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Bilateral TKR 2nd day Post op BTKR-pain is terrible

KL Rio Verde

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I can’t make it from one dose of hydrcodone to the next without level9-10 pain. Also Taking Flexeril and Tylenol. Knees were not swollen much at all this morning, worse this pm. Just talked them into elevating but legs are spread with about 2 ft between feet. Seems they should be almost together, right? Those white bumps sticking up are my feet. Someone here said days 2 & 3 are the worst. Concur? I am going to a “post acute rehab” tomorrow But I’m told that the PT is rigorous. I’m not ambulatory enough for my husband to not lose his mind if I go home
 

Celle

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I'm sorry you're in so much pain, @KL Rio Verde . Have you asked if your pain control regime can be re-assessed?

Ice is great for controlling pain, too. Ask if you can use ice for your knees.

And can you ask for your legs to be re-positioned?

In spite of the regime in the rehab place, those are your knees and you should tell the therapists that you will not allow any exercise that increases pain. Your knees have been through major surgery and they just aren't ready for rigorous therapy yet. They need time to heal, while being treated gently.

Here are our recovery guidelines:
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
ice
take your pain meds by prescription schedule (not when pain starts!)​

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

5. Try to follow this

6. Access to these pages on the website

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

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But I’m told that the PT is rigorous.
Celle is right, rigorous PT is not appropriate for this recovery. It’s your knee and your decision how much and what kind of PT you do.
Saying no to therapy - am I allowed to?

I suggest you just do some walking as your PT. Don’t let anyone bend your knee further than you can yourself.

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.


And, if you don’t like it at the rehab you can always leave. We’ve had members who had bilateral and went home from the hospital without having full time help at home.

So remember, it’s your knee, not theirs, and you call the shots.

And, my husband was in an acute rehab a few months ago and the day we checked him in they gave him a rest day and then said that the next day was work, work, work. It turned out that the PT wasn’t as bad as implied. Hopefully that will be the case for you.:console2:
 

Roy Gardiner

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But I’m told that the PT is rigorous
Don't let them make your pain worse. Have them explain what they're going to do before they do it, and if you're in any doubt don't let them touch you.
I can’t make it from one dose of hydrcodone to the next without level9-10 pain
Pre-op pain is bad, crippling, horrible, demoralising, and only gets worse. Post-op pain can be as bad, sometimes in the first days. Your body is shocked -- someone has attacked you with saws, hammers and other assorted weaponry, cut bits of you off and hammered foreign material in. It's no wonder it's a bit discommoded!!

But the key fact is that the pain gets BETTER.

One's condition post-op is sometimes worse than pre-op for a few days or up to a MONTH later. One has to learn to roll with the punches, to relax, take medication, let the body do its thing and heal. It will do this all on its own. PT can be helpful with this process, but the key element is time.

But it will happen. Millions of TKRs are done every year; this wouldn't be so if it didn't work.
 

sistersinhim

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I am going to a “post acute rehab” tomorrow But I’m told that the PT is rigorous.
Refuse rigorous PT. It will only cause more pain and swelling. I refused all PT for 12 knee surgeries and I recovered great each time! It's your knee. You are the one who has to live with the pain that is caused by aggressive therapy. Gentle therapy is fine, but anything that causes pain and swelling is setting your recovery back. Refuse it! You are the boss, not the therapist, they work for you. Not the other way around.
 
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KL Rio Verde

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Thanks everyone!
Today actually turned out to be a good day! After I posted this morning the ortho’s PA came in, and got us back on track. My doctor does not want me to go to a Rehabilitation Hospital bc of Covid 19.
He also called my husband at my request to go over it. We are going home tomorrow! My nurse today started staggering the pain meds so I am having only a little terrible pain, and mostly in the process of standing or sitting. The elevation was adjusted, and is working great, and the nurse also wrapped my knee with wide ace bandages for compression on the site. That really helped! I worked through the pain to “travel” to the bathroom twice (It really does seem like an expedition!) We videoed the bathroom trip (well, most of it) so my husband has an idea what that entails and how to help me. I think we’ll be fine. Thank you for all your good tips! I’ll post tomorrow to let you know how that went.
 

Jaycey

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Sounds like you are on a better course of action today. Well done! Sometimes it takes a bit of tweaking on the medication.

Please don't worry about moving around on your own. They won't let you go home from the hospital until you can do most things on your own. In the early days it is nice to have someone around just in case. But many of our members are alone during their recovery.
 

Roy Gardiner

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my husband has an idea what that entails and how to help me
I'm sure he's a great guy and is up for helping. Please make sure he knows just how little you'll be doing (ideally, nothing) and how much time you'll be sitting watching telly, legs elevated.
 

Jockette

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I’m so glad to read things are much better. It sounds like you have a very caring staff taking care of you at the hospital. I had an excellent hospital experience, the approximately 36 hours I was there.

I’m also really glad you are going home instead of a rehab. It will be so much nicer being in your own home.

You can also share Bonesmart with your husband and he is welcome to post any of his questions and concerns here with us. We will support you both.
 

kneeper

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When you read this you'll be at home. Congratulations! You might feel a bit worse that first day because of the rigors of the trip home, that's normal even if you have a short car ride.
It sounds like you have a good plan of icing, elevating and pain meds. Gentle movement and lots of rest!
 

bikinglynn

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Do whatever you can to relax and distract from the pain and discomfort. Take your pain meds on time, ice, and elevate.

I watched cat videos and streaming videos the first few weeks. Through the sleepless nights, I would get on Bonesmart and read everyone's postings and watch TV sitcoms from the 1950s and 60s.

I got flowers from girlfriends and my daughter. They gave me so much pleasure, I started keeping inexpensive cut flowers on the table in front of my recliner. I still do, and I still enjoy them.
 
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KL Rio Verde

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Hello and thank you all for your kind words and suggestions. I’m doing very well at home, and truly happy with that decision. My husband/caregiver deserves more than half the credit for that. He’s been patient, even when up in the middle of the night for the “bathroom trek”. Second round of PT tomorrow. She was gentle enough on Tuesday.... we’ll see how it goes .... I’m not above canceling PT if it’s more than my body can take.
Thanks again!
 

Jockette

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So glad to hear things are going so well!
 
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KL Rio Verde

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Well, the second round of PT yesterday was rather brutal, and she wants me to come back today to “get in” 3 sessions. (They were closed Monday due to the holiday) My knees are both more swollen and stiff this morning... I think I need to beg off on today’s session and give my knees the weekend to recuperate. I’m thinking that two days in a row is too much. Interesting comment from my PT- “People say I’m mean, but I’m not.) If I “fire” my PT, how can I word it so that it doesn’t seem like I’m the crazy person? Is there a way to find a PT who believes as BoneSmart does? What kind of questions should I ask?
I’m also running a low grade fever the last 3-4 days. ( 99.6, which doesn’t seem high, except that my normal temperate is around 97.6)I understand it is common, and my incisions look healthy. Should I be concerned?
Thanks for being here for me.
 

Jaycey

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If I “fire” my PT, how can I word it so that it doesn’t seem like I’m the crazy person?
You just say that unless we do this the gentle way I am afraid I won't be seeing you again.

This tells me she probably won't listen to you however:
“People say I’m mean, but I’m not.
Is there a way to find a PT who believes as BoneSmart does?
Are you going to a practice where there are several PTs working? Just interview them. Ask what approach they use. Do they force exercises or take the gentle approach? Will they respect your request and do it your way?

Good that you are taking a break from PT for today. I would suggest as long as you are running this low grade fever you should not be going anywhere. Very early days for you.
 

sistersinhim

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I agree that you should be staying at home until your temperature goes back to normal. Any PT that leaves you swollen and painful is doing more harm than good. While staying at home you'll still be walking around doing your daily activities. That is PT. What's more important than doing extra PT is letting your knee heal.

If you still want to go to PT, take control of it and don't do anything aggressive. Gentle movements is the best thing for your baby knees. Your knees aren't out of shape, they are injured by a traumatic surgery.
 

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pamsknees

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I’d cancel- you don’t even have to give a reason if you don’t want to. It’s your knees & they can’t repossess them . I’m not sure how to find a gentle PT- I worried a lot about how to handle that when I had my bilateral TKR after reading so many horror stories here, but then it was all cancelled due to covid. It turns out when I saw my surgeon at 6 week post op that I was ahead of where people usually are & in no need of any PT at all so I never had any at all. I walked around my house every hour or two, did my exercise bike, did some of the exercises in the book , but nothing to the point of pain. As it got easier I added walks outside, initially with a walker & now without.My recovery has been easier then I expected & now at 10 weeks, I walk almost every day 1.5-2 miles with no pain or swelling. I wonder if my recovery went so well because of no PT causing pain & swelling.
 
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KL Rio Verde

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Well, thought I’d update. I’m 15 days post-op, and doing quite well. Continued with PT, and glad I did. I never felt that my PT wanted me to go beyond what I was currently capable of, though she reminded me that it is work to get my flexion and extension back. I am starting to use trekking poles instead of the walker, and EVERYTHING is getting easier. I’m planning to go to church tomorrow, which I have really missed since the Covid19 closures. I am happy with my decision to do a bilateral TKR...... I’m now finished with “knee-fixing”. I doubt that it is the right decision for everyone, but it was for me. Thanks to all who weighed in on my questions and concerns. I’ll check in periodically, and would be happy to weigh in if others are thinking about BTKR.
 

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