Bad Knees

[Bird]

the only good thing good about being on coumadin is ...bruises/hickies go away fast

That's something I hadn't thought about, but maybe not fast enough to suit me. One of the odd things (to me anyway) is that most of the soreness is the front and inside front of that leg above the knee. And that whole area looks bad; like it's taken a real beating; black & blue.

I didn't ask what caused that; just guessing maybe it was the anesthesiologist's doing. I knew that they were going to do a "nerve block" (not to be confused with an epidural or spinal block), but before putting me to sleep, she (yep, female anesthesiologist, maybe 30 years old) felt around the right side of the knee, then I think she poked a needle in 2 or 3 times; told me beforehand it was going to make my foot flop around and it did. Then she moved up to my groin and did the same thing causing the calf of the leg to do a lot of jerking. Now as injections go, those were quite painful, but not intolerable. I guess they have to do that before putting you out so they're sure of getting the right nerve. And it was Tuesday night before the last of that nerve block wore off.

Walking is no problem and the physical therapy exercises, so far, are not bad except bending the knee beyond 90 degrees; i.e., lying on my back and trying to pull the heel back to my butt; gotta work on that one.

 

[Bird]

And thanks for everyone for all the well wishes.

 

[sweettractors]

Welcome back Mr. Bird and remember, Therapy, Therapy, Therapy . Ken Sweet

 

[texbaylea]

Bird

Glad to hear how well you are doing. They treat orthopedic patients well here but the treatment you got is unbelieveable. I will have to ask about that CPM. That has not been mention when I have asked about post surgery PT. I can see its benefit.

I hope I do as well as you when I start knee replacement.

Enjoy life :thumbsup:

Vernon

 

[texbaylea]

Bird

Did your PT management team say how soon you can return to driving? Just thinking ahead.

Vernon

 

[ronjhall]

Welcome back Bird.

 

[heehaw]

i guess each Dr does it different: the wife had not "nerve blocks"..just the epidural for the first day or two then oral meds after that: an she brought the cpm home and is suppose to use it for 6 hours every day for 20 days: a guy at the same pt, used the cpm while in the hospital but none after that??? the wife goes to pt every day for 2 weeks then 3 times a week for 2 weeks: everyone else we have talked to goes 3 times a week for 4-6 weeks...oh well, as long as it all works out an folks get that motion back in the knee it doesn't matter. i've only talked to one person that their knee surgery did not improve their life dramaticly: an they admitted they did not exercise or do any pt on their own; plus they are really heavy.
heehaw

 

[Bird]

i guess each Dr does it different: the wife had not "nerve blocks"..just the epidural for the first day or two then oral meds after that: an she brought the cpm home and is suppose to use it for 6 hours every day for 20 days: a guy at the same pt, used the cpm while in the hospital but none after that??? the wife goes to pt every day for 2 weeks then 3 times a week for 2 weeks: everyone else we have talked to goes 3 times a week for 4-6 weeks...oh well, as long as it all works out an folks get that motion back in the knee it doesn't matter. i've only talked to one person that their knee surgery did not improve their life dramaticly: an they admitted they did not exercise or do any pt on their own; plus they are really heavy.
heehaw

The home health care physical therapist told me yesterday that every doctor is different. In addition to the CPM, I had the machine on which I could push the button every 10 minutes for another little shot of morphine the first 36 hours or so, was told to just ask anytime I wanted oral hydrocodone/APAP in addition to that. Thursday morning, before I was discharged, the doctor said I could get rid of the TED stocking on my left leg, continue wearing the one on the right leg in the daytime, but could take it off at night. Nurses said that was something new; they normally continue wearing both for a couple of weeks 24/7. My doctor does not send the CPM out of the hospital. The doctor told me I'd have the home health care therapist come to the house every day, Monday thru Friday, for 2 weeks, then decide if I needed to go to outpatient therapy in the building next to the hospital 3 days a week. However, the therapist who came yesterday thought he was supposed to only come 3 days a week, but when I told him what the doctor told me, he said he'd be back this morning, and then every day, Monday thru Friday, the next 2 weeks.

Of course, he says I'm already where most people expect to be in 2 weeks. He measured the angle of my knee with me just bending it myself at 108 degrees and said most would be 70-80 degrees. And I don't need very much, if any, pain medication. So who knows? I sure don't consider myself to have a high tolerance for pain, so am I just lucky, did I just have an extra good doctor, or will I have set backs later? We'll see.

 

[Bird]

i guess each Dr does it different: the wife had not "nerve blocks"..just the epidural for the first day or two then oral meds after that: an she brought the cpm home and is suppose to use it for 6 hours every day for 20 days: a guy at the same pt, used the cpm while in the hospital but none after that??? the wife goes to pt every day for 2 weeks then 3 times a week for 2 weeks: everyone else we have talked to goes 3 times a week for 4-6 weeks...oh well, as long as it all works out an folks get that motion back in the knee it doesn't matter. i've only talked to one person that their knee surgery did not improve their life dramaticly: an they admitted they did not exercise or do any pt on their own; plus they are really heavy.
heehaw

Heehaw, I got my staples out this morning. I think the leg looks terrible, and it's definitely sore, but as my wife says, it sure looks better now than it did a week ago. I don't know what they did to "bruise" it like that, but the nurses and physical therapist say it's normal. Did your wife's doctor leave her leg bruised like this?

 

[Reg]

Hey, Welcome Back.

I can tell you about the groin (and ankle) bruising.
It is from the clamps that they put on just before they start cutting.

Just like in a workshop, figure they need the parts to align, so if they clamp the top and bottom of your leg before they saw the bottom off the top half and the top off the bottom half you won't wake up with your foot on backwards, or pointing an extra 30 degrees to starboard (-:

They have to work with your old alignment, which may not be perfect.
If they "corrected" an existing misalignment you would have other problems.
Any alignment problems you have are what you have learned to compensate for, so they want to put you back together the way you were.

Yes, I think hospitals HAVE changed a LOT and very much for the better.
Better food, better consideration, no "talking down" to patients or spouses, understandable (not Latin) language to describe things.

So, no CPM machine at home ?
I'm a little surprised at that, we didn't bring one out but the outpatient services folk delivered one the next day that we kept for 3 weeks.

I forgot all the drug names my wife had, one was a blood thinner that she had to inject herself with - into her stomach/belly area. Fortunately she could handle that.
I suppose I could have done it for her, but I'm not disappointed that she did it herself.

Again, WELCOME BACK !!!
(-:

 

[Bird]

Hey, Reg, I appreciate the information. I wondered about it and what you say makes sense. My wife wondered about the bruise on the right side of the foot.

I've been thinking that it appears the alignment is not perfectly straight ahead; toes aim very slightly out; certainly not enough for concern, and nowhere close to my Dad's natual alignment.:laughing: I used to think, when I was a kid, that his footprints looked funny. What do the skiers call it? Herringbone?

As for the blood thinner, they were giving me a daily 5 mg tablet of coumadin (warfarin) in the hospital, but the prescription for use at home is just a 3 mg tablet. So Monday the nurse came and pricked my finger and checked my blood with a gadget that looks like the ones used to check blood sugar. She said I was 1.5 when I should be between 2 and 3; i.e., blood not thin enough. So Tuesday morning the doctor's "surgical assistant nurse" said to take 2 tablets a day instead of one. The home health care nurse will be back again Monday to check it again.

But they haven't given me any other medications, except the hydroco/apap to take 1 or 2 tablets every 4 to 6 hours, as needed, for pain.

I do kinda wish I had that CPM machine because the knee gets to aching when it's not moved for a little bit, which makes it a bit hard to sleep. I keep waking up, move a bit, go back to sleep. The ache isn't a bad pain; just enough to interfere with comfort and sleep.

 

[Egon]

Hope all goes well with the knee Bird.:thumbsup::thumbsup::thumbsup:

 

[Reg]

Hey, Reg, I appreciate the information. I wondered about it and what you say makes sense. My wife wondered about the bruise on the right side of the foot.

I've been thinking that it appears the alignment is not perfectly straight ahead; toes aim very slightly out; certainly not enough for concern, and nowhere close to my Dad's natual alignment.:laughing: I used to think, when I was a kid, that his footprints looked funny. What do the skiers call it? Herringbone?

As for the blood thinner, they were giving me a daily 5 mg tablet of coumadin (warfarin) in the hospital, but the prescription for use at home is just a 3 mg tablet. So Monday the nurse came and pricked my finger and checked my blood with a gadget that looks like the ones used to check blood sugar. She said I was 1.5 when I should be between 2 and 3; i.e., blood not thin enough. So Tuesday morning the doctor's "surgical assistant nurse" said to take 2 tablets a day instead of one. The home health care nurse will be back again Monday to check it again.

But they haven't given me any other medications, except the hydroco/apap to take 1 or 2 tablets every 4 to 6 hours, as needed, for pain.

I do kinda wish I had that CPM machine because the knee gets to aching when it's not moved for a little bit, which makes it a bit hard to sleep. I keep waking up, move a bit, go back to sleep. The ache isn't a bad pain; just enough to interfere with comfort and sleep.

I think I grew up hearing "quack footed" as the term for toes that point WAY out and "pigeon toed" for those that point way in (-:
You may straighten out closer to where you were as you heal and build strength.

PART of what I like so much about the medical profession these days is that they have really turned the corner on communication.
Maybe they still get a lot of their training in Latin, but my wife's surgeon in particular is very good at describing the "mechanics" of things in everyday language and LISTENING to the patient/spouse play it back to check our understanding.

If your surgeon is anything like ours and you think the CPM machine would help then I think it would be a good idea to ask about having one, suggest it even.
My guess is that there are a number of nominal regimens for this and that some flexibility within any one of them is very desirable to tailor it to each individual need.
Same with the medications, nominally it is so much of whatever so many times a day for so many days, subject to review of patient response.

You may be ahead of the curve with your flexibility, obviously that is GOOD, but if a progress milestone has been reached early and that milestone normally signals the end of a NEED for a CPM,,, well, I can't guess at that (-:
If I get a new knee in the next few years and they don't give me one I'll tell 'em my wife had one for three weeks and it benefited her greatly.
If I get a new knee more than 5 years from now I'll try to accept that as a whole generation of progress.

or
Ya wannit ? Then Ask fer it.
If Ya still don't get it and wannit bad enough then DEMAND it (-:

You ARE the customer and you are the only one who REALLY knows your level of discomfort, so part of your responsibility is to tell them what you think would help.

 

[jinman]

I forgot all the drug names my wife had, one was a blood thinner that she had to inject herself with - into her stomach/belly area. Fortunately she could handle that.
I suppose I could have done it for her, but I'm not disappointed that she did it herself.

Reg, the drug your wife took is most likely a liquid blood thinner called Heparin and administered subcutaneously (sub-Q) rather than into a muscle like many other medications. I believe insulin is also administered subcutaneously.

 

[Reg]

Reg, the drug your wife took is most likely a liquid blood thinner called Heparin and administered subcutaneously (sub-Q) rather than into a muscle like many other medications. I believe insulin is also administered subcutaneously.

All she is remembering is that it began with an "L" (she thinks, but I know that vague look).

 

[Bird]

All she is remembering is that it began with an "L" (she thinks, but I know that vague look).

I mentioned that to my physical therapist this morning and he said "Lovenox", which is one form of heparin, so your wife, jinman, and my therapist were quite likely all correct.:laughing:

 

[Reg]

I mentioned that to my physical therapist this morning and he said "Lovenox", which is one form of heparin, so your wife, jinman, and my therapist were quite likely all correct.:laughing:

I shouted that through to her in the kitchen.
Yes, that is it.
I mess with words, we had a slightly obscene exchange based on love and nox.
(as in knocks).

Its late here, I think we're going to turn in now (-:

 

[texbaylea]

Bird

I appreciate your postings about your knee replacement as I have become more firm that I need to do the same. Because of the pending reduction in medicare reimbursements after the first of the year I am also becoming more certain that I need to do this soon.

Vernon

 

[jinman]

I mentioned that to my physical therapist this morning and he said "Lovenox", which is one form of heparin, so your wife, jinman, and my therapist were quite likely all correct.:laughing:

I bet your therapist failed to mention that it is made from the mucous inside pig intestines. When it comes to blood thinners, you have the choice of injecting something from pig guts or coumadin which is sodium warfarin also know as rat poision. Ain't technology wonderful?:laughing:

 

[Bird]

Bird

I appreciate your postings about your knee replacement as I have become more firm that I need to do the same. Because of the pending reduction in medicare reimbursements after the first of the year I am also becoming more certain that I need to do this soon.

Vernon

Vernon, I wish I knew more about the pending reduction in medicare reimbursements. I don't really know just what effect that will have on us. Having a knee replaced is certainly no fun, but not just real bad, either. Perhaps my biggest problem is sleeping here at home. The knee gets to aching if it isn't moved for awhile; not a severe pain, maybe a 2 or 3 on a scale of 1 to 10, but just enough to keep me from sleeping comfortably for any length of time.