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[TKR] Cold sweats

Milomann

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I am 18 days out of surgery and having a hell of a time with cold sweats when I sleep. I keep thinking that they will pass, but it just keeps happening. I did take a lot of pain meds the first 13 days but have been off all pain meds the last 5 days. I keep thinking it’s the pain meds and the surgery drugs that I have taken, any suggestions. Thx
 

Jamie

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Hi, @Milomann.... and welcome to BoneSmart!

Eighteen days out may have been just a bit premature to totally stop all pain medication following a knee replacement. If you stopped prescription pain medication "cold turkey," that can give you the cold sweats you're describing. But so can uncontrolled pain. Have you tried taking Tylenol at bedtime? A 1000mg dose of Extra Strength Tylenol (2 pills) can help. You can take a second dose if you wake up in the night uncomfortable as long as you have at least 4 hours in between the doses. Just be sure you don't take any more than 4,000mg of Tylenol in any 24 hour period and that you count any other medications you take with acetaminophen in them (like cold and sinus medication). I also suggest you try icing your knee through the night along with elevating it in bed. Be sure you have a towel between your skin and the ice source so that you don't damage your skin.

Here are some articles about the recovery process that will help you understand what you are and may in the future go through with your knee. Please don't hesitate to ask any questions that come to mind.

Knee Recovery: The Guidelines

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
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
5. At week 4 and after you should follow this
6. Access to these pages on the website

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?

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.
 

Cjackso21

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I’ve had the same problem for each surgery and felt like it was both getting off pain meds and anesthesia. It will pass. If you ever have to get off pain meds again (hopefully not) I found something online that shows how to make a solution with water and ground up pills. Then you take a little less each day. Helped a lot. When I did cold turkey I was sick and had sweats for around 7-10 days. Hang in there, it will pass
 
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Milomann

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So my cold sweats have stopped, hallelujah. Now if I could just get more than 3 hours sleep a night I would really celebrated. Now the nerve pain has started and as always it’s worse at night. I still can’t lift my leg 27 days after surgery. I would ask if that is normal but I know there is no normal with this procedure. I start out patient PT this week, hopefully good things to come.
 

maryo52

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You can't lift your leg? I had a week of that my first TKR and none at all my second. That sounds slow to me. Hopefully you end up with a gentle and supportive PT who can guide you. Keep us apprised of your progress.
 
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Milomann

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It has been 1 month and i still can not lift it. My PT person says it is severe muscle atrophy and we are working on it. I am seeing some progress working with them but it is slow going. I am really hoping to be able to lift it soon. My swelling is still pretty bad so I believe that also is working against me as well. Just staying positive and working hard. Thx
 

Jaycey

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My swelling is still pretty bad so I believe that also is working against me as well.
Are you icing your knee? Our medical expert recommends 45-60 minutes icing several times per day.
 

TimeBuster

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My swelling is still pretty bad so I believe that also is working against me as well.
Ice and elevate.

Ice at least 4 to 6 times a day no less than 60 minutes a pop. Also, don't just ice the top of the knee and sides make sure you're also icing the back of the knee. If you can tolerate icing during the night I would do that too.

It has been 1 month and i still can not lift it. My PT person says it is severe muscle atrophy and we are working on it.
Your muscles need time to strengthen, I know I was in your shoes, I had to fire up my muscles from being dormant for so many years. Every week that goes by my muscles is getting stronger and now I'm able to do things that I couldn't eight weeks ago after surgery.

Keep the faith and best of luck with your rehab.
 

maryo52

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I totally agree with the advice to be aggressive with ice and elevation. I went and looked up research on quad function after TKR and find that a degree of weakness is prevalent in TKR patients, not just in the post op period. One thing to bear in mind is that the nervous system plays a role with inhibition of the quad, which is not well understood. Straight leg raises and quad sets are helpful, as is time I suppose.
 

Jockette

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My swelling is still pretty bad so I believe that also is working against me as well. Just staying positive and working hard.
It is hard to do anything with a painful, swollen leg. We are all different and there is no set time frame in this recovery.

“Working hard” can have the opposite effect we want, it can keep our leg upset, swollen and painful.

It seems PTs want our body to recover in weeks, rather then the full year this particular surgery will take. A year does not mean you will feel like you do right now for the year, you’ll feel better in a couple of months, and continue to improve after that.

Here is a general description of this recovery:

first stage: 1-3 months
second stage: 4-6 months
third stage: 6-12 months

Try to relax, rest and elevate, ice as tolerated, and keep your activity low. You are very early in recovery. :console2:

It’s not exercising that gets our range of motion back, it’s Time:

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.
 
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Milomann

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I am icing enough times a day, but it looks like I am not keeping the ice on long enough. I will definitely up my duration. Thx everyone for the advice, I can feel my leg is right around the corner from working again. I will do my best to be patient. Thx
 
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Milomann

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So I am so frustrated and tired. I am starting my 9 week out of surgery and nothing is going well. First it was my calf that locked up solid for 2 weeks. Next it was severe atrophy to my thigh that took 6 weeks to finally be able to move my leg. And through all of this I have had severe swelling in my knee that is finally starting to go done a bit. I have iced it, used a tens unit on it and did everything my PT people have said. No matter how hard I try I can’t get better than 80 degrees Rom do to the swelling. The only good thing for me is that I have been pain free since week 3, I don’t take any pain meds other that Tylenol. I do take Naproxen for swelling, that’s it. But what bothers me the most is my Doctor says if I don’t show any more real progress in 2 more weeks he wants to do a forced manipulation. I just don’t want that or can see how that would help with all the severe swelling I have. I am at the point were I wished I new had this surgery.

I can’t sleep at night , I have lost 25 pounds and have no appetite. My thigh looks like a shark took a bite out of it. This surgery has been the hardest think mentally I have ever done. I just want to get better and move on. This slow pace that I am on just sucks. THANKS for listening to my complaining.
 

Benay

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I think we all so suffer the "this sucks" moments. They'll pass and you'll move on. I'm looking forward to this is an distant memory time too.
 

Celle

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Hi @Milomann - From what you wrote in your first post, I think your knee replacement was done on May 1, 2019. Please will you confirm that is teh correct date, or tell us if I have it wrong? Knowing the actual date of your surgery does help us to advise you appropriately.

I have had severe swelling in my knee that is finally starting to go done a bit. I have iced it, used a tens unit on it and did everything my PT people have said. No matter how hard I try I can’t get better than 80 degrees Rom do to the swelling.
Your knee won't bend better until you get rid of some of that swelling. As well as icing your knee, are you elevating it? That's important, too.

The other thing that might help is to cut back your exercising and your everyday activity.
I'm going to ask @Josephine , our Nurse Director, to advise you about that. She has many years of experience in orthopaedics.
She'll probably ask you a lot of questions. Do try to answer them as fully as possible, so she has all the information she needs, to advise you appropriately.

It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.

People often make the mistake of thinking that the harder they try with exercises, the better the result will be, but that's not the case here. Doing too much can increase swelling and retard your progress.
TKR: work “smarter” and not “harder”

But what bothers me the most is my Doctor says if I don’t show any more real progress in 2 more weeks he wants to do a forced manipulation. I just don’t want that or can see how that would help with all the severe swelling I have. I am at the point were I wished I new had this surgery.
You're correct. Forcing your knee to bend while it is still so swollen would be a pointless exercise.
I suggest you tell your surgeon you would like some more time before a manipulation is done. It's your knee and you have the right to say what happens to it.
Saying no to therapy - am I allowed to?

In spite of what you've probably been told, there's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR
 

sistersinhim

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But what bothers me the most is my Doctor says if I don’t show any more real progress in 2 more weeks he wants to do a forced manipulation. I just don’t want that or can see how that would help with all the severe swelling I have.
You really shouldn't have the MUA. The swelling is inhibiting your ROM. A MUA will make your knee swell even more. Then your bend will be less. You do not have to have it. You are the boss, not your OS. Give your knee time to heal and for that swelling to go down. A MUA won't allow that.
 

kneeper

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And through all of this I have had severe swelling in my knee that is finally starting to go done a bit. I have iced it, used a tens unit on it and did everything my PT people have said. No matter how hard I try I can’t get better than 80 degrees Rom do to the swelling.
Could you be overdoing in PT? If you overdo the swelling will continue.
In some cases MUA can be helpful, but we see a lot of people here on Bonesmart (including me) that find their bend goes up as the swelling goes down.
 
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Milomann

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Need some advice please. It is 10 weeks from surgery and still having ROM problems and Doctor wants to do a manipulation. My flextion is at 0 and my ROM is a comfortable 85 degrees. It’s seems that I am stuck at 85 degrees. I am still fighting swelling and stiffness in my knee, lots of swelling. My swelling goes down when I sleep but immediately returns when i use it. How do I know if it is swelling or scare tissue. My PT people say that my knee is guarding and seems overly swollen. The only drugs I am on are Noproxen for the swelling twice a day. I am not in any real pain except for when it is manipulated at PT. I don really want the manipulation if swelling is the problem. I know that this is my decision, I just don’t know what to do. Thx
 

Jockette

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I am not in any real pain except for when it is manipulated at PT. I don really want the manipulation if swelling is the problem. I know that this is my decision, I just don’t know what to do. Thx
A low pain level most of the time is very good. Stop allowing your PT to manipulate your knee, it is not necessary and they are causing you pain. It also causes more swelling, which prevents your knee from bending. They are causing a vicious cycle.

Manipulations can be done any time. If you don’t want it, tell them you want to wait.

If it was me I’d stop going to PT at this point. Try to rest as much as you can, ice and elevate. Instead of working hard on ROM, “work hard” to reduce your swelling.

It’s not exercising that gets our range of motion back, it’s Time:

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all
along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.
 

Jockette

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One of our members, Bertschb, kept a record of his ROM process. He agreed for us to post it for those of you that are afraid you're stuck. The key is to have patience! Bertschb says:

“I'm 12 months out from my surgery and have some advice based on my experience:
1- Stop going to PT (all it will do is make your knee swell and reduce ROM)
2- Don't worry about your ROM
3- Be patient - VERY patient!!!

Here is my ROM history (more or less):

1 month - 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

I spent waaaaay too much time worrying about ROM. I thought I'd be riding my bike a couple months after surgery but it took SIX months! Looking back on my surgery, if I knew then what I know now, I wouldn't have wasted my time with PT and I wouldn't have worried about ROM.”
 

Jockette

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Please tell us the date of your surgery. We need that information so we can advise you approximately. :flwrysmile:
 

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