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TKR TKR with Fibro and Raynauds and RA, anyone else?

Staples out today. Wound looks healed,clean and dry, but they put another dressing on but that can come off Monday. I had a really good day yesterday. Managed to do more gentle walking and just gently increased my exercise without any ill effect or increase in pain. Also had slightly less pain relief meds, so definite progress.

I still find it hard to elevate. Even having nicely arranged soft pillows all I feel is like I have an iron bar pressing into mycalf. I keep rearranging the pillows and think oh that feels better but within 5 minutes it’s really uncomfortable. My swelling isn’t bad at all, I will persevere.


Feeling it a bit now cos of going to the GP I’ve done more steps than any other day just in one morning so will be taking it easy for the rest of the day. Feels like progress overall so am very happy.
 
I still find it hard to elevate.
While most of us feel that elevating is helpful, we are all different. Just sit or lay anyway that you can find comfortable. I’ve often used @Nivea as an example of someone whose surgeon told her not to ice, but interestingly enough, he also told her not to elevate, though I never found out what his reasoning for that is. However, I don’t think he meant always keep your feet on the floor when sitting, as most of us know that is painful and increases swelling, in the early months. Anyway, Nivea had a great recovery, doing things differently.

I did elevate on a foam wedge whenever I was in bed sleeping. When I was not in bed, and sitting, my legs were only up as high as my ottoman, which was just a tad lower than the couch I was sitting on. This position was very comfortable for me.

Do whatever works best for you. As my uncle always says, “that’s why there’s chocolate and vanilla!” :heehee:
 
Thanks. Yes I still have my feet up on a footstool all day with a pillow, never just down for any length of time.
Even if it’s only an hour or so within the day I try and do toes above nose. It’s something I guess. As said so far the swelling isn’t too bad.
 
Glad you are feeling better! I have the same problem with elevating. Tried the 3 pillow stack in bed last night and that lasted all of 5 minutes. Tried it again on my recliner today but nope, my body just can't handle being in that position. At PT yesterday, my CLT (certified lymphedema therapist) put me in pneumatic compression pants for 30 minutes, as my swelling was even worse than last week. And wow, what an improvement! I had much less pain last night, slept like a log, and my swelling is noticeably down. My PT office may be able to loan me the compression pants to use at home until my insurance decides if or when they will cover it. I'm already starting to cut back on my pain med, which is a good thing, since US docs don't like prescribing opiates longer than 2 weeks.
 
Glad you are feeling better! I have the same problem with elevating. Tried the 3 pillow stack in bed last night and that lasted all of 5 minutes. Tried it again on my recliner today but nope, my body just can't handle being in that position. At PT yesterday, my CLT (certified lymphedema therapist) put me in pneumatic compression pants for 30 minutes, as my swelling was even worse than last week. And wow, what an improvement! I had much less pain last night, slept like a log, and my swelling is noticeably down. My PT office may be able to loan me the compression pants to use at home until my insurance decides if or when they will cover it. I'm already starting to cut back on my pain med, which is a good thing, since US docs don't like prescribing opiates longer than 2 weeks.
Ah @TeriseD I’m so glad the compression pants brought relief. Must have been wonderful for you and anything that helps bring any relief has a huge effect physically and emotionally. I find getting sleep at night just helps you see things from a better perspective and really sets you up for the day.

Like you the pillow thing just doesn’t work for me. I start off the night with the intention of using the pillow stack and always end up having to abandon it. Sleep is too valuable at night to keep at it so I’ll just reserve the toes above nose for day time and do what I can. As Jockette says we’re all different and we all have to find our own way to recover.
It’s interesting I’m not sure we’ve (the UK) caught up with the U.S. in terms of restricting the prescribing of opiates. I know it’s something that’s being pushed here though. It could be that as the NHS requires us to be registered to a single GP, I guess tracking of opiate prescriptions is easier.
I think as in most things there’s a place for short term prescribing of opiates that won’t lead to addiction but it feels as though the US are much stricter than the UK on this.

Hope you have a good day. I’m definitely suffering from the walking yesterday so won’t be doing anything beyond gentle movements.
 
Just a little add on. I’m probably a little behind the curve but my husband bought me a Fitbit for Christmas. I always thought I wouldn’t have much use for it as I’m not able to do any sustained exercise,but it’s really come in handy since the surgery.

Not only is it tracking my sleep but most importantly my steps. I’ve been able to gradually add steps in little chunks and keep track of exactly what I’m doing. Although I’m suffering a lot today after my first outing yesterday it is interesting to note that I did more steps yesterday than any day since surgery. That means I know exactly what’s too much and what will mean I’ll be back to monitoring my pain relief religiously and hoping for sleep to get away from the pain.

It’s been a good way of monitoring things and enables me to set targets. I’m sure it will be even more valuable as my recovery proceeds. Anyway just thought it was interesting.
 
It could be that as the NHS requires us to be registered to a single GP, I guess tracking of opiate prescriptions is easier.
GPs have a bit more flexibility in the UK I think, because we haven't had a real crisis of over prescribing in the past. There is oversight of GP prescribing though. If a GP was prescribing a lot more opiates than other GPs it would be picked up and acted in.
 
Wow @Layla @mendogal @Jockette and anyone else I’ve forgotten. I’m certainly learning your lessons of doing too much does set you back. I obviously had no choice to get my clips out on Friday but boy have I felt it. Getting washed dressed, the travel there and back, sitting on a hard chair with my leg hanging down, yesterday was a complete go slow on doing anything with my pain levels right back up to 7/8 and felt like I was behind all day getting good pain relief.

Fortunately I had 7hrs and 45 mins sleep and then an hour later had another 1.5hrs!! I managed to keep my leg well elevated all night and this morning pain was reduced. My energy is rock bottom(tbf that’s not strange for me anyway) but at least my pain doesn’t seem quite as bad today.

I can see how easy it is to get frustrated and feel like you’re not moving forward enough. My extension is still really good, but my flexion is minimal and slow in it’s improvement, but I’m trusting in the process and praying all will be well.
 
@beralc I had swelling of nonop foot early on, also pins and needles in bottom of that foot. I think it lasted a couple of weeks, better when I started keeping more weight on op leg. Elevation seemed to help. I do have some arthritis in nonop knee, it’s been a little sore since surgery. I also tried compression sleeve on nonop knee, seemed to help foot swelling.
 
@beralc I had swelling of nonop foot early on, also pins and needles in bottom of that foot. I think it lasted a couple of weeks, better when I started keeping more weight on op leg. Elevation seemed to help. I do have some arthritis in nonop knee, it’s been a little sore since surgery. I also tried compression sleeve on nonop knee, seemed to help foot swelling.
Yes it’s strange. Same as you I do have some arthritis in the non op knee ( although it was actually operated on in September for a badly damaged cartilage). I’m trying to be mindful of elevating and I had been wearing a sleeve on it but kept forgetting to take it off at night and it dug in and became itchy but now I’m a bit more with it may try again. Thanks.
 
Those first outings can wear you out! I'm glad to read you were doing well after a good nights sleep...and it has to feel better having those clips out.
Keep doing what you're doing and trust the process. You WILL get there! :thumb:
@beralc
 
Well I took the dressing off today. I’m really pleased with the way the wound looks. Clean and dry and no inflammation to see. I’m also really pleased that it really doesn’t look very swollen. In fact it’s only half an inch bigger in circumference than the left knee!
The reason I find this interesting is because I’ve not been icing, I’ve hardly done any fixed exercise, I’ve not even done much walking after this weekend due to, too much pain on Saturday, not enough sleep and very low energy levels yesterday and today. I’ve simply done the BoneSmart suggested foot pumps quad tightening and knee presses. My feet are always elevated out in front of me and I’ve managed a couple of nights of about 8hrs straight toes above nose elevation.

I’m hoping that the lack of swelling will mean I can make some real headway once my energy levels improve.
 
That's great!!!
Those few simple exercises are truly all you need even for another few weeks, along with just taking very short walks every hour or so.

Here's a handy activity progression ....

Activities of Daily Living (ADLs) include:
~ Personal hygiene and grooming
~ Dressing and undressing
~ Functional transfers, e.g. Getting out of bed
~ Voluntarily controlling bladder and bowel elimination
~ Ambulation (Walking or using a wheelchair)
~ Housework
~ Meal Preparation
~ Care of pets
~ Meal preparation and cleanup

Walking and other activity
Walking is about the best exercise you can do but again, you need to moderate your time and distance.
Always use your walker, crutches or canes as appropriate, only moving from one to the other as you gain confidence.
Don't be despondent if you have to go back once in a while in the early days.

Week 1
Just walking around the house - trips to the bathroom and kitchen are included!
Be up on your feet several times a day as you need to but don't get obsessive about it
A 5-6 minute walk every 3-4 hours is plenty
Spend most of your time resting and elevating

Week 2 - add this to previous instructions in Week 1
Start on a plan of walks around the house 3-4 times a day for about 5 minutes but don't
a) get obsessive about it
b) get into too much pain and
c) get too tired. Stop before you get to that point.

Week 3 - add to all the previous
Lengthen the walks to about 5-10 minutes as before
Activity: prepare yourself a small meal or a snack

Weeks 4 and 5 - add to all the previous
Increase walks to out in the garden or street; to 20mins or longer if you feel up to it bt don't forget that means 10mins there and 10mins back!

Additionally activity:
Gather a little bit of laundry OR put it in the machine OR take it out but not all of it
Now you can do a little dusting and tidying;
Do a little meal prep (for yourself not the entire family!)

Weeks 6 and onward - add to all the previous
Start taking car trips to the shops but keep them short and sweet at the start, no longer than 15-20 minutes
Take at least one 5 minute rest while you are out

Activity: a very little ironing, washing, meal prep but get someone else to clear up after. Wash up but someone else clears the table, brings you the dirty dishes, dries and puts them away after, NOT you!!

Week 10 add to all the previous
Bed making and changing sheets, cleaning bedrooms etc., can wait now by which time, all things being well, you should pretty much start getting back to normal but don't rush it. If you start getting pain and stiffness in your knee, that's a sign your knee doesn't like what you're doing, that you're rushing ahead too fast. Slow down, right down, and start again. This stage might last until week 14 or even 16 but if it takes a even longer, don''t worry about it.

Returning to work
It's becoming the norm for knee patients to be pressured back to work after 6 weeks or so. This can be done but it is even more important one needs to try and negotiate a "Phased return to work" because going straight back to full time work can be very hard on the new knee and cause tendinitis in various places. But in essence, I would advise that 6 weeks is far too early and 10-12 weeks would be a more sensible target!
 
That's great!!!
Those few simple exercises are truly all you need even for another few weeks, along with just taking very short walks every hour or so.

Here's a handy activity progression ....

Activities of Daily Living (ADLs) include:
~ Personal hygiene and grooming
~ Dressing and undressing
~ Functional transfers, e.g. Getting out of bed
~ Voluntarily controlling bladder and bowel elimination
~ Ambulation (Walking or using a wheelchair)
~ Housework
~ Meal Preparation
~ Care of pets
~ Meal preparation and cleanup

Walking and other activity
Walking is about the best exercise you can do but again, you need to moderate your time and distance.
Always use your walker, crutches or canes as appropriate, only moving from one to the other as you gain confidence.
Don't be despondent if you have to go back once in a while in the early days.

Week 1
Just walking around the house - trips to the bathroom and kitchen are included!
Be up on your feet several times a day as you need to but don't get obsessive about it
A 5-6 minute walk every 3-4 hours is plenty
Spend most of your time resting and elevating

Week 2 - add this to previous instructions in Week 1
Start on a plan of walks around the house 3-4 times a day for about 5 minutes but don't
a) get obsessive about it
b) get into too much pain and
c) get too tired. Stop before you get to that point.

Week 3 - add to all the previous
Lengthen the walks to about 5-10 minutes as before
Activity: prepare yourself a small meal or a snack

Weeks 4 and 5 - add to all the previous
Increase walks to out in the garden or street; to 20mins or longer if you feel up to it bt don't forget that means 10mins there and 10mins back!

Additionally activity:
Gather a little bit of laundry OR put it in the machine OR take it out but not all of it
Now you can do a little dusting and tidying;
Do a little meal prep (for yourself not the entire family!)

Weeks 6 and onward - add to all the previous
Start taking car trips to the shops but keep them short and sweet at the start, no longer than 15-20 minutes
Take at least one 5 minute rest while you are out

Activity: a very little ironing, washing, meal prep but get someone else to clear up after. Wash up but someone else clears the table, brings you the dirty dishes, dries and puts them away after, NOT you!!

Week 10 add to all the previous
Bed making and changing sheets, cleaning bedrooms etc., can wait now by which time, all things being well, you should pretty much start getting back to normal but don't rush it. If you start getting pain and stiffness in your knee, that's a sign your knee doesn't like what you're doing, that you're rushing ahead too fast. Slow down, right down, and start again. This stage might last until week 14 or even 16 but if it takes a even longer, don''t worry about it.

Returning to work
It's becoming the norm for knee patients to be pressured back to work after 6 weeks or so. This can be done but it is even more important one needs to try and negotiate a "Phased return to work" because going straight back to full time work can be very hard on the new knee and cause tendinitis in various places. But in essence, I would advise that 6 weeks is far too early and 10-12 weeks would be a more sensible target!
Thanks for this

I guess like everyone I’m focused on my ROM and I wouldn’t say my flexion is more than 45-50. My extension is roughly almost at zero. Should I be concerned?
 
@beralc
You have finally gotten the swelling reduced, let things be for a while.

If you can keep the swelling down, and can focus on good walking structure, flexion will come.

Many of us have found it more productive to focus on function (as in, tiny milestones) than on numbers.

In terms of numbers, my surgeon's standard goal is 90 degrees flexion at six weeks. Many of our BoneSmart members do not achieve this but slowly and steadily do get a fully functional flexion during the first year. As you so beautifully expressed it to another member, your autoimmune status can be expected to put you on a slower track.

I honestly don't think a specific flexion exercise would benefit you so soon after getting the swelling under control. Let's see how this week goes!
 
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That’s great @mendogal it’s nice to be reassured and sounds like a good approach.

I try when walking with my Walker or my Bob Dylan as my OH calls it (Zimmer frame hope you get it ) to reenact proper walking in slow motion. So I stand up nice and straight and softly flex my knee and move forward to land with a heel to toe action. I don’t do it for the whole walk but maybe a bit at the beginning and a bit at the end.
I definitely feel the difference from the alignment. I feel slightly taller but also a bit lopsided but of course it’s because I’ve actually been lopsided for years and now I’m straight
 
Yes, I got it!

Your walking approach is good!
 
I don’t do it for the whole walk but maybe a bit at the beginning and a bit at the end.
That's okay! You'll find that the more you practice, the easier it will become and you'll be able to sustain for longer and longer until you can do it the entire time.

You are still early days in this recovery. Take it slow and steady.
 
@beralc You'll love your Fitbit even more once you've recovered and are walking/exercising more frequently. Got mine about 18 months ago and it motivates and challenges me to keep improving both fitness and sleep. Have fun with it! Hope you're doing ok today.
 

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