MUA Oct 2017 TKR - Hematoma - MUA - Finally past 90!<

[SusieShoes]

My OS saw me just twice: 12 days after the surgery, and at 7 weeks (which was my six week appointment). At the last appointment he released me and said he’d see me in a year from my surgery date. I was an average or maybe slightly better than average recovery.

I think if someone is struggling with low ROM after surgery, or is having lots of pain, the surgeon is more likely to want more follow-up visits. The OS wants to make sure things are going well as far as his/her end goes. PT has different reasons for wanting more visits. In my case, PT wanted me to continue not because I needed it, but because “your insurance will cover 40 more visits.” Um, yeah. But the OS is looking at getting functional results.

 

[Robinmhs88]

After my first forceful pt appt ( at 1 wk) I was schedule with someone who did more massages and light exercises and not tough exercises. she too moved my knee cap and it hurt a little but was tolerable. Haven’t been to PT or OS since the end of October, mainly because of insurance change, but I wonder if I should go back. Every moment is a different thought- one moment I think do it, than I say no. Not sure what my next step is but I keep trying and thinking new things I just have to remind myself my knee is in charge and I take cues from my what it will allow me to do.

 

[sistersinhim]

Is there a requirement to go back to our OS at certain times?

No, there is no requirement for going back to see your OS. I had a visit at 4 weeks and again at 12 weeks. He said I was doing fine and to come back if I needed to. I did go back after my fall, once I could walk and drive on my broken ankle and foot, just to check the knee out since I fell directly on it.

If I were you, I'd cancel that appointment. It sounds like to me your OS just wants to make some more money from doing a MUA on you. You are improving and you will continue to improve. You will get to 120, but on your knee's time schedule, not your doctor's. He is being unreasonable. I believe you are doing quite well for what you have been through!

 

[funkymuse]

I think I would like a thread name change in hopes that story may help others coming along that have experienced a Hematoma:

Slow and Steady Progress after Hematoma

Thank you!

 

[skigirl]

Good job for editing your thread to be helpful to others!! That is what we like to see around here!

 

[Jockette]

Love your new title!

 

[funkymuse]

BTW.. not that I'm thinking I have this problem at my stage.. but how in the heck can the OS find out if a person has adhesions? What are the signs? Can they see them on an MRI or something?

 

[Celle]

No. I don't think adhesions show on an MRI.
Many surgeons tell their patients they have adhesions because their ROM isn't what the surgeon expects it to be - but usually the problem is just persistent swelling, not adhesions.

In spite of all the fuss that some PTs and surgeons make about them, true adhesions are actually quite rare.

 

[funkymuse]

SO GLAD to hear this @Celle. I won't let him scare me with such tactics when I go in.

 

[sistersinhim]

There have been quite a few of us on here through the years that have had our knees in an immobilizer for at least a month or more. I was in one on each of my legs at different times. None of us developed adhesions in those 4-6 weeks of no bending at all. PTs and OSs talking about adhesions so often is just a way to keep the PTs employed! Also, so many facilities and OS are affiliated with each other, helping keeping both sides in business. Everyone needs to look at the whole picture when hearing about adhesions from this surgery.

 

[funkymuse]

Well I just read my PT's notes after my very first therapy appointment and here's one of the NEGATIVE things he wrote:

Also, the patient volunteered that she does not wish to "work through pain" as part of her rehabilitation; this may be a barrier to pursuing adequate left knee ROM. Potential Barriers to Rehabilitation: Include the patient's supportive husband, baseline of physical activity, and motivation to succeed with physical therapy and rehabilitation.

ARGH!!
Of course I want to succeed but why do they think we have to work through pain? This is a dumb question I know but here it is again slapping me in the face! Also calling my husband a barrier and my motivation a barrier!?! Also the 'baseline of physical activity?' Hey I can only do what I can do before my leg turns into a log! How in the hel.... am I supposed to go into a bend when my leg is a log? No wonder patients end up screaming and crying as PT's push their legs back!

I'm glad he called them 'potential barriers' as I hope to prove this entire statement WRONG!

So could someone send me the link to the page where the Mayo Clinic statement is.... I think I remember reading it on this forum somewhere... I'm going to send it to them!

 

[Jockette]

I think they are trained in the no pain no gain theory, which we know is wrong!!!

This is why I will not go to PT next time around. Many of them are a wealth of misinformation. I don’t have the patience to argue with them or try to transform them.

In fact, after reading various members PT experiences, I don’t think I will ever trust a PT again.

And how did you get that report?

 

[liam2015]

omg @funkymuse, i'm at a loss for words. all i can think of is that your p.t. has misunderstood you when you said you wouldn't work through pain, meaning that you would work through some discomfort but will ask him to stop if he pushed too far, as in when he is manipulating your knee or asking you to go further in your bend than what your knee will do. wow, so he really thinks you have to experience pain to improve!!?? having said that, i had the same conversation with my p.t. and one time she did go too far with the manipulation and i was sore for 2 weeks after that but the majority of time she only went as far as i could stand it and i told her "that's it" and she stopped. i didn't have exercises at p.t., just treatments: massage, laser, tens and acupuncture. goodness knows what her notes said, i didn't have access to them and this was private, not through my surgeon.

i'm sorry you had to read those notes. did he mean that your husband supports you in your request to not push through pain? i suppose he has to explain to your surgeon the timeline of your rehabilitation, whether it's too slow or not. my surgeon was of a similar mindset. he said that i wouldn't be able to gain r.o.m., nor would my p.t. be able to help me, because i wouldn't be able to stand the pain involved to get me there at that supposed late date of starting p.t. (6 weeks post-op). he wanted to do a m.u.a. it has taken me a longer time than most but i'm doing great now with my r.o.m. and it's still improving at 8 months post op.

please stick to your guns and don't let the p.t. push your knee or manipulate it to the point where you scream ~ there is no need for that and just sets you back.

 

[kneeper]

Oh, just ignore the PTs report. They have to file reports to get credit for doing their jobs.
I remember when mine asked me "What are your goals?" Well, duh. To carry on with life without a painful knee?

 

[liam2015]

@kneeper ~ i told my surgeon that my goal was to be able to walk my dog again...lo!

 

[Pumpkin]

Sounds like the PT just clicked on boxes in the electronic medical records, not really paying attention. I would pay no attention to that note.
You are the boss and can say "NO" to any procedure you feel is counter productive.
Saying no to therapy - am I allowed to?

There is no window of opportunity for ROM, many members, including myself gained range well over a year after our TKR's.
Myth busting: the "window of opportunity" in TKR
ROM: it's never too late to get more ROM! You will be interested in post #3.
ROM (range of motion) information ditto for post #19

As our forum advisor RoyGardner said.
When you are icing and elevating and watching telly you are not 'dossing around' you are 'engaging a carefully considered proactively designed heuristically programmed dynamically structured recovery programme'.

 

[funkymuse]

Thanks you both for your wonderful supportive responses!
@Jockette when I was in PT last Tues, I told Nick, the 2nd PT that I was working with, (not the PT who wrote the note who I am scheduled to see next week who's name is David who I had seen for my initial evaluation), that I had been trying to reach him by phone to possibly cancel the appointment if he was going to do anything like push my knee to try and gain flexion. He said that if I signed up for a thing called My Chart (I guess through this particular hospital), I could read the notes and send messages. So I got on there today and sent the PT's a message about possibly canceling the series if they were going to want to continue to push me toward a painful recovery and to let me what particular therapies they planned to work with me on since I would not let them push my knee. I didn't read David's note until after I wrote this!!! LOL !!!! Now he can really go to town on me!!!

he said that i wouldn't be able to gain r.o.m., nor would my p.t. be able to help me, because i wouldn't be able to stand the pain involved to get me there at that supposed late date of starting p.t. (6 weeks post-op). he wanted to do a m.u.a. it has taken me a longer time than most but i'm doing great now with my r.o.m. and it's still improving at 8 months post op.

@liam2015 - your entire post was very kind and so helpful to me. Especially the above quote. This gives me incredible hope.

Today has been a tough day. I worked yesterday, came home rested up really good - iced, elevated, and my knee felt pretty darn good this morning. However today I did the half turns on the bike for about 6 min and then with the addition of being up doing some ADL's, well, I guess my knee didn't have enough rest to handle all this extra today. And in reality it's not really EXTRA but after yesterdays work session it was.

Learning, learning learning. This weekend I was hoping to take my first outing into a grocery store but now after today, no. I'm going to really rest up.

Thanks again my friends....

 

[funkymuse]

So: My husband and I have been so upset by the stupid PT statement that I decided to write them a message:
Here it is!!!

Hello Nick.. Thank you for your reply. I was reading David's report from my first PT Evaluation with him and both my husband and I were slightly upset by the following comments within his report:

"Also, the patient volunteered that she does not wish to "work through pain" as part of her rehabilitation; this may be a barrier to pursuing adequate left knee ROM. Potential Barriers to Rehabilitation: Include the patient's supportive husband, baseline of physical activity, and motivation to succeed with physical therapy and rehabilitation. "

So.. let me make clear a few things:

#1: I have read many many stories of patients working through the pain and remaining swollen and in pain and unable to function and finally taking on a slow, steady and gentle approach and achieving the same ROM as those who pushed and struggled and suffered. Also I have read the same number of stories from patients mostly in the UK, who's Doctors and PT's DO NOT advocate such a strenuous push to get ROM and they recover fine. The USA does not seem to have caught up on the more gentle methods of healing with a TKR but there are some who are beginning to advocate such methods such as the Mayo Clinic. So, since I get very sick from the pain meds that have been provided to me, I am unable to work through the pain that would ensue from aggressive therapy working to push my knee into compliance, and I don't feel it will be a barrier to my recovery.

#2: I don't know where David might find the reason to mention my husband as a potential barrier to my achieving ROM. This was a complete insult to him. We both just don't understand it.

#3: The comment that my "baseline of physical activity, and motivation to succeed with physical therapy and rehabilitation," would also be a potential barrier to my gaining ROM. Again, I can only feel that David has made this comment because I don't want to push into pain. I want to recover badly, and I have extreme motivation. So much so that I have pushed myself beyond what my knee can handle again and again here at home and have suffered and been set back and have finally come to listen to my knee and do what I can to walk that fine line of doing to much and not doing enough. If I succeed one day with the PT here at home with no excess swelling and pain, I do a little more the next day. My 'baseline of physical activity' is to do as much as my knee can handle without pain, swelling and set backs, so I'm not sure how either of these things can be a 'potential barrier' to my reaching a good ROM.

Like you told me, each person recovers differently and sadly for me, I'm on a slow and steady recovery path. I certainly DON'T WANT TO BE. I've suffered many days of tears and deep depression from the Hematoma setback stealing two weeks of my recovery time which including a trip to emergency and so much extra hassle including a removal surgery and an MUA which mostly likely tore up whatever tissue healing had occurred and didn't seem to help me at all; when all that time could have been spent in good recovery had the Hematoma not occurred. I would love to feel I am at 8 weeks and counting BUT Dr. Picco concurred that I'm truly at 6 weeks moving toward 7 due to the 2nd surgery on 10/31. So no, I have not reached extremely good ROM at this juncture, and it hurts my heart to know I'm not but it is what it is and I'm doing the absolute best I can to work on it.

So I hope this clears up the mis-understandings that I feel David has written into my chart notes which I feel are completely incorrect and I would hope he would revise this statement based on all that I have informed you of here and in my previous message to you.

Christina James

 

[Jockette]

Personally I think 6 minutes on the bike is a lot at your stage and with the swelling you get.

I don’t remember when I borrowed my pedal thingy, but I only did 10-20 rotations which took less than a minute, once a day, and I thought that was plenty. Actually I found it an overrated experience! My knee wasn’t crazy about it.

I really think you are desperately trying to find things to do to help your knee heal, but all it really needs is ADLs, rest and time. You are back to work early, that in itself is plenty of ADLs/PT. Your knee has already been through more than most and it’s only been 2 months since the original surgery.

I know stopping PT goes against everything most of us in the US hear. I wanted to stop going to PT by 5-6 weeks post op because I felt they were adding things that were counterproductive. I also thought it was a waste of time for me to go and not to everything they wanted. My husband has always been very athletic, he coached high school basketball for 20 years, and he was not in agreement for me to stop PT. (other than that he was exceptionally supportive of my recovery) We were both also afraid that if I didn’t do what my surgeon told me to do that he might not be helpful if a problem came up. So, I continued with PT, but at this point, due to scheduling, I was only going to PT once a week and thanks to Bonesmart I didn’t do anything at PT that I didn’t want to. I cancelled some appointments and it turned out after they stopped the pool therapy I only had 2 more sessions before I was discharged.

Please think very carefully about the PT that you are going to. Bonesmart says it is not necessary. I agree. If I have a replacement in the future no one will be able to pay me to go anywhere near a PT office! (I have already told my husband this and I think at this point he’s ok with that)

I also think at this point I am not as afraid of my surgeon’s opinion as I was earlier, so next time will go differently.

I’ve heard of My Chart. I actually have things in it 2 different doctors have set up for me but I’ve never looked at it. One was a foot doctor and the other was an eye doctor.

 

[Jockette]

That is a great rebuttal to that note the PT wrote!