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Blather, clicking knees and Hi Herbm!
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GrammaBear Offline

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Post: #41
RE: Blather, clicking knees and Hi Herbm!
Thank you Peter_C for your response. I wish you well in your continued effort to make your life better. My situation isn't the same as yours, but I've been offered a bit of the same opportunity to make my life better. You are so right, rehab isn't easy, but I feel like I cannot give up.....just can't. Stay strong.
10-07-2014 12:43 PM
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herbm Offline

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Post: #42
RE: Blather, clicking knees and Hi Herbm!
Grammabear it is really a combination of everything -- including luck.

A great surgeon and the best surgical method (in my case a truly world class hip surgeon who specializes in Anterior Approach to Total Hip Replacement.)

The Anterior Approach was a BIG part of my rapid and virtually pain free recovery from hip replacement surgery.

Also note, hip replacement in general is already easier than replacing a knee (all things being equal) so we may not see such amazing results with my upcoming BTKR.

Exparel was another huge factor for me -- 72 hours of EFFECTIVE anesthetic in the joint is an AMAZING ADVANTAGE -- most of the worst pain happens in those first few days. Most people spend these 3 days in the hospital after joint replacement and that is in large part due to pain management where they can get IV meds and more powerful narcotics typically.

Condition and strength play an important role -- you level of fitness. This also includes doing "pre-hab" BEFORE surgery to prepare for it.

Age matters because typically those who are older don't heal as quickly.

Aftercare: Peter and I do NOT share the same level of trust in the physical therapists -- many people are actually injured or set back by incompetent and overly aggressive PTs.

Even though I PERSONALLY might push HARDER than my therapists demand, the key is doing as much as you can safely do without causing further inflammation, swelling or later pain (even the next day).

We don't want to waste recovery time but we don't want to push too hard either. So for me, a big part of the recovery is the knowledge and experience I have with both my own body and how much pain is "Ok" versus pain that is not good for me. Having been in extreme physical activity throughout my life, I know these parameters much better than most any PT could learn in a few sessions.

I used all the PTs for ideas, guidance, focus, and assistance, but I never "trusted" a single one of them to DECIDE what was right for me.

Mental preparation can be a very large factor as well, along with attitude. (I am a trained hypnotist and engage every trick available to both make the surgery more pleasant and my recovery easier.)

This is both the will to do the (proper) rehab and the attitude to just "get better" (as well as the ability to deal smoothly with any set backs.)

For me, actively deciding to ENJOY the process (and succeeding in doing so) was a great help to my attitude. I don't just enjoy my new hip, but enjoyed THE ENTIRE PROCESS, even the things you would think would not be pleasnt. I made something of a game out of HAVING FUN and if nothing else being both proud and delighted at my ability to deal with this.

This is actually a good use for some personal traits that aren't usually considered positive: arrogance, pride, selfishness (you have basically ONE JOB to do after such surgery: HEAL & REPAIR you body.)

Finally there is LUCK. You can do everything right (and so can your surgeon) but develop an infection or other problem despite that.

Luck probably won't every get you a great result by itself, but if everything else is optimized, luck can give you an experience like mine: 1/2 second of total pain for a Total Hip Replacement.

To me, even that 1/2 second was a GOOD THING -- it made clear all the pain I had avoided. Smile

All of the above.

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
(This post was last modified: 10-07-2014 02:34 PM by herbm.)
10-07-2014 01:44 PM
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GrammaBear Offline

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Post: #43
RE: Blather, clicking knees and Hi Herbm!
Thank you both for such honest and open insights. And I wish you a lot of luck in your next procedure and a speedy recovery.
10-07-2014 08:04 PM
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Peter_C Offline

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Post: #44
RE: Blather, clicking knees and Hi Herbm!
Mine will just take time 4-6 months to heal (based on my right shoulder) - I'm waiting to see if Herb has as much 'fun' with his two knees...

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
10-08-2014 12:39 PM
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herbm Offline

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Post: #45
RE: Blather, clicking knees and Hi Herbm!
One key above that perhaps deserves more elaboration is Aftercare and doing the right thing....

Probably the main keys to this that get overlooked are:
  • Proper elevation -- more sophisticated than most would expect -- see link below
  • Proper Icing -- almost continuously, none of that 20 minutes and stop nonsense -- just keep a light towel or something in between your skin and the cold and ensure you don't cause frostbite etc.
  • Proper medication regimen -- taking meds "by the clock"

There's an elevation link (with pictures) below, but the proper way is to have an almost straight leg but not one that is forced straight. (See pictures.)

Icing can be done almost continuously -- my extra attachments for the polar care machine prescribed originally for my hip replacement -- arrived yesterday, so I will be able to use the Polar Care for my (two) knees.

General principle is that meds should be take precisely AS PRESCRIBED or "by the clock" at least until pain management is confirmed. The idea being to never get 'behind'.

BoneSmart is likely the best place to get information and support on knee or hip replacement -- what follows is an excerpt and reference to their 'standard posting' to those who just completed such a surgery.

[url= Pain and swelling control: elevation is the key http://bonesmart.org/forum/threads/pain-...7602/]Pain and swelling control: elevation is the key
[/url]http://bonesmart.org/forum/threads/pain-and-swelling-control-elevation-is-the-key.7602/

Standard Bonesmart recommendations are seen in this thread: http://bonesmart.org/forum/threads/i-mad...ost-683149

BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!
Pain management and the pain chart
Healing: how long does it take?
Chart representation of THR recovery
Dislocation risk and 90 degree rule
Energy drain for THRs
Pain and swelling control: elevation is the key
Activity progression for THRs
Home physio (PT)
Post op blues is a reality - be prepared for it
Myth busting: on getting addicted to pain meds
Sleep deprivation is pretty much inevitable - but what causes it?

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
10-08-2014 12:50 PM
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Peter_C Offline

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Post: #46
RE: Blather, clicking knees and Hi Herbm!
(10-08-2014 12:50 PM)herbm Wrote:  One key above that perhaps deserves more elaboration is Aftercare and doing the right thing....

Probably the main keys to this that get overlooked are:
  • Proper elevation -- more sophisticated than most would expect -- see link below
  • Proper Icing -- almost continuously, none of that 20 minutes and stop nonsense -- just keep a light towel or something in between your skin and the cold and ensure you don't cause frostbite etc.
  • Proper medication regimen -- taking meds "by the clock"

There's an elevation link (with pictures) below, but the proper way is to have an almost straight leg but not one that is forced straight. (See pictures.)

Icing can be done almost continuously -- my extra attachments for the polar care machine prescribed originally for my hip replacement -- arrived yesterday, so I will be able to use the Polar Care for my (two) knees.

General principle is that meds should be take precisely AS PRESCRIBED or "by the clock" at least until pain management is confirmed. The idea being to never get 'behind'.

BoneSmart is likely the best place to get information and support on knee or hip replacement -- what follows is an excerpt and reference to their 'standard posting' to those who just completed such a surgery.

[url= Pain and swelling control: elevation is the key http://bonesmart.org/forum/threads/pain-...7602/]Pain and swelling control: elevation is the key
[/url]http://bonesmart.org/forum/threads/pain-and-swelling-control-elevation-is-the-key.7602/

Standard Bonesmart recommendations are seen in this thread: http://bonesmart.org/forum/threads/i-mad...ost-683149

BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!
Pain management and the pain chart
Healing: how long does it take?
Chart representation of THR recovery
Dislocation risk and 90 degree rule
Energy drain for THRs
Pain and swelling control: elevation is the key
Activity progression for THRs
Home physio (PT)
Post op blues is a reality - be prepared for it
Myth busting: on getting addicted to pain meds
Sleep deprivation is pretty much inevitable - but what causes it?

I can't agree more! If only I knew (any) of this instead of slowly learning it for myself.

My two biggest issues is the post-op blues, and feeling bad that I recover (more) slowly than the "average".

I am being fitted for a new weird brace on Friday that will slowly (they say) over time stretch out my ham string. I want to get to ZERO and am unhappy/upset because I am stuck at 3 degrees.

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
10-08-2014 12:58 PM
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herbm Offline

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Post: #47
RE: Blather, clicking knees and Hi Herbm!
3 degrees is NOTHING in the grand scheme of things.

I would currently be ecstatic with 3 degrees of extension -- right now I am 11 & 15 and don't walk THAT badly.*

* Though there is separately pain, varus (bow legged), bone on bone, and other issues.

It's good to have goals and I am all in favor of your getting to "0" but it may be much like 0.0 on CPAP so you should NOT feel bad about it, except to motivate yourself to keep working on it.

Post-Op Blues are fairly normal and to be expected (IF they happen).

I am not the best person to help you with that perhaps since so far I haven't been affected by them. Some of that is the much easier time I had and the far less experience I have with surgery than you do.

Some of it may be the hypnosis and other attitude work that I do BUT REMEMBER THIS:

Post-Op you have a RIGHT to feel bad or blue some of the time. You have a duty to yell, cry, rant, rave or whatever it takes (as long as you don't hurt yourself or family) to get back to the job of healing.

It's OK to be "selfish" post op. Unless you can heal yourself, it's unlikely you will have much energy or ability to take care of your family.

If needed, come here or even call me to complain. I may not be great at sympathy but I will understand and encourage you -- just as you would do for me.



My new knees are coming 13 days from today and yes, I am counting. Smile

FYI: Part of the isssue the Bonesmart admins had with my posts is that I never had pain, never had an "energy drain", and never had "the blues".

I do NOT (and did not) tell anyone else to expect to be so lucky, but they spend so much time encouraging people WITH BIG PROBLEMS that it is hard to understand how someone (like me) just sailed through it -- even enjoying it thoroughly.

Generally, I suppose most of their cautions while at the same time APPEARING to be much more aggressive than the forum recommends.

So how is the paradox resolved? I believe for those who are highly experienced in "Pushing" physical activity (e.g., extreme athletes and special ops soldiers, marines etc.) who KNOW their body, AND who also understand thoroughly the cautions then this can be a much faster and much more pleasant experience.

Very few people have that experience and many who THINK they have it will still get in trouble by pushing without fully understanding the UNUSUAL risks of joint replacement and similar surgeries.

Even those who have a lot of extreme physical training incorrectly assume they can just POWER THROUGH IT and get themselves in trouble.

"It ain't what you don't know, but what you know that ain't so that will get you in trouble."

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
(This post was last modified: 10-08-2014 04:54 PM by herbm.)
10-08-2014 04:42 PM
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Peter_C Offline

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Post: #48
RE: Blather, clicking knees and Hi Herbm!
Well, one thing you'll like about getting the knees done, is you can 'power through it' all you want, as long as swelling is controlled. With your hip, you had a few cautions to follow, but otherwise there too, you get to set the pace. The shoulder is the exception to the rule. The damn joint is so fragile that the caution list can't even be given until after surgery - it all depends what gets done during the surgery.

On my right shoulder, my elbow could not be allowed to move away from my body for eight weeks (started with four, then six, and finally had the restriction lifted at eight weeks).

Oh well, another day closer for both of us.

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
10-08-2014 06:06 PM
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herbm Offline

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Post: #49
RE: Blather, clicking knees and Hi Herbm!
Maybe I will do the shoulder(s) next year Smile

You are right, the shoulder is barely a 'joint', mostly imagination and muscles. It's probably got the most degrees of freedom and ROM of any joint on the body (even the thumb) and yet must at times support the entire weight of the body.

For the anterior hip replacement, I didn't have any actual precautions though. (The posterior hip replacement is usually replete with them, e.g., no breaking 90 degrees, no crossing the legs, no close adduction, etc.)

The problem with powering through the knees is that this can cause bleeding and that swelling and inflammation you mention.

I am very curious to see how much of an advantage the Exparel will be in the knees as compared to the hip. That could be a major advantage or a large disappointment.

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
10-08-2014 09:14 PM
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herbm Offline

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Post: #50
RE: Blather, clicking knees and Hi Herbm!
3 days until my surgery. Getting excited, rearing to go!

Tue Oct 21st, 2014

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
10-18-2014 10:12 PM
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