT but nothing major. She and the supervisor (who came over when he realized how upset I was and crying), BOTH told me I was doing very well and was perfectly NORMAL for my stage. Luckily, I have 2 days before another PT session and should be fine by then. I will surely take a step back.

Josephine, I do follow the ice and elevate religiously every day. Ice has become my friend, although there are times I cant stand the site of my cryo cuffs, when push comes to shove, they always win! I rest alot, watch TV alot, sleep less than I would like only because of discomfort, but hoping tomorrows pain management visit brings me some relief. Speaking of the visit, HAS ANYONE EVER HAD A NERVE BLOCK INJECTION FOR PAIN, AND IF SO, HOW DID IT WORK FOR YOU? Josephine Is it dangerous in any way?

Thank you so much for listening and helping......Luisa

 

[new knee in June]

Dear luisa,
Please don't be upset about any rom or extention my dear you are only 1month out.
You are asking all the right questions at p.t & they are addressing your concerns.
You have a list for your surgeon & I'm positive she will answer & you will be satisfied with her
Answers
I know it's hard not to worry....please have a peaceful weekend
Remember, ice, elevate, pain meds. On time, gentle stretching only
Hugs....Diana

 

[Kavan]

Luisa I had some popping at about a month. It worried me but it only happened 2-3 times. I stressed out terribly. Like you said I just iced and elevated.

Have they got the headaches under control? Those alone could be causing you anxiety.

 

[Josephine]

The PT did NOT make me do these things, I asked her to push harder,

I know you did but if the PT had any sense or good knowledge, she would have said no!

HAS ANYONE EVER HAD A NERVE BLOCK INJECTION FOR PAIN

What makes you ask about nerve blocks? Thinking of having one?

And can you be a dear and stop using CAPs so much. In forum-land, it's known as SHOUTING and not considered polite - though I am quite sure you weren't aware of that. The odd word is okay for emphasis (I do it often) but not whole sentences.

 

[Lmarshall]

Josephine sorry about the caps, just try to stand that part out...wont do that again.

Yes...I am going for one tomorrow. Pain management dr I have history with told me if the pain killers my head and stomach can tolerate dont give me relief, he will give me one. I think its a nerve block....but its a shot he can give me once a week for a few weeks for pain. Im feeling alittle desperate for pain relief and vicodin which I have so far been able to tolerate doesnt take away a lot of the pain.

 

[Josephine]

I think I said somewhere yesterday that anywhere there is a nerve a block can be used. But poor you - I can only imagine what it must be like to not have pain meds work. Some people seem cursed like that - my sister is one just like you.

 

[Lmarshall]

Kavan so far, the vicodin hasnt given me a headache, but with the other meds ive tried, it seemd like it takes a few days then bam, the headache comes in full force. Ive been fine for the past 3 days.

 

[Lmarshall]

Kavan so far, the vicodin hasnt given me a headache, but with the other meds ive tried, it seemd like it takes a few days then bam, the headache comes in full force. Ive been fine for the past 3 days.

 

[Lmarshall]

Thanks...I will post tomorrow after my appointment and let everyone know how it goes. Hope everyone has a great sleep tonight....especially all my recent post op buddies!

 

[Lmarshall]

I just got back from my pain management dr. He administered whats called a sympathetic nerve block. So far I feel mild numbness in my left leg which feels terrific! I do have slight discomfort at injection sites. The procedure wasnt painful but definitely odd and uncomfortable. Plenty of poking and when the meds went invery odd feeling. They used a floroscope to make sure meds were going to correct spots. Imhoping to get some relief and sleep now that my whole leg isnt uncomfortable. Pain relief should last a week then I can go back for another if necessary. They also have ordered acream for me that will be mailed. Nof sure of the name yet. Will let you know what it is when it comes in. Fingers crossed.

 

[boydmom]

Your nerve block sounds encouraging. Definitely take advantage of it and get some rest. I'm sure that will make you feel much better. I hope this is a solution to your pain.

 

[Lmarshall]

Thank you Boydmom! I do have some pain at injection site, but understand its normal for a bit. I iced and it feels better. Will report back with the longer term effects. If it works, it would be a good option for people struggling with side effects from pain meds like myself. I would have to go back weekly for another shot, but assuming it works, I would only need it for a coupe of weeks til the worst of the pain is over. I am really hoping for a better nights sleep from this, I sure could use a few hours in a row!

 

[gidem]

Hi Luisa,
Hope you can get the pain meds straigthened out. I can't imagine having to deal with heaches besides the legs.
I have had trouble with my meds- but human error has been involved. Glad to have that fixed.

 

[Lmarshall]

Thanks gidem. So far so good. Im still holding out on commenting how well shot has helped since ive basically been in bed since coming home. Will comment more as the day wears on...

 

[Josephine]

You are most fortunate to have a doctor who is prepared to think outside the box like that. There aren't too many of them around.

btw "sympathetic" just means nerves that deal with pain messages.

 

[Lmarshall]

I really am josephine! HI must confess, originally wednesday, he told me to come back saturday if pain relief wasnt optimal with new meds (he is going to coference next wk and wont be in) so I went today and he said he would like my OS opinion first. I was crushed. I started t leave, knowing I would have to wait 10 more days started the waterworks. The PA who is friend, y with me saw my tears, I explained situation and she got the dr back. He realized he SHOULD have asked me to give OS the note wednesday. I specifically asked if there were any contraindications or concerns he had re safety etc and he said no....sooooo...he gave me the injection.

Pain is improved so far especially on left (shot was on left...or shots really...lots of pricking and prodded back ther). I do have so e soreness at injection area but its improved and supposedly normal. I hope the improvement lasts and I also hope it leads to even slightly better sleep tonight!

Didnt know that about "sympathetic" interesting!

 

[Lmarshall]

I thought I posted this earlier but it seems to have never been shown.

I had a pain free night, havent taken pain meds since 12pm yesterday and that was due to pain at injection site. Only meds I took last night was xanax. I didnt sleep more than small 2 or 3 hour stretches, but woke up with no moaning or pain, just stiffness and needing to use the potty. Im up and raring to go, meeting a friend for breakfast. Is this wbat pain free is like??? I had forgotten. Im being extra cautious not to strain myknown triggers for pain...namely trying to over stretch extension or walking too much. Bug my pain level hasnt reached more thana 1 or 2 since yesterday.

I can get theseshots once weekly for a few weeks. Ipray the pain free time lasts untilmy next appt and I also pray they continue to be effective. Moral ofthe story, if you cannot tolerate pain meds like myself. Go to a reputable pain management center for relief!