TKR Two (almost) matching knees at last!

[bottomshollow]

Dulcimer Diva, Happy to hear that rehab was a bit like a summer vacation and you enjoyed it along with getting all you needed toward recovery. But somehow nothing really beats being at home when we're up to it.

Take care and keep us posted. We care.

 

[Dulcimer Diva]

Home at last!! My cats seemed a bit wary of me (although I've been away this long while on tour), but Happy (the baby, a 5-yr-old perma-kitten) caught on very quickly and has been all over me like a cheap suit. (His favorite places to cuddle and purr are my chest--especially when I'm in my recliner trying to type--and nestled against my leg, especially when I'm under the covers and he's effectively sealing me in). I have my ice packs in the freezer and pre-filled baggies of ice cubes for my cooling machine. Gonna hook myself up in a moment or two, since I needn't get up till my next meds due at 11pm. Took 2 Norco before PT (and it was a LONG session) and OT; and they did serve me a farewell lunch at rehab (a big bagel with cream cheese, lox and all the trimmings, split pea soup, salad and peach pie)--I was too stuffed to go downstairs and have an ice cream cone for the road!

We had to stop at a couple of pharmacies to pick up meds, and I went inside, using the shopping cart as a walker. Not difficult at all. Easy going up the deck stairs and into the house too. Of course, it's tougher to get comfy here than in rehab--the recliner and the daybed can't be adjusted to avoid stretching my hamstrings or my hip flexors, but I knew that going in. No way we could rent a hospital bed because there's no room for one. My cats will just have to let me rest. I remember from last year how much my non-operated leg hurt because it was trapped in one position all night. I'll just have to deal with it.

I have just a few days left on Coumadin, after which I will have lost my excuse not to be on my low-carb/high-green-veggies diet; so tonight I treated myself to some real NY-style pizza from Jimmy's, which I hadn't had since January; tomorrow I'll walk to Lickety Splits on the corner for a small dish of chocolate frozen custard with sour cherries; and assuming we have no leftovers from grilling tomorrow night, Friday I will order out for Chinese or Indian food. Tomorrow I will have either my first fried or my first soft-boiled egg since surgery: in rehab we were limited to pre-scrambled eggs or a single (ugh) hard-boiled egg. Who knows--maybe I'll even have French toast on Friday! (I will have to cab it over to the health food store that carries my special low-carb bread from Tampa, since my corner health food store sells only local artisanal bread; I have only 3 or 4 slices of low-carb remaining). I also ordered a Caesar salad tonight but have no room for it.

The prothrombin time/INR visiting nurse is coming tomorrow. I assume the PT will be coming either Fri. or Sat. I'm staying down here on the first floor, though I will have to go upstairs to the bedroom if I want to use my hand weights. I have all my other therapy supplies down here.

I have my MSNBC, CNN, HBO and Showtime (which the rehab didn't), plus a full DVR hard drive of shows I'd recorded to wade through and catch up. And I have this full-size laptop (with legible fonts) instead of the little MacBook Air I used while "in the joint." Nice to be able to post right away without having to wait for the rehab center's access page to pop up!

 

[Lovestoread]

Hope you were able to get a decent night's sleep. You sound so much like me.....what an overachiever! (That's my nickname at work) You've got everything planned down to each meal. Those kitties are so glad you are home, even if they don't show it. For the most part it's not in their nature to show their feelings. Just remember not to over do! That's the hardest thing for me. I'm not used to people waiting on me. That's usually my role. I do have three people offering to take me to my first out-patient P/T on Monday and I'm actually going to let one of them do it....a huge step for me! Enjoy the 4th, just remember to rest, ice, and elevate!

 

[Dulcimer Diva]

I slept like a baby--hit the pillow at midnight and next thing I knew it was 7:30--took my scheduled meds, rolled over and slept another couple of hours. Happy lay on my chest and purred me to sleep (though this morning he tried to explore my legs beneath the duvet). Sciatica is acting up, so sitting in my recliner, feet elevated, heating pad at my lower back.....aaaaaahh. After I do my weights this afternoon upstairs, I may reward myself with a session in the massage chair (w/o calf massage, of course).

While I was "in the joint," the quarterly meat shipment from Signorello Winery's wine-and-dead-animals club came in: gourmet sausages, ground venison, filets. My housekeeper put it all in the basement freezer so I wouldn't be tempted to overdo by grilling. She forgot that I have my minions (Gordy and his ex-GF) to fetch stuff for me today.

Cooked my first meal in over three weeks: lightly fried farm-fresh egg, 2 slices artisanal bacon, and coffee. Filled and fired up my espresso machine, chilled a carton of almond milk--will reward myself after my shower with a low-carb cappuccino (and maybe a plain double ristretto espresso)......because I can!

 

[Lovestoread]

So jealous of your sleeping!! I have insomnia and seldom sleep more than 3-4 hrs total on any given night. Regular Ambien doesn't even work for me. I have the extended release Ambien that works well enough to give me 5 hours of sleep, but I worry about taking that with the cocktail of meds I'm on. I've been icing with the ice machine even at night, so that stupid hose makes it pretty uncomfortable. I'm constantly tossing and turning. Even a regulator ice pack keeps me awake.

It is a great thing to be able to cook, isn't it? I love to cook, so I feel better being able to do normal things again. I have such a taste for lobster rolls! I plan on ordering some lobster meat and split top rolls next week and give in to my cravings. A lovely glass of wine wold be nice, but alas, I don't think it would be a good idea.

Since my surgery, I've been having a cappuccino every day as my little treat. We do need to pamper ourselves after this terrible intrusion on our bodies! I have a massage booked for a week from Sunday. I've been going to the same woman for four years and she's going to work on my knee a bit. I told her she had better study up on it, as its not something she normally does. She sounds like she's looking forward to it as much as I am!

 

[Dulcimer Diva]

Where do you get the split-top rolls? (I Googled "split-top potato-flour buns" and "New England hot dog rolls" and got nowhere for local vendors). I don't have a pan that makes small enough mini-loaves (and don't have the stamina or patience to make and raise the white bread dough). Peapod does carry the lobster meat (or Dominick's has whole lobsters--though I'm leery of crossing Broadway to get there because of my tortoise-like walking pace).

Missed my mani-pedi last week (had nobody to take me there and it'd have been totally nuts to hire a medi-car for that) and as a result, my chronically ingrown (but thus far non-infected, knock wood) toenail is driving me nuts. My surgeon's office says to consult my FP before going to a podiatrist; my physical therapist said just soaking it in an epsom salt or peroxide solution before going to my nail tech--the nail spa owner--and telling her not to dig too deeply should be fine; my husband says to tease the barb out and stuff some bacitracin-soaked cotton underneath but I don't have the tools to do that. Meanwhile my nails have grown out so much that the edges of the gels are starting to peel. I've been oiling the cuticles & nail beds and using a glass file for the past couple of weeks.

That stupid hose on the ice machine has been frustrating for me too. I've decided not to sleep with it on my knee, but just do it while awake. My surgeon and his PA said a couple of elevating sessions a day should be fine so long as I don't spend too much time on my feet or sitting with my legs down. My deep sleep came courtesy of Norco--two pills are my bedtime dose. I'm taking one every 5-6 hrs. while awake, with the first one nine hours after the nighttime dose (I took the Opana & Neurontin upon arising); because I have no PT today the only 2-pill dose I need is at bedtime--and that's to make sure I stay ahead of the pain. I had a few Norco 10s left over from last year and some 5s from when I threw my back out earlier this winter, so I can taper. The rehab center gave me a hard-copy 'scrip from my attending to fill when I got to my pharmacy yesterday--but he phoned it in along with my other meds. Also found some leftover 2-and-3mg Coumadins (splittable) from last year--when I talked to the INR nurse last night, she said they're still good and my husband confirms that.

 

[Lovestoread]

Believe it or not, my local Jewel had them about two weeks ago sitting right next to the regular buns! Couldn't believe my eyes. Put them in the freezer, so haven't had them yet. Recently a friend told me about thelobsterguy.com we ordered the lobster roll kit and they were excellent! Ok, pricey, not something we'll do on a weekly basis, but worth every penny! In the past we've ordered from lobstergram.com and discovered last year they have a warehouse on the north side off the Kennedy expressway. Good god...the stuff is like 1/2 price from their website and catalog! Kinds of far for us, but not too bad for you. My husband has gone and couldn't believe the prices, especially on live lobsters. Unfortunately, although we could get packages of lobster meat from them, they didn't have the rolls. About two weeks ago, however, we got a catalog from them and they, too, are now selling the lobster roll kits. Might be worth a phone call to see if they have them at the warehouse.

I got my mani/pedi the day before my surgery. I go to a girl's house and have for years. Next week she's coming to my house for my manicure. She lives in the same suburb, so it's not a bid deal to her. Guess I'm vain, but I do have to have my nails done. I was so thrilled I didn't have to remove a nail or any polish for the surgery like I had to in the past.

I sure wish the norco helped me sleep. I told them that it usually didn't do much for me, so they have me taking 2 every four hours. Not sure it's doing much for the pain, but hesitate to stop it at night. I spoke with the nurse yesterday and she said I could take m extended release Ambien along with the norco, but that kinda scares me. Maybe I'll try one norco and the Ambien one of these nights. I do take the norco every four hours at night, because, heck, I'm awake anyway just looking at the clock.

 

[Dulcimer Diva]

You might also ask your doc if it's okay to try a small dose of a benzo like diazepam (Valium) or a muscle relaxer like cyclobenzaprine (Flexeril) with a small dose of Norco. For my back, I usually take 5 mg. Norco and 2.5-5 mg. diazepam (depending on how stiff & sore my back is) q. 6-8 hrs., with 500 mg. acetaminophen if there's breakthrough.

You may be unconsciously clenching muscles (esp. jaws) that keep you from relaxing enough to sleep. I learned a creative visualization technique in my Bradley childbirth class that allowed my Halcion (now proven too strong a benzo) to work during the depths of my anxiety-overlay postpartum depression:

1. Gather up as many pillows as you can, and support each limb plus your head with them.
2. Lie down on your back in a dark and quiet room (or put soft ambient music or nature sounds on the stereo or computer--headphones or earbuds might make you tense up). Eliminate distractions--turn the ringer off on your phone and let calls go to voicemail (don't even try to listen to the answering machine or determine who's calling), turn off alert sounds on your computer or mobile device, don't let your pets walk on you, etc.; keep the outside world out.
3. Let your face, neck and jaw muscles relax and allow your eyelids to close (don't squeeze them closed). If it's more relaxing for your eyes to stay open, that's okay too. People fall asleep all the time with eyes open. Let your mouth relax and stay open. The only muscles you should feel working are your heart and those that let you breathe.
4. Imagine yourself in the most tranquil and beautiful place you know: a secluded beach, a lounge chair in a garden, floating on a pond of water lilies, a comfy mattress in a forest, lying on a carpet of thick soft grass at perfect room temperature, etc.
5. Stay limp and let your limbs feel heavy. Do not imagine you need to hold them up--that's what the pillows are for, reassure yourself they will support them. Do not think of results, or worry about anything (especially falling asleep). This is a time to let go.
6. Breathe in deeply and naturally through your nose--the air will pour in like water into the bottom of your diaphragm; breathe out slowly and naturally through your mouth, as your breath pours from your diaphragm. If you find yourself unable to determine when to breathe through your nose vs. your mouth (and don't care), you're on the right track and heading towards sleep.
7. Starting with your feet and going upward, imagine all your limbs falling asleep (not as in "pins & needles") all the way up to your face, neck & jaw.
7. You will probably have fallen asleep by now, and may even be drooling (a sign you're really doing it right). You will probably have started unconsciously thinking stuff that makes no coherent sense, the way you do as you fall into twilight sleep, not quite a dream.

If it doesn't work the first time, lather, rinse, repeat. When my sister fell off a chair in her hotel room (she was trying to change a light bulb, don't ask) I talked her through this as she waited for the paramedics to arrive. I never got to fully use this in childbirth, as my son stopped descending 8 hrs. after I broke water and they had to do a C-section. But it got me easily through each contraction--unnecessary muscle contractions tell your nervous system to "compete" with the only muscles that should be actively contracting. I was disappointed that I wasn't going to be able to continue labor past stage 1, since it felt so soothing to go with the flow!

 

[Dulcimer Diva]

My youngest kitty has been monopolizing me, to the point where I can't see my keyboard or even half the screen and it takes several tries to type a word: imagine Garfield on my chest, front paw resting on my right forearm, head nuzzling my glasses! (My husband said to be patient--Happy's been without his "mama" for three weeks and wouldn't let anyone else in the house pet and love him while I was away). And right now my senior kitty Matthew (17, in kidney failure for a year now and getting sub-cu hydration every other day) is curled up on my daybed, so there goes elevating. Have to improvise here on my recliner and hope I can turn it enough so that the back is free to recline fully. (Have the "elevate and ice" part okay, but still working on getting the nose below the toes!

My first PT visit is tomorrow aft., and he's also coming Sat. He is concerned that I have some hard lumps along the incision, and wants to make sure I can at least maintain the 100 degrees flex/0 extension we were able to reproduce my last two days "in the joint." I've been doing my gentle squats and hamstring curls while standing at the sink or counter, stopping at the point where there's just no more bending happening (well short of pain, or even discomfort). I will have an introductory talk with him as to how hard I choose to work and my "safe word" (which worked with my therapist in rehab). I realize this knee was more of a "problem child" than I'd originally thought: valgus, leg length discrepancy, a full year's extra wear & tear--especially while rehabbing the right knee, tearing my L meniscus attempting to climb into a van in January and thinking my L leg was still the "good" one.

It was a trying night with the cats. We live not far from the lake & Loyola campus, and there were local fireworks galore (not to mention firecrackers too). All three huddled with me, Matthew actually trembling. They even tried to follow me into the loo! But I had to get up from time to time and walk around the first floor, out to the porch and out to the deck in order to stay limber (or what passes for limber post-op). Bob brought home ribs, reasoning that grilling was not such a hot idea and I should do only the barest minimum cooking for awhile in order to lie down and rest. Glad I ended up not inviting anyone over, just taking phone calls!

Paradoxically, for all my complaining about the rehab nurses' delay in bringing and rationing of my pain meds, I find myself going an extra 30-60 minutes before I realize it was time to take them. I am taking the same number of Norcos a day (6) but allocating them at more even intervals, with 2 at bedtime--and 2 half an hour before my PT comes over tomorrow.

 

[Titianlady]

Dulcimer Diva. Aww, bless the kitties hearts, they missed their mama! I have three cats now, and all three of them stay with me 24/7
My little Egyptian Mau, Chloe, keeps me in sight at all times,and even tried to push the walker with me. During the day, she slept in the basket my husband put on the front of the walker. At night she is snuggled right next to me. She is right beside me whenever I get up to walk.she walks right beside me where ever I go. She even sat outside the shower door while I took a shower.

Last year she wouldn't let the therapist touch me. She stood over me, and would grab his hands in her mouth when he reached for my leg. She didn't bite him, just didn't want him to touch me at all. My husband had to come and take her out of the room.

We had lots of major fireworks here. Lots of huge booms and noise. Funny the cats didn't mind at all.in fact they kept going to the doors and windows to see what it was.they were fascinated.

Seems you are doing very, very well Sandy! I'm still dealing with a lot of internal tightness and swelling. I can bend the knee wonderfully, and my extension is 0. Straight leg lifts are easy. But when I stand up, I can feel the swelling and stiffness start immediately.

Lots more elevation and icing with this one. Oh, well, it will resolve itself when it's ready.

Enjoy the rest of your evening Sandy.

 

[Lovestoread]

Fireworks were crazy around here! I haven't been home for the 4th in at least 25 years, so I didn't know what to expect. Normally we spend the week at our cottage on a lake in central Minnesota. Neighbors invited us over, along with several other neighbors and just relaxed. Unfortunately I wasn't moving much and I was pretty stiff last night with the sciatica acting up. I slept a little better in spite of all this. I had been sleeping with the ice machine and ice packs, but tried to go without last night. That hose was making me crazy as I toss and turn all night. Guess I'll try sleeping without the ice again.

 

[Dulcimer Diva]

Today was my first home PT visit, and I learned several surprising things. One, was that by doing just an occasional squat, ankle pumps and extension exercises but not doing my non-weightbearing flex exercises after I got home and yesterday, my knee stiffened up (from too much walking--see infra) and I lost quite a bit (nearly 10 degrees) of flexion since my last measurement. Two, that "pre-hab" did make a difference: my quads and hip flexors are quite strong compared both to last year and my initial "pre-hab" evaluation. Three, that just because I can easily walk without a cane doesn't mean I should. (Something no one ever mentioned during rehab). Therapist explained that an accidentally broken leg takes at least 10-12 weeks for the broken surfaces to heal; and that one surgically broken still takes at least 6-8 weeks. <4 weeks post-op, the bone surfaces are still quite tender even if it's not apparent from the outside; and that too much independent walking too early irritates the bone surfaces even if we are scrupulous about avoiding "impact loading."

He says that it's okay if I need to get up to walk within the room and to the bathroom a few times a day, but he'd rather I use the cane whenever I can--even walking around the kitchen, out on to the deck and using the stairs (I have two rails). He thinks that even though I can go up & down the stairs I should sleep on the first floor a few days longer; once sleeping back in my bedroom I can use the upstairs tub/shower (which has better water pressure) w/o a transfer bench but I should use a shower seat instead of standing. I mentioned I wanted to walk to the corner (1/2 block at most) for a frozen custard, and he said that is the maximum distance I should be walking, no more than once a day.

We did get to 90 degrees but not pushing to the point of pain--he says we need to work hard but I probably got 100 by pushing (or being pushed) too hard at rehab the last couple of sessions. He says I should probably do two weeks of home PT and then get back to Athletico, but that my criterion for discharge to outpatient PT should be 105-110 degrees (toward the conservative end of that range). He'd like to see one degree of improvement per day--and to achieve that I need to do my flexion exercises (especially supine with a leash, seated with feet on the floor and scooting forward to the edge of the chair, and modified lunges on the bottom stair with my non-surgical leg doing the weightbearing) twice a day. Once is not enough (which means I should get in a bedtime session) and three times is way too much. And that I must rest & ice before & after, though after icing a little moist heat before the exercises to loosen things up is okay. He also says E-Stim is a great idea.

He's coming tomorrow & then Monday. I think I'm really gonna like this guy. (Doesn't hurt that he's easy on the eyes too). My ice pack is tepid....so off I go to Lickety Splits. Slowly. With a cane.

 

[Lovestoread]

Very interesting! My therapist said I should be walking around the house without the cane. Honestly, sometimes I set it down and just walk to the sink or whatever. I guess that's ok. I walked about a block (with the cane) this morning and boy, did that do me in! I've been exhausted ever since. I do use the cane on the stairs even though there are rails on both sides. Just feels better that way. Isn't amazing that we can stiffen up in such a short time? I guess they mean it when they say to do your exercises daily. I was told 3-4 times a day though and you were told no more than two. I won't feel guilty about only doing them twice, then. I noticed my knee would stiffen up, as though I were over doing it when I did the exercises three times. It will be interesting to see what my new therapist says on Monday when I start my out-patient. Since I continued to go to my gym working on my leg muscles right up to my surgery, I was happy to see that it seemed to help me after surgery. My upper body was pretty strong already from years of heaving myself up out of chairs when my knees wouldn't cooperate.

 

[tori645]

last 2-3 yrs i've been using this sleep aid stuff from costco.. one little blue pill.. out until the morning.. if i have to get up for the dogs or other reasons.. no issues in being groggy.. do what ever and go back to sleep.. use it when traveling to canada.. 3 13 hrs days on the road.. no issues being groggy when it's time to go..

 

[Dulcimer Diva]

Decided not to go out for frozen custard, but rather nuke the rest of my leftover ribs and eat a salad--dinner first. No room for dessert; plus the weather cooled off, I'm in shorts, and I don't feel like changing clothes again before getting into my nightgown. (I don't need the carbs or calories, either). Tomorrow will be warmer--maybe a reward after my aft. PT? Besides, my knee is angry so I am icing it as soon as the gel pack refreezes--several cycles thus far. Not enough ice cubes in reserve to fill the machine.

Except for the part about no PT until 4 wks out, my therapist agrees completely with the Bonesmart mantra. (I got to 87 without trying--and 90 was with discomfort & tightness but not pain). He was concerned about the three shows I'm doing next week, but relaxed when I told him I'd be sitting the whole time. He made me promise not to play out more than once a week till August; wasn't hard for me to agree since I have just one firm gig till mid-Aug. (the farmers' mkt. I'm playing will let us return on 7/20 if my partner & I want to--but he'd have to drive down from WI again so I have an "out" besides my knee--unless we do REALLY well in tips & CD sales on the 11th).

It was time at 8pm for a Norco, but seeing as how I took 2 at 3:30 before PT I'm not in pain--so I took a 5/325 Norco (the equivalent of half a 10/325 but with the full amt. of Tylenol) instead. If I still hurt a bit, I'll add a Tylenol. (I just took my long-acting oxymorphone as prescribed, so I'm not disobeying the mantra). At bedtime, I'll see if I feel I need 1 or 2.

Tori, the Costco sleep aid is an antihistamine and I take Zyrtec already for my allergies. But you're right, it works very well. So does valerian root (it drops me like a plugged buffalo), but it's a no-no if still on blood thinners because it can thin blood even more. Besides, it smells like feet.

 

[Lovestoread]

last 2-3 yrs i've been using this sleep aid stuff from costco.. one little blue pill.. out until the morning.. if i have to get up for the dogs or other reasons.. no issues in being groggy.. do what ever and go back to sleep.. use it when traveling to canada.. 3 13 hrs days on the road.. no issues being groggy when it's time to go..

Tori do you know if it has melatonin? For some reason that has the opposite effect on me....keeps me wide awake! I've tried so many things over the years, I've about given up! What is the name of this miracle pill at Costco?

 

[tori645]

Lovestoread... i think it's just called Sleep Aid... doxylamine succinate 25mg

 

[Lovestoread]

Thanks, I'll have to look into that!

 

[Dulcimer Diva]

Yup--doxylamine is a type of antihistamine that aids sleep as well as Benadryl (on which first-gen OTC sleep meds were based) does without a residual groggy feeling. One thing that people sometimes forget when dealing with insomnia is that light at the wrong time during your intended sleep cycle can mess up your circadian rhythms and make it difficult to fall asleep. Get your room as dark as possible and don't use your computer or watch TV w/in 1/2 hr of bedtime--the light emitted by the screen can inhibit falling asleep.

For the first time since early in my rehab stay, last night I had pain so intense I couldn't fall asleep. By 90 min. after taking my two Norco 10s, they still hadn't kicked in and my deep muscle aches and stretches--combined with sharp pangs over my kneecap--brought my pain level up to about 7. (Even the edges of my ice machine's knee pad, despite the cloth underneath, irritated the skin over my incision). Earlier in the evening, when it was time for my single Norco 10, I'd substituted a Norco 5. So at that 90-minute mark I had to add back another Norco 5. That--plus a second round of icing and one-pillow-lower elevation--finally did the trick and I slept like a rock (kitty on my chest purred me to sleep).

I was ready to tell my PT today that twice-daily exercises (my second session was between dinner and bedtime) were too much for me, as I was sure that's why my knee and its muscles were so "angry." He asked me to demonstrate how I was doing my exercises; and told me I was doing them too intensely. He told me that it's always better to stretch longer than to stretch harder, and to take my sweet time in between reps to calm my knee down. He did some gentle but firm scar massage, and it helped relax the scar and its surrounding muscles. We were able to get 92-93 degrees of flex (yesterday was 90) and maintain 0 extension. He said it's not so bad if I improve very slowly--some people just do. He also said that elevation isn't nearly as vital any more, as I no longer have lower-leg edema so toes-above-nose isn't necessary--just knee-above-hip. Also, if I am getting severe hamstring & piriformis aches, I can support the knee with a pillow if necessary since I do have full extension. I've been icing gently now for the past couple of hours, and can stop. (Bob had to bring home a bag of ice last night because our freezer's icemaker can't keep up with my ice machine's demands).

And when it's time to take my after-dinner Norco, I'm not going to cut the dose in half. Hopefully, my midnight dose will suffice; if not, a Tylenol and a Costco sleep aid (or perhaps half a diazepam) will do the trick.

 

[Brithael]

I read somewhere on this forum that freezing solo cups of water works better in the ice machines than cubes. I've already started freezing some to be prepared.