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

[Lil Cyborg]

Good for you telling the doctor's office how you feel. Everything you said made complete sense.

I am sorry that you're feeling so terrible about the possibility of having an MUA. I would, too. It really does seem the way they are talking to you and presenting it is not helpful or kind. An MUA should not be considered a punishment! I have read posts on the forum where people had low ROM numbers (even after higher ones), then they increased without an MUA. Of course, it is up to you to make the decision for yourself as to what you think is best for you. I hope nobody tries to bully you into doing anything just because it is their opinion. There are different ways of approaching knee recovery, and one way is not the perfect way for everybody.

Sending you virtual hugs!

 

[Jajakio]

Have you been xrayed since the surgery to see if everything is situated where it should Be? I think if it were me, I'd want to know that before a MUA. Is this concern for an MUA based solely on 1 PT measurement? Or has this been a problem for a while.? Is it possible to put doctor appointment off a week or so and rest and ice and see what happens? Tough decisions to make. Hope things will get better for you, Ruby.

 

[Ruby9297]

I did have X-rays since the surgery. The first one was directly after surgery while I was still under anaesthesia, again one month post-op. Everything looked good. My leg is just stiff and still swollen. Besides icing and elevating, Ans doing the exercises that I can, I don't know what else I'm supposed to do

 

[sistersinhim]

What you are supposed to do with that knee is nothing! This whole thing is totally unacceptable. Do not go for that appointment Monday. There's no good that a MUA would do right now. But, it sure would do a lot of harm and set you way back. Then the swelling will be even worse. You know what that means...the ROM will decrease because you can't bend a knee that swollen. It's against the law of physics! Then your OS and PT will continue to harass you and physically push on that knee keeping it swollen and inflamed.

If I were you, I'd stop all exercising and never go back to PT. You don't need it. God has built into our bodies the know-how to rehab itself without someone telling it how to do it and then setting it way back in recovery. You are not quite 1/6 of the way of a healed knee. I know from experience that it takes at least that long to heal and sometimes even longer. Every knee is different as is every body.

What this last PT and your OS's office has done to do is unconscionable. Your ROM is getting worse because you're doing all those exercises and letting PT push on your knee. Please stop everything you're doing for at least a month. Ice and elevate as much as you can during this time. (I iced and elevated the whole time I was sitting for at least 4-5 months!) This will give your knee time to flush out that swelling. Then your ROM will come back in. Doing your ADL is all your knee needs. Walking is the best thing for it. After all, isn't that what it's for?

 

[bertschb]

Hi Ruby!

@liam2015 mentioned my name a few posts ago here in your thread so I started reading your posts to learn more about your journey. I thought my TKR recovery was slow with some depressing twists and turns along the way but compared to what you've been through, mine has been a piece of cake! I feel guilty now for whining. You've received a lot of great advice and encouragement here - just as I did. I'll add my $.02 although I'm not sure it's worth even that.

The first thing I can speak to is ROM - or the lack thereof. I came into my TKR thinking I would be one of the people who recovered faster than the next guy. I was in great shape physically. I was retired so in no hurry to return to work. My wife literally did everything for me around the house. And to top it off, other than the first few days after surgery when I thought my leg would explode when I stood up, I had zero pain. So, although I had everything in my favor to quickly regain ROM, my knee had other plans and those plans were to teach me patience. My ROM was at 60-70 degrees a month after surgery. My PT was threatening MUA just a couple weeks after my surgery! I eventually got to 90 degrees at around 6-8 weeks maybe? Once at 90 degrees, it stayed there for many months. It took about six months for my ROM to improve beyond 90 degrees! I haven't measured my ROM lately but at ten months post-op, I would say it's 120. Could be 130. It's still stiff if I sit with my leg up for extended periods of time and it still doesn't bend as far as my other knee but it's WAY better than it was at 5-6 months post-op. After many, many months of no progress at all my ROM started improving. On it's own! YOURS WILL IMPROVE TOO!!

re: MUA...Just say no! After doing a ton of research and reading great posts from the fantastic admins here on Bonesmart I learned that although a lot of PT's and surgeons will recommend an MUA very early in recovery, very few people actually need one and even fewer will benefit from one. I decided early on that I wouldn't do an MUA no matter what my surgeon or anybody else said - and no matter how poor my ROM was. I knew I just needed to be patient and ROM would come.

Finally, PT. Once again, thanks to Bonesmart, I learned early on that PT was probably not necessary and could actually set me back in my recovery depending on how aggressive my therapist was. My surgeon actually doesn't recommend PT for his patients but after seeing how poor my ROM was at my first post-op appointment, the PA recommended PT. He kind of made me feel like I hadn't done all my post-op exercises even though I did exactly what was asked of me. I think I was at 60 degrees at that point and he was expecting 90. Anyway, I felt like I needed to at least try PT for a couple weeks which I did. My therapist wasn't happy with my progress and recommended an MUA before the two weeks were up. At one month post-op we headed south for the winter and I stopped PT and never returned.

Well, I'm running out of time and getting too many distractions to continue writing. I didn't mean to hijack your thread but I wanted to share my experience in case it helps you somehow. Your ROM will improve all by itself. I actually don't think my recovery will be complete for another year. When the wonderful admins here on Bonesmart tell you this is a long recovery, they are not exaggerating!

Btw, you are an excellent writer! I really enjoyed reading your story even though the content was depressing at times

Hang in there!!!

 

[Celle]

I agree with the others. You don't need an MUA, so don't go in to the surgeon's office to discuss it. Just tell them that you want to leave it for a while longer and ask them to stop harassing you. Say you will come in for your regular appointment and not before. If that surgeon's assistant phones again after that, hang up on her.

I'm glad you told her how you felt, but I think you should say the same things to your surgeon himself. Many times, an assistant will tell you something that isn't right. He needs to know when his patients are being let down and treated badly. Tell him that the PT who reported you had only seen you that one time and you felt his care was detrimental to your progress.
If you think you'll forget anything, or get too upset to say it all, write it down, so you can give it to him.

You were doing fine with a good therapist who understood to treat your knee gently, until that clot of a stand-in PT intern took it on himself to bully and "report" you. He's not even fully trained yet - all full of theory and minimal experience on how to rehab a knee.

For now, I think you should stop all your exercises - yes, every single one of them - for at least 3 weeks, so your knee can settle down. Instead, spend as much time as you can resting, icing and elevating your leg, to try and get rid of the swelling.
Your knee will get enough exercise just walking around the house and doing the things of your everyday life.

When/if you go back to PT, speak to the head person and insist that you see your good therapist, and nobody else, or you won't keep coming.

Finally, it makes me mad to hear how you've been treated. Big hugs to you.

 

[Milosnanna]

Wow - I feel for you doesn't sound like your so is very nice, okay so perhaps you are to as quick as some people. It some people are not as quick as you, I do t know why they do not respect the fact that we are all different, I was given the impression I would be back to some form of "normal" by 6 weeks, I went to wedding in a wheelchair the other day and was met by a few people who said oh I k ew someone who had theirs done they were fine after a couple of weeks, I got really frustrated, then someone came on to me and said my friends had theirs done, one was great the other, took a lot longer etc. That made me feel better. Hang in there they work for you and should never ever disrespect you.

 

[SusieShoes]

I'm getting angry on your behalf just reading your posts. I don't think MUAs are bad at all for those who need them, but you might not need one. Your experiences with PT have been dismal and contributed to worsening your knee. That your surgeon doesn't give you credit for trying so hard, including going to PT, is hurtful.

I'm wondering... is the PT clinic associated in any way with this OS? Just curious, because that's sometimes the case, where orthopedic groups have their own PT services. That might make your OS more invested in 1) making you do PT, and 2) believing the therapist over the patient. It might be more difficult to just ditch the PT if the surgeon really pushes it.

You're getting such good and hopeful advice. Do without PT. That outfit is clearly not working with you anyway. I see you have an appointment with your OS on Monday. It might be good to go in with a battle plan of your own: no MUA for a set period of time (perhaps a month), and a discussion of how you are going to rehab your knee either on your own or using a different PT outfit. You truly are in command of this ship.

Above all else, never let anyone get away with making you feel like less than the caring, honest, and hard-working person you are.

 

[Thesoutherncook]

Ditto what everyone else has said. I have nothing new to add, but I do have a huge amount of empathy and caring for you and your situation. As my mantra says.. This is YOUR knee. This is YOUR recovery. This is YOUR life.

 

[jboles]

I whole heartedly agree with everyone else. I too have not had good experiences with PT, I cancelled my appointments this past week because I knew that my ROM would not be as good when I went for my doctor appointment. My knee always swells from PT. Why not try to give it some rest and see if that works. If it doesn't you can talk about an MUA later.

 

[Fire wolf]

Oh Ruby, I feel so bad for you! You have had one bad experience after another in this recovery. No wonder you are so upset and in tears . I must say that you are one tough woman to be dealing with all of this and still able to assert yourself to PT and that assistant from OS office. Spence wants to visit your PT and OS's office and kick everyone's on your behalf! I am reigning him in, as it seems that you need support more than anything right now. (But say the word and he will be there! )
I certainly can understand how you are losing ROM at this point in time. Remember it was only a couple of weeks ago that the PT pushed you and caused an enormous setback. I would imagine that you still have swelling from that, as well as from what you might have done since then, and the soft tissues probably need more time to heal from all of that as well. I certainly cannot tell you what to do or not to do, but please be gentle with yourself, not just with regards to tkr, but in all aspects of you. You have so many *professionals* who sound as if they are just bullies, and that is so detrimental to your overall recovery. This journey is difficult enough to get through in and of itself, that added stress just makes it even harder than it needs to be. In my opinion, the only ones who are not doing enough or their jobs during all of this is the PT and OS's office. I know that it has been repeated many times, but less is more in this recovery.

Besides icing and elevating, Ans doing the exercises that I can, I don't know what else I'm supposed to do

My thought is that for now, as others have said, icing and elevating is probably the only thing that you are *supposed* to be doing right now. Your poor knee will get enough *exercise* when you do ADL's, no need to add any additional work. What it seems to me that you need right now is time, rest and positive support. I think that if you give yourself a break from all of the extra nonsense for a few weeks that you will find that you will feel much better all around, including with ROM. While I know that it is difficult not to, I think that worrying about the *numbers* will just make things worse for you at this point. Perhaps you can just watch for level of functionality instead. After all, how many of us really went around before TKR saying "my ROM is...."? If you think about it, it all seems quite ludicrous. We start being interested in the numbers because other people tell us that we should be. Believe me, I am a numbers person and get caught up in it as well. But to be honest, throughout my recovery I was really more interested in what I was able to do, and *measured* my progress based on that.... how am I doing getting in and out of the shower, how far do I need to kick my leg out to go to the bathroom, how does going up and down stairs feel, even if it isn't foot over foot, which leg am I shifting most of my weight to when doing the dishes, etc. Those are the things that, in my opinion, really matter. If I were you, and I am not, so only you can decide this, I would wait until the appt. on the 20th, and between now and then would ice and elevate as much as possible, including while sleeping, and let your ADL's be the only exercise that you do. No PT, no home exercises, nothing. That gives your poor knee a chance to settle down some and heal more. You may be surprised at the outcome. If nothing else, you deserve a break from all of the pushing, physically and mentally, harassment, contrived expectations of what your recovery should look like, stress, etc.

 

[OJ2]

I would add to the ice, elevation, and mild exercise, look for a way to get your mind in a strong and peaceful state. Your body has been through the mill, and it all affects your mind. Find something that brings you great joy, whether it be chocolate, a nap, a good tv show, a certain person, or a wonderful book. You deserve it.

 

[Ruby9297]

As always you have all been so generous with your advice and concerns for my current situation. I am freshly humbled by the kindness and consideration shared amongst and between members of this site. It truly is a community of learning, support, kindness, and wisdom. I feel very supported, which is exactly what I am in need of right now. Even my own family cannot fully comprehend what I'm going through in the same way you can. My husband is the best guy ever. He supports me, and so does my mother. The problem is that as many times as I've asked them to check out Bonesmart, they never have. I get that they're busy doing other things, and the motivation or interest is not as high for someone who's not the actual patient, but I wish they would just take an hour to peruse the articles or some of the forum posts; it would help them to be supportive of me in the way I need them to be right now. They would understand my current conundrum more clearly if they had. It's difficult for them to understand the Bonesmart philosophy towards PT because like me (until I discovered this site, by the grace of G-d) they had only ever heard that the patient had to do all the PT assigned, work super-hard, right through the pain, and if they didn't follow doctors' and PT orders, even when it hurt, then there would be a bad outcome that they could only blame on themselves. I share a lot with them about the things I've learned from Bonesmart, but it's not the same as reading it for oneself. And to avoid the risk of boring them to death by constant chatter about all things TKR, I often don't talk about what I've learned.

My husband has made all the right comments acknowledging that I'm upset, and still running to refill the ice machine, bring me breakfast and coffee, or anything else I need, but he doesn't get it and I can tell. That makes me feel somewhat lonely. So, yesterday afternoon and evening I "worked harder" at my exercises. No one on this site would be surprised to learn that now my knee is swollen even bigger, hurts more than it has in weeks, and without measuring, I can tell my ROM is even worse than yesterday, I'm back on more Norco, as well as Diazepam for muscle spasms, and I can't walk as well. I was down to 2-3 Norco per day and completely off the diazepam. No amount of icing and elevating is seeming to help yet, but it's more comfortable that way. I feel like I gave myself a setback because I succumbed to the pressure to go against what I have learned here on Bonesmart. I have no interest in even getting up, much less putting myself through additional torture. I hurt! I hardly slept last night. My stomach is upset. I feel quite stressed by all of this.

At this point, my plan is to see my OS on Monday and hear his spiel. He will hear mine. I will also share with him the results of my experiment of "working harder", per his assistant and the PT staff. It's not working for me. With my husband there at the appointment, who has just witnessed my transformation from relatively painless, able to get around, and be almost completely of meds to what he sees now--a visibly more swollen and stiffer knee, and miserable wife, he will be able to vouch for my claims that much of what the PTs are asking of me is causing more harm than good. I am not in favor of doing an MUA, especially because I feel that it's been hung over my head as a punishment for their perception that I haven't taken an active role in my recovery. If I do get a MUA, it will be a decision I arrive at because I need it, not something I threatened by as "encouragement" to be a "good girl ". So frustrated!

 

[sistersinhim]

I would add to the ice, elevation, and mild exercise

I agree with the first part of this statement, but not with the exercising part. I say no exercising at all, just ADL! It is worth a try for at least a month! And you don't have to tell your OS you didn't go to PT. It's really non of his business. His job was your surgery. Your job is healing your knee!

Don't let your OS talk you into a MUA Monday. I wish you wouldn't go. Then you wouldn't be under that pressure from him. Is it possible it could be from a financial reason for him? He certainly isn't listening to your side of your progress and that aggressive PT is keeping you swollen and setting you back.

 

[Fire wolf]

Oh Ruby, it is breaking my heart to read that you put yourself through even more torture and pain, although I do understand your reasons for doing so.

to avoid the risk of boring them to death by constant chatter about all things TKR, I often don't talk about what I've learned.

I would bore them to death if it were me, although I admittedly am a bit *off center* in my approach to things, and life in general! Granted, you can't force people to *get it*, and I do believe that nobody who hasn't gone or isn't going through the process can truly understand it. I know that I had no idea that it would be like it is before having it done.

That makes me feel somewhat lonely.

I can very much relate to this. My first few months of recovery were filled with feelings of loneliness and depression, from the isolation of not being able to go anywhere or do much to not having anyone who understood what I was dealing with to being frustrated with myself because of unrealistic expectations I had for my recovery, etc. Even when I found this site and joined, it took awhile for me to feel truly supported and not so alone. I can't say that the loneliness isn't still present at times, especially when I am lying awake at night, or if I am not doing things as quickly as I would like, or when people tell me how *great* I am doing based on the fact that they see me walking around at work, but don't understand that I still have swelling and pain, etc. I guess what I am trying to get at is that at some point I figured that I was in this with myself alone, and that I could either be kind, gentle, supportive and understanding of myself, or I could allow myself to fall down the slippery slope that leads to nothing good. So I started to do things to treat myself well. I removed expectations, I colored, I read things that I enjoy (that had absolutely NOTHING to do with TKRs, rehab, recovery, etc.), I joined here, I would sit outside, ate ice cream (even once or twice as a meal! ), and when things got really bad, I posted on here and received extraordinary support and encouragement. We are here for you! You are not alone, and you have people from all over the world who understand. I know it's really hard for you right now, and believe me, if I could do something to make it better for you I would in a heartbeat. You are tough as nails, and you got this!

 

[Lil Cyborg]

@Ruby9297 I think you gave yourself the answer. Stop! Do not push your knee anymore. Your knee needs to rest and heal under your loving care. Believe the results of what you have just experienced. Relax. Take a deep breath. Remember you are in control. It is your knee. It wants to get better. It will get better.

 

[bertschb]

Ruby-

Everybody around me thought I was crazy to quit PT. But, after each PT session, my knee would swell up and the next day my ROM was worse. My therapist told me if I didn't continue PT that my knee would freeze and I'd need an MUA. He was a super nice guy but rather than argue with him I just told him I wasn't going to return without explaining why. I stopped all exercises and PT and relied 100% on icing and elevation from that point forward. Had my knee on ice and elevated about 80% of the time I was awake for around 4-5 months. As I mentioned in my previous post, my recovery was FAR longer than I expected and isn't complete yet. But, I can do whatever I want now.

Just one example of what I've been doing just about every day for the last month:

As the advisors here on BS have said, your knee will heal just fine all by itself. It just needs time and you need the patience of Job.

 

[liam2015]

wow ~ that is amazing and brave. i would walk that trail, but seeing the drop on either side, i don't think i would ride my bike. good for you ~ obviously you know what you're doing. where is this ~ the scenery is beautiful.

 

[OJ2]

@sistersinhim I was adding mental health to what she already said. Ruby 9297 said she was doing what exercise she could. I think of mild exercise as whatever one does to move, and depends totally on where a person is at, and ADL counts as exercise in my book. For some it is walking to the bathroom, or walking to the kitchen. For others, mild might be heel slides, etc. for me, mild exercise is something that does not hurt, does not take a lot of effort, etc. so we really are on the same page.

 

[Ruby9297]

@bertschb impressive story! And that mountain biking is probably way more than I'm interested in being able to do, but also very impressive!
@sistersinhim i do a lot of ADLs, which I also count as exercise while I'm in this position, trying to heal. I am so discouraged at the moment. I can't even bring myself to do anything.