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Suearl2020

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Dec 2, 2024
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Well I am almost 2 weeks post op. Had TKR and my knee had already had dislocation surgery when i was 17. Stapled knee not glued maybe due to old surgery scarring. Off Heavy meds. Everything my friends warned me of I didn’t or don’t have. Constipation- prepared well. No problem. Severe pain? Well under control. All my problems were different. Could be age related. I am 74.
Had terrible nausea a few days after surgery that was hard to get under control. Took juggling of meds and nausea meds. Doctor never prepared me for that. Kinda upsets me. Made progress hard. Couldn’t eat or sleep. Made it hard to do exercise. Was off to a great start and then I think I went backwards with ROM. Got that under control and then restless legs kicked in. I had told doctor that I had the problem. Keeps me from sleeping. Awake all night and then want to sleep in morning but need to start my day! Exercise, ice, eat, bath. Then we got scammed and I spent a few days chasing all the financial stuff. Exercise put off again. Went to PT a couple days ago. Kept warning me about 2 week window. Im trying!! I go again today but discovered I had a swollen leg this morning. Soooo no exercise yet today. Managed 3 times yesterday. My butt is also sore and top of leg so sitting can be hard.especially for sitting exercises. Also…. Got this crazy tickle in my throat that comes on and immediately makes me gag if I dont put a cough drop in my mouth. Try sleeping with that!!! Stupid but aggravating stuff.
Thank goodness I have wonderful support from hubby ,family and friends
Any advise on insomnia/ restless legs, butt pain, ROM would be helpful. Thanks for reading
 
Hello and Welcome to the healing side of the forum!
I will leave our Recovery Guidelines and type more in a post below.


KNEE RECOVERY GUIDELINES

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
4. PT or exercise can be useful BUT take note of these
the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy
5. At week 4 and after you should follow this
Activity progression for TKRs
The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

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

Nutrition is of paramount importance. Available here are dietary tips, nutrition basics and additional food supplements. These articles are both general advice on food and specific guidelines aimed at people both pre- and post-surgery.

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 
Wow, you have some history with that knee.
Went to PT a couple days ago. Kept warning me about 2 week window. Im trying!!
Please ignore unrealistic goals and timelines and refrain from engaging in movement that causes discomfort or pain.

ROM -
Do not allow anyone to forcefully manipulate your leg. While your range of motion is currently limited, it will naturally increase as the swelling subsides and the pain eases. Give it time.

Got this crazy tickle in my throat that comes on and immediately makes me gag if I dont put a cough drop in my mouth. Try sleeping with that!!! Stupid but aggravating stuff.
Have you tried one of the small table top (nightstand) type of cool mist vaporizers? I use one often and love it. It doesn't coat the furniture with a white film like some have in the past. I find it effective during heating season as it puts a bit of moisture in the air while sleeping.

Insomnia -

Pillows certainly help me get comfortable in bed, making it easier to fall asleep. You can experiment with different arrangements to find what works for you. I surrounded myself with them so I could rest a leg, or arm easily enough, whatever felt comfortable. Doing whatever you can to basically "set the scene" for sleep may be worthwhile. I suggest making up the bed with your most comfortable bedding / blankets along with a few extra bed pillows of different degrees of firmness. Try to block out the light if it's daytime. Minimize noise unless you feel listening to calming relaxation music, a fan, or white noise may help lull you to sleep. Make sure the room temperature is not too hot or too cold. Try to disconnect from the devices at least an hour before the targeted nap or bed time, so it's easier to wind down. Limit caffeine throughout the day and consider natural sleep aids such as Valerian, Chamomile or, Magnesium, my personal favorite, which can assist in muscle relaxation and nerves and promote healthy sleep (falling asleep and staying asleep)

Apply ice for a time before bed to reduce swelling and numb the discomfort. Try some relaxation techniques if you feel they may work for you such as deep breathing, prayer or meditation or even some gentle stretching may help relax your body and mind.

An article on Magnesium from our Library -
https://bonesmart.org/forum/threads/magnesium-is-a-star.20301/

Most large grocers carry a variety of teas such as Celestial Seasonings - Sleepytime Herb Tea,
Yogi Teas, Bedtime, Bigelow Cozy Chamomile, all of which may help you relax...at least worth a try.

Time will also help, but that takes patience, especially when you're restless and tossing and turning all night.
Wishing you many nights of peaceful sleep soon!

Restless legs -
Magnesium Glycinate supports the following:
Bone health
Healthy blood sugar
Cardiovascular health
Muscle relaxation and nerves
Promotes healthy sleep (falling asleep and staying asleep)


I've also heard of drinking 4-6 oz of Q-Tonic before bed which is a water that contains quinine.
Read the label as some of the waters do not contain quinine, but quinine flavoring instead.

Pain in buttocks -
Can be from compensating as your gait is changing once again post op. You're likely straining muscles which is causing the pain. Try gentle stretches for the glute muscles to relieve any tension and see if it helps. Also exercises to strengthen the glutes and core. Heat / Ice also. Heat will relax tight muscles while icing may help reduce inflammation if the area is feeling swollen or tender.

I wish you the best on the journey and look forward to reading more updates as your recovery progresses. Over all you seem to be doing really well. Happy Wednesday! :)
 
Welcome @Suearl2020

I want to reinforce what @Layla wrote: there is a direct cause and effect between your PT's misguided aggressive approach and your increased swelling, and it's the increased swelling that is causing your decreased range of motion.

Before and just after surgery my entire ortho team united behind the mantra that in the initial weeks Less Is Better. This is so true! We have to heal before we can challenge these traumatized soft tissues!

Ice and elevate "toes over nose" at least 45 minutes at a time to reduce swelling. Take your hourly short walk. Take your meds on a schedule.

Be patient with migrating pains (buttocks, low back, ankles are often noted by our members) as our entire weight bearing structure has been "reset" in surgery.
 
This is first time I have seen my responses. Not too savy using my phone to post. Thanks for all the great advise. I wish I had seen some before but it is my fault.
To report:l at 2 weeks:
I am mostly pain free with Tylenol and almost embarrassed to say that as many are not at this point and I am very grateful. Worst is thigh pain at times but found I needed to keep up level of medication.
Slight nausea many times during day is very disconcerting. Haven’t tracted why. Its like my mouth says “yum” and my stomach says “wait a minute”
Insomnia is still raging. Hard to believe I can go so long without sleep and it makes me worry about healing process. Certainly makes it hard to accomplish all my daily exercises as I tire easily
Restless legs come and go at night. Prescribed muscle relaxer helps some-annoying!
My main worry is getting that knee bending. They say I am on track. Seems I gain snd lose ground. Terrified of not being able to get enough bend to manage stairs. Exercise tires me. Have had all different PT people work with me since the start. Some put that great fear in you which always lingers in the back of your mind. Being so tired I do not exercise many times a day but do get up and walk. They graduated me to a cane yesterday. Trying for three times s day exercise but thinking maybe a little exercise more often may be the key?
I see you now recommend long walks at end of 2 weeks? Three problems
Its winter
I live in small apartment
I tire easily
Thanks again for encouraging words snd looking forward to replies (if I can find them-hehe)
 
We're happy to hear from you!
Worst is thigh pain at times but found I needed to keep up level of medication.
Slight nausea many times during day is very disconcerting. Haven’t tracted why. Its like my mouth says “yum” and my stomach says “wait a minute”
A side effect of a medication you're on? Check the insert / side effects of any prescriptions.
When you're able...Try to target protein since it promotes healing, supports muscle strength, enhances our immune system and helps boost our energy level.

Snacks are a good option if you don't want a full meal. Some of my go to protein snacks are -
Greek Yogurt, Peanut Butter & and Apple, Edamame, Hummus and Veggies, Cottage Cheese, Cheese Slices, Protein Shakes, Nuts or Trail Mix, Hard Boiled Eggs, Chicken Salad, Egg Salad, Turkey or Chicken Roll-Ups, Canned Tuna or Salmon, No Bake Energy Bites.

I hope the issues that are bothering you ease soon. Have a nice weekend, Suearl!
 
@Suearl2020
First, please do not let PTs frighten you.
Your bend is already there, the ortho checked it in surgery. It's swelling that is interfering with the bending, and it's too much activity that is creating more swelling.

At two weeks, the only activity you need is a short hourly walk, and perhaps just a few quad sets and a few heel slides a few times a day. These can be done slowly, and only well within your current comfort zone. You shouldn't be doing multiple sets of many repetitions of anything for another several weeks, when basic healing will have happened.

Pain during or after PT is not helpful! Pain is your traumatized tissues telling you to stop.
 
So glad the say the nausea has subsided! I still cant eat as much as post op but my appetite is coming back.
I am also happy to say that I have found a good therapist. She is older maybe in 60’s and is kind to me. Yes she pushes sometimes but also massages and lets me relax. I am making good progress. I Don’t dread the PT anymore and walking and doing gentle exercises during the day
My biggest problem still is sleeping.I discovered that my leg is not only restless but also aching at night. Hard to distinguish between the two sometimes. Tonight’s strategy was Tylenol more often at night which I discovered I could fo and don’t have to wait in agony. So tylenol and muscle relaxant at bedtime did give me two hours sleep/ real sleep. Awaited 5 hours for next Tylenol And now trying to get back for some more. This was also PT day so not expecting much. Hopefully will get more. Last night I had about 5 hours sleeping and waking but was improvement. I feel I am making progress but it is very tiring. Sad to not feel happy to go to bed.
 
This was also PT day so not expecting much.
Mentioning this makes me wonder if you're still pushing too hard, or being forced to push through pain in PT?
If you're noticing a distinct difference in your level of pain in the evening, after your PT sessions you are likely aggravating healing soft tissues. IF you feel this is true you can explain to your PT that you value their time and guidance and you're committed to making progress, but you'd like to focus on what feels comfortable for your body. A good PT will respect your honesty. Let them know that you're not comfortable "pushing through pain" and ask that any exercises be modified if they're too uncomfortable.
I hope you're able to get some restorative rest soon.

 
. I feel I am making progress but it is very tiring. Sad to not feel happy to go to bed.
Sleep was really difficult for me too.
Once I was off any opiates I persuaded my GP to prescribe some zopiclone for sleep. I alternated it with OTC remedies like diphenhydramine ( a sedative antihistamine called Nytol in the UK) and herbals like valerian or magnesium.
I also found it really helpful to rest my knee on the opened cool water jacket of my Aircast Cryocuff. I would refresh this when I woke in the night.
A half decent night's sleep made me feel much more positive.
 
Sleep was so hard again last night. Slept but fitfully. Upper butt and thigh pain is the cause. Seems worse not better. During the day I can go without pain a lot, but once I lay down to sleep there is no way to get comfortable. Tylenol often is not working anymore. Tried Aspercreme which did not touch it. If I could only not sleep on that side, but I have tried and tried to lay on other side and cannot position my leg well enough, or when I do, getting it back to position is excruciating. Back sleeping became hard tonight as I was doing some kind of counter short squats which were fine at PT but ended up flaring up old back injury, so now I contend with that and sleeping position that usually helps that is impossible. Maybe I should sit in a chair all night? Visit chiropractor? Need pain meds? Any thoughts?
 
Just wanted to add that this is very hard fior me as I was not in a lot of pain pre surgery. Just had s knee that would not work to climb stairs snd would get painful only if I walked too much or on cement o hoe I have not made a mistake
 
You are still extremely early in your recovery, and unfortunately, pain is to be expected. Cut back on your exercises and increase your resting, icing and elevating. This is all you need to be doing the first month or so. Doing exercises doesn't increase your healing, but can slow it down by causing increased inflammation and swelling. This is counterproductive. Think of your knee as a newborn baby because that is exactly what it is and needs to be treated as such!
 
@Suearl2020 really feel for you. It seems lack of sleep plays a massive part and then feel so weak and tired. I tried sitting in the dining room chair early hours this morning, even a small break stops you from feeling anxious about everything. I had pt yesterday and although nothing untoward, the car journey, alone starts the leg off. Hence, my leg did not want to rest last night. Also, my back starts and it's just heyho bring it on. I tried lying on my side the other night, basically had no option as my coccyx was horrific and although had discomfort, persevered and my coccyx better next day. But, after laying elevated for 2 nights, guess what back is grim. I now dread the evenings, this is like a 24 hour day with no meaning. I am 5 weeks and very selective on exercises, definitely no squats. Walking around the apartment concentrating on bigger steps seems to be helping. Don't rush anything, the advice we receive on here is valuable, try to nap when you can. Wish you well, let me know how you get on x
 
was doing some kind of counter short squats which were fine at PT but ended up flaring up old back injury,
It's awfully early in recovery to be doing squats. Since they are causing problems, I'd encourage you to stop them for a while.

It really important to recognize that all the soft tissues in your leg were traumatized during the surgery -- it's unavoidable -- and it can take up to 6 weeks for muscles to heal and 10-12 weeks for ligaments and tendons. Trying to push your self into strengthening exercises before the healing is done can set you back and delay your recovery.

My old back problems also flared up as I was recovering from my first TKR. I found massage therapy helped. If you decide to try something like that, though, check with your surgeon's office first.
 
Insomnia is a real bummer for many of us in the initial weeks after surgery. It's generally not the meds, it's... everything about the trauma, discomfort, energy drain!

Definitely sleep whenever (and wherever it's safe and comfy!) - many of us sleep and/or nap in a recliner, or surround ouselves with soft pillows.

Icing, elevating, napping.... All help, but you might also consider some nonprescription remedies....

If you're lactose tolerant, a glass of warm milk! If you're not diabetic, a teeny bit of honey makes it even more comforting... plus milk is high in magnesium! Helps us relax!

If you aren't a milk drinker, or want an easier way to, an evening magnesium supplement has been very helpful for some members.

OTC diphenhydramine, an antihistamine also used as a sleep aid (Benadryl) because it makes you drowsy; it's also included in some cold, flu, etc "nighttime" combination meds.

Low dose melatonin, sustained release - not for long term use but I have used for a week at a time without ill effect. It should be taken an hour to hour and a half before going to bed, and during that time stay in a dimly lit area to allow this hormone to activate.

Valerian root - an herbal remedy, it can be taken in capsule form but that dose might be high compared to my preference, herbal "sleep" blends that include a smaller dose of valerian and make me pleasantly drowsy. Plus the other tea flavorings make it nice tasting! Celestial Seasonings and Traditional Medicinals sell teabags by the box. Their sleep blends without valerian have never ever made me sleepy.

What finally worked for me: a mug of sleep tea with valerian followed by a 3 mg sustained release melatonin, immediately going into a dimly lit room and relaxing. When I got sleepy, turning off the light and lying down with my legs up on the Lounge Doctor. After a few hours I would wake, move the Lounge Doctor away, and sleep more.

Be aware: even benign herbals and supplements can interact with your routine or post op prescription meds, either making their effects weaker or stronger. If you're on meds you may want to check with your doctor or pharmacist, or even check online for interactions.
 
Just wanted to add that this is very hard fior me as I was not in a lot of pain pre surgery. Just had s knee that would not work to climb stairs snd would get painful only if I walked too much or on cement o hoe I have not made a mistake
Before surgery you “just” had pain from arthritis. Now you have pain caused by the trauma that the surgery caused, which as was said above, takes time to settle down.

I also agree to cut back the exercises until you’ve healed more. This will help you have a less painful recovery.
 
I really don't think you made a mistake. It's understandable you feel that way this early into recovery especially since you mentioned you weren't in a lot of pain before surgery. Please beware that squats can cause generalized tendinitis particularly in quads, glutes and hamstrings. You don't want that.
Hopefully your back is feeling better as the day progressed and you're able to resort to sleeping on your back comfortably tonight. :fingersx:
@Suearl2020
 
Happy One Month Anniversary!
I hope this is a good week for you. :wave:
@Suearl2020
 
I was doing some kind of counter short squats which were fine at PT
Squats are really tough and I would be extremely cautious about them early on.
Just wanted to add that this is very hard fior me as I was not in a lot of pain pre surgery.
Like you, I didn't have much pain pre-op ( my kind of arthritis in the lateral compartment presents late apparently). I just had a very twisted, swollen leg.
Like you, I then wondered if I had made a mistake. It took longer for me to get to a better stage than before surgery. I am sure you will get there. It is a tough recovery- but take it easy. Too much of certain exercises can make things worse not better.
 

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