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HerbM Bilateral Total KNEE Replacement surgery Oct 21st, 2014 -- WOW!
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herbm Offline

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Post: #21
RE: HerbM Bilateral Total KNEE Replacement surgery Oct 21st, 2014 -- WOW!
BTKR Day 3 Post Op


My BTKR is incredible easy.


Going home today after in pool therapy at 9:40 -- quite literally could have done this outpatient with no narcotics.

A little bit of sore muscles in lower quad and back of calf.

I can walk with one cane well (since surgery day actually), and my main goals now are to loosen up the sore muscles and retrain my gait (already working on that.)

My doctor has me doing in pool therapy since Day 2 (yesterday) and that is going to be my main form of official therapy.

I have the CPM machine strapped really tight (most of the slack out) and going through its full range (-10 to 120 degrees.) Note: due to slack my knee isn't really going THAT far, but we are close to 0 extension and getting close to 110 probably on flex.

No pain from CPM, only tight at the full flex.

Already both knees are better than pre-op probably. I will get the physical therapist to check the actual range during the therapy session this morning.

Again note: I am not walking quite as good due to the soreness in the muscles and tendons.

A few days and this soreness will probably leave, a week or so and it will just be 'details' (gait etc.) if my luck continues to hold.

Right about the Exparel but it might already be gone -- it was a split does, and the "nominal chart" for it suggests it would be gone within 8 hours (4pm) from now (8am).

Based on the hip, I am pretty sure we are good in the joint itself.

Re: "Bogo" -- both knees were free for me. Insurance paid the entire bill, except for a few incidentals (e.g., polar ice "Y-adapter") but I will submit those bills and probably get some/mot of it refunded.

As to the CPM, it only GOES to -10 through 120, so gave it the whole thing.

All the personal medical stuff is good too (category TMI): bowels moved a couple of times yesterdy, temperature nominal, blood pressure good, pulse ox Ok, they checked me for a blood clot right with ultrasound but there was no issue, energy levels HIGH.

I've only been getting about 4 hours sleep due to all the waking the patient up (for stupid stuff) in a hospital and due to my high energy levels and that I am jut having so much FUN.

I am on vacation and having a blast - gong to take a couple more weeks off from work (sick leave, floating holidays, etc.)

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."
10-24-2014 08:28 AM
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Peter_C Offline

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Post: #22
RE: HerbM Bilateral Total KNEE Replacement surgery Oct 21st, 2014 -- WOW!
i am here and interested! not typing much at the moment.

Great for you herb! it sounds like it will be a short rehab for you, and i hope you have 'fun' the entire time. please keep posting updates? i for one really wish to read them.

*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."
10-24-2014 06:04 PM
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herbm Offline

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Post: #23
RE: HerbM Bilateral Total KNEE Replacement surgery Oct 21st, 2014 -- WOW!
Home. Tired. Sore. Just past full Day 3 Post-Op (74 hours)

Stopped at pharmacy on way home; Carol dropped off meds Rx.

Carol dropped me at Chinese massage -- she went home briefly then back to pick up meds while i got the
90 minute full body massage ('the works').

Wearing only shorts and t-shirt with bandages showing at knees.

Small, Chinese women did my massage -- no English.

Lot's of improvement for soreness, especially the very tender muscles and the charlie horse in the right calf.

Arrived home and brought in all the 'stuff' from the car.

CPM machine was waiting for us at garage -- dropped off by rep. Positioned it on couch and plugged it in but did NOT finish setup. (Tomorrow probably.)

Lying in my new electric Laz-E-Boy with extra elevation from my excellent 5" riser pillow.

Two hours overdue for pain meds (last were at discharge), 2 hours past likely Exparel efficacy.

No real IN JOINT pain. Only issues are the stiff and sore muscles and tendons. Almost no actual pain, but this is about as bad as it has been.

Very little sleep last night (they woke me at 4:20 for blood stick.)

Took pain pill 30 minutes ago when I sat down so I am already feeling better.

RICE -- Rest Ice Compression Elevation


Going to eat dinner -- will try to make video (30 seconds) after supper IF I have enough energy.

Otherwise, nighty night my friends.

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."
10-24-2014 07:23 PM
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herbm Offline

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Post: #24
RE: HerbM Bilateral Total KNEE Replacement surgery Oct 21st, 2014 -- WOW!
I am having a great time -- I am LITERALLY on a GREAT vacation.

I returned home about 5:45 Oct 24th

I haven't seen much in the way of a 2 over the last few days, and cannot testify to any 3's reliably, though I have had a few brief excursions near there tonight as we were arriving home tired and low on pan meds.

Really though, it was more fatigue than discomfort (3 hours sleep Thu night, awake for 14+ hours on Friday, 6 hours with a 4-hour (half-dose of max) med, Exparel wearing off, and the stress of the second PT in the pool, packing to leave the hospital, and the trip home, plus setting up once we arrived home.)

But note this was also NOT a big surgery drain, just the deserved tiredness of a short sleep followed by a long day.

And of course the puppies had to get me to play briefly with them too. (170 lbs of puppies packaged in all white and all gold.)

I made (at least one) minor, tactical error: Scheduling the trip home to overlap the likely exhaustion of the Exparel. It turned out to be acceptable but it wasn't a good 'plan'.

Exparel is basically "time release Bupivacaine" (the most common child birth epidural anesthetic); Exparel is advertised as lasting "up to 72 hours" -- weasel words, but I have read the monograph on it and it really is likely to have a 72 hour efficacy curve.

This is also twice now that my own results have born out the advertised Exparel efficacy even though this time the surgeon was required to "split the vial/dose" between two separate surgical sites whereas he put the entire dose/vial into my hip when replacing that single joint 9 weeks ago.

I slept from about 10pm until 12:30am in my recliner (and yes, that is a big boon to my recoveryPeter I am so glad you are making it and so sorry it is not an easy time for you.

Maybe you could get one of those harnesses the movie people use to "stage a hanging" scene on video?

Saw this done as a prank by a troubled teen on that new TV Series "The Affair" -- near the beginning, his dad (the star) comes up to the kids room to find out what is delaying him joining the family vacation. The brat is hanging there, faking his own suicide.

Your wife could just hang you up and let you down when she has time to watch over you. Wink

I am having a great time -- I am LiTERALLY on a GREAT vacation. I returned home about the time you were posting that first 1-finger message above (5:45 Oct 24th) and even with two hands, 10 fingers, and very little pain it was tough to write such a message so *I* am HIGHLY IMPRESSED by your ability to string a coherent message together while you are so much less comfortable that you would prfere and using only 1 finger.

Call me if you wish, as we previously discussed, and we'll work through some exercises to determine if those are of any value TO YOU.

Do NOT put that knee brace back on until YOU feel that it will do you more good than not, Ok?

Put that brace on as soon as it is the right and most effective thing to do to improve YOUR situation, current and future health.

Your wife continues to sound like a beautiful gem -- we're just trying to figure out what YOU did to get her to LOVE YOU.

You 6-7 knives and 5-6 burning sounds very difficult to deal with or put aside and I am HIGHLY IMPRESSED by your ability to keep going. (I don't think most people know how uncomfortable a "5" is on a true scale; they tend to call every bad an 8, 9 or even 10 -- on an accurate scale there must be room for levels that most people have never even dreamed of.)

A 10? That's the one where the Vampires in TrueBlood (great TV series) "greet the sun" and explode into a big pile of vampire goo. Smile

I haven't seen much in the way of a 2 over the last few days, and cannot testify to any 3's though I have had a few brief excursions there tonight when arriving home tire.

Really though, it was more fatigue than discomfort (3 hours sleep Thu night, awake for 14+ hours on Friday, 6 hours with a 4-hour (half-dose of max) med, Exparel wearing off, and the stress of the second PT in the pool, packing to leave the hospital, and the trip home, plus setting up once we arrived home.)

And of course the puppies had to get me to play briefly with them too. (170 lbs of puppies packaged in all white and all gold.)

I made (at least one) minor, tactical error: Scheduling the trip home to overlap the likely exhaustion of the Exparel.

BTW, it SOUNDS like you had something like Bupivacaine http://en.wikipedia.org/wiki/Bupivacaine infiltrated into YOUR joint.

Bupivacaine usually lasts about 7 hours (it's the most common epidural drug used for things like child birst.)

Exparel is basically "time release Bupivacaine" which is advertised as lasting "up to 72 hours" -- weasel words, but I have read the monograph on it and it really is likely to have a 72 hour efficacy curve.

This is also twice now that my own results have born out the advertisement even though this time the surgeon was required to "split the vial/dose" between two separate surgical sites whereas he put the entire dose/vial into my hip when replacing that single joint 9 weeks ago.

I slept from about 10pm until 12:30am in my recliner (and yes, that is a big boon to my recovery and wish you had one) so feeling pretty good now. (Good enough to write the above.)

The TWO Polar Care cold therapy machines have been happily chilling my knees for the last 4 hours as well.

My meds are caught up, though I can now have a full does of 2 more Percoset (Oxy+Tylonol) now (1:45 AM).

The sleep refreshed me, and now I am going to figure out what the best next step is.

(My choices include going to bed dragging the two Polar Care machines, watching TV and/or eating again. s in my recliner with the 2 machines, take some more oxy or Norco [hydrocodone + Tylenol], play on the Internet, etc.)

I am almost certainly NOT going to work on setting up the CPM machine (by myself) and certainly not going to drive anywhere Smile Carol is asleep and I don't know anyone who would want to visit or talk this late at night Smile

Thus the chatting here on this forum which is a BIG PART of my recovery strategy.

Unfortunately they banned me on the BoneSmart Forum (hip and knee joint replacement) so I can't go over there to read, comment, and chat with others dealing with similar issues.

You are all I have Peter Wink Along with the other kind folks here who are taking an interest in my recovery.

Seriously Pete, you MIGHT want to check it out and see if reading and asking questions over there is of any value too you.

They really are nice people mostly and very well-informed about joint surgery and replacements.





Peter I am so glad you are making it and so sorry it is not an easy time for you.

Maybe you could get one of those harnesses the movie people use to "stage a hanging" scene on video?

Saw this done as a prank by a troubled teen on that new TV Series "The Affair" -- near the beginning, his dad (the star) comes up to the kids room to find out what is delaying him joining the family vacation. The brat is hanging there, faking his own suicide.

Your wife could just hang you up and let you down when she has time to watch over you. Wink

I am having a great time -- I am LiTERALLY on a GREAT vacation. I returned home about the time you were posting that first 1-finger message above (5:45 Oct 24th) and even with two hands, 10 fingers, and very little pain it was tough to write such a message so *I* am HIGHLY IMPRESSED by your ability to string a coherent message together while you are so much less comfortable that you would prfere and using only 1 finger.

Call me if you wish, as we previously discussed, and we'll work through some exercises to determine if those are of any value TO YOU.

Do NOT put that knee brace back on until YOU feel that it will do you more good than not, Ok?

Put that brace on as soon as it is the right and most effective thing to do to improve YOUR situation, current and future health.

Your wife continues to sound like a beautiful gem -- we're just trying to figure out what YOU did to get her to LOVE YOU.

You 6-7 knives and 5-6 burning sounds very difficult to deal with or put aside and I am HIGHLY IMPRESSED by your ability to keep going. (I don't think most people know how uncomfortable a "5" is on a true scale; they tend to call every bad an 8, 9 or even 10 -- on an accurate scale there must be room for levels that most people have never even dreamed of.)

A 10? That's the one where the Vampires in TrueBlood (great TV series) "greet the sun" and explode into a big pile of vampire goo. Smile

I haven't seen much in the way of a 2 over the last few days, and cannot testify to any 3's though I have had a few brief excursions there tonight when arriving home tire.

Really though, it was more fatigue than discomfort (3 hours sleep Thu night, awake for 14+ hours on Friday, 6 hours with a 4-hour (half-dose of max) med, Exparel wearing off, and the stress of the second PT in the pool, packing to leave the hospital, and the trip home, plus setting up once we arrived home.)

And of course the puppies had to get me to play briefly with them too. (170 lbs of puppies packaged in all white and all gold.)

I made (at least one) minor, tactical error: Scheduling the trip home to overlap the likely exhaustion of the Exparel.

BTW, it SOUNDS like you had something like Bupivacaine http://en.wikipedia.org/wiki/Bupivacaine infiltrated into YOUR joint.

Bupivacaine usually lasts about 7 hours (it's the most common epidural drug used for things like child birst.)

Exparel is basically "time release Bupivacaine" which is advertised as lasting "up to 72 hours" -- weasel words, but I have read the monograph on it and it really is likely to have a 72 hour efficacy curve.

This is also twice now that my own results have born out the advertisement even though this time the surgeon was required to "split the vial/dose" between two separate surgical sites whereas he put the entire dose/vial into my hip when replacing that single joint 9 weeks ago.

I slept from about 10pm until 12:30am in my recliner (and yes, that is a big boon to my recovery) so feeling pretty good now. (Good enough to write the above.)

The TWO Polar Care cold therapy machines have been happily chilling my knees for the last 6 hours.

Changed out the ice (bottles) myself since Carol went to bed earlier.

My meds are caught up, though I can now have a full does of 2 Percoset (Oxy+Tylonol) now.

The2 hour nap refreshed me.

I was able to get the dropped urinal bottle (empty/clean) from behind the sofa and to position the (heavy) CPM machine on the couch but did not finish the setup of that machine.

My knees are stiff so that is something I will NEED tomorrow, as early a practical.

What to do now? 3:15 AM (Watching TV at the moment and playing on the Internet from my recliner while using he Polar Ice machines.)

(My choices include going to bed dragging the two Polar Care machines, watching TV and/or eating again. sit in my recliner with the 2 machines, take some more oxy or Norco [hydrocodone + Tylenol], play on the Internet, etc.)

Chatting here on this forum is a BIG PART of my recovery strategy.

Unfortunately they banned me on the BoneSmart Forum (hip and knee joint replacement) so I can't go over there to read, comment, and chat with others dealing with similar issues.

They really are nice people mostly and very well-informed about joint surgery and replacements.

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."
10-25-2014 03:16 AM
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herbm Offline

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Post: #25
RE: HerbM Bilateral Total KNEE Replacement surgery Oct 21st, 2014 -- WOW!
Comfort level good = 1-2
Temperature good = 98.4
Energy good --
BP good == 111/65 with 71 pulse
Kidneys and bowels producing well

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."
10-25-2014 03:19 AM
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retired_guy Offline

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Post: #26
RE: HerbM Bilateral Total KNEE Replacement surgery Oct 21st, 2014 -- WOW!
"I was able to get the dropped urinal bottle (empty/clean) from behind the sofa..........."

--------do not pee behind the couch. Your wife would not like that and then you would need some more things replaced.
10-25-2014 11:22 AM
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herbm Offline

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Post: #27
RE: HerbM Bilateral Total KNEE Replacement surgery Oct 21st, 2014 -- WOW!
Ok RG, I will try to remember that advice, but it does seem pretty technically complicated.


Day 4 Post Op

Slept a little last night (in the chair) and went to bed this morning when my wife woke for couple of hours, dozing of a little (15 minutes maybe but that is a lot with my high energy levels.)

Set up the CPAP (it had been at the hospital so it and all this junk has to be repositioned and setup at home again.)

Also did the CPM (continuous passive motion) machine adjustment and setup; been in it for about 90 minutes so far (left leg, the less good one).

Took me a few cycles to get the cpm back to -10 through 120 degree full range but it's there now. Extension is easy but flex is pretty tight the last 5 degrees.

The folks at the hospital had barely a clue how to set this machine. I have doubled the speed (120 degrees per minute and added delays at each end -- extension and PAUSE, flexion and PAUSE.

With the loss of the Exparel effectiveness at about 80 hours (plus perhaps the reduction in therapy, e.g. CPM, and work of "going homea") my ROM and walking comfort dropped off quite a bit but there isn't really any significantly more pain.


So first step seemed to be to get this CPM operation again. We'll know more this afternoon.

I loaded up with 2 Oxy (percosets) to make using the CPM easier. I am RIGHT ON THE EDGE of pain at full flex but not realy there.

I will work out the ideal parameters over the next few hours and days.

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."
10-25-2014 12:41 PM
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Peter_C Offline

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Post: #28
RE: HerbM Bilateral Total KNEE Replacement surgery Oct 21st, 2014 -- WOW!
sounds like you're doing great herb! i would caution you slightly on the cpm machine as far as either max extension or flexion goes? you still have a fair bit of internal swelling as it is very early days post-op, i wouldn't do 'any' flexion that creates any discomfort at this time. firt week is more about healing than it is about rom-just my opinion...

and yes, i do need to add the leg brace back in, but not til my pain levels even out into the 3-4 range average. all i can say is unlike knee pain (usually steady, constant), my shoulder is neither. i go from zero (actually pain-free) one moment, then i lean/shift/turn my head/something and 3 hot needles will stab about 4" in, wiggle a bit, and then slowly slide back out, taking a good 90 seconds or so to do it. then my shoulder will pulse for a while, then calm back down (remember, am in a sling this entire time).

if it were a constant 6-7, i'd be at the ER right now.

i did actually sleep for seven hours last night with no wake-ups! am right at 5 days post-op as of this writing, and would call it 'good' sleep last night, am still getting stabbed while walking my morning laps around the house (gotta work the knee).

i've never seen nor used either of those fancy machines, but i suspect they are a big help for you. please remember, while you are having fun, its not a race, and your body does need some time before you get too busy on the rehab,

*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."
10-25-2014 02:46 PM
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herbm Offline

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Post: #29
RE: HerbM Bilateral Total KNEE Replacement surgery Oct 21st, 2014 -- WOW!
You are correct, it is not actually a race beyond using the success to have fun and power our joy to give us more endorphins and thus remove discomfort etc. Joy is (one of?) the most effective pain killers on Earth..

It is certainly understandable that my comments and discussions on the CPM machine and ROM would suggest an over=focus on ROM, and very early in the rehabilitation process.

The real motivation today was that my excellent mobility, comfort, and, yes even my already excellent ROM from immediately after surgery on Tuesday evening when I woke and then Day 1 Post-Op.

Given that I already had this capability, it made sense to expend reasonable effort to maintain it.

You are also correct that pushing too hard for ROM (or anything else) can actually cause swelling, increase inflammation, pain, and generally CREATE a setback.

I assure you that the CPM is causing NO PAIN. The method I use is to set it wide open, and press the "comfort" button when it gets to the end of the comfortable zone.

None of the nurses at the hospital knew fully how to work these machines. (Same model was provided for home as was at the hospital.)

So, you hit this button and then it the change there, sets it as a temporary value, and if you don't take further action slowly increases it back towards you original goal. For me this has always meant being able to run it wide open but each time I am careful to ensure this is really comfortably.

Along with this I am icing almost constantly (when not doing something else), including while USING THE CPM machine.

Doing this today, taking the oxy 'by the clock' (although mostly half max dose0 and going to see my massage therapist friend (and new combatives training partner, i.e., Michael) for a long, thorough massage this afternoon has left me very, very comfortable an quite mobile.

Michael and I have already planned a few more sessions -- thanks Michael.

My rule is "No pain, especially 'no bad pain" -- soreness and pushing soreness can work.

Tomorrow I will talk to my stretching and mashing coach and likely we'll start planning some of those sessions as well.

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."
10-25-2014 08:51 PM
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Peter_C Offline

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Post: #30
RE: HerbM Bilateral Total KNEE Replacement surgery Oct 21st, 2014 -- WOW!
sounds like you're in the groove! may the next six weeks fly by as enjoyably as these first few post-op days. have you ever measured your thighs to see how evenly you use both legs? pre-op, my left thigh was 4.5" larger than my right. will be interesting to find out how long it will take me to even out

oh! it's official, i am now 6'1" tall. i've been 6'0" for at least 20 years.

while not a perfect day here, it's a major change since yesterday (did the weather change?) as my pain level never went over a 4-5, with most of the day being bout 1-2 - course, am not yet using the knee brace, decided to wait til monday and focus more on standing in place, doing laps in the house, quad work, lifts, and at least one round trip a day down and up the stairs to the basement.

all stuff i cant do on days that i wore the brace (too much stress on the knee-pain&swelling).

*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."
10-26-2014 01:25 AM
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