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Discussion in 'Knee Replacement Recovery Area' started by Momma-me, Jun 8, 2017.
I agree with @sistersinhim. If PT or OS ask just tell them you’re icing, no more.
I’m 4 days out from surgery. I asked for a refill of Oxycodone. Dr says they need to see me. After a hellish drive into the office, I shuffle by my OS with my walker with tears in my eyes from the pain, and guess what he says to me???
That I have a contracture and going to need a manipulation if I don’t work harder at extension. He said he’ll do manipulation and get flexion but he can’t help me with extension. And if I don’t want another surgery I better understand this.
So... his PA tells me to go in the exam room and put my foot/ankle up on a stool and left it there for about 10 min. to stretch it out and see if I could get full extension. It was very painful. But the PA came back in and saw that I had extension.
The OS ordered home PT 5 days a week. (Whattt???) The PT just called me and told me that the OS’s order said that I need to be pushed past the pain!
I am like.... what the heck??? I’m 4 days out!! What is going on???
I’m so furious right now I can’t see straight
If it was me I wouldn’t let that PT near me. Who talks about MUA at 4 days out. It is your knee, not theirs and you have the final say what happens to it.
Saying no to therapy, am I allowed to:
I’m so sorry this is your surgeon’s attitude.
Did you at least get a refill or different pain medication?
@Momma-me, it amazes me the difference approaches our doctors take. My OS didn’t prescribe any home nurse or home PT after discharge from the hospital. I didn’t go back to see him until 2 weeks after surgery. Only instructions were the various home stretches and gentle exercises shown to me by the hospital pt prior to discharge. At my 2 week follow up, my OS asked if I felt up to starting outpatient PT! Luckily I had found BS by then, so took that opportunity to have a heart to heart with him about overly aggressive PT. He stated there is no reason for anyone to try forcing my knee to bend until the swelling goes down and more healing occurs. That all takes time. Why is yours so different? I just don’t get it!
Regardless of what your OS says, it is your knee. It’s up to you to decide what to do, the doc can’t force you. Worst case is he labels you a non-compliant patient and refuses to continue seeing you. In my particular case, since I was also off on short-term disability from work, my insurance carrier also assigns a health care case manager. I’m able to contact that person for guidance as well as to voice any complaints about my care while off on disability. I found them to be a great patient advocate. Maybe yours has something similar?
Ya I had a PT come to the house the first day I was home from the hospital and now he wants PT 5 DAYS A WEEK!!!! To do what exactly?? I don’t even feel I need PT until maybe a month out.
The PA gave me a refill of the pain meds and the OS gave me a week course of Medrol.
??? Idk... I’m just so disgusted with him right now. Yes, why is he threatening me with a MUA 4 days post surgery?? Who does that???
His PA seemed way more understanding.
I have no idea why your OS was so aggressive with ROM, except that he is old school regarding TKR recovery.
You can say NO to the PT and refuse them to push you at all. It is your right.
Saying no to therapy - am I allowed to?
Swelling is blocking your ROM, you are still in the early days of the very angry knee stage. You knee is inflamed and swollen, all the pushing your knee is going to do is cause more inflammation and swelling. Setting your recovery back.
What PT can do for your is retrograde massage, show you save gentle ways help your own ROM, and instruct you in TEN's use for knee pain.
Here are the two gentle activities we recommend:
Heel slides and how to do them and Extension: how to estimate it and ways to improve it .
Momma-me, your story continues to astound me that you found such archaic treatment in Rochester. Being on my second Knee implant done at Rochester General, and being treated with the utmost respect, and consideration, I can’t believe what you are going thru. I have a home care nurse, and a pt tech thatcomes2 times a week. My quad is very sore and he has me do a number of different exercises that are designed to ,get movement in knee, promote extension, and activate the different muscles that are injured during surgery. In no way ,and I repeat IN NO WAY, does he have me do anything that causes anything more than discomfort. If there is pain ,there is no gain. Like you hear from all the bonesmarties that have been thru this , over manipulation early on is non productive,produces pain and additional swelling ,and serves no constructive purpose.
Couple this with improper pain medications and you end up where you are now.
Many here do littleor no PT, and have successful outcomes. Some like me look forward to the PT sessions, even though I feel a bit sore afterwords. I believe that is normal after any workout, so ice and elevation are my go to place post PT. If I thought my PT tech was even remotely trying to push me into the pain arena, I would quit.
At your point in recovery any pt other than GENTLE heel slides, and hanging your heel on table or armrest letting gravity pull it down. , ( if you are like me this is painful ,early on so I would only do 10 to 20 seconds at time ,rest try again for2 sets. Total.). Or forget all of this and just rest ,treat the pain ,and do gentle walks every hour or so to keep leg moving.
I have same tech I had for left leg last September ,and in 10 weeks , 2.5 months I was playing golf , pickleball, had flexion over 135 ,which started at 75 after surgery , and 0 to -2 extension ,which started around 8 after surgery. Long story ,sorry ,,but the approach to your treatment so close to home infuriates me, just knowing how much discomfort a knee replacement can be right after surgery.
No need to take my route, PT wise, it’s just an option , done right. Definitely rest , ice ,which reduces swelling , and time will all help with getting your leg to working normally. At your point in recovery ,talk of manipulation, seems so absurd, that I would definitely get to another reputable knee surgeon and get a second and/or third opinion.
Momma-me lives in South Carolina now and had her surgery there.
This shouldn’t happen anywhere, but I can definitely understand how shocked you are, @Softtail having had an excellent experience in this same area.
I also had an excellent hospital experience in Delaware, no complaints whatsoever. It was a week later in outpatient PT that my problems began.
It is so very sad and mind boggling that some surgeons are like this.
Cynof4, thanks for the correction. Outrage continues, just hope someone brings that hospital and caregivers out of the dark ages.
@Momma-me ... Please take a deep breath and follow your instincts here. Your surgeon is not making good recommendations for you. Trying to work through the pain at this early stage of your recovery is sure to bring you more pain and swelling and potential problems with your recovery. Your knee must have time to heal before it's exposed to anything but the most gentle movements. It's okay for you to push it to the point of mild discomfort throughout the day, but any more will hinder reducing the swelling. Be sure to use plenty of ice and elevate as much as you can during the day and night.
You can talk to a therapist about gentle tissue massage during these early days. Not all of them do it, but it can be helpful. If (heaven forbid) your surgeon demands you follow his rules or no more pain medications, you'll need to turn to your GP for help.
Please let us know how you're doing.
You know what I think? I think your surgeon didn't recognise you or remember that you had had your surgery so recently.
He probably mistook you for someone who was further along in recovery.
I'm glad his PA gave you some more pain meds.
As for the PT, what Jockette said is right. You are the boss and you can refuse to have it. Set your limits for PT from the outset. Tell the therapist, when he/she arrives, that you will not allow him/her to touch, push or pull your knee, that you will not do any exercise that hurts, and that you will not do multiple repetitions of any exercise.
Your knee isn't lazy or unfit - it's wounded from major surgery. It needs gentle treatment and just a little exercise, not PT boot camp.
Right now, walking around the house is all the PT your knee needs. Just take a little walk every hour or so. If you can, try to lengthen your stride a little, so that you stretch the back of your knee.
I agree with you about not needing PT for the first month, because that's what my surgeon recommends.
My surgeon doesn't allow any PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house.
After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.
Yes, thank you... and I agree with you all!! I’m just in shock that this happened.
@Celle no, He def remembered me. It’s just not good patient care to threaten them with more surgeries if we don’t do what they say. I’m already exhausted, been crying a lot these past few days, dealing with unrelenting pain.... I just don’t need to be treated like that.
And I have never heard of PT 5xs a week the first week home! (Or really EVER. For that matter)
I will NOT let this PT push me around. She’s coming tomorrow with orders from the doc to make me “push past the pain” Ummmm...I know what my body needs. I also know that I have a strong inflammatory response to injury so I’ve been working really hard here at home to balance my elevating, icing and walking; trying to keep the excessive swelling at bay.
I’m not going to have someone ruin what I’ve started.
Yes... this surgery is an absolute assault
on our bodies. For any OS to not understand this is mind boggling.
They weren’t going to give me any more Oxycodones but she changed her mind once she saw me. I was sweating and shaking from the pain.
So... they sent me home with 3 days worth of pain pills and then we’re going to cut me off.
I’m just dumbfounded by it all
What crummy patient care your surgeon practices!
Can you ask your own doctor/PCP for help with pain relief? Some doctors are more willing to help than this arrogant surgeon is. If he/she will prescribe Tramadol, you can combine that with Tylenol, for good pain relief.
Don't let this PT touch you and don't listen to any arguments from her. In fact don't discuss it at all, but just tell her your wishes.
Myth busting: no pain, no gain
What your surgeon believes is wrong.
There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR
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.
Be sure to set the limits and tell the PT under no circumstances should he/she touch your leg. I wasn’t here on BS during my initial recovery, but I was so afraid of anyone touching my leg that I set that rule with every PT.
I’m so sorry this is happening to you. I cannot even imagine. It makes me even more grateful for my kind, compassionate OS (so far).
I’m also very guarded with people touching me. I don’t like it. I have to really trust someone to let them do tissue massage.
Sending positive thoughts for your PT visit tomorrow ! You’re right. You do know more than anyone else what your body needs.
@Momma-me I will echo what has already been said. It's your knee and no one has any right to threaten or touch you without your permission. In fact you can set the rules for this PT immediately on their arrival and advise them that if they don't agree they can leave as fast as they came.
If your surgeon continues to bully (yes, this is bullying) please go to your family doctor for any medication you need. Please keep us updated. We are with you all the way!
All I can continue to say is wow. To top it all off if I have been following this correctly, you had your knee done by a revision specialist, who, as I understand it are specially skilled at fixing mistakes or problems with previous implants. AND, someone you go to because the previous implant is causing you enough PAIN that you want to /need to, go thru this assault again. Mind boggling he wouldn’t be even more in tune with managing the pain ,and emotional distress that goes with this surgery. I am starting on 3 weeks, and have been cutting back on opiate gradually, down to 20 per day now from 30, but my OS gave me carte blanch to increase up to 60 per day if needed no questions asked. On my previous leg I had more pain from beginning , so I had to ask for a second script after 10 days ran out, and he called in another weeks worth on the spot . Point being he didn’t attempt to manage my pain , He let me determine what I needed to manage it.
Every day I check in with you, I hope you have found a way, and by that I mean, a GP, or other doctor that isn’t living in the dark ages to help you.
@Softtail thank you so much for your responses and your concern. I appreciate your kind words and support
@Jaycey I just wanted you to know that my daughter's name is "Jacie"
UPDATE ON PT:
She came today and was the sweetest thing ever. She told me right up front that she doesn't agree with my OS's treatment of his patients and especially the way he is handling me. She also told me that she will not touch me or push me to do anything, and she set me at ease immediately.
She took my vitals and my resting HR was 115. I told her it's the pain!! She said I have full extension; down to 0 already and am at 52 flexion. UMMM... not too shabby for barely 5 days out!!! She said I am doing great and continue light stretching, icing, etc.. and that my current issue is managing the pain, which I am not getting any help with. She suggested that my pain meds be switched. She put a call in to the on call doctor (it's Saturday) and actually, she just called me to tell me that she hasn't heard anything back from them yet. She said ultimately, it is up to them as to whether or not they want to prescribe me anything or not. But she said she was going to put the call in and make the recommendation. She told me I am doing great, apart from that. For whatever reason, my OS has it in his head that I'm being over dramatic or something.
Let's remember, this is my 3rd surgery on this leg and I also had the other one scoped at the same time. I am managing all of this as well as I can, but without pain meds, at least for a couple of weeks, it is going to be nearly impossible.
As for my PCP.... funny story. I moved to SC last fall, and it wasn't until February that I went to see her. I just googled until I found someone I thought I might like. I made an appointment with her just to establish care, so at that time, we spoke about my knees and the surgeries, etc..
I told her I didn't really want another surgery, so she suggested I go see a pain specialist to have a "Coolief" procedure done. I actually DID go to see him, because I wanted to be advised of all of my options before making any decisions. Well, it so happens that that pain specialist happens to be her husband!! And when I needed her to sign the medical clearance form so that I could have surgery, she gave me the hardest time because I chose the surgery instead of choosing the RFA and her husband. She actually scolded me about it (???) I know... hard to believe.
I'm just giving you all the backstory, because I know for a fact that she will not help me out. She probably would be secretly happy to know that I'm suffering because of the surgery.
I was wondering though - it seems that those of you in the UK do not have these problems with getting help with pain relief. Are the laws different there or do docs have a different mindset about this? Maybe not. It just seemed to be what I was finding as I was reading everyone's posts.
I will keep you'll in the loop. I appreciate you all SO MUCH... xoxo
I am so happy and relieved to hear what a good experience you had with the PT! Hopefully your doctor’s office will be swayed by the opinion of another health professional.
I’m so sorry this aspect of pain relief has gone this way and I pray things change.
I agree your current PCP probably won’t help. FYI, I wouldn’t have had that coolief procedure, either. I’d also be interviewing (I love that word in this situation!) another PCP in the future, when you feel up to it.
In any of your pre op appointments with your surgeon and his office, was there any hint of this current attitude?