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TKR ACIM

Oh, believe me, I understood you are using an assistive device...or you'd be a "phenom" :wink: so early into recovery.
Since you've explained the stair situation where you reside, I understand it's necessary for you to master this, but some people avoid stairs at all costs, for varying lengths of time out of apprehension. You may be surprised.
I have stairs, but didn't need to use them, but hubs the drill sergeant made me practice each day anyway. So I'd begrudgingly hobble up and down. You're doing great, ACIM, keep it up and have a wonderful day! :)
@ACIM
 
Hi Sistersinhim: thank you so much for your feedback. I hope that my lack of elevation and icing is not harming my leg. I am doing it, just not enough.
Because of your feedback I will put off doing any PT exercises. Funny, but I have been told by physical therapist to take the pain medication before doing the exercises. So your information is brand new to me.
And yes, it does reassure me to know that the swelling, of which there is quite a bit, is due to going up and down the stairs three times a day. I say that it is reassuring because I did not want it to be something else that might appear to frighten me. Thank you again for responding.
 
Hi Ms. Layla: I woke up at 2:15 a.m. in the morning craving a cup of coffee! Imagine That! Had a cup of coffee and went right back to sleep. The caffeine did not keep me awake at all, haha. Now it is about 10:00 a.m. eastern standard time and I suspect that you are about 6 hours ahead of me, right? Am I correct and that you are somewhere in the UK or did you already tell me you're here in the states?
Okay, so I can feel myself starting to get antsy on my 5th day after surgery. It's supposed to be a beautiful day here so I would love to be out on the large front porch just enjoying being outside. Knee is doing fine- a little sore and tired so I really must pick up my meditation exercises again today as they will call me down and quiet me down. I have no reason for any concerns about the knee at this point in time. I have my two week follow up a week from this Wednesday. I truly truly adore you for continuing to be a constant in my recovery. Blessings.
 
I'm so glad I was able to help you! Your lack of icing and elevating won't harm your knee, but not doing it will cause you to have more swelling than if you did do it. For the first 3 months or so, I iced and elevated every time I sat or lay down. This helped so much with lowering my pain and swelling. You can not over ice or elevate, as long as you had a cloth between you and your leg.
 
@ACIM … our staff is located all over the world. It’s why we can respond quickly at almost any time of day or night. But BoneSmart is a US organization and most of our staff is here in the states.

It sounds like your home has a lot of stairs. If so, you probably do need to plan out your days so that you minimize trips up and down especially during these early weeks. Those steps put a lot of strain on your tender muscles that are trying to heal.

We definitely tell people not to take pain meds before surgery for precisely the reason sistersinhim mentioned. I have always suspected that some therapists tell patients to do this because they think it helps them perform better in therapy and makes their job easier. But the idea of therapy is not to push your knee beyond what it’s really ready for just to reach a “good” number. You need to be fully aware of when and how much your knee is being challenged in any exercise so you can stop at the mild discomfort stage. Pushing beyond that will likely result in additional pain and swelling and can even set your recovery back. If you’re on pain medication, you should be on a set schedule throughout the day and night so that medicine is always available when you need it. If you’re doing that, then just take the meds on your regular schedule without regard to when therapy is done.
 
Hi ACIM,
I am in the US right along with you, living in the Upper MidWest and on Central time so you're only a hour ahead of me. Hopefully when it's sunny and warm you're able to get out on the front porch for a bit, that can be a mood booster. Boredom does set in so I hope you have some things planned to keep your mind occupied. You're a pleasure to support and I'll keep checking in on you. Wishing you a good nights sleep hope you have a good day tomorrow. Hugs! :friends:
 
Hi Layla,
Help! Started having significant pain last night and took quite a few acetaminophen and finally got to sleep. Woke up this morning with intense pain and walked downstairs to fix my coffee. Icing my knee and elevating but going right back to sleep now, I can't stand this! Was going to start exercises one two and three today but I am miserable right now. Thoughts? Thanks.
 
Good Morning,
I am so sorry that you're hurting as you are. This is cold comfort, but it's certainly not uncommon for pain to increase around this time even if you're doing everything as directed. There can be increased inflammation putting pressure on nerves, limiting motion and causing more pain. Try to ice / elevate as frequently as you wish for as long as you're able. Do some ankle pumps and take short walks to help with circulation and hopefully reduce some stiffness. This will pass. You don't need to stress over any list of exercises right now, just rest and if you need to, speak with your OS's office about better pain relief. I hope you feel better as the day progresses. We're here for you if you need us. :console2:
@ACIM
 
What exactly do you mean by “quite a few acetaminophen”? How many did you take and in what time frame? There are risks even with this over-the-counter medication that I want to be sure you are aware of.

Do you have any prescription pain medication that was provided by your surgeon? If not, you need to call his office immediately and tell him you are in a lot of pain and need something stronger than Tylenol for it. If your surgeon refuses to prescribe something like Tramadol or Hydrocodone, call your GP for assistance. It is VERY important to keep your pain managed in the early weeks of your recovery.

Your surgeon likely put a cocktail of pain medication in the incision before closing on the day of your surgery. This keeps you comfortable for the first 2-3 days. But once that wears off, pain can return and be very uncomfortable. Having this pain causes inflammation in the soft tissues. That signals to the body that there is an injury and it will send fluid to the area (swelling). If the pain doesn’t get controlled, this becomes a cycle of pain and swelling that continues. You have to be able to greatly reduce the pain to stop the cycle.

Ice as much as you can as Layla recommended. Get on a schedule for pain medication where you take a dose throughout the day and night. If it’s Tylenol, make sure it’s the Extra Strength Tylenol (500mg) and take 2 tablets every 6 hours. This gives you the maximum daily level of 4000mg. Be sure to count any other medications you are taking with acetaminophen in them like cold a sinus medications so you don’t go over this maximum. You can also add doses of NSAIDs if you are able to take them. But honestly, it sounds like you’re going to need something stronger for at least a little while. Tramadol would be better than Hydrocodone since it’s not a controlled substance that is sometimes more difficult to get refilled.
 
Appreciate the feedback. Here in Pennsylvania Tramadol is a controlled substance, go figure. This is my fifth joint surgery and I know my body pretty well. I definitely want opiates after a joint surgery as I could never withstand the pain without them. Typically in the past I have been given, depending on which joint was being replaced, 10 to 20 mg of hydrocodone every 6 hours. Indeed, after my left hip revision my doctor in South Carolina had me on 60 mg of oxycodone for about 3 weeks. I never wanted oxycodone because it doesn't really work well with my body. I did get a prescription for this knee surgery for 5 mg of Norco every 6 hours. I overused it because the pain was greater than the relief I was getting from the 5 mg hydrocodone. I called my doctor today and thought he had called another script in for me but it turns out he did not. I will try again tomorrow but I will also tell you with no pain medication I can't even put a sheet of paper on my knee without it hurting so I am unable to ice it at all. I'm elevating it now but pretty surprised that here in Pennsylvania they only prescribe 5 mg of oxycodone or 5 mg of hydrocodone after a surgery. Really?? I had a rough day. I hope tomorrow is better.
 
@ACIM….thank you for letting me know that Tramadol is a controlled substance in Pennsylvania. That led me to do some research and I have to apologize for my misinformation. We have been a fan of Tramadol for post-op pain since the early 2000’s. One of the big reasons was that it was not as tightly controlled as were the other drugs like Percocet, Oxycodone, or Hydrocodone but was very effective for pain. I was unaware that changed in the US in 2022 when the government decided to put it in the same category as all the other opioid medications. This was done because there is a potential for dependence or even addiction in some people. So, even though it is still an excellent medication and not as strong as many of the opioids, it is more tightly controlled and possibly more difficult to get from your doctors.

Sadly some states are more brutal about their regulation than others. I’m sorry to hear that about Pennsylvania. Quite frankly, 5mg of oxycodone after a knee replacement is an extremely small dose and I can see why it may not have touched your pain. Not everyone’s tolerance for pain is the same, so it is bothersome that state regulators feel the need to cripple doctors who are trying to treat individuals with acute pain with a one-size-fits-all solution.

You might also try discussing your pain levels with your GP rather than your surgeon. We’ve found that many times the GPs have a little more flexibility with the prescriptions in some states. You’re just out of surgery. You have extreme pain. You need the meds for a short while. It’s so sad that you are not able to get them.

But, one caution….if you have a prescription for pain medication, please do not take more than what is prescribed. Doctors don’t like to see you self-medicating. The better thing to do is contact them as soon as possible, let them know the prescription is not working and ask what you should do. I would think it would be rare for a physician to tell you just to “tough it out.”

Until you get your pain to a manageable level, be sure you are not trying to do a lot of exercise or activity. No household chores or errands. Exercise should be only gentle bends and stretches throughout the day and short walks of about 5 minutes around the house every hour or two. If you cannot bear the ice, at least elevate your leg whenever you can. Sometimes you can decrease the sensitivity by lightly touching or massaging your knee (circular motions from the base of your knee, over the knee cap to mid thigh. And try light touches of soft fabric across your knee and work up to heavier materials or the pressure of an ice pack wrapped in a kitchen towel.
 
Good Morning,
I am sorry you had a rough time yesterday, ACIM. Being in pain and likely feeling unsupported by your surgeon has to be frustrating possibly even overwhelming in these early days post op. You deserve to feel cared for not only with adequate pain relief on board, but for your peace of mind as well. I hope you were able to sleep some last night and you make a connection with your surgeon soon leading to a better day today.
We're here for you. :console2:
@ACIM
 
Hi Layla,
Doctor called in my script early this morning and I am hoping to have it within the next hour or two at most. I did sleep much better last night. I think I may have done too much a few days that that nerve block was still in me as I am hurting and sore. But I was so exhausted by last night that I slept. Taking it easy today and have been up and down the stairs once already. I will keep you posted and I thank you again for reaching out.
 
This is good news. I’m thankful your doctor was understanding and providing you the pain relief you need. It is really common for people to overdo those first few pain free days. That’s the down side of those wonderful injected pain meds surgeons use nowadays when they close the incision. Either they don’t warn patients about what happens when they wear off in 2-3 days or people are so excited to have a functioning knee that they do a bit too much. The good news is that things will settle with some rest, ice, elevation and those pain meds.
 
Hello ACIM,
Please continue with your good attitude and keep up your progress.
 
Thankfully you have meds on board again and hopefully they're keeping you comfortably mobile.
You've passed one week post op now, yay! That was the first milestone I wanted to reach. I'm sure you recall from prior recoveries that the first several days seem long and move slow, but soon the weeks start clicking on by.
I hope today is a good day! :)
@ACIM
 
Thank you my dear. Yes, back on the pain medication which has really made a difference.
However, sleeping about 75% of my day. Making my bed is a Monumental task in and of itself, haha! But taking it a day at a time. Bonesmart has been fabulous!
More later Layla. Getting very sleepy
 
I thought of something else you might want to try. At one point you'd said even putting a piece of paper on your knee was too much so you weren't icing. I totally understand that. But have you tried icing under your knee? In other words, putting the ice bag down and then a tea towel then your leg on top of that. In the past I've found that I would rotate where exactly I'd put the ice would help. It's just a thought.

I'm glad that you are doing better. It's a slow process but your doing well.
 
Don't worry about sleeping so much. It's actually good for you. When you are asleep your body can concentrate more on your knee, so sleep away as much as you want, just be sure to get up and move around when you wake up between your naps. I was right there with you on sleeping, taking morning afternoon, and evening naps!

It hurt my knee when I first applied the ice machine baffle, but after a few minutes that initial pain went away and the soothing cold helped to relieve the surgical pain. I iced and elevated the whole time I was sitting or laying down. This really helped to reduce my swelling and pain.
 
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