SEVEN WEEKS - CHECK IN WITH THE SURGEON

I had to give up on going Percocet free after 2 nights up watching all night TV,  moaning and whimpering, I gave up.  I am told this is not only normal but ok - so I am going to give myself that break.

My PT went fine - no reversals of flexibility, I took a big dose of Tylenol before and started taking some Advil as well for the anti-inflammatory properties.  This was approved by the surgeon in prescribed doses.  I am hoping that following this rotation consistently will get me into the no complaints zone! Still icing with the machines 2-4 times a day and using ice packs in between along with elevation.

The surgeon was very happy with my progress (Said I am a star!) and gave me some suggestions for the incision pain and sensitivity I am experiencing - a cream called SalonPas.  Just started it a while ago so I hope it helps.  By the end of the day my incisions are so sensitive they keep me from sleeping.  He also recommended massage, which I had been doing around the incisions but will now add direct contact to my routine.

 I am cleared to drive, plan to start back to work part time late next week.  I dropped into my office for a brief visit after the doctor's appointment and then went out to breakfast and stopped at the drug store on the way home.  I am beat - so I think the part-time start back to work is a good plan!

STILL STRUGGLING AT 6 WEEKS

While I may have met some flexibility goals last week, I am still struggling with my recovery.  I have been weaning off the Percocet in order to get back to work (and gain my much missed freedom of driving a car. )

 Saturday I went all day only using Tylenol and  the prescription meds at night. I felt ok and moved around well. Even binge watched UnReal with my daughter most of the afternoon... But today, I am in pain all day, very stiff, having trouble stretching and can't relax in any position for any length of time.  I know this is a process.  It doesn't change the frustration.  When in pain I can't work to improve my flexibility.

 I hope that my PT session tomorrow doesn't show lost ground. Not to mention that it will be the first time I attempt PT without the opioid. Yikes. Bring on the ice - lots of ice.

PEOPLE TOLD ME THIS WOULD HAPPEN - WEEK 6

At least 3 people with experience of surgeries or serious medical issues told me that I would get to a dark place, hit a wall, wish I had never had the surgery - and then I would turn a corner.  Guess my last post came from that dark place and then - I turned the corner into the light.

I got over the stiffness that had been plaguing me for days and managed to hit the 120 degree mark on my flexibility.  Apparently that was my goal - so I need to keep at it, keep working on improving my mobility and get to the place where I can walk without a hitch, get in and out of the car and on and off chairs, up and down stairs and stand and walk for more than 20 or 30 minutes at a time.

I am still working on the pain medication weaning.  I am now able to go all day just using Tylenol. The nights are a different thing.  I am not managing to make it through the night without being awoken in pain - then can't go back to sleep with Tylenol .  If I take another Percocet I am still awake an hour or so before I can sleep again. So need to work on that.  I am down to 2-3 in a 24 hour period but hope to be off entirely next week and see about driving the car....Freedom!!!

FRUSTRATED AT FIVE WEEKS

Prior to surgery for TKR there is a required class, a pile of paperwork, binders full of information all about the pre-op process, the surgery and preparations and equipment needed  for the  home. We are told there will be a call to set up PT appointments and a couple of follow up visits with the surgeon's staff. 

At the time time it seemed like a lot of information.  I was anxious about the realities of  recovery, but I  assumed there would be more guidance offered along the way.  Bad assumption. The last tab in the binder is "Follow-up".  There is one sheet of paper with a phone number. The number is for a general appointment call center.

At two weeks I saw the PA. he took off the dressings and advised on care (basically, do nothing to it - no creams, etc.) renewed the Percocet prescription while suggesting I should start reducing my use, asked about PT and that was it. 

I moved from home based PT to a class twice a week.  We rotate from exercise equipment and stretches and are measured to determine our level of flexibility. I am aware there are goals, but they are not discussed... We are told to do the stretching 3-4 times a day at home, not to spend too much time walking around and over using the joints.  The PTs are very nice and very reluctant to discuss any issues other than the class related exercises - we are told questions should be referred back to orthopedic staff.

So I have been waiting longer to take the pain medication, using ice and elevation more to help the pain, doing my stretches many times during the day, taking breaks between tasks so I don't cause additional swelling, only using the bike once a day as I was told - in other words, doing my best to be a good rehab patient.  I have seen the small increases in flexibility and mobility but wonder if I ould be doing better.

So why am I frustrated at five weeks?  I am still very stiff and experiencing a lot more pain than I was in the first post-op weeks.  I am very pain tolerant - not one to whine.  I find myself whimpering and screeching in pain quite a bit.  I am not afraid of getting hooked on opioids, I have been fine with taking the meds as I feel I need them, but there have been many days and nights the pain has gotten ahead of the medication and there lies much misery. One day I go 7 hours before feeling the pain building and another night I'll wake after 4 hours in throbbing pain and can't sleep. So how do I do this?  I need guidance. 

I emailed the surgeon's office and requested a consult.  They referred me to my GP who offered me a phone consult a week away.  Sigh.  If it is like the last phone consult I had with him, he didn't even know why he was on the phone with me and was not prepared.  It was a complete waste of time.  So I called my future daughter in law, a nurse, to discuss whether I should add an OTC between doses  and how much.  She was a great help.

There doesn't appear to be anyone in the orthopedic office available to discuss the rest of my questions, goals and concerns.  I have a follow up appointment on the 28th, so I hope there will be some answers then.

The other issue weighing on my mind is going back to work.  I can't even imagine it right now.  I can't sit for 8 hours at a computer being kind and helpful when I am in pain after about 20 minutes of sitting and need a break to move around and stretch out.  Can't exactly strap on my ice machines while at my desk!  So how do I get there from here?  I am expected back at work in less than 3 weeks - will everything suddenly turn around?

It doesn't seem reasonable to cut me apart, add new parts and sew me back together and then leave me to figure this out on my own.  Right?

KEEPING SPIRITS UP - ONE MONTH POST-OP

I know that I have had an amazingly positive experience with my bilateral total knee replacement.  I planned well, got onto pretty good shape ahead of the rigors of the recovery and have a good support circle.  I seem to be hitting all the markers per the PT staff, I have been reducing my pain meds but feel free to take more if it creeps up. We have even had a couple of weeks of temps in the 70's so I have gone outside to sit in the warm sun with a book a few afternoons.  Still, one month in,  I am tired of the whole thing and having to make a real daily effort to keep my spirits up.

One of the ladies in my class summed it up - we just want normal again.

That is gonna take a while!  It may be 2 months before I go back to work, but it may be 6 months before I can bend my knees without some pain.  Each little moment when this experience is not uppermost in my mind is great - then there is a reminder laying in wait!  Yesterday I went to stand up without thinking and without using my arms to leverage myself up and I thought I was going to pass out it hurt so much.

There is some distance to go.

On the other hand - I am up on this bike!!!!

DAY TO DAY RECOVERY - ONE MONTH

The average time time off work for total knee replacement patients returning to a desk job is 8 weeks.  Some say longer for bi-lateral replacements, but not all.  I plan to return after 8 weeks with some possible accommodations.  Maybe a shorter day, longer, more frequent breaks - not sure until I get back to it and see what weaknesses remain.

The biggest mystery of all with this surgery was what the heck will I be doing all day, every day after the initial recovery period.  I can't drive. Not sure what my capacity for housework or yard work might be.  Not making any money so online shopping must be avoided.  Just how much TV and reading can I handle?

So here is where my days are right now.  I can shower and dress myself but it takes time.  I can spend short periods in the kitchen but find it hard to carry anything of any weight even a few steps without support - so just moving from stove to sink to drain water from potatoes felt a bit perilous.  I keep my meals simple, break down the tasks and leave many of the dishes for my spouse to deal with.

I am supposed to save my energy for doing my PT exercises several times a day, so going out for recreational walks is not recommended.  My walking is just around the house, standing at short intervals for meal prep, folding laundry, wiping down a counter and the occasional foray into the world.  Today we will go to Sports Basement to buy protein bars!  WooHoo.

I do about 4 different rounds of my PT exercises and stretching and then get my ice machines strapped on - that lasts about half an hour.  So I figure about 2 hours a days just on icing.

 I can only sit for 10-15 minute intervals to write notes, read the paper or use the computer, then I haul myself up and move about for a while, then sit down again.  These short blog posts take an hour or so to write.

I expect that my stamina will continue to increase and I will be able to spend more time sitting, standing and be be to add in exercise time on my bike which has been set up on a "trainer" in the living room just waiting for me to be able to climb on and put it to use.   Maybe tomorrow will be the day...

FINALLY A CANE

I have been wanting to move on from the walker since week 2 - just a matter of graduating from the clunky equipment to something more subtle.  Not that I didn't NEED the support and ease of the walker, but once I started taking multiple steps without any aid, it seemed like more than I really needed.

Then we went to the store and I was so glad I had the support of the walker.  I am accustomed to moving swifty and surely around the store. Not the case when shopping with my spouse.  I am following my list and simply needed him to follow me and put the items in the cart - but he kept wandering off  and playing with stuff he found on the shelves.  Sigh. Can't wait until I can drive again.

The only other thing I find I miss abut the walker is the bags we had attached for my stuff.  I could easily transport my phone, Kindle, cup, notebook, etc. Now it takes more thought and balancing than I am sometimes up for.  Might have to start wearing a little back pack around the house!

THE DREADED FIRST 2 WEEKS

If you do any research about total knee replacement the time frame emphasised over and over is he first two weeks.  It is built up as a frightening period of time which, once survived, might need to be forgotten like a difficult birth.

For me, it went by in a bit of a haze - probably due to the opioids but also because I had truly loving and excellent caretakers surrounding me.  What I can say is that each day there is a tiny but noticeable improvement. Each day while people are fetching and carrying and hauling me in and out of bed and up out of an ill chosen seat, I can tell I can do a bit more for myself.

The pain meds kept the throb to an ache, the brain kicked in enough to learn to lever the legs up onto the bed using a strap and when the home health tech arrived to do some PT, I was excited to have something definative to do during the day to aid the recovery.

My son's fiance is a nurse and she not only had the kindest touch but a grasp on what was needed to get things organized and tracked properly.  She created a notebook with each day scripted out for meds, other supplements, PT, icing, water intake, etc.  this helped keep track of when meds were taken and what needed to be done each day. I was also on a good schedule for my nutritional needs - and though my appetite was not that good and I felt some nausea most nights, I think I did ok with my bariatric surgery requirements.

At the end of the two weeks, I was so much more self sufficient, I could shower and dress myself, get around the house, and with thought and time, even make myself a cup of tea and get it to my seat. Hey -I am using  walker and there is a step and a water cooler in another room involved in this process!