Major Tom
Thinks s/he gets paid by the post
I had originally posted this in harllee's thread about her DH's total knee replacement (TKR), but it ended up being such a lengthy account, that I think it might be better to make it the subject of a new thread.
My right knee had been giving me problems since a motorcycle accident in around 1991/92. In around 1998, I had an arthroscopy, to clean up the torn meniscus, but soon learned that I was still no longer able to sprint up stairs, and had to begin thinking in terms of not putting undue stress on my knees. In 2008, I visited an orthopedic doctor, who informed me that I had degeneration of the knee joint, due to osteoarthritis, and would need a knee replacement at some point in the future. It was then that I had to accept the reality that I could no longer run or sprint.
Fast forward to today. My right knee had progressed to being bone-on-bone and, although not as painful as I would have expected a bone-on-bone joint to be, it has been putting limitations on my life for a few years now - notably on the distance I was able to walk without pain. On a good day, I could walk up to a mile without much pain though on a bad day, the distance was considerably less. At the age of 57, I wasn't prepared to accept the crimp this put in my leisure activities. It basically meant that I couldn't take a sightseeing trip to another city, unless I confined myself to a tourbus for seeing the sights, instead of walking the city. I'll make that compromise when I'm 75, but not now.
I saw an orthopedic surgeon, who tried me with a cortizone shot. It worked wonderfully - for about a week. Obviously, this was not the way forward. I was originally scheduled for a total arthroplasty in February, but decided to postpone, until I had had the COVID shot. The surgery was eventually rescheduled for 5/24, and the first couple of weeks has been quite a rough ride.
I am finally on the upswing, and hope to do well, but got off to a rough start. I was told that it is standard to keep patients in hospital for 1 night, but was kept in for 2 nights, due to concerns about the approximately 50 steps, divided into 5 flights, required to get to my apartment in this old house I live in. Occupational therapists coached me in how to walk with a frame, and how to go up and down stairs. In the hospital, navigating stairs was extremely painful, as it was on the first day home. After that, it became easy, and the pain much less.
The big mistake that I made, was skimping on the pain meds in the first 7-10 days after surgery. In my case, the pain meds were oxycodone and gabapentin. As a result, I suffered a great deal of acute surgery pain, and what I can best describe as "existential misery". I wasn't suicidal, but there were some nights when I was seriously thinking that death must be quite wonderful, for the lack of pain experienced. In retrospect, I think I was going through a bout of post-op depression. This was unexpected, as I have never suffered depression in my life before - not even mild depression. Quite honestly, there were some moments in which I felt lonely, and completely broken as a human being. I was also regretting having the surgery in the first place.
I live on my own, but had support from family, friends and neighbors. The cards, texts, and offers of help were really touching. They didn't help my post-op depression a lot though because, at the end of the day, we each face this stuff on our own. If I had been living with a partner, and had someone to give me rides to PT and the orthopedic surgeon's office, it might have helped. However, I am far too stubbornly independent for my own good and, apart from the ride back from the hospital, insisted on doing everything via public transport. My lowest moment came at about 7am on a cold morning. I was waiting for the bus near my house. I had had to wake up at about 5am in order to have a washcloth bath. At 7am, I was clean, but cold and miserable, bending over my walking frame, and staring at the ground. I must have looked so lost, because a young lady walking her dog, stopped and asked if I was OK. I replied that I was fine, and just waiting for the bus, but it helped a lot to feel recognized. Without realizing, she helped me that morning. Shortly afterwards, I was at PT, and things started looking up. They assured me they'd have me off my walker and back on my feet in no time.
A day or two later, at the 10 days after surgery mark, I made my first post-op visit to the surgeon's office, to meet with the physician's assistant. He took a look at my leg, and started telling me that I was running out of time to gain full ROM (range of motion). He really read me the riot act. In retrospect, he must have been more concerned with my extension than flexion, as he smashed my knee down onto the examination table until I was screaming in pain. I eventually stared at him pointedly and yelled, "Stop!" The poor feller looked quite taken aback. Everyone in the waiting room and the other exam rooms must have heard me! He could see that I was quite down, and really suffering, and assured me that it would get better - and that the more work I put into regaining flexion and extension, the faster the pain would go away. Then he left the room, and I didn't see him again. His assistant brought me a prescription for more pain meds, and I was on my way.
I realize that the physician's assistant was trying to put the fear of God into me, as he didn't think I had been exercising hard enough to regain my ROM. He was partially right, as I feel that the information I had been given in the hospital wasn't very clear. I was shown exercises in the hospital, and given a handout with a large number of knee exercises. I was told how important it was for me to take responsibility for rehabilitating my knee, and reminded that scar tissue would begin forming immediately after surgery, so I had to begin exercising straight away, to break the scar tissue. The problem is, it wasn't emphasized to me that, in the first few weeks, all I had to worry about was increasing my ROM - an objective that could be achieved with a very few simple stretches. The handouts said things like, "Do 2 sets of 10, 3 times a day." I got the impression that all I had to do was a few exercises from the handout (I didn't know which ones) a few times a day, and I'd be OK.
Luckily, in the days following surgery, I did a lot of online reading, and began to get a feel for what I was supposed to do. One comment the physician's assistant made to me, which was very useful, was,
"You should be doing this stuff all day."
That was the first time anyone had impressed upon me that my entire days needed to be dedicated to increasing my ROM. What a shame I didn't realize this 10 days sooner! Now, I wake up, dose myself up with pain meds, have a cup of tea, wait for them to take effect, and begin the stretches. Then I ice the knee. Then rest a little. I do 4 sessions like this a day. I do a total of 12 stretches, each 10 minutes long. Half of them in flex, and the other half are extensions. That way, I spend a total of an hour a day in flex, and an hour a day in extension. It hurts, but it's a good pain.
At my second PT visit, at the 2 week and one day mark, my flex was measured at 120 degrees, and extension at 11 degrees. I do think the 120 degrees was off, as it looks more like 100 to me. They insisted that it was 120 though. I was advised to ease off on the flex stretches, and do more extension stretches. This extension of 11 degrees at 2 weeks and 1 day after surgery concerned me, but my therapist told me there is plenty of time to get it down to zero, and that she has had patients with greater extensions, who successfully got them down to zero.
After my initial awful 10 days immediately surgery, I am enjoying my recovery, and believe I can do this. As others have noted, 2 useful sources of info appear to be -
https://www.yourorthomd.com/
and
https://bonesmart.org/
These 2 sites seem to represent the 2 different ways of thinking. Chris Gorczynski, on his yourorthomd site, feels that it is important to strive for maximum ROM by the 6 week mark - and that any increases in ROM after that point are minimal. He thinks that even if your knee joint is swollen and painful, you should keep stretching it in both flexion and extension, without a break, in order to reach your goals. The folk at Bone Smart, however, take the view that you shouldn't do anything that hurts you, and that the 6 week mark is not that important - that meaningful increases in ROM can be achieved even 6 months or a year after surgery, by the use of gentle stretching.
With both camps being so convinced that their viewpoint is the correct one, it is hard to know who to believe. Frankly, after my very unpleasant and painful experience at the hands of the physician's assistant, I'm inclined to lean towards the more gentle view espoused by the nurses and nurse practitioners at Bone Smart. I'll be quite happy to spend every day for the next year exercising, and doing gentle stretches. If my increase in ROM after 6 weeks are incremental, that is fine with me, as long as I eventually reach my goal.
My surgical knee is still swollen from the procedure, and I can't help feeling that if I were to stop walking on it and stretching it so hard, the swelling might go down, and my ROM would magically increase.
Anyway, that's my story so far. If I have the other knee done, or a hip (which is probably going to happen), then I will learn from this experience. I will double up on the pain meds for the first week, to avoid the acute surgical pain. No skimping on pain meds next time!
My neighbor has been urging me to get an ice machine. I do ice the joint a few times a day with gel packs, for about 20 minutes each time, but wonder if I should be doing more icing.
EDIT - I did want to add that my rather awful experience with the post-op blues could have a silver lining. It has sensitized me to the things and people I am grateful for. My little cat would jump up onto me, looking for affection, and I'd begin crying tears of happiness, feeling so grateful that I have her. I have also realized how blessed I am for the friends and family I have. I think this experience has humbled me, and hopefully made me more aware of the suffering of others. I hope that I don't forget this, as I progress towards recovery.
My right knee had been giving me problems since a motorcycle accident in around 1991/92. In around 1998, I had an arthroscopy, to clean up the torn meniscus, but soon learned that I was still no longer able to sprint up stairs, and had to begin thinking in terms of not putting undue stress on my knees. In 2008, I visited an orthopedic doctor, who informed me that I had degeneration of the knee joint, due to osteoarthritis, and would need a knee replacement at some point in the future. It was then that I had to accept the reality that I could no longer run or sprint.
Fast forward to today. My right knee had progressed to being bone-on-bone and, although not as painful as I would have expected a bone-on-bone joint to be, it has been putting limitations on my life for a few years now - notably on the distance I was able to walk without pain. On a good day, I could walk up to a mile without much pain though on a bad day, the distance was considerably less. At the age of 57, I wasn't prepared to accept the crimp this put in my leisure activities. It basically meant that I couldn't take a sightseeing trip to another city, unless I confined myself to a tourbus for seeing the sights, instead of walking the city. I'll make that compromise when I'm 75, but not now.
I saw an orthopedic surgeon, who tried me with a cortizone shot. It worked wonderfully - for about a week. Obviously, this was not the way forward. I was originally scheduled for a total arthroplasty in February, but decided to postpone, until I had had the COVID shot. The surgery was eventually rescheduled for 5/24, and the first couple of weeks has been quite a rough ride.
I am finally on the upswing, and hope to do well, but got off to a rough start. I was told that it is standard to keep patients in hospital for 1 night, but was kept in for 2 nights, due to concerns about the approximately 50 steps, divided into 5 flights, required to get to my apartment in this old house I live in. Occupational therapists coached me in how to walk with a frame, and how to go up and down stairs. In the hospital, navigating stairs was extremely painful, as it was on the first day home. After that, it became easy, and the pain much less.
The big mistake that I made, was skimping on the pain meds in the first 7-10 days after surgery. In my case, the pain meds were oxycodone and gabapentin. As a result, I suffered a great deal of acute surgery pain, and what I can best describe as "existential misery". I wasn't suicidal, but there were some nights when I was seriously thinking that death must be quite wonderful, for the lack of pain experienced. In retrospect, I think I was going through a bout of post-op depression. This was unexpected, as I have never suffered depression in my life before - not even mild depression. Quite honestly, there were some moments in which I felt lonely, and completely broken as a human being. I was also regretting having the surgery in the first place.
I live on my own, but had support from family, friends and neighbors. The cards, texts, and offers of help were really touching. They didn't help my post-op depression a lot though because, at the end of the day, we each face this stuff on our own. If I had been living with a partner, and had someone to give me rides to PT and the orthopedic surgeon's office, it might have helped. However, I am far too stubbornly independent for my own good and, apart from the ride back from the hospital, insisted on doing everything via public transport. My lowest moment came at about 7am on a cold morning. I was waiting for the bus near my house. I had had to wake up at about 5am in order to have a washcloth bath. At 7am, I was clean, but cold and miserable, bending over my walking frame, and staring at the ground. I must have looked so lost, because a young lady walking her dog, stopped and asked if I was OK. I replied that I was fine, and just waiting for the bus, but it helped a lot to feel recognized. Without realizing, she helped me that morning. Shortly afterwards, I was at PT, and things started looking up. They assured me they'd have me off my walker and back on my feet in no time.
A day or two later, at the 10 days after surgery mark, I made my first post-op visit to the surgeon's office, to meet with the physician's assistant. He took a look at my leg, and started telling me that I was running out of time to gain full ROM (range of motion). He really read me the riot act. In retrospect, he must have been more concerned with my extension than flexion, as he smashed my knee down onto the examination table until I was screaming in pain. I eventually stared at him pointedly and yelled, "Stop!" The poor feller looked quite taken aback. Everyone in the waiting room and the other exam rooms must have heard me! He could see that I was quite down, and really suffering, and assured me that it would get better - and that the more work I put into regaining flexion and extension, the faster the pain would go away. Then he left the room, and I didn't see him again. His assistant brought me a prescription for more pain meds, and I was on my way.
I realize that the physician's assistant was trying to put the fear of God into me, as he didn't think I had been exercising hard enough to regain my ROM. He was partially right, as I feel that the information I had been given in the hospital wasn't very clear. I was shown exercises in the hospital, and given a handout with a large number of knee exercises. I was told how important it was for me to take responsibility for rehabilitating my knee, and reminded that scar tissue would begin forming immediately after surgery, so I had to begin exercising straight away, to break the scar tissue. The problem is, it wasn't emphasized to me that, in the first few weeks, all I had to worry about was increasing my ROM - an objective that could be achieved with a very few simple stretches. The handouts said things like, "Do 2 sets of 10, 3 times a day." I got the impression that all I had to do was a few exercises from the handout (I didn't know which ones) a few times a day, and I'd be OK.
Luckily, in the days following surgery, I did a lot of online reading, and began to get a feel for what I was supposed to do. One comment the physician's assistant made to me, which was very useful, was,
"You should be doing this stuff all day."
That was the first time anyone had impressed upon me that my entire days needed to be dedicated to increasing my ROM. What a shame I didn't realize this 10 days sooner! Now, I wake up, dose myself up with pain meds, have a cup of tea, wait for them to take effect, and begin the stretches. Then I ice the knee. Then rest a little. I do 4 sessions like this a day. I do a total of 12 stretches, each 10 minutes long. Half of them in flex, and the other half are extensions. That way, I spend a total of an hour a day in flex, and an hour a day in extension. It hurts, but it's a good pain.
At my second PT visit, at the 2 week and one day mark, my flex was measured at 120 degrees, and extension at 11 degrees. I do think the 120 degrees was off, as it looks more like 100 to me. They insisted that it was 120 though. I was advised to ease off on the flex stretches, and do more extension stretches. This extension of 11 degrees at 2 weeks and 1 day after surgery concerned me, but my therapist told me there is plenty of time to get it down to zero, and that she has had patients with greater extensions, who successfully got them down to zero.
After my initial awful 10 days immediately surgery, I am enjoying my recovery, and believe I can do this. As others have noted, 2 useful sources of info appear to be -
https://www.yourorthomd.com/
and
https://bonesmart.org/
These 2 sites seem to represent the 2 different ways of thinking. Chris Gorczynski, on his yourorthomd site, feels that it is important to strive for maximum ROM by the 6 week mark - and that any increases in ROM after that point are minimal. He thinks that even if your knee joint is swollen and painful, you should keep stretching it in both flexion and extension, without a break, in order to reach your goals. The folk at Bone Smart, however, take the view that you shouldn't do anything that hurts you, and that the 6 week mark is not that important - that meaningful increases in ROM can be achieved even 6 months or a year after surgery, by the use of gentle stretching.
With both camps being so convinced that their viewpoint is the correct one, it is hard to know who to believe. Frankly, after my very unpleasant and painful experience at the hands of the physician's assistant, I'm inclined to lean towards the more gentle view espoused by the nurses and nurse practitioners at Bone Smart. I'll be quite happy to spend every day for the next year exercising, and doing gentle stretches. If my increase in ROM after 6 weeks are incremental, that is fine with me, as long as I eventually reach my goal.
My surgical knee is still swollen from the procedure, and I can't help feeling that if I were to stop walking on it and stretching it so hard, the swelling might go down, and my ROM would magically increase.
Anyway, that's my story so far. If I have the other knee done, or a hip (which is probably going to happen), then I will learn from this experience. I will double up on the pain meds for the first week, to avoid the acute surgical pain. No skimping on pain meds next time!
My neighbor has been urging me to get an ice machine. I do ice the joint a few times a day with gel packs, for about 20 minutes each time, but wonder if I should be doing more icing.
EDIT - I did want to add that my rather awful experience with the post-op blues could have a silver lining. It has sensitized me to the things and people I am grateful for. My little cat would jump up onto me, looking for affection, and I'd begin crying tears of happiness, feeling so grateful that I have her. I have also realized how blessed I am for the friends and family I have. I think this experience has humbled me, and hopefully made me more aware of the suffering of others. I hope that I don't forget this, as I progress towards recovery.
Hopefully she is on her way to recovering from this dreadful surgery.
Sounds like you are doing much better now. 
