TKR t2paythepiper's LTKR Recovery Thread

[t2paythepiper]

@mendogal I have always been very limber. Used to sit Indian style and walk on my knees; elbows, wrists etc hypermobile.

Anyway, I know that's why I probably have decent numbers to start with. It doesn't mean they'll improve. As I mentioned above I think I have to pay a lot more attention to what I'm doing each day.

To put it nicely I have inconsistent help here so I do tend to try and rely on myself and then adding in the PT and what feels good to do is probably too much by the end of the day

 

[Jockette]

To put it nicely I have inconsistent help here so I do tend to try and rely on myself

Doing these daily activities is what I like to call “natural PT” It’s all the movements, but a little at a time, rather than in a list of reps of exercises. It all counts, towards healing.

then adding in the PT and what feels good to do is probably too much by the end of the day

Yes. Cut back the formal reps and just live your life and you’ll heal fine.

Is it allowed to post a picture of the incision here?

Yes, posting a picture is fine.

 

[mendogal]

Yes, there's a link, fourth from left, at the top of your message composing box, for uploading an image.

 

[t2paythepiper]

Red circles are visible and maybe the creases are under the skin?

Surgery was 4/10 and OS appointment is not until 5/7.
That was the appointment time scheduled when the surgery was scheduled. I believe the surgeon is on vacation or out of state or something this week. My understanding as to why I didn't have an earlier appointment was that they were unavailable.

 

[t2paythepiper]

I know it is to be expected and I have read about energy drain and I am doing less but, I am soooooo tired and low energy (mental and physical)

There, I said it to someone, hopefully that will make me feel better

It has been so much worse the past two days, as has the swelling and stiffness. I suppose this is just a few down days (i.e. more healing happening).

My husband is leaving for a 4 day golf tournament. Since I am still not cleared to drive, he took me to Costco and I stocked up on rotisserie chicken and some other fresh foods. Hoping that upping my protein intake will help.

Yawn.......

 

[benne68]

Here's what I wrote in my first TKR recovery thread as I reached the 4 week mark:
"I just want a magic wand that speeds up the recovery and jumps me ahead about month. If anybody has come across one of those, please share!"

The fatigue does eventually recede. In the meantime, just listen to your body and let it heal. @t2paythepiper

 

[mendogal]

To quote staffer Roy Gardiner
"When you are icing and elevating and watching telly you are not 'dossing around' you are 'engaging a carefully considered proactively designed heuristically programmed dynamically structured recovery programme'."

In other words... Rest! All your energy and metabolism is, on a cellular level, focused on repair.

The extra protein is a good idea. Apparently we seniors do best if we have ample protein at each meal, not just a protein heavy dinner.

Ample fluids (any source - water, coffee, tea, yogurt, fruit, puddings) will also help fuel this ramped up metabolism. We might not have energy in recovering, but we are burning it like crazy!

 

[Layla]

Some protein snack ideas for in between meals...or maybe a meal for some.
Greek Yogurt, Peanut Butter & and Apple, Edamame, Hummus and Veggies, Cottage Cheese, Cheese Slices, Protein Shakes, Nuts or Trail Mix, Hard Boiled Eggs, Chicken Salad, No Bake Energy Bites.
Have a great Wednesday!
@t2paythepiper

 

[t2paythepiper]

Hi - I have searched the forums and noticed a few of you have used the Colpac icepack. My PT used one on me the other day and I am in LOVE! It is like a soft, cold hug! LOL

I have made almost a dozen of my own ice packs with water and rubbing alchohol and have some small gel packs but nothing feels like these do.


Do the Colpacs from Amazon feel that much different than the other brands or homemade pacs? I am wondering if the PT clinic is able to chill them to a lower temperature and maybe that is why they feel so heavenly?

 

[t2paythepiper]

Yesterday was PT session #5 and week 3 post op! Next week I see the surgeon and get the stiches removed (photo above). I am still very anxious about that but trying to push it out of my head as there is nothing I can do about it. Flexion was 115 and I didn't realize she was doing the measure ment (she usually waits until the last rep) so I probably could have gotten a little further. Just happy I didn't go backwards.

After several bad days in a row, I feel a bit better today. Recording this here so I can come back and read it next time I am feeling discouraged as I know that will come and might remind me this too shall pass.

1) I think it helped to tell a few friends how I was feeling (and of course tell the Bone Smarties ).

2) I was pretty straight with my PT the past two visits. Not putting this here to complain, I think it was a good session and good outcome. I tend to push myself too hard and need to be told to cut back but I also need to understand what is happening in my body and what is good pushing vs bad pushing. Yesterday, she put me on the bike to warm up and I asked her to move the seat further out (less bend). I just couldn't get around even after rocking back and forth or trying backwards. She did move it to where I had been last session and I still couldn't get my leg around. After more rocking, I tried again successfully but it HURT. I accidentally dropped the f-bomb and then quickly apologized. I know I had tears in my eyes, not so much pain as just the shear exhaustion and frustration of feeling I was going backwards. Anyway, nice thing was she was very sympathetic, we had another good talk about discomfort vs pain including what pain was, about doing too much, ADL PT (I had to clean up a dog mess instead of ice before appointment...up and off floor...she of course said all of that counts as exercise and PT) and she told me to think of outpatient PT as gym day. Pre-surgery me didn't do all my gym exercises at home.

3. Last pick me up was going out! My husband had a few friends in town on their way to their golfing weekend. We met a few of them for a drink (yes, I indulged but didn't take any meds). It was refreshing to get out and I was able to prop my leg up so was pretty comfortable for an hour.

@benne68 YES!! You must have been reading my mind. I am one to NEVER wish time away but this has been a struggle.

@mendogal - I love that quote!! He sounds like a smart guy

@Layla - Thank you for the additional ideas. I pre-stocked my nest with protein bars and also with little tupperware containers that each held about 1/3 cup of mixed, unsalted, roasted nuts (thank you Costco!). I actually use those to keep dog training treats strategically placed around the house and they turned out to be perfect! A friend gave me some of the individual Peanut Butter packets and those have been very handy as well.

Anyway...wanted to pass along the tiny container snack staging in case it helps someone else.

 

[Jamie]

It is possible that therapy clinics freeze their cold packs to a lower temperature than people keep their home freezers. I think all of the gel cold pack products use the same technology, so I’m not sure there is much or any difference in the various brands. If the size of the gel pack the clinic uses is larger, that could make a difference. The larger the pack, the more area covered and the slower that it warms.

I like your last post. You are putting this all in perspective and also doing a good job advocating for yourself and communicating with your therapist. All these things contribute toward a successful outcome. You’re going to do just fine! And….115 ROM at this point is fabulous! So SMILE!!! You’ve got this.

 

[Peterfox]

I am also in my fifth week. I cannot make a complete rotation with my knee on a bike. I know it will come. I’m just taking care of doing the correct things. Ice elevate walking stretching. Don’t push it. Especially if you’re in pain. Take a deep breath when your PT works the knee. Good luck.

 

[t2paythepiper]

Today was my first post-op appointment with my surgeon (tomorrow is PO week 4).

Great appointment, all thumbs up and pleased with my progress! Stitches removed, incision looks great, x-rays look great, walking/gait is great, flex and extension good, released to drive and to use our swimming pool!

We had lunch to celebrate and then I went home, sat down with my new Chattanooga Colpac, my laptop and then promptly fell asleep for 4+ hours. Just the universe reminding me that despite all the good news, today is just the day after tomorrow and this recovery is still just one day at a time.

So all thoughts of what I was going to do the rest of the week have been adjusted back to one activity a day but I am super excited to start doing some excercises in our pool, increasing my walking time and ultimately getting back on my recumbent trike with my dog.

That said, these are all outside activities. What have others found helpful for protection incisions from the sun? My hip was easier to keep covered with clothing but it is already in the high 80s/90s here in Florida and I would rather not wear leggings or long pants in the summer. The sun here is brutal and anyone with fair skin knows you can tan/burn through fabric. Now that the stitches are out, I can use sunscreen but I don't trust that as being sufficient.

My husband looked for some plain zinc oxide and couldn't find any, just sunblock. I have tried wrapping it with an ace bandage but that isn't working too well, it slips. I read about scar tape but when I asked the OS's PA she said that is used for breaking up the skin/muscle adhesions??


Thank you in advance for any suggestions you have!

 

[mendogal]

Sunscreen and clothing are really about it.

There is clothing made, including very lightweight casual pants, with sunblocking. I believe LL Beane and similar online shops offer them.

 

[Layla]

Happy Thursday and Happy One Month Anniversary, t2paythepiper!

Some internet info on the topic of new scars -

Scar tissue is thin, under stress, and requires extra attention. While skin is healing, it becomes a lot more sensitive to the harmful effects of the suns ultraviolet rays. That is why its important to take precautionsand be diligent with care while healing.

Fresh scars, that can be described as still pink and healing, are highly vulnerable to ultraviolet (UV) light from the sun and can easily burn. This is because the tissue is still actively repairing itself and healing. At this stage in your healing process, multiple inflammatory mediators (chemical messengers) are released in the skin, which can stimulate the activity of pigment-producing cells called melanocytes. If you add sun or UV exposure into the mix, you may end up with post-inflammatory hyperpigmentation or hypopigmentation (lightening of the skin).

Post-inflammatory hyperpigmentation can lead to darker, more prominent scarring that can last months to years. It is also important to note that people with darker skins are more prone to discoloration caused by post-inflammatory hyperpigmentation.

I recommend you call your surgeon's office to get thoughts from your OS's care team. I'm sure they'll be happy to advise. Stay safe!
@t2paythepiper

 

[t2paythepiper]

Tomorrow marks 5 weeks PO.

Having more freedom, pool access and more walking outside, has me back to recalibrating what I can do each day. The pool feels so good it's hard to not do it even if I've already done my share of daily activity. Even stretches feel so gentle and easy with the water. I also have just started being able to walk my dog. It is hard to pace myself and combine the really WANT to do with the PT exercises. On the days I am not at PT, I am trying to scatter the exercises out throughout the day. That seems to work better for me than doing them all at once.

Monday, I had a fantastic PT session with a few new exercises I really liked. Nothing felt like it was too much and I walked out feeling strong and so positive. I didn't do anything before the session but ice and elevate (I usually do some stretches). Iced, elevated and rested when I got home. Took my dog for a walk in the early evening, iced again and fell asleep early. Easyish day, right? Nope. Woke up a little after 10:00 with this horrible deep throbbing ache in my lower quad area, upper and lower knee, and upper tibia. From what I've read and what has been explained by the OS, I'm guessing it was a combination of the Quad tendon and possibly the bone as well getting used to the implants. I am not trying to drive myself crazy with reading about the procedure but I do tend to handle pain better if I understand the cause.

Have done nothing today but rest, ice, normal house activity and will walk the dog in a few hours. Then will ask at PT tomorrow what caused so much drama today.

I am getting to the point where when I have a really good day I know that a reality adjustment is just around the corner!

@Layla @Mendoza- thank you for the scar/incision protection info.

I did ask the surgeon's office and all they suggested was sunscreen. I just always feel we need extra protection here in Florida. I'm doing my pool exercises after the sun has dropped a bit so it's not directly on the pool. Grabbed some extra clips and wrapping with an ace bandage when walking. I have noticed it's a handy visual for my neighbors. They give me a little more berth so I don't have to worry as much about getting out of the way from another dog or bike. If the swelling were down more I would use my old compression sleeves but I don't want to reduce blood flow while it's still swollen. Has anyone used sleeves after surgery and stitches are removed?

 

[mendogal]

Your PT session seems to have put you in the OverDid It Club (ODIC).

It's not at all unusual for a new or increased activity to feel fine during doing it but create temporary misery afterwards (ask me how I know! ) - normally a full day of rest, ice, and elevation combined resolves it.

Plus, in my experience if the new activity or increased activity involved, to make up a number "X x 6" I would next time cut the increase to "X x 3" and if that was well tolerated after a couple of sessions or walks like that then try "X x 4"...

 

[t2paythepiper]

@mendogal
I think my downfall with the ODIT club (love that lol), is that I exercised so much up until surgery that my muscles are in good shape. It feels so good to use them again so I probably do larger sets than I should. This PT clinic's magic number is 30. They don't push it but would like 30 reps in as many sets as you need with as much rest as you need. Since it felt good, I "may" have done some sets of new stuff of 15 or more. Yes, bad idea and he and I even talked about how you don't know you have overdone it until much later.

Whenever the knee hurts or the tendon or whatever is in there I'm quick to go easy on it.

Love to know why something like the walk I just did can feel great but within minutes of getting home and not striding, my knee feels like a watermelon stuffed into a grapefruit rind. These aren't long walks and am using the time to practice heel toe and today did the longer strides I saw recommended here for extension. This was the only thing I did today other than ADL. It doesn't look visibly swollen so I guess that is the internal swelling. I am going to ask if there is a gradual way to end exercise and not have this happen as it doesn't seem to happen (usually) at PT.

I'm in the pool now , moving very gently and letting the cool water get on it before I go ice.

This is definitely a day to day adventure and it is so helpful to remember that.

 

[mendogal]

I agree with scattering exercises throughout the day; it's one reason I quit formal PT!

"Not long walks"... compared to what?

In my recoveries I always measured either time or distance (pick one) and backed off if the swelling after was too much.

For example progressing from 1/2 mile to a mile took a few weeks of very small increases - after too big an increase created a very bad evening and I had to go back to 1/2 mile for a week.

 

[t2paythepiper]

"Not long walks"... compared to what?

Before venturing out with the dog, I walked back and forth in front of my house (corner to corner) to determine my stability, stamina and whether I would have any suprises like a leg cramp, sudden sharp pain or light-headedness. Did this for a week and worked up to 2.1 very boring miles

The dog walks I am currently doing range from 1-1.5 miles. You comment re. time/distance made me realize that stopping to talk to neighbors might be contributing to the swelling as I don't do well at all. Sit and elevate or "move-it, move-it" (can't remember the movie LOL). Leaving now and will time the walk as well.

Question about massage - I have searched the index and the forums and haven't yet found what I was looking for. I have never been a fan of massage so know nothing about it. However, the PTs and OS office PA have each said I should gently massage the incision area (it is fully closed) and around the knee and now ask if I am doing it. I am but haven't a clue if I am doing it correctly. Some of this is to help desensitize (numb on lateral side of knee and hyper sensitive on medial) and then also for swelling. Are there any resources on how to do this on this site?

I have seen such a range online of scar massage suggestions and then I was looking for lymphatic massage (one PT mentioned elevating and massaging toward the heart for lymphatic drainage to help the swelling?).

Thanks in advance.