TKR Starting week 3 post-op: interesting developments

[Sqrlvr]

Hi all...you guys are SO helpful! I LOVE this thing called the Internet because I can connect with folks like you - the Real World - and get practical info. A True Blessing...the day today started a bit rough with pain: took a dilaudid at 5 AM but by 8:30, was in pain so took 2 percocets. Did some exercises that AM and got on the CPM for two hours (I LOVE that machine and always fall asleep on it!) PT was due around noon so took another dilaudid which did pretty well. This was a stand-in therapist - my regular one who I know from PT with my 88 yr old dad after his back procedure last Nov is kind of tough but, I think, reasonable. She didn't push dad too hard. The one today pushed me but laid off when I complained. She was very fixated on The Number...she said my OS will want to see X number when I see him in two weeks...I said Dr. OS will get what I can give him! They seem to believe it's now or never which, from reading here, isn't necessarily the case, is it? So this next step may be what I bug you guys about in future weeks...if that's ok?
Ironically, after my hubs shook some branches on Wed in the hospital, the nurse in charge DID give me flowers! Ha!
Iam tapping this out after popping a dilaudid at 7:30 PM with no relief by 8:30 so two percocets but the thing that worked is elevating with nose to the toe....ahhhhhh....SO much better. Will sleep this way...Good night, my knee friends. You are great!

 

[Bionic woman2]

I also brought with me some Percoset--in my handbag

I like that! BYOPM! Bring Your Own Prescription Meds! lol I didn't have that problem, they pumped me up with one medicinal cocktail after another. It's only now that I'm home there seems to be a quota that's easily reached. They TRULY have no idea what our knees feel like after surgery, especially once we try and USE THEM!

Still wondering how you are doing... Hope P/T went well.

 

[maryo52]

The one today pushed me but laid off when I complained. She was very fixated on The Number...she said my OS will want to see X number when I see him in two weeks

I love it! And I cannot tell you how many on the forum get these kinds of comments from PTs. Consider telling a PT who says that, "I'm sure your heart is in the right place, but that comment was not helpful."

One thing to work toward is proactive pain management instead of reactive pain management. Ideally, your hospital care staff would've done this with you so that you grasped the principles for going home. Unfortunately they didn't : [ You might, for instance, try this: alternate dilaudid at, say, noon; then a percocet at 2 pm; then a dilaudid at 4 and a percocet at 6. This is an example, not a suggestion. You'll have to figure out the intervals and dosages (and ortho offices should teach titrating pain meds instead of worrying we'll get addicted). The goal is to keep your pain below 4 on the pain scale, which means taking pain Rx before the pain becomes too much. You might after a couple of weeks get by fine with just one of those drugs, but you'll still need to take it on a regular schedule for some weeks (or months!).

RANGE OF MOTION -- there are many myths afloat. Your hired professionals fear their patients having ROM issues so they resort to unhelpful comments, practices, and thinking. You just have to do your best to ignore all of it. Your knee has undergone major trauma and needs lost of TLC and rest. They underestimate how much we have to leave our knees alone to do this. If we simply do range of motion activity every day -- 15 minutes is all that is needed -- the knee will achieve ROM. Just like our babies learn to crawl and walk and do all the rest of it without our intervention, our knee tissues actually will resume their normal flex and extend abilities without PT, without doctors, without people worrying over them, without threats. It just happens. And ROM improves for a long time. I've had gains in my third year!

You're on the right track . . . never forget this is not the 400 meter track, it's the 26.2 mile marathon.

 

[Josephine]

I also brought with me some Percoset--in my handbag which I did not give to them.

I did that too! I was so determined not to be caught out. But I needn't have bothered as the nurses were there promptly every 4 hours with the little pot of pills. So if I didn't want them at that moment, I could put them in my locker drawer and wait till I did. Sometimes I had a little stash of Tramadol in there because they would always give me two but sometimes I felt I only needed one!

They seem to believe it's now or never which, from reading here, isn't necessarily the case, is it?

It's not the case at all! Did you read all those articles I left you in post #15? There's one called "myth busting: the window of opportunity" which is all about that.

 

[maryo52]

I thought about, but didn't, smuggle some percocets in for my TKR hospital stay. I figured I'd behave. Not gonna make that mistake again.

 

[Sqrlvr]

Thought I'd log in with an update...after two hideous days after surgery, the challenges being hospital care and lack there of, a no pain meds ride home of one hour, peeing comfortably, pain meds tweaking, lack of appetite and painful PT, I can report all is going swimmingly on Day 8.
The differences are: getting on a good pain med sked'd, pushing the stretching but not too much, getting the advice from this blog for icing, elevating, not worrying about a "number" and getting a good PT at home. Right now, my fave exercise she showed me is a long towel under the instep, ends crossed along shin and slow pull of knee up toward chin, hold for 30 seconds, slowly bring down knee and repeat...three times, three times a day. It hurts but it's a "feel good" hurt. Also, I love my CPM and use it pretty often.
I could not have gotten to this point if it wasn't for this blog/site. If I only listened to the "experts", I think I'd be a lot worse off...
Thanks to all here, your compassion, understanding, wisdom and support...a true blessing, to my mind.
I hope you all fare as well as I am...Squirrel Lover.

 

[maryo52]

I love your towel exercise. If I had had that person as my PT, I wouldn't have quit PT.

I also love hearing that we've been able to help you. Some people we can't help . . . and some people feel too conflicted by our advice. Continued progress!

 

[leejaa]

I am so glad you are doing well and followed the advice here. This site has helped me have two good recoveries. My home PT also had me do the leg lift with assist except I used a strap that the hospital provided. This same strap I used to help move leg up unto bed and down and in bed if I could not move it myself.

Keep at it slow and steady and you will win recovery. Have a great day.

 

[Sqrlvr]

So things went pretty well during the two weeks post-op after first two days of hell, with pain management working and PT being effective. Yesterday, had my follow up visit with my OS who was quite pleased with progress and said I'm good to go. Went ahead and booked other TKR for late Feb.

Walked around offices without a walker - almost back to normal - no sweat - feeling pretty full of myself. Get home, take a nap, wake up and then start to feel the pain. Not from the knee but in my lower back, over the left leg of post-op knee. It was horrendous and put me to bed early with pain meds, Tiger Balm and a heating pad... yikes! I'm thinking, man! I was cruising through this and look what happened! So took it easy today...and am much better.

Here's my theory which I will confirm with PT: the new knee has made my leg longer!!! I know it was shorter with the knee damage and now, after all the walking on it yesterday at the doc's office, my back said, "Whoa!?! What have you done?"

Just thought I'd send this out to find out if anyone else has had this happen and as a heads up for you all in the process... will let you know what PT says but as the balm and heat helped, I know it's muscular... interesting, no?

 

[Jamie]

If your knees are bad enough, it is possible that your new knee has made that leg longer. When a TKR is done, any abnormal alignment is modified and your leg is straightened when the prosthesis is placed. And it's quite likely that a walking jaunt like you did would irritate your back, as it is not used to the immediate realignment that has taken place.

You have done the right thing by chilling out and taking things easy for a few days. It will be a good idea to pace yourself in this time while you're waiting for the second TKR. If your knees are/were severely deformed, don't be surprised if you gain some height once both are replaced. Mine were only slightly knock-kneed and I'm now 1/2 inch taller (actually, I'm just back to my "normal" height).

Excellent analysis you did there!!!

 

[Josephine]

I know it's muscular... interesting, no?

Actually not muscular at all - it's nothing more complicated than post-op pain. Did you ever read all those articles I left you links to? (I merged your threads so now it's in about post #4 of this thread).

You are only 2 weeks out and really shouldn't be doing so much. The BoneSmart Mantra is your credo right now. Nobody gets that much better in 2 weeks!

I have some questions to ask you:

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery!

)

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

3. how often are you icing your knee and for how long?

4. how high are you elevating your leg, how often and for how long?

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

6. what kind of PT/exercises are you doing? How much and how often?

 

[Sqrlvr]

Hi, Josephine...first, thanks for setting me straight on the blog posts and merging my two...I now know the etiquette!
This morning (Sun, 3Nov) I'm on my CPM, morning coffee and iPad in hand. Yes, I have been doing too much!!! And I paid for it Wed night last and last night. So will be much more cautious in the future. Here are direct answers to your questions:
1) My pain level right now is at a 1; during most of the day, maybe a 3; last night at 7, trying to go to sleep, before a pain pill.
2) I was initially prescribed Oxycodone - APAP (Percocet) 5-325 then supplemented with Dilaudid (2 mg) which I am finished with and am now on Roxicet 5/325. The first script was to be taken 2 every 4 - 6 hrs but adding Dilaudid, it was one Dilaudid every 5 hours with one Oxycodone in between which seemed to do the trick to manage the pain. I am taking one Roxicet very five hours now.
3) I ice whenever I feel the need after PT or walking around some or if it hurts for about 30 minutes at a time.
4) I elevate the entire leg for a morning session for a bout 2 hours, an afternoon session for the same and at night, sleeping (but not so much the last few nights). Early on, it was a life-saver and to my mind, I felt anything that felt this good can't be all wrong! It's elevated the height of a squishy, king size pillow, running full length of the leg.

 

[Sqrlvr]

Oops! Doggone IPad!
5) Activity level has been more than I should have done, I'm afraid. I have helped in the kitchen but for no longer than 15 - 20 mins, done a it of laundry as well as folding, take a standing shower for about 15 mins and have been up the stairs to our office once this past week. I thought about church today but after last night, thought against it. My OS, last Wed, said there is no limit to what I can do (ahem) now and I start out patient PT this Tues.
6) as to PT, I start the day with 2hrs on the CPM to loosen up, then do some stretching and lifting, rest then do it again in the afternoon. That's it...I'm concerned for this up coming out patient PT but will keep in mind the BS mantra!

 

[Sqrlvr]

Ok, here goes...I hope someone will read this and recommend a course of action...I'm not sure how to handle this.
I am finishing Day30 since having a LTKR on Oct 15th. Had a horrible hospital stay and first day at home but have done real well, with the usual ups and downs, since then. Last weekend, in the shower, I happened to look down and noticed my left leg (the TKR one) is slightly canted out to the side from the knee down. It has obsessed me ever since. I've shown it to the out patient PT guys and got responses from "if it doesn't hurt, so what" to "it's weird and we don't know what to say". It doesn't hurt and as I've said, I have had an almost too easy time of it, it seems. Before, I kept saying something's wrong, this has been relatively smooth -when is the other shoe going to fall? Well, this may be it.
Has anyone heard of this phenomenon? Could this indicate a bad alignment? Might this get worse over time?
I want to get the other knee done in Feb - should I?
I will be seeing the surgeon about this on Wed, 20 Nov, and hope to have it cleared up but would be interested in some of your opinions...

 

[NetballKnees]

Hi Sqrlvr ... I had my LTKT on 17 October, so only 2 days behind you. I am in awe that you stand up when you shower. I am still using a shower chair and cannot imagine standing up for 15 minutes. I must admit I liked the description of your exercise using a towel under your instep and bending knee up to chin, so I will borrow that and do a couple of times a day. I am having lots of trouble with bending of the knee and it is still very swollen and tight.

As far as your "weird" phenomenon goes, I am afraid I cannot be much help. Is it canted to the side as compared with your other leg? Are you sure it is not the other leg that is not quite right? I am not trying to be funny saying that. Is it canted out like a "bow" type shape? I am sure there are other much more experienced forum members who may be able to help you out with this.

Like others, I am sorry your hospital stay was so horrible. I was in for 6 days and the pain was so well controlled - pain meds on time and always willing to give me extra if I felt any "break through" pain in between times.

I have never used a CPM - they don't seem so invested in their use over here in Australia. I too am supposed to get the right knee done sometime - but at the moment I do not want to have another replacement. Maybe in a few months I will change my mind.

Anyway, I wish you all the best in your recovery and hope it is pretty straightforward for you. Take Care ...
Ellen

 

[leejaa]

What does it look like when you are lying in bed and looking down with no weight on it and as Netballknees said-maybe it is your other knee that is off kilter. I noticed after my first knee lying in bed that my other knee was pointing sideways but looking at new knee in bed it was straight.

Look at your knees and than speak with your OS on Wed. I would not panic till you speak with him and make sure whatever is said you keep asking questions till you are satisfied with your OS's answers.

 

[Sqrlvr]

Hi, Ellen in Oz! So nice to know someone is reading this thread and cares enough to respond. I really feel ungrateful because I have done so well - yes, I was able to stand to take a shower fairly early on but have a bench in there so if need be, was prepared to sit just to get clean. The towel exercise is great but only pull it toward you gently, putting a slight strain on the joint, not to the point of pain. It'll come when you least expect it! The CPM is a lovely contraption to have but masks your true ability to flex, I think - I used it mostly to ease the stiffness in the morning.
After reading some threads here late into the night, after my huge melt down (my husband was so upset, he was asking malpractice!), I'm calmed down and looking at things with a better perspective. I'll talk to the surgeon on Wed, find out what he thinks and decide if I buy it or not as well as if I have him do my other knee. I was like you the first week, thinking about doing it again but I shut down the thoughts and fears, deciding to take it one day at a time. This forum really helps put everything in a good, positive light so I feel better able to cope.
I guess the bottom line in surgery as well as life is everything is a risk, you pray it turns out well and if there re complications, you deal with hem the best you can! Cheers to you; I DO believe it gets better so good luck to you! Squirrel Lover

 

[Sqrlvr]

Hi, Leeja and thanks for your concern!
I have looked at the blasted limbs, extended out on a flat surface and you can see a slight out turn from the knee to the foot. The right leg is straight. But I need to get the right done in the new year so have worries I'll be knocked kneed after both knees have been worked on!
You are SO right, I need to wait to see what the OS says. He is a bit intimidating because he is the local genius of knees in the area and I'm afraid of souring our tentative relationship! I've never done well with OSs! But will chill out until Wed, see what he says then try to cope with it all afterward. Thinking the worst case is I may have to have a revision down the line; the best is it may correct with exercise and second knee replacement. We'll see....thanks for caring, Squirrely