Bilateral TKR Walking towards a new life!

[referee54]

Question for the Bone Smart forum members, did you use a CPM machine during your recovery?

Not at all---I asked my OS and he said that he felt that they did not help you at all; my father, though, for both of his TKR's, used one---his OS thought that they helped. My father swore at it and about it.

Purchased a Don joy ice machine with many little bottles now freezing nicely in my freezer waiting for me to get home. I think I'm all set. Can get good fresh food delivered.

You are all ready---logistically and psychologically---and you will feel great when you get into your home!

 

[TracyW]

Hi@jozilla! Thanks for replying so quickly. I done these exercises today.

1). Walked to/from the bathroom
2). Basic exercises 3x.
3). Sat on the edge of a hip chair for an hour.

I think the CPM hurt me yesterday, so iced all day in addition to the drug I'm taking and I today/I felt a little better. Nursing staff says I'm moving well.

I truly understand what Dr. L's PA told me about bilaterals, which was you don't have a good leg to stand on. Good news is that I'm taking it easy and focusing on me for a change.

Have a great night!


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[TracyW]

Post op 6 days. Inpatient rehab.

Well, I made it. It's hard to know what side is up and what to do in the meantime. Checked out of Lenox on Monday late and into Mt Sinai for rehab.

The overall facilities are old, but the people have been almost universally warm and caring.

Trying to get meds on time has been the hardest part of my stay. Big drug list, but with my increased level of exercise, I'm not sure that I am getting enough. Now I have my daily schedule so I can make sure that the PT staff and Nursing staff are working together.

Still wearing my Teds and skid proof socks. Icing 22 hours a day, but there don't seem to be enough of the thin pillow the hospitals issue to get my knees above my nose.

Knees feel like they're more like a section of sink plumbing than flesh and blood. Rehab center says that that's normal. Of course a bit worries about MUA as I don't have time to get set backs. To get into a rehab, patience need to guarantee they'll work a mandated 3 hours per day. I can tell you now that's a big ouch.

Today, I did my first 2 sets of staircases today. 5 up and 5 down. Cried. Not so much from the pain, but from the sum of all the experiences in this past week. The heavy drugs do me no favors; instead, of being my normal cheery self I cry every day. Well, at least I know where it's coming from.

Looking forward, I can shower, brush teeth, dress, but (TMI warning still no movement). 4 days of senna and colace with no results. Unfortunately, I ate very little before and after the surgery on top of when I get stressed, despite intervention and gallons of water, no movement.

Have a good knee night everyone.
Tracy

TracyW, New York City,12.59
THR 4.20.2012
Bilateral knees 4.23.2014
Living life walking through the big apple!

 

[Jozilla]

It will get better! Think of how great you will feel in 3 months, 6 months and a year. I visualized a lot. I honestly don't know how you btkr's do it. I give you a lot of credit. Way to go keeping up with your schedule on meds and PT. If I remember right they gave scheduled our pain meds for about an hour before PT. if you walked up and down stairs already you are doing great! Do you live on one level? Remember we are here for you and look forward to your recovery! I am passing around cupcakes today on the forum from my grandsons 1st birthday last weekend. Feel better!

Hope they make you smile.

(((Hugs))). JoAnne


RTKR - 9th December, 2013

 

[Wednesday]

This is a tough stretch, but you will get through it. I had my btkr on April 1 so I'm a few weeks ahead of you. My doctor had me using the CPM when I was in the hospital, but I refused it when I went home and did just fine. Movements were a problem for me too. Things got better when I cut down on the prescription meds. Hang in there.

 

[VancouverUSAgal]

I can't really say much about the CPM. My OS ordered it but I was only put into it once or twice in the hospital and couldn't get any help with it at Rehab so I opted not to take one home. If it feels good to you, use it. If not, don't since there doesn't seem to be any proof it helps.

My OS also wanted me to wear the TED stockings daytimes an have them taken off at night. Again, Rehab was so understaffed, I never got help with them, they kept rolling down, and were awfully uncomfortable so I didtched them when I got home. My primary care doctor thought it was okay since I'm on blood thinners.

Good luck to you. This is quite a journey we're on.

 

[Tamsmom]

Hope it all went well....just saw your post for the first time.


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[Tamsmom]

Didn't have on of those machines, my sister is a physical therapist and doesn't really see them to be very valuable. And just glanced at someone's post that said laughing how loaded
you really were the first month, I went back and read Facebook post that I had and they are mildly embarrassing and pretty darn funny!


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[TracyW]

Hi BS friends, I have so much to catch up you up on but need some medication help currently. I have been on a very long drug list while in rehab:

Base pain relived: OxyContin ER - 12 hours 12 mg 1 X 8 hours

Breakthrough pain reliever: HYDROmorophine (Dilaudud) Mg 4-6 mg. PRN, 1 x 2 hours.

Anti Inflamatory: Ibuprofen 800 mg 1 x 8 hours (ibuprofen not very effective for me, Drs. Choice; naproxen best).

Protect from stomach ulcers: Pantoprazole (Protonix) EC tablets zmme

Nerve pain: pregabalin (Lyrica) 25 mg 3 x daily.

Blood Thinner: rivarxabam (Xarelto) 10 mg with dinner

Constipation: Colese, Miralax, Sennakot, magnesium sulfate.
*Bowels haven't moves since 4.22. This is somewhat normal for me. Stress, no privacy, etc. I also ate very little before and after surgery - approximately 5 days.

My OS has prescribed only:

Base pain reliever: Percocet 5-325, 1-2 tablets every 4-6 hours.

Blood Thinner: rivarxabam (Xarelto) 10 mg with dinner.

Currently, I'm in a great deal of pain
After the Oxy wears off. Rehab Director prescribed 30 mg and I fell asleep in PT.

Don't know how much I really need as I took the same 2 RX listed above during my hip recovery.

Keep in mind the Rehab Director also suggested the rehab nurses give me warm milk for pain. I heard them talking at the nurses station when I was first admitted. They had asked him to check in my pain levels and he suggested ice (had 4 bags already) and warm milk

Can I get feedback on these drug lists? I can to Rehab last Monday, April 28th. Director would like to release me tomorrow. He's so weird that I'd like to go anyway.

Thanks, Tracy

TracyW, New York City,12.59
THR 4.20.2012
Bilateral knees 4.23.2014
Living life walking through the big apple!

 

[bottomshollow]

@TracyW, lets have @Josephine look at this drug list in your post #29 for her input.

 

[Jozilla]

Yes Josephine is the one to ask. I only had one knee done and was prescribed one to two 5 mg tablets of Percocet. I have to say I always took two. Hope your pain improves. Xoxo


RTKR - 9th December, 2013

 

[Josephine]

Tracey, I'm sorry but I'm a little confused by your list.

You say you had 'this' in rehab and then that your OS only prescribed you 'that'.
Am I to understand you had

OxyContin ER - 12 hours 12 mg 1 X 8 hours, hydromorphine (Dilaudud) mg 4-6 mg. PRN, 1 x 2 hours, Ibuprofen 800 mg 1 x 8 hours and pregabalin 25 mg 3 x daily
Notes: ibuprofen is rubbish as a post-op pain killer, narpoxen also. And why the pregablin? Who prescribed you that? It's not really appropriate for post op. So effectively you only had Dilaudid and oxycontin as pain meds.

and then - was it to go home with? - only Percocet 5-325, 1-2 tablets every 4-6 hours? That's outrageous!
Have you discussed this with the surgeon at all and informed him of your level of pain? You need more than this. If he's not helpful, contact your GP and see if he will help. They are often a lot more sympathetic than surgeons!

Additionally, I'm going to ask you some questions and I need you to 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 knees and for how long?

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

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

6. 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)

 

[TracyW]

Hi Josephine,

Thank you for your reply. Please have patience, I am working from my iPhone.

"Am I to understand you had:

OxyContin ER - 12 hours 12 mg 1 X 8 hours, hydromorphine (Dilaudud) mg 4-6 mg. PRN, 1 x 2 hours, Ibuprofen 800 mg 1 x 8 hours and pregabalin 25 mg 3 x daily
Notes: ibuprofen is rubbish as a post-op pain killer, narpoxen also."

Yes.

"And why the pregablin? Who prescribed you that? It's not really appropriate for post op."

Hospital prescribed for nerve pain associated with knee nerves.

"So effectively you only had Dilaudid and oxycontin as pain meds."

Yes

Surgeon originally wrote for Percocet which is what I got for my hip surgery.

"and then - was it to go home with? - only Percocet 5-325, 1-2 tablets every 4-6 hours."

That's what the Surgeon's home prescription would have been. Often the Hospital, surgeon and rehab will all pile on drugs/ dosages. Being that I know so little about medicine I wouldn't know if the medications were right or wrong. But thought it was too little for my hip.

"That's outrageous!
Have you discussed this with the surgeon at all and informed him of your level of pain?"

Yes, agree. I did tell Surgeon's PA. There is such a big crack down on narcotics here in NY that if a patient need more Percocet or 10 mg Oxy that they get referred out to a pain management doctor who has apparently more license or liability insurance to prescribe narcotics

"You need more than this. If he's not helpful, contact your GP and see if he will help. They are often a lot more sympathetic than surgeons!"

GP not helpful and unfortunately, will not prescribe around a surgeon unless you have a long standing relationship (I don't). On top if all of this it's 4 PM and all the offices are closing for the weekend. I may be able to call for an attending here at the rehab. Or hope between the Oyx at home from my hip replacement and the Percocet in my medicine closet, that I can cobble a pain program together until Monday. I can call my pain doc on Monday for an appointment.

"Additionally, I'm going to ask you some questions and I need you to 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! )"

8-10 when dosages prescribed are dissipating. 5 on this current Oxy/Dilauded combination. I have been very open to everyone what my levels are from Aid to PT to Nurse. No one seemed so concerned. Maybe they thine we're all whining.

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

see uploaded scans of my RX from the hospital and Rehab.

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

Every 20 minutes for 20-40 minutes.

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

Yes, all night and throughout the day. As of yesterday Compression sleeves
on ankles as of last night."


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

No activity other than bed to bath and back again. Currently in hospital based rehab; going home tomorrow.

End Part 1 Answers. See next replies for questions after 6. Thanks.


TracyW, New York City,12.59
THR 4.20.2012
Bilateral knees 4.23.2014
Living life walking through the big apple!

 

[TracyW]

Part 2 Answers

"6. 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)"

To get into a rehab facility in NYC you have to commit to 3 hours of physical and occupational therapy per day. This commit gets you the highest level facility of which there are 2 in Manhattan.

So this morning I started with PT walking up and down stairs with a quad cane, up and down 5 steps then repeated on the 10 steps. I tried to reason with them several times about pushing but was afraid that they would discharge me to a sub-acute or regular nursing home where you are matriculated into the elderly population with little or no PT. I live alone and have no means or family to take care of myself at home so I needed an acute facility where friends could drop off things needed
If necessary.

I then had walking class where I graduate to a cane and walk a path of 40 steps 3 times.

I took a rest for 2 hours and did PT where we walked through several floors into the hospital Atrium and back to hospital gym. There we dis quad tightening (5 reps-10 sec), behind knee stretching (5 reps-10 seconds) also on parallel bars, mini squats; similar to plies (may have popped some scar tissue - 5 reps) and 5 reps on each leg on stairs to measure standing ROM (100) all exercises except squats are 7 seconds.

Walked back to room on cane.

Unfortunately, it seems my lack of understanding has caused me a bit more pain. I also am prone to leg swelling and my entire leg thigh to toes (in Teds) has qualities of pitting or sausage casing.

Go ahead and rant, I'll repeat from this side of the ocean.

Thanks @Josephine.

TracyW, New York City,12.59
THR 4.20.2012
Bilateral knees 4.23.2014
Living life walking through the big apple!

 

[TracyW]

Hi Joshphine,

Also, when talking to my Surgeon's PA, I can to understand that the Xarelto blood thinner and anti-Inflammatories are causing bruises all over my body, so I have stopped taking ibuprofen 800 mg 2 x daily while I have 2 Xarelto pills left.

Big mess, I now understand.

Thank you for all your help.



TracyW, New York City,12.59
THR 4.20.2012
Bilateral knees 4.23.2014
Living life walking through the big apple!

 

[TracyW]

Day 12 Post Op. Yesterday was my first day home and was tough. As much as I thought I was set up, there were many small struggles.

I realized I needed:

Spread sheet for medications. What's hard as a single person is that you'll be able to put one together quickly. There is no really quick, so there have been gaps in my meds that have caused me more discomfort than I anticipated.

Snacks preset. A little boost close to the bed/lift chair would have been handy. I live in a studio, but the first day home, the walk to the kitchen was too much. I also think having a good supply of water, ginger ale, etc., would also have been helpful.

Blanket/sweater at every place I might lay down or rest.

A change of clothes/slippers so I don't need to sort through drawers. I've got a stack on on my dresser now.

I didn't sleep much last night, but I the cable tv I planned for was great to keep me company.

The assortment of ice packs I had was very handy. The big pack Arctic packs I used while sitting in the recliner. I used my ice machine next to the bed with 3 small iced water bottles that could be changes. I also had a small ice pack with soft cover that was just right to ice before my shower.

The first shower with my knees was easier than with my THR. I had great OT at rehab and it went like clockwork.

I definitely need some additional pairs of Teds. I left them off yesterday which just encouraged the swelling to double in each leg. lesson learned.

My cats were very happy to see me and spent most of the day/night running and playing through the house.

I am finding the biggest issue with my knees are the tendon/ligament connections on the sides of the knees to be most painful. I'll try some arnica oil when I massage them
later.

I'll figure out laundry tomorrow and I have Fresh Direct coming with some extra basics for the house.








TracyW, New York City,12.59
THR 4.20.2012
Bilateral knees 4.23.2014
Living life walking through the big apple!

 

[Jozilla]

Great update! You are doing so well. You have accomplished a great deal in less than two weeks! Good for you!

 

[BigBend]

Just found your thread....some of the comments I might have made earlier are now out of date....drug haze in the hospital, oh yeah...CPM for me good first night but second night the nurse put me in wrong and I can't even describe the painful contortions.....pain meds are as individual as are recoveries...keep ahead of the pain no matter what it takes! You are so early out of surgery, your whole body, mind and emotions are focused on those knees. It gets better. Believe it! Getting through the first painful two weeks is huge! It may not feel like it yet, but you are doing great.

Let me know what you think of the arnica oil. I've been thinking about getting some. I have some ligament pain occasionally, though it has gotten a lot better in the last week or so.

 

[LauraLeigh]

Tracy,
You sound like you're doing great! I'm also doing BTKR but I have a husband at home to help - I'm not sure I'd have gone through with it if I was on my own.

I had a question for you about your cats: did you have any trouble keeping them off of your knees? That's my big concern: I have four lap cats that will all want to be on me if I'm in my recliner. Keeping them off the knees is going to be a challenge, especially if I'm napping! Any advice?

 

[BigBend]

I have one lap cat. He has, thankfully stayed away....probably because when I'm laying down, I have ice packs on my knees. Good therapy and good barrier from the pets!