TKR Put the right knee in...and then the left.

[Fire wolf]

WooHoo on the stepping up in the world! I would say that we know we are making progress when we find ourselves not always thinking before doing things with tkr. It seems like in the beginning we are always thinking about how we are going to negotiate the *obstacles* of everyday life.... stairs, chairs, getting in and out of vehicles, walking, etc. Then, just as we slowly start to miss taking regular doses of pain meds, our bodies start going back into *automatic* and get us where we are going.

 

[Pheebs52]

Gertie, I think that 3-4 week post-op period may just have been the most frustrating. You're *neither here nor there* with activity and independence, but you're itching for more. I found getting back in the Driver's Seat to be the most thrilling milestone. The freedom and independence that comes with driving again just can't be beat. The good news? You're almost there! Let's hope this week speeds by for you!

Huge kudos on the baby step, literally, lol! Every. Step. Counts!

@Celle, my surgeon has been much the same as yours all along; phew! Hopefully, his PA will see things the same way this coming Friday. At this point, my list of "Can't Do's," is pretty short and I'm fairly content. I'd be more content with just a bit more flexion, mostly just to make stair navigation easier. If I lived all on one level, I think my only real complaint at this point in time would be the stiffness that still arrives most evenings. Whether I do a lot or a little, the stiff stuff lingers on, but I expect that will be the case for many more months. Oh well, it's much better than the awful bone-on-bone pain.

 

[gertie]

Good chilly morning all. Fall has come early to New England so I'm tucked up indoors in the recliner rather than in my favored spot on the back porch--it was 50 degrees out there first thing this morning!

I had my 4 week follow up appt with the surgeon's assistant yesterday. All is well. As usual, this was a lot of driving and sitting for a brief appt but they did take x-rays and the implant looks good. She had me straighten my leg to show extension. I reported the PT's most recent flexion measurement and she nodded and said that reached the goal and that was that--didn't ask me to demonstrate, didn't measure. Although I'm mostly off daytime pain meds I did take some yesterday and am glad I did since all that sitting with feet down took a toll.

All in all I feel like things are going well although I'm still impatient and ready to be back to an active life. Patience, grasshopper, patience!
--I am walking around the house increasingly with no aids except at night and first thing in the morning. Still using a cane for outdoors.
--I am being a bit more active although I'm finding it harder to get in the groove with this second surgery (I blame that partly on getting hooked into binge watching "Six Feet Under" ).
--Energy drain is more noticeable with this surgery. I'm sleeping well at night but still feel draggy during the day. I am napping less and for shorter periods when I do doze off.
--As mentioned, I'm mostly off daytime narcotics and just using ES Tylenol. Still taking a dose of stronger stuff before bed and sometimes in the middle of the night if I wake up with pain--happening less and less.
--I could start driving again--have medical clearance to do so once I"m off the strong stuff during the day--but I'm a bit reluctant since I get so stiff in the car. Maybe over the weekend.
--I've been signed off from in-house PT and have a Rx for outpatient. I need to find someone I can work with. I'd love to hear others' experience in finding a good PT. Can you ask questions over the phone or do you need to go for an initial appt? And what questions do you recommend asking? I'm in no rush but the Rx expires in 30 days so I do need to move forward with this.

 

[Pheebs52]

@gertie, first I'm so happy to hear you are enjoying "Six-Feet Under," Hah! I liked it so much, I could actually watch it again and that's very rare.

Congratulations on such a positive 4 week post-op visit! I know the long ride in the car and the waiting room sitting was a drag, but, you aced the visit with flying colors! I'm delighted to hear you are cleared to drive even if you don't feel quite up to it yet. Soon, you will feel more than ready for short spins around town.

I was referred to Gary Glitter by my OS when I expressed extreme dissatisfaction with Home PT at just 2 weeks post-op. If I hadn't been, I guess I would've tried calling a few first just to see if they'd give a telephone interview so I could grill them about their recovery philosophy. That said, we all know they're in business to make $$ and don't receive any for phone call interviews, so I don't know how far you'd get with that approach, but, I think it's worth a try. My other thought is perhaps your PCP or OS could make a recommendation? If not, how about some friends who have had a need for gentle PT?

With respect to questions, my primary (and perhaps only, hah) one would be "Do you follow a "No pain/No gain," path or do you practice gentle therapy instead? Just that answer alone could make for a very short phone call, eh?

Like you, we are definitely experiencing a taste of Fall the last few days. I woke this morning with heavy Nemo on my back, clinging to me for warmth, LOL. I just love this weather and wish it could remain for at least the next 6 months. In the spirit of the season, I ordered a new pair of ankle boots yesterday, lol.

 

[Polkadot]

I could just ditto everything @Pheebs52 said. It seems as though lately we are almost sharing a brain! I agree that doing phone interviews for therapists with a "gentle" philosophy would be good but possibly not very do-able. In my experience, within the facility I chose, the staff of PTs have differences in their philosophies and how they work with patients. They would cover a range of patients who prefer a gentle to more aggressive approach. So, here's a hands-on way to be proactive in finding a good fit in a PT:

Is there a facility near your house? If so, I would walk in and look around. Ask questions of the desk staff. At my facility, when I described my reluctance for massage therapy, for example, two people behind the desk said, "You want Vinny, then." (There are 3 massage therapists on their staff.)

See if you can observe and listen to the therapists for a while. (You may have to ask which are the PTs and which are the assistants.) Most of the activities take place in a large room. The PTs do their manipulations in small private rooms around the edge.If you spend some time observing, you may be able to narrow down to one or two, then ask to speak with them. My PTs spend some time between patients updating their notes, so they are able to have a short conversation.

I'm a big believer in "vibes." If you get a positive vibe from observing someone, you are likely to be able to work with that person.

One last observation that may or may not be true: The PTs whom I see working with athletes seem especially knowledgeable about how joints work, and I've observed that they make what seem like very small adjustments in activities to produce better results.

 

[kmak81230]

I "lucked" in to my PT clinic although I had heard good things about the clinic and my experience with our hospital outpatient PT was mixed over the years - lots of "old school" folks. So definitely ask around. I live in a small town without many options although lots of ortho services due to residents and tourists who come for the "active" lifestyle and who subsequently break, tear, or dislocate things. But I agree with the others in that if you can ask questions that might help - I would definitely ask an open-ended question about their philosophy of therapy post-TKR. Ask if they will work on functional mobility and gait . . those are really important - much more important than working on bending and straightening IMHO. Congrats on the good OS report and all of the milestones achieved.

 

[gertie]

Thank you all for your replies re: finding a good PT. There are limited choices near where I live but I'll take a closer look at the various websites. I might end up going back to the woman I worked with post hip replacement, at least for an assessment. I liked working with her for the hip--she seemed focused on letting me set the pace and on not doing anything that would inflame soft tissue. But when I spoke with her pre-op about TKR rehab she seemed to buy into the "push through pain" approach so we'd need to have a frank conversation about how we'd proceed.

My one friend who had a TKR also subscribes to the "push through pain" approach so would not be good at recommending someone. I am getting a bit tired of various well-meaning friends asking with a worried look if I've booked a PT appt yet as if I'm going to seriously damage my recovery if I don't immediately start seeing someone several times a week. Ah, well.

On the small victories front--I'm off daytime Rx pain meds so I drove myself to do a small errand yesterday. It was easy to get into and out of the car. I'd already driven at about 4 weeks out from the first knee so I knew the right knee could handle the driving task. This time, it's the left knee so it just needs to sit there looking pretty. It doesn't like being foot down and bent for any length of time so trips right now will be brief, but it's nice to know I can zip out to the ATM or a small market if I need to.

 

[Pheebs52]

Congratulations on getting behind the wheel again @gertie! Yeah, the left knee doesn't really like just hanging down while driving during the first 2 weeks or so, but it will acclimate soon. My car has some sort of built in, wedge-like gizmo, much like an enlarged doorstopper that elevates the left knee a bit. Perhaps you could buy something like that? I found it much more comfy than driving hubby's car which doesn't have that feature.

Oh, the *well-meaning* friends can become tiresome, as can family members who just don't get it. For the most part, I managed to pretty much let it all go in one ear and out the other. Selective hearing complimented by hearing impairment, lol.

I think it's worth a shot to have a chat with the woman who rehabbed your hip. You know what you can and can't tolerate, so all a PT really has to do is LISTEN to you. It's a real plus if they are also encouraging.

 

[gertie]

@Pheebs52 Yes, the PT I saw with the hip might be my best bet since she's familiar with me and repeatedly acknowledged how well I knew my body (and I think saw that as a plus). Since my ROM is OK she might back off the more pushy stuff.

 

[gertie]

My car has some sort of built in, wedge-like gizmo, much like an enlarged doorstopper that elevates the left knee a bit.

My car has that too but it's underneath the emergency brake which means I'm sitting with the emergency brake pedal aimed at my shin--all I can think about is what if I stopped suddenly and that brake pedal got jammed into my leg--yikes! Poor design.

 

[Pheebs52]

I'd definitely go have a chat or evaluation with Hip-Woman. You make an excellent point when stating that since your ROM is very good (and it is) there really shouldn't be any need for the types of things that aggravate knees. Not that there ever should be, but you know what I'm saying. I'd think all you might need at this point is some gait-training, balance work, gentle stretching, and a bit of massage. Sound good?

Oh gosh, that really IS a bad design in your car! There's absolutely nothing in the way of my little footrest, as it should be. But...it IS a *Geri-Mobile*, lol.

 

[Pheebs52]

Oh, and remember, no strength training yet! That means no squats, lunges, leg presses or weights. So, if she can stick to these guidelines, your PT should be very beneficial.

 

[gertie]

no strength training yet!

I do feel like my first knee, which is now 10 weeks old and will probably be closer to 12 weeks when I start working with someone, could benefit from some careful strength work so that will be something to discuss--how to coordinate 2 knees that are 6 weeks apart and make sure each gets what it needs.

 

[SusieShoes]

Sounds like you're making all kinds of progress! Careful strength work makes sense. Do you trust this therapist with the "careful" part?

As for driving the car... way to go! You're independent again.

 

[gertie]

@SusieShoes She was careful with the hip. I went to her at about 10 weeks post op with the hip and we did focus on rebuilding strength in both legs and proceeded gently. Ultimately, my bad knees limited what we could do. I will need to find out her approach to rehabbing the knees.

 

[gertie]

Today brought home the reality that stamina is certainly less this time around. Had a quiet morning then after lunch drove to a local farm shop, did a bit of shopping, then drove home. Later in the afternoon went for a 1/2 block stroll. And I'm pooped big time. At this point with the first knee I did the farm shop trip and a walk that was 3 times as long and met a friend for coffee in the morning and felt OK in the evening. I'd say I'm probably at least a week behind where I was in July in terms of energy/stamina. But I sure am sick of sitting around!

 

[sandi4213]

Lynn, I totally agree that the energy drain is worse the second time around. I guess it really makes sense that if the recovery lasts a year or more and you have a second surgery a few weeks or months after the first, your body is going to have to put much more energy towards healing. It will get better.

 

[Canada35]

Lynn I am sure that the energy drain is compounded by having the second knee done. You were not recuperated or even close to 100% energy from your first TKR and then had the other one sap whatever energy you did have. I think you should cut yourself some slack. Lay back and give your poor body a rest and a chance for your poor knees to get over this major trauma. Most of us that had our surgery weeks before you are still dragging our butts in the stamina department.
It will all come in good time. I am the last one that should preach patience but I'm learning lol!

 

[liam2015]

 

[gertie]

Oh, yes, there's no doubt that my body took a double whammy this summer. It's a balancing act--some amount of being in motion, getting out of the house, is good for both body and spirit but too much and...ODIC here I come! The good news is that my knees felt fine last night and still feel fine today. Stiff of course--that's to be expected at this stage--but little to no soreness. In fact, I was walking around the house last night thinking they were close to feeling like normal knees--not quite there but much closer.

Cool rainy day today so I doubt I'll be tempted to go anywhere. A friend suggested meeting for breakfast at a local cafe but I declined--maybe next weekend. I have things to do around the house but can pace myself--and if something doesn't get done, tough.