FIFTEEN WEEKS POST TKR - GETTING SOME SLEEP

I am happy to report that I am finally getting some sleep - the medication has been helping a lot.  Not every night, but most nights I am getting at least 6 hours of sleep. I would prefer 7 1/2  so I am taking the meds a bit earlier each night.  The medication I am taking is called Gabapentin.  I still have tender and sensitive incisions, but the sharper nerve spikes have diminished and I am not waking after I am asleep - at least not due to the healing incisions.

I am still leaving work a bit early to do my PT every day.  It really helps to do this - I feel so much stronger and more flexible each week.  I am able to get up and walk around enough at work that I experience much less stiffness, also my walking has improved a lot, hardly any "hitch" in my gait.

I spent several hours on my feet at an event this weekend and rode 10 miles on my bike the next day. I was tired and sore each day, but I think I need to push myself in order to build my strength back.  Besides - before the new knees I could not have stood and walked as much as I did!  I could, however, put many more miles in on the bike - so I have more work to do. I am 10 days away from 4 months post-op.  I think I am still doing really well. Yay.

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!!

STARTING BACK TO WORK

I graduated from physical therapy last week about the time I got a paycheck for $54.00.  Time to go back to work so I don't owe them money for my benefits!

Over a week ago, I achieved a flexibility level of 126 on both knees - had no issues from the start with getting to 0 on my straight legs. I have some wobbliness and weakness on my right knee that I am working on strengthening for, but I was the first of my PT group to "graduate".

 I spent my last few sessions working on things like balance, climbing stairs and the hardest for me - getting on and off a regular chair without pushing off with my arms.  Ouch.  (I admit my biggest fear is getting stuck on a low public toilet and not being able to get up!) I had to put my fear of the pain behind me and after a few practice tries at standing up from the low chair in the gym - I could do it pretty well and it got less painful as I went. 

I also started driving during week 7. Freedom!!!  Though I wouldn't want to try to drive very long or far at this point! That driving leg is my weaker one and it gets stiff when I am in stop and go traffic.

At my appointment with the surgeon I asked for a letter to return to work on a limited basis and was given permission so long as I keep in mind this is still "early days" as he put it. So I started last Friday for just 3.5 hours with 1  break to ice and a few stretching out walks around the office.  I went again today for the same amount of time and might try for 4 hours tomorrow. 

Not sure if there was a betting pool on the likelihood of my returning at 8 weeks - but there were some very surprised people...also very welcoming people.  Nice to be out of the house for a few hours a day, then home to do my PT and rest.

Normal here we come.

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.

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?