TKR Poptarts' Surgery on December 24, 2018<

[Jamie]

That's what we're here for, @poptarts! Helping people like you is what we love to do.

 

[poptarts]

massage

@sistersinhim
The massage went well. We agreed upon just a lympthatic massages for my legs and a switch massage for the body. She had me start on my side to work on my back but after I short time, it was uncomfortable. She then performed the lympthatic massage and ended with a neck and scalp massage. It is too soon to tell if it will help reduce the inflammation in my surgical leg but overall it felt good!

As a price point, the in-home massage for Orange County, CA was $85.

I will add massage to my recovery plan but next time I will go to either a salon offering a deal or a local massage school where the prices are very reasonable.

 

[ebungalow]

@poptarts

Thanks for the massage info! I’ve found a local massage therapist offering lymphatic massage and may give it a try. The cost for the massage is about the same as your cost.

At that price point, I may wait to hear from you if it helped the inflammation in your knee

 

[Josephine]

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[poptarts]

Yes, thank you!

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[poptarts]

1. pain levels:2-3

2. pain medications: oxytocin-acetaminophen 10mg/325mg every 4-6 hours and occasional Tylenol, not to exceed approx 2,000 mg per day

3. swelling: moderate

4. 65 ROM. Extension; I do not know. It is pretty straight when laying on a bed.

5. icing: 20-40 minutes 4-5x a day

6. elevating: 15-30 minutes 5-6x a day

7. activity: I walked one block for the first time today. I am doing very light cleaning up around the house, mostly picking up and moving things to other locations and quick meals once a day such as scrambled eggs and toast.

8. Ankle pumps x20 x5 sessions per day.

I did have 2 in-home PT visits and I have the prescribed exercises. After reading about your journey "no PT and no formal exercises for the first 3 weeks".

THANK YOU!!!

 

[poptarts]

My cat is my best therapy.

 

[sistersinhim]

He/she's beautiful. I agree with pets being the best therapy. At the time of my tkr I had 13 cats. I'm a rescuer and had a house full at the time! I have 8 left. 6 of them are teenagers and impossible to adopt out, so they will stay with me! I love everyone of them!

Who needs PT when we have pets to take care of?!

 

[poptarts]

@ebungalow

I don't see any improvement in the inflammation in my knee from the lympathic massage. I really wanted my legs massaged; the tightness is so bothersome. I thought having a lympathic massage would be an extra benefit although it is less "hands on" so I think my combo of lympathic for the legs only and regular massage was good.

I'm going to hit up some foot massage places as soon as I get comfortable enough to do so. I'm so afraid someone would accidentally touch my incision. For those who have never had a foot massage (aka reflexology), they are wonderful. They are appx $25 per hour, you are fully dressed so no bothersome undressing, and they soak your feet in a barrel of hot water with herbs while they massage your shoulders, neck, etc. The massages take place, typically, in a large room with other customers present.

This is one of my fav foot massage places.

https://www.yelp.com/biz/tustin-foot-massage-tustin

Alternatively, for regular low cost massages, I can highly recommend this place:

https://www.yelp.com/biz/american-institute-of-massage-therapy-santa-ana-2?osq=massages+school

 

[ebungalow]

@poptarts

Thank you for the update on the effects (or non effects) of your lymphatic massage!

Well dang, so sorry it didn’t really help.

Since surgery, I’ve done a sort of lymphatic massage when my leg is elevated, lightly massaging from knee area toward the groin area, hoping to encourage some draining.

The reflexology massages are wonderful - I’ve had a few of those- as are other forms of massage. I always seem to forget how soothing bodywork can be. Thanks for the reminder!

I hope you slept well last night and have a healing day

 

[Josephine]

1. pain levels:2-3

That's quite impressive for only two week out!

2. pain medications: oxytocin-acetaminophen 10mg/325mg every 4-6 hours and occasional Tylenol (acetaminophen), not to exceed approx 2,000 mg per day

That's okay but do make sure you don't exceed 4,000mg of Tylenol (acetaminophen per 24hrs.

3. swelling: moderate

Okay but you did remember that swelling is also pain and to factor that in to your overall pain score?

4. 65 ROM. Extension; I do not know. It is pretty straight when laying on a bed.

Many make that mistake. ROM is not just flexion. It's flexion AND extension. So your ROM is 65/?0.

I can assess your ROM for you if you wish.
If you would post a photo of your knee in either of these poses that would be for flexion

And you can assess your extension yourself using this technique
1. put your leg on a bench, seat, bed, floor or anything similar but preferably something fairly firm.
2. with not too much pressure, press the back of your knee down - use your leg muscles, not your hand!
3. slide your hand, palm down, under the back of your knee

a) if you can get your entire hand under easily, it's probably about +10 degrees
b) if you can get just your fingers under, it's about +5
c) if you can get your fingers under but it's a push, it's +0
d) if you can't get your fingers under at all, it's -5 or more​

Here's a graphic to explain the degrees involved

5. icing: 20-40 minutes 4-5x a day
6. elevating: 15-30 minutes 5-6x a day

You accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day.

7. activity: I walked one block for the first time today. I am doing very light cleaning up around the house, mostly picking up and moving things to other locations and quick meals once a day such as scrambled eggs and toast.

That's a lot for two weeks out. Did you read the Guideline articles sisterinhim left you in post #5?
Among them was this article in which it is stated

Week 1
Just walking around the house - trips to the bathroom and kitchen are included!
Be up on your feet several times a day as you need to but don't get obsessive about it
A 5-6 minute walk every 3-4 hours is plenty
Spend most of your time resting and elevating

Week 2 - add this to previous instructions in Week 1
Start on a plan of walks around the house 3-4 times a day for about 5 minutes but don't

a) get obsessive about it
b) get into too much pain
c) get too tired. Stop before you get to that point.​

8. Ankle pumps x20 x5 sessions per day.

Since these are only required the first few days when you're not very mobile, these are now unnecessary. Specially if you've been walking a block. Though you should stop that for the time being.

I did have 2 in-home PT visits and I have the prescribed exercises. After reading about your journey "no PT and no formal exercises for the first 3 weeks".

Excellent!

I don't see any improvement in the inflammation in my knee from the lympathic massage.

Nor will you. The swelling you have is NOT lymphoedema. It is reactive trauma swelling and is unlikely to respond to lymphatic drainage massage.

 

[poptarts]

@Josephine

THANK YOU, THANK YOU, THANK YOU!!! Great feedback and I will follow your advice. I so much appreciate it!!

 

[Beezknees]

Hi! I had left TKR on 12/17 . The surgery went well. I just had my 12th and final in home therapy. The focus was on getting my knee straight to prevent it from buckling. On the final day of in-home, the therapist gave me an exercise meant to get my leg to bend. I saw the Doc the day before my last session, Doc said i need to get bending the knee and switch from a walker to a cane and he wrote a script for me to go to out patient therapy 2-3 times a week for 4 weeks . I should add that I had a bilateral hip replacement this past August, (had 12 in home PP sessions) and the muscle on the outside is still somewhat weak causing a slight jerky limp. My knee therapist worked on the hip a little. What I'm getting at is every since FridAy when the therapist finally had me do an exercise to bend the knee, I've had more pain and spasms than I had been having . The spasms wake me up when I manage to get comfortable enough to sleep. I'm feeling out of sorts and really don't know what I should be focusing on. I still have some swelling but Ice and elevation work to keep it in check. What to do? I was off meds week 2 after hip replacement but this knee is starting to get me down. Oh, and @poptarts I craved poptarts too, what's that about!