Mako Robotic Arm TKR Week Three

Posted by saeternes @saeternes, Dec 17, 2019

Three weeks have passed and I reached 116 bend and 2 extension. Still more to go.

What is surprising me about this entire process is how all-consuming it is. I exercise, elevate and ice, sleep, eat, repeat. That's about it. Perhaps because I still take the meds to do the exercises, I am not able to focus or work. It also surprises me how much I sleep, and how the knee feels nothing like normal yet. I don't know when that starts to happen. We did start working on stairs today at PT, the opposite of what they teach you in the hospital when you leave, so more weight is put on the damaged knee. Still swelling on the knee but it is going down in the leg. Lymphatic massage is helping.

Any advice for the upcoming weeks from those of you who have been through this?

@saeternes : mostly: patience. I still remember having to do 3 30-minute exercise sessions each day, with an additional 3 20-minute excruciatingly painful static leg extension stretches, with lots of icing in between. At about the 4 week mark I was tired of the pretty constant pain (remember, I voluntarily stopped all prescription pain meds. at about 9 days), and at that point decided to join an indoor pool (saline, in a fitness center associated with senior living) to do my knee rehab. The trained person in charge of the pool developed a specific water exercise program for me and my knee, and I found it much less painful to do the lifts and squats etc. in the warm water, and was able to do a lot more repetitions. One example: instead of step-ups I was told put my foot on a pool noodle under water and push down on it, let it raise up, and repeat. I still did the step-up at home in addition, but I believe the pool version did a lot to strengthen my respective muscles. At about 6 weeks I started swimming some laps as well. Just a thought, in case you get frustrated, and want to change up your daily routine.
Also, since this is an old folk’s home, quite often I had the whole – small, 10 x 10 meters – pool all to myself, so I could grunt if I wanted to!
Regarding day-to-day functioning, at that point I was back to my normal routine re. household, cooking, cleaning (except no kneeling to scrub bathtub, and no walking for exercise because of inadequate leg extension). Also had the fun of hosting houseguests with an active 5 yr., old 5 weeks after TKR.
As to when the knee feels “normal” – no clue. An acquaintance said around 6 months. I’m still waiting. (14 months…. it works “normal”, just doesn’t feel “normal”).

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@ellerbracke thank you, I will try to be patient and actually grunting sounds great right now. I do plenty of it at home. The pool is something I want to look into in the new year. Alex says I can also start light weight lifting again in January so I am hoping that will help. My knee generally feels like a lump of concrete. I think one thing I never figured out is that looking at the milestones that people reached I never thought to ask how they feel. Alex feels my fatigue is mostly due to the meds, but unlike you, I feel I have to have them to get through the exercises. I really admire you quitting so early and forging onward.

I have a friend who threw up with the narcotics so never could take them. She barely avoided a MUA and dosed herself with Ibuprofen and Tylenol, that was all she could do. She is over a year out and said her knee still aches after sitting for a few hours. In France, where she is from, TKR patients spend a week in the hospital and then another three weeks in a rehabilitation center. She said they are "good to go" after that but I doubt the tissue would be completely healed no matter what they did.

The itching has largely gone away, still a lot of stiffness and I assume that will go on for a while. I could get by with no meds as long as I didn't have to exercise, but the window is small so it is a trade-off I guess. Thanks again!

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Also on the bike more now, edging toward 30 minutes at mild resistance. Hurray!

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@saeternes

Also on the bike more now, edging toward 30 minutes at mild resistance. Hurray!

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@saeternes : congratulations on your biking! I never liked any kind of stationary bike, even though I used it a little in the beginning. The fitness person made me aim for keeping my heart rate at 120 bpm or above (roughly 5 to 6 weeks after TKR), and that was pretty intense. And boring. And my butt hurt after 20 minutes.
Re. pool: no idea what facilities near you look like. Since “my” pool is specifically designed for seniors, it is moderately warm water, hand rails all around the inside pool wall, 2 entrances with wide, low concrete steps with hand rails on either side, depth ranging from 4 1/2 ft. (for lunge walks) to 6 ft. That is about as ideal as it can get. And to top it off, it’s less than a mile from my house…. walking distance if I should chose (I don’t! either I walk, or I swim, not both.)
Regarding pain medication: I had been prescribed Percocet or Oxycontin roughly 6 times over the past decade for various legitimate reasons, and I simply dislike the way they make me feel. I have no fear of addiction – if I am “addicted” to anything, it’s doing Sudoku or other brain games, reading of any kind, a good pinot noir – specifically from the Willamette valley in Oregon, more specifically from Stoller, Sokol Blosser, or Lemelson. Hard to impossible to get in SC., so I indulge when out West.

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I don't understand the oxycontin addiction problem – the dose must be much higher than what I am taking. As far as I can tell, it just takes the edge off the pain, doesn't give a high or anything like it associated with addictive drugs.

Today for the first time the numbness on the outside of the knee seems to be shrinking in area. The top part has some feeling now. I am practicing going up and down stairs the normal way with the surgery leg taking most of the weight. Managed 30 min on bike yesterday although it did make me tired. Another thing I am doing is using a bench to put the top of my foot on, and then bending down while holding the walker. This stretches the quad very well. In the lower leg there is still pain right under the skin if I push on it – Alex says it is edema. So the lymphatic massage is helping. I didn't even know there was such a thing.

@ellerbracke yes those are great wines. Try some of the Columbia River Gorge wines too if you get a chance, both from Oregon and Washington.

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Today 3.5 weeks, 120 degrees bend and 2 degrees extension. Extension is much more difficult although not as painful. Looks like I have a few weeks to go. Just for fun we measured my other leg – 150 deg. bend, of course 0 extension.

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@saeternes

Today 3.5 weeks, 120 degrees bend and 2 degrees extension. Extension is much more difficult although not as painful. Looks like I have a few weeks to go. Just for fun we measured my other leg – 150 deg. bend, of course 0 extension.

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@saeternes : nice to find a fellow slow-straightener. Alas, I think you are coming up on close to a month, and you are definitely coming up on holidays. I wish you the best, and continued great progress.

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I am indeed finding the straightening much harder and hope I can make progress over the next week. How did you manage to do it? I have cut down the drugs again as pain is receding. What I didn't expect is the exhaustion and feeling of just wanting to hide under a rock until it is over. I slept 12 hours last night, amazing.

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@saeternes

I am indeed finding the straightening much harder and hope I can make progress over the next week. How did you manage to do it? I have cut down the drugs again as pain is receding. What I didn't expect is the exhaustion and feeling of just wanting to hide under a rock until it is over. I slept 12 hours last night, amazing.

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@saeternes : my PT guy made me elevate the leg – as straight as possible – for 20 minutes sessions 3 (or more) times a day. I put my heel on the armrest of the couch while on my back. For me, discomfort set in after 5 minutes of that, by 10 minutes I was in pain, and by 20 minutes I was in tears. Hard to believe that just laying there, doing nothing but keeping knee totally straight can be so bad. In addition, I would sit on the floor with my legs straight out, and push down hard on the TKR knee for several 30 second sets, also a few times a day. It still took me months to get those last 1 or 2 degrees. At least you are lucky that you can sleep. I think I averaged 4 hours or less for the first month. Mostly because of pain. And of course I did not do my usual activities or exercising to the level that I’m accustomed to, and that make me tired enough for a solid, uninterrupted sleep pattern.

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@ellerbracke that's close to herioic. I can't imagine doing all of this without the meds. I've found a new exercise on the web that involves lying on one's stomach, from knee down leg hanging over bed, and a rolled up towel right above the knee. It's pretty good. I also do the one you mentioned. I also haven't been able to do my regular exercises and that takes a toll. I have found that I am pretty happy when left on my own, just because it takes so much energy to interact. Hopefully that will diminish over time.

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@saeternes

I don't understand the oxycontin addiction problem – the dose must be much higher than what I am taking. As far as I can tell, it just takes the edge off the pain, doesn't give a high or anything like it associated with addictive drugs.

Today for the first time the numbness on the outside of the knee seems to be shrinking in area. The top part has some feeling now. I am practicing going up and down stairs the normal way with the surgery leg taking most of the weight. Managed 30 min on bike yesterday although it did make me tired. Another thing I am doing is using a bench to put the top of my foot on, and then bending down while holding the walker. This stretches the quad very well. In the lower leg there is still pain right under the skin if I push on it – Alex says it is edema. So the lymphatic massage is helping. I didn't even know there was such a thing.

@ellerbracke yes those are great wines. Try some of the Columbia River Gorge wines too if you get a chance, both from Oregon and Washington.

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@saeternes I think some people must just be much more easily addicted. I have been on oxycontin, oxycodone, hydrocodone, Dilaudid, and tramadol at various points in time but have never become addicted at all. After my first TKR which was in 2012 or 2013, before all of the concern about opioids, I was on oxycodone for about 3 months. At another time I was also on five phenobarbital, nightly, for about 6 months just stopped with no effects.
I am impressed with both you and @ellerbracke though in how well you are doing. I have noticed when I exercise, even now, the knee that had the first TKR still hurts a bit afterward — not really bad, but enough to be conscious of it. The knee with the Conformis never hurts at all. My flex has never reached beyond 120 but listening to others I think maybe I am to blame for not exercising it more than I did. I never had a problem with extension.
Those pinot noirs sound pretty good to me too. We always used to go to CA yearly and along with visiting my step-son outside of SF, our son in L.A., we went to wine country. I miss those days, I wish I could still have my glass of wine with dinner. After transplant they say no alcohol but I have yet to figure out why if your cirrhosis was not caused by alcohol. Still, I adhere to it.
JK

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@contentandwell Wow, I have never heard that rule about no alcohol after a transplant! But you don't mean the knee, right? If so I have already broken it. When I don't have to take any meds I have a glass of wine or two–of course with the meds you can't have any alcohol. ON your first TKR, I wonder if the first knee may not fit very well, and that's why you have problems? Back then the Conformis wasn't available and I am not sure how many sizes they had. It's great that you have one that is working really well. More later on my progress or lack therof!

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@saeternes

@contentandwell Wow, I have never heard that rule about no alcohol after a transplant! But you don't mean the knee, right? If so I have already broken it. When I don't have to take any meds I have a glass of wine or two–of course with the meds you can't have any alcohol. ON your first TKR, I wonder if the first knee may not fit very well, and that's why you have problems? Back then the Conformis wasn't available and I am not sure how many sizes they had. It's great that you have one that is working really well. More later on my progress or lack therof!

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No, @saeternes, I had a liver transplant. It’s pretty common to be told to not drink alcohol after a liver transplant, even when the cause was not alcohol. I haven’t figured out why the restriction exists except for the fact that alcohol is not good for anyone’s liver. I have heard of a transplant center that said a patient could drink a very limited amount, like one glass of wine a month, and my surgeon said for a very special occasion one drink would be OK. I had a glass of champagne at my son’s wedding in August. There are transplant centers that say “not one drop, ever”!
JK

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@saternes: long time no update. Things are going well? Extra stress with holidays? Miss your TKR dairy notes.

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Make that diary notes….

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