TKR Toni Lee Recovery Thread

[Jockette]

According to her and her measuring rulers, I am doing okay

Please don’t worry about their constant emphasis on the numbers, especially this early in recovery. Swelling is blocking your ROM, when it goes down you will be able to bend your knee just fine.

Don’t believe them if they tell you there is a window of opportunity in which you must regain ROM. It’s not true. My ROM improved after my first year anniversary and after my second year anniversary.

Right now you don’t need lots of exercises, just move your knee gently to keep it mobile, take short walks around the house every hour or 2 that you are awake.

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
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. Normal activity is the key to success.

 

[Macknit]

Discussing pain management is an extremely important part of the surgical process, an important step. Your OS and others will positively plan-out this part of recovery. You can do it. Just know the USA is on tilt right now regarding the opiate epidemic and be proactive, advocate for yourself. It's okay to feel fear, which is normal but make the best decisions for yourself and unlike me, please do not be fearful about speaking up.

Yes, yes and yes! A tilt is the perfect way to describe our US procedures with narcotics right now! I did run out on day 5 and luckily, my OSs team was all set for me Rx went in same day and DH ran to Costco for me...(27 miles he drove, didn't run!) When I realized the day before that I would be running out I just cried. Of course, the 4 day old surgery wasn't helping much with the emotions either. Luckily, somewhere between 5 and 14 days (my first follow-up) emotions and pain started settling down!

@pipn do remember that pre-surgery if osteoarthritis is your issue, we tend to get worse, even with exercising and doing all the proactive treatments. Excellent communication with your surgeon and his team will be the key in your decision. I've been blessed with excellent surgeon, PAs, nurses and PTs!!
Good luck on your decision making!

 

[luvcats]

The US is a complete nightmare right now about opiates. I was horribly undermedicated for my first knee and it was awful. For the second knee, I had a long conversation with my pain specialist to have a better plan.

I'm sorry to hear about your cat. I did ringers on a cat for about 6 months and it is an intense procedure requiring you to pay careful attention to the placement of the needle, not to mention restraining the cat. Given how fluffy-headed I was on meds, I'd say at least 3 weeks, or see if your husband can't do the standing part. We contracted out the litter box cleaning for the first 2 weeks, and that's a lot less standing than 20 minutes. It was probably a month before I could easily stand that long.

 

[pipn]

@tlfiore
You have a great attitude and I do think you're right that being positive is so important especially in difficult times. It's going to help you on your road to recovery.

I just can't believe that they gave you only 5 days of possible pain relief....I would even question if 5mg of oxycodone is strong enough to really do the trick, given my shoulder surgery experience 4 years ago. I actually can believe it because it's a typical knee jerk reaction to a problem. Even more so, I am surprised they made you start out with only tylenol in the hospital, and so slowly got you to the point of administering a narcotic. That's kind of.....unnecessary torture. I hope they have refilled or prescribed something now that your meds are pretty much done.

Do you think your bp and pulse rate might be up because of the pain? Please take it easy.....I'll be checking in on you when I can. Sending positive comforting thoughts your way.....

 

[tlfiore]

I am overwhelmed by the amount of support from all of you. I cannot thank you enough. At the risk of sounding repetitive, I'd be LOST and over-the-top FRIGHTENED if not for the supportive and INFORMATION given by this valuable community. I feel so grateful.

Okay...good news...I will get this, I will, I will, I'm determined for myself and for all of you, too to make this recovery possible. I hope to help you along the way, perhaps bring about a smile, or two!

So, another horrible, awful night last night "primarily" fretting over pain control and experiencing greater than usual amounts of pain, I'm sure the spike in pain is secondary to my first full PT session, as well as everything else this journey entails at Day [HASH=56]#7-8[/HASH].

DH had to return to work today (I've never seen a 65 yr old man so keen to return to work in my lifetime), so this has also been my first solo day. Usual over-the-top pain, take oxycodone (or not) ice, elevate, potty, rest, fluids, etc. My routine has been like 12:00 am prep for bed, 3:00 am awake & re-prep/doze, 6:00 am awake & re-prep/doze, 9:00 am up for the day. Do whatever is necessary 'til 12:00 midnight, REPEAT.

GOOD NEWS:
1-OS office calls with new written narcotic script. There is zero way I can manage (Uber) the 50+ mile round trip to obtain the written script. I am working with one of my neighbors, who frequents the town where my OS practices, to secure the script and bring it home to me. Then, DH can bring MY DRIVER'S LICENSE, HIS DRIVER'S LICENSE and the script to our local Walgreens and hopefully, I will have another 5 days (I guess) of pain meds to utilize (if required).

I DIDN'T EVEN QUESTION WHICH MEDICATION IS PRESCRIBED. I couldn't bear listening to the "Medical/Office Manager," aka "Debby Downer" get into it with me. So, I profusely thanked "Debby" for her help and immediately tried locating someone to fetch the script for me, etc before I run out of Oxycodone tomorrow morning, Friday the 8th around 6:00 am.

2-Of course this part was MISSED by me but I recall reading about it on BoneSmart...as time goes by, extreme tightening, inflexibility, stiffness, pain and rigidity develop in our knee replacement area upon waking. OMG. Anyhow, I massage, cried, ROM'd, exercised it all out at 3:00 am and managed to make it to the bathroom. I'm thankful for Depends Silhouettes. Slow & steady but I managed to recall the Bone Smart info and safely make my way to the bathroom.

3-I cried, gritted teeth, cringed my way slowly around after rising BUT I DID IT! I thought, "I feel like one of those bullet wounded Desperados you see in the old Western Movies!" You know when the outlaw receives a bullet wound, yet he and his posse must stay underground. So, the posse drags the person to some unsavory 'doctor,' who hits up everything with whiskey (the wound, the outlaw), places a nasty rag between the outlaw's teeth, outlaw grits away and screams as bullet is removed with this nasty looking forceps tool. DONE! I cannot imagine how people did it before "modern" medicine but that's another post. Anyhow, that was me this morning. I thought, "As I enter the start of Post-Op Week #2 (8th post op day today), I'm gonna do whatever it takes to make it through this recovery with a positive mindset." I am literally taking things one hour at a time, one day at a time. This is a new normal for my recovery 'cause from today forward, I'm gonna basically be on my own during the daytime.

4-Even though it was a challenge, I managed my morning routine...freshen up a bit, putz around kitchen, get coffee on, warm some lunch, exchange ice packs, take morning meds, feed by kitties, comfort my beloved Havanese Dog, Ernie, rest, elevate, etc.

5-After I insisted, DH and I tried a different infusion set-up for Rexie last night...surprisingly it went very well. I sat in my Recovery Chair, super-duper padded myself up, placed Rexie in his cozy cushion and held him on my lap, dangled the infusion bag off my floor lamp, comforted Rexie, infused away. I know I must be super cautious about any accidental scratches and I am. Accidental is the word. In 18 years, I've never seen this cat hiss, claw, bite, or growl at anyone (or anything). He is special and the fluids are temporary comfort measures. I will miss Rex deeply when he is gone

6-Today, Ernie is my emotional savior and my constant companion. This lil' guy has not left my side since I returned home from hospital on Friday, November 31. He's been without doubt, the EASIEST CREATURE to deal with...certainly easier than 1) the inpatient nurses, 2) Debby Downer at OS's office and 3) DH.

 

[tlfiore]

Oh and I meant to acknowledge luvcats, pipn, Macknit, Jockette and others.

Yes, yes and yes. Vitals were definitely elevated in response to pain. Glad I'm not practicing directly anymore 'cause I'm sure I'd be emotionally ill if I had to go through all the bureaucracy, red tape and whatever else for my patients to procure proper pain relief for them. And please for anyone reading my posts and my TKR Recovery Thread, please do not think my humor about the current addiction/overdosing/death problems in the USA is demeaning, or attempting to minimize such problems, all sides.

I feel heart-sick, worried, fearful, anxious and hopeless about what is happing in this world. When my head is feeling clearer, I hope to post something interesting I read about opiate dependence and opiate/narcotic overuse in the USA, why the epidemic might be happening, why older & elderly law abiding citizens are the biggest casualty, what can/cannot be done about the problem and what the impact on our country has been/might be. It's tragic.

 

[Macknit]

I'm hoping you are feeling better as we settle for the evening. And your DH enjoyed going back to work...
My DH is already retired and he was a trooper for 4 weeks, then he just kind of melted....he understands in his head how long this recovery is....however, let's just say patience is not this 1/2 Italian, 1/2 German's forte . Gotta love 'em anyway!

I'm sure your Ernie is a true champ! And animals do just have that 6th sense when we're hurting. I can't believe your Rex is 18! Wow!

Sounds like you have the recovery routine down, in the BS way! You will be surprised, even though these are baby steps, one day you'll just turn a corner, I promise, it will happen!

 

[caredFL]

Sorry you are having such a rough time with pain med access. I am 100% sure my pain control for this first 10 days is because I had access to the meds I needed, knowing I would not run out before I could see my OS. I have taken them as prescribed alternating between Oxy 5mg and Tramadol. Today, I was able to just take Tramadol and Tylenol since I did not have formal PT today. Today was probably my best day yet and even feel like I can walk without the cane, but I won't especially since I don't have anyone with me now. Thinking of you and hoping you get that script filled before you run out tomorrow. Better days are to come!

 

[tlfiore]

Hi everyone-I've been doing lots of BoneSmart reading but not much posting. Today is Saturday, 11/09/19 and Post-Op Day #10. The past week seems like a whirlwhind...I can barely recall what has transpired.

Well, OS refiled (much to my surprise) oxycodone 5 mg q3-4 hrs PO. I guess I was expecting a "lesser" narcotic (?). But, not to my surprise, I can already tell the oxycodone is LOSING ITS EFFECTIVENESS. I am in no way, shape, or form getting the pain relief from 5 mg q 3-4 hrs at post-op day 8 that I received from day 10.

So, I'm relieved to be seeing my OS this Tuesday, 11/12/19 for my first post-op visit. My thoughts are 1) switch to some form of prescription strength anti-inflammatory for pain, 2) add safe dose of Tylenol either q 8 hrs, or as breakthrough, 3) utilize oxycodone 5-10 mg PO at bedtime (when pain level has been the highest and pretty unmanageable...I'd say a 7-8/10) and pre/post PT.

And PT...OMG...I really detest the entire ridiculous concept.

So, we must reach the magical number of 90 degrees, right? PT on Friday at each and every yank/twist/turn, I must listen to, "Oooh we're at 84 degrees...oooh almost at 84.754321 degrees, oooh almost at 85...good job...doin' great!!!!!!"

Finally, I told Rachel, "Look the numbers mean zero to me...I know I'm doing okay...please stop...the numbers thing is annoying me."

Well, then I got the "one more try-flexion-PUSH." The pain sent me into tears. I YELLED, SCREAMED, yes yelled, "PLEASE PLEASE NO STOP PLEASE!"

Last night, Friday night was among my top two worst nights yet.

I'll be okay.

OS and I are going to have a little discussion come Tuesday.

Just having a mixed day with mixed emotions.

 

[Jockette]

Please stop allowing your PT to force bend your knee. Not only is it unnecessary, it is counterproductive and will hinder your healing.

I had the same kind of PT. My surgeon was also a fan of pushing my knee to a painful place to get the number he wanted. At my 4 month check up, he did it a second time because the first time the number wasn’t good enough.

As a result of all that I have some PTSD. I will most likely need a revision of my partial, that has had a bad outcome, some time in the future. I am terrified to do this over again.

But now I know better and no one will be allowed to hurt me again in this situation. How dare they do that just because it’s their opinion.

Please take charge of your recovery before they do some actual harm. The first time my PT (I no longer call them therapists) forced my knee was exactly one week post op. I hung onto the table for dear life. 2 hours later at home I woke up from a nap with excruciating pain in my left shoulder. The Dilaudid I was taking didn’t touch it. A few days later an X-ray was taken of my shoulder. The X-ray was fine and my surgeon’s PA called it acute tendinitis. All because I grabbed the table so tight because of the pain the PT caused me. Like I needed any additional pain. It took a while for my shoulder to heal. I couldn’t even dress myself because it hurt that bad to lift my arm.

I will do my own rehab at home next time for sure.

 

[Starsfan22]

@tifiore, I honestly think surgeons medicate for their median patient. Some patients have a lot of pain or a lower pain tolerance. They start low for those which translates high for the others. I think they feel if your really hurting with the initial dosage you'll call the office. By giving the lower dosage they're also more in line with what the narcotic police want. Don't think they aren't under pressure. Tell your OS how you're honestly feeling, tell the PT person too.

 

[tlfiore]

Thank you Jockette and Starsfan22. Yes, it seems so highly counterproductive to opt for "treatments" that continually aggravate & irritate the healing tissue. My PT keeps saying, "I am not injuring your knee...you are too anxious...what I am doing will do nothing to your prosthetic knee."

Uhhhhh...duh...yes, I get that! It's the surrounding edema and tissue trauma that is causing the pain, thus my inability to ROM at this time. I know the implant is fine. It's the surrounding areas.

@Jockette your story about grabbing onto the table 'til you wrenched your shoulder made me smh & chuckle. The entire concept is ridiculous.

Thank you again. I'm looking forward to my first post-op appointment come Tuesday.

 

[Jockette]

I hope you “tell it like it is!”

 

[flacie1]

So glad your OS refilled your meds. I need to call mine on Monday. Im only taking mine when the pain is really bad. When I was discharged from the hospital I was given instructions to take Tylenol every 6 hrs if needed, not to exceed 4000 mg a day.

My follow up is on the 19th so i have 9 more days to go. I wish they wouldn’t put so much stock in the numbers. You are doing great and I’m a little jelly, but I know with time I’ll get better and better. Today has been a great day for me, got my exercises in twice today.

I always let my PT when I’ve had enough and she’s been really good about not over doing it.

@Jockette that’s crazy about your shoulder...but I know exactly what you’re talking about. When they make me do the leg lifts I’m grabbing the table with all my might.

 

[Pumpkin]

@tlfiore ,
You can say no to PT.
Saying no to therapy - am I allowed to?

For ROM here are two gentle activities you can do on your own.
Heel slides and how to do them and Extension: how to estimate it and ways to improve it .

Your PT should be working on getting your swelling down with Elevation, Ice, Electrical Stimulation, Retrograde Massage/Lymphatic drainage, and Gait training.
Once the swelling goes down, your ROM will be there. Right now it is like a full water hose, hard to bend.

 

[pipn]

Finally, I told Rachel, "Look the numbers mean zero to me...I know I'm doing okay...please stop...the numbers thing is annoying me."

@tlfiore, This part made me laugh.......only because i totally empathize and would feel the same way.

Re the pain meds: I really have been shocked over the lack of pain meds being issued and do think that the post surgery 5mg of oxycodone is a bit low. My shoulder surgery required 10mg and that did not completely take the pain away, but made it bearable. Too bad we didn't opt for (or need) the knee replacements 5 years ago when it may not have been an issue. We are being asked to suffer needlessly, unfairly I think...one reason I dread the whole prospect so much.

As for the PT, when I got my shoulder repaired (which was not a simple one, there were pins put into bones and other stuff), my PT was awful. They did all the pushing that made me scream and there was one guy who actually made me cry (which I know was BAD). I know the bonesmart thinking on this is that it's unnecessary and even counterproductive but I'm not certain this is the last word on it. My therapist at the time told me that the reason they push is because scar tissue is forming and if too much forms in the wrong spots, you could lose the ability to gain proper rom. With the shoulder, it was a matter of trying to prevent "frozen shoulder." They also massaged the wound area for the same reason.

I don't know what's real and I don't want to steer you anywhere wrong and I don't think PT to screaming levels is good. I'm very glad you will be seeing your surgeon soon to discuss both pain management and PT. Be very honest about that pain. I have always have a tendency to downplay it when confronted with that darn stupid pain scale. I mean, I've never been shot....maybe that's a 10? How would I know? I know childbirth was terribly bad but that was so long ago....is this as bad as that was? Was that a 10?

Hang in there...........

 

[Macknit]

I still stand by my approach with that silly pain scale...add a few numbers to what I think I am, so that there is relief. If I choose to back off of the medication I will do that because I'm an adult who knows how to manage their pain. However, give me the medication/tools to do it appropriately!!

My first PT was 3 days after surgery....my PT asked me about pain and I couldn't even focus on a number....I just said, "it's very, very bad." She was excellent with me all 6 weeks and didn't ever push!

PS... @pipn Yes, childbirth is a 9-10...but it is on and off with the contractions....this knee pain was never off until the medication was under control!

 

[tlfiore]

@pipn Thank you for your kind & thoughtful post. You actually gave me some hope today, a day that's not been great. Still, I'm trying to keep my spirits up.

Your shoulder surgery and rehab sounds horrific & painful. From what I've been told, the knee and shoulder surgeries are amongst the most difficult orthopaedic rehabs due to the nature and complexity of the joints.

And yes, I hear you about the entire PT dilemma. I'm torn on the entire debate also, knowing as with most situations the "truth" is likely buried somewhere in the middle. However, I'm a voracious reader, a bit of an information junkie and (I don't want to sound like a braggart, so forgive me if I come across as such) an extremely well-educated, well-traveled, well-placed woman. In the core of my heart I know one thing is 10,000% true regarding PT. The sad truth is for those of us who have Private Healthcare Insurance, the Utilization Management folks utilize industry standardized "Clinical Pathways & Guidelines" to determine who receives what, for how long, where and by whom...

It's a complex but necessary evil, I suppose.

And while health care providers will swear 'til they are blue in the face "the pathways and requirements are all based on patient improvement, quality of care, positive patient outcomes, blah, blah," that is a downright LIE. Clinical Pathway decisions from the health insurance provider's perspective are deeply influenced by one thing and one thing only...cost savings and profitability.

You can bet all of us with private insurance have case workers closely following our cases, who must hear/see, "PT PROGRESSING, patient making PROGRESS, Flexion of R knee within Day 10-12 post-op standardized guidelines/goal of 90 degrees, blah, blah," ABSO-POSI-TIVE-lLY-LUTELY NECESSARY in order for insurance to continue doling out payments.

So EVERYONE is under pressure, top down. The hospital CEO's, the Department Heads, the Surgeons, the Healthcare Team, the nurses, the PTs, the OTs...everyone. Everyone is under pressure and the pressure completely falls on the patient.

Among several position's I've held, I did Managed Care, Utilization Review for CIGNA & Aetna for a decade or more while living (first life) in Connecticut and (second life) in Manhattan.

 

[tlfiore]

@Macknit you are totally spot-on. Yes, yes and yes!

 

[newlybionic]

If the physical therapist keeps pushing at your knee when you told her to stop that would be assault which is a crime! You don’t need that sort of ‘therapy’ to continue as it is of no help to you. I hope your visit with your OS this week goes well and you can get your medications set up so your pain is abated.