Post-Surgery Recovery at Home vs. Rehab?

[Sue]

I'm having a total knee replacement in one week. Some people I know who have had this surgery went to a skilled nursing facility for about a week after release from the hospital. Others I know have gone home. What do you folks who have been through this recommend?

I have very mixed feelings about it myself. My husband does not like being around sick people. He is not a nurturing type. I am not trying to badmouth him here, I'm just trying to be realistic...he would be the first to admit that he hates being around people who have medical needs. Yet he says he will give me better care than I would get a a nursing facility and he's really angry right now because I've stated my fears about his being able to care for me. I'm just not sure what to do.

My insurance will pay for rehab, because I'll have reached my out-of-pocket limit , so cost isn't really an issue.

A secondary question: If I do recover at home, what medical equipment should I be getting right now? I have a walker, and I've ordered a toilet seat riser. I was going to buy a wedge pillow to put behind my back in the bed so I'd be at an angle like a hospital bed, but my husband got really upset and said I was being paranoid, that I don't need all this stuff, and that it's all going to work out fine.

I don't think I'm buying things out of fear...I think I'm just trying to be prepared for whatever is predictable that I'll need. I've been trying to think through things like how will I get up the stairs, into the tub, stuff like this--and my husband is calling this obsession and paranoia.

I would like to recover at home with my teenage daughter, my cat, on-demand TV, my computer, etc....but I'm not so sure about my husband...

Advice, please!

 

[Josephine]

Oh dear! How tough it is when your nearest and dearest don't sympathise with you very natural desire to be comfortable during your recovery. How can he think that simple comfort devices like cushions can be being paranoid? Still, it's not the first time I've heard it. I know in some of these threads there are people advising others to get a recliner chair and to be prepared to spend the night in it for a week or so as it is more comfortable to be able to elevate your legs that way than laying in bed. And you do need to elevate your legs a lot to prevent the swelling that so easily occurs. One member has advised renting a recliner and it seems like quite good advice to me.

See, the focus on this period is mostly about a) exercise and b) rest in equal proportions. If you're going to try sitting in an ordinary chair with feet on the floor or on a foot stool, you're going to get swelling and that means discomfort, even pain, which will prevent you getting proper rest.

I also think you should forget about having baths. Getting in and out of a bath is not going to be an option for several weeks. A shower will be okay, though. You might also invest in a quantity of those gel ice packs to keep in the freezer. You will find them a life saver.

Perhaps you might get your husband to read to few of the posts on here and see if that helps to re-educate him! But do try to explain to him that it's not about what may or may not go wrong, it's about your comfort and well being and you will need all the help you can get in the way of aids in the first few weeks. Hope it all goes well for you.

 

[Sue]

Thanks for your kind words, Josephine. I did give my husband some pamphlets from the hospital, plus some information I found online, and now I think he understands better what the recovery will involve. He is still minimizing it, but I guess he'll see what it's really like when it happens, even if he's in denial about it now. (For some reason, he seems to think that no matter how hard recovery has been for anyone else, it's gonna be a breeze for me! I hope he's right, but I'm trying to be realistic...)

In the meantime, I am lining up some friends to come over and spend time with me after the surgery. The day I'm supposed to get out of the hospital, my husband is scheduled to work that night. So a friend will come over, give my daughter dinner, make sure I have my meds, etc.

Also, a neighbor gave me one of those shower chairs so I don't have to try to step over the side of the tub to get in to take a shower.

And I went ahead and ordered that darned wedge pillow online, regardless of what hubby thinks about it! LOL.

Yee gads, I am not looking forward to this process, but I sure am looking forward to being able to walk more normally, without pain, when it's over.

 

[Josephine]

You have my sympathies, Sue. My sister in is much the same boat. She lives with her son (44) who has this attitude that no matter what happens it will get better eventually and there's no need to call a doctor or go to hospital! A couple of years back, having put off her knee replacements again and again because of denial, she ended up with a locked knee and in such extremis she was no longer making sence. And you know what? He still would get her help as he insisted it would be 'better in the morning'. When he finally let me know, I got an ambulance and sent her into hospital. I followed her there and in A&E, she was in such a state she didn't even know me! They ended up putting her on a morphine syringe pump (PCA) which she had for three days!

Men!

 

[Sue]

Thanks again for your kind thoughts, Josephine. I got a list of rehab facilities that my insurance covers and I'll be bringing it with me to the hospital to give to the discharge person. If there is any question at all about my husband's ability to care for me--like if I have any complications or anything--I will have them send me to rehab instead of sending me home.

 

[Josephine]

Let us know how you get on, okay?

 

[maggie]

Hi. I had bilateral knee replacement surgery 8 weeks ago. I found that both the PT and the OT were extremely helpful in letting me know what equipment would be go to have a home. We did rent a stair glide for a few months because all of our bedrooms and showers are upstairs. I did go a rehab hospital for a few days but there was still a lot for my husband to do when I go home. You are definitely doing the right thing in being prepared prior to the procedure. A positive attitude is so important. Also I found that doing all the exercises they tell you to do post op is also important to recovery. I work up from the surgery and started doing ankle pumps!!! I wish you all the best. I intend to return to my full time job next week. I am not using any aids in the house or at the PT location but still am using a cane when I go to a store, church, the mailbox, etc.

 

[Crinks]

Hi Sue Firstly, I hope things go well with your surgery and you are smart to be prepared ahead of time for your needs after surgery. I had a total knee replacement done in May of this year and definite items needs are: a walker, a cane, a shower seat, a hose for the shower head and ankle weights. My hospital stay was a total of 10 days, 3 days in the surgical ward and the 7 remaining days in the re-hab unit of the hospital.

After my release from the hospital I was going to re-hab 3 times a week but had to do home exercises multiple times during the day (this is where the ankle weights come in handy) In my opinion, you would be better off re-couping at home. In re-hab they give you suggestions to make your life easier once you get out of hospital. (ie) carry a bag with you for things you have to tote up stairs or down. The cane will come in handy for your stair mobility.

Im now 5 months out of surgery and had to go back in in August for a manipulation of the knee as it wasn't bending beyond 90 degrees. After the surgeon did the manipulation I was in re-hab for 2 full intense weeks. Things are starting to ease up now as I can navigate up and down the stairs without the aid of my cane.

I wish you well, Sue. Let us know the outcome
Sincerely Lin aka Crinks

 

[Sue]

Well, I had my surgery a week ago, and I got home on Sunday. I've been getting more able to operate independently every day. I can get in and out of the bed, in and out of a chair, use the bathroom, etc., with no help. I really only need a little bit of help with a few things now--I can't go downstairs to get myself any food, and I need a little help taking a shower.

The physical therapist is coming to my house nearly every day and she's been helpful not only in developing my strength and range of motion, but also having lots of practical ideas for how to function around the house. For instance, she suggested some ways to get more comfortable in bed and therefore get better sleep.

My husband is still being difficult from time to time, but thank God I don't need him as much as I thought I would. For the most part, he is doing a good job of caring for me. I try to keep my demands on him at a minimum and to let him know ahead of time what I'll need, so I'm not constantly asking for something that he didn't expect. I've also had him buy me some things to decrease my need to ask him for things--for example, some single-use cold paks that I can use in the middle of the night, rather than having to wake him up to go downstairs and get me some ice.

The wedge pillow that precipitated the big argument before the surgery has turned out to be one of the best things I could have purchased! I'm very comfortable with a big foam pillow that approximates the angle of a hospital bed. It hadn't arrived yet the first few days I was home from the hospital, but when it did, it improved my sleep and sitting comfort greatly!

I can now confidently say that I'm glad I decided to come home to recuperate. And if I were to do it again, I would do even more ahead of time to be prepared, regardless of what my crotchety old man has to say about it.

 

[Josephine]

That is wonderful news, Sue. I am delighted to hear that things have worked out so well. Planning ahead is a good system if you know what to expect and that's half the trouble with these situations - one really never knows what to expect! I am giving you the star of the month for being so positive and triumphing over the odds!

 

[Sue]

Thanks, Josephine! I'm getting even more independent the last few days because now I can go up and down the stairs. I still spend most of my time upstairs in the guest bedroom, because staying upright to do things is exhausting. But it sure is nice to get a change of scenery once in a while!

Today I go to the doctor to get my staples out. I'll check back in later on and let you know how things progress.

 

[lindaolson65]

I am currently 3 months postop and think I can give you some perspective. If you know you won't have sufficient help at home and know of a good rehab facility, I would definitely go to the rehab facility. You will need lots of help initially - even for the most basic needs. So I'd definitely vote for the rehab facility. I was very fortunate to have my husband home with me, and I simply would not have survived without him.

As for medical supplies, I would get a porta-potty instead of the riser. I have a riser, and it wasn't stable enough for my needs. While I was in the hospital, I noticed they placed the porta-potty stand over the toilet, which provided handrails and an elevated seat over the regular toilet. I was so pleased with that setup that I asked my husband to buy one and place it over our toilet in the BR (taking out the actual "bucket"). I kept it there for the first couple of months. Works much better than the riser.

I'd also buy a "reacher," which will enable you to access items that otherwise would be impossible for you to get - particularly items that may be on the floor or out of your immediate grasp. I got two sizes: a 48" and 22". That worked great.

If your doctor doesn't prescribed a CPM machine for you (which moves your leg into flexion and extension), I'd highly recommend getting one and using it from day one. It will help you regain motion right away. One of the biggest challenges after a TKR is getting good ROM, and the first 6-8 weeks are the most critical. I was in the CPM almost day and night initially, and while I was still numb in bed the first day of surgery, I cranked that thing up to 90 degrees (with my doc's permission). Since I wasn't going to feel it anyway, it would give me a great head start. I'm now 0-136 degrees at 3 months, which is really good. However, you need to know that you MUST work on your ROM throughout the day, EVERY day, or you'll lose ground. There's no short cut to that.

Best of luck in your surgery. I hope I've helped.

Linda