TKR Help not getting any sleep

[Simmy]

Hello
i Had a tkr on the 12 october all went well I left hospital after 3 days and I was walking in the garden doing exercises feeling good. My physio was very happy with me and after 2 weeks told me to only use 1 crutch.
I was then told to come off the meds tramadol and ibuprofen , I don’t do well on meds . I am off the meds and WOW did I go downhill feeling low no sleep waking up feeling hot then cold shivering very emotional upset stomach . I saw my doctor and he said it was withdrawal . I’m feeling a lot better emotionally still not getting a lot of sleep but it’s improving .
im now taking 8 paracetamol a day and using lots and lots of ice .
I am a little worried as everyone keeps telling me I will have to go back on strong meds to be able to do my physio is this true ?.
I walk every day and am doing my exercises I did cut down on these whilst I was really very very low.
im also not eating much have no appetite .

 

[Zanza]

If you need "strong meds" then your physical therapist is doing it wrong. Your physical therapy should NEVER be painful. At the first visit you say to your PT therapist:

• I expect discomfort. I DO NOT expect actual significant pain.
• The definition of what is painful is owned by me, not you.
• When I say stop, we're crossing the line into pain. I expect you to immediately stop.
• Trying to force me past the pain point or not listening to me will completely break my trust in you.
• I want us to be partners in this. I'm willing to try almost anything, as long as I can continue to trust you.
• If I trust you, I will go right up to the line between discomfort and pain. If I do not trust you, I will likely start tensing up as soon as any discomfort starts. At that point I may as well get a new therapist.

 

[Jockette]

Hi and Welcome!

I'm sorry that your doctor didn’t wean you off the medicine. You did go through a withdrawal if you didn’t wean off properly. My husband experienced a terrible withdrawal when we cut back his Parkinson’s medication, doing it the way his doctor’s office told me, but it was too quick, and he was not ever an addict, either.

Tylenol is very good for post op pain. If it doesn’t bother you, the most effective way to take Tylenol is 2 x 500 mg tablets every 6 hours, to a total of 4,000 mg (4 doses) in 24 hours. You need to take it regularly, to keep up the levels in your bloodstream. If you just take the odd dose now and then, it's far less effective.

Check all other medications you're taking, to make sure there is no Tylenol/Acetaminophen/Paracetamol in them. If there is, scale back one or two of your regular Tylenol doses, so you stay within that safe 24 hour limit of 4,000 mg.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary

2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

​

If you want to use something to help heal the incision, ​

BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.​

3. Do what you want to do BUT

​

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​

b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

​

​

4. PT or exercise can be useful BUT take note of these

​

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity Progression for TKRs​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[Jockette]

I am a little worried as everyone keeps telling me I will have to go back on strong meds to be able to do my physio is this true ?.

We hear this a lot. Too many people and too many PTs believe this rehab has to hurt. They are wrong. Go with your gut feeling and don’t be intimidated into doing something that hurts. Just say no. Don’t let any medical person bend your knee for you. It will heal very well with gentle treatment.

 

[Simmy]

Hi I had a TKR on 12 Oct . I had my first physio class yesterday didn’t feel whilst doing the exercises that I had done too much . But later in the day and all through the night I had a lot of pain and still got a lot of pain today . Is it normal to be in pain after physio ??

 

[panammaniac]

Pain is an indication that you probably pushed it too hard during PT. Rest up for a few days and try not to push as hard next time. You’ll get a lot of advice along those lines here and I’m sure you’ll hear from a staff member shortly. Many PTs and even doctors believe that therapy has to be painful to be effective. “No pain, no gain.” But that has been widely debunked in this forum with many people skipping PT completely and just rehabbing through normal daily activities.

 

[Jaycey]

@Simmy Welcome to BoneSmart!

Is it normal to be in pain after physio ??

No, physio should not be painful. You should not let anyone force your knee. As you have experienced, this is just counterproductive.

We find that the slow and steady approach to this recovery is best. You are not in training, you are healing.

Here's a bit of reading for you:

Knee Recovery: The Guidelines
We are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for YOU.“ Your doctor(s), physiotherapist(s) and BoneSmart are here to help. But you have the final decision as to what approach you use.

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary

2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork​

3. Do what you want to do BUT

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​

b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

​

5. Here is a very general week-by-week guide. Activity progression for TKRs

6. Access these pages on the website

Oral And Intravenous Pain Medications​

Wound Closure​

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[Simmy]

Can anybody help . I am 5 weeks post op from TKR . I’m taking paracetamol 6/8 times a day and I have not had a nights sleep . I wake very few hours . It’s not pain that wakes me it’s weird sensations in my leg . It feels like my leg is moving like there are strings attached and someone is pulling all the strings . I know that might sound odd it’s such a very uncomfortable irritating feeling .I’ve tried ice , relaxation music meditation nothing is helping , I’m so tired and emotional. Any advice would be appreciated .

 

[sistersinhim]

It feels like my leg is moving like there are strings attached and someone is pulling all the strings

This feeling is what we call zingers. Your nerves are walking up, reattaching, or rerouting. This is completely normal and a sign of your healing knee. I found that nothing could stop these zingers and pain meds didn't really touch them. The good thing is that the bad ones don't last really long. Mine would be so bad that my leg would actually jump. Now, that hurt that healing knee! I still have very mild ones every so often. Of course, I've had 6 surgeries on this knee so there were a lot of nerves that were affected.

Lack of sleep is also a normal complaint. So have found that melatonin helped some, others, Benedryl. Tylenol PM is another suggestion. Be sure to sleep whenever and wherever you can. Naps can be quite helpful and you should welcome them. Your knee and body will!

 

[panammaniac]

I didn’t sleep well at all the first week or so. Tylenol PM helped me get over the hump. I was taking regular doses of Tylenol anyway, so it was very easy to swap out the bedtime dose with Tylenol PM. I continued to take it for a couple weeks, then started weaning myself off of it with a week of half a dose (one Tylenol PM, one regular Tylenol), and then just back to regular Tylenol the next week.

 

[Layla]

I have not had a nights sleep . I wake very few hours . It’s not pain that wakes me it’s weird sensations in my leg . It feels like my leg is moving like there are strings attached and someone is pulling all the strings . I know that might sound odd it’s such a very uncomfortable irritating feeling .

I am sorry you're struggling to get comfortable enough to obtain some restorative rest.
You may want to consider Magnesium -

Magnesium supports the following:
Bone health
Healthy blood sugar
Cardiovascular health
Muscle relaxation and nerves
Promotes healthy sleep (falling asleep and staying asleep)

An article on Magnesium -
https://bonesmart.org/forum/threads/magnesium-is-a-star.20301/

Read up on it and see what you think.
Wishing you comfort, relief and a good nights sleep!

 

[Bix]

Hi ya, at 5 weeks I was the same. What I would’ve given for just one nights sleep!!
I would fall asleep for half hour and that was it. I thought if I’m so tired why do I wake up?!
I took ibuprofen and paracetamol through the day and night, I counted 550 tablets taken in about 6 weeks :(. Eventually I slept longer every few nights which felt amazing. I’m now 3 months and I sleep all night mostly, although when I turn over I do make a noise and wake myself up!!
Good Luck.

 

[Simmy]

Hello everyone I need some help & advice .
I had my TKR 7 weeks ago all is going well during the day I’m doing exercises walking pottering around the house , shopping .
But night time is a nightmare I’m not sleeping . I was very tired last night went to sleep at 9pm woke at 10.45pm unable to sleep again .
I don’t want to take sleeping tablets as they are addictive . Does anybody have any advice please .

 

[Roy Gardiner]

You'll notice that I have merged your newest thread with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:

• That way, you have all your information in one place. This makes it easier to go back and review your history before providing advice.
• If you start new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

So please post any updates, questions or concerns about your recovery here.

 

[sistersinhim]

Unfortunately, sleep problems are quite common after this surgery. It doesn't matter where or when you sleep as long as you do. Take lots of naps until your nighttime sleep gets better. Many have found Tylenol PM to be quite helpful and it's not addictive. Here's an article to help you understand better what you are going through. Sleeping problems

 

[Arjay]

Four weeks tomorrow here for my LTKR.

Last night: Awake from 1030pm (after a 1 hour doze) until……630am. Oy! By 3 oclock, I wanted to go bang my head against a wall. A CEMENT wall! I have had chronic sleep issues for years often worse around the coming of the full moon (another night or two to go for that). Benadryl not cutting it most nites. I have some trazadone, prescribed for this after my hips; I didnt think it was much help then (but I also didnt really pay attention to the 'Take with Food' caution). Going to give that a try tonight. And cross my fingers.

Empathy to all of you struggling w sleepless nites - it's the pits!

 

[Whoodee]

I know what you mean. It seems I only sleep two hours at a time. What I wouldn’t give for a solid night’s sleep. I hope you can sleep well soon.

 

[MarkTKR]

Don't hesitate to as your MD for drugs to help you sleep. I had a TKR a year ago December then in January ruptured the same knee patella tendon which required another surgery and a full leg cast for 8 weeks.

Sleep was something I only dreamed of as I don't tolerate pain meds well at all.

Finally I decided to ask for some Tramadol which my doc was more than happy to give and slept for close to six hours the first night. I went through three Rx of Tramadol taking them only at night for sleep and it made a huge difference.

Don't hesitate to ask, but do know what you are being given and research it.

 

[Whoodee]

Thank you for your advice.

 

[Layla]

Hello Simmy,
Has your sleep improved any over the past week? Hopefully so, if not, it will improve with time.
Try to sleep whenever you're able, even if it involves napping during the day until your sleep regulates.
Happy Two Month Anniversary! I hope you have a good week and a lovely holiday season.
@Simmy