PKR Two weeks in and support waning

[icep707]

You are in a pickle , ideally you should just rest , elevate and ice all day, but since your ever so helpful hubby aint helping , thus making you do chores, your knee is swollen internally. It wont bend . !! I doubt you even have adhesions . I had crummy flexion for my first 4 weeks because basically I did everything by myself , I kicked my girlfriend out after 1 week. I thought she was gonna smother me with a pillow. You really get to know who can caretake and who cant . Granted my first week was the most crucial and she did drop off food daily after week 1 but jeez , it was rough. And I started getting paranoid about it. All for not . My OS told me to take it easy , I was doing way too much. With low flexion and all. Fortunately I had very minimal pain . Thanks to round the clock med intake and excessive elevation and iceing. I would wait on the MUA and rest over the weekend, light exercises . Give it another couple of weeks . To me it sounds like a money grab from your OS. You are not even a month in . ! Totally ridiculous and uncalled for . My humble opinion. Lets ask @Josephine and get her imput. I know she doesnt believe in MUA till at the very least 12- 16 weeks. Best of luck. Iceman

 

[ChubbsterPT]

Chubanana.
Well I have just written a long post at 15 weeks. All I can say to you is that it is not an easy path. The operation is brutal to say the least. As a Personal Trainer and a fit and healthy 66 year old I thought I would sail through the operation and be back to my normal self in no time. What an eye opener that proved to be. I spent the first 6 weeks horizontal, not wanting to eat and drugged to the eyeballs. Living on my own I had to manage and luckily have a sympathetic partner who was constantly looking in on me. It was three months before she came and stayed with me as I said I will keep you awake at night tossing and turning. I hope you have made your hubby watch the operation and shown him Bonesmart. Don't give in when people moan at you but just give them your crutches and tell them to spend a day or two trying to get about on one leg!! I hope your recovery goes well and there is always someone on this site who has a sympathetic ear.


Sent from my iPad using BoneSmart®

 

[ladymax]

Hmmm icep707, now I'm starting to worry! I'm going to rest, ice, and do light ROM exercises this weekend myself, and see how I progress with range. If it starts improving, I'll let the Dr. know.
One thing my home PT said (today) he had a concern about, was if my MCL had detatched from the bone, which would explain the new medial knee pain and high sensitivity I'm having. Yesterday I told the Dr. about the medial knee pain, but he didn't evaluate further. He said x-rays looked fine. Can you see ligaments on xray?

 

[Josephine]

Yesterday was a bad day for me (2 1/2 wks post op) with nausea, pain, fatigue, blues.

I'll have some questions for you later!

I had to walk on crutches a couple blocks from parking spot

Why didn't you wait at the theatre and they come round and pick you up? Not that you should have been doing that at 2½ weeks! Asking for trouble!

Who was it, btw? Anyone we know?

One thing my home PT said (today) he had a concern about, was if my MCL had detached from the bone, which would explain the new medial knee pain and high sensitivity I'm having. I told the Dr. about the medial knee pain, but he didn't evaluate further. He said x-rays looked fine. Can you see ligaments on xray?

Because it's so unlikely. I've never heard of such a thing. Perhaps in athletes and sporting types but not in a TKR.

Bad news is that I am going to need a manipulation. It is scheduled for June 17. Any advice, experience, or input will be appreciated, please! He feels it is necessary to do now or I could really be set back

No, no, no! It's far too early to be making that prediction! There is NO "window of opportunity". did you not read the articles Kelly left for you earlier?

I urge you to refuse this MUA and tell him you'd sooner wait a while and see what time will do. It's your choice. He can only suggest a procedure, you are not obliged to comply just because he has. If you find in 2-3 months time you do need one, then will be the time to consider it. But my guess is that you don't need it.


So now I'm going to ask you some questions and it would be very helpful if you would answer each one individually in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery!

)

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how often are you icing your knee and for how long?

4. are you elevating your leg, how often and for how long?

5. What is your ROM - that's flexion (bend) and extension (straightness)

6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

7. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)

 

[ladymax]

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery
lowest is 2 after 30 plus minutes rest and ice. pain on bending is 7-8, after activity 5-6
!

)2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often? Celebrex 200 mg twice per day (pres. twice per day, taking twice per day), Percocet 5-325 mg, (pres. one or two every 4 hours as needed,) typical days taking one every 8 hours, two when pain level is high. Tramadol 50 mg (pres. two every 6 hours as needed) taking one every 6-8 hours, two when pain level is high.

3. how often are you icing your knee and for how long? 4-5 times a day for 30-45 minutes, and if I'm feeling sore or painful

4. are you elevating your leg, how often and for how long? once or twice a day. I barely have any swelling.

5. What is your ROM - that's flexion (bend) and extension (straightness) flexion mid 50's, full extension

6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and
straighten house, do all household laundry, help with dishes sometimes, make my own breakfast or lunch sometimes, try to help tend to chickens, occasional pool maintenance.
7. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that) I've been told my OS to only do gentle range of motion until manipulation. I'm doing gentle range of motion within pain limits 4-5 times a day, about 10 reps. Standing flexion 1-2 times a day 10 reps, walking with about 50% weight bearing, using two crutches.

 

[ladymax]

No, no, no! It's far too early to be making that prediction! There is NO "window of opportunity". did you not read the articles Kelly left for you earlier?

I did read all the articles, yes. I understand the myth of window of opportunity, but both OS and PT feel I'm stuck, esp since I've actually lost about 10 degrees of ROM in general in the past week and a half.

 

[kneeper]

To me it sounds like you're doing way too much daily activity on top of your PT. A bit of a knee vacation in that regard (knee-cation) might help.
We'll see what our expert Josephine has to say.

 

[ladymax]

Today I'm heading up to my parents lakeside cabin for some R&R. My parents will be there to give some support and caring, and I'll have my daughters with me to lend a helping hand and just have some fun! I figure I can lay or sit with ice on there as easily as I can at home, but with less stress about things going on at my house. I'll medication up in time for the hour drive, then have two days of calm and relaxation. Ahhhh......

 

[ladymax]

The time away at the lake was great. SO nice to have a change of scenery and different people to talk to. First night bed was awful, hardly slept all night, but second day I found a better bed for me, and napped and slept well on it.
Yesterday I started outpatient PT. They are much more focused on knee range of motion, and while he said it's ok to push to discomfort, I can say "stop" when I'm at my pain limit. Which I did. I started recumbant bike, pedaling forward and backward as far as I could, but not around. I'm at about 85 degrees flexion now. Woke this morning with black and blue across top of knee and to the sides a bit. Icing continuously today, with PT again later this afternoon.
This recovery stuff is a lonely ride. Hard to keep my spirits up, but reading others posts helps tremendously! Feels like I'm part of something

 

[Mai5ie]

@ladymax Hang in there, it does get better.

 

[puffin]

Make the most of being away to rest, ice, elevate and do a little gentle stretching

The main problem that people encounter after knee replacement surgery is that they try and do too much too soon (either in PT or doing housework or too much walking) and then the knee swells. A swollen knee will never bend properly. Many people find that their ROM increases magically by itself by having a "kneecation" where they stop aggressive PT and too much activity and let their knee heal. Any sort of knee replacement surgery is major surgery and not something that you recovery from in a week or two

Hope you have a good break

 

[zlady]

@ladymax you're doing a great job just try stay positive! As @Mai5ie said, it does get better!

 

[ladymax]

thanks all. Keeping positive IS really important, you're right! I do think I'm probably doing more than I "should", but there is alot of pressure at home to keep as active as I am capable of. I'll try to take more care of myself, and keep reading the positive words of others on this forum!

 

[ladymax]

I seem to be having another ROM set back. I had manipulation June 17, and he bent the knee all the way. This past week in PT I was getting 90 degrees with some pain, but not too bad. Been doing ROM exercises at home, though the past two days tried to rest it more than work it, due to last week PT being pretty assertive. Today trying passive ROM, and seem to be only 60 degrees again, with pain at the end point. So frustrating! Anyone else get ROM loss, then able to gain it back on your own without manipulation?
I'm still icing several times a day, though have reduced pain meds to 4 Tramadol a day (2 every 8 hours) and one Percocet, then Motrin PM at night to help me sleep. I'm out of Percocet now, so I guess need a refill? I'm not crazy about the narcotic side effect, so maybe he can prescribe something new?

 

[puffin]

What is your level of swelling like? ROM is very influenced by swelling

In the early months I used to suffer ROM loss all the time when my knee swelled up and I could feel it bent less- then I rested my knee and it improved - luckily I live in a country where there is no number obession. My ROM has only been formally measured 3 times in a year at 2 days, 6 weeks and 4 months

 

[Pumpkin]

Ladymax,
Sounds like you are overdoing, resulting in less ROM, and are undermedicated. Here is a link to the importance of good pain managment.
https://bonesmart.org/forum/threads...ing-pain-after-a-tkr-and-the-pain-chart.7969/
Looks like you need to get the swelling down before your ROM can increase, ask for another PT who will realize it is the swelling blocking your ROM, and will address swelling first, ROM will follow.
Let me tag @Josephine so she can take a look at the answers to her questions in post #25.

 

[ladymax]

Thank you for the helpful article. I suppose I am not taking enough pain meds. I will call for a Percocet refill, and also continue with the Tramadol.

My swelling isn't too bad, but I still do have some. If the day after surgery was a 10 for swelling, I guess today I'm about a 3 or 4. I ice regularly.
My Dr. and PT are ROM obsessed for sure. They are very verbal about this. I am in Pennsylvania in the U.S. and ROM is definately a focus. It's so hard not to be hustled on to that bandwagon, especially with the doomsday predictions of MUA (a second for me) and lack of "progress" with my recovery. My husband is also not so supportive, and is starting to push me to be better and be active. That's alot of pressure.
I will continue to do my best and follow the advice I'm given.

 

[Pumpkin]

Sorry you do not have the support you need for this challenging recovery, do the best you can, that is all you can do.

 

[Josephine]

In order to give you constructive advice, I'm going to ask you some questions and it would be very helpful if you would answer each one individually in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery!

)

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how often are you icing your hip and for how long?

4. are you elevating your leg, how often and for how long?

5. What is your ROM - that's flexion (bend) and extension (straightness)

6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

7. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)

Note:
If you're not familiar with this, it goes like so:
1 lift of a 500kg bell bar = 1 rep or repetition.
Doing 5 reps and then a brief rest = 1 set of 5.
And doing 5 sets and finishing = a session.

 

[puffin]

It seems totally absurd that your medical team is talking about a second MUA when you are only 4 weeks out -

Pushing the recovery may in fact be delaying it

So sorry that you are not getting the support you need at home and from the medical staff