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

[Polkadot]

It's early days for you still. That ROM will come! Walking really helped me, and I too did it by taking very short turns around the house and yard and then increasing distance gradually. Another thing that helped me was using a small exer-cycle I found on Amazon. I would pedal at no resistance for 10 minutes at a time. I found it really loosened me up. I even took it to my OS's office at my 10-week appointment so I could pedal down in the lobby beforehand and loosen my knee before I had to "perform" for him!

 

[Celle]

Yes I do have issues with bending.. I guess I'm in the Slow Benders Club and that's ok.

It's so early in your recovery that you are not to consider yourself a slow bender. Your knee is reacting normally to the trauma it has received. It knows what it's doing. It will bend more when it has healed more and when more of the swelling is gone.
Try not to get impatient about that.

Don't listen to anyone who tells you that you "Should be" at a certain number of flexion by now. There is no realistic target that you have to meet and you know that ROM can continue to improve for at least a year.
Don't go thinking that exercising more will make it happen faster. It won't.

Remember that it's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.

 

[skigirl]

I am not sure that I wore firm support! If they are too much, get the lighter ones.

 

[funkymuse]

Hello all... I plan to respond to the last several messages in a little while and give a PT update. I came home and just zonked out! But in looking at my Tylenol Bottle it instructed me not to take more than 6 capsules in a 24 hour time frame which confused me because it is different than what has been recommended on this site. So I looked up how much I can take on the web and found this:

To help encourage the safe use of acetaminophen, the makers of TYLENOL® have lowered the maximum daily dose for single-ingredient Extra Strength TYLENOL®(acetaminophen) products sold in the U.S. from 8 pills per day (4,000 mg) to 6 pills per day (3,000 mg). From the Tylenol website: https://www.tylenol.com/safety-dosing/usage/dosage-for-adults

I want OFF Oxycodone. It makes me completely nauseous 24/7 and since I'm on such a low dose anyway and not really using it for extreme pain anymore I have called my doc's office for Tramadol so I can step down and use Tramadol with Tylenol! In contemplating this move, what kind of withdrawal will I have, if any, when I don't need the Tramadol anymore?
Thanks all...
More soon!

 

[skigirl]

This is one of those questions where the answer is "It depends"!. I used tramadol as a step down drug, it was a relief because it does not have the side effects of opiods. Tramadol is a sythetic opiod. I never had any problems---took it one day, did not take it the next. I have seen posters speak of weaning off tramadol over a week or two week period, but I have never experienced that effect.

I personally would only take 3000 mgs of Tylenol a day. It works as a "booster" drug with Tramadol. You can take the tramadol by itself or with Tylenol for more effectiveness. I know that Jo, who is a nurse recommends 1000 mg of Tylenol for pain. But, it found that 250- 500 mg was adequate when taken with Tramadol.

This area is personal, we don't know how you will react to any drug. So, use caution while trying it out and see if you can find a dosage that works for you. I am sure your doc will have a recommended dose of Tramadol as well, and that should be your starting point. Tramadol's is sold as Ultram, then with tylenol in it as Ultraset.

 

[kneeper]

Was it painful @kneeper ? The nurse said it was. I'm not into anymore pain!!!

Given that you're shortly out of an MUA and not far from tkr, I'd say it's too early for scar massage. And don't let them talk you into deep massage or "Graston"--where they actually use tools on your leg. I let them do that to me with my first knee (the old "we have to break up scar tissue and that's why your bend is slow" nonsense) and it just aggravated the tissues and left me with pain a lot longer than necessary.
With knee #2, I did lightly massage the leg in the sense of doing that while putting lotion on but no "program" of massage. I had no residual tendon/muscle pain with knee #2.

I did no scar massage after having a plate put in after a broken wrist and guess what--it healed fine.

 

[funkymuse]

So... getting back to checking in after what I would consider a bit of a failure of a day at PT. The guy was nice enough and didn't push me to pain. He pushed me a bit into a deeper stretch than I'm used to and I told him when he needed to back off. He showed a couple of nice exercises to do, which I did, and we measured my ROM which was at 62 with a bit of a slight push from him. I'm sure it's around 60 without any push.. so I'm happy with that. I mean last week I was only 45 - so on my own, walking and stretching and doing gentle bending work, my knee is losening up. He gave me the song and dance of needing me to come in twice a week so he could help get me through to that ellusive ROM measurement before that WINDOW OF TIME is up!

The whole time was spent on the bending work and then I did some short arc quad lifts with a roll under my knee, which I have been doing here at home - but only about 5 per day.

So here's my rationale. Why go there and be put through all these exercises in a short span of 30 min only to experience swelling and tightness the rest of the day? I mean I still need to function a bit at home and so if I do this, it shuts me down from being able to take my gentle walks around the house, and do a few things in the kitchen and move about when my body gets restless!!! I can do all these exercises at home at a gentle pace throughout an 8-12 hour period rather than shoving them all into 30 min which causes everything in my knee to be unhappy because she is not ready to do all this all at once!

I called the day a failure because I came home and ended up having to be bed-locked because of swelling and stiffness all from this 30 min PT session, which truly was not that bad but again my rationale is that it happens all at once, so in that regard, at this stage in my healing, my knee does not want to go there!

So what I plan to do is to stall a bit. I'm cancelling my next week PT. The following week I see my surgeon before my PT - so I'm going to ask him if I have to do these PT sessions and tell him my experiences and see what he says and then go from there. My gut feeling is to NOT GO BACK!!!

@Polkadot - yes I researched those little peddlers quite extensively and decided instead to buy a used stationary bike since at some point when I'm ready, I'm going to want to get back to cardio work.

@Celle - I'm grateful for your words of support and wisdom. They are hitting home more and more - especially after today!

@skigirl - yes well I looked all around and the toeless ones only came in firm, extra firm and ultra firm. So I'm hoping these work. The ones with the toe come in light, med and firm... so we will see! I'll send them back if they are too tight. And thanks for the information you shared on the Tylenol and Tramadol.

@kneeper - I'm definitely NOT going to do scar massage. Maybe that's an old school thing as the PA is very old school about things but after reading your post and another one on my thread, I'm NOT going to do it!!!

 

[Celle]

But in looking at my Tylenol Bottle it instructed me not to take more than 6 capsules in a 24 hour time frame which confused me because it is different than what has been recommended on this site. So I looked up how much I can take on the web and found this:

To help encourage the safe use of acetaminophen, the makers of TYLENOL® have lowered the maximum daily dose for single-ingredient Extra Strength TYLENOL®(acetaminophen) products sold in the U.S. from 8 pills per day (4,000 mg) to 6 pills per day (3,000 mg).

The recommended safe daily dose of Tylenol (Acetaminophen) is 4,000 mg in 24 hours, from all sources.
In the USA, the authorities restricted the recommended safe dose to 3,000 mg in 24 hours, because of a fear that people would neglect to count the Tylenol included in other medications, such as Percocet - which contains Oxycodone HCl 5 mg and Acetaminophen (Tylenol) 325 mg.

I agree with you that the PT session was too much for your knee. Remember this:

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
​

And, by the way, never let your therapist push on your knee. It's bad for it. IN any case, the ROM numbers you get when being pushed on don't count. The only numbers that count are those that you get by using your own muscles.

 

[Jajakio]

You really have to find your own sweet spot about how much you can do. Pain and swelling afterwards are a pretty good indication you are pushing too hard for where you are now. I found it helpful to keep a kind of recovery diary of what I did each day and how it made me feel. Some exercises are going to be more painful than others and it won't be the same for every individual. Listen to your body.

I had one hour PT sessions 3 times a week for the first month and sometimes I think I'm the only person who actually enjoyed PT. I had pretty great people though. They seemed to take individuals into account and i would see others who were struggling at a couple of weeks out and not being given nearly as much to do. One really swollen guy just got a quick check of his ROM , icing and a suggestions on how to get swelling down. If your PT place is pushing for more than you are comfortable with, you have the option to not go back or go but only do as much as you are comfortable doing and saying no to the rest. But that stresses some people and i definitely think you can rehab at home if you want to. I think I made the most progress after i was done with PT when i was between 6 and 8 weeks just by walking, recumbent biking, a few stretches and a few stairs.

I never let anyone push my leg back to get increased ROM. I just don't see how it helps. You are going to have to move your own muscles to make real life progress. It's like someone lifting you up to the bar to do pullups. Yes, you can surely do more pullups with someone lifting you up and down, but does it really count For anything?

 

[funkymuse]

Yes.. well.. just getting up after having my leg elevating and icing causes it to swell. So before I even get into the PT room, the walking and the sitting in the waiting room waiting, and I'm already behind the 8 ball of swelling and stiffness. Then the onslaught of even gentle therapy has to be followed by walking back out to the car. The PT office happens to be quite a ways from the parking lot and you have to walk to get there.

On another note, I've been going through quite a number with my emotions today. I'm very sad and depressed, that this long ordeal is only going to be longer since I'm now only officially 4 weeks out from the first surgery and I am wanting to lunge ahead to the 6 week mark where I hear really good things begin to happen.

I feel like a small child with my whimpering and bursts of tears. Thank God that my husband understands my dilemma. In 2006, he had triple fusion back surgery and it took him months to recovery and he remembers well the struggle to find his way back. He also said that PT pushed him as well and he would leave there feeling crippled. He remembers canceling several appointments.

On a good note, he's getting pretty darn good at shopping. I may keep him to that task when I go back to work!!!

 

[kneeper]

I would say I was pretty prepared that the first couple of weeks would be tough. But around your time of recovery is when the little episodes of frustration and tears would hit.
Sorry that your husband had to have that surgery but great that he understands.

 

[funkymuse]

Hello Moderators... I was reading about the phased return to work and there's a link on one of the pages that does not work for me: Read this for more information Knee pain after sitting for a while
Can you help me get to that page as I'd really like to read about this!

Thank you!

 

[Celle]

It appears that the article you're talking about has been deleted from the library.
Basically, it said this:
"This is known as the movie sign (pain in the knee with a prolonged period of sitting such as when going to the movies)

There are two leading theories for the movie sign.

1. while sitting we predispose our knee to change normal position so structures can impinge on a swollen and inflamed synovial lining

2. as we sit the knee's intra articular pressure increases, resulting in pain

Studies have shown that the knee is an extremely fibrotic and capsular entity, meaning it is contained in a tough, fibrous bag. When put in prolonged flexion we may impede venous outflow and increase arterial blood flow in to and away from the knee. This change in blood flow can increase the pressure within the joint as we sit."

 

[Sammi2]

Hi @funkymuse I just wanted to drop by and say hello. We had our ops on the same day and I have been following your story during the last few weeks when I was lurking on the website. I am in the UK and my experience has been so different from yours, very gentle and relaxed which has enabled me to make good progress. Please don't be too hard on yourself, your body is doing its best for you. I find that listening to an audio book helps if I wake during the night. It helps me relax and go back to sleep. Maybe you could try this instead of getting up?

 

[funkymuse]

Well here we go with my update... Today I'm 5 weeks from my original TKR surgery and 3 weeks out from my Hematoma/MUA surgery, and I think I'm feeling some progress. I've left the walker behind and am using my cane. I am on no pain meds. My pain consists of the pressure of swelling and a bit of burning if I stand in the kitchen too long but that's about it - around a 1 or 2 at most. Getting off the pain meds was a complete nightmare. I weened down but still had residual effects for about 3 full days. Today was the first day I was totally free of nausea, headaches and face pain. YIKES.

I don't know how much progress I'm making measurement wise because I cancelled my next two PT appointments and plan to ask my surgeon on the 29th if I need to go back. I'm still laying around a lot icing and elevating and taking walks around the house and I'm up to a 15 min slow walk outside when the weather permits. I'm doing some knee bends on a stool and some heel slides on the bed. I do more knee bends on the stool as I like those. I do maybe one or two sets of heel slides on the bed because I don't like them as much. Would there be a reason I need to do those in addition to the knee bends with my foot up on the stool? I also sometimes do heel slides on the wall which I also like a lot. Very relaxing. I have also done a few quad sets with knee bent over a pillow but not many. I do like how that one activates my quad muscles.

I have noticed when I ice really well for almost an hour with 2 pea bags completely covering my knee held in place with an ace wrap, that when I get up, my knee does not feel swollen for about a minute and I feel like I could have more range of motion! So that tells me that once the swelling starts to subside that my ROM will be there! I have had quite the journey with the icing thing. When I got home from the hospital I was using Pea Bags and they seemed irritating, bulky and they kind of grossed me out thinking about the possibly of the peas going bad, and so I got all caught up in the icing machine thing and got a Ossur Cold Rush. But I failed to read the MANY reviews that tell how they fail after awhile and especially if you put them in storage and try to use them again later on. However, the Ossur served me somewhat well for awhile but what I began to hate about it was being strapped to that thing at night! It became more and more awkward to unstrap to go the bathroom and me.. well I go a lot during the night. So I began to look for other options and got a Flexi Cold Pad. I thought that would be the answer to not having my leg be strapped in at night. However, it only lasted 30 minutes and so that wasn't going to work. So I tried the alcohol bags and those didn't last as long as I needed them to either and try as we might we couldn't get them to not leak the liquid out of the bag as they melted. So I told my husband.. let me try the pea bags again and WAH LA!!!! They stay cold for well over an hour and they make my entire knee area very very cold! The Ossur only cooled the sides of my knees and not the top because of the kneecap hole. So in the end the Pea Bags won the battle!!

I did get my compression stockings in the mail and yes @skigirl they are too tight. They hurt my scar - so back they will go and I will try to find a lighter toeless stocking. I'm hoping I can put up with them. I've read a few peoples comments about how they help when it's time to go back to work.

Well.. I think that's about it for my 5 week update. I can't believe I've come this far. My husband is doing well and is still in House Mum training , and if I have my way.. he will continue on with many of these chores when I go back to work! That would be a bonus for me since he's retired with a disability and I work 40 hours a week.

I'd also like to say that I've been thinking about @Josephine, @Celle and the many other Forum Advisors who run this site and you all deserve an award! Your support and constant reminding us to be gentle, to listen to our knees, to not over do, and the overall enormous advice on this site is beyond amazing. So thank you so much for your time and energy. I don't know what I would do without it. I'd most likely still be on med's pushing myself to unbearable limits at PT.

 

[Josephine]

How nice of you to say that, funkymuse! We'll always accept nice compliments!

 

[funkymuse]

Oh my gosh.. how does anyone EVER do any housework or cooking? I mean I put in a load of laundry, and made my lunch and when i was finished my leg was so burning and swollen! I don't know you the folks on this site that live alone ever did it! Will it ever go away!???

 

[Celle]

Yes, it will go away, but it does take time.
The trick at the moment is to do only one extra thing per day. So, on a day when you decide to do the laundry, have a simple, easy lunch, preferably something prepared the previous day.

 

[Jockette]

Well, I didn’t do any housework. Not that my house is a mess, but I’m also not a houseworkaholic, and my husband came to accept that years ago and he’s not crazy about doing it either. But he did do anything that needed to be done for a while until I could. I don’t remember when I started back to it, and he wouldn’t let me vacuum for months, even though I thought I could handle it.

We are real laid back as far a cooking goes. The first week or more friends brought us dinners, and there were plenty of left overs, so they went in the freezer and if neither of us felt like making anything we pulled something out of the freezer.

We ate a lot of chunky soup, sandwiches, and one night we even had cold cereal. Anything easy. He’s good at making breakfast so that’s always an option for dinner.

I’m glad we are both so laid back about these things. It made for a less stressful recovery and prevented me from overdoing things.

At about 3 months post op his brother and wife cane for a weekend. We ate frozen pizza with salad one night and a frozen skillet meal the next and had a ball together. No one cared what we ate or that I wasn’t ready to go sit in a restaurant.

 

[sistersinhim]

I don't know you the folks on this site that live alone ever did it! Will it ever go away!???

I was alone most of the time. I achieved the needed tasks very slowly. I do something for many 10 minutes and ice and elevate for an hour, then I'd get up and do something else for a short time, then back to icing and elevating. This would go on for as long as I had to energy. Needless to say, any task took at least 10 times what it normally would have. But, the sense of accomplishment was wonderful!