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TKR Quicklab's recovery: the second time is the charm.

Wow~ I had 10 hours of almost uninterrupted sleep last night. I can easily sleep on my side. Today, I will make it a priority to take 2 mg Dilaudid about an hour before I do my gentle exercises. If it weren't roughly the temperature of the sun outside, I would love to sit outside, but there is no point in getting myself stressed with heat indexes well over 100 degrees. Hope everyone has a good Sunday.
 
I know that many people suffer from constipation with use of opioid medicines. I am having the exact opposite problem. To put it as delicately as I can, I seem to be setting some kind of personal best record in output at least 3 or 4 times a day. I am not taking any Colace, Senekot or any other such "aids", so I don't understand why I am being so very productive.
 
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quicklabs said:
I just can't seem to stay awake! After my first PT session, I slept for 2 hours. Had a three hour nap yesterday, and slept through the night. It is as if my body is making up for years of sleep lost due to pain..
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I was lucky I was able to sleep , 10 hours at night, 4 hour naps. Don’t fight it. Your doing great, take it slow, it is so easy to overdo it
I’m glad you had such amazing team at the hospital, it makes all the difference mentally.
 
You’re walks to the bathroom are excellent ADLs (activities of daily living) so look at that aspect as a positive.

If it doesn’t let up maybe check with your doctor or pharmacist.
 
I just talked to the on-call doc. He recommended that I increase fiber to increase bulk.
 
Day 7 - I took two ten minute walks down my block today. Felt so good to MOOOOOOOOOOVE! I noticed coming down the driveway incline that the knife-like pain that used to cut into my knee so badly is GONE. Did my ADLs--showered, dressed and today was able to get on both shoes and socks by myself. It feels much better to walk than it does to do some of the PT exercises. I can do short arcs, but the straight leg lifts are very painful, so I'm not doing to do those. Heel slides are also not great, but I can sit with a good leg bend in a chair (more than 90 degrees there). Practicing shifting my weight onto my left leg--no problem with that at all. My first PT session was on Day 3. By Day 6, he had doubled reps on all the exercises. That's just too much! I am doing what I can, spacing things out through the day. Pain managed today on just 2 mg Dilaudid and Tylenol so far.
 
You are taking a very sensible approach and are able to do more on Day 7 than I was able to.
 
Whoop. Did a bit too much yesterday, I think. Pain kept me up through the night. Still trying to find the sweet spot of rest and activity. Seems like those lessons are learned mostly the hard way.
 
quicklabs said:
Still trying to find the sweet spot of rest and activity. Seems like those lessons are learned mostly the hard way.
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Exactly this. Just to keep it interesting, they keep moving the line! I'm finding my knee will tell me when I get to enough, but she has a teensy tiny brand new little voice and I have to listen carefully or I'll bulldoze right over the sweet spot back into a long painful night.
 
For how long and at what rate do we need to keep icing?
 
At least four times a day for 60 minutes at a time. But, I iced whenever I was lying down, and elevated at the same time. I just kept the ice wrap on the entire time I was resting, plus all night long. Just don't forget the cloth between your skin and the ice. I walked around regularly also, following this article.....
https://bonesmart.org/forum/threads/activity-progression-for-tkrs.14334/
 
For the first two weeks, I was icing every time I was up moving. It was less after that and I iced for a few months.
 
Day 9. PT was far too long. 75 minutes worth of exercises. On the bike for the first time. Rode .75 miles in 10 minutes. Then one exercise after the other, some with a 1 lbs weight. When we got to straight leg raises, I began to cry and told them that I would not allow anyone to break my rule of stopping when the pain makes me cry. They assisted me with then, insisting I needed to get my quads strong. I am at 0 extension, 108 flex. They said I don't need to use the walker at home anymore. I am so torn about whether to continue with PT there. I have made remarkable progress in such a short time. I don't want to hurt myself or let anyone else hurt me.
 
I would not stay with that PT facility. That is far, far too much PT for Day 9. Compare that to the Activity Progression in the Recovery Guidelines we gave you.

At this very early stage of your recovery you only need to move your knee gently.
 
Jockette said:
I would not stay with that PT facility. That is far, far too much PT for Day 9. Compare that to the Activity Progression in the Recovery Guidelines we gave you.

At this very early stage of your recovery you only need to move your knee gently.
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With my first TKR, it seemed as if it took many weeks to do this. Crazy numbers of reps on the exercises as well. I am really hurting tonight. I don't plan to do much of anything outside of short walks and ADLs tomorrow.
 
That is far too much on a recovering knee at only day 9! The fact that you were in pain and in tears and they still pushed you, tells you all you need to know about that facility! They are obviously not interested in your input or limits; rather it sounds as if they have their agendas and ways and will never listen to a patient. My advice is do not go back to that place. If you must do formal PT, find a place that listens to you, and follows your limits. Remember, you are paying them, and you are the boss as it's YOUR knee, and no one can do anything to you, or force you to do anything, without your permission. You have the right to say NO, you have the right to choose your facility and therapist, and you have the right to refuse any and all formal PT. They were specifically told your limits and ignored them, so they are not the place for you (or for anyone, IMO).
 
Also, how long you use the walker, and/or cane, is also your decision. You can get input about the devices from your OS and a PT if you choose, but in the end, it's YOUR decision.
 
I am mostly mad at myself today that I did not enforce my own rules and set limits. Through the tears and great pain, I continued to try to cooperate even when I said I reached well past the limit. That one is on me. My sleep went from 10 hours of night without PT to less than 4 since I started. My husband remarked that, When they see you cry, they probably interpret that as "wimping out" and seek to push harder as a result. I think he is right.

I am amazed at how hard it is to insist that "No means No" and to refuse to proceed any further. I believe that PT has some good things to offer, but the pace must be set by me. That is the main thing for which I must take responsibility. This level of discouragement is definitely not healthy at this stage of the game (or any stage, really). At my next session, I need to start by laying down the law before I do a single exercise. I will assess the response to this.
 
quicklabs said:
Through the tears and great pain, I continued to try to cooperate even when I said I reached well past the limit. That one is on me
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That is not on you, an appropriate PT would not push you this far or even suggest you do the things they had you do, at only 9 days out.

You just had major surgery, 10 days ago. This facility is not going to meet your needs. They have already betrayed your trust.
 
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