TKR ACIM

[ACIM]

Oh, also meant to tell you that though the last 2 days have been rough today I had a good day. Actually did a little clothes shopping which was so good for my womanly instinct to buy! LOL

 

[Jamie]

I hope you skipped any exercising today since you drove the car and went shopping. That is physical therapy too….it counts, even though you’re having fun. You’ll know by how you feel tomorrow whether it was too much or not.

 

[ACIM]

Hi all, just a quick update I'll let you know I started back to work yesterday, only 4 hours and very doable. Had my leg elevated for most of the 4-Hour shift and there was some definite but mild swelling when I got home. I work today but then I am off for 3 days. Most of my walking now is without the cane unless I'm going up or down stairs. There is constant discomfort just below the knee on the inside but the acetaminophen seems to help. It's good to jump in and say hello to everyone.

 

[sistersinhim]

It sounds like your first workday went well. Remember that on your work days, no exercises or PT. Just going to work gives you plenty of exercises!

 

[Layla]

Hello ACIM,
Thanks for checking in to tell us how your first day back went. You did well! Getting back to work at five weeks is a huge accomplishment, especially with manageable symptoms. As you know through experience, discomfort will fade as healing continues and strength increases.

I think the mild swelling is to be expected when you're sitting and standing for extended periods, even with elevation. The discomfort below the knee is healing soft tissues, tendons and ligaments. Thankfully it's manageable with acetaminophen. I suggest you ice after work and still avoid sitting or standing without moving for extended periods of time.

Happy Thursday...I hope you have a pleasant end to the week!
@ACIM

 

[Jamie]

Thank you for the update and it sounds like things went well. Still be cautious because the increased activity of going to work and all that involves can build up over time until your body completely adjusts to the change. You could experience more pain next week, but hopefully you will not. Sistersinhim is right and you need to make work your only activity on those days. It’s plenty for a while until you build up more strength.

 

[ACIM]

Got it guys! I'm actually tired after work anyway and just go home and rest afterwards...you're feedback means everything to me. I have 3 days off now before returning to work and then work 4 days next week...then 4 days off. Hugs to you all.

 

[ACIM]

3am in the morning and I have not slept a wink since 9:00 p.m. when I went to bed. Yesterday, saturday, had a really good day and got some walking in. Had not slept much the night before, Friday, so by the time I went to bed last night at 9:00 p.m. I really felt like I was going to sleep. Boy was I wrong! I was up every 45 minutes to an hour because of a throbbing and somewhat swollen knee. Finally at about 4:15 this morning I went downstairs to the kitchen and made myself a cup of coffee, (yeah, right!!! Like this is going to help me sleep, right?), and I'm sitting here now icing my knee and elevating it.
I know everyday can be up or down but I am really so sick of this right now. I've just had it with the constant throbbing at night while I'm sleeping, or trying to sleep. I have taken way too much acetaminophen p.m. because I don't have anything that would help me sleep. I go to see my ortho for my final follow-up this coming Thursday, the 23rd. Just sitting here and it is almost 5:00 a.m. now. Thank God at least it's Sunday so I have nothing I actually have to do. Hopefully I will sleep. I feel miserable, like when is this all going to end? Really trying to be patient here guys... but feel like I'm about ready to cry.

 

[ACIM]

Okay, 5:38 a.m. now, EST, I'm going to try to go back to sleep. One thing I forgot to mention was that, because of the reaction that I seem to have had from walking yesterday only began to occur about 8 hours after I finished walking, it's difficult for me to tell how much I can do or not do given these delayed reactions.

 

[EalingGran]

have taken way too much acetaminophen p.m. because I don't have anything that would help me sleep.

Just be really careful not to exceed the maximum 24 hour dose for this ( paracetamol in UK). It is surprisingly easy to get permanent liver damage or dangerous OD with this drug- especially if you are small/ slim.
If you can take non- steroidal drugs then alternate paracetamol with ibuprofen or another over the counter anti inflammatory.
Not sleeping really sucks. I persuaded my GP to give me some zopiclone for the early weeks after my PKR. I alternated it with Nytol ( an OTC sedative antihistamine). I also rested my knee on the opened cool water jacket of my Aircast Cryocuff to sleep and refilled the water jacket if I woke.

 

[Alice Nutter]

There's a pain management app called Pathways which I have found very helpful on and off before during and after hip replacement and knee replacement. The free tier was adequate for me. It teaches techniques for not letting pain dominate you.

 

[Dolphin5]

Hi ACIM. I've just read your threads. I can hardly believe the progress you've made in such a short time. And how lucky to be driving so soon after surgery.

One suggestion would be when you want a hot drink when you can't sleep is to have decaffeinated coffee. Or better still, a hot chocolate with lots of warm milk. Or just warm milk on its own. Another suggestion, to avoid the stairs, is to have a kettle in your bedroom, with coffee, hot chocolate etc on a tray.

I've also been surprised at the amount of times you've taken advice from a PA instead of the actual GP or OS. PAs, whilst knowledgeable, are not qualified and can often be wrong.

I share your frustration in wanting to get back to a strong physical health, but please do not spoil your amazing recovery by overdoing things.

 

[Layla]

I've also been surprised at the amount of times you've taken advice from a PA instead of the actual GP or OS. PAs, whilst knowledgeable, are not qualified and can often be wrong.

I think everyone has their own comfort level with the different members of their care team overall. Sometimes a PA is able to build a better rapport because they may have more time to explain things clearly. In many cases members return to the same PT for a second joint replacement because of their previous experience and the relationship and understanding established between the two. Trusting the PA, doesn't mean you don't trust the opinions of the others (GP and OS). Sadly some OS's can come across as rushed and less communicative in explaining things in detail, may not encourage questions, and don't always seem empathetic.

 

[ACIM]

@Layla
@Dolphin5 see
@EalingGran
@Alice Nutter

Thank you all for your feedback. It really is quite comforting to have access to you. I believe my nerve pain is pretty intense and my doctor's office tells me that they no longer give pain meds after 4 weeks post-op. I am seeing my OS for final evaluation on Thursday. I will ask him again for short-term pain management because of the nerve pain issue. But I was also able to pick up some Gabapentin today and I can feel the nerves quieting down already.
I will keep you apprised and bless you all in the most Divine manner for being there for me.

 

[Jamie]

I suggest you stop taking Tylenol PM completely. As I’ve mentioned to you before, this is not the type of Tylenol you should be using for post-op pain. It sounds as though you’ve taken so much that your body has become dependent on the portion of the medication that helps with sleep. It’s not meant to be taken in large amounts and this type of dependency happens. It’s not addiction, so don’t be concerned about any problems if you stop taking it cold turkey. You will have some sleepless nights, but it will get better in a few days. This won’t hurt you to be awake more than you’d like. Just go with it.

Instead of worrying about sleep, treat your pain. This is what can cause difficulty with sleep. To do that, take either a prescription pain medicine or Extra Strength Tylenol on a regular schedule through the day and night. For Extra Strength Tylenol, that would be taking two tablets (1000mg) every 6 hours. Set an alarm so you maintain this schedule. If you can take NSAIDs, you also can use those with the Tylenol for pain. Just stay within the maximum daily dosage indicated on the label. Then also ice your knee as much as you can. Be sure to keep a towel around the ice source so that your skin is not damaged. If you do this, it should help with pain in a day or so. I still do not agree with your

If you do this, eventually your body will adjust to the lack of the Tylenol PM and you’ll be back on a sleep schedule once again.

I am confused about your gabapentin prescription. You indicated that you got it and started taking in on May 6th. Then you mentioned picking up another prescription today. Did you get two prescriptions? Can you tell me what strength you are taking and how often? There are many levels that are prescribed for nerve pain and sometimes doctors start you at a low dose and ease it upward if there is no reduction in pain. Gabapentin does not work like a regular pain medication and it usually takes several weeks before you feel the effect of it. So it may not give you the pain relief you’re looking for. It is not an immediate relief product.

Since your surgeon does not like to prescribe pain medication beyond 4 weeks from surgery, why not start working with your GP instead? He or she should know a lot more about your history of problems with anxiety and can deal with the situation better than an orthopedic surgeon or their PA.

 

[ACIM]

@Jamie:
Hi. Thank you for all of your wonderful feedback. Let me begin my response to you by stating that I moved up here to Pennsylvania about 8 months ago and have yet to find a general practitioner that I am comfortable with. I know that I told BoneSmart that I had a GP but that was a little white lie. The fact is that I live with my sister and her husband. He is a surgeon and he suggested the gabapentin. I took Gabapentin that night and slept like a baby! All of the nerves were very very quiet and I really didn't have any pain. It was such a relief. I don't know that I need to be on any prescription pain medication anymore as I haven't had any pain since I started the Gabapentin again.
As far as the Tylenol PM I totally get where you're coming from Jamie. I don't know how I got hooked on taking it but it is a wise idea for me to stop using it. I know this. I actually take diazepam for anxiety which grew to intense proportions after the surgery because of the pain.

Thoughts from you are welcome. Thank you so much.

 

[Layla]

Hello and Happy Monday, ACIM!
If your brother in law is a surgeon, practicing in the area, possibly he's able to recommend a reputable GP through asking trusted colleagues in his network.

Hopefully you're able to discuss with your brother in law, how to gradually taper off of the Tylenol PM.
Consider trying Melatonin, or Magnesium to aid in falling asleep and staying asleep, if you haven't already.

Is your brother in law able to supervise and advise on spacing out the use of Diazepam, Tylenol PM and Gabapentin and share how they may interact if all are taken within the same day, possibly causing you to be overly sedated, drowsy or confused, I read there can also an increased risk of breathing problems? The Diazepam can cause respiratory depression especially when combined with other depressants.

Hopefully as the weeks progress, your pain and discomfort will ease, allowing you to gradually reduce the medications and feel more like yourself again. Healing takes time, but you're making progress and you'll eventually get to where you want. to be. Hang in there and have a great Monday!
@ACIM

 

[ACIM]

Thank you Miss Layla:
My brother-in-law is a trauma surgeon and therefore not home a lot. I'm only going to be on the Gabapentin for another week or so and then see how the nerves do. I will be tapering off the Tylenol PM as well. However, because of my PTSD I will continue to take my diazepam, quite likely for the rest of my life. I love love love how you and Jamie I really encouraging me to get rid of some of these medications. I feel cleaner without them but the Tylenol I have been taking for years. And you both are so right. There is no better sleep than natural sleep. Perhaps this knee replacement has awakened me to a new approach and taking care of myself. As my good friend Mary always says, ( despite appearances that look bad), " I can't wait to see the good that comes from this!"

 

[ACIM]

Hi everyone, okay, getting antsy here. Would love to start doing some practical exercises but I know it's too early to do so. Have continued to stretch, take my Gabapentin and monitor the knee. My final follow-up is tomorrow with my OS. The Gabapentin is causing some weight gain which is upsetting. Evidently Gabapentin can cause fluid retention, a Slowdown of metabolism and a desire to do less because of the sluggishness that can go along with the Gabapentin. But it has been a lifesaver for me in terms of keeping my nerves quiet during the night. I hope all is well with everyone. Blessings.

 

[Jamie]

I’m glad you’re doing a bit better. Resist that urge to do more than just walks around the house and gentle bends and stretches until you have at least a week with your pain under control. You don’t want to mess up all the good work you’ve been doing taking things easy to allow your body to heal.