9 Steps to a Smooth Recovery after Total Knee Replacement Surgery

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Below is a list of important things to do after a total knee replacement to help you have a successful and easier recovery.

1) Prepare a Safe Home Environment

You will be using a walker or crutches the first few weeks after total knee replacement surgery. You want to make sure your furniture is arranged so that you can fit the walker/crutches through all pathways. There should be no cords or throw rugs in the pathways for you to trip over.

Tub seats, grab bars, and dressing aids will make your activities of daily living safer and this equipment will be recommended to you by your occupational therapist. Showering is not recommended until a home safety evaluation is performed by your home care occupational therapist.

Also remember footwear is important. You want to make sure you are wearing non-skid socks/shoes. Do NOT walk wearing only regular socks, TEDS, or bare feet because your walking and balance will be different the first few weeks after surgery and you do not want to slip and fall.

2) Balance Activity and Rest

Some of you have been looking forward to resting as you recover, others are afraid to move, and then we have those of you who do not know how to rest and overdo it when you return home.

In order for you to have a successful recovery after a total knee replacement, it is very important for you to move. Get up and walk or stand at least once every hour during the day. You want to focus your activity on your therapy program to restore motion and strength, while avoiding strenuous activities.

As much as it is important to move, it just as important to rest and allow your body to heal.

3) Position Your New Knee Correctly

Whenever you are resting with your leg up, keep the operated leg as STRAIGHT as possible. This means NO pillows under the knee. Having the knee bent throughout the day/night, will cause knee flexion contractures, decreased motion of your joint, and poor surgical outcomes.

Total knee replacement leg position

4) Chill Out

Use an ice or cold pack surrounding the operated knee to control pain and swelling. It is important to ice the whole knee, placing the ice/cold pack on top AND underneath the knee.

Cold Pack Placement

Make sure you place a towel between the ice/cold pack and your operated leg and keep in place for 20 minutes. Use the ice immediately after performing your exercises and throughout the day to control pain and swelling.

You can make your own cold packs by squeezing a bottle of dish soap into a one quart Ziploc bag, then place that bag into a second Ziploc bag (in case it leaks) and place it flat in the freezer.

5) Keep Wound Infection Free

Keep the incision clean and dry. Do not use any lotion on the incision unless instructed by your doctor or nurse. If you note any new redness, swelling, or drainage from the incision call your home care team right away. If your incision does drain, cover it with a sterile dressing.

6) Prevent Blood Clots

There are several methods used to prevent blood clots after surgery and they will vary depending on your needs and surgeon recommendations.

TEDS or other anti-embolic stockings are compression stockings that are effective in preventing blood clots and to help control the swelling. Follow your doctor’s orders for wear schedule of the stockings.

Blood thinners are usually started after surgery. Coumadin (warfarin), Lovenox (enoxaparin), Xarelto (rivaroxaban), and aspirin are the most common blood thinners. If you are on Coumadin, you will need to have your blood level checked periodically to make sure you are getting the appropriate dose.
Movement is also an important step in blood clot prevention. This ankle pump exercise specifically will help with circulation and edema control. Perform 10 repitions of this exercise every hour while you are awake.

If you notice any of the following symptoms call your home care provider immediately as these are all possible signs of a blood clot:

tenderness, redness, or pain in your calf
increase swelling of the operated leg
increased warmth in the back of the leg
a red streak moving up the leg
If you develop sudden shorness of breath or chest pain call 911 immediately as this could be a sign of a blood clot in the lungs and can be life threatening.

7) Take Medication as Directed

It is important to take only the medication that you were instructed to take after surgery by your physician. You do NOT want to start taking any vitamins, supplements, or over the counter medication without your doctor’s permission as they could interact with the other medication you are taking, especially the blood thinner. Take medication at the same time every day as directed by your physician.

8) Manage Your Pain

Make sure you take adequate pain medication to allow you to sleep well at night and to participate in your exercise program with minimal discomfort. Do not be afraid to use the pain medication as directed by your physician. With less pain you will have a faster recovery. Remember to take your pain medication with food. Take action as soon as the pain starts. Use ice/cold pack along with the medication to help relieve the pain.

9) Eat a Balanced Diet

Your appetite may not be what it used to be before surgery, but you want to make sure you are getting the proper nutrition for healing. Continue to drink plenty of fluids. 8 cups of water a day will help you stay hydrated and help prevent constipation. Note that constipation often occurs after surgery as a side effect of the pain medication.

Try to limit your coffee intake and avoid alcohol altogether.

If you are taking Coumadin, you need to restrict your vitamin K intake. Foods rich in vitamin K include broccoli, cauliflower, brussel sprouts, liver, green beans, garbanzo beans, lentils, soybeans, soybean oil, spinach, kale, lettuce, turnip greens, cabbage, and onions.

Please remember you just went through major surgery. Your activity level and medications have changed. It is not unusual to experience difficulty concentrating or lack of interest in activities/hobbies after surgery. Muscle soreness, tightness, and stiffness are all normal after surgery.

These are general guidelines. If you have been instructed otherwise by your doctor or healthcare provider please follow their instructions. If you have any questions do not hesitate to contact your home care provider.

Happy Day! Here’s to a Speedy Recovery!

Protect Your Family Against Accidental Poisoning or Unsafe Use of Opiod and Other Prescription Medicines


Protect your family. Keep medications safely locked up and away.

The Washington Post reported this week that Poison Control Centers receive 32 calls a day about children exposed to opiates. While the number of exposures has decreased in the past 6 years, there is still need to protect unaware families of the possible risk to children and family members taking prescription pain medications and other drugs inappropriately, leading to poisoning and possible death.

The Center for Disease Control (CDC) recommends storing and locking medications up and away, out of the reach of children.

Important safety tips include:

1. Never leave medicines or vitamins out on a kitchen counter or at a sick child’s bedside, even if you have to give the medicine again in a few hours.

2. Always relock the safety cap on a medicine bottle. If it has a locking cap that turns, twist it until you hear the “click” or until you can’t twist anymore.

3. Tell children what medicine is and why you must be the one to give it to them. Never tell children medicine is candy so they’ll take it, even if your child doesn’t like to take his or her medicine.

4. Remind babysitters, houseguests, and visitors to keep purses, bags, or coats that have medicines in them up and away and out of sight when they’re in your home.

5. Get rid of expired or unused medications using recommended methods as outlined by Consumer Reports:

  • Return unused medications to your pharmacy. Many pharmacies have take-back programs or drop off bins for safe disposal.
  • Drop off unused meds during National Prescription Drug Take Back Day  on Saturday, April 29.
  • Mail medication to a collection site.
  • Use a self-service disposal kiosk at Walgreens and other participating sites.

S.A.F.E.: Be Informed, Be Empowered, Be Prepared


Patient Safety Awareness Week #PSAW2017

Most patients have taken care of their personal needs in a certain way most of their adult lives. When frailty occurs, or a person needs home health following an illness or surgery, the rehab team will often recommend personal care support for a period of time. That’s when  Health Calls Provides C.N.A. support to help with personal care until the patient is strong enough to do so safely and independently again. Cindy Babula, Certified Nurse Assistant suggests the following acronym to the patients she supports :

S. it
A. lways
F. or
E. very thing.

Frail or weak patients need time and patience to to do things safely. Of course, they may not need to do ALL things from a sitting position. Sitting to button a shirt, for example, allows time to conserve energy or catch one’s breath after showering. Many patients take pride in reminding Cindy when they have ideas of ways that she or they might do something in a safer way.

TOUCHE! Cindy says. It’s a give-and-take when each of us, patient AND a caring caregiver, puts SAFETY FIRST!

Cindy says a patient once pointed out a sleeping cat in their path as they were walking towards her bathroom; it was not a “stuffed animal,” but rather a living, shallow-breathing, deaf cat who would have to be picked up so the two could safely traverse the room.

Safety takes team work.

Here are more #SAFETYFIRST2017 ideas from the Centers for Disease Control:

 

 

 

Making Old Friends As People Achieve Home PT Goals

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Wendy Bergeman, PT, MS has been a physical therapist for over 25 years. She has provided physical therapy in many different settings including hospitals rehabs and outpatient clinics. She started working in home care about 15 years ago and knew on the first day that home care was where she was going to be able to make the most impact for her patients. Home care is a unique setting.

You get to see the patient in their own environment. They show you what is important to them and where they are struggling. Many times patients come home after doing well in rehab, but when they get home it all changes. Each house has its own challenges and the thrill for me and the patient is to work through those challenges and return the patient to independent living and enjoying life again.

The difference you see in these patients from the first day to discharge is amazing. On day 1 they are tired and weak —getting up and walking to the bathroom is a struggle. In a week or two they are taking care of themselves and then on the last day they meet you at the door with coffee and you feel like you are saying goodbye to an old friend. A lot of my patients feel like family by the time they are discharged.

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Wendy Bergeman with her old friend, Mervin Lewis.

Health care is forever changing and today patients are coming home sicker and weaker since they are leaving the hospital faster. There is a huge need for these patients to get physical therapy. Many times without physical therapy, frail patients fail and end up back in the hospital or another type of facility. This is not only a huge cost to the healthcare system but can be devastating emotionally and physically to the patient.

Home physical therapy concentrates on building up strength and improving mobility but also focuses on making that patient safe and functional in their own home. The true goal of a home care physical therapist is to keep a patient in their own home for as long as possible, in the safest way possible. Sometimes this means getting adaptive equipment, making home renovations or hiring help.

This goal: keeping people safely at home, is what makes home care so fun. Each visit is different – somedays it is teaching a patient to get out of bed and other days it is showing them to how to safely take out the trash.

Safety is always the key and falls are always a concern in home care. Falls in the elderly are the leading cause of traumatic hospitalizations and a leading cause of death according to the National Council of Aging. About 25% of the elderly who fall and fracture a hip will die within 6 months and many more will never be able to return to their own homes again. Physical therapy can do a lot to help identify high risk fall issues and intervene to prevent fall injuries. “As home care therapists we stress the need for patients to stay active and safe,” Wendy says.

Wendy has been a member of the Health Calls team since 2013. When Wendy is not working for Health Calls Home Health Agency, she is busy at home. She lives with her husband and three kids- Katie – a senior at PSU, Rachel a Senior at Oley Valley High Cchool,and Richie, an 8th grader at the Oley Valley school district. She spends her weekends at PSU football games, watching Rachel in horse competitions or Richie in sporting events.

Occupational Therapy: Helping People Live Safely At Home


Teri Rothenberger, OTR/L became a licensed Occupational Therapist (OT) because she had an interest in helping people. A high school guidance counselor came up with Occupational Therapy as a possible career that fit Teri’s interests and she now boasts 30+ yrs experience. Teri joined the Health Calls team 6 years ago. As an OT, Teri’s specialties include helping people improve their strength and endurance to be safely independent with the daily activities we take for granted every day like showering, dressing, cooking, and doing laundry.


Teri says it feels great when patients have a “lightbulb moment”, that magic moment when she provides advice that is going to make a difference in the patient’s life. Working in home health, Teri realizes that she is always a guest in the patient’s home.

“I can make recommendations, but ultimately it’s their decision if they follow the advice. I knows it’s not a reflection on how good or effective I am as a healthcare provider if the family doesn’t use my suggestions.”

Teri finds that in many homes she visits, people already have safety and adaptive equipment like shower seats and 3in1 over the commode seats. She always checks the height of all these pieces of equipment because most times they are positioned on the lowest height. When Teri adjusts the height to the proper setting for the patient’s height, families wonder why no one else had thought of this. Families also will often report 3in1’s over the toilet seats don’t have the splash guard in place or say it doesn’t fit over the toilet. With some adjustments, such as removal of the back and lid, it usually fits.
Like the tools that she carries to make the appropriate equipment adjustments, Teri has expert tricks up her sleeves. When someone is discharged from a rehab facility to home, it’s difficult for therapists to know exact sizes of bathrooms and shower areas before the patient goes home. At rehab they send home a tub bench (goes inside and outside the tub), but there isn’t enough area to safely place the bench and therefore families often end up not using it. This also happens when showers have built in seats which make it difficult to find room to place an additional seat in the tub. Teri says one issue patients often have with the benches is where to go with the shower curtain so that water is not all over the floor. There is a simple solution, but most people just put lots of towels on the floor. When she shows them her trick for safe bench use to bathe safely, they are very happy.

Teri shared that one of her patients was having difficulty with his current bathroom with a regular tub. Transfers in and out of the tub onto a tub bench required the help of 2 people. The patient and family decided that since the disability was permanent, a full renovation would make the routine safer and easier. Teri made recommendations, met with the contractor and determined the best renovation for his disability. He ended up with a bathroom in a different part of the home. The new bathroom had a wheelchair height toilet with pull down grab bars, a wheel-in shower with hand held shower head and grab bars all around the shower, and wheelchair accessible sink.

In this YouTube video, Teri shows the proper placement and use of grab bars in a shower.

Teri is truly a rehabilitation expert but her work in her profession is only one part of a very full life. Teri has been a widow for 3 yrs and has 2 sons, a daughter-in-law, and a future daughter-in-law (son #2 will be married in 2018). Teri is very excited for her first grandchild to arrive in a few short weeks. Teri is very active with the music program at her church where she sings in the choir and plays the keyboard and organ. Teri also boasts having many other “adopted” kids through the relationships she has forged working with the youth of her church.

Teri is a person of quiet strength and a true asset to the Health Calls team. She serves many well in her professional and personal life with her desire to help and improve quality of living.

When Parents Don’t Want an Advocate: A Caregiver’s Dilemma


Giving up independence temporarily while working to get stronger will improve quality of life.Giving up independence temporarily while working to get stronger will improve quality of life.

 

One morning last month, a registered nurse in my office received a phone call from “Mickey” who was interested in referring her father for home health services. Her dad, an 83 year old man whom we will refer to as “Bill” had been in the hospital recently.

Bill was pretty sick when he was admitted. He spent time in Intensive Care and was treated with IV antibiotics for septic shock due to an infection of a non-healing wound on his leg. He was very lucky to recover.

Mickey did her best to advocate for her dad while he was receiving treatment in the hospital. She asked that he be referred to a rehab hospital to recuperate for a short time after his hospital stay. He had been in bed for 5 days and she was afraid he was too weak and might fall if he went straight home. Since Bill passed the walking test with the physical therapist he wasn’t a candidate for inpatient rehab. Mickey asked for home health to come visit her dad at home but Bill refused.

“I don’t need help,” Bill protested. While Mickey tried to advocate for her father, the hospital failed to consider that her father might have limited idea into his real needs at discharge and the discharge planner didn’t ask his daughter to verify the information he provided.

Mickey told me that even before spending 5 days deathly ill in the hospital, he needed help with the simplest of tasks at home. When Bill went home, Mickey and her mother did their best to help her dad settle in safely at home. Mickey works full time and her mom has health problems of her own. Now, Mickey was completely overwhelmed as she tried her best to hold things together juggling her job, her own home and her parents’ needs. She noticed that her dad was now short of breath with the most minimal activity, like putting on his shirt.

Mickey waited the long week to her dad’s follow-up doctor appointments. Finally, with the audience of the doctor, Mickey shared that things weren’t going well at home and asked some difficult questions. Wound care orders were never provided when Bill had outpatient surgery in the weeks before his hospital stay. While the doctor admitted he didn’t provide the right instructions, he never admitted he was wrong. The doctor insisted that her 83 year old father was capable of doing his own wound care, even after the hospital admission due to infection.

That same day, the family visited the family doctor. At this visit, Mickey laid out the hospital stay, how poorly things were going at home and revealed some of her own stress in trying to hold it all together. This time she came away with orders for home therapy and nursing visits. Mickey tells me:

People are going to say no because they are proud. My dad was really struggling at home so he was finally open to receiving help. The nurse and therapists were no longer strangers. These were people who took time to make a personal connection and so my parents were open to their visits. They were helpful without being bossy.

Bill allowed the nurse and therapists to visit, they formed a bond. Bill and his wife committed to the agency’s home equipment and safety recommendations, allowed these former strangers in to treat his wound, and provide therapy to make him stronger. Bill was back to his personal best in 3 weeks.

“What do people do if they don’t have somebody?” Mickey asks. Mickey believes this whole experience has helped reshape her caring relationship with her parents. She feels empowered. In the past, her parents would go to the doctor’s office and she would ask questions about the outcome and get vague answers. They weren’t being evasive; its hard to remember and the experience is overwhelming when you are the patient in the “hot seat”. Instructions provided by health care providers can get watered down in translation while trying to capture everything that’s been recommended. Mickey now realizes these types of errors and omitting important recommendations often lead to hospital admissions.

Now, Mickey goes along to keep notes, and to ask the important questions, understand and follow through on treatment. Fortunately, her parents now see that she has helped them and view her as more credible.

Mickey says the real turning point came when she said to her dad: “You have 2 choices. You can be a grumpy, unhappy old man who has to depend on others to live your life or you can be pleasant and appreciative while Mom and I care. We are not taking your independence away; we are helping you so you can get your independence back. You need to give it up, and work to get stronger, so you can get your independence back”.

Health Calls Home Health Agency recognizes and honors the 39.8 million adults caregivers (2015 Report Caregiving in the U.S. research report conducted by AARP and the National Alliance for Caregiving)  in the United States.

National Prescription Drug Take Back Program October 22, 2016


Doing some fall cleaning? 

Worried about aging prescription drugs sitting in your medicine cabinet? 

Are you worried about how to safely dispose of your prescription drugs that are no longer needed?

Today, local law enforcement officials across the country will provide drop off sites for your unused medications as part of the National Take Back Initiative. Today, Saturday October 22 is the 12th National Prescription Drug Take Back Day.

Many communities have safe medication disposal programs for drop off of unused medications available year round, but this is not available universally. Check your community’s drop off sites for today’s program by searching using your zip code at this link
Community programs collect expired or unused, prescribed and over-the-counter medications at police departments. Community members can utilize these drop boxes to ensure that medications will not end up in the wrong hands but rather properly disposed of.

Proper medication disposal also prevents accidental use, intentional misuse and protects the environment.