Knee Replacement X 2 Post-Op - It's Not Over Yet

After losing over 200#, I finally bit the bullet and decided to have both of my knee's replaced at the same time!  I've had several surgeries in the past so I'm no stranger to pain but I all too soon found out the bones is a whole different animal and in a league all its own.  I've always been told that I'm a tough gal and have a high pain tolerance. On lookers; general public; and those that had knee replacement, all think I'm very courageous and tough and think I've done extremely well.  They say they could never do that!  But the intense pain with 2 knee's was unexpected to me.  Everything didn't go according to MY plan.  But I very thankful to God that I had no complications and had an excellent surgeon.  I don't regret doing both knee's at the same time and would still make that same decision again. 

I had the whole plan worked out--all my ducks in a row--because I'm very organized.  But after surgery my hemoglobin and BP dropped very low so my doctor wouldn't allow me to get out of bed to do my physical therapy.  Understandable but this started a chain a events. When it came time for me to be discharged to the acute care rehab facility that "I planned" to go to, they wouldn't accept me because I wasn't ambulatory yet or could walk X # of feet.  Another facility agreed to take me that wasn't acute care.  I will spare you the bad details but after 3 days there a very dear friend came to help me advocate with the Director of Nursing about my quality of care. I still put in for a transfer to acute care. The food was so gross I could hardly tolerate it; especially being a bariatric patient.  But the food wasn't suitable for a normal healthy person to eat either.  Why is fried bologna always available in nursing homes and rehab centers? 

At 10 day post-op when I went to get my 70+ staples removed, my range of motion (ROM) in my L Leg  75, R Leg 68.  Surgeon said they should be at least 90.  I was devastated.  I thought I was doing good.  My physical therapist never told me otherwise or that I needed to push harder.  I told him about the poor care I was receiving.  He said I needed to get home ASAP.   Long story short; by the time insurance approval came through for my transfer to acute care, I was asking to be discharged.  I was there 2 weeks.
 
Then I started outpatient therapy May 25 at acute care facility.  I had PT to do at home also and I was committed to doing them faithfully every day as instructed.  June 5, L Leg 96,  R Leg 88 ROM.  Tried to get  approved for aquatic therapy but my insurance denied it saying it was not medically necessary, which is bullshit.  It would have helped me tremendously but you can't fight the system.  Insurance only approved 10 PT sessions.  My last visit July 5, L Leg 115, R Leg 105 ROM. 

Therapists said I exceeded her expectations and that I've done very well. She even said that my ROM was in the range that it should be.  (These must be "her standards" because my surgeon did not agree). She said my doctor would be happy with my progress and would not want to do knee manipulation.  Yeah right!

July 11 I had follow up with my surgeon and X rays.  He said that he would strongly advise that I consider manual manipulation because the average patients at 9 weeks has 125 ROM.  He feels that anything less than that will inhibit my quality of life and what I am able to do.  He said it's my decision but he would prefer to do it in the next 2 months. 

In manual manipulation, he takes me back into surgery and manually bends my knee's all the way back.  It doesn't take long at all.  Then I go back into PT for about 10 sessions.  I would hopefully gain 5-10 degree's ROM. (hopefully more) He says I have lots of scar tissue in there that is inhibiting my ROM.

I'm having a roller coaster of emotions about this.  No, things didn't go as I planned!  I worked very hard in my PT and did everything that I was told to do.  I feel like the system let me down and so did my insurance company.  I feel like the rehab center and physical therapists were just jerking me around.  I gave them 100% and I expected 100% from them and I don't feel like I got that.  I'm frustrated, discouraged, angry, and I feel like I let myself down.  Dare I even use the F word...failure?

I told my surgeon that I signed up for an aquatic class that is 6 wks and 2 days a week.  He also released me to go back to the gym with no restrictions.  I also have PT exercises to do at home.  I'm hoping all these things will help increase my ROM.  But I'm seriously considering the manual manipulation. 

I'm walking almost normal now.  Still have a bit of difficulty getting in and out of cars, with steps and curbs, and shopping in large stores for a long time.  I get tired.  My iron level is still low and I'm anemic.  I rarely take any pain meds anymore.

I'm discouraged and feeling like I didn't do enough.  There are no do-overs with this.  I need to get it right because these are the knee's and legs that I'm going to live with and walk on the rest of my life.  From the very beginning I was behind in my PT because of circumstances out of my control.  I could never catch up.  We thought aquatic therapy would catch me up but insurance denied it. I can't quit.  I've come to far and worked too hard to settle for a mediocre result.