TKR svo’s recovery road

[svo1956]

Just checking in on a good note instead of a complaint or concern. Today is 3 weeks post op and I just had my next to last home PT. I have been feeling as though I haven’t been doing even minimally enough activity-wise, so I am pleased that I could run through the exercise routine with no trouble. No one had measured rom for over a week and it’s still improving, now at 110 on my own steam. Plus pedaling my recumbent bike was easier than even just yesterday. So I feel so much more confident and less worried than I have been feeling. I can’t wait until the heat breaks and I can start extending outdoor walks a bit, that was by far my favorite part of the rehab last time. Plus today I am freed from the TED hose! Trying to ignore that I just heard that someone else who does the same job I do had his knee revision yesterday and is only taking a month off and I am taking 12 weeks - no one wants to appear to be a shirker. But I’ve been through this before and I know I will need the time to return ready to really do my job when I go back. This other person went back after 2 months when he had the replacement done 2 years ago and he was crabby and tired and in pain and it showed. Oh well - I have to try hard not to think about what other people think.

 

[chicklet]

Pffffft!! Forget about them!!!

(Do as I say, not as I do.)

 

[Jockette]

no one wants to appear to be a shirker. But I’ve been through this before and I know I will need the time to return ready to really do my job when I go back. This other person went back after 2 months when he had the replacement done 2 years ago and he was crabby and tired and in pain and it showed. Oh well - I have to try hard not to think about what other people think.

You go, girl! Stand firm on what you know is right for you!

I have never had any other recovery where I have had to prove myself or be blamed for not doing it right. This whole experience has been a shock for me!

And 110 at 3 weeks on your own steam is lovely. Many would love to have that, but if they don’t, thats fine, too. We each recover on our knee’s own schedule.

 

[Laurenkate]

Wanna bet that other guy's co-workers wished he'd stayed at home and kept his pain and crabbiness to himself? You're doing so well!

 

[sistersinhim]

Trying to ignore that I just heard that someone else who does the same job I do had his knee revision yesterday and is only taking a month off and I am taking 12 weeks - no one wants to appear to be a shirker

If he just had his revision yesterday, there's no way anybody knows if he'll be back in a month. Don't listen to the gossip, it'll only stress you out!

 

[svo1956]

Ok - I’m back with a PT question. I went to my first out pt PT appointment last Thursday and there were things I liked and things I didn’t. I’m preparing myself for how I want to communicate with the therapist when I go back tomorrow. One thing he had me do were “bridges”, which I had never done before. I’m sure I’ve read here on Bonesmart that these are not good to do. Can someone give me the reasons they are no good so I can tell him why I don’t want to do them? Otherwise, I think he was all around too aggressive, though it didn’t necessarily feel that way while I was there. I was very sore for 2 days after and did almost nothing until I felt better today. So I plan on talking to him about that. I almost think the fact that overall I’m doing pretty well and my bend is pretty good (though nothing amazing) encouraged him to be so aggressive. I am happy to be slow and steady. Thanks for any responses!

 

[Jockette]

I can’t explain why bridges are bad after TKR, they probably put too much pressure on a new knee, so I’ll let someone else explain that.

You really don’t have to explain why you don’t want to do something. They will just “argue” with you. All you need to say is no, and they have to accept your “no”, end of discussion.

2 days to recover from PT= a counterproductive session. Been there, done that. Which is why with my next replacement I won’t go to PT.

Also keep in mind, it’s not exercising that gets our range of motion back, it’s Time:

Time to recover.
Time for pain and swelling to settle,
and Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

 

[KitKat64]

But I’ve been through this before and I know I will need the time to return ready to really do my job when I go back.

It's kind of the same with me. After my RTKR, I went back to work at 12 weeks; after the LTKR, I went back at 10 weeks ( I had to return when I did, as my short term disability was due to run out in another week). My knee is holding up very well. My job involves a lot of physical work, such as walking, bending, etc., and I have been experiencing some minor swelling and aches on occasion. I've been icing my knee and elevating my legs in the evenings, which does help. This is actually how I found BoneSmart. I had Googled why I had swelling 3 months after a TKR, and a few of the posts came up.

 

[sistersinhim]

Can someone give me the reasons they are no good so I can tell him why I don’t want to do them?

Don't tell why. You're the employer and what you says goes with no explanation! Just say that it hurts your knee and you aren't going to do them. Anything that takes you 2 days to recover from has set your recovery back those two days. This does not help your recovery, it hurts it. You are the boss, and your knee is your baby. You should be protecting it, not letting harm come to it.

 

[svo1956]

Thanks for the responses about the PT! I went back yesterday and talked about my concerns and we had a very mild PT session. He absolutely believes that I have to keep pushing it to bend more or scar tissue will form and get me stuck. I think we agreed to disagree and the only thing that really matters is that I get what I want out of the PT. I am curious about one thing, although I am not focused on flexion numbers it is nice to see progress, he is measuring ROM while I lie on my stomach and bend my knee up toward my back. The number comes in quite a bit lower than when home PT measured it in a heel slide. He says it is a better way to bend because it is more effective in stretching the hamstrings or whatever. I told my surgeon my home PT number and he was thrilled (120) but now I guess I have a lower number (110)? I realize this doesn’t matter in the scheme of things, but what are the numbers for if they are this arbitrary? And one thing seems clear - this therapist wants to see that number go up. I also recognize that what he wants doesn’t matter.

Anyway - my biggest challenge at 5 weeks today (hooray!) is sleep deprivation and how it is getting in the way of my being as active as I would otherwise want to be during the day. I don’t so much mind not sleeping at night when it’s happening, and this happened to me last TKR also, I just read and give in to it. But the mornings are brutal and I am so low energy all day. I have tried the Saran Wrap, icing and elevating at night, and I just can’t tolerate those things while I’m in bed. Yesterday I got a tens machine and tried it before bed, can’t say it helped at all because it was an especially bad night (as in 2-3 hours of sleep all night). I don’t want to ask for a sleep aid from the doctor. I still take a couple of dilaudid at night, but I don’t think it’s so much pain keeping me up. It’s all that other crazy stuff that goes on with this recovery. Well - having read so many of others threads about this I don’t expect any magic answers and I know it will eventually get better. It’s just so hard, harder this time it seems to get myself into a routine of walking and being appropriately active. Any tips on most effective ways to use the tens machine, from those who have thought it helped? Thanks!! Susan

 

[Laurenkate]

This won't help much but I re-discovered a great sleep aid last night but fortunately, I'm only taking Tylenol at this point. I've had a nighttime cough and am starting to feel a summer cold coming on so I took some NyQuil last night and it knocked me out. Wonderful to sleep through the night except for two bathroom visits! Obviously can't use it every night but am going to use it once a month just as something to look forward to. It's bad when your life has been reduced to looking forward to taking Nyquil to sleep!

Agree with you about the mornings; it takes me forever to get up, get my leg stretched out so my foot will hit the floor, blah, blah, blah. It seems like a waste of time when it takes 2 hours in the morning to get ready for a day of the same old stuff. You're doing really well though; as much as I try to tell myself the ROM numbers don't matter, it makes it difficult when the p.t. people seem to think that's the only measurement of their success, don't you think? With the exception of gentle stretching and walking, none of the p.t. stuff makes much logical sense. My husband & I compromised that I would go to half of the therapy sessions my doctor recommended - and will be glad when they are over so I don't have to hear about "scar tissue" and "ROM" anymore.

Since I seemed to have pulled the majority of muscles in my body after this last tkr, I use the tens machine on most of them and it does help with the pain but I get better results if it's used consistently - not just once. Sometimes i'll have a heating pad on my thigh, ice on my knee and the tens machine on my calf or ankle - so ridiculous. It takes some experimenting to see what feels and works best for you.

 

[chicklet]

Sometimes i'll have a heating pad on my thigh, ice on my knee and the tens machine on my calf or ankle - so ridiculous.

I did the same thing - a LOT of experimenting to find the right combination. I never could tell if the tens was helping or not but I kept using it, hoping it was working some invisible magic. The heating pad definitely worked on thigh, hip, calf, and ankle pain.

As for sleep ....sigh....the only thing I know for sure that helps is time. I’m sure you already know that and didn’t need me to say it! Melatonin gummies did help me get a good 4 hours of sleep a night the last few weeks. And the last 3 nights in a row I’ve slept the longest stretches since my surgery, 6 and 7 hours. I don’t know if it’s the time factor (14 weeks post op) or if my body has finally reached total exhaustion! Either way, I’ll take it.

 

[svo1956]

@chicklet - maybe I should try melatonin. I took it once years ago and felt unwell in the morning so have never wanted to try it again. And @Laurenkate - am I to hope for a cold then? It’s so true - it takes me those 2 hours to be up, showered, dressed and have eaten breakfast, taken whatever pills, and made sure my stomach is behaving. Then I’m tired and start losing steam. Some days have been better though, when I take a walk, use the recumbent bike, do a few stretches. As wasted as I feel today - a friend I haven’t caught up with in a long while is bringing bagel sandwiches for lunch and my son just texted asking if I want him to come over later with dinner. And I just vacuumed! So even if I don’t do any exercise, it seems like a good enough day. I love the late summer air we are having here in Mass!

 

[sistersinhim]

Many people find Tylenol PM a good sleep aid. You might want to try those.

 

[Laurenkate]

@svo1956 - Yes, you need to get a summer cold! Honestly, I don't understand how anyone can stand the headaches long enough to get addicted to oxytocin; Nyquil is a different story! And I'm jealous you're having good weather. We're heading up to the Cape in October and I can't wait to get out and just stand in that cold, cold water. (And yes, my husband thinks i'm certifiable but it feels so good).

It sounds like you are having a good day - and just think, you probably couldn't have vacuumed a couple of weeks ago even if you wanted to. Any day where someone else is bringing food and/or cleaning up is a good one too. Onward and upward....

 

[svo1956]

@Laurenkate - being a north shore person I like the cold water . The Cape in October should be glorious.

Here’s my question today. All is going fine, moving along at the expected slow pace. Like everyone else, I swing between acceptance and frustration/distress. While I can walk down stairs step over step, with some mild discomfort (so I don’t often do it), I just cannot walk up stairs step over step. My operated knee is simply not strong enough, I get quite a bit of pain above the knee cap if I try it. I talked with the PT person about it and he had me do some sort of step up exercise that, as I told him, also hurt. His response is that some things just have to hurt, but I don’t think so. Not like this. It’s not a bit of soreness, but a sharp pain as I lift my weight on that knee going up the stair. So I’m not doing that exercise. But I am wondering what I can do to address this - is it something that will just come in time or is there an exercise I can do that would help it along without that sort of pain? I am almost 6 weeks post op and most days I walk a mile (slowly, it takes me about 30 minutes) and do 10-15 minutes on the recumbent bike with no tension, and otherwise just very modest daily activities. For what it’s worth, stairs are a constant in my life since I live in a townhouse and there are 7 steps between each room. Suggestions? And thanks!!

 

[Jockette]

Time should take care of being able to go up the steps foot over foot. I’m surprised you do so well going down foot over foot!

6 weeks is very early days. PTs think recovery should happen quickly. As you know, and they should also, recovery takes a long time and should not be rushed.

 

[Laurenkate]

Good grief; now I feel like a major slacker. Doubt I could walk 5 blocks much less a mile...

It took months for me to be able to walk up the steps (after first tkr) normally but that may have been because I didn't try it. Tried it yesterday; it was extremely painful and my knee was swinging out away from my body in an odd way. I have to go up and down steps more than I want when my husband isn't home; there seems to be the law that whatever I need is on the other floor. Time will take of it; try not to worry too much.

I wonder how many p.t.'s have had knee replacements? And now that I think about it, has anyone ever seen a p.t. over 40 years old? It would be interesting if their "hurry up no pain no gain" philosophy would change if they'd ever dealt with a replacement.

 

[Jockette]

And now that I think about it, has anyone ever seen a p.t. over 40 years old? It would be interesting if their "hurry up no pain no gain" philosophy would change if they'd ever dealt with a replacement.

The PT I saw the most looked to be in his 40s, he’s the first one who pushed my knee beyond it’s limit and lowered the table further while my feet were on the floor, forcing my knee to bend more by default, and brought up the infamous “window of opportunity “ AND told me my surgeon wouldn’t be happy if I wasn’t at 95 by my 2 week check up.

All of those kind need a reality check.

And I’m at a point where it’s not about “if the surgeon is happy” or not, it should be about the patient. Rather than being blamed for our recovery we should be nurtured while going through one of the most difficult experiences of our life.

 

[svo1956]

Last TKR my PT was a woman close to my age and I enjoyed working with her. This time I went back to the same place but got a guy probably around 40. He mentioned he expects he’ll have knee replacement in his future but he is wedded to his point of view. So far I’m standing my ground ok and he does do massage at the start of the session, which is worth a lot to me. I was reduced to telling him I went through natural childbirth twice with back labor to get him to accept that when I say something hurts it really hurts. That is so unnecessary. Anyway - thanks for the reality checks, I’ll just wait for going up the stairs normally. And the mile isn’t so far, shorter than 5 long blocks I’d guess. I’m drenched in sweat when I’m done but the walking feels good. I do so little else.