TKR Anemic after TKR ..exhausted

[Josephine]

Pain levels now 3/4 but the most of her pain is from her back which over the day has been 5/6

2x500mg paracetamol every 4 hrs
2x30mg codeine every 4 hrs
2xtramadol 50mg - I give 1 every 4hrs in day and 2 at night and 2 first thing in morning
Naproxen 250mg 1 in morning
Oramorph oral solution 10mg/5ml -10ml up to twice a night of required
1x gabapentin 300mg 1 at night

paracetamol daily maximum is 4,000mg - she is taking 6,000mgs
Codeine's daily maximum is 360mg - this is the maximum she should take
Tramadol daily maximum is 400mg - she is taking 600mgs

I suppose that most of these pain meds are for her back, yes?

Her swelling in her thigh I would say is huge but knee more moderate

So I see

Icing leg roughly 5 times a day for 15/25minutes

You accomplish little or nothing in 15/25 minutes. Ice for at least 40-60mins and more than 4 times a day.

Elevation 5 times today only managed about 5 mins each time

I suspect she has been attempting to elevate with her leg totally straight, yes? And I expect the physio or nurse told her never to rest with her knee bent? That is a total fallacy. Of course it's painful to do that! Most of the swelling is in the back of the knee and everything there is so tight and already filled with pain. She must allow her leg to bend a little.

See here - this gives you the do's and don't's of elevating! It's quite simple really and her knee won't seize up and set rigid because of it!

She can get 90degree and can almost fully straighten when laying on bed

Jolly good.

Walking with frame roughly 8 times to toilet in total 13 steps to toilet and 13 back (she also gets up for walks about upstairs a few times)

I'll give you a tip - DON'T count steps! You end up obsessing about it! She'd doing fine, just let her get on with it!

Today exercises:
Holding rubber band round foot and lifting leg hold for 10 seconds - 10 times -2 reps
Lifting leg straight hold 10 seconds -10 times-2 reps
Pointing toes to head hold 5 seconds 10 times 2 reps

I suggest she stops doing these exercises and just rests. The last one appears to me to be totally pointless anyway! She doesn't need exercises, she needs rest and ordinary activity like walking to the bathroom. She's only 10 days out. Far too soon to be doing exercises anyway. I did none at all for either of my knees and came out the other end just fine! I suggest you read my recovery thread to see how little exercising I did for either knee! Knee recoveries UK style Parts I & II (Josephine)

You could also read this one too - BoneSmart philosophy for post op therapy

We didn't do all the exercises today as she has been very

Very what?

 

[Fairydust]

Sorry it must have cut off when I posted. We didn't do many exercises that day as she had been very tired.

Her medications we are trying reduce (cutting the paracetamol and codeine down to 1 rather than 2 alternatively) she can take 2 paracetamol codeine and Tramadol every 4 hrs so I give these at 10am 2pm 6pm and 10pm however she only takes 1 Tramadol at these times.

A lot of the problem is her back, elevating really pulls on her disc compression, I have looked at the pictures about elevation and think I am doing right, she isn't bending her knee when elevating, sometimes it automatically dies a little but generally she is good and straight)

I am icing much more throughout the day and for longer periods.

I guess I wasn't expecting the recovery to be this hard (very naive I know) it's such a huge operation but so common so I think that's why.

I think my main concerns now are:

Her exercises, the hospital sheet wants her doing so much throughout the day but she is exhausted and in a lot of pain so they don't happen, although she moves to the toilet and had been downstairs and sat in the garden I worry this isn't enough to get the best result for the future

Anemia - the original iron tablets made her very nauseous but she has anti sickness tablets which I think are helping but her hb was only 8.7 (the tie transfusion at 8.0 which is frustrating as this add to her tiredness. She was anaemic earlier this year but her levels were 11.3 and 10.3 and raised to 12.2 before surgery and in worried how long it will take them to normalise again.

Infection - she had 2 big fracture blisters which burst and they look horrific, in worried this may lead to further complications

Pain - she is on high pain medication. She was prescribed a lot before the surgery for her back but didn't particularly take them, only when she was having a very bad day. All the medication she takes for pain just makes her 'drugged up' and I worry when we can ease her off. She stopped taking Tramadol the other day before the anti sickness medication was given as she thought that would be the reason and was in agony so it's clear the Tramadol are needed but these are strong. When is realistic to be able to be Tramadol free?

I'm sure it's clear I'm a worrier, we have had a crappy year health wise and this surgery was the first step to help her, she's looking forward to getting back to riding her bike and going swimming but it feels like a lifetime before that's going to happen.

A friend of her had TKR and was walking unaided 2 weeks later. It's 2 weeks on Wednesday since her surgery and that's not even an option at the minute.

It's so frustrating, I applauded anyone who has been through this and thank everyone for their help and kindness

 

[newlybionic]

It's too soon to cut back on her pain meds. Tramadol is used by many people as needed for several months. She doesn't need to be doing a lot of exercises at all. Your mom had surgery less than two weeks ago. She needs time now to heal. When your mom elevates her leg there should be a slight bend in her knee. Keeping her leg straight can cause a lot of pain.
Getting up to use the ladies room and grabbing something to drink is more than enough for her to do right now. The anemia is already making her feel tired so rest will be important.
Since it's only just two weeks hers energy is going towards healing your knee and there isn't much left for anything else.
Energy drain for TKRs

Give her time to heal and recuperate and don't try to rush things. Being patient now will pay off big time later.
Activity progression for TKRs

Finally, having problems sleeping is aos to be expected. It will improve but, for now, sleep where you can, when you can, and how you can:
Sleep deprivation is pretty much inevitable - but what causes it?

 

[Fairydust]

Im really over the top worrying aren't I? It's my mum, she is everything to me. We have always been so close, she's my best friend and I just want to make it all better instantly!

This forum has saved me from insanity. I cannot thank everyone enough!

She's a fighter so it's hard for her(and me) to accept we need to be patient, we are very much a get up and deal with it family so sitting back and letting it happen gradually feels very foreign.

I certainly wasn't prepared for this. The end goal of having her more mobile and able to do things she wants to is definitely a drive!

The sleep deprivation link is really helpful, so good to know its not just get going through this.

 

[charmed-life]

Some people do recover quickly with no issues but each person's recovery is what it is. Just try to help her feel better and progress at her own pace.


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[Celle]

Her medications we are trying reduce (cutting the paracetamol and codine down to 1 rather than 2 alternatively) she can take 2 paracetamol codine and tramadol every 4 hrs so I give these at 10am 2pm 6pm and 10pm however she only takes 1 tramadol at these times.

Pain-she is on high pain medication. She was perscribed a lot before the surgery for her back but didn't particularly take them, only when she was having a very bad day, all the medication she takes for pain just makes her 'drugged up' and I worry when we can ease her off. She stopped taking tramadol the other day before the anti sickness medication was given as she thought that would be the reason and was in agony so it's clear the tramadol are needed but these are strong. When is realistic to be able to be tramadol free?

It's much too soon to be thinking about cutting back the pain medication. Your mother has had a major operation, and she needs all that pain relief. If it makes her sleepy, so much the better, because her main job right now is to rest and let her knee start to heal.

Taking the medications will also help relieve some of the pain in her back. It's not at all unusual for people to still need some pain relief (although not the heavy-duty meds) for as long as 4 months.
She is taking these drugs for a genuine reason, after major surgery, and she is not likely to become addicted.
Myth busting: on getting addicted to pain meds

She'll need to keep taking the anti-sickness medications as well.

I have looked at the pictures about elevation and think I am doing right, she isn't bending her knee when elevating, sometimes it automatically dies a little but generally she is good and straight)

She doesn't have to keep her knee completely straight all the time - that hurts. If you look again at the pictures that show how to elevate properly, you'll see that the legs are slightly bent.

I guess I wasn't expecting the recovery to be this hard (very niave I know) it's such a huge operation but so common so I think that's why.

Yes, it is a difficult recovery. That's because it was such an extensive operation, with soft tissues cut and pulled aside, bones sawed and shaped, then large metal objects hammered and cemented into them. Then everything is put back together again, with lots of stitches internally and then the skin wound closed.
I do wish that surgeons prepared people properly for a long recovery period, but many of them don't.
It can take as long as a full year for complete recovery, although your mother will be able to do most things long before that.

By the way, part of your mother's extreme tiredness is because of the Energy drain for TKRs . Most of her energy is going towards healing her knee and there isn't much left for anything else. The anaemia will be contributing, but it's not the only cause.

I think my main concerns now are:
Her excersises, the hospital sheet wants her doing so much throughout the day but she is exhausted and in a lot of pain so they don't happen, although she moves to the toilet and had been downstairs and sat in the garden I worry this isn't enough to get the best result for the future

That is more than enough. You don't have to exercise hard for a good recovery. It isn't exercise that brings back the ROM (Range of Motion) in her knee. It is time, and the reduction of swelling. Her knee can already bend, but pain and swelling are preventing it. So, concentrate on reducing the swelling, with lots of rest, ice and elevation. TKR: work “smarter” and not “harder”

Apart from walking around the house a little, the only exercise your mother needs to do is a few, gentle
Heel slides and how to do them .

I have had three knee replacements. My surgeon doesn't allow any formal PT or exercises for the first month after surgery. He says that the new nee needs that time, to start on its healing journey. All his patients do well. My knees are atrong dan reliable, with good ROM. I can do anything I like with them now.

Infection-she had 2 big fracture blisters which burst and they look horrific, in worried this may lead to further complications

The fracture blisters are superficial. As long as you keep them clean, they shouldn't get infected... Cover them with a sterile dressing if they're oozing.

A friend of her had tkr and was walking unaided 2 weeks later, it's 2 weeks on Wednesday since her surgery and that's not even an option at the minute.

It's not a good idea to compare recoveries. Every one of them is different. Some people will recover faster and some slower than your mother. Nobody else had exactly the same surgery as she did, and nobody else's knee was in exactly the same condition before surgery as hers was. Her knee and recovery are on their own journey and it can get depressing to see others apparently doing "better".

 

[charmed-life]

Feel I should comment for her safety, Celle, that Josephine told her to cut back as she is over the maximum for some of the medications.


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[Tabbycat]

Hi, I would just like to say that you love and care for your mum shines through and I know you really want to do your best for her. I can't advise you any better than newlybionic and Celle, but I'd like to say as others have said that everyone is different, and please don't compare with others. I'm just weaning off Cocodamol and I had a TKR on 21st April! Many people don't need meds this long, but I did. Just make sure the pain meds are within safe limits. Healing is going on all the time, but will take as long as it takes. It's hard to deal with this recovery, especially when you realise how much time and patience are needed, but it will be worth it in the long run.
Best wishes to you and your mum,
Tabby xxx

 

[Josephine]

Her medications we are trying reduce (cutting the paracetamol and codeine down to 1 rather than 2 alternatively) she can take 2 paracetamol codeine and Tramadol every 4 hrs so I give these at 10am 2pm 6pm and 10pm however she only takes 1 Tramadol at these times. All the medication she takes for pain just makes her 'drugged up' and I worry when we can ease her off. She stopped taking Tramadol the other day and was in agony so it's clear the Tramadol are needed but these are strong. When is realistic to be able to be Tramadol free?

She needs to be using one one drug or the other. Codeine's not much good for TKR so I suggest she sticks with the Tramadol but 50mgs is inadequate.

The routine I used for my knees was this - I suggest you give it a try.

she isn't bending her knee when elevating, generally she is good and straight

You misunderstood what I said. I said she should NOT lay with her leg completely straight! That's a good way to increase her pain exponentially! And it would be easier on her back too.

I mean like these

Her exercises, the hospital sheet wants her doing so much throughout the day

Simple, then don't do them! They're not necessary anyway. Did you not read my post (#21)

Anemia - the original iron tablets

These will contribute to her constipation and subsequently to her fatigue and low mood. I suggest she stops taking them for about a week and see how she feels.

she had 2 big fracture blisters which burst and they look horrific, in worried this may lead to further complications

They are quite common and also very superficial. As long as they are kept covered with sterile dressings until they dry, there is nothing to worry about.

A friend of her had TKR and was walking unaided 2 weeks later. It's 2 weeks on Wednesday since her surgery and that's not even an option at the minute.

So what - her friend never had your mother's arthritic knee and surgery and she never had her friend's. They are about as alike as chalk and cheese! Stop worrying and comparing. It matters not. And she's still only 10 days out!

 

[Celle]

Feel I should comment for her safety, Celle, that Josephine told her to cut back as she is over the maximum for some of the medications.

Thank you. I just noticed that myself. Josephine has advised further.

 

[kneeper]

Anemia makes you extremely tired in my experience. Add that to the normal energy drain with tkr and she'll be very tired. It's ok to nap even a couple of times a day at this point.

 

[Fairydust]

Feel I should clarify regarding drugs.

2 paracetamol 4 times a day
1 tramadol 4 times a day
1 codine 4 times a day
1 gabapentin 1 time a day
250mg naproxen 1 time a day

Apart from paracetamol she Takes a half dose of what she is prescribed pain killer wise and they were prescribed prior to her TKR for her back.

The exhaustion has come on so quickly which is why I was worried, on Saturday she walked around the shops for half an hour with a trolley to balance and did great. On Wednesday her friend visited while I was at work for 4 hrs where she was sat chatting (up and down for toilet and general movements in the house to be comfy) and her leg swelled up, right to her foot, overnight elevation really helped and it came back down.

I don't think I was at all prepared for the recovery, on one hand you get told swelling is normal your body has been through a lot but on the other hand you get told watch out for any swelling as it maybe a blood clot so it inevitable you are concerned at every little thing.

The main swelling now is her inner knee/thigh and I think it's fair to say that won't be going anywhere soon.

Last night her bp was really low 94/45 so I was automatically worried, trying to be logical I thought 'she's anemic and hasn't got all her blood, no her bp is low? Is she bleeding? Do I need to do anything' all these little things have a huge impact on everything you think, yes I'm a worrier, she's my mum and I'll always worry and try do right by her but there's a fine line between warning signs.

I just want to thank everyone who has helped me. Close to 4 weeks post op now so I'm hoping we keep improving in different ways.

To anyone reading this who is preparing for this surgery, unfortunately everyone is different, don't spend time comparing recovery, takebit day by day.

 

[Fairydust]

Also I thought id share fracture blister pictures so if anyone has this in the future they have reference (it would certainly help me) 1 picture is 6 days post op, 1 is 2 weeks post op and the last 3 weeks post op.

The last looks bad but you have to bare in mind that it is new skin formed under the blisters. You can see how full the blisters are on the first picture and how they absorbed on the second and then once that skin came off (wasn't pulled or sore it just came off with the dressing) how there is new skin underneath. I've been assure by various nurses this area is not infected it's just healing

 

[Fairydust]

My colleague at work (nurse) said 'oh she's got cellulitis' to which I replied she is very tanned and her skin looks red but it's just Brown and the light x

 

[kneeper]

I'm tagging @Josephine to see what thought she has on your posts above.

 

[newlybionic]

IMO I don't think it's cellulitis but just new skin that was under her blisters. The rest just looks like ,the remaining bruising from the surgery itself.

 

[KarriB]

As Kneeper said, the energy drain from TKR surgery is massive, add that to anemia and wow! She's going to be tired. I was whipped after my surgery and definitely wouldn't have been able to walk around the shops at 3 weeks. I found my body needed a lot of sleep and since that didn't happen as much through the night I napped often during the day.