TKR Right TKR 6/5

[snowleopard]

Hi Jean,

It's not a rigid swing, it's like a net basket suspended from a cross-piece. I would be uneasy about getting out of it. Maybe in a few weeks, but not yet.

Came to peace yesterday with the idea that my sleep schedule right now is about four hours in the night, and then nap and nap again later during the day. I might not prefer that right now, but it's what is. Four hours is about the max I can stand--I wake up needing to get more comfortable, feeling like I've been sleeping with my mouth open and super-thirsty. Last night I set a you-tube documentary playing, and when I would start to drift awake, I'd restart it and listen to it for a few minutes and fall back asleep. I think I may need to go back to taking pain med more frequently. I've been trying to cut back to once or twice a day, but last night was not a comfortable night, even though I took half a pill.

Also had the recognition that until the sleep is closer to a full night's sleep, I'm not going to be ready to go back to work.

I've figured out that the horizontal band across the knee is what's limiting my extension at this point. And what gives that band more fluidity is reduction in swelling. So that gives me something to focus on.

 

[KarriB]

I believe there's an article somewhere about the IT band that everyone feels for a few months. It lessens after a while, but does feel like a rubber band across the knee area.

 

[PolarBear60]

Oh! I would be uneasy with that type of swing, too. I was thinking traditional porch swing.


Jean

LTKR (Stryker Triathlon): 21 April 2015
Right Knee Arthroscopy: 25 July 2006
Left Knee Arthroscopy: 10 February 2005

 

[Raffs]

Just finished reading your thread from start to finish. Like you, I've spent the past few months looking at people walking around pain free and not thinking about their knees and know that is what I want to be able to do again soon. Our cat (Patti, who sadly passed away in May) wasn't a hunter, thankfully. I would have freaked out totally if she'd have bought me gifts at anytime let alone during recovery! I've got my hubby looking after me until next week and am worrying about how I'll cope alone but you've given me some confidence that with some planning it'll be ok. We have quite an old house with narrow and small stairs that I can manage but am not confident yet. Right, off for a pre lunch snooze now....

 

[Celle]

I've got my hubby looking after me until next week and am worrying about how I'll cope alone but you've given me some confidence that with some planning it'll be ok. We have quite an old house with narrow and small stairs that I can manage but am not confident yet.

I'm sure you will manage fine. Some people here go home to manage on their own straight away, and they do it.
Try to get downstairs while your husband is still at home, and arrange it so that you don't have to go upstairs again until he comes back.

There's a thread in the Knee replacement Pre Op Area, called Home Alone after Surgery, which offers some suggestions about how to manage. Here it is:
https://bonesmart.org/forum/threads/home-alone-after-surgery.31170/#post-789759

 

[Raffs]

Thanks @Celle I'm going to read that now.

 

[snowleopard]

Pretty wiped, so this will be short. PT came again today, and this was the best session yet, I think. I explained that my goal was to find a smooth, steady, even if it's slow, arc of progress, rather than the lurchy push-too-hard-loose-a-couple-of-days progress I'd been experiencing. He said he was fine with that. Increased my extension to about 5 degrees and my flexion to about 70. He said that the short-term goal for flexion would be about 90, and then I'd continue to experience slower gains over time. He mentioned more aggressive therapies for increasing ROM, such as the MUA and I said that I understood that those became necessary in some cases, but I wanted to put that off until we were about out of the window of opportunity for that, later rather than earlier.

Walked around a little bit outside on uneven ground with the walker, got safely up and down off the deck a couple of times. He respected my pace. Felt some anxiety about being out there, and he pointed out that last time we were out there together, I got hurt. Sat down and just processed it, felt the sun and the breeze and enjoyed the dance of the poplars, admired my flowering baskets. Walked around a bit more, and when I said I'd had enough, he respected that. So I'm feeling like I was able to successfully advocate for myself, and I should see smoother progress from here on out.

Am back in bed icing, elevated, took a pain pill.

Talked to insurance company. Due to the payments I've already made towards deductible and out-of-pocket, my hospital bill of over $68K will cost me around $200, and the surgeon's bill of $15K+ will be about $500. Thank goodness! I know there's more bills coming, but those were the biggies. I also learned that I have virtually unlimited PT sessions available, even the home visits. (130 annually--wow!) That takes a lot of pressure off.

 

[Braunzie]

@snowleopard - Sounds like you had a relatively good day! Love the description of your experience outside. Great news about your insurance too! I live in a "split-level", otherwise knows as a "daylight basement" house. Essentially, once in the front door, you have to go either up stairs (7 - yes, I counted.. ) or down. Upstairs is the main living area - kitchen, dining room, living room, bedrooms and office area.. Downstairs is the "TV room", laundry room and a spare bedroom.. So.. once I get up those SEVEN stairs, I should be good for DAYS.. thinking I'm not going anywhere and I'm not doing any laundry.. hahaha! .. The one part I'm looking forward to is going out on our deck, just outside the dinning room and enjoying sitting in the sun and watching the birds, squirrels, and chipmunks (and even raccoons) that come along to enjoy the food I put out for them. I figure not only can I enjoy the warm sun (a rare commodity in the Great Northwest most of the year!), but I can play at getting a great wildlife shot while I'm 'just sitting around'. We bought a special deck chair that allows what looks like the right kind of "reclining" that will support elevating my leg.. It may take a while, but that's my short term goal for when I'm once again "home alone" on medical leave from work.

I plan on doing lots of rest, elevation, icing and taking pain meds (with the necessary other supplements!) early on and take it from there.. I'll be learning from experience, but also from all the great advice from folks that have gone before me.. Wishing you continued "forward progress"!!

 

[snowleopard]

Slipping in for a minute to share a discovery. I googled harp music on youtube, and found many options for relaxing, multiple-hour music. Apparently there's an audience for people looking for music to help them sleep. Went with some celtic harp, and will see if that will help me catch the next train bound for dreamland. Will report my outcome.

The rest of you night-owls-not-by-choice, I wish you a restful and refreshing night's sleep.

ETA: results are in, and I'm yet again awake in the night. But I'm okay with that. We have wildfires in the area, and the wind has shifted, as the smoke has closed in. The smell of smoke was the first thing I noticed, and probably what awakened me. So I got up and went to the bathroom, fed the cat enough for her to let me sleep in come morning should I be so lucky, and switched out my ice packs. My cryo-cuff ice has melted, and I don't want to go downstairs right now to get more ice, so I laid the cold gel packs on my leg, strapped the cryo-cuff over it, and filled it with the cold water still in the thermos. Very soothing. Ate a few tangerines, drank some water, and took another pain pill. Just getting up and walking a big encourages circulation and eases stiff leg muscles. So my creature comforts have been attended, and all very promising to for getting back to sleep.

The fact that I got my first four-hour stint in starting in the middle of the night means I still have the option of going back to sleep and getting another couple of hours in before morning. A promising development in getting my sleep schedule turned around. The music was helpful without being a panacea. Unfortunately, a lot of what is available marketed as restful, soothing music wasn't terribly restful or musical. A bit elevator-music-ish. But I think if I poke around I can find something that actually works.

I also pulled out some instruments of my own yesterday and played with them a bit. It's something I've put aside for some years now as I just didn't have the time or the focus, and was one of the things I envisioned doing during my down time. Up until now I've pretty much been on a Netflix-and-solitaire level instead. Haven't even read a book. So I'm taking that as an encouraging development as well.

Good morning, where applicable--and you know who you are--and good night to the rest of us.

 

[Raffs]

Apparently the time difference between London and Anchorage is 9 hours - so, 4pm here now means 7am in Anchorage - or are you in a different time zone from there?

Anyhoo, good morning and I hope you managed to get some reasonable kip, as we say over here.

Great re the PT session. I'm going to say that to my PT when I see him on Friday. Slow and steady. Very good.

Have a good Tuesday.

 

[snowleopard]

Well, 9 and 15 equal 24, so apparently our math was correct, even if one of us--not saying which one--is chronodyslexic. ("No, not that direction! I can't look! Aiiieee . . ." )

I did! I slept and slept and slept! Awakened a few times, but went back to sleep and slept deeply both times. Had almost a round-the-clock marathon, but am awakened optimistic and excited about the day. Only concern is all this smoke. It can be from a fire 100 miles away or five, so I have to take something of an interest. Generally, if an evacuation is likely, fire service personnel come by and check in, do a nose count, and give an evacuation alert. I think if they do I'll meet them at the door in my wheelchair with my cat, just to watch them choke.

Braunzie, I'm in a daylight basement style house, too, but my upper story is at ground level, and the bathrooms/bedrooms/laundry are upstairs, the kitchen down. So right now my microwave is sitting on the washing machine, and I have a field-kitchen spread out in the bay window in the upstairs living room. It works, after a fashion. I've also got a cooler in the bathtub that holds four bags of ice, so that extends my days of independence.

I was looking forward to deck time as well, so asked the PT to check my deck to see if there were any obstacles or concerns before we did that. He tried it, and said, "I terribly sorry, but the bottom hinge on your door just broke." It's a heavy triple-pane door that opens both from the side or from the bottom, depending upon which way you turn the handle, and it's thirty years old, so unsurprising that it would finally fail. So close to getting out there, and yet so far away. We got it to shut and latch again, and fortunately I found a local window manufacturer that still uses that same hardware. There's hope, but that's going to be a bit of a bear to repair. So at this point all I can do is look yearningly out the door and hope that the geranium out there doesn't get too thirsty.

 

[Braunzie]

@snowleopard - So glad you got some good sleep!! It's interesting to see how we can adapt the human condition to do what we need to do.

Praying the fires don't get too close to you.

 

[snowleopard]

Thank you, Braunzie. So far, so good. They're evac-ing on the far side of the valley, but that's a long poke off from here. And the air was clear enough today that there was only a tang of smoke. Went out for a walk when the PT was here, all the way up to one end of my driveway. He brought the chair along, wheeled me down the access road, and I walked down (mostly backwards because it was steep) the other side, with him right behind me, and then I walked back to the house. Felt good to get out and get some fresh air and sunshine, and move a bit more.

Leg is, I think, hitting 0 extension at times. First time in almost two years that I've had it any better than 10, so that's a big woo-hoo! Forced a stretch today to get it close to 90 when I was sitting down. I got stretch, but immediately was followed by a tangible thickening and tightening of that horizontal band under the kneecap, and significant swelling and loss of ROM. This knee does not like to be forced to do anything.

PT also slipped the kneecap back and forth horizontally.
"This is something you can do, too."
"Why would I want to?"
"Because it's good."
However, it's feeling weirdly less mobile now, and warm to the touch in spite of icing. I don't think my knee liked that, either.

The scar is looking better daily. Still lumpy where there are obvious thread divots under it, and he encouraged me to do the deep, very uncomfortable pressure to break down scar tissue. I tried instead touching it gently with the back of the head of a vibrating toothbrush, just to get some cellular massage going in there. A bit of a compromise. Felt *major* twitchy nerve zingers in there later, and there's a bit of discoloration under the skin in spots, in spite of the fact that the pressure was gentle. Something happened--good or bad, remains to be seen.

On another note, I took my flute out, which I haven't played in forever, and learned part of a new song on it. Watched some videos of performances of that song, and some master-class vids on you-tube. This is significant because up until now I've mostly been at the Netflix-and-solitaire-and-kitten vids stage of recovery. Oooh, look, a puppy rescue! A returning soldier is greeted by a dog! Pretty much been on a soft-foods diet of the intellect. I'm taking this as positive sign.

 

[Celle]

Forced a stretch today to get it close to 90 when I was sitting down. I got stretch, but immediately was followed by a tangible thickening and tightening of that horizontal band under the kneecap, and significant swelling and loss of ROM. This knee does not like to be forced to do anything.

Don't force it. You'll get there in the end.

PT also slipped the kneecap back and forth horizontally.
"This is something you can do, too."
"Why would I want to?"
"Because it's good."
However, it's feeling weirdly less mobile now, and warm to the touch in spite of icing. I don't think my knee liked that, either.

Don't do it. It's not necessary.

The scar is looking better daily. Still lumpy where there are obvious thread divots under it, and he encouraged me to do the deep, very uncomfortable pressure to break down scar tissue. I tried instead touching it gently with the back of the head of a vibrating toothbrush, just to get some cellular massage going in there. A bit of a compromise. Felt *major* twitchy nerve zingers in there later, and there's a bit of discoloration under the skin in spots, in spite of the fact that the pressure was gentle. Something happened--good or bad, remains to be seen.

Again, leave it alone. Scar tissue is a normal part of healing. It's what holds your wound together. It's not the dreaded adhesions, which are different. Read this:
Scar tissue and adhesions - what's the difference?
And this: MUA (manipulation under anaesthetic) and adhesions
Nature is actually pretty good at healing you and, at this stage, active intervention like your PT suggests is not necessary.

On another note, I took my flute out, which I haven't played in forever, and learned part of a new song on it.

I'm glad to hear this. The brain fog is lifting.

 

[snowleopard]

@Celle, thank you! My patella thanks you! My scar thanks you! Like giving a ten year old permission to play hooky on a sunny day in May and have ice cream for breakfast. I'm sold.

Can't understand why he pointed to the parts of the scar that have healed nicely on their own, and says, "That's okay, but you have to work more on these parts." [points to places where the thread divots still show clearly] When in fact, I haven't `worked' on any of it.

Brain fog, eh? Maybe it's a mercy. The month passed quickly in a mostly-pleasant blur.

ETA: put my leg on the CPM machine after I posted the above. Made it about 20 minutes and the patella started to protest. I shut the CMP down immediately, and checked it out. Definitely warm to the touch. Darn it all anyways! Above all do no harm applies to PT's, too. I have no doubt that he means well, but as I told him this morning, the leg is getting there, and I have time on my side. It's less than five weeks, and I'm walking on it (with a walker, able to straighten it (at times). Little to no pain almost always. Scar is healing. No sign of infection. Slowly increasing my ROM. Isn't that good enough?

I appreciate a lot of what he has to offer. He's very good at patiently encouraging me to do more functionally. I felt as if I could safely maneuver down that slope backwards because I knew he wasn't going to let me fall. (Although I have to wonder why he showed me that, because no way am I going to go down a hill so steep I have to go backwards--that's just asking for a fall.) Maybe he feels he has to keep pushing me. Well, tomorrow will tell. If it's an ice-and-elevate day, we know that wasn't what I needed, and if it's a get-up-and-do-more day, then I am being a wuss here. It's just that I feel I had a golden surgery and a great recuperation so far. That's a gift to be cherished and protected.

Also, I have the privilege of taking my time. I don't have three-year-old triplets to chase around. I don't have to be back at work until next month. Zombie apocalypse, thankfully, has held off so far. I am a happy member of the Turtle Club, and proud of my recovery, even if it's not going to set any records. I want this knee to last a lifetime, and taking a few months to be well-started on this path seems the course of wisdom to me.

 

[Celle]

@snowleopard - I don't know why it is, but some PTs must be trained to believe that nothing heals properly without their intervention. I don't believe that's true, but some obviously do.
I agree that, in some circumstances, intervention is necessary. I don't think it needs to be done routinely, though.

I've had 3 knee replacements. I had (and needed) PT for the first one (PKR), mainly to help address the distortion of my tendons and ligaments that resulted from leaving it too long before having the replacement.
After my revision to a TKR, I had minimal PT.
I had no PT at all after my left TKR.

At no stage did any PT suggest that I needed to do the manipulating and deep cellular massage your PT recommends.
MY ROM in both knees is 120+, with full extension. My kneecaps are mobile and they track properly.
Both incisions have healed just fine, even the one on my right leg, which was opened up a second time for the revision. I didn't routinely put anything on the scars, but i did use a little Bio Oil when my skin looked dry.

Listen to your body and to your knee. If it hurts, don't do it. If it feels wrong, don't do it.

 

[snowleopard]

I feel as if I've reached a new level in my recovery. Sleeping better the last few nights, leg is loosing that chunk-of-driftwood heaviness in the thigh, didn't wake up this a.m. craving ice on the knee. Able to put my weight through the leg more easily, feel as if my hips are leveling out when I walk.

This is subtle, but encouraging.

 

[snowleopard]

Could anyone tell me when you know that it's okay to cut back on the icing. I haven't been cleared medically to drive yet, and so am dependent upon friends picking up bags of ice and driving out from town with them. I store them in an ice chest that I keep in the bathtub. It's been pretty warm, so I've insulated the chest cooler with blankets and towels. I'm going through about a bag of ice a day.

All of which is fine by me, as long as it's necessary. Today was the first day I didn't crave that sensation of icing, or feel that I needed it to keep the swelling down. I still iced, but just wondered for the first time when that becomes unnecessary. My pain level is about zero, and my ROM continues to increase. I think it's pretty close to 5/90. Honestly, before I put the ice on, sometimes I have to stop and think about which knee it's supposed to go on.

I read a thread here about a man who is walking a few miles a day and riding his bike the same a few weeks out from surgery. I'm nowhere near that in terms of restored function, but still feel happy with my progress. Scar is looking great, stamina slowly returning, brain fog lifting. What happens next from this point in recovery?

 

[Celle]

@snowleopard
Buying all that ice must be costing a bit! It sounds like a bit of a performance to keep the ice frozen, too.

Why not ask your friends to buy you about 4 gel packs from Walmart? You keep them all in the freezer and rotate them, so that you always have one in use, 2 frozen and one in the process of freezing again. Don't get the instant ones, which can only be used once. The one below is $7.14.


Unlike the picture, don't forget to put a tea towel or something similar between your skin and the frozen pack - to make sure you don't get freezer burn.

I continued to ice for at least a couple of months, but cut back the frequency. I'd use them whenever my knee felt uncomfortable or hot and I would leave one on my knee until it had thawed. They're soft and squidgy and they mould to the shape of your knee.

If you get smaller ones, you can put one at the front of your knee and one at the back.

I believe that @referee54 bought larger ones from Amazon.

I found it useful to always have these in the freezer, so that I could put it on bumps and bruises and so that I always had them handy if I overdid the activity and joined the ODIC.

 

[referee54]

I bought these:

They worked great!! I still have them and use them for bumps, bruises, and strains.

They keep their cold for a long, long time.