MUA Ruby's Tuesday--July 11th, 2017<

[Josephine]

I have a new pain along the incision area and deeper in the joint area that is a shooting sharp pain that comes and goes. PT came today and moved my leg in ways that hurt me lots.

These two things are related! If you allow someone -anyone, even if they do have a medical qualification - to hurt you, you will get consequences like this. Read this Saying no to therapy - am I allowed to?

He says my quad muscle on my surgery side is too weak, why would it be any stronger now that someone severed right through it

You don't really believe the surgeon never severed right through your quads, do you? Heaven forfend!

I'm in pain and frustrated, and scared that at this rate I will not be ready to return to work in 9 weeks.

9 weeks is a long time in TKR recovery so lots can happen.

However, I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[Ruby9297]

Thanks @liam2015 , the experience was actually with the Physicians Assistant from a different clinic: spine &a nerve pain, and not my surgeon. However. I made sure to let my surgeon know what she said about him..

As for the poop fairy visit. It was more like giving birth to a 4lb jagged rock, followed by violent and endless diarrhea. Kind of like the volcano blowing it's top after a long build up of pressure, then the lava flow. I have been taking laxatives and eating prunes everyday for about two weeks, with no results, thrn bam! It hit me like a volcanic eruption! Good grief!

 

[Ruby9297]

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

yes, Josephine. Ask Away--

It sure feels like someone severed through quads and everything else in there!

 

[liam2015]

i had a similar experience with the poop fairy @Ruby9297. i couldn't stand the diarrhea anymore and quite all meds. finally i was regular again, taking pieces of natural black liquorice to help just in case. hope you can get your bowel issues sorted out and find some balance.

 

[Ruby9297]

Like the black licorice idea--license to eat candy!

 

[Ruby9297]

Ok, so today was the best day ever for pain control, and I hardly took any pain pills . My acupuncturist came over today and gave me a treatment this morning and I've been pain free most of the day! I was starting to forget what not being in pain felt like.

I did my PT exercises, but not the ones that force me to bend my knee in ways that hurt. I've also had to talk to my DH because he was doing what the PT told him and I had to explain to him why we won't be doing those exercises anymore. I don't think he's entirely convinced, but he's respecting my wishes.

I also began the initial stages of lodging a formal grievance against the PA who was so rude and unprofessional to me on Friday. That required a lot of phone calls and repeated re-tellings of the events that led up to me making these complaints. I now have a new list of local pain specialists to choose from, so I will research their credentials and ratings online before choosing a new one.

This is precisely 3 weeks from my surgery day, and I'm seeing a (dim) light at the end of a very long tunnel. In much better spirits now that I have had some hours of painlessness.

 

[kmak81230]

So glad your pain was better today - that makes all the difference.

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. Please also factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[nensi]

Hi there You're gonna be busy answering Josephine's questions so I'll keep it short !
It will get better. You are already better! And accomplishing so much with the kitties, now it's your turn.!

 

[Ruby9297]

1. Yesterday I was at about a 2 after an acupuncture treatment. Then, I was walking around the house Looking for something my mother (out of country absolutely needed) and tripped on a bag. I had left my walker out of that room because there's too much stuff in there to move around with the walker. I didn't fall, but I felt my knee get jammed and my ankle too. The pain has been at a 7-8 since and is currently pushing a
9. Aching, deep in the joint area (both knee and ankle) muscular pain in thigh and calf. Had me up in the night.

2. I started on Norco 10-325 1-2 tablets every 4 hours as needed , the maximum dosage wasn't helping, so OS changed to Percocet 10-325 1- 2 tablets every 4 hours as needled. This was a bit better. I was taking 2 every 4 hours. And went through 60 Pills too quickly for my doctor's liking. He sent an email about not wanting me to get addicted to narcotics, but gave me a refill. Because I'm on my last few now, I'm taking 1 instead of 2, and stretching the time out to as much as 8 hours apart. That was ok yesterday but I can tell it won't be today because I'm hurting quite a lot. Still muscular and nerve pain, plus a new pain: incision pain be deep joint pain, some ongoing, and some sharp, intense, stop you in your tracks pain that subsides.

I had been on a maintenance dose of Gabapentin for nerve pain for a previous diagnosis of spinal stenosis. But because of the issue with nerve doctor being rude and unprofessional, I never got that dose increased until Friday July 28th. I take 600mg 3 day as against twice a day like I was taking before. That dose will titrate up over the next weeks: 2 pills 2x day the next week, then 2 pills 3x day thereafter. Nerve pain is now improving.

For muscle spasms I take diazepam 5 mg every 8 hours as needed. I've been taking ½ a pill because my OS has intimated that I'm taking too many narcotics and he doesn't want me to get addicted.

I use a topical gel of diclofenac sodium topical solution 2% around my knee, not in incision, and some in thigh and calf areas. It works pretty well. I also take flector patch (diclofenac sodium 1.3%) which I place over the Pennsaid after it dries. Flector patch is supposed to last for 12 hours. I find it lasts longer. I was already using these topicals/transdermals, plus diazepam and Gabapentin prior to surgery.

3. swelling is between extreme and moderate but closer to moderate. It was extreme before.

4. ROM: 74 with the PT pushing my leg back until I'm almost in tears. Extension -2

5. Lots of icing. Icing now in fact. I have a new Ossur cold rush therapy ice machine, plus a machine sent by insurance company that I keep for a month. It useless as an ice machine, but it also has those things that squeeze your calves to prevent DVT so I used it quite a lot the first two weeks. I don't live in any particular schedule but I ice a lot and always after PT

6. I elevate almost all day long & frequently nap while elevating and icing. I also use heating pads for thigh, back, and calf while elevating,

7. I Make my bed, pick up a little. In my bedroom & bathroom. Make my morning coffee, feed the cats (14 including my own, strays outdoors, and neighbors who don't feed their animals), vacuum my bedroom/bathroom, hallway, living room. Occasionally throw a load of laundry in the machine, shower myself (4-10 time a day because the warm water on my leg helps the pain). I don't leave the house, except once for a medical appointment and once to take the cat to the vets.


Ankle pumps several times a day.
PT has shown FH how to place hand against my foot to apply resistance.
Pressing knee down on husband's fingers 20 reps 2-3 times per day
Knee bends, using strap behind knee to pull knee as far as possible. Painful! 20 reps 1-3 times-day
Sit in higher chair and let surgery leg dangle for as long as possible 2-3
Sit in higher chair and move leg back and forth on plastic bag as far back as possible. This is when PT pushes it back far and makes it hurt.
Get up and get all laps around house when I can or when I need to walk off pain and stiffness.

PT the same as home exercises. PT comes twice weekly. My last home visit is supposed to be tomorrow, but because I've made such "poor progress " it might be extended. They want me to go to a facility for PT after this week, but I am not cleared to drive and I have no one to take me.

I also use heat and electric massager for thigh and calf. I have acupuncture, Reiki treatments and use the cream you told me not to talk about on this forum, but it doesn't help much at all

Thanks,
Ruby

 

[sistersinhim]

You should never, ever let anyone push or pull on your leg. That causes much more harm than good.

Josephine will be back soon to talk to you about your answers.

 

[Josephine]

tripped on a bag. The pain has been at a 7-8 since and is currently pushing a 9

Yow!

I started on Norco 10-325 1-2 tablets every 4 hours as needed , the maximum dosage wasn't helping, so OS changed to Percocet 10-325 1- 2 tablets every 4 hours as needled. This was a bit better. I was taking 2 every 4 hours.

Seems good.

And went through 60 Pills too quickly for my doctor's liking. He sent an email about not wanting me to get addicted to narcotics, but gave me a refill.

Don't listen to him. You are only 3 weeks out and need your pain meds. It's ridiculous of him to talk about addiction when you are so early in your recovery.

Because I'm on my last few now, I'm taking 1 instead of 2, and stretching the time out to as much as 8 hours apart. That was ok yesterday but I can tell it won't be today because I'm hurting quite a lot.

Exactly - but if your surgeon won't, do ask your GP as we've observed that they tend to be more helpful than surgeons.

3. swelling is between extreme and moderate but closer to moderate. It was extreme before.

Okay

4. ROM: 74 with the PT pushing my leg back until I'm almost in tears. Extension -2

Under NO circumstances allow anyone to push on your knee! Apart from being very harmful, it also gives an inaccurate estimation of your ROM. Only that which you obtain under your own efforts is valid.

5. Lots of icing.
6. I elevate almost all day long

Jolly good!

7. I Make my bed, pick up a little. In my bedroom & bathroom. Make my morning coffee, feed the cats (14 including my own, strays outdoors, and neighbors who don't feed their animals), vacuum my bedroom/bathroom, hallway, living room. Occasionally throw a load of laundry in the machine, shower myself (4-10 time a day because the warm water on my leg helps the pain). I don't leave the house, except once for a medical appointment and once to take the cat to the vets.

That's far, FAR too much to be doing this early. Did you read the recovery articles left for you earlier? It included this one which is one of the most important Activity progression for TKRs


Ankle pumps several times a day - these are just anti-clot exercises so since you are so active, you don't need to do these any more
PT has shown FH how to place hand against my foot to apply resistance - under no circumstances is this a good idea. Don't let him do it
Pressing knee down on husband's fingers 20 reps 2-3 times per day - you mean having your leg straight to do this? That's not a good idea. Extension is always lagging in the first few weeks. It will come later though it could take some weeks.
Get up and get all laps around house when I can or when I need to walk off pain and stiffness - okay that's good activity

Knee bends, using strap behind knee to pull knee as far as possible. Painful! 20 reps 1-3 times-day
Sit in higher chair and let surgery leg dangle for as long as possible 2-3
Sit in higher chair and move leg back and forth on plastic bag as far back as possible. This is when PT pushes it back far and makes it hurt.
These are all flexion exercises and together make far too much. Four of these and so often is counter-productive. They cause excess pain and swelling. So stop them!

PT the same as home exercises. PT comes twice weekly. My last home visit is supposed to be tomorrow, but because I've made such "poor progress " it might be extended. They want me to go to a facility for PT after this week, but I am not cleared to drive and I have no one to take me.

I think your 'poor progress' is down to a) the exercises you are doing and b) the tender mercies of your PT! I think you should cancel any further sessions and give that leg of yours a rest!

You also need to read this BoneSmart philosophy for sensible post op therapy and see how a less aggressive mode of rehab is better! Also read the second part about consent!

 

[Ruby9297]

Thanks, @Josephine, for your time and sharing such valuable wisdom. I have a PT appointment today, but he hasn't even told me what time he's coming, so I guess I'll have to wait and see--guess it's a good job I don't have a hot date to go anywhere beyond my kitchen today!

I have read and reread your responses to my responses to your questions. You make a lot of sense. I read parts to my husband because he comes from the school of 'Do whatever the doctor tells you to do and don't ask questions.' He and I are very different in that respect. I have asked DH repeatedly to log on to Bonesmart, as well as my mother, and neither of them have. They have now promised to do so. We shall see.

My mother lives overseas, but we talk on the phone every day, so she is always up to date on my progress. She was very cross with me for almost falling whilst looking for her letter but on the flip side of that she seems have forgotten how much pressure she put on me asking almost every day if I'd looked for it yet. My response to her each time was something like this, "mum, I was in a lot of pain and then I slept for hours on end then I felt sick to my stomach, and had diarrhoea for an hour, then went back to sleep. I'm weak, and I'm in pain. I was able to get a bit of dinner down, but I just cannot move. My leg is on ice right now and I can feel myself needing to sleep again," then she'll say something like, " I know, love, but when you get the chance, please take a look because I really need that letter."

So when I felt so good on Tuesday after my acupuncture appointment I decided to try and find the letter. I couldn't find it but almost fell in the process. This caused me a setback yesterday, which made me feel awful and depressed and now my ankle hurts as well as my knee.

I felt so ill yesterday, and the pain level was out of control. I am now completely out of Percocets and fear asking my doctor for more because he was reluctant to give me my last refill. I still have Norco to fall back on so I've started taking those. My PCP is in the same network at my OS so their computer access shows all medication and communication between me and them. My PCP will see that my OS said he did want me to get addicted to narcotics and she most likely will not go against his wishes.

My husband is besides himself with sleep deprivation because I need ice in the night and medication and he's getting a bit short tempered with me. On the one hand, he's annoyed if I ask him to get me something I need and on the other hand, he's annoyed if I try to do it myself because I don't want to disturb him.

I have told him from the get go that we should sleep in separate rooms so I don't disturb him with my tossing and turning. I can call him on his cellphone if I need him, but he won't have it. Now he's starting to think that's not such a bad idea.

I am nervous about my PT appointment today because no one will be here except me. In my current emotional at state I feel pretty vulnerable, especially when I'm alone. I know I need to tell my pt that I will not be letting him push my knee back and that is going to be problem. Wish me luck.

Meanwhile, I lodged a formal complaint against the spine PA and doctor, and their office manager was very curt with me. I think that may have contributed to my feeling so bad yesterday. She seriously seemed more concerned that I'm moving forward with a formal complaint than by the fact that a member of her staff treated me so badly. She said she will speak to her staff to hear their side of story but she hoped I would change my mind about the complaint and give her office another chance. I told her they'd had all the chances they'd be getting from me. When I asked if I would be getting any summary of the outcome of her investigation, she responded with a flat, but emphatic "NO". So I told her that this would be yet another reason why I will not be coming back to their office as she clearly was not being transparent in her alleged attempts to resolve the issue. Not a happy camper today, but I'm sure I'll get over it. Thanks for letting me vent.


Sent from my iPad using BoneSmart Forum

 

[Josephine]

Oh dear, a growly husband and a growly mother! No wonder you are feeling vulnerable. However, if you manage to do this one thing and stand up to your PT about pushing on your knee, you will really feel you've accomplished something!

Think of it like this: if you walked up to someone in the street and started pulling on their leg and twisting it, what do you think their response would be? Exactly - they'd dial 911 because that would be abuse and the law forbids it. Get that? THE LAW FORBIDS IT! Doesn't matter if he's got a medical qualification, he's still not allowed to do it!

 

[sistersinhim]

It is assault if PT does anything to you that you do not consent to. Check this out:
CONSENT: what it means and how it can be used

 

[kneeper]

I had short prescriptions for pain meds but I would call and talk to the nurse and explain how my pain level was and how much I was taking and the doctor always prescribed more. Over the weeks it was clear I was taking less and less so he was ok with it.
Maybe if you explain that you hurt yourself and that's why you had to increase again briefly?
I hope the hydrocodone does the trick for you in the meantime. If it does work maybe you can get a prescription for that. My OS started me on oxycodone but then I dropped down to hydrocodone after a few weeks.

 

[Ruby9297]

PT came today and I'd been feeling pretty rough all day. His arrival actually interrupted a nap, so I was groggy, in pain, and not in the best mood. He asked me how I was I and told him about my near fall two nights ago, which had caused me a setback. I was in pain since, that I had not done any of his exercises since then, and I was not interested in any activities with him that involved him pulling, bending, or touching my leg.

I also told him that I am in agony after each of his sessions and have to ice after each time he comes and I wasn't interested in anything else that causes pain. I didn't think that was good for me. He actually respected my wishes and backed right off--never made me bend my knee and never touched it. Wonders will never cease.

I have to get up early tomorrow morning and try to fix myself up for a teacher pre-services day, via Messenger. This will be the first time I have ever missed the beginning of a school year, and I feel bad about that, so the next best thing is to welcome my staff back from my bedroom, via technology.

 

[SusieShoes]

Made your accommodation this time and take joy in that it's not a permanent thing, because your knee is getting better quickly now. You'll soon be back up to speed, though maybe not as soon as you want to be. We all get a little disheartened over not being where we want to be. We are getting there, though!

 

[VW54]

Seconding SusieShoes.
I have to force myself to think it will get better at times. I'd *so much* like to ♢not♢ think about knees anymore... so yes, my sympathy.

 

[Ruby9297]

My Lounge Doctor Just got delivered . Now THAT'S what I'm talking about! I should have had this thing since the beginning! This and my ice machine = heaven!