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TKR 3-17 RTKR and Totally "On Course"

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One thing I haven't brought up in my recovery is the degree of fatigue I feel after doing the most minor things such as after brushing my teeth or standing at the sink and shaving. I have to sit down and rest for several minutes before I can carry on. On OPT days, I am pretty much wiped out for the rest of the day after my 1 hour of PT.

Prior to surgery, during the pre-approval process, some may recall I was diagnosed with Chronic Lymphocytic Leukemia (CLL) but I am/was totally asymptomatic with no lymph node nor organ involvement. I was said to be in stage 0, watch and wait. After surgery, while in in-patient PT, I was diagnosed as being anemic. Since I was not anemic prior to surgery I will chalk it up to that. During my stay in IPT, I was given iron pills, 3 doses IV Iron when they weren't getting the job done, and two shots of ProCrit and sent home with a 30 day supply of iron tablets.

So at this point I am not sure what to tribute the fatigue to, just the natural energy drain related to the healing process, the anemia or the CLL or all three combined. I am hoping it is the anemia and healing process which would give me hope that this will soon pass. @Josephine @Orthodoc Any thought or comments?

PS: For those curious, based on a somewhat compromised immune system (the CLL) the only thing my OS did differently was to use ABLC (Antibiotic laden cement) to fight off possible infection.
 
I am 2 weeks post op today and am fighting with the fatigue @Phil75070. Today I have been back to the hospital to have the clips removed. Was out about 4 hours and completely exhausted even though I was mostly either in a wheelchair, on crutches or laying down, I still found it so draining. Even having a shower wears me out. I think this is par for the course with this type of major surgery. Sounds to me like you are doing absolutely great. Take care.

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Phil , all 3 can be factors for sure !! And I see you are 3 weeks out. But everybody experiences the dreaded energy drain and ironically lack of sleep. Your flexion is great . Congratulations. Its too early to worry about extension but its great that your PT and yourself are working on it. I wonder if he uses the electric stim to fire your quads up. ? That might help as I was led to believe quads are a factor in extension. However I could be wrong, also you are too early out for electric stimulation. Overall I say you got off to a very rocky start but seems like you are rounding the corner. It takes time and you cant speed it up. My first 3 weeks seemed almost surreal to me since I had never taken medication before my tkr. I do remember that I did ice and elevated almost all day and night. However when I did wander around the house I did have a tendency to over do it. Try not to do that. Well Phil , take care
 
@icep707 We haven't done any electrim stim but have certainly focused on strengthening the quad with the various exercises we do. PT believes that as that quad strengthens the fluid around the knee will lessen. I had read about the fatigue and energy draining nature of this major surgery from the literature provided here and in the recovery threads, yours included, but I just had not experienced anything like it before and thus could not have anticipated just how fatiguing this would be! :)

@lori107 I, too, get really tired just taking a shower even with the use of the shower stool. I find myself often bending over resting my head against the far wall as the water beats down on the back of my neck and between my shoulders! Good luck with your recovery!
 
Oh how I remember the energy drain , I doubt anyone has felt anything like this before, unless you climbed mount Everest or lasted 12 rounds with iron mike tyson . It gets better. I promise.
 
Phil75070 said:
So at this point I am not sure what to tribute the fatigue to, just the natural energy drain related to the healing process
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did you read the articles Kelly left you in post #4 of this thread? Evidently not as in there is an article about the Energy Drain which explains precisely why it happens.
 
Josephine said:
did you read the articles Kelly left you in post #4 of this thread? Evidently not as in there is an article about the Energy Drain which explains precisely why it happens.
Click to expand...
I've read every article both pre and post operative. I just could not believe that the degree of fatigue I feel could be that severe from the surgery alone.
 
It probably is the energy drain since you're less than a month out. It should improve a bit--where you're not exhausted by brushing your teeth, but do get wiped out fairly easily.

If it doesn't improve a bit over the next month, given your health conditions you could ask your doc about getting blood work.
 
Phil75070 said:
Pain is much more of a "ache" at this point and still with a lot of swelling and tightness in the knee itself and the lower leg.
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That's wonderful and very lucky! I still need a fair amount for pain control.

I think the fatigue is just par for the course. Enjoy the right to nap as often as you want - you have a good excuse. Best wishes for a continued good recovery.
 
Phil.....another Texan here!
Sounds like you have really been put through the ringer! Two things are for sure: We all have the feelings of uncertainty when it comes to how long and how hard our recovery is going to be and the certainty: It's not going to be easy and will probably be filled with ups and downs. Sounds like you are doing everything right though. With the exception of pain pills.....I think you should take more. You have cut down to really very little already. I think most people here will agree with that.
I'm at 4 months post-op and still having flexion problems, even with the manipulation of my knee a couple of weeks ago. Although yesterday was probably the best day I've had so far. Today at PT my flexion was 95, which is good for me. Not good in a lot of people's opinions, but good for me, and I have learned to be happy with what I can get. I am seeing progress again and I'm happy about that. Good luck on your journey. You have a ways to go yet, but you'll get there!!
 
I had home p/t for 3 or 4 weeks before starting outpatient p/t. When I started outpatient p/t, I was at 10 degrees extension and 99 flexion. I was at 0 and 121 at 9 weeks. My knee swells if I do all the exercises they tell me to on the off days from p/t. I keep it moving while watching tv. Drawing the knee up and straightening it, sitting on the sofa. As for the energy drain, I too thought it would never get better. At one month, I would nap everyday. Showering still wore me out, too. I turned a corner at 6 or 7 weeks. It will get better. Hang in there.
 
My latest PT session was yesterday and I was doing various exercises pretty much non-stop for the entire 1 hour plus. My latest flexion measurement has me at 132. I asked my PT what the goal was and he said it is 120 so I have exceeded that. As far as extension, I am still at about 10 and he says if it were adhesions or scar tissue that were the problem preventing me from getting those last 10 degrees I would not have the great flexion that I have. He believes it is just the strengthening of the muscles and continued reduction of the fluid that will get me there. I trust he is correct.

I think if I wanted to I could start swinging a golf club again as I have swung an imaginary club a few times and feel pretty stable. However, I put my membership on medical hold and think May 1 might be just a tad too soon to resume playing. June 1 is now my new target date for actually getting out on the course though I may chip, putt and maybe even hit some shots at the range prior to that. I know the left knee has to be done, too, but I am going to see how it feels when I try to play again and see if I can put it off until the Fall so I don't miss playing during our prime time.

Also, looking back, when I get my right knee done I think I will see and do things a little differently. 1st of all, being unable to be given a spinal I will know what the worst case pain in recovery immediately after surgery could feel like. I think just knowing that and knowing how I have recovered since will eliminate me from having the same anxiety I did about the procedure at that time, thinking something had to have gone wrong to be in that much pain!! Secondly, given the option, I would not elect to do inpatient PT again, or at least would explore a different facility. I will not put up with PT that inflicts that much pain again. (My outpatient PT does push down on my leg in an attempt to get it as extended as possible at the very end of our sessions but lets up as soon as I say I have had enough!) Going through this once, even though two knees may not heal exactly the same, I will have that benefit and will know what I can do on my own and how far I can push myself.

Finally, upon discharge, I was given a prescription for 60 hydrocodone indicating I could take one as soon as every three hours. I never took them anywhere near that frequently and it was the only pain reliever prescribed. It got to the point where in the last week or so I only took one an hour before bedtime, then when I would awaken in the middle of the night I would take another. They were great for getting me 4-4.5 hours of sleep at a time but I ran out. I tried taking other pain relievers at night but nothing helped me sleep or helped get the leg comfortable enough for me to doze off for more than a few minutes at a time. While at PT yesterday I stopped across the hall and had my OS's PA call in a new prescription and took them again last night. What a relief getting some sleep is!

QUESTION: Do you think taking just two hydrocodone 10/325 in total overnight that it would be OK to start driving again? If not, how long do you have to stop with the narcotic pain releivers before they are out of your system and it would be OK to resume driving?

All-in-all I guess my recovery has been about as good as can be expected. I can walk around the house without any artificial aids with little to no limp. The knee is still noticeable and "achy" but not what I would describe as painful. I have been using a cane since my first OPT at 2 weeks post-op for any outings but it is just more of a security blanket than a necessity. I still elevate and ice frequently and some of the fatigue is beginning to wane. I am anxious, like all of us who have gone through this, to get to the "totally back to normal" stage!

I wish all a successful recovery keeping in mind that you can't measure your success by someone else's timeline. My OS in our pre-op meetings told me I could be using a walker for 6-8 weeks, that it could be 6-8 months to even start to feel normal and as much as a year to be totally recovered.
 
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If you're only taking the hydrocodone before bed my guess is that it would be mostly out of your system during the day. I just wouldn't try to drive at the crack of dawn. :)
 
I agree with kneeper. I would make my first outing very short just to see how I felt.


RTKR - 9th December, 2013
 
So glad to hear you are doing well. You did hit a few bumps along the road. But it sounds as if the worst is behind you. Please be aware that your other knee can have a very smoothe recovery or believe it or not worse. No 2 are ever the same . Patience is a virtue with these recoveries. Im close to 10 weeks and my flexion is 120 , you exceeded that early on . Way to go . Your extension could be a weak quad. Work on your quad. Have your tried electric stimulation at OPT. That really fires up the quad . Well Phil . Keep up the great work .Iceman
 
They haven't done any electrical stimulation at this point but, as you did, they do keep stressing the quad strengthening exercises. I see from reading the BTKR recovery threads that even knees done at the same time can heal totally differently so I have no expectations, only wishful thinking, in regard to how the 2nd one might progress! :) Thanks for the continued encouragement @icep707 !
 
Hi Phil .... I'm sorry you're struggling with this, but believe me, you're normal. Just don't try to push it. Like another poster said, don't stand if you can sit, don't sit if you can lay down. Now, you can take this from one who DIDN'T do those things, and now I'm paying for it. My surgery was May of 2011. I remember absolutely nothing of the 3 days I was in the hospital - nothing. I went to rehab for a few days and then home. I was to have used a walker for several weeks, but, did I? No! I found myself walking away from it, so I figured, I guess I don't need it (WRONG!). I didn't take the pain pills by the clock, but only when I thought I "needed" them ..... also wrong. I was almost trying to prove to myself that I can do this - no problem - a piece of cake. Well, it's not and it takes a long time to recover from this. After about 2 months, I did another stupid thing ..... I fell in my kitchen, face forward, flat on my knees. I got up, and what do you know? Nothing bad happened ..... or so I thought. About a year later I had to have scar tissue cleaned out and when I asked my OS why this happens, he said that some people are just prone to it and others ...... just do too much too soon. OOPS! Well, ever since the scar tissue removal, my right knee hurts on the outside terribly and sometimes down the right side of the tibia. It's been going on for months and months, and I finally called a recommended doctor who did "revisions." I have an appt. to see him in June which feels like a long way away. I don't know if I will need a revision or not, but I do know something is wrong. And .... I probably will have only myself to blame.
So, take it easy, take your meds. by the clock, don't compare yourself to anyone else, don't try to push yourself, rest, rest, rest, use ice and don't expect too much too soon.
Can I ask you one question and you'll probably think this is weird (but that's me) .... do you happen to be an Engineer?
Take care of yourself and don't push .... it will come in its own due time.
abby
 
@amberpep I think we all try to tell ourselves all of the things you said in your post, but do we all listen? :) We have a really good day and all of a sudden think we have permanently "turned the corner" only to have the knee remind us that it is in control, not us.

I actually anticipated a worse recovery, the only real negative was the amount of pain the first two hours after the surgery because no spinal could be given. Glad I had the knee replaced, though, despite any and all of the negatives so far. I could not have gone much longer with the pain I was experiencing pre-op but I do want to hold off doing the left knee a bit longer than I had originally planned and discussed with my OS so I can get some golf in this summer.

No, I am not an engineer though I was in sales/sales management in a highly technical industry all of my working life.
 
Update from my PT session this morning. Flexion took a little step back to 126* (from 132* the last time it was measured) but extension improved to 8* from 15* the last time measured thought I have attained 10* on occasion in the past. I am also being pushed more in PT with new exercises and things like increased tension on the bike. I still have some swelling and my calf muscle knots up like crazy at times. Other than that, I am now driving with no discomfort and total confidence. When out, I still take the cane with me just as a safety precaution and not because I really need it to walk.

Before resuming golf my primary PT wants me to be able to stand balance on my surgical knee for 15 seconds with my eyes closed. I can do double that easily with my eyes open. What difference does eyes open or closed have to do with my ability to resume playing golf? :)
 
Your ability to balance is different with your eyes closed?
 
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