Bilateral TKR Second Year Progress

[SusieShoes]

Your PT is right about the degree of coordination involved with walking. We spent many years of our toddler and childhood learning to walk as well as we did before surgery. It might take a little work (not too very much for most of us) to get used to our new knees, new gait, and new balance. This maybe be especially true for bilaterals, because everything about our knees and gait is new again. I remember being amazed after surgery that I could walk without a lurch. It was like a miracle.

But yes, it takes time to rebuild our muscle strength after years of walking very little. You were in a walker, so your muscles might have been weaker than someone who was not using assistive devices. So you give your knees and legs some time, and realize they will get stronger but it might be a few months.

Your ROM is excellent, so I don’t think you need PT. You already know what to do. Walk. With a cane at first, if you need it for stability (I did). Then just walking, going up and down stairs, getting in and out of cars, getting down onto and up from toilets, and just living your life. All those things build up your quads, your calves, your balance. I started walking per my OS’s orders: he believes walking is the best rehab. I like walking anyway. So up and down the block with my walker. Then with my cane. Then around the block. Still had pain, but not too bad. By four months I was walking a couple miles without pain. It just happened.

Uneven ground will bother you at first. Going up and down curbs will be less than smooth at first. But it all comes with time.

As for driving... long drives will still cause your knees to swell and get stiff at two months. You could do it, but know you will have this consequence. If your son can do anything to cut some of that time from your trip, it would be a wonderful thing. I just took a three hour drive on a trip to the grandkids... but I am six months out and having a good recovery. I could not have done it, at least not comfortably, at two months without having swelling and needing to give my knees a couple days of rest after. If you’re having a good recovery and want to test if you can do this... just have a backup plan should you find yourself at the doctor’s with swollen knees.

Thirty minutes, though, should be no problem. I was doing that to my doctor appointments at two months. It was sitting for two hours (at the dining table) and suffering for it that leads me to think it might be problem for driving. You know your knees best!

Glad to hear your stamina is up. That energy drain is a killer! Things like appointments, trips, and social gatherings will probably continue to tire you our for a little bit yet. But you will get back all your energy, and then some.

 

[Celle]

Anyone else have any thoughts of taking pain meds at 9 weeks post op?

Many people are still taking some sort of pain medication at 3-4 months. so don't worry if you still need something at 9 weeks.

I found a PT that I really like, but I wonder if 3 times a week is too much? My last session was Thursday, and today, Sunday, my knees feel very comfortable with occasional discomfort. I took a 500 mg Tylenol about five hours ago. My extension and flexion are fine, 120 and 0 (or vice versa - I'm a novice with these terms), I am mostly having trouble being wobbly when I walk. . . . . . . So, for me, I was on a walker for about five months prior to surgery, and now have had both knees operated on. My PT said its going to take some time for my body to get used to coordinating all that walking navigation, not to mention that the muscle strength needs building up. So my thought is I need PT to help me build up my strength and coordination. What do you guys think? Part of me thinks I can do that just by walking without any PT, but I feel so unbalanced while walking. I'll start in a straight line and before you know it I'm veering off on the diagonal. So funny. I especially notice it if the ground is even a little uneven.

I don't think you need to go to PT at all any more. Your ROM (Range of Motion) is excellent and you won't lose that.

9 weeks is too soon to start any strength training. We usually recommend not starting that until at least 3 months post-op.
Your legs will strengthen gradually with use during your ADLs (Activities of Daily Living).
The balance will come gradually, as your legs regain strength and co-ordination.

Since you were on a walker for so long before your surgery, I think you should still be using it, until you can balance and walk normally. Don't think of the walker as something you need to discard, but as just a tool, to help you walk steadily and safely, until your own legs have recovered enough to do that without its help. At the very least, use a stick. It's much better to do that than to risk a fall.

Is driving in my car an hour each way next week too much for me at this point? I have a call back visit at my doctor's next week, and the office is about 50 minutes from my house. I hate to ask my son to leave his business to drive all the way to my house (also 50 minutes for him), take me to the appointment, return me to my home and then drive back to his area. I suggest to him that we meet at a park and ride about 30 minutes from my house, and he can pick me up there?

I think the plan to ask your son to meet you at the park and ride is the best way to do it.
Driving for an hour each way at this early stage would be really uncomfortable for your knees.

 

[mlwreader]

Your ROM is excellent, so I don’t think you need PT.

I don't think you need to go to PT at all any more. Your ROM (Range of Motion) is excellent and you won't lose that.

Hello friends: I saw my doctor this morning for a two month follow up, and he agrees with SusieShoes and Celle, he says my ROM is great and I don't need PT any more. He wants me to continue on the bicycle though. He says the best way to recover at this point is for me to resume doing the things that I love to do, which I was unable to do because of all the pain I had pre-surgery. I love that thought. He also didn't want to renew my handicap parking placard, which will expire in three weeks, because he said I am no longer in need of it - and he is right!

As for the driving to my appointment today, I did meet my son at the park and ride, and it worked out perfectly. It was 30 minutes of me driving, and then he drove the rest of the way to the doctor and then back to the park and ride. My son is great to take to doctor appointments because (he's so cute) he interprets what I'm saying for the doctor, kind of like a patient advocate. And he remembers what the doctor tells us long after the appointment. I am a blessed mama.

I am not hurting much tonight, just a few little twinges, so I think psychologically I got a big boost from the positive things the doc told me. He congratulated me and said I have done a good job. I am to follow up in a year, unless there is a reason to contact him sooner of course. They are very accessible through an interactive internet portal, and I have made use of that numerous times since my surgery in September. I always hear back from them the same day, either via internet message or telephone call.

I am excited tonight, so much so I can't fall asleep. Funny, last night I was so depressed and scared about the doctor visit all I wanted to do was sleep. I had X-rays taken today, and everything looks great.

I made the decision that I didn't want to travel to my other son's house for the holidays this year, because my knees are still so new, and all the crowds and holiday rush at the airport, plus my son's house has three sets of stairs, and the guest room is only reachable by one of the stairs. I told him I would come for sure next year. They have decided to come out to see me for a quick visit in early December and bring the girls, and that will be an early Christmas. And I will be spending Thanksgiving with my local son and his family, and that will be fun as well.

I ran into a lady - another one of my doctor's patients - today and she and I got to chatting. Our doctor did her tkr in 2000, and she is having a little problem with it lately, and so she was in for an appointment. As she came out she told me they had decided she'd better have surgery to remedy the problem. She looked to be in her 60's, and she had the tkr 17 years ago. She said prior to this recent problem, she has had virtually no problem with the knee at all. Another fun fact: my son was reading a San Diego county magazine, and one of the doctors featured in the magazine was my surgeon.

Anyway, I am rambling. I appreciate the advice I received regarding the meds, driving and walking, although I don't think I will go back on the walker, as I have been off it for over a month. I may bring my cane with me as suggested, but sometimes I feel like the darn thing is going to make me trip over it. I had no problem walking from the car to my appointment today, and the doctor's office is in a huge patient pavilion. I think the wobbly and herky jerky problem occurs if the ground is not level. So no hiking for me as yet - kidding.

All best,

Mary Lou

 

[sistersinhim]

Yay, no more PT! You are doing great! There is a learning on using the cane, but you do need it until you are secure on your new knees. You don't want any falls.

 

[SusieShoes]

Gosh, I couldn't wait to get rid of my walker. I despised the thing. Oh, I needed it at first, but never loved it. My PT pushed back on me using the cane and wouldn't teach me. I used it around the house anyway. When PT guy flew off to Greece to get married, I browbeat his fill-in guy to teach me how to use the cane. So I did and it was such a great thing to be able to walk that way! I started walking more and farther once I was on the cane.

I was always a little afraid I would trip over my cane in the house somewhere, not while I was using it, but if it was propped somewhere. It was a good thing to have along on walks, though soon I was merely carrying it and not using it. Eventually it sat in a corner of the living room looking like Tiny Tim's abandoned crutch. I moved it to the trunk of my car... to have just in case.

The herky jerky on uneven ground will get less, even if it might take a while to go away entirely. I still do a little Grandpa McRoy (Real McCoy's reference here) hitch step when going down one of the steps to my backyard. It's a little high. You're doing just great! Keep doing those activities of daily living and the knee will settle in beautifully. And yes, avoid falls. Being careful still pays dividends.

 

[mlwreader]

So this is the day after my adventure driving south to my doctor's appointment, and my knees are sore and swollen. I am having a problem with my stitches as well, because apparently my body is not liking that they are dissolving and being absorbed, and I am rejecting them. This is causing them to push up to the surface, which is totally driving me batty. My doctor told me that it happens in very few surgeries, that I am one of the lucky ones - haha. Well he didn't put it that way, but in my mind I am. So there are about four on the left knee and three on the right. I have to clean them and apply antibiotic ointment and bandaids twice a day until they completely heal. All the while in my head I'm screaming - why me????????? Yesterday at the doctor's office they were able to remove a couple of the stitches. They were sticking straight out from my knee like a couple of hairs, I swear. Very tiny but there. Creepy really. I mean really, as I told the doctor, in all my research and in all the documentation they gave me, I never saw anything about this kind of reaction to stitches when they reabsorb. I guess it is uncommon enough that they don't warn about it, and it won't be harmful as long as I keep them clean and protected so they don't get infected. The stitches are only open superficially and the implant is not affected at all. It just makes me frantic to think about it, and also made me have a good cry as well.

Otherwise I spent much of the day today resting, icing and elevating. The PT gave me quite a bit of feedback about quitting pt, but I told her that even if I do decide to get some more pt for strength training, it will not be for another month or so.

As for a cane, I have a sweet, old fashioned wooden cane, that belonged to the husband of one of my dear friends. He passed a few years back, and I feel honored to use his cane. I am pretty tall, so the cane fits me quite well, and I love its history. I will take it with me on my next walk.

Gosh SusieShoes, the pt in skilled nursing was the one that taught me to use the cane. And I agree I have thought i might trip over it here in the apartment just because it is in the way - lol. I have stopped using the potty lift chair, but still use the shower seat. I actually like it better than a full on shower, because I can control the hand held thing perfectly while seated. I've always preferred baths to showers and am like a cat when it comes to the water. Showers and getting the hair wet are necessary activities, but I don't enjoy them. Silly me.

Good night all. Thank you for letting me vent on this forum

Best,

Mary Lou

 

[SusieShoes]

One of the beautiful things about being a fully functional, independent adult is that we can use a shower bench for the rest of our lives if we so wish. It is a rather pleasant way to bathe, knee awkwardness aside.

Stitches popping through knee incisions happens quite a lot, it turns out. You can see a picture of mine in my thread, when I was wondering what in the world that thing was. Oh, just a stitch, said everyone, including my OS. I had two total, both on my left incision. Having four or more must be annoying. They usually resolve themselves by falling out eventually.

Just another road stop on the highway to wonderful new knees.

 

[mlwreader]

One of the beautiful things about being a fully functional, independent adult is that we can use a shower bench for the rest of our lives if we so wish. It is a rather pleasant way to bathe, knee awkwardness aside.

Stitches popping through knee incisions happens quite a lot, it turns out. You can see a picture of mine in my thread, when I was wondering what in the world that thing was. Oh, just a stitch, said everyone, including my OS. I had two total, both on my left incision. Having four or more must be annoying. They usually resolve themselves by falling out eventually.

Just another road stop on the highway to wonderful new knees.

@SusieShoes you have me in tears. I have been so worried about these suckers. Frantic really. And my doc seemed so unmoved by it all, just had this big, sappy smile on his face because he thought my ROM was doing so well and my xrays were so spot on. And I'm thinking "but my guts are coming out my knees and you are sitting there smiling you big dope". He was not my hero at that moment. So it gives me great comfort that you experienced this and made it through alive, with your new knees intact. And that it is a common enough occurrence that you had them too and everyone seems to know about them (except me that is).

Well you have made my day. Now perhaps I can quiet the busy mind and continue to ice these knees. After all that time in the car on Tuesday, the knees are still quite swollen, especially my bad boy left knee.

Have a great day everyone.

Mary Lou xoxo

 

[mlwreader]

It was suggested to me that I post a summary of my experience with certain drugs post-surgery, but before I do that I just have a yen to post about my history with my TKR journey. So here goes:

Part 1 - pre-surgery

I have been developing knee issues for several years. I first noticed some minor knee problems in my 50's, but it has only been in the past couple of years that the knee pain really took off. (I am now 72.) In particular, my right knee got worse and worse. I began to see an orthopedic specialist, and received injections in the form of orthovisic treatments, which made absolutely no difference in my pain. I graduated to cortisone injections, which also made absolutely no difference in my pain. The truth is I was about bone on bone in the right knee, which had also begun to noticeably bow. I decided to get the knee joint replaced, and had a date set for August 1, 2017. My left knee still had some cartilage in it, and was not very painful, and my doctor explained I had at least another year in that knee before the need for surgery. My right knee surgery was set for August 1, 2017. I needed time to complete work on a project, and to get all my ducks in a row for my recovery time. I live alone and needed to get everything in place for when I was released from the hospital. Plus the doctor's surgery schedule meant that I would have to wait a bit to get on his surgical calendar.

In mid-April, 2017, I stood up in my living room and was hit with the most excruciating pain in the left knee. It was horrendous and I could barely walk across the room to grab my phone. I called my neighbor, who came running to my apartment, and we decided I needed to call 911. I had no clue what had happened, this was my "good" knee.

I spent the day in the ER, and after X-rays and ultrasound tests, it was determined I had a baker's cyst in the left knee, and that there was no issue re: a blood clot (thank God). I was issued a walker and sent home with pain meds, and told to contact my doctor and be seen in his office within a week.

I spent the next couple of days trying to get a response from my doctor's office. I called and left messages three times, and even tried calling the after hours number. The scheduling arm of the office would not give me an appointment until it was cleared by my doctor's assistant, and the assistant would simply not get back to me, despite her voice mail message stating that she would do so by the end of the day if called before noon. On the third day with no call back, I finally left a message implying that I was senior person whose blood pressure was going up due to lack of response from their office. Miraculously, (ya think?) my phone rang five minutes later and it was the doctor's assistant, who was so solicitous and smarmy she made me want to puke. However, at that point I needed them more than I needed to pick up my marbles and try to find another orthopedic doctor, and I got the appointment I needed.

When I went in to see my doctor, my left knee, for some unknown reason, let up on me a little bit, and I had less pain than I had been experiencing. My doctor had me walk across his very small examining room, barely looked at the X-rays on his computer screen, and said that he thought a cortisone shot would fix me up fine. I agreed to the shot, and 24 hours later was in intense pain again. I suffered with that pain for the next month until my follow up appointment with said doctor. At the second visit, he scratched his head when he saw how crippled I was with the bone on bone right knee scheduled for surgery, and the left knee causing me so much pain. He suggested an MRI, and prescribed me Tramadol.

Ten days later at the follow up visit to review the MRI, lo and behold: stress trauma to the bones in the knee and other issues that showed real damage had occurred in the left knee. Way more than a cortisone shot would cure. And by then six weeks had gone by since my ER visit, and I was still in terrible pain, and pretty much house bound on my walker. When I asked my doctor if he would do TKR on both knees, now that we knew the extent of the damage in the second knee, he said no. I can't even remember his reasoning.

Meanwhile, I had been talking to friends who had previously had TKR's, and a college friend who lived close by and received double TKR's a few years back, gave me the name of her ortho guy, who was not local to me, but only about 45 minutes from where I lived. I made an appointment with this doctor to at least get a second opinion, and the appointment I got was about 30 days prior to my surgery date scheduled with my first doctor.

My son went with me to the second opinion appointment, as he had done with all my other appointments with the first doctor. We were both so impressed with this new doctor, he took so much time with me, explained so much to me, way more than my first doctor had done. Plus there was none of that nonsense about having to have my appointment cleared by the doctor's assistant, and I came to find out that they were so accessible through an online portal where I could send messages and receive answers by the end of the day. This doctor told my I was healthy and there was no time like the present to fix both knees. If we only did one knee, the PT would be almost as difficult as if we did both knees, because both the knees were in such bad shape. I was sold, and I went with the second opinion doctor, scheduled my surgery for early September, and let the first surgeon's office know I was going with another doctor. It was so tempting to go into all the things I believe they had done wrong, but I decided not to go there. I simply thanked them for their care and wished them well.

I don't know where the thought came from, but I just figured that I need positive energy around me. And if I took out my anger at the first doctor's somewhat cavalier treatment of me and my fear and pain, then I would be sending out negative energy that would hurt me way more than it would hurt this doctor and his staff. So my motives for taking the higher ground were somewhat selfish, but still better than getting angry and leaving the first doctor on a negative note.

The next six weeks were spent finishing up my project (thankfully I work at home and didn't have to navigate out in the big bad business world with my walker), reading everything I could get my hands on about TKR's, finding the bonesmart website (such a lucky find!) attending the pre-surgery class (online), gathering the in home medical equipment I would need post surgery such as potty lift chair and shower bench seat, and arranging with family for help at home after the surgery.

My family was so generous with their offers of help. First of all, my local son, married, self employed with three children, was so attentive and helpful. He lives a good 40 minutes away, but was up here every week-end practically, shopping for groceries, helping me with household stuff - he was so amazing. Plus he was my sounding board, and listened to me and offered very helpful advice. We pretty much decided I would have to spend some time in skilled nursing rehab, due to the two knees plus living alone. However, my cousin offered to come and stay for a week after I got home from rehab, and then my out of town daughter in law offered to come and stay for a week after my cousin, and those are the arrangements we made. How blessed am I?

To be continued . . .

 

[mlwreader]

Part 2: Percocet and Skilled Nursing Rehab

My Denver son flew in the night before surgery, to spend some time with me and drive me to the hospital the next day. I live in South Orange County in CA, and my OS and hospital are in San Diego. We arrived at the hospital in plenty of time, meeting my other son at the hospital. It didn't take long to check in and go to the pre-op area. I don't remember too much, just meeting the anesthesiologist. Also had a conversation with my OS' "fellow", who asked what I thought was the strangest question. Since I was having both knees done, he wanted to know which knee I wanted done first, and I told him the left. He marked the left knee, and explained they always ask the question to set the priorities in case the surgery is interrupted for unexplained reasons like. . . war or pestilence I guess. I still don't get it, but no longer really care - both knees got done and we didn't go to war.

Both my sons were with me in the pre-op area. Two very large fellows at 6'5", but they managed to squeeze into the small space and make their usual silly comments to each other. I love my boys - at 43 and 49 they are still my boys. Next thing I know the anesthesiologist did his thing and I woke up later with a couple of new knees. I don't remember a whole heck of a lot from the first 24 hours. My sons tagged teamed being with me. I do remember that the view out my hospital window was spectacular. The window opened onto a golf course with the ocean in the background, and around mid to late afternoon up from behind the cliff at the back of the golf course the most beautiful hot air balloons and parasailers arose. It was magical - they were multicolored and slow moving and dreamlike. Picture it - golf course, hot air balloons and Pacific Ocean. If my son hadn't been there to see it I would have thought I was hallucinating.

I was in the hospital for three nights, and then was transferred to a skilled nursing rehab place close to where my son lives in San Diego. My cautionary tale begins at this point. The transfer was effortless, as I was heavily sedated with Percocet. I was in a semiprivate room, and my roommate came in a few hours later. I'll talk more about her in a minute, as she was so incredible, fun, and interesting. But first my experience with the Percocet.

I was so uncomfortable and agitated, I remember feeling it in an undefined area of my chest, almost the way you would feel if someone were continually poking you in the arm, or the way it feels if a fan is blowing directly on you. I just felt agitated. And queasy. And I couldn't eat. And I was horribly backed up. It was a nightmare. In the middle of the night the second night at the rehab, I awoke to find a complete stranger sitting next to my bed. She said she was taking my vitals, and I kept asking her why. She said I had surgery, but she couldn't tell me what kind of surgery. I looked around the semi darkened room and did not recognize where I was. Truthfully I couldn't even really remember who I was. I kept asking and asking, and finally my roommate said to me "Mary Lou, look at your knees, you had your knees done, you had knee surgery". And I looked down at my knees and sure enough there were the bandages, and everything came rushing back. However, and this I don't remember, I was later told I became argumentative with my caregivers, and on top of everything else, I began to vomit all over everything. The next day there was discussion of moving me to the floor where they deal with "difficult" patients. This was when my son was visiting, and the head nurse took him aside to discuss it with him. He, bless his heart, saw what was happening with me, and he guided the discussion to where she consulted the on call doctor and they made the decision that Percocet might be the culprit. They discontinued the Percocet and started me on Tramadol and Tylenol, and all the digestive and psychological issues immediately began to dissipate. I started to be able to eat, I was able to use the bathroom, I stopped arguing with everyone (well, mostly - haha) and things really settled down.

A couple of thoughts occurred to me after I got home. One was I am definitely listing Percocet as a medication to which I am allergic on any and all medical forms I ever have to fill out in the future. My second thought was how important it is to have an advocate when receiving in-patient medical care. I don't know what would have happened if my son hadn't been by my side and so vigilant. He was the one who checked out the skilled nursing rehab places for me before my surgery, since we had decided that I should select one in San Diego, closer to where he lived. And he was the one who came to the rehab place very day during the week I was there, at lunchtime, for a cup of coffee and to check on his mom. (A couple of other times he brought the kids over too, and that was so special for me. They were so cute (8 and 10) and one time brought a board game for us to play.)

I felt so shamed after the episode with the vomiting and argumentative behavior. I know it wasn't my fault, but the way the head nurse talked to me, she scolded me and told me I was taking up too much of her time. It almost was bullying, and if my son wasn't so vigilant, it might have crossed the line to bullying behavior. And another cautionary tale around this particular nurse. She and my roommate went round and round about my roommate's meds. My roomie had a particular medical condition which required a strict regimen of pain meds aside from anything related to her knees. Roomie and roomies' doctor had worked it out carefully before the surgery in preparation for rehab. This head nurse apparently didn't' like what she saw, and tried to change the regimen, resulting in a great deal of stress for my roomie and many long discussions with said nurse. Then, as if this wasn't enough, this same nurse, who often bragged that she made all the decisions and that the doctors all listened to her advice, tried, on two separate occasions to give me someone else's meds. By this time my credibility was kind of shot due to the Percocet problems, and I hated to argue with this nurse, because, to tell you the truth, I was a little afraid of her. However she was not going to get me to take someone else's blood pressure medicine, when I have never taken blood pressure medicine in my life and have always had perfect blood pressure. As it turned out, it was my roomie's medication, but this head nurse tried to give it to me on two different occasions. The second time when I stubbornly shook my head and clamped my mouth shut as she held out the drugs to me, and my roomie piped up with "that's my medication", the head nurse just bolted out of the room. Seriously she ran out of the room.

The next morning the day head nurse came to us (me and my roomie) and asked us about our version of events. My roomie and I spilt the whole beans on the other nurse, and this day nurse assured us we would not have to deal with the nurse again. Later on in my walks around the facility, I noticed the night nurse working on a different wing. And yes, we did not have to deal with her again. But I wonder what has happened to her. We (me and my roomie) can't be the only patients who have had a bad experience with her. I wonder if she is still there.

I haven't as yet filled out the questionnaire that the facility gave me for feedback when I was discharged. Other crazy things happened, which I'll write about in the next post, and I put it on the back burner. I will say, however, I must be a magnet for other people's medicine. When they send you home from rehab, they send home your meds as well. Medicare has paid for them, so they are yours. When we got home, there in the mix of my meds were another patient's medication, some man that I never met and didn't know. So not only did the night nurse screw up meds, but the discharge nurse did as well. Pretty scary.

So my take away from e all this is, ask as many questions as necessary to prepare for this process. However, be prepared for the worst and have a plan. My doctor''s office gave me a list of rehab places, and his very experienced nurse pointed to this rehab place on the list and said that she had heard good things about it. My son went and visited the place before we decided to use it, and he was very impressed. And yet, the worst happened despite all the precautions because of the incompetent nurses. So my son was there to help and advocate for me, and disaster was averted. That was my fail safe. And it worked. I was taken care of and protected by my son, and I have to say by my roomie. We watched out for each other.

On the positive side, two great things about my rehab were the PT and OT staff, who were awesome, and the food, once I was able to eat, was outstanding. Another great thing was me getting to go home! With two new knees.

Next time I write, I will talk about my experience with Home Health Care services, a much more positive experience than the in patient skilled nursing. Not sure anyone is reading this, but it sure is helping me sort things out. Happy Sunday all. I am excited to be going to a matinee at our local, tiny, 70 seat playhouse here in town with one of my friends. This is my first social outing, as up to now its been PT and doctor visits, with a few short grocery store runs.

ML

 

[sistersinhim]

How was your first outing? It is so uplifting to get out after being cooped up for so long!

 

[mlwreader]

Hey Sisters: Oh my gosh we had such a good time at the theater. It is a tiny little place, set right in town, with a charming patio where you can have coffee or wine or water prior to the show or at intermission. The play was a one man show about Vincent Van Gogh, and it was excellent. I was somewhat uncomfortable sitting still for both acts, which were about 40 mins each. However, I stood for the intermission, so that helped. By the end of the show I was beat, and ready to come home and chill. But after getting home I pulled out a book I have on Van Gogh, and looked at all his paintings and thought about the show. What a fun and enriching afternoon!

 

[sistersinhim]

What a fantastic evening you had! Wow, and so early in your recovery! You are an inspiration!

 

[SusieShoes]

Your theater outing sounds lovely! Those date nights are extra special following surgery. Just being able to do it special, on top of being with someone special.

I'm enjoying reading your summaries, too!

 

[mlwreader]

Part 3: Working out the kinks - infection, antibiotics, home health care, meditation and visualization

The day before my discharge from skilled nursing rehab, my cousin arrived from back east to help me during my first week home. Mary and I grew up together as first cousins who were more like siblings. Our moms were sisters, Irish twins really, so close in age. Mary made the offer to come help me from the minute she leaned I needed the surgery. Not only that, but she was my long distance sounding board during the months leading up to the surgery when I was mostly housebound on my walker. So I am eternally grateful to her giving spirit.

The next day I was homeward bound. One thing I noticed during each stage of this recovery process is how mixed my feelings were as one phase ended and another began. By that I mean that each step towards recovery brought excitement, at the same time nervousness and some fear about letting go of what I knew in exchange for the unknown. For example, even though there were some rough patches at skilled nursing, there was much comfort and safety. All my meals were prepared for me, my laundry was done for me, the nurse's aids were so helpful and kind, I had a helping hand at the ready for all the tasks of daily living, my bed was made for me, OT and PT right on the premises, it was very comforting. Plus my roommate and I had a great deal in common and bonded quite well, almost becoming like family for that week. I got to know her sons who visited, and she got to know mine. My son coming over every day was such a treat - he really was my rock. He told me that they had 24 hour visiting at the place and if I needed him day or night I had only to call. I began to wonder who was the parent and who was the child, except it was all good because the goal was to get me back on my feet and independent again.

Anyway, the return home was great. We had some concern the next morning, as the skin around my incision on my left knee was starting to look really red and inflamed. I still had my staples in, since my OS had instructed that home health care was to remove them. During my time at skilled nursing, my stitches were "weeping" from time to time, especially during exertion in PT and OT. Now the skin was looking red and felt hot. When the nurse arrived from home health that day, she was concerned. She took my vitals, and I had no fever and bp and pulse were good. However, when she left (this was a Saturday) she told me she was going to contact my OS office because of the looks of the left knee. At this news I went into a deep dive of anxiety and fear like I don't remember experiencing before. And of course it was Saturday, so I couldn't get to the doctor for 48 hours.

Despite my anxiety and fear, I was being well cared for. The nurse telephoned me the next day, Sunday, to let me know she had spoken with the on call doctor at my OS office, and that person told my nurse that they would call me the next day, Monday, to speak with me. The home health care nurse had taken photos of the knees and forwarded them to my OS office. Monday morning, my OS nurse called and asked me to come in. Now I was really terrified. I, like most TKR patients, had been advised of the relatively few risks of the surgery. One of the more serious risks, although not that common, was the risk of bacterial infection. And, I read, the chance of such an infection was increased in going to a skilled nursing rehab facility. The best way to prevent such an infection was to go straight home from the hospital.

My family and I discussed all this prior to having the surgery. I live alone, and in a very small apartment. Having a bilateral TKR, it did not seem possible that I would be able to be home alone right after the procedure. My cousin was not going to be sleeping at my place, but would be nearby at either her timeshare or a local motel. And my doctor also felt that skilled nursing was indicated for me, a bilateral-TKR. However, I was informed and instructed to make sure all contacts with me were preceded by hand washing, and other sanitary precautions. And I was vigilant.

However, when I learned that I might have come home from skilled nursing with the dreaded bacterial infection, I went into an emotional nosedive. My cousin drove me to my doctor's office in San Diego. He examined me, and prescribed two powerhouse antibiotic meds, and had his assistant remove the staples. The doctor said it was a superficial infection as yet, implying his belief that it had not reached the new joint. My cousin drove us home and filled my prescription. I was so depressed and I really thought it was the beginning of the end. I took the whole thing out to max mentally, saw myself permanently crippled because of the failed left knee replacement, and saw my life going quickly downhill. It was so awful. It was just the worst week I can remember.

The medication made me queasy, and I didn't have much appetite anyway. I was not a slender person going into surgery, about 15 pounds over a desired weight for my 5'9 1/2" frame. However, I knew I was losing weight after I got home. I knew I needed to eat quality food, and I did do that, but I had no real appetite for it. The days passed, the home health team came and went, the nurse, the pt, the OT. I don't think I was a very good patient for my cousin. I argued with her about everything. I was so tense and scared. Terrified really. I looked at my left knee constantly, checking for any changes. To me there were no changes, and I felt like I was doomed.

At the end of that first week home there was a changing of the guard. My dear cousin was scheduled to leave, and my daughter in law from Denver arrived to pick up the caregiving duties. (Do I have a great family or what?) During the week after my doctor's visit, I took daily photos of my knee and forwarded them to my OS office. They were pretty encouraged by what they saw, and by the end of the week, they told me the infection was gone. I did not need any more antibiotics. Although I was overjoyed at this news, I found it very difficult to trust this outcome.

I realized I was still operating under a lot of fear, and I know how harmful that mindset can be to recovery. I have a strong belief in the connection between the energy generated by thoughts and physical manifestations in the body. I began to practice visualizations of healing, using my trusty smartphone to find meditation music, and spending time envisioning complete healing in the knee. (I should mention that during this whole time my right knee was doing absolutely splendidly. The poor thing was practically neglected because we were all so worried about the left knee. It absolutely blows me away that the right knee was the original knee set for surgery way back when, and now it was the good knee, giving me no problems, healing nicely.)

As the second week home went by, my daughter in law, Annie, was so great. When she arrived I was an emotional mess, a real basket case. She helped me to regroup, even making me laugh when she suggested we name the infection something really awful, and affirm how we would not let it win. I picked the nastiest name I could think of (it's a two word name, and each word begins with "f"), and we had a good old time that week referring to it in various disparaging ways. She made me laugh, she made me feel light hearted, and she fed me wonderful food. Between the meditation, visualizations and Annie, I began to mentally heal too.

Can I tell you how much I missed that girl when she left to go back home to my son and her two young daughters, my precious grandgilrs? I did. A lot. It was now approximately 3 1/2 weeks post op. I weighed myself and learned that I had lost 10 pounds since I had come home from rehab. I know this because they weighed me before I was discharged. I was emotionally exhausted, and physically as well. However, I felt like I was finally on a good path to recovery. The infection drama was gone, and now I could concentrate on healing.

To be continued. . .

 

[sistersinhim]

Congratulations on kicking that infection away! You have been so blessed to have the help that you have had to help you get through these first few weeks. It sounds like you're on the right track to a good recovery!

 

[SusieShoes]

THe suspense about the infection would have killed me. I’m so happy you were able to banish it. Infections of only the skin can still be problematic. Your recovery has certainly seen a few bumps!

 

[mlwreader]

Hello bonesmart folks:

Wishing all of the stateside folks a happy Thanksgiving.

I am dealing with incision problems, at almost 11 weeks post op. I am told that the subcutaneous stitches are not absorbing into my body, but instead are pushing their way to my skin surface. One in particular is problematic, as it has broken open and bled from time to time. My doctor told me to keep the area clean, apply antibiotic ointment and cover with bandage. He also has me on oral antibiotics - Keflex - which he told me is precautionary, as he does not see infection.

I am so frustrated by this - I feel like I am walking on eggshells emotionally. The doctor said to stay off the stationary bike for now, but to continue to remain active. How long is this going to take? I will of course ask him when I see him on Monday, but some days I feel like I am caught in a nightmare and can't wake up.

I chose to stay home from Thanksgiving yesterday because I would have had to drive an hour to my son's house, and then ride with them to their club. Then sit at the meal for however long, then sit and chat after the meal, then drive to son's house, then me drive myself home to my house. All the while checking to make sure the stitch hadn't broken loose and wasn't bleeding, or if it was bleeding, trying to find somewhere that I could cleanse it and reapply, etc., etc. So I just threw up my hands and stayed home.

However, I didn't have a bad day really. I did some self care type stuff which really helped my mental attitude, and I walked, and I binge watched some good shows, and chatted with a few neighbors, and talked on the phone for the Thanksgiving calls from my sons. But seriously, I am so over sitting in my apartment. I did that for the months leading up to the surgery because both knees were so bad and I was on a walker. I was able to do short grocery runs and errands like that, but the pain was terrible, so I mostly stayed home. And now after surgery I am still staying home.

I know I am whining and complaining, but I just feel so out there and unsupported. On last Tuesday, when my doctor's assistant called me after I emailed her, I felt like she thought I was being a pest. I had emailed them pictures of my knee right after the stitch broke open with the blood all over it, and then pictures of the stitch after I cleaned it up. She was so dismissive of me until almost the end of our conversation, when I mentioned the blood again. She asked me how much blood was I talking about, and I said I sent you a photo. At that point I realized she hadn't even taken the time to pull it up and look at it. She got really quiet when she saw the photo, and then gave me instructions about staying off the bike, icing, and saying she'd show the photos to the doc. I said to her that I didn't understand why she hadn't looked at the photos, and she said that she guessed she had just been really busy. An honest answer, but one that didn't inspire confidence. Then later the office contacted me and said the doc was sure there wasn't an infection, but to be safe he wanted me to take Keflex for a week, ice, compression bandage when going out, stay off bike but remain active, and come in on Monday.

Today is another gorgeous SoCal day, and I am determined to run a few errands this morning and not stay cooped up. The stitch is still oozing, but does not show signs of infection. And it is not bleeding like it did last Monday. How can this be happening? I feel like I am going to be stuck in this half life, somewhere between being house bound and on the other hand active and participating in life. And band aids - who knew there were so many kinds and varieties.

Thank you all for any and all thoughts.

Mary Lou

 

[sistersinhim]

I think the best thing is to stay off that bike and follow your OS's instructions. I will tag @Josephine and see if she has any suggestions.

 

[mlwreader]

Thank you @sistersinhim And now when I got home from errands and unwrapped the compression bandage, the area below the stitch is all red and itchy. So I ask myself, is it red and itchy because of my sensitive skin? Or is it red and itchy because an infection is setting in? And how do I know? And today is a holiday. It seems like it just keeps getting worse and worse. I am at my wits end.