TKR Total knee replacement - despairing

[Dolphin5]

Hi Beraic and Bonnie. Thank you both for your time in writing to me. When I opened my iPad initially I thought nobody had replied.....slight panic. Yesterday, and previous days it crossed my mind as to whether I may be one of BoneSmart's failures and whether people on here may eventually give up on me......

I sit in a large armchair and have lately tried putting the cushion behind me further down to my lower back for better support. I ALWAYS have my feet up on a footstool. Lunchtime I often sit there for 45-60 minutes with my feet up. I've always suffered from swollen ankles. Decades ago I even had a couple of bricks under the bottom of my bed so it was raised slightly. Made no difference! It's a bit annoying because I'm so active and I feel swollen ankles belong to inactive people!!!!

I'm going to wait for the arrival of my elevation pillow before elevating through the night. I've never converted to a duvet and currently have a sheet, 3 blankets and a bed cover over me. This all weighs quite heavy to lift up over a suitcase and pillows. I'm up at least 3 times every night for the loo and sometimes one of my dogs gets me up, so having to negotiate getting back on to the suitcase and pillows will definitely be difficult and stressful, but once the elevation pillow arrives then I'm going for it. When I do the two elevations each day I quite often fall asleep as I'm actually quite comfortable so I think the nighttime elevation may not be too bad.

I do have a routine which changed a bit after joining the forum and learning not to induce pain in the knee.

For the past 10 days after getting up 6.30-7am and seeing to my 3 cats and 2 dogs I go back to bed with coffee and ice pack. I get up after 30 mins and then go back to bed with breakfast and another ice pack. Get up 30-45 minutes later. Busy then for an hour before back to lie on bed with elevation for 45-60 minutes. I've then often gone back to bed for 45 mins with coffee and another ice pack. Up about 12 and go on the computer for an hour. Lunch in chair for an hour with another ice pack. Will do my second elevation about 2.30ish. In between I'll have done some exercises and stroll round the garden and 10 mins walk around the bungalow.

I'm changing the above so that after my breakfast without ice pack I'm up straightaway, get dressed etc and go for a 10 minutes walk OUTSIDE on the pavement. Then exercises and elevation. I'm understanding the negative mental aspect of being in my bed so much albeit it is still more comfortable than sitting in a chair. I understand the importance of keeping moving but then that contradicts doing too much and resting. Keeping moving means walking.....I know it's all about balance and changing each days activities according to how my knee is reacting.

I agree that it is all consuming. I'm now I living a totally different life and want my old life back.

Beraic surely jarring the knee would impact it? Sudden excruciating pain would make the knee swell up even more?

I have the physio on Thursday and am half dreading it in case my ROM hasn't improved at all. I know right now my ROM is the same as it has been for at least 6 weeks. Even the smallest of improvement will make my day.
I'd be happy with 47o. Anything better than 45o.

 

[benne68]

it crossed my mind as to whether I may be one of BoneSmart's failures and whether people on here may eventually give up on me......

You are still very, very early days in this year-long recovery -- but be assured we would never give up on you. If you wander around the forum a bit, you will see that we have members who have struggled with their recoveries for multiple years and we continue to support and encourage them.

This recovery requires a great deal of both physical and mental patience. Please don't give up on yourself. Keep your body moving as much as you can throughout the day. Take breaks to ice and elevate. And find time in your day to do things you enjoy that will distract on this journey.

Sending hugs

 

[Layla]

I'm understanding the negative mental aspect of being in my bed so much

This IS real.
I was instructed to bring street clothes the day of my joint replacement. I was to dress for the day in the recovery area just outside of surgery, with the help of a nurse before they took me to the room where I'd spend the night. Being dressed can signal that it's time for us to get moving, get on with our day, so I believe you may feel better about your recovery if you dress right after breakfast as you mentioned. Dressing also makes you feel like less of a "unwell person, or patient". I thought this sounded a bit crazy when I received instruction pre-op, but I brought some soft comfy clothes and it worked well. It gave me confidence and reenforced that I wasn't unwell, no one viewed me as a patient, so I dressed from that day forward.
I hope you have a good day, Dolphin!

 

[mendogal]

@Dolphin5
It's still early days, honestly!

I was advised by my team to walk hourly starting post op day 1 - of course not much further than the equivalent of to the bathroom and back and with a walker at that point - but honestly, walking is essential.

I suggest setting a timer every half hour and getting up for a three minute walk.

Also use a timer to find what is a comfortable non stop outdoor walk and aim for twice a day - if the weather doesn't permit it, walk laps inside your home (I swore I would wear a rut into my floor after my winter time TKR!)

 

[Jamie]

@Dolphin5…..there has never been a BoneSmartie we “gave up on” during the entire time since 2008 that I’ve been with the forum. So that won’t happen. At this early stage, you’re still in the “normal” category. I know it’s frustrating to figure out the right balance between activity and rest, but you’ll get there.

Sometimes there are misinterpretations in words being passed over the internet. When we talk about walking after joint replacement (especially knees), in the early months while there is still the possibility of pain and swelling taking a walk can be as little as getting up and walking to the bathroom and back to where you were resting, icing, and elevating. If you can do a few turns around the house to equal 5 minutes or so of activity each hour, that’s what you should work toward. Of course, longer walks like you’re planning outside are also good, but that should be a once a day effort for now until you reduce your swelling.

You mention that you’ve always had ankles that swell. Have your doctors ever done testing on the circulation in your legs? Or have you seen a cardiologist to be sure your heart is functioning properly? If you could locate someone nearby who does lymphatic massage, that might help your leg swelling.

I think your new activity plan is a great place to start. Good job making a positive change in your routine!!

 

[Dolphin5]

Hi all and again thank you for your messages and encouragement.

Benne68 unfortunately there are not many things I enjoy indoors. My perfect week would be horse riding, badminton, table tennis, walking, swimming, cycling, dancing etc. Most of these I can no longer do but the walking, table tennis and dancing still feature in my life. I like cards and Scrabble but have nobody to play with! There is monthly Scrabble in the village but I can't get there and it would be uncomfortable and not good for my knee to sit with the leg sticking out!

With regard to the swelling of the ankles, I've periodically seen doctors over the years but it would appear nowt can be done, it being gravity etc. I do have 3 slightly leaking heart valves and the last echocardiogram was only about 7/8 months ago.

I recently bought a Tens machine which has excellent reviews about it helping with circulation. However the instructions say it is not suitable for 'abnormal blood pressure'. Since my normal blood pressure is 95/90 over 65/60 I'm guessing I fall into that category. It is also not suitable for someone with blood clots. I rang the company and was told to check with my GP. I'll ask the physio tomorrow if he thinks it's suitable.

Lymphatic drainage. One of my sons suggested this. Again I'll ask the physio tomorrow if he thinks it'll help.

A couple of questions: is it ok to do the heel slides in bed sitting up rather than lying down? I know it's trial and error but how many heel slides should I (be trying) to do daily? And are the chair ones different to the bed ones?

Last couple of days I've done the chair ones 5 times, holding for 10 seconds, twice a day. Bed slides 5 times holding for 5 seconds, twice a day. No negative impact the next morning.

12 min walk outside and 10 mins walk in bungalow. Will try to increase this. I enjoyed 15 minutes weeding yesterday but was conscious that this wasn't good for my knee as I was standing and not moving much but mentally it did me good.

One of my sons is coming to see me on Saturday til Wednesday. I'll actually be able to get some walks in by the sea. I'm hoping to do 30 minutes as after he leaves on Wednesday I won't be able to do this again til one of my sons visits me again. I hope I'll not regress my recovery.

 

[Layla]

A couple of questions: is it ok to do the heel slides in bed sitting up rather than lying down? I know it's trial and error but how many heel slides should I (be trying) to do daily? And are the chair ones different to the bed ones?

Hello and Happy Wednesday Dolphin,
Consider asking your PT about the heel slides tomorrow. They can observe you doing the heel slides, explain the difference between doing them sitting and lying down and in watching you, advise on how many you should strive for currently.

It's great your son will be coming this Saturday and staying until Wednesday so you're able to get outdoors for some walks. If you're only walking 12 minutes outdoors currently and 10 minutes indoors, increasing to 30 may feel too much. Consider trying to increase those walks each day before your son gets here and if you continue to get outdoors to walk each day after he leaves, your recovery shouldn't regress.
Best Wishes for your PT appointment!

 

[Jamie]

Since you know you have leaky heart valves and you have the lower limb swelling that goes along with that sometimes, it will be important to see your cardiologist annually for a check on that condition. Should you have any worsening symptoms such as chest pain or shortness of breath with activity, it might require additional visits to your GP for a check. As we age, these things can get worse and need treatment.

Have you tried any of the free online apps for card games or Scrabble? Granted they aren’t as fun as being with a group of people, but they can be entertaining.

 

[RunA42K]

Have you tried any of the free online apps for card games or Scrabble? Granted they aren’t as fun as being with a group of people, but they can be entertaining.

Besides being on Bonesmart constantly after my TKR and revisions, the game Words with Friends was very popular at the time. I would play that a lot. If you are awake in the night and can’t go back to sleep, things like this can occupy your mind until you are sleepy enough to fall asleep. You can play online with people you know or just random strangers. I even ended up playing with some other Bonesmarties while we were recovering. Keeping yourself busy without being outside and physical activity really does help until you can move around more.

 

[mendogal]

Heel slides lying down have been excruciating for many of us, while slowly done sitting in a chair are much easier.

I finally parsed it out late in my recovery from the second knee replacement:

I was lucky and had great flexion early on... but still the lying down heel slides were awful.... as was ANY knee flexion that occurred while my hip was also flexing. Which is exactly the difference between lying down heel slides and sitting up heel slides. The seated posture essentially locks the hip in place.

 

[Dolphin5]

Morning everybody. Thank you for your messages.

Firstly, the 12 min walk I did on Mon and Tue only took me 10 minutes yesterday. Amazingly I was pain free and walking, sort of, normally. Obviously limping cos of the stiffness. It was so encouraging but I'm trying not to get too excited.....I later did 2 X 10 minutes round the bungalow. Heel slides/stretching twice during the day. Usual elevation twice and numerous ice packs. My knee doesn't seem any the worse today so will do the same today.

I'll ask the PT today about the heel slides. Also about the Tens machine I've got to see whether or not I should use it, also about having lymphatic drainage. It's only the second time I'll have seen him so I hope he doesn't disappoint.

Yes, since my leaky heart valve(s) was diagnosed about 8 years ago I've had regular check ups with a cardiologist.

Scrabble on line? Not so sure as it's the interaction with people that I miss. I've had it at the back of my mind though......but if I could play with others then that is something to think about.

I was just reading a thread about someone who at 10 weeks post op, like me (10 weeks yesterday) was disappointed at only getting 70o flexion. I've yet to read about anybody like me with only 45o .

Being able to drive again is something I'm desperate for. I'll then be able to get to the shops and take my dogs for walks to places where they can be off the lead straightaway. I've only one couple who have helped me the past 10 weeks. Very disappointed with so-called friends who've never even rung me, and neighbours who are just not caring enough to,even offer to do any shopping for me. Some are church goers!

I'll let you know how my PT session goes.

Thanks everyone.

 

[Dolphin5]

Just got back from my walk outside. Yesterday's pain free walk seems to have been a one off. Today same ol' same ol' with the pain/discomfort back at about 3/10. Still not sure if this is pain or discomfort but I guess if it's as low as 3 it's more discomfort.

When the taxi drops me off later, before I go in to my dogs, I'll do another 10 minutes outside. It's certainly better than doing the walk inside.

 

[Layla]

Still not sure if this is pain or discomfort but I guess if it's as low as 3 it's more discomfort.

It's mild pain, noticeable and distracting, but you can get used to it and adapt. Does that describe what you're feeling? Good for you getting outdoors for these walks, Dolphin! I'm proud of you and happy you're enjoying it over walks around your bungalow. Hopefully a little rest with ice will have you feeling better. Please use a cane outdoors if you're limping, or as support if you're feeling discomfort.

As far as your friends and neighbors go, I'm sorry. Try not to be too disheartened. Often times others may not realize the type of support we want / need unless we express it. Consider reaching out to those you're closest to even if only to say Hi, or catch up. Maybe you can express that you'd love to get out for coffee, or a restaurant meal and they'll offer to drive, or accompany you. Or, if you're comfortable, invite someone over for coffee and dessert. Possibly if you create an opportunity for conversation, some of these friends may realize you can use a little support and step up in that area. It may be worth a try.

I'll bet you're getting excited for your sons visit. I hope you have a great time together while he's there.
Happy Thursday!

 

[benne68]

Yesterday's pain free walk seems to have been a one off.

Having a good day followed by a less-good day is not uncommon during this recovery. It may be that your body needs a day to recover after pushing your limit a bit as you did by reducing the amount of time it took you to walk the same distance.

Something that helped me get through those early roller-coaster months was to alternate between an active day and a rest day. Perhaps you could try walking every other day and see if that helps?

 

[mendogal]

3/10 is not unusual at this stage.

At least on my own gauge of pain, it's minor pain that isn't worrisome - part of daily life - and just hits my threshold for acetaminophen (paracetamol).

I agree with alternating more and less active days. It's how I handled my knee recoveries.

 

[Dolphin5]

Hi and thank you for your messages.

Layla yes it's mild pain, distracting and noticeable. So is it ok to carry on with exercises with this level?

Today at physio: measurement of me pushing back my knee was still 45o, same as 9 days ago. When he pushed it back to where I could just bear the pain it was 55o, it was 50o 9 days ago. Not sure if this is a positive thing or not.

He said we must get the knee bending or it may become stuck. Not something I was keen to hear.

He did some exercises with me, again said I was stable and I do not need a crutch though I explained I'm not using it but take it out with me as a precaution.

Soooo basically he has given me exercises to do. The main one is the heel slides in a chair. He wants me to do this once every hour or two. 3 repetitions and holding for 30 seconds to a minute. Using my good leg to push back the knee.

Next exercise is lying down, towel around the ankle and bring the knee back as far as possible. 3 repetitions 2 or 3 times a day, holding for 30 seconds to one minute.

Another one is standing to sitting. 2 or 3 times a day, 10 repetitions.

Last one is knee extension. Lie down, rolled towel under the thigh, just above the knee, push the thigh down into the towel and lift up the heel. 1-2 repetitions, 2 or 3 times a day, hold for 2/3 seconds.

I did the first one in the chair, 3 repetitions, holding for 30 seconds. Just on the edge of pain. All ok. But later I thought of the forum and feel that what he's given me is too much???

Today I did 2 walks outside. The second one, straight after the physio, was actually more comfortable than the first one. I've done the exercise mentioned and 10 mins walk round the bungalow. Tomorrow I'll continue the walking and do just some of the exercises the PT wants me to do and if no I'll effects will do more each day.

On a disappointing note it's 2 weeks since I started the new regime via the forum with exercising with no pain, 10-12 ice packs each day and 45-50 minutes elevation twice a day but still at the same flexion of 45o.

Thank you for reading this.

 

[Dolphin5]

Thank you Mendogal. I have no problem with the 3/10. My main concern is not making my knee worse with pain. If 3/10 is acceptable and won't make my knee worse then that's great. My big fear is setting back my recovery by causing my poor knee pain thereby making it swell more......

 

[mendogal]

Heel slides and knee extensions are safe in terms of the stage of healing you're at.

The heel slides were a key rehab exercise for me. They are best treated as a very slow stretch, with your quads as relaxed as possible (warmed up with a three minute walk first and maybe a gentle massage) and done with slow deep breathing, relaxing into the stretch as you exhale.

The lying down with the towel is, like heel slides, essentially a passive stretch. It's hard to do them in a state of relaxation though given the tendency to skew the body to achieve it. If you want to try it, again approach very slowly, with slow deep breathing, aiming to relax thoroughly into the stretch.

The knee extension is basically a variation of a quad set, which was the only other key exercise in my own regimen. I strongly recommend that the "push down" should be a natural result of contracting the quads, not assisted by your hands. If you tolerate this well you might find it translates well into doing the quad contractions randomly during the day while sitting around resting, even without the towel, as it promotes effective quadriceps firing.

My real quibble is the high number of repetitions on the sit to stand. Our recovering bodies often don't like repetition. May I suggest trying one set of 5, done at a relaxed pace, every other day, then slowly increase only as they are tolerated.

 

[Jamie]

I agree with mendogal about the exercises. The “bend and stretch” ones are consistent with what we tell people is really all that’s necessary to keep the joint mobile during the early weeks of recovery. But the stand and sit is a strengthening exercise and something that may cause you additional pain if you do it at the levels suggested.

Please try to ignore the thearapist’s threats of your knee “freezing.” That’s not going to happen if you’re up and moving about during the day and evening. People just won’t let go of that idea that you only have a small window of time at the beginning of recovery to regain your ROM. That just is not supported by any current scientific data and it was an older idea taught years ago. Actually, the opposite is now supported by studies that you can continue to gain ROM well into the years beyond your surgery. It’s just much slower than what is gained at the beginning.

I did read a comment where you indicated that you were limping on your walk. If so, this is not a good thing. Even though you may be stable enough to not need a crutch, if you limp on those walks, please use a cane until such time as you can walk slowly without a limp. Limping causes problems with your whole body and can result in additional pain for you.

But I think you’re doing well!!! Keep it going.

 

[Dolphin5]

Hi Both

I'm greatly encouraged by your comments and now understand what I need to do. In my ignorance I was thinking that the sit/stand exercises were the easiest and least harmful.

Thankfully I have no ill effects from everything I did yesterday. So should I do the main one of the chair heel slides every one or two hours like the PT wants me to do or should I err on the side of caution and only do them 3 times today, perhaps 5 times tomorrow and gradually increase? Also for 30 seconds or aim for a minute? I'm just so worried about overdoing things, causing my knee pain which then increases the swelling.

Limping. Am I limping? I can only lift my leg about 4 inches off the ground. Therefore I'm walking 'funny'. My leg swings out slightly to accommodate the stiffness. Only slightly. Perhaps wobbling slightly from side to side is a better description. I take the crutch but don't use it.

I tried the elevation in bed last night but unfortunately it didn't work. After 2 1/2 hours I had a very strong ache where my heart is. I'd also slept very badly during this time. So I abandoned it. Disappointing but at least I tried.

One exercise never mentioned on here is standing, going on to tip toe, and coming down counting to 5. I actually quite like doing this cos it's so easy!! Is it beneficial though in your opinion?

Thanks again.