Momentus decision: Return to work yet?

[LinZee77]

Hi guys
It's been a while since I posted, visiting my OS for the 8 week check up.
I have my list of questions laid out to ask, but what really is looming uppermost in my mind is the dreaded "return to work" day.

I had told my employer that I would be back to work full time on July 11th.
That is next Monday! However, I do not feel ready, and am just making the improvements in P/T with my ROM (around 125)and gait that took me weeks to establish. AT P/T I can do 10 min on stationary bike with full revolutions, and 10 min on treadmill at 1.5 m p/h with normal stride/gait. Then I do the step-up exercises and the stretching ones lying down. I also do some aquatic exercise specifically for arthritics most days in my pool for about a half an hour. .

I still need to take some form of pain meds every day. I take 400 mg of Advil upon waking and again about lunchtime and then around dinner and at bedtime. That is my baseline. If I go to P/T (or anywhere else) which involves driving, I will take 50 mg of Nucynta, which is kind of like Tramadol. That usually covers about a five hour stretch. My Rheumy Doc prescribed me Percocet 5/325 two weeks ago (OS would not renew, and rx'd Nucynta) which I will usually resort to by 4 PM (take two)because that is when the real pain will kick in. I have pain in the back band of muscle behind my knee, and some nerve pain that starts behind my calf will cause a burning feeling stretching all the way to my toes!(this is only intermittant) I think some have referred to this as the IT band. (Correct me if I am wrong here) There is also some sharper pain in the center of my knee cap. If the band behind my knee gets really bad. I use Lidocaine patches at night. BTW
I have been sleeping much better( only wake up to tinkle) once I started back on the Percocet.

I also have been getting Euflexxa shots in my "good knee" (RIght side) for the past two weeks, third one due this Friday. However, this knee is troubling me more these days too. I am hoping this will be enough to quell the inflammation there.

So I guess what I am really fishing for, is can I justify to my employer that I need more time before returning to work next week? I just don't think I could make it through an 8.5 hour day plus 30 min each way of commuting. I do have a computer workstation job, but I worry about my afternooon stamina lag and the level of pain I still am dealing with. Since I am not the only paycheck in the household, it is not essential that I return just yet and my DH supports me and helps tremendously all thru my recovery.

I know that it probably would do me good to get out there in the real world, but I am afraid that if I can't cope with such a full day I will regret it and it will be harder to get the medical leave again rather than just extending it.

I have appreciated this forum for the past 10 weeks that I have been visitng it and value all of the input from the members and admin volunteers od Bonesmart.:biggrin:
Thanx in advance for any input

best to all in your recovery

Lin Z
LTKR 5/09/11
LK Arthroscope 9/16/10
RK Euflexxa injections 6/11-7/11

 

[Jaycey]

Hi LinZee77, frankly I think it's too early to be going back to work. Just my opinion and not based on any scientific facts. But if you are not feeling 100% or very close to that then it's not time.

Normal recommended return on a phase approach is at 10-12 weeks. Read Jo's thread about this again.

You are absolutely right to consider your level of stamina and the need for continued pain control. The stress of a full work day can set your recovery back - so consider this carefully.

Can you go to your GP and get your medical leave extended?

 

[goodasnew]

Hi LinZee, I tried to go back to work at 5 weeks, felt great being at home, but was unprepared for the sheer exhaustion that hit me when I started working again. I clearly was not ready for it and had to take another 4 weeks off. Even then, it was difficult returning to work but got gradually better over the next couple of weeks. I would say it is still too early for you and you can certainly justify more time to rest and heal. Don't hurry this, I tried to and just set myself back. I'm fine now (at 5 months) and have been back at work for about 6 weeks without too much trouble. Be easy on yourself.

 

[zjrog]

I wanted to be back after 3 weeks, but wound up being 5. I might have managed at 3 though. They were very accomodating to me when I did return, plenty of time to rest and keep my leg up. We have an ice machine and I made full use of it!!! I also had to work with our Occupational Med folks which proved to be more a hindrance than my surgery, to be honest. It was a slow period for us, over the winter. We do work 10 hour days and the commute is an hour each way or so. I vanpool, so no worries about driving, and they were nice enough the first week to pick up and drop off at my house.

If you don't feel ready, see if they can make accomodations to help you. Or, if you can wait another week. Maybe telecommute?

 

[Bees Knees]

I went back to work part time at about six weeks. It worked because every other day I could rest. It was probably too soon even with part time. The first week I stayed half a day and then build up my stamina. It was challenging. If you have achoice I would take the time to heal.

 

[Josephine]

Many people have posted here about returning after only 8 weeks and I say the same to all of them - as an occupational health nurse, there is no way I would let you back to work the way you are feeling. Not only would you put your recovery back you wouldn't be able to concentrate on your work properly. In my opinion, you need at least another 4 weeks and even then to make that a 'maybe'. For others reading this, I would urge you to never, ever give a firm date for return before the surgery as you just never know how your recovery is going to be. And I know there are some surgeons who state positively that their patients can return after x number of weeks. Maybe some people can but it's still an awful pressure if things don't quite work out.

So, I suggest you contact your boss and tell him how it is and that you are going to take a few more weeks off and you will be getting in touch in two or three weeks and let him know how you are progressing. I'm sure if you see you doctor he will be more than willing to sign you off for another few weeks.

 

[PhoenixS]

I went back to work at 6 weeks. Then I had a rotator cuff repair a week later. Untimately returned to work FUL time at 8 weeks post op knee, and 2 weeks post shoulder.
I have very much regretted this stupid decision. (I am the only paycheck, and I knew my patents and staff were anxiously awaiting my return- AND I also needed to get out of this house)
Nothing but struggles.

Now out on a mandatory medical leave d/t severe knee and back pain which require narcotics to control. Since I am forbidden to use narcotics while at work (no-brainer actually), I got by on heavy doses of Aleve, motrin, thylenol, etc. This left me with a gastric ulcer.

PLEASE, please, if I can offer any advice, extend your medical leave.
I'm not sure if I had actually stayed out for a full leave if I would be in this position anyway. No way of knowing, but you are doing well, don't rush it. Take your time to heal.
To He!! with work.
You come first.
Sandy

 

[referee54]

My OS saw no problem with me returning to work at 8 weeks---that was my goal. I did it; but I can tell you that, in my mind looking back, that it was at least two weeks too early. I had a BTKR and both knees were stiff and sore at the end of the day---I would say that returning to work at eight weeks prolonged my recovery.

I did return to work; I teach and, regardless of how hard I tried, I was on my feet A LOT. It slowed me down and added to some frustrations. I iced at school and rested when I could, but eight weeks was certainly a stretch for me. I would urge you to consider waiting a few weeks longer.

 

[JackieS]

It doesn't sound like you're ready and it does sound like it may set you back some.

With both of my knees (2008 and just two weeks ago), my OS believes in being 100% before returning to work whenever possible. With my first knee he warned me that it's a long recovery process and I might have to be out of work from 3 to 5 months. I have a job and lifestyle in which I really need to be up to snuff walking, catching trains, etc. Plus, my short term insurance doesn't allow a part time phased in re-entry to work. I have to return full time or not be able to survive on part time pay.

For both knees, he informed the short term disability folks right off the bat that expected return time is 12 weeks. My FMLA leave (unpaid but job protection) at the workplace covers 12 weeks. However, my employer, with medical documentation, will allow up to a year on such a leave. Alas, the short term disability only covers 6 months! Nonetheless, I realize I'm very lucky to work for a company with this outlook on leaves.

Due to recovery complications with the 2008 knee, I was out for 24 weeks. I was still fatigued when I returned, but the knee itself wasn't an issue.

I will be out the minimum of 12 weeks with this current knee. That just might do it. I'm coming along a lot better. But no way do I want to return earlier then have problems! If you can, take the time. You won't regret it.

--Jackie

 

[zjrog]

I'm glad my return to work had a very soft landing. Not only did I have to have my PT and OS onboard, but then convince the Occupational Health DR I was ready. Occupational Health Doc gave me a clean bill of health about 3 months ago, no restrictions (about 30 days after I started trying to jog again!). I had to demonstrate some basic exercises and balance. I know my case isn't the norm, and the Occ Doc didn't believe I could do what I was doing so I had to show him. He called another couple folks in to see... Nothing like being someone's dancing monkey...

 

[LinZee77]

Thanks for all the feedback. I really appreciate it.
.I can't explain it, but whenever I go to my OS I always have this idea of how things will go, and because I get sort of tongue-tied and almost intimidated by him, I can't ever seem to get the kind of results that I want. Long story short, he stood there flabbergasted that I suggested I wasn' t ready to go back to work next week. When I calmly cited my reasons : can't sit too long (that drew an incredulous response from the PA) and that I am exhausted by the middle of the day when I have alot of activity (i.e P/T & pool or a drive for errands or even just a Doctor visit), and am still needing pain management, he then said, "Well, we encourage our TKR patients to get back regular activity because it isn't good to be inactive too long", and ended up issuing me a note for "Light duty" back to work (no extended standing or walking for only 1 month longer (GRRR, am I the one paying these people or not?) and more P/T for six weeks(which I actually did ask for)
.Anyway, I will have to appeal to my boss to just use out my FMLA (which I had stressed to the OS was UNPAID leave) & which expires 7/23/11. I thought maybe I could extend that for a few months, but that isn't going to happen from this OS.
If worse comes to worse, I will see the GP to buy more time.
Oh don't you love the medical profession? I seem to get mixed signals everywhere I turn. And I feel that I am the one caught in the middle.

best to all in your recovery,

Lin Z
LTKR 5/9/11
LK Arthroscope 9/16/11
RK Euflexxa injections 12/10, 6/11-7/11

 

[kneesrus]

Lind Z. Here is what I use for graduation.
6 min walk test How for can you walk in 6 mins. You can stop during the test, but, the clock keeps going. I want the patient to be able to walk for 400 to 600 meters.
10 meter test: How long does it take you to walk 10 meters. This will measure if can you get across an intersection. A good time is 8secs.
Can you go up and down 2 flights of stairs, only one foot on a step at time. Basically go up and down normally.
Last: can move from sitting to standing from 12inch height.
If you can pass these test, then you have a good chance of returning to work. But, your rehab does not stop just because you are going to work.
Best of luck,
David

 

[Josephine]

I just get more and more staggered by these US surgeons who seem so unbending in their protocols. I am speechless!

 

[kneesrus]

Jo, the OS don't want to see the patients after they leave the OR. They feel their work is done and go get on with your life. They have never rehabed anyone, and probably never have had surgery. I had one OS tell me "I don't want to talk to these people, put them asleep, let me cut them, and send them on their way."
They don't know about anxiety and what level of endurance someone must have to return to work. You have to work with the whole forest and not just the tree.
David

 

[doxiemom]

My OS tried to talk me OUT of going back to work. He wanted me to take another month. I wish I had listened to him, but since no-one was doing the work in my absence, it was just piling up and I was half-working anyway from home but without the paycheck.

 

[1jt@atime]

My OS has always been very supportive of whatever I felt was best for me. This last time he definitely agreed I should extend my leave past the planned eight weeks and would have signed off for me to stay out of work for as long as I felt was needed. So you see Jo. It's not ALL US surgeons.

 

[cotton1958]

Jo, the OS don't want to see the patients after they leave the OR. They feel their work is done and go get on with your life. They have never rehabed anyone, and probably never have had surgery. I had one OS tell me "I don't want to talk to these people, put them asleep, let me cut them, and send them on their way."
They don't know about anxiety and what level of endurance someone must have to return to work. You have to work with the whole forest and not just the tree.
David

Surgeons are a different breed. My Grandfather was one. Ask a nurse. I know nurses. Anyway. Thank God for Surgeons. And we should pray for them as they are not Gods. They are humans.

I had one of the best for my knees. But I don't know if they will ever get any stats out of me. It's too common of a surgery I assume these days.

It's probably getting to be like, when you had your tonsils out 20 years ago, did they grow back? Obviously I am not in a study group...but who is I wonder!!

Edited to add: Good ones get you into surgery...nothing wrong with that....... It's a business. ALWAYS get more than 2 opinions.

 

[JackieS]

I'm in the US and my surgeon asks me how I feel, cares and would never let me go back to work earlier than I should unless I told him I must. (And I don't have to return early!)

I love my OS -- but not in a creepy stalking way, you understand!

--Jackie

 

[zjrog]

This is where I feel more than lucky. My OS' PA is a former PT. AND, he is very close friends with MY PT. So everyone was one team, supporting me. Nothing was ever sugar coated for me.

 

[sashayinglady]

I went back to work 12 weeks post-op BTKR, 12 hr night shifts at my favorite hospital....felt exhausted for the 1st month, but I had other issues to deal with . Probably, if I had taken 16 weeks off I would have felt more energized and stronger, but FMLA & the HR dept kept sending me letters every 3 weeks "are you able to return to work by 02/23/11", I sure wasn't going to say no.

My OS must have UK roots ...he ordered 6 weeks home pt only, it was I that forced him to order out-pt PT, which was too aggressive.

Take care and Rest, Relax, Elevate and ICE for several months...your knee will Love you for it!
Darlene