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3 weeks out. Pain, tightness, insomnia

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Dtman44

Dtman44

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Hi guys,

I guess it was Lissa's Sleepless in Seattle thread that prompted me to start this one.

I was considered a "poster child" for rapid recovery even before I got out of the hospital. I started walking stairs like a big kid at 2 weeks. I have had some really great days. Minimal pain and lots of activity. I've even lost 23 lbs. I'm sure that the fact I have zero appetite is the reason for that...and all the exercise. It seems that for every good day I have, I also have one that is miserable. I dont think I've slept more than 2 or 3 hours in one stretch yet. I have real long stretches with extreme tightness from mid calf to the top of the knee. This drives me absolutely crazy, and is really messing with my frame of mind.

Last night was brutal. I had the tightness plus a constant ache. I was able to knock out the ache for the most part with Norco. I didnt sleep a wink. Sometimes gentle ROM exercises will loosen it up a little, but not if its a result of me overdoing it. I think I'm being too paranoid about my ROM. My OS did tell me that it was one of the nastiest looking knees he's ever seen, and would have assumed from looking at it, that the patient was not mobile.

As I go about my day, I will test my ROM from time to time, and rarely get past 90 degrees. When I work on it and really push it, I get more. I hit 120 today for the first time. Is this normal for the rest of you? I'm really hoping I'm just being impatient and this is normal. Every day seems like 3 steps forward and 2 steps back....sometimes 3 steps back.

The insomnia is something that I have dealt with alot in the past with my bipolar disorder, but this is different. This is because of the tightness and just overall discomfort. I hate it and the sense of always being tired, but I can handle it. My main concern is my ROM issues, (or paranoia).

Sorry for the longwinded post and thanks for any insight, or commiseration you guys might offer.

Dan
 
Hello Dan

I am 4 weeks out of my BTKR. I have to say. Your ROM is just fine...actually its great! I was also concerned about this and once I got some sound advice from Jo and many others on this site...things got better for me. As far as sleep goes...I am in the same boat. I had to finally resort to lorazapam just to help me get three to four hours of straight sleep. I was so weary from no sleep...it was really starting to make me depressed. My body was so so tired.
I had to finally get off my pain medication due to my heart just could not take the medication. So I am on Naprosyn and tylenol 3. or regular strength tylenol. It helps with the pain. But the stiffness is there. So...I try and walk every hour for a little bit. I do myexcercises every morning...whne I feel the best. I also, do some stretches when I am done. I found after I stretch I feel better...not so tight. The tightness. Try doing a stretch, by pulling your foot towards you...leg straight and giving a little strech. Toes should be coming towards you and hold for five or ten seconds and release. Do this a few times. I found it helped me with the tightness. If you can't touch your toes...then use a belt and pull on the foot that way.
Hope this helps.

Theresa.
 
You are not normal. You are ahead of normal! :D Jo will come on and remind you what a huge operation this is, and that it didn't take three weeks for your knee to get bad, so why would you think it would be all better!?

We all suffered from difficulty sleeping. It gets better when it gets better, but it does get better.

At this stage you should probably be doing more frequent icing and elevating than you are currently doing. It really helps.

By the way, hitting 120 at three weeks out is very, very good. Some of us are lucky to ever get that. It took me about a month, if I remember correctly, and that was still pretty darn good. Both knees now bend to about 145. That is really, really good, by the way.

I know the patience is hard to come by, and there are some really low points along the way, but it sounds like you are doing exceptionally well.
 
Dan,
Sorry you are having these problems...but what you need to know is what you are experiencing is absolutely consistent with this surgery.

Insomnia feels relentless. You don't sleep well because you hurt. You wake up crabby and tired. It's hard to do your PT least of all get up or out of the house. If I am not correct, the insomnia and really be a trigger for your bipolar disorder as well. I would sugges that you give your psychiatrist a call and see if there are any sleeping meds you can take. He will know how these will interact with all your other meds.

The other thing do not try to Mr Strong Guy. Take your medications as prescribed. If it says every 4 hours, take them every 4 hours. Pain just leads to further discomfort and misery. The other important component is the ice and ice and ice...this will decrease you swelling ans should as help with the discomfort.

The other thing is do NOT obsess about ROM. It is a number. As long as you can do the things you love...that is all that really matters. Some things that can help to improve your ROM are rocking in a rocking chair or modified squats

This is the stage of recovery that the docs do not warn folk about...no sleep and depression.

I know you are going to do well. Be patient with yourself.
Barb
 
Minimal pain and lots of activity.

Last night was brutal. I had the tightness plus a constant ache. I was able to knock out the ache for the most part with Norco. I didnt sleep a wink. Sometimes gentle ROM exercises will loosen it up a little, but not if its a result of me overdoing it.
Click to expand...
Dan, can you see a contradiction in these two phrases?

You are not in 'minimal pain' - you said after it was 'brutal'! Tightness and ache is pain and needs medicating. Please don't be all macho and try to fight this - there is no need for you to be in pain and so miserable. Take what you need to to be more comfortable, please.

And for what it's worth, I do think you are overdoing it a bit for this early stage.
 
Ok, point taken. Thanks alot for your replies. It really is a relief to know that I'm not behind on my ROM. Everyone and their brother is giving me a hard time about not going to PT. My Doc had faith in me that I would be aggressive about doing PT on my own and you guys have validated that for me.

As for the meds. It's not that I'm trying to be a hero or macho. I'm just really low on meds and who knows how fast I can get it filled on Mon. My Doc will only prescribe a weeks worth at a time. I went from Oxycontin and oxycodone to just norco, and I only have 4 of those to get me through the weekend. I know I'm in for some suffering.

Thanks for the stretching tips. I'm really flexible so I shouldnt have any problem with that....and thanks for listening to me whine. I cant get away with it around here. hehehe
 
Hi Dan,
so sorry you are having this pain. We are only three days apart on the surgery and I, like you, felt like I was doing very well the first two and a half weeks and then a terrible pain on the inside of the knee began to surface..it felt lke I had pulled something in PT, when the weight was placed on my knee when my leg was propped up at the heel.
I rested a couple of days and the therapist backed off 7 lbs to 5 on the weight and it is better.

I was reading a study of Knee Replacement Surgeries on the web yesterday and it showed that the most significant pain reduction seems to be at 4 to 5 weeks.

I am on the same medicine as you and am only given a week at a time too.

I started taking the Aleve Gel caps every 8 hours and that has helped significantly.

I think we are both being rather impatient and trying to do too much too soon and just not accepting the fact that this is just going to take some time for healing and cannot be rushed.

I have decided to take my meds, do my exercise, but not to the point of the pain that feels like I have gone too far..and just relax about it all a bit.

I hope you are feeling better..have you tried the Aleve??

Who is your team today??

Best wishes,
Marquesa
 
Dan, don't let them get at you about not going to PT. In the UK no-one gets much in the way of PT - they have to do it on their own and our results are every bit as good as those in the US! :wink:

As for the pain meds, if you're running out, why don't you try some Tylenol Extra (x 2) and a full dose of the Aleve Marquesa suggested? Will be better than nothing.
 
Dan...your ROM is great! I learned early from Jo that the # for ROM is just that...a number. As long as you can do these that you want to do then don't stress about the #. As far as sleep goes almost everybody has trouble sleeping. I was a special case though. Not once did I have problems sleeping...not even in the hospital did I have problems. Sleep when you can....take naps when possible. Best of luck to you. You are doing great!:thmb:
 
Thanks guys, I am taking Alleve, but thought I could only take it like once or twice a day. I just took my last couple of Norco an hour ago. I feel pretty good now, but I'm dreading tonight. I will go get some Tylenol extra and give that a whirl.

You are right Marquesa, I am being impatient, and I am overdoing it. Its hard for me to sit around. The people around me are used to having me get things done, and its driving me nuts to do so much sitting around.

Thanks Cindy, I'm going to just quit measuring my ROM. I know I'm not dogging it and I'm going to stop holding myself to such a high standard.

You guys are really great. I feel much better about things after your imput.


One more thing...why am I paying so much for cable when there is never a damn thing on? :D
 
Crystal...(Ship4)...recommended the following for sleep. I have not tried it...but some swear by it.
Lissa,
It is normal with TKR. My suggestion?
Take 2 Calcium + D (600 mgs) pills along with 2 Magnesium (250 mgs) pills at bedtime. Make sure you have taken your pain pill too. If you awaken, ice and take Arthristis Strength Tylenol (2) and go back to sleep. Let me know how this works for you as it is a remedy I used and have used in the past for insomnia. Worked great for me.
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Dan, I too had a hard time sleeping in those early times, and I did take Crystal's suggestion of Calcium,VD,Magnesium at nite and it helped me a lot. For pain I took Tramadol 100 mgs. and Tylenol every 4-6 hrs. for the first 4-5 weeks. After that I changed to Ibuprofen at nite and when needed.
I also think you are doing too much at this time, and also have too much emphasis on ROM, my PT only checked my ROM once in the beginning and then again after my 6 wks were up. If you do a few exercises daily, ROM will come. Good luck, and remember its a long slow recovery, but its worth it!
 
Men...it's so hard for you guys to learn to relax. I take ambien to sleep cuz I've suffered from insomnia for years and sometimes that didn't even help so I would get up and walk around and cry on my walker. I also try to take frequent naps, even if I couldn't sleep I went to my room and cuddled up to my hot water bottle and rested. Turn off the phone, it always seemed to ring when I went into my room.

I know, it's so hard to be couch bound when you are used to going, going. Remember, when you rest you heal..Good luck to you.
 
Linda2 said:
These doctors who restrict pain medication drive me wild! Can you check with your primary care physician about taking over your pain control? Mine really helped me with that.
Click to expand...


Man, I'm still here waiting for a refill. My GP told me I had to get it from my OS. I'm so ticked right now I could hurt someone.
 
Oh so not nice! Most GPs (US ones) I've heard of are usually so accommodating.
 
Phew! That's a relief.
 
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