TKR MB's road to recovery - 7th month update

[kneeper]

Yeah, it sounds like you needed to try something re: the GI system, especially if you've tried the usual remedies of high fiber or prune juice, stool softeners or other options.

 

[71Beetle]

Sounds like you are doing great @dtmbf, congratulations! Your ROM is great at 110. Mine is 105 on a good day at 6 weeks.

I'm still using a walker as ordered till I see my OS next week but I'm not ready for just a cane - think the Canadian crutch is next.

Being Canadian, I have to ask, what is a Canadian crutch?

 

[annabella2]

My post op day 1 is coming to a close & I have so far been threatened with the formation of scar tissue & an MUA if I don't work hard. 1st my hospital based PT tells me my goal is to reach 90 degree flexion in 2 weeks or scar tissue & adhesions would form. Then the case manager tells me if I don't keep up with my PT I would need an MUA. I laughed at both of them. But I really am in a bit of shock - I just cannot believe this is the approach used at this highly regarded orthopedic hospital. Thank god I know a different reality from BoneSmart.

Sorry they are giving you such a hard time! I found out after being pushed waaaay too hard by the in hospital rehab unit that my insurance company gives them a BONUS if they get you to a certain ROM and get you out of there quickly. So that may be what all that was about.

 

[dtmbf]

A quick update - my efforts to stop my narcotic pain meds lasted a whole 26 hours! Just couldn't do it, even tho I'm really not taking all that much. My knee stiffened up - it wasn't any more swollen than usual but it felt like the knee turned into a cement block. It was affecting the way I walked & what I could do for PT. So onto Plan B, which is using Miralax every other day, or even daily if needed. A good friend who is an NP on the GI service at MGH gave me their protocols so let's hope this works.

@71Beetle a Canadian crutch is a forearm crutch - the kind that has a cuff around your forearm & a hand grip. It's shorter than a regular crutch & doesn't fit under the armpit. Way easier to use IMHO.

I used the bike for the 1 st time today, couldn't go all the way around but rocked it pretty good, I think it gives a pretty nice stretch. Plus I was able to walk a lot today as my OS lifted his prohibition against walking on inclines. Our house is built on a knoll and believe me the walking was a challenge today. I am waaaay out of shape with no endurance! Something to work on!

 

[dtmbf]

6 Week update & I'm happy to report slow but steady progress - I now feel like I might actually survive this entire experience!

For the numbers people (that would again be me) I'm at 111 unassissted flexion and 0 degree extension. Assissted fexion gets up to about 113 degrees.

I lost the tight band feeling at 5 1/2 weeks!!!!! Got up in the middle of the night & it was gone, gone, gone. Such a relief. My knee is still stiff & swells, especially at night, but at least I don't feel as if I'm ripping it to shreds each time I bend it.

Still doing home based PT 3 times a week - yes it means I can't drive, but I'm still taking the occasional Dilaudid so I feel this is the safest for me right now. Plus I have no compelling need to drive - I don't want to go shopping and my husband is retired & can do the driving. I ice at least 2-3 times a day, especially after I do the bike or step downs. From a PT perspective I've made what I consider to be great strides:

• I can go up the stairs with reciprocal steps - using mostly my legs with some arm assisstance
• I can go around backwards on the bike a full rotation
• I can step down a 9" step with my good leg first and can bend my "fixed" knee so my heel hits the ground 1st. But no reciprocal steps going down as yet - still a week away at least
• My flexion, while not at the 120-125 I can expect is slowly improving - there's no real pain when I push it - just the stiffness that won't let me go any further
• I can actually sit in a chair, with my legs down - it just allows me to do so much more
• I can take some steps without the cane or crutch - I don't go far but I don't think I have a limp - but then I haven't really tested it with any kind of distance
• I can stand one legged on my operated knee for 40 seconds

My knee is still numb, altho not as dense as it was. My incision has lost most of the redness and is white except in 2-3 small areas. But with exercise my entire kneecap turns a dusky blue/purple - when I massage it, it will go back to normal - does anyone know what that's about? Hamstrings are quite tight - they will be my cross to bear for the rest of my life I'm afraid. I'm trying to loosen them up & PT has switched around a couple of the exercises to try to involve a stretch to the hamstrings. I did go shopping for the 1st time - I need a dress for an outdoors party - I can't stand anything to touch my knee tightly and I didn't want to worry about shorts & the sun, so I got a long dress that should do the trick. But the big news is that I was on my feet for about 50 minutes in the store & altho I did swell afterwards, it wasn't an obscene amount or as much as I feared it might be.

My gut finally quieted down once the Dilaudid dose decreased and I added fiber bars to my diet. Thank God - I really think my recovery would not have been so miserable those 1st weeks if my gut had been working.

No pain per se, just the stiffness - for which I take 3 gms of Tylenol each day. I supplement that with Dilaudid 2 mg, as needed - usually after a really intense PT workout or in the evening - which is my bewitching time. I hate the hours between 8-11 PM. I just feel very unsettled and I don't want to go to bed too early and wake up in the middle of the night!

So I think I might live! I'm encouraged by the progression of PT without a big increase in pain or discomfort. But I'm awfully tired of this journey!

 

[kneeper]

 

[bottomshollow]

update, @dtmbf, Mary Beth! And it's only going to get better and better with more time and patience. Just resist the urge to overdo when you're feeling really good. It always comes back to bite you.

Take care and keep us posted. We care.

 

[Quasi]

@referee54

Will these gel backs work for me. I need some thing I can wrap around my knee while working at a desk and it not falling off? I have bought several things at the drug store, one is like a Velcro weep rap with a oblong pocket on inside to pipit frozen gel pack in, but keeps falling off!

I tried my old cyro cuff that I've had for years, no go! Keeps falling doe , not cold enough. I do have the automated iceman bucket, but the notice is too much for my office!

Do you have any ideas?

Thanks!

JoAnne

 

[Quasi]

@dtmpf

Good for you! You are doing wonderful! I had my surgery on the 13th of May and am still plugging along. I wish I had found you sooner so we could have followed each other's progress through the beginning! But I am on your there'd now, so I can check up on you!


Because I've had to work the last three weeks I have not had the amount of PT you have, but I my ROM is around 110 and I'm good with that. My problem is still the sharps pains I get from tendinitis that I have in my lower knee near the incision. and the ! I don't get to sleep until around 3am and I am back up at 6 am, I think the pain meds help me stay awake during the day, however, they must be the culprit of not sleeping at night.

You are doing wonderful and I am so happy for you! Your story gives me hope that real soon I am going to be making greats strides and will be back to normal soon.

I hope you have a fantastic time at the outdoor party, just remember to rest and not stand up the whole time!
A long dress sounds comfy! Maybe I'll get one to wear to work instead of baggy paints I've been wearing!

Oh, another thing! Wear some blitz in your hair, on your feet or toes! How fun, it will lift your spirits and be pretty to look at!

Talke care!

JoAnne

 

[dtmbf]

@Quasi we sure can track together based on our surgery dates! Are you sure it tendinitis? I had pain in that same area & my OS told me it was where he did the internal incision to visualize the knee. So I have 2 incisions - te visible skin incision tats nice & straight & an internal incision that runs about 1 inch (maybe a tad more) to the right of my LTKR. That was causing me quite a bit of pain alto it has receded over the past 10 days. Both I & my PT thought I had tendinitis also till I asked about it.

Re another of your posts - use a 6 inch ace bandage to hold your cold packs in pace. Works like a charm!

 

[mommamagoo]

I had my TKR May 27. I am only up to 95 after 4 weeks. They just took me off of the 325 aspirin and back to baby aspirin. Do we take it twice a day or just once a day? Do you recall? Also, they said we had to Dr permission to resume sex ... What have you been told? Can we sleep on our side now that the staples and the strips are off?

 

[Quasi]

@dtmbf

Thanks! The ace bandage sounds like it will work! Great idea!
As far as the tendinitis , I had My OS look at it on my 4 week check up, and yep, that's what it is!me it is also swollen unless I get ice all day! Therefore, walla! The ace bandage!

Keep in touch and don't forget the Blitz (or maybe a pretty flower in your hair)! Both sound good to me!

 

[referee54]

Thanks! The ace bandage sounds like it will work! Great idea!

I was going to mention Ace Bandages---I used them at home and at school, and they kept everything in place properly.

 

[dtmbf]

At 6 1/2 weeks had a bit of a setback - first one and hopefully the last. I was on the stationary bike, going backward cuz I can't go around forward yet, and felt a sharp pain from the right side of my knee into my kneecap area. I went around one more time & that was it! When I walked, the same pain occurred but not with every step - and then the swelling began. By bedtime I had lost everything I had gained over the past 2 weeks. I iced, elevated, took pain meds. By the next day, no more pain but the swelling was still there, only on the left side of my incision. The right side is just ducky. PT thought that I had maybe internally rotated my knee trying to get the full backward rotation and tweaked the knee. I was kinda upset as she told me she had noticed a tendency for me to do that, but she never said anything to me at the time, so I was totally unmindful and couldn't watch out for it.

This happened on Thursday, on Friday PT came and we did light exercises, but I mostly iced & elevated thru the day. Saturday the same. Today, the swelling seems to down a little, but I am so depressed. You think you are doing the right thing, trying to be safe and then - wham - you go backwards. Now I'm a bit anxious about doing anything - PT told me to take it easy all weekend, which I'm doing, but other than going back to the basics I'm at a loss. And depressed. And back on some pain meds. Not the direction I was hoping to go in. Sorry for the whine.

 

[kneeper]

Sounds like it is probably a glitch and you'll get back to where you were after a bit of TLC. Bummer, though. :(

 

[dtmbf]

I'm at 7 weeks today and the setback from last week has resulted in slightly more stiffness but no impact on flexion or extension - and the pain has pretty much subsided. I'm stuck at about 110-112 degrees of flexion, I get there fairly easily but can't go any further. I've decided this is my plateau and I'll chill for a bit since I see progress in other areas. I finally got over my fear & sat on the bike again - just to rock - and then figured I was being a wimp so went all the way backwards - no pain! So then I decided to see how far I could push the knee on the bike and lordy if I didn't do a full forward rotation, with a lot less effort than the backward rotation! So I've been gingerly riding the bike but I'm not ready to lower the seat yet!

I'm going up the stairs with a reciprocal step and coming down I'm doing reciprocal steps on the last 2 steps of each landing. I have a problem with cane coordination going down so I decided not to test myself on all 15 steps. Plus I'm not that good at it yet. Pretty much walking without the cane except outside or in the middle of the night or 1st thing in the morning. I'm told I have pretty good strength.

Still on the tylenol 3gms/day and Dilaudid - usually only 2 mg before or after PT. I've been out of the house a bit more - went to a party for about 3 hours on Sunday - drove the 1 hour with ice on the knee and on the way home also. But it was good to get out around a bunch of people again. Small trips to the doctor or store don't seem to be any problem, but riding in the car is still uncomfortable. I haven't driven yet but will need to start pretty soon. Another hurdle. If anyone asks I'm still telling them this is an awful surgical recovery - I think I'm still truamatized and the memory hasn't receded. But I just keep plugging along...

 

[kneeper]

way to go on the full rotation! An important milestone.

 

[dtmbf]

It's now been 8 weeks since my surgery - functionally I am doing better than I was even a week ago - but practically speaking, I don't feel like I'm doing all that well. And I'm probably overreacting & emotional but I still have an awfully stiff knee which really stops me from doing a whole lot. It still swells, especially after any PT or exercise or even walking. Every time I bend my knee I feel as if I am tearing all the tissue under my skin and I have this fairly large numb, hard area on the bottom left of my incision line. This hard area even perplexes my PT. It's not that tight band feeling, cuz I don't have any pain or feeling of stiffness when I'm just sitting. I've read thru a ton of posts & it seems like this is the norm for 8 weeks, but I gotta admit, it's wearing me out. I'm pretty confident I'm not overdoing PT or the exercises I do on my own - I've been real careful to keep that under control & not go wild. I can go both ways on the bike, we've been gradually lowering the seat & I can get my flexion up to 116 now - I'm not expecting more than 120 based on what my OS said. I can with difficulty and using a cane do reciprocal steps up & down. I can get out of chair without using my arms (most of the time). I have nothing really bad to say about where I'm at, except for the ghastly stiffness & that hard area.

Still icing, taking Tylenol & just switched from Dilaudid to Vicodin - it seemed like the Dilaudid really wasn't doing much for me & since I have a bunch of Vicodin left I thought I'd give that a try. My PT thinks my head is into this recovery way too much, and that I don't trust my knee - which is true - I don't trust it to bend when I need it to. I've decided to go to the Y and use the pool - my PT thought that was a great idea but I just have to make sure I don't overdo it as I'll be on my own. She's also told me I really need to go to oupatient PT which I really don't want to do at all!!!

My gut is back to normal, I'm sleeping normally for me (which means I wake up every 2-3 hours - I know lots of folks post how horrible that is but I've been doing that for about 8 years - started when my hips got real bad & I couldn't move in bed without waking up & I've never been able to break that learned behavior. I think my sleep is awesome if I go for 4 hours without waking up!), still haven't driven yet. I may be in the 8 week doldrums, but I don't see any end in sight. I'm worse off now than I was before my surgery from the pain perspective is you include stiffness as a form of pain. Someone please tell me I'm being melodramatic altho it doesn't feel like it! Sorry for the whine tonight...

 

[gr82cu2]

@dtmbf Mary Beth, I've just read your entire thread. You poor thing! I'm still waiting on my LTKR on July 29th (to be followed by the right later in the fall, I hope) so I can't offer any advice really. But, I can tell you this, if you go back to the beginning of your thread and read your posts in order you will see what remarkable progress you have made. You're looking at it from an 8 week investment of your time and I'm looking at it from a 30 minute investment of my time. It leaves a much different impression. I can't help but think that with you having previously had both hips replaced your journey has been harder. You are one tough mama! And you are doing great! It probably doesn't compare but I've had a couple of previous abdominal surgeries and from experience I know that this 2 steps forward and 1 step back stuff is pretty routine for any major surgery. It happens for sure. And recovery from those uh-oh moments we all risk take a lot longer than we think they should.

p.s. I learned the miracle of Miralax with my prior surgeries so I will definitely be taking that from the get go. With my 1st major surgery I was on seriously heavy duty pain meds and got so constipated and bound up after 9 days I couldn't even pee sitting down. On all these threads I've been reading with people suffering with constipation from the pain meds I'm sitting here shouting "take Miralax" you can thank me later, LOL.

 

[kneeper]

Learning to trust the knee is one of those difficult milestones. I think it only comes with practice.
I don't know about the hard area, but an area of numbness is normal. Feeling will come back in large part over the course of a year or so.