PKR Two weeks in and support waning

[Yorkimom]

Sorry to hear that you're not getting the support you need both at home and from the doctor and PT. They are really pushing for the ROM.
It also sounds like you are still doing too much and not keeping up with the meds. I had my RTKR in December 2012 and still remember people telling me that they were only on meds for a short time, etc. I just nodded and said it's better to take the meds and keep ahead of the pain and not try to be a martyr, and that I learned this from Bone Smart. That would keep hem quiet.
You said you were from Pennsylvania. Where in PA? I'm from Delaware. Anne

 

[ladymax]

Hi there. Anne, I'm near Allentown, PA - Eastern PA.
Saw the PT today, and started session with about 50 degrees flexion, ended with 85, so that's equal to last week. I'm pretty happy about that.
Called the Dr. for percocet prescription. They started to give me a hard time, saying surgery was a month ago, am I really having that much pain? I told her that I do still occasionally need more than Tramadol, and she asked if I could try a "step down" med of Vicoden. I said yes, I'd try that, so they are sending that to my pharmacy. She asked if I was doing ice on my knee, and I almost laughed out loud....of COURSE I'm icing! Many times a day still. She said that's good :/
It's so interesting to me how different the experience is for each of us, depending on our country, our Dr., and our PT.
I hope everyone is having a good day today. Good healing thoughts to all!

 

[ladymax]

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!

)
pain levels range from 1 at rest to 9 during painful stretches. Typically more like 3-4.
2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?
Tramadol 1 or 2 50 mg tabs every 8 hours as needed. I'm taking 1-2 every 8 hours, but not through the night. I ran out of Percocet, and when I called for refill, they prescribed Vicaden. I don't know that mg or frequency yet. Getting them later today or tomorrow, depending on when husband goes for them. Also taking (on my own) 2 Motrin PM at night.
3. how often are you icing your hip and for how long? ice my knee every 3-4 hours for 45 minutes

4. are you elevating your leg, how often and for how long? no, not in the past few days.

5. What is your ROM - that's flexion (bend) and extension (straightness) after PT, got 80-85 flexion, 0 extension

6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and
laundry, 1-2 loads daily, wash, dry, fold, daily one or two outside chores such as pool maintenance or picking some weeds (still on two crutches, so limited), straighten house, make my breakfast and lunch, sometimes for kids. each night responsible for getting 9 and 6 yr olds off to bed, which included making sure they get showers, help them get their rooms ready for bedtime, reading, tucking in 6 yr old, getting them any meds or other things needed. My 9 yr old has Aspergers and 6 yr old has PDD, so more high maintenance than neuro-typical children.
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) sitting knee bends 10 reps, hold 10 seconds, twice a day. Lying straight leg raises 10 reps, twice a day, standing knee bends 10 reps twice a day, stair stretches 10 reps, 30 sec holds, twice a day, knee straightening with towel roll under knee 10 reps twice a day. I do each exercise then rest for about an hour then do the next, etc. Not all exercises at once.

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.

 

[ladymax]

I'm happy to report that I've recently begun to use one crutch periodically throughout the day, on flat safe surfaces, and it's going pretty well. Even cooked a couple easy dinners! yay!
Today I was outside and spent a couple hours helping (to the best of my ability) my husband organize our large outdoor shed. I overdid it, and now I'm paying for it. Lesson learned!
I'm still at about 85 degrees flexion, and that is only at PT after very vigorous stretching. It's so painful I've decided tomorrow to talk to the PT to tell him I just can't take that pain anymore. Once I almost passed out, the other came close to throwing up. I know it's against the bonesmart mantras, but I've never been one to speak up much. I am so wanting to improve motion, I've put up with it for the past couple weeks, but need to stop. In that time I haven't gotten any more motion, so what's the point?? WIsh me luck speaking up tomorrow!

 

[ladymax]

Just got back from a three day vacation out of town with extended family. I am SO glad to be back at home and in my own bed!!! It was so nice to be out of the house, doing different things, but my leg is yelling at me now. Last night I hurt so bad I cried myself to sleep - and I'm typically NOT a cryer. Man, that was a challenge. Good news it that I am now able to drive short distances, if I allow a day or two in between. At least I can now drive myself to PT and not burden others for that.
Last PT session last week, they told me they are looking into getting me a CPM unit to use at home. I'm still at 90 degrees, and been sort of stuck there for a few weeks.
Anyone else start CPM seven or more weeks after surgery?? I didn't have CPM at all in my recovery, so doing it now seems a bit odd to me, but I'll do it if it will help.
I see my Dr. tomorrow for a check up. I'm hoping he doens't start talking about return to work yet. After this weekend, I know I can't do it yet.
Ran into a lady 12 yrs post op TKR, who saw me using one crutch, and said "you're STILL using a crutch this long after surgery??" I thought that was kind of rude, considering she knows nothing about me or my history. Why do people feel they can make such comments? It really made me feel bad for about a day, till I let it sink in that she has no clue about me.

 

[ladymax]

Saw the Dr. today. Said yes to CPM or "flexinator", whichever the PT wants to try. He said he's very surprised at my lack of ROM after partial, saying he sees ROM difficulties after TKR, but never with PKR. That was depressing. He said to keep working on it for another month, then see him again. He said at that point we'll see how ROM is doing, and if another manip is indicated. He said nothing about returning to work yet, which is a good thing.
Dr. also showed my a picture of my knee after surgery, showing about 130 degrees of flexion, which he said was easy to get under anesthesia - no struggle to bend me. He said "a picture is worth a thousand words" and wanted me to see the picture. I couldn't help thinking he thinks I should be getting active motion easily. What is wrong with me ? I know I'm not a wimp, I've had 30+ years of surgeries and rehab and pain with this leg, not to mention bulging discs in my back, and managed through it commendably. This knee just doesn't want to bend!

 

[Snooz]

@ladymax, am I correct in reading that you had PKR on May 21st? I am scheduled for Thursday, and would love to connect with you via private message with a couple of questions. Hope you are having a good day and feeling better.

 

[kneeper]

My guess would be since you had an mua they're sort of treating you like you're early in the process as far as trying the cpm. I seem to recall others who had MUAs say you sort of reset the clock.

 

[ladymax]

The PT didn't give me any ROM machine this week (to use at home). Not sure why, except that my PT was on vacation so saw PTA's this week. Saw a new one Thursday that was brutal. She did this stretch with me prone, then she lifted my bent leg at the knee, and pushed at my ankle with her shoulder. OUCH! I don't want her again, that's for sure. I came home with a very sore SI joint (I have a history of trouble with it) and upper and lower back spasms from my bracing and responding to pain. Seems they forgot they were going to do a gentler approach!
I've started walking a few steps here and there with no crutch. Going ok, though my knee does buckle occasionally so need to make sure I'm close to a counter or something I can grab if I start to go down.
I'm at 7 weeks post op now, and like others here, wish I was farther along. This is a long process and I'm losing my patience. Not every day, but often Like today. I'm out of Tramadol now, and if I need anything stronger than Advil, I have to take the Vicoden. I guess I'll see Monday if they will refill Tramadol.
With hindsight being 20/20, I'm thinking doing this surgery in Spring was a bad idea. So much to do outdoors - mowing, trimming, gardening, etc.....I always feel behind and things out of control. I wish I had done this in Fall instead. Couda woulda shoulda!

 

[Pumpkin]

She did this stretch with me prone, then she lifted my bent leg at the knee, and pushed at my ankle with her shoulder. OUCH!

Next time say NO!
I have SI joint dysfuction, and would be very unhappy if someone flared it up with what they did during PT. We have enough to deal with already pain wise.
I had my primary TKR in the Fall, was a real pain with all the weather going through and irritating my knee, then not being able to get out because of weather. I do not think there is a great time to have this surgery.
I do agree, I am missing so much this summer.
Take it easy this weekend,

 

[Jozilla]

The recovery is so long I do not think there is any good time. I had mine in December and was glad to miss two months of the winter. It was such a bad winter here though and getting to PT was a challenge. My PT also recommended I walk in a local mall as walking outside was not a safe thing to do. My left tkr will be in September and it better not be snowing!

 

[ladymax]

Jozilla, I guess you're right. I wish you the best of luck for September !
I guess I'm just in a funk and wishing this would go faster, esp since OS told me he's "never" had a PKR patient have difficulty this long. That was depressing!

 

[kneeper]

Pooh on your OS.

 

[skigirl]

I think that the reason you have rom problems is the chronic swelling. You are doing a lot physically and I would cut out all exercises for a week or so. I never did anything outside of pt---rom? 150. You do not need to "work" like this to get rom. In fact, working like this has given you chronic swelling and now you are going to have to spend some effort to get rid of that swelling.

You don't seem willing to cut back on your activity level--but really, that is part of the answer. I would take a weekend and do nothing at all, but keep that leg up---two hours up for every on hour down. Here is how you should be elevating.

Elevating your leg to control swelling and pain
Using ice

take a week off from pt and NEVER let them push on your leg again---that just makes more swelling which means less rom---even if you do get a momentary increase. Basically, you are abusing your leg---running around, doing housework, yard work, et---and no having enough rest. Your poor tissues have not had a chance to heal--you are constantly ripping them apart---with the help of the PT, of course. Yikes.

I had a full tkr--never had one minute of pain in pt---never took a pain pill just for pt---always, gentle, gentle stretching and lots of rest on my part. I just reread your posts and almost every one of them contains the line--my leg is killing me, I am paying for it now.

So--speak up for yourself at pt. Just because some pt assistant wants to push on your leg--you do not have to let her do it. YOU are the paying customer. Do you really think a pt assistant knows more than you do right now?

second, you have got to rest that leg so that it can heal. Otherwise, this will go on and on.

 

[ladymax]

skigirl - I totally hear what you are saying, and you are right. I am overdoing it, both with my responsibilities at home, and with PT. Unfortunately at home I am being pushed to do more, both by my husband, and by my responsibilities to my children. I have spoken up in PT, and while the PT has backed off, the assistants are not. I need to talk to them again so they all have the same method with me.
Strangely, I see my knee is swollen, it's obviously larger than my good knee, but when the OS looks at it he says "well you don't have any swelling". What?? So I am getting conflicting input which is confusing.
I just read your post to my husband, who is one of the most guilty when it comes to pushing me, and he said "well ok so stop PT for a week and see how it goes" . I said "it also says to stop doing so much at home" and he was far less supportive of that.
I thank you for your input, and reminding me, again, that I need to slow down. Sometimes I need to keep hearing it to keep doing it! I was never very good at speaking up for myself, so having others to remind me I and my healing are important is actually very helpful to me.

 

[Spider]

WOW Ladymax, you are having a tough time in the support area aren't you?? I agree with what ski girl is saying, you are slowing your recovery by doing too much. I had a BTKR a day after you, so we're in the same 'stage' of recovery. Think of this time as a push to look after yourself and stand up for yourself. You aren't asking for support because you are lazy, you NEED support. Start reading some horror stories about how long it takes, and long term consequences of overdoing it to your husband. Say NO to people who want you to do things, get help - and let things go. YOU are important, and your needs can't just be ignored. Get strong, and do less - you will be amazed at how much that will help. Compared to some on here - I have been given VERY minimal exercises, we don't do weekly 'PT' over here, so I do very low level exercises on my own each day (well I don't even do them every day to be honest). I went to my GP for pain relief help because he was more sympathetic than my OS. So after my minimal exercises, PT and activity - I am turning a corner, I have really good ROM (dont' think it is much less than I had prior to BTKR), and my physio and surgeon are really happy with me. I'm not saying this to make you feel bad - but to add weight to other people's arguments about doing less is better - MUCH better.

 

[ladymax]

Been listening to all the advice, and I'm working on it! Been doing less at home, and resting more. Regardless of complaints of others! I even turned down the opportunity to go to local firehouse carnival tonight with husband and kids. I knew I'd just have to walk and stand around, but esp at the end of the day I thought it would be more than I should do. Have to admit I'm missing being there, but putting my knee health as priority.
I'm continuing to ice several times daily, but have upped it by a time or two, and lenghtened the time I'm on ice. I also backed off on home rom and exercises, and lightened up on PT as well. I plan to back off even more on things over the next few days and see how things go. It will be a very low activity weekend.
Thanks for all the support and input from my bonesmart friends.

 

[Jazzy4564]

@ladymax, I feel for you! I haven't had my surgery yet and my husband and I are empty nesters so I don't have children at home to care for. I've tried to emphasize to my husband that he is going to have to do more around the house than he ever has. He says he understands that but we'll see how it goes. I hope you can have a restful weekend. I agree with your statement that we have to make our knees a priority. I'm 48 years old as well and I'm doing this now so I can keep up those future grandkids

 

[ladymax]

PT measured my flexion today - it's 85-90 degrees........exactly the same as it was a month ago after MUA when I started PT. So dissappointing.

 

[Jazzy4564]

@ladymax, I'm sorry to hear that. I'm sure I've read this somewhere but what is the goal for flexion after surgery? Will you have to another MUA?