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

[Ruby9297]

On the verge of tears now. The PT came round about an hour and a half ago and I told her about last night and how I found heat to be helpful in alleviating the pain. She said my pain is unusual and she would call my doctor. My ROM went from 64 last week to barely 50 today. Then my OS doctor's assistant called and said I am not working hard enough, that I will have a bad outcome of I don't do my exercises, and will end up having to have surgery again to bend my knee. I asked her how would she know how hard I'm working when she's never seen me since surgery. I asked her how would the PT know how hard I'm working when they keep sending different people each time. They each come with a different skill set and philosophy. They tell me to do things that contradict each other, but I'm doing my best. I reminded her that my leg swelled up so much that they had me go in for an ultrasound to check for a clot and I was instructed by the PT not to do exercises until the clot was ruled out, and even then, it was so swollen that I couldn't do the ROM exercises the way I had been before that. The swelling has gone down some, but I have to work back up to it, and I'm dealing with excruciating nerve pain, but I am doing my exercises, and I'm am working hard, and I have found a way to deal with the pain other than what any of the 'experts" have suggested, and I am offended that she would accuse me of not working hard enough. Then she said, "well we're not giving you any more narcotics!" I never asked for any more narcotics! You asked me how I was doing and I told you that the medication wasn't helping, but moist heat was helping. That's hardly asking for narcotics! I told her that I have felt very depressed and discouraged and her comments have only served to make me feel worse, and that from her I expect some encouragement, and I don't expect her to blame me for a setback in my ROM because it's not my fault! So then she back tracked and told me she was only conveying the message sent from my OS. I told her, "well, I'm conveying that I don't appreciate the implication that I'm sitting around doing nothing, just putting my hand out for narcotics!" So then she said, "well do you want to come in and see the doctor?" I asked her why? What would he do? Tell me the same thing she just said, but charge me a copay for coming into the office? All I would get out of it would be more pain and swelling from traveling in the car to get there and back, And a telling off like some errant child. No thank you! Now I feel that I cannot trust my care team if I tell them that I'm in pain, and now I have to stress if my ROM isn't where they tell me it should be. [emoji32] my ROM should be at 90 degrees, one week after surgery. Feeling completely discouraged, angry, and defeated!


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[Ruby9297]

I found the muscle type pain as bad or worse than the knee early on. I'm so glad to read that the heat on the thigh worked for you. I would have ice on the knee and a heating pad on the hamstrings....

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LTKR scheduled on July 11th, 2017 [emoji51]

 

[Ruby9297]

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[Jajakio]

I'm so sorry things are tough Ruby. You are stronger than you think. The pain is pretty much non stop though isn't it? I think I'm a tough guy and really did not expect things to hurt as much as they do. I don't think I'd be too happy with a parade of contradictory nurses and therapists and you have every right to be annoyed at doctors assistant. But you are not doing anything wrong. Take a deep breath and let them go. Rest, ice and concentrate on healing. No one can make you feel inferior without you consent.

 

[kneeper]

Talk about not listening to what you said and making assumptions. You were saying moist heat helped, not asking for narcotics. (Though imho you would be justified asking for meds at 10 days out. If not narcotics, muscle relaxers or something.)
Good for you for standing up for yourself.

You do wonder when you're getting a third hand message from the OS what the OS would actually say in a direct conversation.
Keep on with the ice, heat, rest, elevation.

I think I was about where you are, in the 60s at week 2. I progressed slowly into the 80s and didn't crack 90 until around week 6--when the swelling went down (surprise, surprise.) My total ROM is a bit lower than others b/c of the many years I had with restricted ROM but I got to around 115 ultimately--which is a bit better than what I had pre-op. Many other "turtles" wind up with excellent ROM. Plateaus seem to be normal.

Hang in there.

 

[Celle]

What a very unhelpful PA your surgeon has! I'm glad you held it together well enough to tell her what you think of the "care" she suggested! Well done!

I think you will get more sympathy from you own doctor (PCP), who may be willing to prescribe Tramadol for pain relief when you next need something. Tramadol is a synthetic narcotic, but not as strong as the ones initially prescribed, so it's a useful "step down" drug. It is important to keep your pain well controlled. Your PCP may also be willing to prescribe Gabapentin, which could calm down some of your nerve pain.

As for all the rubbish you were told abut needing to keep doing the exercises - forget it!
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.

Frankly, I think the best thing you can do to help your knee is to quit all the exercising and just let the activities of your daily living be your exercise. Walking is the best exercise of all for your knee, and walking around the house and garden will be sufficient for now.

Spend the rest of your time trying to help the knee swelling go down, with lots and lots of rest, ice and elevation. Helping that swelling to go down will not only make your knee bend more easily, but it will also reduce some of your pain.
Ice to control pain and swelling
Pain and swelling control: elevation is the key

There's no need to rush to get ROM, no magic "window of opportunity". ROM can continue to i8mprove for a year, or even much longer, after a knee replacement.
Myth busting: the "window of opportunity" in TKR

 

[Jennszoo]

I just wanted to chime in as someone who thought the muscle pain was the worst part of recovery. My left, the quad hurt so bad. I think he tore it when he relocated my patella. It's all I thought about the first 2 weeks. And that leg is still weaker then the knee that's only 3w old. So hang in there. Your pain is real and don't let anyone discount it.

 

[Happydale]

Shoot, Ruby! I was hoping to check in and learn that you're in a better place. Your PT's and your PA are really doing you a disservice. I'm not surprised that you don't want to go back in OS office, but it strikes me as a good idea. It seems to be the only way we can talk directly with the surgeon. All of my communications with my OS are filtered through his secretary and I in fact discovered that at least one time, what she told me and what my doctor said to tell me did not match. If you schedule an appointment, at least you'll be dealing directly with the doctor. It is his responsibility to help you! And I think good doctors have lots of strategies to employ.

I think your worries, combined with the troubling conversations with PT and PA are making your pain worse. If you're able to confirm with your doctor that there is nothing to be worried about, I'll bet you'll start feeling better. You need reassurance and not blaming!!

Lastly, I've spent a long time on BoneSmart and have read about so many recoveries. Lots of folks here had struggles, swelling, and small ranges of motion at some point. Many of them have been threatened with MUAs and refused to have them. After that, they eventually get good range of motion. Remember that you are in charge of your own recovery, and all these other professionals technically are working FOR you.

 

[liam2015]

you were told your r.o.m. should be 90 degrees just one week after surgery? i'm only just making 90 degrees on my own at 12 weeks post op. my surgeon wanted 90 degrees at 6 weeks post op. i don't see any fault whatsoever ~ your body/knee dictates what you can or cannot do depending on a lot of things like swelling, pain, activity, etc. you're only 10 days post op ~ be kind to yourself. you did very well dealing with the PA and standing up for yourself. i agree with Happydale that it might be a good idea to see your surgeon in person to clarify a few issues. wishing you an improved recovery.

 

[Ruby9297]

My OS called me yesterday afternoon. He fell short of apologizing for the unprofessional behvior of his staff ,-and he had clearly been told a version
that minimized their poor behavior . This was obvious when I asked him if his assistant always threatens
Patients with more surgery if they don't make the "right"' amount of progress, but he sidestepped the question by waffling on about how he likes to keep it positive. This is unfortunate because it affects my respect for him when he doesn't just acknowledge the fact that members of his staff acted unprofessionally and that I am owed an apology and more respect moving forward. My PT came over again today so I told her what was bothering me as believe it's what she said to the assistant that caused this problem in the first place. My ROM improved to 62 because I forced it, and now I've been in pain ever since; and my knee is swollen all over again. I think it's a foolish game they play to make themselves feel important and in control. I am currently medicated so heavily for pain that it's taken me since 1:30 this morning to write this post

 

[Ruby9297]

Thanks everyone for your kind responses . It really helps
Boost my spirits. @Celle , I am ,very familiar with Tramadol because my dog takes it every night for his hip arthritis. But I had a severe reaction to it that caused me to have major stomach cramps, nausea, diarrhea, sweats etc. I spent the night in urgent care and was told not to take it again I already take Gabapentin because I have spinal stenosis; I have asked for a higher dose while I heal from my TKR. No response to that request yet.. They say my OS cannot change the dosage because it was a PA at the Spine and Nerve clinic who originally prescribed it.

 

[Celle]

Sorry you can't take Tramadol. Your own doctor may be able to work out some effective method of pain control for you, though.

 

[kmak81230]

Hang in there Ruby - I'm glad you are advocating for yourself. Don't force things with the knee -- if it swells, it won't bend in the way you want. I am a slow bender . . . took me six weeks to get to 90 degrees and there it stayed for a few more. Your ROM will come eventually. I wish for you a better, more compassionate PT.

 

[knit2tog]

I am glad you are finding a way to manage your pain. Is it possible to find a different Home Health agency? You do need one that has a consistent nurse and PT. I will be finding a different one when I do my other knee. I was not happy with the nurse assigned to me.

 

[Ruby9297]

Sorry you can't take Tramadol. Your own doctor may be able to work out some effective method of pain control for you, though.

I sure hope so! Post-surgical pain and suffering to this extent, in this day and age seems unnecessary . I bet if they (medical professionals) were having this done, they'd find something safe and effective to reduce the pain levels.


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LTKR scheduled on July 11th, 2017 [emoji51]

 

[Ruby9297]

I am glad you are finding a way to manage your pain. Is it possible to find a different Home Health agency? You do need one that has a consistent nurse and PT. I will be finding a different one when I do my other knee. I was not happy with the nurse assigned to me.

@knit2tig I wish I could, but I am enrolled in an HMO, so I have to go with their own Home Health Agency. The nurse I had yesterday was wearing leggings that were too tight, and covered in animal hair, and a tank top,with stains down the front--not very nurse-like in my old-fashioned opinion. Perhaps it's a a cultural thing--,I was born and raised in England, and I can't imagine a nurse being allowed to show up to work looking like that there. But I also can't imagine that this nurse's boss would be very pleased if he or she was aware that one of their nurses was representing their company in this way, it doesn't look sanitary.


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LTKR scheduled on July 11th, 2017 [emoji51]

 

[Happydale]

PT "shopping" is worth the time and effort. Last year my home health PT was a woman who had had a hip replacement herself. That was a fabulous qualification in my book. She understood recovery from a patient point of view.

 

[Ruby9297]

I just wanted to chime in as someone who thought the muscle pain was the worst part of recovery. My left, the quad hurt so bad. I think he tore it when he relocated my patella. It's all I thought about the first 2 weeks. And that leg is still weaker then the knee that's only 3w old. So hang in there. Your pain is real and don't let anyone discount it.

I strongly suspect that some damage was done to my thigh muscles and nerves, not only because of how debilitating that pain is but also because I found out that towards the end of my surgery the surgeon had to pull out the entire implant and redo everything, which included digging out the cement that had already started to set, and starting all over with a new implant. I might add that my OS was not forthcoming with this information. I had to really probe him about it, and then he referred to it as a "slight hiccup"'

 

[Jajakio]

I strongly suspect a lot of people's recovery issues are due to rough or less than stellar surgery techniques. People struggle through months of poor flexion or tight band or enormous pain and are told it is their fault for not doing enough only to later find out another surgeon thinks the implant was the wrong size to start with or that it was put in poorly and revision is their best choice. Statistics I read said 9 out of 10 people are happy with knee replacement and would do it again. But that means one out of 10 isn't happy. Lots of different reasons for that I suppose. That was my big nightmare before surgery that I would be the one who was sorry. I don't mind mucking through the pain if I get several good years of mobility out of it, but this would be a lot of pain,bother and expense not to have a big improvement long haul.

I just realized that sounds pretty negative and I'm actually doing very well postop and so are most people. But it's not always the patient's fault when things don't go well.

 

[kneeper]

@knit2tig I wish I could, but I am enrolled in an HMO, so I have to go with their own Home Health Agency. The nurse I had yesterday was wearing leggings that were too tight, and covered in animal hair, and a tank top,with stains down the front--not very nurse-like in my old-fashioned opinion. Perhaps it's a a cultural thing--,I was born and raised in England, and I can't imagine a nurse being allowed to show up to work looking like that there. But I also can't imagine that this nurse's boss would be very pleased if he or she was aware that one of their nurses was representing their company in this way, it doesn't look sanitary.


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LTKR scheduled on July 11th, 2017 [emoji51]

I wasn't raised in England and I think this is very unprofessional.