TKR Worried Sick about Progress

[Tabbycat]

This surgery is like a lot of things in life, like,for instance, depression, you have to experience it to understand it. But there's a definite cameraderie and connection between those who have. There are people on this forum who have helped me more than anything, and feel like real friends,because they have been through it.

 

[PoorKnees]

Hi @charmed-life, I had mine done at Methodist and thought they did a good job with pain management and general attentiveness, etc. Part of my fretting is due to the fact that I feel I have to return to work asap and at this point I feel like a total invalid. I was crippled by an arthritis flare-up EXACTLY on 1/22/16 and have been really able to, physically, do very little, to the point of having to use a wheelchair at work - I have a sedentary job. I am sure my pre-op period of severe disability has exhausted much of whatever my quota of patience was - I am just exhausted by all of this, physically and mentally.

 

[KayeKaye]

Hi @PoorKnees I am in the metro area as well, near Stillwater. I had both knees done at the same time. How soon do you have to be back to work? I don't think you will be able to do much before 12 weeks from all that I have read on here. The people that go back earlier than that are in the minority do fine and are unusually remarkable, but most of them don't benefit from going back earlier.

 

[Josephine]

My husband had to pick up a prescription for oxycodone in person, for example - they wouldn't just call it in.

Did you expect them to? It is a listed drug after all and absolutely they cannot just call it in.

when I told my PT that I was feeling very tired and weak, she told me that at this stage (at 2 weeks) I should be really using oxy only on an as needed basis, maybe only at night

That is outrageous! I bet when the time comes that she has a TKR, she'll be taking them a lot longer than that and I hope she remembers what she told her patients! I certainly think it's unconscionable that she should be advising people to reduce pain meds at that early stage - not even at two months!

neither my surgeon nor the nurse I talked to last week seemed to have a clue about the adverse interaction and told me to take ibuprofen even though I am on aspirin!!! The fact how little the medical profession seems to understand the patient aspect of all of this is very scary

It is indeed! And it also shows how they don't appear to keep themselves up to date either. I do agree with Celle, that if you are taking aspirin, albeit for another purpose, you don't want to be taking a second NSAID. I certainly wouldn't. I suggest you read this article for more information Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers

 

[charmed-life]

@PoorKnees, you are just getting to the point (at 3 weeks) that I felt any better - but it's still a ways before you'll likely have much energy or stamina or mobility to work, although I sympathize with the problem of needing to get back. I'm fortunate I run my business from home and had a daughter home who could take over the most critical parts. Your pre-op period no doubt has made things slower too. Try to find a way to take things slowly and put off a return to work a little longer than you planned. There are those who can recover quickly but you can't count on that!

As for patience, my knees were fine until a fell and dislocated one and broke the bone near the knee - back in Sept 2015 - knee replacement was Feb 2016 - still slowly recovering and yes, pretty tired of it but I see no alternative...


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[PoorKnees]

Thank you for confirming my suspicions re ibuprofen: I am sticking now to Tylenol, will try to get Tramadol, and, until then, will continue oxy for the night at least. I am more rational on a normal dose of sleep!
@KayeKaye: I think the recovery period for a BTKR is by definition longer so I am sure short-term disability plans, etc., take that into consideration. My short-term disability was automatically granted through June 12, so 5.5 weeks. Tomorrow's my 3-week mark and I really find it very difficult to imagine how I will be able to go through a whole day at work in 2.5 weeks!!! When I was originally planning the whole thing, I was counting on returning after 4 weeks - that seems crazy to me now. I know people do it, but how I just cannot imagine: they either have a much faster recovery or they are much braver than me - probably both: hurting stresses me out no end. Having said that, I did go through two natural births and they seem to me relatively easy affairs compared to this labor - no doubt I forgot quite a bit, but I sure know that my recovery was swift.

 

[Celle]

We normally advise people to try and take at least 12 weeks after a knee replacement before they go back to work, and then to do a Phased return to work .
So, if you don't feel ready to return to work in a couple of weeks' time, ask your surgeon to certify that you aren't fit to return to work yet.

 

[skigirl]

I loved my OS who greeted me at three weeks with: "Now that you are at three weeks your pain is gone and how active are you?" I asked him if that worked for him--to tell me I had no pain instead of asking . . .LOL.

Ask your PT where she got her medical licence. she has no business recommending anything to do with your pain meds---it is literally none of her business.

 

[bdink21]

@PoorKnees I'm sorry you are having a rough time. I didn't like the dopey feeling of the oxys either but knew I needed them for the first month or so. You could try taking 1/2 doses of oxycodone during the day with the Tylenol. That might give you better pain control and less zombie feeling. I do find tramadol to be a great alternative and find it works well without the side effects of opioids. I too find the advice of some docs and PTs laughable regarding pain management and activity expectations after such a major surgery. They really have no clue. I went back to work at 8 weeks but I'm taking Wednesday's off for a few weeks and the day off in the middle of the week is a nice recovery day from the 2 days at work.

 

[newlybionic]

I only had one knee done and my OS office filled out my papers for three months short term disability. That way if I wanted to go back sooner he would let me. I'm taking advantage of the full three months.

 

[PoorKnees]

What are your views on the rehab benefits of a stationary bike? My PT put me on it during the session and it was brutal. As you know my bend is lousy and I continue being swollen. Should I be investing in a stationary bike? Can one properly recover without one? I am also concerned that my other, unoperated but bad, knee will not like it (my arthritic knees hated the effort of biking so I had to give it up three years ago).

 

[Celle]

Don't bother buying the stationary bike. It will be wasted money. It's completely possible to recover without ever using one - I did and I know of many others who have done so. In fact, I did no formal exercise at all after my last TKR and my knees bend beautifully.

Your knee can't bend properly because it is swollen. Instead of thinking all the time about doing exercises to help your bend, concentrate much more on reducing the swelling. That's what is preventing your knee from bending. If you think about it, your knee is a bit like a hose that's filled with water - it's stiff and it doesn't bend easily. But get rid of the water and the hose becomes softer and much easier to bend. That's what your knee is like. It's no good doing lots of rest, ice and elevation to reduce swelling, if you keep on doing the exercises that are irritating your knee and making it swell up again.

So, do lots and lots of this: rest, elevate, ice and much, much less exercise. You've been advised several times to cut back the exercising. Please do so.
You see, it's not exercise that brings back your ROM (Range of Motion). It's time, rest, healing and gentle treatment. Your knee isn't lazy or unfit - it's wounded and it needs gentle treatment.

Besides, there's no need to rush to get ROM. Your ROM can continue to improve for a year, or even longer, after a TKR. You've been worried all along about not achieving goals fast enough, but there's no need to worry. Is your PT therapist telling you that you are "behind"? You aren't. You are going at the pace that your knee needs to go.
Myth busting: the "window of opportunity" in TKR

It's all too easy to get into the mind set where you think that the harder you work, the better the results will be. That's often true in life, but it's not true for recovery after a knee replacement.
TKR: work “smarter” and not “harder”
Knee recovery - Lose the Work Ethic!!
Life in the slow lane
What You Should Not Expect To Do After a TKR

Do read these articles and try following the advice. What you've been doing until now hasn't worked very well, so you have nothing to lose by trying something different.

 

[LoveGiants]

After my meniscus injury and surgery, my PT wouldn't let me on the bike until I had the ROM needed. I'm a cyclist, so was quite excited to pedal anything—even a stationary recumbent bike .

You do have to be able to bend your knee quite a bit to ride, so I agree that you don't want to worry about that until you're ready.

 

[PoorKnees]

Help!!! I am really down in the dumps, totally depressed, I am working like a dog on my poor ROM and getting nowhere: now the PT is talking about a CPM machine for me. Does that make sense?! I am seeing my OS tomorrow and intend to tell him that all the PT does not seem to move me forward, but I am now more in pain than I was before and just as swollen, the tourniquet feeling around my knee is just as awful plus I am feeling so completely hopeless, I don't even recognize myself. I have to literally force myself to eat, an unheard thing for me. Should I be taking an anti-depressant?! I am now using tramadol for the night (got off oxy because it was making me feel like a zombie) but read that tramadol and certain common anti-depressants, like Zoloft, can have really bad interactions with tramadol. I want to just quit formal PT and follow Bonesmart's gentle and commonsensical way but what if my ROM remains awful and I am basically crippled for life?!?!?! And of course EVERYBODY, including people that had TKRs themselves tell me that PT is crucial?! I don't think I have ever felt as helpless, confused and, frankly, emotionally out of control!!!

 

[sistersinhim]

Read the articles here. You don't even have to have PT. Painful rehab is causing your knee to swell. When it's swollen it can't bend. Not only is it swollen outside, it's swollen inside, too. You need to rest, ice and elevate. Stay away from PT until your knee's swelling has gone way down. We're talking about months. Out of 10 surgeries I did PT only one time. Just living my day to day life rehab my knee. Never let the therapist touch your leg and don't let them make you do anything that hurts. If it hurts, it's injuring your already injured knee. PT should never hurt. If it does, it's just setting you back, not forward.

 

[GimpyGal]

EVERYBODY tells you that PT is crucial? Not around here. My PT was so minimal as to almost have been non-existent. I could go through my exercises in less than 5 -10 minutes a day. That was supervised by the PT who came to my house. Once she cut me free, additional PT was optional and I declined. There were days I did the 5-10 minutes I'd started with, and days I didn't. And if an exercise caused me pain while doing it, or additional pain the next day, I no longer did it.

You really do need to tell your OS that you believe the PT is making things worse and that you are going to take a break from it. You will gain ROM as your swelling goes down.

Also, you are a 'mere' 4 weeks out! Week 3 was very hard on me. By weeks 3 and 4 I felt I should be having less pain and doing more. I felt I should be reducing my meds and was confused why I still needed narcotics. I had cabin fever. I was tired of everyone having to help me with so many things. Tired of not sleeping well, putting up with the side effects of my meds. Tired of not being able to soak in a hot tub, drive myself to the store, prepare a nice meal. Tired of not being able to walk my dog. I was even angry I could not enjoy an evening glass of wine because it was not wise to add that to the narcotics in my system.

So, you have some company in the 'helpless, confused and emotionally out of control' department. Honestly, I would venture at 4 weeks most of us were where you are.

So, get the PT issue resolved tomorrow and there's one step forward. Allow others to help STILL and don't ask too much of yourself yet. Make sure you have good pain management or take care of that tomorrow, too.

I'm eight weeks out. Life is looking a lot better. I'm doing more and more each day, off pain pills, back to running the household. I'm still very aware I have a new knee, there's no doubt about that, but life is no longer the struggle it was at 4 weeks. By laying off PT (it IS optional!) and being kind to yourself, you will make a lot of progress and the dark cloud will lift.

 

[Tabbycat]

@PoorKnees
I really feel what you are going through. I'm having the exact same worries as well. I'm 6 weeks from my RTKR today, and since I had a setback when I overextended my knee a couple of weeks ago I feel my knee is worse. My ROM was 75 at my last pt session but I fear it is now less. It is very hard not to panic that it will not improve and we will be left with basically a non functioning knee after all we have been through with this surgery. I am confused about what exercise I should be trying to do as well. My physio gave me only one exercise to concentrate on, a quad strengthening one, but I've read on here not to do strengthening exercise until 12 weeks, so am I doing more harm than good?
I've just read Gimpy Gal's last post and agree, we are putting too much pressure on ourselves. We can't see the light at the end of the tunnel yet, but others more experienced are here to reassure us that what we are experiencing is normal, and knees are all different in how they recover.
All the best with your appointment with the OS. Keep us posted.
Love, Tabby xxx

 

[newlybionic]

I tried rehabbing my knee by what I thought I was supposed to do. Painful therapy, stopping medications and forcing myself to do more than I should and it left me in pain, had a poor range of motion and felt very depressed. This time I've taken it very easy. Minimal PT where no one touches me and I don't do anything that hurt me. I iced and elevated my knee most of the day and slept whenever I could. I continued routine pain meds for the whole time I had pain. This time my range of motion is great, my pain is minimal to none and I have not experienced the depression I had the first time. Just think would they have someone who had a broken leg start exercising the day afterwards? Of course not. You need to let it heal first. Hang in there. It does get better just give it time.

 

[Nammy925]

My short-term disability was automatically granted through June 12, so 5.5 weeks. Tomorrow's my 3-week mark and I really find it very difficult to imagine how I will be able to go through a whole day at work in 2.5 weeks!!!

Oh my goodness!! I can't imagine going back to work that early! My OS said "no work" for 4 months. He was right, I'm three months post-op and feeling able to do so many things, but going back to a full week of teaching is not one of them. I'm sure if you tell him you are not ready he will extend your time.
Good luck!!!...and know that you are not alone in this journey!


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[Clipless]

I agree with Nammy925- I wasn't ready to be back at work for 18 weeks and I've had a *good* recovery. Taking the time off now will help prevent a chronic pain situation later. Get your forms signed, put your feet up, get lots of rest.