TKR Back to square one?<

[Lynne Cleveland]

I’m still taking the Tramadol and Tylenol, OS called in another refill for me. I only take one 50 mg with 2 -500mg tylenol due to he only gives me a certain number of pills and then
I have to call back for a refill. He prescribes to take one every 6 hours but I’m still taking one every 4-5 hours. For the most part I can get to 5 now, thank goodness! My pain levels were high in the beginning. I do take 2 Advil sometimes to make it to 6 hour intervals. Does the NSAID
Cream work for you?

 

[emmysmom]

The NSAID cream seems OK. It doesn’t have the magic results that the 1 tablet of Aleve did, but at least my stomach feels better.

I’ve been doing a lot of walking (Thanksgiving prep) so the back side of my knee feels swollen and is harder to bend as far as I could last week. I try to put most of each dose back there - but I don’t know if that’s right or wrong. I’m also trying to spend more time icing and elevating but there’s just so much to do.

My OS team said that my last bottle of 50mg Tramadol was my last so I was being stingy with it. I must admit, I was much more comfortable on days with it than without it.

Here’s the kicker, though. I haven’t been able to sleep that last three nights. I’ve decided the Tramadol was to blame. On on my 2nd day of just Tylenol and the NSAID cream. I’m uncomfortable, but I can’t say I’m in serious pain. Maybe about a 2.

Are you sleeping OK on the Tramadol?

 

[KarriB]

It sounds as if you’ve joined the ODIC. If you can’t delegate then you definitely need to break up your activity so you’re elevating longer than you’re on your feet. I hosted Christmas Eve 2 months post op and broke up my jobs so I would do part or one thing then sit with my legs up. I started a week before and that night I put everything in the oven and set out the buffet, but everyone else cleaned up while I put my leg up. Please let your family know you won’t be able to do what you usually do this year and they’ll need to step in.

 

[Lynne Cleveland]

I do have trouble some nights getting to sleep, maybe it is the Tramadal. I just thought it may have been on the days that I didn’t have much activity. Speaking of to much activity in planning for Thanksgiving, just got back from the grocery store with my husband, shopping for the holiday. Put the cold items up and I’m icing and elevating now! Cutting way back on what I will be doing for the meal this year. Still on a cane so going on n a Saturday night wasn’t a bad idea, it wasn’t busy at all. Christmas shopping will be online this year.

 

[emmysmom]

@KarriB:

ODIC sounds right!

I feel like I’m doing such a small fraction of what I usually do, so it makes me antsy.

Also doing this holiday in increments. Started last week making dishes and then freezing them. Already told my husband we need to set up the tables days ahead so I get them ready bit by bit ahead of the holiday.

I had thought I should rest for the same amount that I’m up - but I guess it has to be more.

@Lynne Cleveland:

I thought it was the lack of activity keeping me awake,too. The last three days though, I’ve been so exhausted (ODIC!) but unable to sleep. I’ll let you know how my dropping Tramadol works - hopefully I’ll sleep tonight.

I’ve been to the grocery store three times in the past week. They recently remodeled the store making it seem twice the size it was. I think that walking the aisles makes 3/4 of a mile in distance. If I get to the dairy aisle and realize I’ve forgotten some fruit or vegetable I usually just forgo the forgotten item until the next time.

I agree with you about the online Christmas shopping. If only I could order online house and tree decorating!

 

[SusieShoes]

What you do for home and tree decorating is go online, buy yourself a faux (but glittery) crown and scepter, seat yourself in a chair amidst boxes of holiday items, and give regal orders to your minions as to how to place the decorations. They will develop a new appreciation for all the work you put into the holidays!

Yes, for another month or so you and your knee will benefit a lot from long sessions of rest and even napping. The sleeplessness seems to hit almost everyone and it can be quite draining, as well as frustrating. But just a couple more months of this should see you in a whole different, better, place!

 

[Jockette]

Oh, @SusieShoes, I LOVE the glittery crown and scepter idea!!!

 

[emmysmom]

That really made me smile! Thanks @SusieShoes !

 

[KarriB]

Susie is right, delegating is necessary for your recovery. It’s often hard not to over do during the holidays, but it’s just for this year and as Susie said, everyone will appreciate you so much, especially your knee!

 

[Lynne Cleveland]

HA, my husband picked up a rosemary plant that is shaped liked a Christmas tree. It's looking better all the time as a possibility in tree decorating! I love to decorate with candles for different seasons. Of course, Christmas is one that is hard not to pull those boxes out. I'm not going to overdo it this year, just saying "No" to my self early.

 

[emmysmom]

@Lynne Cleveland regarding the NSAID cream - the pain relief was not nearly as effective as the Aleve. It was very effective in bringing down swelling in the back of my knee. The swelling was a result of the constant overdoing but I spent two days after Thanksgiving resting, icing and using the cream.

I’ve had a constant low level pain/discomfort which became worse every afternoon/evening and ruined any sleep. The only pain relief options available for me were Tylenol and the cream. My feeling was it would be at least a month or two before I could even consider a normal life. Pretty draining and depressing. My family is pretty much “over it” as far as my recovery goes and I was pretty depressed - feeling like a slacker.

Three days ago, my pharmacy called to say my Gabapentin prescription was ready. (My surgeon had taken that script away from me over a month ago.) I rushed out to get it BEFORE asking the doctor if it was a mistake, of course. Started taking the Gabapentin twice a day as prescribed, along with my usual Tylenol and the results were amazing! Felt good all day and night time only mild twinges and low level ache.

I contacted my surgeon and told him that this is the first time I’ve felt “normal” since the surgery. I had been afraid of returning to work, but with this pain relief combo I felt I could do it. The doctor said that since it was working so well, I could stay on it for “a while”. Such relief!

So, in the end, a very happy accident!

 

[Lynne Cleveland]

Glad you got your script! What a blessing! I’m pretty much right where you are. Still taking the Tramadal and Tylenol but not totally covering . I do use Advil in between some as well. When are you planning on going back to work? I know this is the stage when you think you can do more, then pay for it later.
I’m still having the pain behind my knee as well. Going to see the OS for follow up next week. I may ask about the nsaid cream and Gabapentin. Any side effects? The Tramadal is still making me nauseated at times, have some Phenergen left for nausea. We will get there, just trust it’s a matter of timing and Gods healing power. I do have to keep reminding myself that!

 

[Lynne Cleveland]

Are you still going to PT?

 

[emmysmom]

@Lynne Cleveland Stopped PT after three or four torturous visits. I’d be incapacitated the next day. My OS said that I was doing fine and could continue with my at home exercises- I do them sporadically but I do a lot of every day things like walking, stair climbing, etc.

My work involves standing for 7 to 11 hours a day, climbing stairs ladders and scaffolding, and carrying heavy things. And that’s just the part where the work starts! Lots of huge scale painting, texturing and carving.
I’m thinking I may wait until after the holidays - still haven’t made up my mind. The money would be nice but I’m happy to feel well enough to tackle some at home projects.

My ROM and extension seem good but my leg muscles are still atrophied. Working on that - have no idea how long it takes.

 

[Josephine]

The NSAID cream seems OK. It doesn’t have the magic results that the 1 tablet of Aleve did, but at least my stomach feels better.

The only pain relief options available for me were Tylenol and the cream.

Actually, there was a very detailed documentary on our TV a while ago where a doctor/tv journalist allowed himself to be tested for the use of topical creams. He had a series of electrodes inserted into his skin around his knee that measured the effect of the creams at various depths. It was quite clearly demonstrated that the drug only penetrated to the depth of about 3mm at any point in his knee! That's barely skin depth. BUT it was also discovered that nevertheless, it still managed to find its way into the stomach where it could cause side effects.

My OS team said that my last bottle of 50mg Tramadol was my last so I was being stingy with it. I must admit, I was much more comfortable on days with it than without it.

How mean! Have you tried asking your GP to help you out? Many other US members have and most have found them to be very obliging.

I’ve had a constant low level pain/discomfort which became worse every afternoon/evening and ruined any sleep.

Hmmm .... I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[emmysmom]

Hmmm .... I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

Absolutely!



Sent from my iPhone using Tapatalk

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[emmysmom]

1. Pain levels generally 2 : mostly aching, swelling and evening stiffness

2. Taking 1000mg doses of Tylenol 3 to four times a day (I skip 4th if I sleep through it)
2 grams Diclofenac 1% gel twice a day - rubbed into the back of me knee and the outer side at the bending point.
On my third day of Gabapentin 200mg twice a day (morning and late afternoon

3. Moderate swelling - might be slight - both legs look kind of fat

4. According to my phone app, my ROM is 143 and extension is -4. On my back I can get my heel exactly my hand’s length away from my bottom.

5. I have been doing less icing lately, usually 1 or 2 times for about an hour but I haven’t wanted to ice it for two days - no good reason other than I didn’t feel I wanted or needed to.

6. Until this week I was elevating whenever I sat down - I also have the lounge doctor cushion that until this week I was using for sitting and sleeping. Now maybe an hour or two a day, preferring to sleep flat on my stomach now - sometimes with a bed pillow under my feet.

7. All housework,cleaning, shopping and cooking - I would say about 5 to 6 hours a day.

8. Exercises at home - was told to do these 3 times per day. In the past 3 weeks as activity level has drastically increased, I’ve done them once ever 2 or 3 days

Seated static chair scoot 3 sets 10 reps
Supine hamstring stretch. 3 sets 10 reps
Supported standing squats. 3 sets 10 reps
Standing side stepping 3 sets 10 reps
Seated gastroc stretch 1 set 15 reps
Long sitting quad set on couch 1 set 15=reps
Standing bilateral calf raises 1 set 15 reps
Supine Straight Leg Raises 1 set 15 reps
Supine ankle pumps 1 set 10 reps
Hook lying glute sets 1 set 10 reps
Side lying hip abduction 1 set 20 reps


No more PT - left after 3rd session.

 

[Josephine]

1. Pain levels generally 2 : mostly aching, swelling and evening stiffness

Oh, okay

2. Taking 1000mg doses of Tylenol 3 to four times a day (I skip 4th if I sleep through it)
2 grams Diclofenac 1% gel twice a day - rubbed into the back of me knee and the outer side at the bending point.
On my third day of Gabapentin 200mg twice a day (morning and late afternoon

Do you think any of these are working?
The diclofenac cream has been shown to penetrate only 2-3mms into the skin so actually don't have any real effect on joint or deep tissue pain. But it does affect the stomach. (read this Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers)

3. Moderate swelling - might be slight - both legs look kind of fat

Are your legs usually plump?

4. According to my phone app, my ROM is 143 and extension is -4. On my back I can get my heel exactly my hand’s length away from my bottom.

12 weeks. That is most excellent!

5. I have been doing less icing lately, usually 1 or 2 times for about an hour but I haven’t wanted to ice it for two days - no good reason other than I didn’t feel I wanted or needed to.

If your legs have any swelling then you need to ice.

6. Until this week I was elevating whenever I sat down. Now maybe an hour or two a day, preferring to sleep flat on my stomach now - sometimes with a bed pillow under my feet.

Okay

7. All housework, cleaning, shopping and cooking - I would say about 5 to 6 hours a day.

That's a lot for only 12 weeks out.


Exercises at home - was told to do these 3 times per day - given your excellent ROM, you really don't need to do any exercises any more as you've made it! Quite apart from which you have been doing around 360 reps of exercises a day which is totally insane! Stop them all!

In the past 3 weeks as activity level has drastically increased, I’ve done them once every 2 or 3 days
Seated static chair scoot 3 sets 10 reps
Supine hamstring stretch. 3 sets 10 reps
Supported standing squats. 3 sets 10 reps
Standing side stepping 3 sets 10 reps
Seated gastroc stretch 1 set 15 reps
Long sitting quad set on couch 1 set 15 reps
Standing bilateral calf raises 1 set 15 reps
Supine Straight Leg Raises 1 set 15 reps
Supine ankle pumps 1 set 10 reps
Hook lying glute sets 1 set 10 reps
Side lying hip abduction 1 set 20 reps

No more PT - left after 3rd session.

Good!

Really, you are twelve weeks out and still doing all these exercises? Plus all that housework? You have excellent ROM, you've made it, you got there. If you want to maintain your good status as it is at the moment, then stop the exercises!! You will find over the next few weeks that your pain abates and you will no longer need the pain meds!

 

[emmysmom]

@Josephine

Thanks so much!

You are right that I should ice more, and I will.

I do wonder about building up strength in my calf and thigh muscles - my right calf is visibly smaller. Should I wait on that, or are there exercises you feel might help?