TKR Suz's Recovery Journey

[newlybionic]

You're doing fine. I want to applaud you for not letting the PT force your knee to bend any more than its ready to do right now. Your range of motion will continue to grow by the week.

 

[Suz]

Remember how I was bragging a day or so ago about graduating to a cane? That one little visit from PT set me back so much yesterday. When she arrived I was happy and my pain level was no more than a 2. When she left, even though I didn't let her push my knee in for better ROM, my pain started increasing. By the end of the day I was back on my walker and pain level was upwards of 8.. into the night, a miserable 9. So today I'm apologizing to my knee and in full rest, ice & elevation mode.. all because of her evaluation visit-!!

I hope so much my insurance denies the request for more in home PT. I would end it on my own but I need to show my OS that I am cooperating in his recovery protocol for employment & insurance reasons.

I will definitely speak with him at our 6wks visit about my decision to recover on 'my' terms! Even though I didn't let PT manipulate the ROM yesterday- the things I did allow set me back as if I had been walking around on my knee all day long. I'm still learning that 'you over-did-it' lesson!

 

[Happydale]

Suzie, I love reading your posts and keeping track of your recovery. To me, it sounds like you are doing great! Your best strength is having a fantastic positive attitude, so don't let the PT (or anybody!) steal that from you!

 

[sistersinhim]

You see the correlation, pt then terrible pain. That can't be good for the knee. I pray you feel better really soon. Why don't you skip pt for a few weeks so your knee can heal?

 

[newlybionic]

It's hard to limit what you do in a therapy session because at the time you might not recognize its causing you any pain. Make sure you tell them that you were in a lot of pain after the session and you need to do less in the next session.

 

[Suz]

Well good for me she has to submit her evaluation to my Insurance Company for an approval for 9 more visits. So I won't be called for therapy anymore this week- and if they do call, I won't answer until next week- LOL! But you best believe 'pain' is teaching me allot about how to better rehab my knee! I just need to learn more from the veterans here how to 'appropriately' rehab it. My knee and I are on pain-leave for awhile! I appreciate everyone's wise words & encouragement so much! (Clock in following avatar ='s PT)!

 

[Suz]

Oh cool.. look what I just found. This looks like a good place to start 'studying' while I'm *sitting-here-under-ice* recovering-!

https://bonesmart.org/forum/threads/post-operative-exercise-–-the-bonesmart-view.25463/

 

[sistersinhim]

Thanks Suz. I just bookmarked it. I will be referring to it frequently, I'm sure.

 

[CaliGirl]

So sorry the PT flared up your knee. Definitely rest and take care of yourself.

If the insurance does authorize more PT, can you ask for a different therapist?

 

[Suz]

I'm pretty sure my regular therapist will honor my 'new' requests of a more passive exercise routine when we're together Gayna. I'm sure she's also documenting what I allow and don't allow.

This recent painful occurrence was from a supervisory therapist visit who reports my current state (numbers) to the insurance company in 'her' hopes of getting me 9 more visits. Altho she didn't push my knee in for ROM- she still had me doing other exercises to show how far I had come. Like you said yesterday I was already swollen and uncomfortable so I didn't give her what she wanted- plus what I did give that she asked compounded my pain- which I'm still experiencing 36hrs later. I've hardly been able to walk to the bathroom today.

My OS wants me to accomplish the therapy protocol of course- I'm just not in agreement with their methods now that I know what's best for my knee. After what I've read here from others, I will NEVER go into a physical therapy center which is where I'm suppose to graduate to from home therapy.

In the meantime I have a very easy part-time job sitting with my adult daughter who is mentally impaired. I'm currently on medical leave of absence from that position because of my surgery. I have to pay 100% of my insurance premium during this time but am not receiving any wage. I understood I would be out for 6wks but now I've learned I won't be allowed back until I've been released by my OS. He won't release me until I'm off of narcotics and meet his recovery requirements.

I don't even mind waiting 8wks for said release- but now I have my doubts that I'll recover even in 10wks if I continue to allow PT to traumatize my knee. So..

I'm going to develop my own PT routine from the resourceful pages here in the forum and hope I'll be at least able to come off of the narcotics in another 4-6wks.

I just think it's disgusting I have to sit and worry about all of this while trying to recover from a TKR!

 

[CaliGirl]

Now I understand. Yes, the therapists who come out and work with me are much more gentle than the guy who first came out to do the initial evaluation (and who is coming out next week for my final evaluation).

Can you not explain to your surgeon the financial reality of your situation, as well as the physical demands (or lack thereof) of your job? Most doctors have patients asking to prolong disability. I would think he'd be sympathetic with someone who is eager to get back to work. I can understand wanting you to be off narcotics - at least during the day - before releasing you to work. Do you know his arbitrary physical requirements for release to work?

 

[Suz]

No- not yet Gayna. I have an appointment with him on the 14th of June and will explain my situation at that appt.

The most important thing I need to remember is the proper recovery of my knee. I do have an emergency savings I can turn to should his protocol require I 'safely' (on my terms) recover longer than the 8wks he told me it would probably take to get back to light activities & driving.

You're so sweet- thank you for your concern and advice! It's so easy when down like this and without the control I'm so accustomed to, to panic!

And hey, I can always sell one of my cows if this tarry's on too long, haha! *First humorous moment I've had in 2-days*, thanks!

 

[Celle]

I hope so much my insurance denies the request for more in home PT. I would end it on my own but I need to show my OS that I am cooperating in his recovery protocol for employment & insurance reasons.

You do know it's your choice whether or not to have PT, don't you? You don't have to please either your PT therapist or your surgeon. Just do what feels best for our knee, which will recover better without PT upsetting it.

 

[Suz]

Thank You Celle! My heart lights up when I see you and other veterans stop by. I'm amazed at how ignorant I have been coming into such a big surgery even though I 'thought' I had done my homework. You, Josephine, Jamie and many others here have taught me so much more than any of the medical staff I have had access to regarding this TKR.

I received the phone call today that let me know my insurance had denied any more home therapy. YAY! I was so relieved to hear that- lol! I was also told that my OS could request more therapy in a facility and it would most likely be approved. Not interested. So to come here and read your above response regarding PT was so refreshing!

I am running out of my oxidcodone this coming Sunday. Today being Friday, I made a 2nd attempt at running down a refill. We're going into the Memorial Day holiday here and my OS won't be in his office until next Tuesday. I'm concerned about running out of my pain med, they sure don't seem to be.

When I finally through, at first his nurse told me he was not going to continue my oxycodone. (After all, I am 3.5wks out from surgery and soon to become an hard addict you know). I can't make him continue the pain control that has been effective- but then I asked her what he was replacing it with. She was dumbfounded?? She said, 'what do you mean'? I said, 'I'll be completely out of prescription pain relief this coming Sunday morning- what medication do I take Sunday afternoon? Aspirin, Australian Dream, surely I'm going to need something for pain. I said, 'please ask him what he recommends for pain after my oxy runs out- even if it's over the counter. 2hrs. later she called me back and said he was having her call in Etodolac, 400mg tablets 2xs a day.

I don't know one thing about this medication. So I'm back to my 'real' TKR experts to ask your opinion on this change. I've been taking 10mgs of oxycontin every 12hrs and 10mgs of oxycodone every 6hrs for the past 3.5wks. Can I just come off of oxycodone and start right up with etodolac or should I taper off of the oxycodone (I'm out of the oxycontin now). In your opinion, is this etodolac going to be sufficient pain control or should I supplement it with Tylenol?

I'm so disappointed in my OS. I've liked him in the past so much- he has always been so supportive leading up to my TKR. Now it's like he's MIA (missing in action). To his defense I've heard they are really cracking down on oxycodone and similar meds here in the US. But don't treat me like a drug addict when I feel like I've been on his recommended relatively low dose anyway since my surgery.

I'm no longer concerned about his opinion regarding my recovery. I'm not going to be aggravating my knee anyway with his PT protocol- so I'm believing I can recover my own TKR with the wonderful opinions from this site. Any insight regarding my upcoming pain med change would be so very appreciated.

And thank you all for 'really' caring about us newbies!

 

[Celle]

I don't even mind waiting 8wks for said release- but now I have my doubts that I'll recover even in 10wks if I continue to allow PT to traumatize my knee. So..

We usually recommend about 12 weeks off and then a Phased return to work

Even a job where you are sitting most of the time is hard on a new knee. It's not just what you do while you're at work, but the added activity of getting ready for work and travelling to get there and back.
You may experience an increase in swelling and pain and could find that this happens:
Knee pain after sitting for a while
In any case, your knee will get stiff and you'll need to get up and walk around for a while, at least every hour.

If you're going to do your own exercises, do remember that it's not the exercises that rehab your knee and improve ROM. It's time to heal, reduction of swelling, and gentle treatment. The ROM Is already there, inside your knee, just waiting to reveal itself when the swelling and pain have decreased enough. You don't have to work to get ROM.

Like Josephine, I did no PT at all after my last TKR (and I only had 3 visits to PT for the previous one). I just let the ordinary activities of daily life be my exercise. Both my knees recovered very well. They are strong, have great ROM, and I can do anything I want to with them.
My surgeon does not allow any PT at all for the first month after a TKR and, after that, PT sessions are only one very two weeks. He says that your knee needs that first month to begin its healing.
His patients all do well and he hasn't had to do a manipulation (MUA) to help with ROM for the past 3 years.

 

[newlybionic]

That medication in a NSAID. In my experience I've found that I needed to wean myself off narcotics and not just stop them. It won't matter if you take the two together but NSAIDS can cause other problems. Check with the pharmacist for all the info about it.

 

[Celle]

I'm disappointed in your OS, too. That's a pretty callous way to treat someone with such a new TKR. You still need to be taking effective medication for pain relief and then you should be weaned off the strong meds gradually, stepping down slowly from the narcotics.

Marian (newlybioinic) is correct. Etodolac is an NSAID. NSAIDs are anti-inflammatories and they are not nearly as effective as pain relievers. There are some dangers associated with their use, too.
Plus, having to stop your narcotics suddenly like that could lead to unpleasant withdrawal symptoms.

Can you ask your own doctor (PCP/GP) if he/she will prescribe something like Tramadol?

I'll ask @Josephine for her suggestions and comments.

 

[Suz]

I will certainly see my PCP immediately after his office reopens after our holiday Celle. I was actually taking 100mg Tramadol 2xs a day prior to surgery and I believe I still have an open prescription from my PCP. I know I have almost a full bottle of it as I was taken off of it to start meloxicam just before surgery. By my PCP. I'll do my best to get into his office first thing next Tues. morning to discuss my sudden removal from the narcotic. In the meantime, I wonder if I should perhaps try to slow my dose of Oxy over the next few days. I have enough to last me through Sunday morning but I wonder if I could take say one 5mg tablet every other 6hr scheduled dose instead of the prescribed 2 tablets, (10mg) and see how I do? Alternating 5mgs & 10mgs of oxy. Perhaps adding either Tylenol of Tramadol? I realize I may be way out of line asking for this medication insight here but I'm frightened now over cutting the Oxy cold turkey once I run out on Sunday morning.

 

[newlybionic]

I was given tramadol post op for breakthrough pain. So I would take both when needed and slowly I stretched out the Oxycodone I had and took Tylenol with the tramadol but I had to make sure I added the Tylenol amount that was in the oxy that I was taking so I didn't take more than 4,000 mg per day. You'll have to try to figure out what works for you.

 

[Suz]

Thank You Marian~