TKR post op 1 week. pain control and sleeping issues

[skittlemac]

I first posted here about 4 hours before my surgery. Now, Im over a week post op and thanks to this forum, much was as expected. I was suprised at the size of my incision but after several knee procedures on both legs, I'm not too vain and it is healing nicely. I left the hospital with 30 percocet and when I asked for refill, I felt a bit like I shouldn't be asking for more. I'm still having a lot of trouble sleeping and even though, I'm at 8 degrees for extension and about 81 for flexion, I feel a bit stuck. I didnt get a CPM. The nurse said it was my choice and I did want one but she forgot to get the doctor to sign the order...one of many nursing issues. So, I dont have one but have been religiously doing my exercises. Sleep, however, is a huge problem. Any advice. I've tried every position. Im icing constantly. It's true though that I can sure nap like a champ!

 

[Jaycey]

Hi skittlemac, welcome to the other side!

Unfortunately sleep issues tend to be a part of this recovery. But are you under medicating. You should be taking pain meds regularly - around the clock. If you are out of meds contact your GP for more. At this earlly stage you need meds to gain mobility.

 

[Roy Gardiner]

Hi, skittlemac, I'm afraid you have to put up with it a bit. Sleep is tough at night, easy in the day

Make sure you get your prescription refilled, don't feel guilty.

Big DON'T feel 'stuck' now, that's not for weeks yet, if ever. Recovery is so serious the body seemingly can't do much (although it's flat out doing it!) right away.

 

[Brownie51]

Hi Skittles! Congrats you are done with the surgery! You are so young for a replacement. You are doing fine and like Roy says you SHOULD be taking the pain med so that you can work on your stretches and flexes. Your doc might be stingy with the meds but that is his problem not yours. So don't feel guilty for expecting/wanting relief. I don't know if you've watched a knee replacement online but it is brutal and you have alot of healing to do and it will happen quicker if you are not stressed with constant pain! I'm sorry you've had nursing issues. Go ahead and complain we are hear to listen!
I am 4 weeks out and woke up throbbing but luckily it's not every night like at the beginning. Josephine will post information for you about adding Ibuprofen, icing, elevating etc. Keep reading! All the answers are right here and will help you get through this. I'm glad you are getting some relief from the ice.
In your signature please add the date of your surgery, day, month, year.
Keep us posted Skittlemac! Sure hoping the pain starts to subside soon..I remember that in a couple more days each day should start to be a tiny bit better. But if you OVERDO exercises/activity you will have a 1-2 day setback so please keep that in mind. Best to you!

 

[Shubbles]

I found that once I placed two pillows under my legs (One under the thigh/knee area and one right below it to support the calves/ankles) I had a much easier time sleeping. Unfortunately, I am a tummy sleeper so it was a bit difficult for me to sleep on my back so much but with my legs elevated it helped. Also, I have 3 sets of ice packs so I take one upstairs at night and put it on to fall asleep with. The cold numbs the pain so that I am able to fall asleep. I also have an alarm set for every 4 hours to take my meds. It stinks having to wake up twice in the night to take the meds but I find that if I miss it even by 1/2 hour I notice a difference and it takes about an hour or more to calm back down.
I too was on Percoset when I left the hospital. After the week or so when I was running out, I called in for a refill and they said that they would give me vicodin instead. It helps just as well and it doesn't cause as much side effects like the constipation that the Percoset caused. Maybe they can give you that so you won't feel so guilty. But trust all of us on here, you NEED the pain meds. Ibuprofen is not enough for this kind of pain.

 

[Janet2012]

Gosh, don't feel guilty! If your surgeon is sensitive enough to the pain issues to keep you on the pain pills, be grateful! I was on Oxycontin for one month, Percocet for three months and then transitioned to Tramadol for another month! And you always have to ask. They always send you home with Not Enough. That isn't intended to last through your pain med needs.

 

[Josephine]

I first posted here about 4 hours before my surgery. I left the hospital with 30 percocet and when I asked for refill, I felt a bit like I shouldn't be asking for more.

Listen to the others, don't EVER feel like that. Knee replacements need serious pain meds for about 8-10 weeks and often longer. so you're not a wimp, a wuss or an addict, you've just had a knee replacement! The importance of managing pain after a TKR and the pain chart.

I'm still having a lot of trouble sleeping

Sleep deprivation is pretty much inevitable - but what causes it?

I'm at 8 degrees for extension and about 81 for flexion, I feel a bit stuck. I didn't get a CPM. The nurse said it was my choice and I did want one but she forgot to get the doctor to sign the order...one of many nursing issues. So, I don't have one but have been religiously doing my exercises.

Sleep, however, is a huge problem. It's true though that I can sure nap like a champ!

You don't need a CPM. We never use them over here in the UK and our results are some of the best. Your knee is 'stuck' right now because your leg is swollen and painful. Nothing much with change until you get that under control which is addressed here Swollen and stiff knee: what causes it?

To engage you more on this, please read the following.......


First are the 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!

And then the articles in order of importance .
Group A

Myth busting: no pain, no gain

Progression of activity for TKRs

Group B
How Long Does Healing Take ......
Chart representation of TKR recovery
Energy drain for TKRs
Elevating your leg to control swelling and pain
Using ice

Group C
Knee Replacement - Where Am I in Recovery?
So What Is It Going to Take? The Five “P’s” of Knee Recovery
Work “Smarter” and not “Harder”
About recovering a knee - from one who knows!
Some suggestions for home physio (PT) and activity progress
Myth busting: The "window of opportunity"

Group D
MUA (manipulation under anaesthetic) and adhesions
It's never too late to get more ROM!
It's Worth the Wait for ROM
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it

 

[skittlemac]

Thanks so much for all of your support and advice. I see the surgeon tomorrow and I will definitely adresss the pain issues. I did end up getting a refill of Norco and after taking 2 every 4 hours or so for a few days, I realized the script was for 1 every 6 hours, which seems crazy to me. I'm a nurse, I know about the importance of pain control but being a nurse also makes me that much more paranoid taking them.

How long do most people stay on blood thinners? My PT goal has been 2-2.5 and it has gone from 2.9 to 3.7 today. 3.7 is getting me a little nervous. I am a bit younger than the average TKR patient and I am trying to be more active, which would be easier with good pain control. I'm hoping to stop it tomorrow when I see the Dr.

 

[Jennifer0730]

I had to sleep on my back after my RTKR October 4, 2012. I am a side sleeper so this was difficult. I invested in a memory foam mattress topper which is wonderful! It cradles me enough that I can be comfy on my back. Plus, against doctor's advice, I do keep a pillow under my leg. Sleep is important. Also your protime seems high. Are you on coumadin? Maybe the doctor should switch you to aspirin?

 

[skigirl]

I used Lovenox for 10 days. Coumadin is a pain because so many factors affect the drug. My husband takes it and I refused, so the doc gave me Lovenox. 10 days was plenty!!!

 

[skittlemac]

I am on coumadin and Im starting to feel the same way about it. Im only getting PT's done 1x/week and it just keeps climbing. Seems like a no brainer to stop it but we'll see. I'll remember about lovenox when I have my other knee done. Is that still a subq injection daily?

 

[ljm]

I had a lot of trouble sleeping for 6-8 weeks after my surgery until I finally got a prescription for Ambien from my doctor. As far as the pillow under the knee...both the visiting nurse and the PT said not to do that. I think they said it makes the swelling worse.

 

[skigirl]

Yes, I think I might have had an injection twice a day. They were easy to use and no trouble or pain. K

 

[skittlemac]

I totally broke down in X-ray. It was like a faucet came on and the tears were flowing. I felt so bad for the techs. It wasn't even anything they did. All of a sudden I just lost it. I'm so exhausted. Everyone was very understanding. Doc says if we haven't made you cry yet then we're not doing it right. So, he agreed my pain control has not been adequate and gave me new scripts for that plus something for sleep. I'm stopping coumadin now and starting aspirin. I feel much better.

 

[skigirl]

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This is a common problem and I am sure they have all seen it before. Sometimes the pain meds themselves make you cry and sometimes pain makes you cry!! Anyway, it is fine, we have all been there!!! What was that old Shari Lewis song---"Crying takes the Sad out of You" , I remember singing that to my kids.​

I have included the info below so that you can add your surgical date to your thread, that makes it easy for us to see how far along you are when you ask us questions.

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At around three weeks, you will feel a definite shift toward feeling better. For now rest, elevate and ice. I hope you are tucked into bed with your knee propped up on three pillows with ice on your knee.


Elevating your leg to control swelling and pain Kelly

 

[Titianlady]

Listen to Josephine my dear. You most certainly need your pain meds, and are not a whimp!! As far as PT is concerned, you don't need a CPM machine at all to get great results. And PT should be easy and gentle and not done for hours at a time!!

I was extremely lucky. With the push for aggressive PT here in the US ( which I just do not understand ) I got a PT who recited the BoneSmart mantra to ME. And this was before I was a member here!!!

All he did when he came to my home was give me a fabulous message of my leg with a rolled up towel under my knee for a good 10 minutes, then ask me to gently bend it back myself until it was uncomfortable but never painful. Then he would measure my ROM.

He even scolded me when I did too much!! He told me just what everyone here has been told. A swollen knee will not bend, and trying to force a swollen knee to bend just causes more swelling. That all that swelling from overwork can cause problems.

I never had a CPM machine either. Not in hospital, or at home. I was blessed to have a surgeon and PT who knew how to rehab a TKR.

After reading all the posts and seeing all the PT that others were doing, I felt like a slacker in comparison!! But I soon realized they were spot on right!! I had a good recovery, and one that didn't involve pain and frustration because from the start, I was following the BoneSmart mantra even though I didn't know it yet!!

My flexation and extension came quickly because I was not being forced by PT to overwork my knee. I elevated, iced, and took it gently, and just let it come. And I was never made to feel I wasn't doing enough 'hard work'. I hate it when surgeons and PT makes patients feel guilty if they aren't forcing their knees to bend, bend, bend!!!! It's NOT the way to go, and it's terrible.

Let that knee heal. And let YOURSELF heal!! This is a major surgery that takes a huge toll on not just the knee, but our whole body and mind.

And never obsess about the numbers. Slow, gently, and easy win this marathon. Enjoy the downtime and don't try to force your body to do what it doesn't want to. Sleep when you feel the urge!! Don't get up if you don't feel like it. Heck, don't do anything exept stretch your knee gently and bend a bit gently every so often. For the first month this is all your body is going to feel like doing anyway.

Go with your body, and good things will come.

 

[skigirl]

:iagree: