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TKR Two (almost) matching knees at last!

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Bob's coming by tonight. Turns out the gift shop is open, so the nurse is spotting me the 50 cents for a Fathers Day card. It's a lovely day today, but the weekly picnic in Laramie Park isn't till Tues. so it looks like the patio will have to do. Bob is grateful that there are no group trips to the nearby Village Crossing Mall.
 
Appetite still pretty low, which is a shame because the food's not too bad. Spent more time at lunch today talking than eating, then saw today's movie, "The Guilt Trip," which was so funny (and lunchtime conversations so interesting) I forgot to ask for my pain meds, so I ended up going more than 6 hrs. between doses--they brought it to me in the movie room. Then I realized that I desperately needed the rest room, so I raced my wheelchair over there. The nurse's aide was male, so he helped me move from chair to toilet and I took it from there. I was able to get back up & into the chair myself, and was already washing my hands when the aide came in after I pushed the call button!

PT did come in and evaluate me. Guess what? I'm at 90 degrees seated flexion and near-zero recumbent extension! They took the leg rests off my wheelchair, brought in a walker, and said I'd probably skip crutches and go straight to a cane by next weekend. I am getting hoarse from talking to so many staff members, though. And hydrating like crazy because of the weather.
 
OK, the momentum has definitely shifted. It is so good to hear how up beat you are. Sounds like a fun day, and laughing releases lots of feel good chemicals to boot. Remember, this is a roller coaster, so don't be surprised when you dip back down for a spell. But you have seen the possibilities ahead. Hope you are able to enjoy some of the food while you are there. I still don't have much desire to eat either. Be good and hope you sleep well.
 
Okay--has anyone else here found that the PolarCare cuff during the night, combined with elevation, really, really hurts? Just had my dressing changed for the first time since surgery, and it's not the flexible waterproof kind the hospital uses. Feels really, really tight; the edge of the ice cuff is cutting into my skin even with a towel beneath it. And though propping up my foot and calf was agonizing, even without the pillow my foot, heel, hamstring, hip flexor and ankle ache like crazy, as if circulation's being cut off, especially to the back of my knee--no doubt because of the relentless downward pull of the ice nachine's hose. I want this thing off! I don't recall this happening last year with my right knee. Is this normal?
 
Leg looks a tad less reddish (though Betadine my be making it look worse) and feels warm. Propped back up again--nurse said I shouldn't have spent so much time in the wheelchair but should have been in bed (another nurse & therapist said the opposite). Norco kicking in slowly; male nurse rearranged the propping pillows and the cuff so that the hose isn't yanking my leg. Hadn't taken Tramadol since morning, but they'd rather I didn't take one now lest it throw the schedule off. Didn't ask about Neurontin. Due for more Norco in 3 hrs and an oxymorphone at 6 am. Physio after breakfast, but a different therapist so he/she may be more amenable to the Bonesmart philosophy than the one who evaluated me (he has an MD degree but hated the ordeal of internal med. residency). The male nurse says to let the fluids equalize so they'll be less tight against my skin. That's another thing--forgot all about the compartment syndrome that forced me to give up running in my late 20s. (You know you're not just being a wuss when one of the nation's top running podiatrists examines you and says, "You know, dear, not everyone was meant to be a jogger. How about swimming?")

The night nursing staff says to have my breakfast & lunch in bed tomorrow and catnap, iced & propped, between PT sessions. This is my first experience with what our Josephine calls an "angry" knee. The nurses both said that Day 4 post-op is way too soon for 90 degrees flexion and 0 extension--those should be my discharge goals.

Hard to accept that though I'm thinner and physically fitter than I was last year, I am nonetheless a year older with wearier soft tissues. And Bob said in his practice while visiting nursing homes, his patients seem to have a tougher time with LTKRs than R ones, even if the R ones had been in worse shape and the R surgeries more complicated. And this facility seems to be in no hurry to turn over beds--moreover, all the nurses and TKR/THR patients I've met here say that my PPO is more generous than their HMOs. I suspect I may be in here two weeks, especially with my home care situation. Still cheaper even out of pocket than two shifts a day of home health aides who can't drive me to PT.
 
Good grief, it's exasperating trying to be one's own advocate! Finally got the Norco and Zofran confirmed. But here we go again, had to point out on my discharge meds sheet given to me at the hospital that I am supposed to get Neurontin every 8 hrs (not just "as needed"). Got a dose yesterday morning, yet they tell me they don't have it in my meds tray. And just got my morning non-pain meds: they gave me calcium and iron at the same time! Everyone knows calcium inhibits iron absorption; in fact it's the first warning they put on the iron bottle. They were going to put a note in my chart that I am being uncooperative because I am refusing to take the calcium till lunch. Then, after spending nearly 1/2 hr just getting out of bed to toilet, wash & dress (with leg pointing downward), I told them that before going to PT, I'd need to re-elevate to ameliorate swelling, so the nurse's aide called to delay PT an hour. So who do you think walks in just as I get my leg properly elevated and iced? Yup, the physio. I feel like the sheriff in "Cool Hand Luke:". "What we have here....is a failure to communicate." Repeatedly. :headbang:
 
Keep fighting for what you need. Doesn't matter how "uncooperative" you are, it's your knee, your $, and you will never see them again once you are discharged. Just remember you catch more flies with honey.

Here I am, must a few days ahead of you and I am dispensing all of my own medications and have not overdosed! What I am saying is that you are simply there for physical care and support, not because your mental capacity is diminished. You should be able to be trusted to know your own med schedule. Ask to sit down with the med dispensing goddess and together write down every med and the schedule for taking them. Get a new sheet each day if you have to. Then check off meds you get as you get them so everyone can see what has/has not been given. They probably have it on the computer, but ask for a paper pencil copy. (I am going to my thread next to describe the method I use). You can make it sound like you need it for your own peace of mind, not that you don't trust them.

Good luck, and make it a good Monday.
 
They were supposed to wait an hour before taking me to PT, and it's been two. Thus, I will miss lunch. They don't have real ice packs here--just ziploc bags of ice cubes in pillowcases, which slip off. Unbelievable considering it's an ortho rehab. My dressing was put on crooked and is too tight. Now my Norco is late so I will have to wait another 1/2 hr at least till I can do PT.
Meanwhile i am stuck in the wheelchair and i can feel my foot swelling back up. still no neurontin. I feel like I'm being hazed. I have exhausted my supply of honey--I keep apologizing before every request or complaint--and am running on vinegar.
 
(((DD)))
 
I had **** like that happening left and right when I was in rehab. Probably would have been much better at home, especially when it came to my meds. Hugs!
 
Sorry you are having such a hard time when your requests are really so basic. How much longer will you be in there; do you wish you would have gone home?

I noticed that you had your last knee done at Northwestern (where I am going); how was that experience and why didn't you go back there (hopefully it's not a horror story).
 
No horror story--my surgeon's sched. at NWM was backed up several months due to all the gov't-recalled metal-on-metal hip replacements that had to be re-done. Skokie was available months earlier--which at the time wasn't soon enough! (Had no idea weight loss would make most of the pain go away, and am second-guessing having had this LTKR). Nothing wrong w/NWM, just that Skokie had much better pain management and amenities--like a posh hotel with drugs and good food. Was surprised to find last year that in contrast to the luxe sleep lab and gorgeous prof. bldg. facilities, the rooms at NWM were sort of plain-jane (old-school TVs, boring food).

And it turns out their PTs were gentler and more understanding than the one I have here in rehab. (The best facility my insurance would cover). Today was even worse than yesterday--the meds scheduling mess up totally screwed up PT, and the therapist was brutal despite my pleading. (16 min. at 3 resistance on the NuStep! And she insisted on full extension of my R knee to maximize L flexion; with quad sets held for 10 sec--3 sets of 10 reps--done with leg & heel elevated up; and straight knee raises too--low but still excruciating). When I got to the NuStep and cried out in agony, she had the nerve to tell me to breathe deeply instead because I was scaring the other patients. My knee is getting worse every day. Trying to be my own advocate but hitting a brick wall. Going home is not an option--nobody to stay with me 24/7 and insurance won't cover private duty caregivers--who couldn't take me to physio anyway. Whatever I do, (rest or PT) my leg is getting stiffer and more swollen as time goes by. Still no neurontin (they can't reach my OS by phone, so I've been using his online messaging system). Now they tell me I can take only 9 Norco a day (which, if taken 2 every 4 hrs would require 12 of them). How can I make progress if I can't stay ahead of the pain? Also, nobody knows how to elevate the way Bonesmart prescribes. I fear I'll be in here 2 weeks--or as long as my insurance keeps paying. There's a BTKR patient (May 23) still here with no plans for release. I'm scared. And this is the best place I can get.

Please don't tell me to go home and take care of myself. If I can't move and need help going to the loo, that's not an option--regardless of how many boast having done it all themselves. Everyone is different, and I know what I can and can't do. And there's too much going on at home to keep from impeding my recovery right now (can't discuss that).
 
Have given up on following my self-imposed diet. If I stop losing weight and gain some back while in here, so be it. Did get to enjoy some lovely tomato-basil soup & quiche for lunch. Dinner was bland overcooked broccoli (hey. I'm on a no-salt-added diet to bring down the edema) and an apple pork chop. The fact that it's breaded and oven-fried, with the apples having sugar, is discouraging, but I ate 1/3 of it anyway (it was a BIG chop, at least 10 oz.). Ate the strawberries and nonfat whipped topping off the angel food cake but leaving the cake alone. Not gonna press my luck, and I'm full. But if I'm gonna hurt like hell I might as well not deprive myself of too many simple pleasures. (Although the nurse's aide informed me just now that "everyone gains weight here because the food is so good." Uh-oh. Maybe that's how they keep people from complaining--hard to carp with one's mouth full. All the more reason to stay out of the ice cream parlor).

Oddly, the only prunes they have here are stewed or juice (both ugh!). So I got permission to take my own sugar-free fiber gummy chews (which kept me a regular gal at home).

I am speaking to the head of PT tomorrow, as my nurse's aide urged me to do. (Sigh. If only the hospital had its own inpatient rehab and my insurance would pay for it.....). Ready, they will not let us keep and dispense our own meds--they use a locked drawer system. Nurse came in with 2 Norco (4 hrs. ago I elected to take only one, and I had an Opana at 6:30). She says that I can still have more Tramadol if I need it. Meanwhile, they gave up trying to reach my OS and called my visiting attending here instead, who OK'ed the Neurontin q. 4h.....which I can't have till tomorrow because the pharmacy won't deliver it till midnight. I have visions of there being a drug speakeasy in the basement, with a sliding mini-window in the door and furtive passwords being exchanged between deliverymen and Receiving....

The one thing that's giving me hope it has to get better is that there is an amazing rainbow out my window. I will try to figure out how to post it later.
 
Yeah, I know you can't dispense your own, but you should be able to get a copy of the schedule. BTW, I think it is just as common to lose weight with this surgery as it is to gain it, so make sure you eat enough calories for your body to heal. It needs nourishment for that huge undertaking. I dropped 15 pounds without even knowing it was happening. Hope you have a good night.
 
This morning has been a bear. Sleep was okay, but it seemed the pain began to intensify just before I was to be awakened for my Norco. I was given a shower today, which was an ordeal. My leg is so swollen that it was agony to have it lifted on and off the bed and on and off the wheelchair leg rest; and the toilet is so high that I have to have the aide put a wastebasket under my foot lest it dangle painfully (with the commode-seat edge cutting into my thigh). I was so exhausted that I didn't protest when my shower attendant turned out to be a guy (he was very nice and respectful) and was too tired to be embarrassed or modest. He did most of the washing but let me do my own hair. Just getting up to go to the bathroom (even with the wheelchair) is physical therapy in and of itself.

Met with the therapy director just now and told her my concerns. She asked me what my PT sched was and I told her I don't seem to have one but it ought to be in the window between 40-60 min. after my Norco. She agreed; and she also said my therapy yesterday was way too much too soon and I should not have been made to do the NuStep at any resistance, certainly not for 15 min. She re-propped my foot on the bed--even 10 min. post-Norco it hurts the hamstring all the way from my glutes to my gastroc. She says I need to do this several times a day to avoid muscle contractors, but I'm feeling only the stretch--it never eases. My foot also wants to turn outward, which I've been told not to let happen. I think I will have my leg elevator wedge brought from home.

They brought breakfast, which was essentially half a henhouse worth of scrambled (prefab) eggs, sausage patty and the entire orchard with toast. I waved it off for a bowl of Cheerios and 2% milk. Finished that, so I figure I'm getting more than enough calories. The food here is pretty good and everyone seems to gain weight; at last year's rehab it was like prison food. (Yes, I do have experience with that, having done habeas petitions at a Federal pen when a law student). I am afraid I will not lose the 5 lbs. of water weight I gained in the hospital. I don't want to starve myself but I don't want to be stuffed with foods I'm not supposed to eat.

The therapy director says it's been her experience that the second replacement is more difficult than the first, regardless of how bad the knee was pre-op. She said that patients had no experience and thus no expectations for the first surgery but tend to use the experience from that as the touchstone for the second. And most patients are a year older for the next one. Guess that's an advantage of a BTKR. Too bad I didn't qualify for that, acc. to my surgeon. She says the first week's therapy should be only about gently increasing ROM and learning adapting to ADLs.
 
Oh goodness, Diva, just catching up on here to find you have had your op. You are on that damn roller coaster at the moment, but such early days. I was very interested to hear that LTKRs have a tougher time than RTKRs :shocked: Never heard this before. I wonder why/how?

You still sound positive though, which is good. Don't worry about your weight - you can concentrate on that once you get over these early hurdles.
 
Hello! You might remember me from shul. I have bad osteoarthritis in both knees which has become worse the last few years. Now I am considering getting a knee done this year, the other next Spring. Reading your pain issues has me extra nervous! But I'm nervous about this in general. I've never had any surgery, and being an ICCU nurse makes me more aware of all the potential pitfalls. But then again, my quality of life isn't what I would like. I feel my world shrinking because I pass up activities I know will hurt. So I think I need to bite the bullet. Is it worth it? I hope so!
 
I absolutely do remember you. Trish, right? My bad for not attending shul more often--seems I'm always gigging, out of town, or both (or Gordy's in a show I need to see and cheer him on). They have services here, but at 3 on Friday, and Orthodox to boot.should be interesting if I'm not stuck in afternoon PT.

Go for it. As much as I'm kvetching right now, it DOES improve. Got a different therapist this morning who, though just as intense, let me call the shots, listened to my complaints and went more slowly. Less of a drill sergeant and more of a coach.

As to the decision to have the surgeries, both my knees were bone on bone--the left one since 2006, but the right one was worse all over (and the tibial plateau in danger of disintegrating, requiring some hardware removal & reinforcement); so we did that one first. Can't say it was a piece of cake but a year later it's better than it was when Gordy had his Bar Mitzvah (1997). Did a lot of home and outpatient PT once released, and it made a world of difference. Am hoping I reach that "aaahh, that's more like it" point (where the muscles loosen and the fluids begin to dissipate) not much later than last year. Pain mgmt is better today--we doubled the Opana and halved the Norco, with Tramadol when I need it).

Gonna practice some scales & chord progressions so I don't lose my calluses; then take a catnap before aft. PT. I hope you've got a good surgeon--we'll compare notes. Meanwhile I'll sing a Mi Sheberach for you.

Wanna talk "small world?" The woman next to me on the NuStep in PT this morning was married to Bob Gibson (the folksinger, not the pitcher). Didn't get much of a chance to talk before we were both whisked back to our rooms; wondering if I should tell her of Rick Neely's recent passing? Gibson gave him his prized Božo 12-string.
 
Rehab's Internet is down, so I'm back to using my iPad. Gordy visited me today, a bit sunburned and totally exhausted after Bonnaroo. He loved the music (saw McCartney up close). But their tent was primitive, they brought no lanterns, and it rained in when the tent sprung a leak. He is not enamored with camping.

I have gotten used to the pain and made peace with it, knowing that the most intense constant part of it is tightened muscles stretching out again; and the sharp intermittent ones are due to the injured nerves, sliced-open connective tissue, and edema. My leg feels like a concrete kielbasa. But I'm dealing with it, saving the Norco (limited to only 6 a day) for before PT and letting the Tramadol and the constant level of Opana fill in the blanks.

Making better progress--can bend the knee a bit further, get more extension, and put more weight on it. Even did stairs today, using just the rail. But I doubt I'll be home soon.
 
Gaaaahhhh! The Blackhawks game is in overtime again! This is why I don't like to watch hockey when I have a dog in the fight. Things turn on a dime after long amounts of just batting the puck up and back. And the rules seem arcane. (hey, I'm not Canadian). Football has strategy and suspense, basketball a rhythm and flow (with lots of scoring and a all big enoughbto see easily); baseball is slow enough so you can catch your breath and practically see the wheels turning in the managers' minds (though a home run can suddenly change things). So I'm not watching.

Making some progress though stiffness & swelling set back in. Actual did stairs today using just banisters. And tonight's movie was "Quartet." No going out on the patio due to spraying for skeeters--two in Skokie tested West-Nile-positive. But it wasn't too hot out so I didn't mind,
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Is it just me, or is elevating extremely painful while doing it (mostly hamstrings, sciatic nerve, gastrocs) and makes the knee stiffer when you stop? Noticed this last year with my Footsmart leg elevator at home last year (the rehab didn't elevate at night). I keep waiting for the stretch to loosen as it does with dynamic stretching (as we did in PT and II usually do daily), but the relaxation never kicks in unless I'm so doped up that I fall asleep. Today I used my LoungeDoctor, which is taller but shorter lengthwise, but it was worse than last year. Nurses here say to elevate as tolerated; PT says as long as feet are above heart it's okay and gradually move to the wedge, maybe when I get home. Nurses and aides say no elevating during night sleep. And they start things early here--some folks are dressed an at breakfast by 7. No way--breakfast in bed that early is enough for me. And on shower day I need to be ready by 6:30, eating breakfast at 7:30, and at PT by 9- ish. Of course, there are the night awakenings for meds, vitals and Nature's call. (Smuggled in some prunes today; and word has gotten round the patients that I am the friendly neighborhood endorphin pusher: artisanal very dark chocolate bars).

Insurance has approved me through Friday but the staff is saying I need extra time. They say I should be approved for two weeks as a matter of course; PT thinks I'll be ready by Saturday (expecting me to work on my therapy at home). But patients say I'm not going anywhere unless I give them a concert. It's a tough demographic: except for one BTKR patient here I'm just about the only baby boomer. Almost everyone here is late 60s through 70s. And they're all awake and aware. So aware in fact that I nearly got into a politely heated political discussion from which I pulled out realizing I was about to miss the movie. I sense the debate will continue over lunch. Speaking of meals, I have given in and started eating small portions of stuff I like. Plenty of time for deprivation once I get home. Only thing I regret is that I can't get wine with dinner, because of my meds. (They offer a small glass every night).

UPDATE: HAWKS WIN! So we're guaranteed at least a 6-game series.
 
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