TRIED FULL TIME AND BACKED OFF

My plan was always to build up my work hours back to full time by 12 weeks - and I did.  Now I am backing off.  Only by one hour a day, but this is why:  I leave for work at 7:15 am and get home around 5:15 pm.  I am the "chief cook and bottle washer" as they used to say - so by the time I get home I am straight into  the kitchen getting dinner together, then cleaning up then I am too tired to do a real PT work out.

I tried full time for over a week and found not only was I tired at work all day, I felt like my knees were getting stiffer as the week went on.  I am lucky that my manager was totally behind me reducing back my hours to keep the healing process going forward.  I have had 2 days of a better work out and time on the bike - so I hope this is a good move.

I have a good friend who is a neurologist - I mentioned this issue of incision tenderness and sleeplessness to her, not in hopes of a diagnosis but because we both, as many older women I know, have issues with getting good sleep.  Anyway...she immediately suggested I contact my doc about a prescription which helps with nerve pain and has the side effect of drowsiness.  Started it last night and it didn't make me sleepy.  But I will keep trying it for a while and report the name of the drug if it seems helpful with this particular set of issues (in case there is someone else experiencing them.)

One more piece of news is that I rode a bike OUTSIDE last weekend!  A short ride - a few miles - but I felt it in my quads just above the knees. Even the little rises were a challenge after a stationary bike for 3 months!  The weather is supposed to be great this coming weekend so I am very excited to go out again.  I even wore my bike shorts and let the world see my scars!

So that's the story week 13.

BACK TO WORK - 10 WEEKS POST SURGERY

I survived my first two weeks back at work - weeks 8 and 9 I worked between 3.5 and 5 hours per day.  My job keeps me on a chair, wearing a headset in front of a computer.  I managed very well with taking breaks to stretch my legs and use ice during a break. Put a box under my desk to change my leg position now and then.

I was stiff when I got home - about a 20 minute drive which is hard on the right leg - and usually did an immediate PT session followed by ice, then another one before dinner.  I found I was very tired and in bed early each night.  I am still using Tylenol and Advil  and, though I keep trying to skip it, still using the Percocet at bedtime - hopefully I'll be off that in the next week or so.

The only other complaint I have is continued incision pain/discomfort.  The incision is healing really well and looks good but by the end of the day is so tender and sensitive I frequently go to bed early so I can leave my knees exposed - no clothing,  sheet or nightgown touching them! Have not read about anyone else having this issue...

This week, week 10, I am up to 5.5 hours per day (at work 6 hours due to required lunch break) and plan to increase to 7 hours next week and back to full time on my 12th week following surgery.

 My surgeon thought this was ambitious but I am feeling good, I still have time for at least 2 sessions of stretching and strengthening.  I was concerned during week 9 because my right leg was not showing the same improvement and strength as my left, but it suddenly kicked in, they are getting more equal and my gait is much improved.  I still get more stiffness in the right knee and work it harder during my PT sessions.

 I am only up to about 20-25 minutes a session on the exercise bike - I do feel more pain following the longer sessions so I am trying not to cause a backwards slide - tho I really feel good when I am on the bike!!

HOPEFULLY HELPFUL TIPS FOR TKR PREPARATION

I did a lot in preparation for surgery and for the post op period at home.  I have a few hints that I thought I would share,  Having had both knees replaced, I am in a slightly different position in terms of functionality and recovery, but these things may turn out to be helpful for any TKR patient,

Having some help keeping track of paperwork, post op instructions and pharmaceuticals is a big

help.  My future DIL is a nurse and she actually created a daily chart for me to track all the things we needed to deal with daily.  I could check off the timing of my meds, supplements, water intake, activity, use of ice machines, etc.  Plus keep notes of any issues for follow up.  I am still using it to keep track of my pain and inflammation doses during the day - it can be a challenge to keep track and remember the timing as it can change day to day.

FYI - For those who might be bariatric patients or who take a lot of nutritional supplements - take care with adding vitamin K when taking blood thinners in the first couple of weeks following surgery - check with your physician on this.

Mine is labeled TheraBand

Initially I spent a lot of time in bed - it was more comfortable and close to the bathroom. I recommend having as large a bedside table as possible!  There were a lot of things on it - water bottle, usually a tea cup, meds, phone, TV remote, clock,log book and pen, etc.  I also liked having a chapstick, some gum, a book and hand lotion.  Think about he little things that give you pleasure and make you feel pampered when you are in pain and can't shower with the frequency you would like! This is really just for the first week or so - but FYI.

Having a strap around has been invaluable.  Mine is a stretchy one, but a static one like those used in yoga works, too. I used it to leverage my legs on and off my bed and sofa and now use it several times a day for my PT exercises.

I love my ice machines!  A great tip is to freeze water bottles and use them instead of ice cubes - not as messy, easy to carry to and from whatever room you are using the ice machine in.

I was unable to sit at a table to use a computer for about a month or so - and I could not tolerate a laptop on my lap as my legs were too tender - so a TV tray, breakfast tray or other sort of lap desk would have been great for meals and for computer use.

We put our  family room leather sofa up on bed risers to make it easier for me to get up and down.  Very helpful when you want to use furniture without arms to leverage up and down. With two knees out of commission - I had to have someone lift me up before we got the risers - afterwards I could do it by myself.   Eight weeks later and the risers are still there!  Might as well have some things easier.

Hope these ideas are helpful - going into this surgery there is not a lot of info on recovery - I was lucky I had help and some of these items on hand!

CURIOUS ABOUT THE INCISIONS?

I am posting these photos - don't look if you don't want to know!!

The incisions were closed with surgical glue - which I didn't know until the big reveal two weeks in when the dressings were removed.  The glue is sort of purple and the incision was very puckery which made me nervous.  also the knees are very swollen.

Post surgery dressings

At 2 weeks when dressings removed

This is taken at almost 1 month.

And this is at 6 weeks.

The swelling has decreased - I still get discoloration like bruising when I have over done it - like standing or working out a bit too much. That is an indication of swelling, which I relieve with ice and elevation. Adding Advil has helped in the last 24 hours, too.

 I mentioned the SalonPas cream for tenderness in a previous post - it has helped. I have used lotion right up to the incision to relieve the itchiness and peeling skin - but followed doctor's orders and did not put anything on the incision until now.

The incisions are still puckery but so much improved I am not too concerned for the scar being too bad.  As you can see the right one is curved and the left one straight - didn't ask the surgeon about that! 

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.

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...