THR My Hip Trip - Second Verse

[HollyB]

@Josephine thank you so much for this response especially in light of your current recovery. How has today been going for you? I send you my best healing thoughts.

PP = Personal Physician. It could be just my own "personal" shorthand although I thought I saw someone else use it but maybe not. Actually my Personal Physician is a Family Practicioner, similar to the title of General Practioner. Some physicians do not work with children, only adults. They are referred to as Internal Medicine Physician.

Yes thank you re only 10 reps on those Leg Lifts, ever. And, no, I haven't forgotten about walking as the best rehab (but don't overdo even that!).

The toe raises weren't given as exercises. I think they must have been trying to gage what I could do. I'll ask. But, I have not been asked to do these as part of any regular program.

No, no. Neither you nor anyone on BoneSmart has advocated 24/7 ice. The Home Health Nurse just saw my ice packs and I told her how helpful the ice was (she agreed). But she said not to overuse the ice. Not to use all of the time (believe I paraphrased with that word "permanently"-- I'm sorry ).

Josephine, my concern right now is trying to understand this rehab part of the equation. Don't want to do too much but on the other hand, don't want to do too little. One of the PTs mentioned to me that there were protocols for the exercises. I'm going to try to follow up on that. Could be that the American Association of Physical Therapists has some information. What about the UK?

 

[Josephine]

The world abounds in various protocols varying from one extreme to another! But if you've been reading my thread you will have observed that I did NO exercises whatsoever. Not even a heel slide or two! Not this time nor in 2009. And my flexion is now 123 which is pretty staggering for 5½ weeks! It's actually been that since around 3½ weeks out. It was much the same with the other knee in 2009. I put that down to LOTS of rest, some elevating, moderate icing and regular pain meds. And walking - some. Just to the bathroom and kitchen and that. No marathons! We had snow and it was cold outside so didn't even open the front door for about 3 weeks!

I now have a little issue with extension but that's caused by a pre-existing muscle problem I'd had for almost a year. My chiro is treating that and very successfully too. He advised me not to try any exercises recommended - you know, lower leg hanging with weights on, kind of thing - as we know I have muscle spasms in the back of the leg and those stretches will only make a bad situation worse.

So that's my stand - no exercising. Take it or leave it as you will but I think the results speak - very loudly - for themselves! Can't wait to deliver a paper on this at some prestigious surgeons' meeting sometime!

 

[HollyB]

@Josephine what you say makes so much sense to me. I've read many of the threads on this site where the surgery goes fine, patient goes home and is feeling much better, and. then the exercises start and the trouble begins. It really does look like a pattern. Please,please,please write that paper and send me a copy-- autographed, of course! Pleasant dreams and good tomorrow's for you.

 

[Jamie]

I see Jo has answered your questions. I think knees and hips may be a bit different in the icing requirements. I know for me (with only TKRs in my personal experience), ice was a tremendous benefit for my pain and swelling. I did ice heavily during both the day and night for months (especially all night while trying to sleep without getting uncomfortable) and it worked well for me. But...as mentioned....it is an individual thing and you have to go with what works. Judging from my years of working with members here on BoneSmart, it doesn't seem like hips require lengthy icing for you to remain comfortable.

I know that some people say not to ice much because it slows healing. But....I've not known anyone ever to heal more slowly after joint replacement surgery because they iced for pain relief. Being in pain can inflame sensitive tissues and that is a huge issue when trying to recover. Your body cannot fight inflammation and heal itself efficiently at the same time.

The best thing to do is to listen to people you trust, try things that make sense to you, and see how it works (listen to your body). You will hear ideas and advice here that has worked for a majority of our members over many years of experience with them. It's an excellent starting point for developing your personal recovery plan.

 

[craftdee]

Hi @Josephine I posted a reply here on HollyB's thread

My Physio told me much the same as yours... she said even to heat BEFORE exercise then ice after, but not to ice permanently

The use of the word "permanently" was mine... @HollyB took responsibility for it but it was mine - and it in NO WAY implied or should have been inferred that it was Bonesmarts recommendation As you can see in that quote I did not say that permanent icing was BoneSmarts recommendation, I simply said my physio said not to ice permanently. The "many here" I referred to in my post - where I still did not suggest were icing permanently... I used the terms "a lot" and "for a long time out in terms of weeks"... are members of BoneSmart who have stated how extensive icing has helped.. with which I agreed in my post; ice is your friend and in the early days a real boon. However when you say

Do they indeed? Well if they do, it's not by BoneSmart's recommendation. Only if they have significant pain/inflammatory issues

you may not realize that the article in the library https://bonesmart.org/forum/threads/thr-elevation-icing-for-pain-swelling.15150/ says, and I quote "Ice is an astoundingly effective treatment for pain and swelling. Ice initially constricts local blood vessels and decreases tissue temperature. It also decreases inflammation and pain, speeds nutrients to the area, promotes healing, and decreases swelling, tissue damage, and muscles spasms. Ice gives you a lot of bang for your buck.

There is no such thing as too much elevating and icing." Some people may think that if there is no such thing as too much that icing permanently would be a good thing.

I wasn't offering medical advice, don't profess myself to be professional on any level I was simply sharing my experience... what worked for me and the notion that THR recovery is not a "one size fits all" proposition.

I consider myself smacked and will keep my opinions to myself from now on

 

[Josephine]

@craftdee you weren't being smacked! I was simply offering MY opinion which I hope I can when I see the needm just as you do. Your opinions and experience are always welcome here as you manage to imbue it with a degree of common sense and care I find endearing and reassuring. But I have to think of the wider readership and ensure that some comments are moderated so that they don't get the wrong idea. But in the end, it's all about personal experience and opinion. Please don't let my comments put you off. They weren't intended as a castigation to you!

And thank you for bringing that article to my attention - it has been removed for revision.

 

[craftdee]

No problems @Josephine... I will continue to share my "opinion" which is really just my THR experience, can't really shut me up at the best of times My experience is all I have to offer, but as I really valued the offerings of other BoneSmarties - especially early in my recovery - I agree that, as you said, that's what it's about in the end

Donna

 

[Josephine]

Oh good - I do so hate to upset people!

 

[HollyB]

@Josephine and @craftdee let me just add that I love both of you. Whenever I see that either of you has posted anything I'm right there reading it because I value your knowledge and experience so very much. For my part, I read the posts and try to think about how that might apply to my situation. Would it work for me? Should I double-check with my Personal Physician or OS? Should I just keep this info in my back pocket for the time being and see if the issue arises? That's sort of a shorthand of the way I process things on the forum. It's all good and I think you two just Rock!!!

 

[craftdee]

Hi @HollyB

For my part, I read the posts and try to think about how that might apply to my situation. Would it work for me? Should I double-check with my Personal Physician or OS? Should I just keep this info in my back pocket for the time being and see if the issue arises?

PERFECT!!! That's EXACTLY what you should do with this info... when you come to think of it, it's pretty much what we should do with anything we're told or we discover - not just with a THR recovery but in life in general Pity it's not always the case and we go to watch a movie or go somewhere on holiday or, worse, paint a room a particular colour because it's the "in" thing (well burgundy WAS "in" for a while, lol). I find as I get older I tend to make my own mistakes more often and other people's less often... I call myself sensible some may call me cynical

Donna :cool:

 

[Josephine]

I so agree. I just educated my GP about using Gladwrap on a TKR wound. He was mystified but I assured him it calmed everything down a treat! There's no telling that you can get from this place!

 

[HollyB]

https://www.wsj.com/articles/remote...h-care-1424145642?KEYWORDS=Medical+monitoring

@Josephine and all the Bone Smart Gang: here's a link to a recent article from The Wall Street Journal about home monitoring. I had my surgery done at a teaching hospital about an hour and a half from my home and I was sent home with the sort of equipment described in the article-- a blood pressure cuff, a thermometer, oxygen level devise,and a scale. I was interviewed beforehand about the program and had to consent to participate. My understanding was that monitoring for orthopedic patients is fairly new--or at least in the area where I live. The Home Health Nurses have told me that they have never seen it for orthopedic patients but it is pretty standard for cardiac patients.

Every morning I take the four vital sign measurements, hit a button, and the information is transmitted via WiFi to a Nurse(s) at the Hospital who monitors the numbers. She/he calls once a week as a norm to ask how I am feeling and how the incision looks. However, she calls immediately if any of the numbers are out of range. For example, my temperature was up a couple of days and she called; one time I held onto the walker too long and there was a three pound weight difference from the previous day -- she called immediately.

She transmits the numbers (I don't know how often this occurs) to my OS, my Person Care Physician, and the Home Health Agency. My husband also keeps a handwritten log of the information.

My understanding of this program is that it is a way to catch problems in the very early stages and perhaps avoid a read mission to the hospital. Avoiding those readmissions is a win-win for everyone, in my opinion. As a patient I don't want to go back to the hospital if I can help it; and, the hospital loses money on readmissions so they don't want to see me unless absolutely necessary.

Anyway, I've enjoyed participating in this program and if it is something that can help all of us Hippies then I hope it is the wave of the future!

 

[Jaycey]

Wow - that is an impressive program @HollyB ! Hope it's the way of the future. Certainly would help those who do have the rare complications following surgery.

 

[HollyB]

@Jaycey I've been impressed by the program, too. It has also provided a real "peace of mind" element to my recovery as I see those numbers falling into good normal ranges. Actually I've thought that anyone could monitor the temperature, weight, and blood pressure on a daily basis, keep a log, and then compare numbers with the Home Health Nurses.

 

[NuMe2014]

I attended a workshop about this at a Chronic Disease Management conference I attended eight years ago. It was very interesting and the speaker was from Australia where they were doing a trial run with cardiac patients in remote areas. I was fascinated with the whole concept and thought it would really work in the rural parts of our province ( closest physician/medical facility being 60miles/100km away)!
Unfortunately nothing came of it here due to cost/politics! I am happy to hear though that it has proved to be a viable medical tool somewhere!



RTHR - Sept. 8 2014
LTHR - Jan. 19 2015

 

[HollyB]

That's really interesting @NuMe2014 . A program like this would be wonderful for rural areas. I grew up in a rural area (beef cattle) and travel for medical care was significant. I was really impressed a few years ago when an aunt of mine had a mini-stroke and the local hospital sent her CT Scans and MRIs over a network to be read by experts at a distant Regional Hospital. It was quick and very helpful in my aunt's situation.

 

[Josephine]

interesting

 

[craftdee]

Hi @HollyB ... yup, a lot of diagnostics are done via the internet here now. Especially in remote areas. My nephew suffered a very serious accident when working at a drill site (his Dad has a water drilling company) near the Argyle Diamond Mine in the Kimberley Ranges of our North West... he was 115km from the nearest (very small) town, 550km South of Darwin and 2000km North of Perth; Argyle had First Aid facilities that included a webcamera and internet link to Darwin Hospital - they assessed and directed initial treatment (crush injuries require very specific early treatment for the best long term outcome) and called up the Royal Flying Doctor to evacuate him direct to Darwin where he spent two weeks in ICU before being transferred to Perth. He kept his arm (though it is not functional) but we have been told that if his initial treatment had not been administered how it was that he could easily have died - toxins are released from the crush site back in to the body. So thank goodness for modern technology

Many remote medical centres such as Broken Hill in NSW rely heavily on internet access for specialist input in most of their cases, it is one of the commitments that Federal Governments have made over recent years... that people in ALL areas of Australia, regardless of how remote they are should have access to fast, reliable internet; when you look at it remote areas should have it before us city dwellers really as we pretty much use our internet for entertainment and could function generally without it - wouldn't be much fun though

I would have participated in "your" study in a heartbeat... I find this stuff interesting and can see how valuable these studies are.

 

[HollyB]

@craftdee that's an amazing story about your nephew. As usual you told it so well -- I just read it out loud to my husband and he agrees with me that you have a definite talent for writing. Fan Club is forming! And, yes, isn't is just one of the nicest things ever to see something like technology advances working toward the better good.

 

[craftdee]

Blushing here @HollyB We've had a few "dramas" over the years, yet I describe our family (even our extended families) as particularly "ordinary"... EVERYBODY has a story, as they say. The thing we didn't know about my nephew's crush injury at the time was that it would be a learning experience for when my son crushed his foot in 2013 - he lost his toes but after seeing my nephew's struggles keeping the arm - then having it be useless - made the news that sacrificing the toes may be in Matt's best interest easier to understand and bear. As I've said before all of these incidents make a bit of a bump in a THR recovery fade into insignificance!

Hope you're enjoying your weekend... I'd tell you ours is STELLAR, but I don't want to make you jealous :cool: I'm just "playing" on the laptop while hubby mows the lawn, still, that can't last, sigh. I'll go and wash the car in a minute... had to wait for the shade to hit the driveway as the sun dries the car quicker than I can chamois it - I don't know if it's because we now have a bigger car, the sun's hotter or that I'm slower... I'm guessin' it's nothing to do with cars or sunshine

Once that's done it's time for a swim; we went to a café strip for late lunch and now I have a tight butt... not in a good way so I'll do my stretches in the water then use the passive solar storage facility (the sandstone pool paving surround holds the heat ) to dry off. The breeze is just puffing in now and it's 29C... did I mention our weekend has been STELLAR oops, did it again

See ya