TKR Winner winner, chicken dinner! Bionic Liz's new RTKA

[L.I.T]

You know, I was never very good at journaling as a kid, and I realize that I still am not very good

Anyhow my follow up appt went well. I'm so glad I took my walker b/c we ended up having ice and snow the night before, and the walk across the driveway to the cab was a bit treacherous. But I made it without falling. And for the 3.5 hour excursion, I made sure to bring my ice pack and pain pills just in case LOL

The PA said my incision looked good, and that my flexion was was far enough along that I could skip the 'one month' appointment, and they would just see me in 6 weeks. Yay! He did mention that he has heard some people complain of kneecap tracking/painful clicking issues, and believes it to be related to sort tissues swelling in the knee capsule (bursa, synovium, fat pads), tendons/ligaments needing to scar down, and the implant needing to settle it's path into the plastic insert. It all made sense - and he didn't seem overly concerned, so that was reassuring. He released me to outpatient therapy (to include soft tissue work with ultrasound, laser, and tens) gave me a new script for 60 additional pain pills, and some more celebrex.

It was funny b/c he remembered how swollen my knee was the day I left the hospital.... (and that I told him before the surgery that my body REALLY liked to swell) .... He said whatever I had been doing at home was REALLY working well. I told him that I had found a great online support group who told me rest, ice, and elevate! And that 90% of my time has been spent reclining with my leg elevated and the ice machine on LOL. He said to keep doing what I'd been doing.

Interestingly, he also mentioned that my particular doctor was not concerned about extension at all - that his experience is that it almost just always happens naturally. He (apparently) is somewhat concerned about flexion, but not pushing it to the point of pain - he believes in letting the swelling/pain be your guide. I think I am lucky to have this surgeon considering our small area only has one hospital!

I did have a separate health scare, however, as yesterday I woke up with a pulling/painful feeling under my left arm by the side of my ribcage. Upon palpation, it seems to be a swollen axillary lymph node. And, of course, one of the signs of breast cancer is a swollen axillary lymph node. This was/is a bit frightening, since I haven't had any cuts or infections in my arm or chest. I have had a breast reduction, but even after, am still a rather large size, as the surgeon didn't want to sacrifice my nerves.

Soooooooo.... I'm a little bit scared. But I did remember (this morning) that my IV from the tkr was in that arm... And it did become infiltrated at one point during my hospital stay. So I'm hoping/praying that the swollen lymph node is a result of that, even though it was 2.5 weeks ago. Nonetheless, I will call my ob/gyn and get him to fax me an order for a mammogram just to be safe.

Going to try to post a pic of my knee - swelling is very slight at this point (mostly the internal structures now, I believe) and I realized that I am very lucky - my surgeon did not do a 'minimally invasive', but somehow my scar is only 4.5-5 inches long

Hoping everyone is having a good weekend!

 

[L.I.T]

Let's see if this works...

 

[Celle]

Your knee is looking great, Liz. Still a bit of swelling, but not much at all really. There will still be some internal swelling that you can't see, but you've done a good job with resting, icing dan elevating.

 

[L.I.T]

Thanks! Couldn't have done it without everyone on this forum. And it's still not over by a long run... I can get it pretty nice and swollen just by walking in the house for 30 min. But for the most part I am thankful that you guys put me on the right track. Otherwise, I'd have been killing myself (and my recovery) with the PT schedule they gave me!

 

[mbrown]

@L.I.T. That looks really really good.

 

[Bikesouth]

It does look good for just a few weeks. To me your swelling looks minimal, always a sign of good OS workmanship.

 

[L.I.T]

Thank you guys! Don't be too deceived - there is still a decent amount of anterior-posterior swelling that doesn't show up b/c of the angle of the camera. But compared to what it was when I left the hospital, it really has been rather miraculous.

@Bikesouth, I hope you are right about the quality work... In my xrays, it appears as through my tibial component extends just a hair beyond the edge of my bone on the lateral side. My original bones were not exactly shaped nicely, so I can see that to maintain a neutral angle (which I was before), made it look like one side of the tibial implant would need to be a bit longer than the other. But I don't know hide nor hair about knee surgery. I have been having some uncomfortable lateral pressure, though, so I hope the two things are unrelated. It hasn't interfered with my ROM at this point, though.

 

[L.I.T]

Well, tonight I had my first postoperative depression breakdown. You'd think since my recovery looks great on paper, I'd be ecstatic...

My husband asked me to make home made biscuits tonight while he made the rest of the dinner - mind you, before tkr, I usually did 90% of the cooking. So out of guilt (and against my better judgment) I told him I would be happy to help.

This must be said - I have never ever made homemade biscuits in my life. So as I was getting all the ingredients, and mixing everything, my knee was beginning to hurt and the lateral pressure was REALLY uncomfortable. I was getting distracted, but was determined to keep following the recipe.

It wasn't until the biscuits were in the oven (and I was doing the dishes) that I realized I had forgotten to add the sugar

Let the breakdown begin I feel incredibly guilty for my husband having to do both our jobs, almost all the housework, cook, and take care of me for the past 3 weeks. Not to mention stay home in our gloomy cold weather instead of us going out jeeping, to the movies, or even doing a 'project' around the house. Even my personality suffers, as my pain and discomfort levels change from minute to minute, so a lot of the time, I'm not good company. I know it's got to be affecting him.

And on the selfish side, I'm not handling the 'uncomfortable' knee feelings well - all the pulling, painful popping, grinding , kneecap tracking, intense pressure, and swelling feelings are things that very much make my stomach curdle, but aren't touched by pain pills. Sometimes I feel like I have an alien inside my knee.

On top of that, I can't seem to cut myself a break - my inner voice says "you KNEW it was going to be a long, painful recovery" or "everyone told you it would feel differently than your own knee"... which is all correct... I DID know all this going in. So why the heck can't I seem to handle it. Especially when I should be grateful that my personal recovery seems to be going well.

Finally, I'm worried b/c my blood pressure has been a bit high since the surgery. I'm a gal that usually runs rather low around 90/60. But ever since the surgery, I'm up around 120/80. I don't know if it's stress, pain, or the celebrex... But it's on my mind, regardless.

So... I bawled, and my husband probably thinks I'm nuts. But I'm off the pity pot for the moment, at least.

*sigh*

 

[L.I.T]

I also know most people here are going through all the same things - and many are going through a harder recovery than myself. I'm ashamed for even feeling the way I do. In fact, I'm ashamed of my last post. But maybe it just shows that even in a good recovery, we are still susceptible to the dregs of post op depression. I'm prone to it anyhow... But man, I wish I were better at putting my big girl panties on! (as my friend would say LOL)

 

[mbrown]

Liz, hush! Your husband isn't mad you forgot to put the sugar in the biscuits and he's not feeling resentful that he's having to carry the load for a while.

But yes, I can relate very well right now to the frustrations of even a good recovery. I had a great day yesterday. I felt good from the moment I woke up until the moment I went to bed. I even got sleepy at 9:00 and was asleep by 10:00 with visions of a 8+ hours of good sleep......well, here it is at 3:11 am. Trying to warm up from the ice machine. I've been tossing and turning for 2 hours. Knee hurts and feels inflamed (not terribly on each but enough to not sleep). Even my arthroscopic knee hurts for some reason. Haven't had to take pain meds in the middle of the night in at least 5-6 days but just had to take something and hoping it will take the edge off so I can go back to sleep.

But hey Liz......there is NOTHING to be ashamed of. There are no rules that say that you are not allowed to get upset just because you've had a recovery better than some. That's like being upset because you had a bad day even though you have a better life than some. It's your recovery and they are your feelings. There are no conditions that you have to meet in order to earn being upset. Got it? [emoji6]

 

[L.I.T]

@mbrown, thank you. I have two serious flaws.... One, I'm Catholic, and I swear that guilt is a Catholic genetic trait - it was never learned, it was just there since birth LOL. I can manage to feel guilty for blinking the wrong way....

My other problem is that I'm mostly a Tom boy - about 70% man, who likes outdoors, sports cars, building, and power tools. But every once in a while, that 30% girl with crazy intense feelings and hormones raises her head. ;-) I think she was here last night!

Sorry you were tossing and turning, but glad you took the pain pills. There are moments when I can't seem to find any position that is comfortable, and I just finally take an extra pain pill in hopes that it will either put me to sleep or make me just not care. Works about 50% of the time. I truly hope it worked for you last night.

I guess even the best of recoveries are still no piece of cake. Hang in there! May the best of days become more frequent cheers!

 

[Celle]

My husband asked me to make home made biscuits tonight while he made the rest of the dinner - mind you, before tkr, I usually did 90% of the cooking. So out of guilt (and against my better judgment) I told him I would be happy to help.

I feel incredibly guilty for my husband having to do both our jobs, almost all the housework, cook, and take care of me for the past 3 weeks. Not to mention stay home in our gloomy cold weather instead of us going out jeeping, to the movies, or even doing a 'project' around the house. Even my personality suffers, as my pain and discomfort levels change from minute to minute, so a lot of the time, I'm not good company. I know it's got to be affecting him.

First, have your husband read this article, so he realises what you should and should not be doing at this stage of your recovery:
Activity progression for TKRs
And remember that "this, too, shall pass".

Second, lose the guilt. This is your time, the time when you must come first, so that you give your knee the best possible chance to recover well. You would gladly do everything for your husband, I'm sure. Now it's time for him to step up to the plate and return the favour.
Read this article:
Nurturing mother: how to let go and accept help
Let the housework go hang for a few weeks. Just ask him to do what is absolutely necessary. After all, dust bunnies are your friends - they show that you have been resting properly.

On top of that, I can't seem to cut myself a break - my inner voice says "you KNEW it was going to be a long, painful recovery" or "everyone told you it would feel differently than your own knee"... which is all correct... I DID know all this going in. So why the heck can't I seem to handle it. Especially when I should be grateful that my personal recovery seems to be going well.

I think that's part of the normal, inevitable post -op depression:
Post op blues is a reality - be prepared for it

But ever since the surgery, I'm up around 120/80. I don't know if it's stress, pain, or the celebrex... But it's on my mind, regardless.

That's still well within the normal range, Liz. It's probably a combination of pain and stress. Mention it to your surgeon when you next see him, but I think he'll reassure you.

Sometimes, when you're a patient, it's not helpful to be a nurse - we know too much and our minds go straight to the worst-case scenario every time, so we worry too much.

 

[mbrown]

@L.I.T. How you doing today Liz? Haven't heard from you. Hope you had a good day. I get my staples out tomorrow[emoji322][emoji322][emoji322][emoji898][emoji482]

 

[mbrown]

@L.I.T how you doing?

 

[Mireille]

@L.I.T I can totally relate to your feelings. You are not alone. I feel the same way. So many things going on at the same time, pain, being uncomfortable, feeling like a burden (unfounded), it's a lot to deal with at the same time and totally natural.

I hope you feel better and today is treating you much nicer. Sending blessings your way!

 

[L.I.T]

Hey @mbrown! Congrats on the staples being removed! I bet it will make a big difference in comfort! I'll check your thread later when I get home.

I am doing well... Just tried to take a day away from the Internet Just finished my first outpatient PT session, and let me just say how much I LOVE my usual therapist! He is so reasonable and basically believes slow and painless/no swelling is the way to go. I'll write more later.... Right now waiting at the pharmacy. Going to 'town' where I live means almost a full day affair.

First day driving, too! Although I did practice yesterday in my neighborhood.

Hope the staples are out by now!

@Mireille, thank you so much for the support and encouragement. It really does help more than anyone can know!

 

[L.I.T]

Well, had a great day at my first outpatient PT. Got to see my buddy Roger (therapist) and he said how happy he was that I finally took the plunge and had a TKR. He also took my ROM measurements and we discussed.... I am about -1 on extension and 120 on flexion. But before anyone congratulates me, I have hyper flexibility, so my ROM on my other leg is -10 on extension and 150 on flexion. My PT said taking that into account, he would like to get me as close to symmetrical as he can.

What I love, though, is that he prefers the long and slow approach with pain and swelling management taking the lead. He said by the end of surgery week 6 (2 times of PT per week), we can probably get to 135 flexion, and then maybe the final 20% over the remaining 4-6 weeks after. I have to work on extension, but he feels that most of my barrier right now is residual swelling in the capsular area, and then some quadriceps atrophy from altered gait for the past 2 years (to try to avoid pain).

So we did 3 different types of quad squeezes - and the oddest feeling to me is that I can't tell when I am flexing my quad on the surgical leg. I literally have to touch it with my hands. I swear, an alien has taken over my knee! We also did a little time on the Nustep machine, the tens, and ultrasound. Other than the quad flexes (and an occasional flex stretch), my only homework is to keep elevating and icing to keep the swelling down. Yay! Oh, and Roger also confirmed that every odd 'feeling/issue' that I have had is totally normal and goes away as the swelling does.

So after a grand total of 5 hours in the car, at PT, and with a side trip to the pharmacy, I made it home and resumed my elevating and icing position.

As I was relaxing, one of our cats apparently decided to join me on the couch and missed - in his effort to 'hold on for dear life' (ahem), his nails grabbed onto my bum on the surgical side (since my leg was elevated). Of course it was not a puncture or deep scratch, but it did draw some blood. So I sprayed it with antiseptic, cleaned it with alcohol, then sprayed it again. Dang cats! Now I'm debating about whether to call the PA tomorrow or not. I don't particularly want to be on antibiotics... But I REALLY don't want to go through week 1 of recovery again.

All in all, a good day. Happy to finally be with my normal PT, and even more happy that his philosophy is aligned with the BS way of recovery. He's got over 20 years of experience, so I trust that he's seen it all and knows how things work best.
Hope everyone has a great night!

 

[L.I.T]

I accidentally posted this to a thread I found through a search - the later realized it was the Preop forum... So not sure where to put it but maybe on here. It's a bit of a repeat....

I don't mean to resurrect this discussion - but does anyone have information about cat scratches *after* the TKR. While I had heard no scratches of *any* kind prior to surgery, no one has discussed these types of things with me for after surgery.

We have 3 cats at our house and two are 20lb savannah cats. One of them was trying to jump on the couch today, and missed, using my buttocks (I was elevating my leg) as a safety net when he missed. It was not a deep scratch, but enough to draw some blood. I used spray antiseptic and alcohol on it. However, I am only 3 weeks out of surgery. I've read of people getting antibiotics once infection was verified, but do they typically prescribe antibiotics prophylactically?

I'm not far enough out from that first week of recovery to really *want* to do it again, yet

 

[mbrown]

Ahhh come on Liz, you know you'd love to go back and do it all over again

 

[L.I.T]

@mbrown, OK, you got me! If I reach DEEP down, all the extra pain pills, days off, and my husband slaving around for me sound like utter bliss! Not to mention getting even more use of the ice machine and an extra awesome scar! What in the world was I thinking when I said that! Must have been my inner conscience coming out of hiding.... I'll have to shove it back into the closet where it belongs!