TKR 2nd TKR 10/18/23- recovery time

[mendogal]

My doc said to try one pill every 2 hours instead of 2 every 4. So I am trying that today and hope it gets a bit better. The lack of sleep is weird for me. Usually I can sleep anywhere. My daughter is working on finding something to help the sleep. Fingers crossed!

For sleep.... I was desperate and the usual OTC antihistamines (diphenhydramine) did nothing... I settled on a OTC regimen of two things taken at the same time:
1) herbal sleep tea blend with valerian as an active ingredient
plus
2) low dose melatonin (3mg, time release)
And was finally able to get 5 - 6 hours of sleep.

My sister has had good results from a supplement that combines valerian with melatonin.

 

[KPup]

Hi. This TKR is so different from my first. I had my first PT today and hated every minute of it. When I did it before, I loved going to PT and felt truly supported. Today I was in tears. The therapist was a total jerk. 5 minutes in he is telling me my recovery is not going well because my bend is at 55 and extension at 6 degrees. It’s day 5 post op! I told him that he needed to be supportive and provide encouragement because telling someone they’re not recovering fast enough 5 days after TKR is not helpful.

I can’t activate my quad. It hurts so bad on the top of my knee cap. I can’t lift my leg without using my other. My IT band feels like a metal rod.

Any ideas for activating quad?

 

[mendogal]

Good for you self advocating! I hope you fire the PT and complain to the agency.

Activating quads - Yes!!!! (raises hand) My ortho team was very clear that in the initial weeks "Less is better." In addition to very short walks every hour while awake and the standard (after any surgery) ankle and foot back and forth to aid circulation (and mitigate risk of clots), they did want me to do gentle quad sets while in the recliner.

Many years ago a great myofascial therapist taught me how to target my focus an any muscle by simply touching it with a few fingers. So I had my fingers on my quads while doing quad sets - separately doing midline, then one side, then the other.

The response during the first week was very weak twitching but by two weeks they were firing reliably. That is not to say they were gaining bulk or even strength! It takes longer healing and more time walking for you to notice a strong response. But this simple exercise shouldn't be painful - you don't want to overdo even the quad sets - and really does seem to help wake them up.

 

[Jockette]

Your quad is still in shock and it will fire as it heals.

I agree, find another PT and report this one. That’s no way to treat a patient.

 

[CatieViv]

I feel your pain. It was bad for me too in the beginning. I am at day 25 now and things are much better. I still have pain but I am listening to my knee and resting when it needs me too. I found the 4 hours was long as well. I am still taking pain meds but lasting much longer. I just keep reminding myself that I had major surgery and it has only been 3 weeks. Not my first time down this road either. This is a revision on my right knee.

So glad you stood up to the physiotherapist. I wish I had done that the first time around. This time, I have really good physiotherapist and assistant.

Hang in there. Keep in touch if you need someone to talk to.

 

[Dmcfad2]

Hi. This TKR is so different from my first. I had my first PT today and hated every minute of it. When I did it before, I loved going to PT and felt truly supported. Today I was in tears. The therapist was a total jerk. 5 minutes in he is telling me my recovery is not going well because my bend is at 55 and extension at 6 degrees. It’s day 5 post op! I told him that he needed to be supportive and provide encouragement because telling someone they’re not recovering fast enough 5 days after TKR is not helpful.

I can’t activate my quad. It hurts so bad on the top of my knee cap. I can’t lift my leg without using my other. My IT band feels like a metal rod.

Any ideas for activating quad?

I hope this makes you feel better. I am 5 days post op and yesterday during therapy my bend was measured at 47° and extension at 9°. So, you’re doing better than me! LOL I have a great PT who said don’t even worry about it. It will come in time. I am so happy for BoneSmart where I can get information that keeps me from worrying about how i am progressing! Hang in there!

 

[Layla]

I am so happy for BoneSmart where I can get information that keeps me from worrying about how i am progressing!

We're happy you're happy! I can't imagine my recovery without BoneSmart and my BoneSmart recovery buds.
I think the camaraderie between members, the sharing of minor concerns and the reassurance found here from those participating likely saves surgeon's offices a lot of distress phone calls.

Today I was in tears. The therapist was a total jerk. 5 minutes in he is telling me my recovery is not going well because my bend is at 55 and extension at 6 degrees. It’s day 5 post op! I told him that he needed to be supportive and provide encouragement because telling someone they’re not recovering fast enough 5 days after TKR is not helpful.

I'm so sorry. Are you able to request a different therapist to work with who may be a better fit for you?
No sense in struggling each time you're there and trying to meet unrealistic timelines.

 

[KPup]

Today I was in tears. The therapist was a total jerk. 5 minutes in he is telling me my recovery is not going well because my bend is at 55 and extension at 6 degrees. It’s day 5 post op! I told him that he needed to be supportive

I'm so sorry. Are you able to request a different therapist to work with who may be a better fit for you?
No sense in struggling each time you're there and trying to meet unrealistic timelines.

Yes! I have fired that guy. I felt bad he had a new PT student who he let touch me without giving her any direction. Table too low. Then lift my leg and drop it when I screamed out in pain. Horrible experience!

 

[Dmcfad2]

@KPup Good morning, how are you doing today? Hoping you have a better PT experience next time.

 

[KPup]

@KPup Good morning, how are you doing today? Hoping you have a better PT experience next time.

Hiya. Doing better today. PT Thursday was good. ROM 85 and extension at 0. Next PT Tuesday. How’s your recovery going?

Pharmacy was less than helpful and wouldn’t refill pain meds, saying too soon. I triple counted and it wasn’t too soon. So yesterday wasn’t fun on half doses. I did determine that it’s too early to cut back, so there’s that. Thanks for checking in!

 

[benne68]

Pharmacy was less than helpful and wouldn’t refill pain meds, saying too soon.

The problem could be that the insurance company won't approve the refill.

I'd trying calling the surgeon's office on Monday and asking them to put in a new order for you.

 

[sistersinhim]

I'd trying calling the surgeon's office on Monday and asking them to put in a new order for you.

If he doesn't agree to a new order then call your PCP. Many times they will prescribe pain meds when an OS won't. I know I had to get my Celebrex through my PCP when years before the surgeon always prescribed them. Times have really changed.

 

[KPup]

Thanks. The problem was the original RX said to take 1 every 4-6. One wasn’t cutting it, so OS said to double up. Went through the RX faster than I should have based on RX instructions. New RX was picked up today and says to take 2 every 4-6, so I shouldn’t have problems next time. What I learned is that it’s too early in recovery to cut back on meds yet. Having a hard time chasing pain today. Hopefully tomorrow I will be back where I should be. Thanks for the support.

 

[KPup]

This time around the bone pain is horrific! Now that the tourniquet swelling has gone down and muscles are starting to recover my primary issue is tibia pain. I’d say it’s a constant 8 on the pain scale and goes down to 4-5 after pain meds. It keeps me awake and I just can’t find a comfortable position. Elevation is difficult too- despite my lovely lounge Dr pillow.

Ideas to help?

Thanks all!

 

[sistersinhim]

Have you tried icing your tibia area? If that doesn't work you can try applying heat. But, keep the heat source away from your knee. Heat feeds inflammation and you don't want that.

Does the pain seem to be from your bone or your soft tissues? Do you have any red, hot, and swollen areas in the lower pain area? If so, you might need to be checked for a blood clot.

 

[KPup]

Have you tried icing your tibia area? If that doesn't work you can try applying heat. But, keep the heat source away from your knee. Heat feeds inflammation and you don't want that.

Does the pain seem to be from your bone or your soft tissues? Do you have any red, hot, and swollen areas in the lower pain area? If so, you might need to be checked for a blood clot.

It’s deep bone pain. I had a mako assisted surgery. Yes- icing knee for 20 then shin for 20. No new bruising. Elevation hurts. My muscles are sore from bracing. No hot red spots. Just deep bone pain.

 

[sistersinhim]

No hot red spots.

Oh, that's good. It's probably all part of the normal healing process. I remember that mine also hurt a lot, but for how long.

 

[KPup]

I have questions about pain meds, specifically opiates. Due to 11+ knee surgeries through the years I’ve developed a tolerance to opiates and have to take higher doses to get relief.

I was upfront with my surgeon and his PA promised to take care of it and make sure I had what I need.

I received a refill but it was only enough for 3.5 days. Now I had to ask for another refill. Still no word. I will have my last dose at noon tomorrow.

It is causing me so much stress worrying about it. I am barely getting by taking every 4 hours. At 3.5 hours I start watching the clock so I know it’s too soon to cut back.

I’m icing, elevating and doing all the right things.

I know states have really cracked down on prescription laws, but this is harsh and really stressful. I can’t drive and my caregiver is leaving for home tomorrow. She needs to get my RX before she leaves.

I hope to get a notice that they called in an RX.

Do others have this same type of issues?

 

[Layla]

Sadly we do hear of struggles to obtain refills. I am sorry it is stressing you out.
If you're unable to receive any satisfaction from your OS's office, consider contacting your Primary Care Physician. I'd be surprised if your surgeon's office refuses a refill at only 12 days post op.
Good Luck and lots of comfort to you.
@KPup

 

[KPup]

I'd be surprised if your surgeon's office refuses a refill at only 12 days post op.

I got a message. They will do one week at 20mg every 4 hours and then want me to begin tapering. At least that will get me to almost 3 weeks post op. Last TKR I only needed them for 3 weeks. I think they get scared when patients require higher doses.

It’s just so stressful. I clearly communicated my needs and we had an agreement about what my needs were and she assured me that she was going to take care of it. She even gave me her persona cell number in case of issues with meds.

I understand about being cautious. But dang, this on top of trying to heal is a challenge I don’t need.

Thanks for letting me whine.

Oh - I do have one more question. I have to get my appendix out. I have a pre-cancerous polyp on appendix. I’ve met my out of pocket insurance max this year, so TKR is fully covered with $0 out of pocket.

If I do the appendectomy this year, it’s also going to be laid in full with zero out of pocket.

If I wait til next year I will have to pay $3000 deductible before insurance kicks in.

I’ve got it scheduled for 12/27. Figure I will be 10 weeks post TKR.

Am I crazy? Or do you think I’ll likely be recovered enough to have this done this year?