TKR BBCG's TKR left adventure

BBCG

Staff member since June 30, 2021
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I stumbled upon this group about a week ago, in the middle of one of many sleepless nights. Not sure what to start with, but areas needing help include pain med dosing, side effects and tapering off, ever-present hip and lower back pain, concern over PT need for my ROM to be greater, frustration and dismay over sleep issues and emotional fragility possibly as a result.

When I don't sleep well, waking every 2-2.5 hours, I'm a groggy mess the next day. I need to be getting some " work" done at home, but difficulty focusing, grogginess, etc. conspire against that occurring so far.

I just figured out how to start my posts, and will seek to see if I can find advice on whether to resume the discontinued muscle relaxer, methocarbamol, or not, in an effort to find relief for the deep, ache in hip and lower back area that wakes me at night and keeps me from getting back to sleep...along with the knee area's pain, of course!
 
I have the same kind of pains at night. Dr told me it is a common complaint. When was your surgery? Sleeplessness for me lasted a good 2 months, and although I sleep somewhat better now, I still wake up a lot. It is truly rough on you and will make you groggy and miserable. I really didn't notice a difference after meds were stopped, just seemed like I had to bide my time. Someone with more medical knowledge will be able to address that, but my understanding is that this is all normal for a while and we just need to be patient.
 
BBCG,
Welcome to BoneSmart, glad you joined us.
Sounds like you are having a normal recovery, and all that goes with it. :sad:
Not sure what is causing your hip and back pain, be sure you have new shoes, your old ones have your old walking pattern worn in, and can tweak your hip and back.
Sounds like you PT is pushing ROM, and probably pushing on your knee, causing further inflammation and swelling, which blocks your ROM. In the early days you have to wait for the swelling to go down, your ROM is there waiting to be revealed. The PT works for you, you are allowed to say NO, Saying no to therapy - am I allowed to

To taper off medications, most find they just forget to take them and taper off naturally. Best you don't try to taper too soon, your body and knee will let you know, and you will require more pain meds to get the pain under control.

Please add your surgery date to your signature, hover over your username top right, click on signature, add your information there, Thanks!
How to create a signature

I am going to leave you the post op reading, it will answer your questions about sleep, emotional fragility, pain control, ROM, and PT.

First is the reading - everybody gets a free copy of the recovery reading!

Here are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock as prescribed
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

Next is a FAQ (Frequently Asked Questions) thread.

And here are some very crucial articles
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs

Myth busting: no pain, no gain
Activity progression for TKRs
Heel slides and how to do them

Extension: how to estimate it and ways to improve it

Elevation is the key
Ice to control pain and swelling

Healing: how long does it take?
Chart representation of TKR recovery
Myth busting: the "window of opportunity" in TKR

Myth busting: on getting addicted to pain meds

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

More information about ROM:

ROM: it's worth the wait for ROM
ROM: it's never too late to get more ROM!
ROM (range of motion) information
 
Thanks, all! I was trying to figure out how to create a signature! On to do so now!
 
Hello @BBCG! I have the same surgery date as you, but right knee.

I'm waking up once or twice a night, but am taking a OTC sleeping pill (cannot deal with sleeplessness) and a percocet at 10pm and another between 2–3am. My knee wakes me up in time for that dose :). During the day, I'm taking one 50mg tramadol every four hours and two time-release Tylenol at 6am and 2pm (1300 mg each time). That said, everyone is different, so do what's best for you. One of the articles Pumpkin posted is about addiction, and the very slim chance of it happening when taking the medicine for pain. So please make sure you're taking what you need.

I had one PT appointment because my medical group has the PT remove the staples. It was an hour from hell! It was 13 days after my surgery and my rom was 45*. The PT was practically yelling at me about needing a MUA. Needless to say, despite all I read here, that completely stressed me out and got into my head. I won't be going back to PT, but am stretching at home.

My ROM isn't great, but it's improving, and I'll take that. While sitting on the edge of the bed, I can let it hang close to 80*? I haven't measured it yet.

From reading others' experiences, PTs put too much pressure on ROM and exercises. Our knees have been through a major trauma and need to recover. Everyone's recovery is different, but I admit it can be difficult to read some that do better and not worry a bit. I've taken the attitude that as long as my ROM is improving, even a little, and I'm feeling a bit stronger as the days go by, everything will be OK. I've also stopped evaluating my recovery day-by-day because some days are better than others, but look at week-by-week.

I hope you're doing better!
 
Thank you, LovesGiants!

Was your surgery last year or just a few weeks ago? Your signature says 2015...

It sounds like your pain management is way better than mine. I hurt all the time, just sometimes I can bear it and in the middle of the night or if I overdo it, not at all. I got no advice on pain management, just the scripts and go pick up the bottles. I'm taking Oxycodone 10mg every 4 hours and Ext. Strength Tylenol in the opposite two hour window every 4 hours, cycling between them. But, the pain is always still present, just below the edge so anything out of the ordinary brings me to tears since I so quickly go from background pain level to hurts too much to hardly breathe.

The general idea here is I'm supposed to be at 90 and 0 by 6 weeks and the area just to the top left of the incision is very bulged out and swollen and ice seems not to take that swelling down, and the lack of movement seems to be felt most there. When I try to bend my leg, that area seems to halt further movement.

So, the Tramadol sounds as if it's a lower level than Oxy, I think, but maybe that would work for me during the day? I just don't have any idea where to appeal for help getting the pain better under control, as I can't see the doctor until 6 weeks and his buses say just you have to figure out what works for you... But how?

Sorry... Very hurty and frustrated today as I'm miserable and it's the only day I can see my family but I'm too much of a mess to enjoy a visit...
 
DOH! Typo! My surgery was almost four weeks ago.

If your oxycodone contains acetaminophen, be sure you're not exceeding 4,000 mg/day.

My first OS appointment is also six weeks out, but calling his office for help/questions has been really helpful. Your OS's office should help you, if not, try calling your primary care doctor. Everyone is different and what is working for me might not work for you, at last at this time. If you're still experiencing a lot of pain, the tramadol might not be enough during the day right now.

Is that goal of 90/0 given by your PT or OS? One thing I've learned from reading here is that our knees have their own ideas :yes:, and expectations are not always realistic. The ROM will get better once the swelling goes down. Are you elevating with your knee above your heart or toes above nose? Elevating while icing is very important.
 
Aww, so sorry to hear about your painful recovery. I hope you can call your OS or GP to get some more pain relief. When my pain wasn't controlled by what I was taking the doc prescribed Oxycodone 15 mg every 4 hours. That made a BIG difference for me. You should not be in tears from pain. The nurses sound like they are not checking with the OS. Can you insist that they do? I hope you get some pain relief soon.
 
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I'm wondering if your OS knows of the problems you're having. Can you ask to speak with the doctor or make an appointment? You can also try your PCP, he or she may be of some help if the OS isn't. Also I'm wondering what your level of activity is? Be sure you aren't overdoing things. @Josephine has some questions that may help to answer your questions about the pain you're experiencing.
 
The general idea here is I'm supposed to be at 90 and 0 by 6 weeks
Well, you're only 4 weeks out yet so it's a little early to be setting such targets.

I'd like to ask you some questions if you don't mind, and 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)

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?
ai63.tinypic.com_eta39s.jpg


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

5. are you icing your knee at all?

6. are you elevating your leg, 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. what kind of PT exercises and exercises at home are you doing? How much 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 each day)
enter exercise then enter number of reps and sets
etc., etc.

At PT (how many times a week)
enter exercise then enter number of reps and sets
etc., etc.
 
:welome:Your pain med regimen sounds pretty much like what I had, which worked pretty well. So I'm wondering how much activity/exercise you're doing. We often think we aren't doing very much, but post tkr it doesn't take much to make the knee :tantrum:

I also hate to tell you but the sleep problems are pretty much par for the course. I resigned myself to sleeping in installments overnight and taking at least one nap during the day for the first couple of months.

Check out the links Pumpkln gave you. Lots of good reading material--including on the Energy Drain phenomenon which you're smack in the middle of.
 
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Hi Josephine and all,

Thanks SO much for taking the time try and help... I do feel like I've been hung out here with not much help so I really appreciate you all!

My pain level right now is around a 6-8 and today, the knee itself is painful even with weight-bearing, which has definitely not been the case until this morning. No idea what I did to incur its wrath, either!

I am taking Oxicodone 10mg ev. 4 hours and Tylenol Xtra strength ev. 4 hours, and so one or t'other is ev. 2 hours. I am taking Methocarbamol, the muscle relaxer but only at bedtime, at 10pm. I'm taking a stool softener in the evening and enjoying my morning stewed prunes so the digestive system is okay. I've been drinking a quinine-based tonic water, with the fizz allows to dissipate at a nurse friend's recommendation for muscle spasms. I'm taking Rescue Remedy about 3x a day along with hypericum for nerve pain...though cannot ascertain if they are helping or not. Having been dealing with this pain for nearly 4 weeks now, I'm kinda a mess emotionally which is definitely not me! Scaring my spouse, actually, since I'm always the positive upbeat one...

My leg size is between moderate and larger, and bumpy since there a couple of areas adjacent to the incision that are super tender, hit and more swollen than the rest.

No one is measuring my ROM yet as my PT hasn't done so, but I'm probably at 10-120? I'll ask my husband to photograph and measure when he's back from eye doc.

I am icing a lot, most of my waking hours when I'm not up and active, using an ice machine 9the blue cube, I've heard it called) and sometimes ice packs gel packs I borrowed. My PT didn't think the compression socks were adequate so suggested I wear ace bandages (wide, 4" width one) from ankle to above knee 6" when going out and it feels supportive and safer. I'm using the ice machine all night long.

I am elevating the leg constantly, most hours at least at hip level, and at or above heart level all night and every few hours for at least an hour.

My activity level is pitiful! Remember: I operate a wild bird store so am on my feet, normally, constantly, interacting with customers, advising them , encouraging them etc., so my minimal activity is weird! I am walking about the house at least hourly, going out to either visit my kiddos and 5 year-old granddaughter every few days, going to PT office 2-3x a week, occasionally going shopping with DH, have gone out to coffee shop once and had dinner out once, but only when I know I can have a chair to put my leg on once I arrive. I am not driving yet, but we will be taking a more active picking up from school role with my granddaughter next week when my son-in-law is away for a few weeks, so need to be more able to do so!

Exercise at home:
Ankle pumps (involve quads, core and keep foot at right angle) 20 hour ideally
Quad squeezes 10-20 / hour
Butt squeezes 20 / 4x day
Standing Heel raises 10-20 4x day
Heel slides. 10 4x day
Flexbar* stretches (foot on bar 'side of walke!], gently pull top bar toward self, gently bending knee)
10 3x day (when done softly, gently, feels good by end and ROM briefly improves
Counter mini-squats. (Holding counter, dip knees bent to small degree). 10 ev. 2-3x day
(this makes other leg make terrible grinding sound!)
Standing rock 10 2x / day (operated leg bent, forward of other leg, lean forward and hold 5 Sec.)
Rolling bar backs of legs. Using roller bar, run bar up and down backs of legs, sides and, if not too painful, along peroneous longus and tibialis muscles on lower leg (front and lateral side of leg)

I've been in enough pain that I am not doing them all now, but try to do 10 minutes of some at least 3x day...

At PT office, I am being given guidance in very specific ways to do these, i.e. first engage core, then quads, only then bend ankle to do ankle pumps. PT office has hands-on "magic touch" PT, exercise psychologist, massage technician, etc. PT often uses ultrasound on my leg, does strain-counterstrain manipulations, releases neck, back.], etc. if restrictive, etc. She has not been too anxious about ROM until late last week when my lack thereof made her seem anxious to increase my range. I cancelled my appointment today as I am unable to weight bear without pain and if I go, I want to do more than make a darn puddle after managing to get up the steps!

The Flexbar is a tool loaned to me by a friend who, at 4 weeks after her surgery 2 years ago was out camping at her 4 week mark already! It's a side of a walker cut off the rest with a somewhat lower cross bar to use to increase and hold one's stretch. My friend made her own from a Goodwill walker she bought for, like $5, but here is a link: http://totalkneereplacementrecivery.net/fast-recovery/

I think that answers the questions...

I am going to my PCP doc today to see what she suggests, if there is something that will help reduce the pain and give me my life back ...

Thank you all for your support and sympathy!
 
You seem to be doing much too much so soon. You are less than a month post op. Re-read the article about elevation listed above. Your knee has to be higher than your hip for swelling to go down at all. You should be icing 4 or more times of 45 or more minutes each. When your knee is more swollen then you would want to do it more. Any type of squats or toe raises also cause pain which leads to swelling. If your PT 'magic touch' pushes or forces your knee at all than that is also causing more swelling. Never allow anyone to hurt you. Never do anything that hurts. I would strongly suggest that you skip PT this week or even longer. This is coming from someone who learned that the hard way.
 
If any of the exercises you're doing is causing pain, stop. Squats of any kind this early in your recovery are torture. My first PT wanted me to do squats at 2 weeks, I did one holding onto a bar, looked at her and said "No way". I never did another one until I noticed I was squatting in a pool last summer. This recovery is a no pain = gain recovery.
 
Newly bionic! Where in Poconos?! As a child I spent many joyful days at my great aunt Eloise's along Swiftwater Creek! My uncle had a service station up on the main road there (before the interstate was really much used) and my job was pumping gas...as a "little girl" at the age of about 13! Thought it was kinda fun the surprised comments I'd get upon going out to help folks!
 
BBCG, the link to the device you discussed in the post above does not work. Can you please try again or remove it?

I am concerned that you are doing way, way too much with your new knee. Jo will be back soon to talk about the information you've given her, but I'm pretty sure that's what you're going to hear from her as well. If you're planning on trying to go out to pick up a grandchild at school next week, I would have a Plan B. I doubt you are going to be in any shape to assume a caretaker role, given the pain and swelling you're describing. You are still very early in your recovery. Your first priority is going to be getting your pain properly managed so you can reduce the swelling in your leg. After all this time, that's going to take some serious effort on your part. I know you probably don't want to hear that you need to do significantly less activity and exercise and more icing and elevation (toes above the nose always!), but these things are critical right now for your successful recovery.

I know you've expressed some interest in alternative medicine in another thread, but at this point I can pretty much guarantee you that none of the things you're considering will have any more impact than simply reducing what you're putting your knee through each day. All you really need to do for the next 2-3 weeks is to walk about the house every hour or so for about 5 minutes (this can be your normal movement from living room to bedroom to bathroom to kitchen) and some gentle bends and stretches with your knee 3-4 times a day for 5 minutes or so. No tidying up the house, no chores, no therapy, no exercises, no errands, no car trips, no chasing after grandkids......this is your recovery time and your body needs the time to heal. Please consider giving it what it is telling you it needs.
 
Okay, so an update after just returning from PCP. She wants me to call and get an appointment with my OS or his PA.... Someone intimately familiar with what degree of swelling and pain is in the normal range. She asked why I hadn't gone to the orthotics center's own PT folks, but it was because there is usually not one person you see...it's whoever is on duty that day plus I had the PT I've worked with for years I felt more comfortable with. She suspects they might have been able to get word to the OS about my lack of progress due to the swelling just adjacent the incision near the top. She also thinks that if the Oxicodone is not effective at stemming the pain, perhaps something else might do a better job. She wants me to get an appointment immediately since unless someone very knowledgeable sees and can examine my leg we're working in the dark. So, that's the goal for tomorrow... She did give me a prescription for a fentanyl patch that she says she suspects will work but she doesn't want me to use unless I cannot see the OS this week. It would replace the Oxi if need be, perhaps giving me better pain control... We'll see what the OS says...
 
That sounds like a good first step to getting things resolved.
 

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