TKR Day 4 found this group - TKR - feel like I'm struggling

[SQL_Mark]

Hi, TKR on Tuesday, April 4th. Today is Friday the 7th. 59 YO, in good health and fitness. The first day was bliss really, even the second day. On both days I could get in and out of bed myself, move around well, etc... took it really easy didn't do anything crazy, and didn't hurt myself. Bit of history; about 10 years ago I had a brutal bike accident that broke my pelvis in 3 places, and severed my right leg right off my pelvic bone. Thirteen screws and a chain put me back together and into a wheelchair for 110 days. I fully recovered from that; it was amazing actually.

So, this TNR I think I got, right? Not overconfident just prepared mentally and with various accessories, some provided by my doctor/hospital, and other things I know I need.

Ok, back to our story, day 3 hits (Thursday) and my left leg is so stiff I cannot bend it more than from say 5 degrees of motion to maybe 20. It's swollen, not terrible but notable in comparison to normal. and bruised. All day long I fight to loosen the thing up, carefully mind you, shift back and forth between heat and ice (docs suggestion). Yesterday was miserable, woken up three times last night by the discomfort (I have a high pain tolerance to boot), Tramadol and Oxy are the only things to take the edge off (I'm a pharmacist so I know to be careful with these). I'm doing a bit of self massage on my knee as well. Incision looks very healthy, nothing out of whack there.

I've got;

• Berg Polar Care Glacier system didn't come with any 'pads' but does have a knee bladder. I'm using gauze and other materials, struggling with the thickness, to keep the bladder off my skin while still allowing the cold to reach my body.
• Front wheeled walker, works great in our home.
• Great Coach in my wife although yesterday we figured the right language was Slave, not Coach. Frowny face.
• Shower chair and raised toilet seat.
• Rowing machine when I'm ready, along with a spinner bike.

Questions;

1. Any overall thoughts from your experience?
2. Ice/heat thinking? The heat feels and seems to be helping with stiffness the best.
3. Sleeve for Berg Polar Care machine? From their website it looks like they have a 'pad', I wasn't provided with any of those.
4. I've no idea what day four / today (Friday holds) and my Coach and I, I mean Slave :D, will do what we have to do but any kind of wisdom would be welcomed.

Thanks, Mark

 

[WFD]

I vote for cold and voiding heat, but that's my personal preference. I have the Berg and use this pad, which works great:

 

[WFD]

*avoiding not voiding

 

[Layla]

Welcome to BoneSmart! I will start by leaving our Recovery Guidelines and posting more in a separate note below the guidelines.

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.

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?

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.

 

[SQL_Mark]

I vote for cold and voiding heat, but that's my personal preference. I have the Berg and use this pad, which works great:

HI WFD, Thanks for the reply. I have a bladder, that's what I'm calling the thing that the water runs through, it's a knee version but admittedly is not as large as I'd like. The thing I'm struggling with in this regard is what to use to keep the bladder off my skin (it's too cold to put right on the skin). Berg shows they sell a multi-use pad, which I wasn't provided with and unfortunately, there are no stores in my area. I've been tinkering with gauze and other stuff but haven't got that locked down yet. Thanks again, I appreciate you leaning in to help me.

 

[Layla]

Hello again! Welcome to recovery. Thanks for joining us.
First, I am sorry for the horrible accident you suffered many years ago and the pain it must have involved.

I am guessing the first day post op was bliss due to the anesthetic and meds combo. Often an anesthetic is injected before closing that blocks nerve impulses and gradually wears off over the first 72 hrs post op, which as a pharmacist you're already familiar with. I wish the bliss could have lasted longer.

The post op swelling produces what we refer to as Log Leg - your brain is telling your leg to move but the muscles and soft tissue have been so traumatized that there's no reaction. During the first stage of healing, the inflammatory phase, it's common to notice swelling. After lower extremity surgery, or trauma involving bleeding and inflammation, there will be fluid in the leg causing the sensation of heaviness. Gravity pulls the fluid downward and since the patient is less mobile the fluid is not pumping back through the heart as quickly. The swelling gradually eases, but can persist for up to 3-6 months in some cases. Regular movement will assist in the reduction of swelling, as will elevation and ice. Your surgeon may prescribe compression stockings for a short period of time.

You may benefit from the use of a Leg Lifter making it easier to get in and out of cars, beds, recliners etc.

Regarding heat - we advise against using heat at this point as it can increase / enhance pain and swelling. Whereas cold reduces inflammation and swelling, often relieving pain.

Try a wash cloth or hand towel between your leg and the ice source and see if that works. May need to be a thinner one.

Do you have a grabber? I'm guessing if we took a poll it would win "best recovery item" hands down.

I wish you comfort as you begin healing. Go easy on Coach / Slave so she doesn't suddenly remember a very long errand she needs to run. She will not peel you a grape.

 

[JusticeRider]

Hi @SQL_Mark , welcome to BoneSmart! I’m so glad you found your way here early on…these folks are an amazing wealth of information and support. As for insulation from your ice machine wrap, I swear by the ‘flour sack’ type dish rags. They are nice and smooth and soft on your skin, and are quite thin but large enough that you can fold many times to customize thickness. I think I got mine in a multipack at World Market, but they probably have them at any of the big box stores too. Very affordable. Best of luck on your early recovery

 

[WFD]

I also use dish towels, if I’m not wearing long pants.

 

[EalingGran]

As for insulation from your ice machine wrap, I swear by the ‘flour sack’ type dish rags. They are nice and smooth and soft on your skin, and are quite thin

Another option is the gauze squares that you can use for babies.

 

[Layla]

I swear by the ‘flour sack’ type dish rags. They are nice and smooth and soft on your skin, and are quite thin but large enough that you can fold many times to customize thickness.

Great idea, JR! I didn't have those in my life when I was recovering. I went back to those dish towels a few years ago as I recalled them from my childhood. Muti purpose those old school drying cloths! Sorry for the little derail
SQL_Mark. Great idea though if you have them on hand.

 

[Tino2You]

Hi SQL. I too have a berg unit. Mine is a a Berg Cube as well and I also have the same knee pad WFD. When I was discharged from the hospital they gave me about 6 feet of a cotton sleeve. It looks like this in amazon:

LayerGuard Cotton Stockinette Sleeve Roll, Naturally Stretchable Raw Cotton – Comfort wear, Sweat Absorbent – Prevents Residue build up - Suitable for Under - Over Cast Bandage Wear (Off-White 4 Inch)

During there early days of my recovery (when I was using ice cubes and frozen 6oz apple juice bottles, it started too cold, so I used two (sometimes three layers under the pad. Now I use 3 to 4 ice bottles only and one layer. My knee gets warm, but nowhere as near as hot as it got the first few weeks. If you have old long johns, you can cut the legs and use them Also is you go on Berg.com, they have links to places where you can buy the knee sleeve that WFD described. It really works!

You are in the early stages of recovery. Relax and take you pain meds as prescribed. Being brave just sets you up for more pain. Be careful with any NSAIDs too many can harm your stomach and or liver. Tylenol will be your friend. The PM version works to help you sleep (one of the worst part of the recovery for me was lack of sleep). Take care.

 

[FourCats]

Welcome @SQL_Mark. This site is awesome because folks who had similar experiences are able to share what the majority of our docs have never experienced. During my recovery periods, I had many anxious moments relieved when I found out what I was experiencing was normal such as zingers. It’s not an easy nor short road which most of us were not fully prepared for.

Again, welcome and be sure to visit often and ask questions.

 

[LeftKnee123]

Welcome! I am just a junior member at a little over 7 weeks out but not so long ago to remember where you are at the beginning stage. It is a challenge no doubt and I was not at all prepared. I found this site at around 4 1/2 weeks and wish I had found it earlier. I think you are past the very worst after the first few days. One thing that I wish I had earlier was the “Lounge Doctor” elevation pillow. You can pair it with your ice machine or just a bag of ice etc.Great for swelling and pain and very comfortable. I also was so shocked by that initial pain when the nerve block wears off that I started taking the tramadol and oxy like crazy. Think I took more than was necessary due to FEAR of the pain returning. Took opioids for 10 days and they started to make me a little crazy, just ask my husband. Anyway, have needed Tylenol every day since but think at this date I may be turning a corner just a bit??? Hang in there!!

 

[beachy]

First thing you need to do is read the recovery guidelines that Layla sent. It is so true to everything pertaining to this recovery.
This is my second tkr and I've had two good recoveries thanks to Bonesmart.

The early weeks are for healing, pain control, and getting the swelling down. And not torturing your Coach. You can't bend a very swollen knee. I imagine you needed time to heal after your horrific bike accident.

The ice water machine is great! A dish towel, pillowcase, any of things already mentioned will protect your skin. Still check it occasionally to make sure your skin isn't red. And you need that ice machine on for a good 45 min. Ice and elevation are your friends. And pain meds on a regular schedule for awhile. And no heat.
Its a long recovery, but you are no stranger to that, right? It can be rough the first 4 to maybe 6,7 weeks.
Good luck!

 

[SQL_Mark]

*avoiding not voiding

Hello again! Welcome to recovery. Thanks for joining us.
First, I am sorry for the horrible accident you suffered many years ago and the pain it must have involved.

I am guessing the first day post op was bliss due to the anesthetic and meds combo. Often an anesthetic is injected before closing that blocks nerve impulses and gradually wears off over the first 72 hrs post op, which as a pharmacist you're already familiar with. I wish the bliss could have lasted longer.

The post op swelling produces what we refer to as Log Leg - your brain is telling your leg to move but the muscles and soft tissue have been so traumatized that there's no reaction. During the first stage of healing, the inflammatory phase, it's common to notice swelling. After lower extremity surgery, or trauma involving bleeding and inflammation, there will be fluid in the leg causing the sensation of heaviness. Gravity pulls the fluid downward and since the patient is less mobile the fluid is not pumping back through the heart as quickly. The swelling gradually eases, but can persist for up to 3-6 months in some cases. Regular movement will assist in the reduction of swelling, as will elevation and ice. Your surgeon may prescribe compression stockings for a short period of time.

You may benefit from the use of a Leg Lifter making it easier to get in and out of cars, beds, recliners etc.

Regarding heat - we advise against using heat at this point as it can increase / enhance pain and swelling. Whereas cold reduces inflammation and swelling, often relieving pain.

Try a wash cloth or hand towel between your leg and the ice source and see if that works. May need to be a thinner one.

Do you have a grabber? I'm guessing if we took a poll it would win "best recovery item" hands down.

I wish you comfort as you begin healing. Go easy on Coach / Slave so she doesn't suddenly remember a very long errand she needs to run. She will not peel you a grape.

Wisdom in there Layla! Thank you!

 

[SQL_Mark]

Hi SQL. I too have a berg unit. Mine is a a Berg Cube as well and I also have the same knee pad WFD. When I was discharged from the hospital they gave me about 6 feet of a cotton sleeve. It looks like this in amazon:

LayerGuard Cotton Stockinette Sleeve Roll, Naturally Stretchable Raw Cotton – Comfort wear, Sweat Absorbent – Prevents Residue build up - Suitable for Under - Over Cast Bandage Wear (Off-White 4 Inch)

During there early days of my recovery (when I was using ice cubes and frozen 6oz apple juice bottles, it started too cold, so I used two (sometimes three layers under the pad. Now I use 3 to 4 ice bottles only and one layer. My knee gets warm, but nowhere as near as hot as it got the first few weeks. If you have old long johns, you can cut the legs and use them Also is you go on Berg.com, they have links to places where you can buy the knee sleeve that WFD described. It really works!

You are in the early stages of recovery. Relax and take you pain meds as prescribed. Being brave just sets you up for more pain. Be careful with any NSAIDs too many can harm your stomach and or liver. Tylenol will be your friend. The PM version works to help you sleep (one of the worst part of the recovery for me was lack of sleep). Take care.

Hi Tino2You, my Coach found something real similar to the sleeve roll at a local DME shop. It's been a life saver, it's the perfect thickness for keeping the Berg Bladder off my skin but close enough to feel the wonderful coolness. Someone also suggested cloth dish towels, that's a good idea as well. Being a pharmacist myself I couldn't agree more with your thoughts on taking the meds, waiting on pain to arrive to then fight it back with meds is a recipe for disaster. Thanks for the thoughts I appreciate it.

 

[SQL_Mark]

Hello to everyone that's taken the time to offer thought and guidance, thank you. Your generosity and kindness are a tribute to what we're all on this earth to do, making the lives of a few others traveling with us a little bit better than the trip would have been without us. Thank you, your time offering me thoughts makes a difference!

I'm onto day five (Saturday, surgery was Tuesday) and boy howdy what a glorious day, slept through the night, and enjoyed a cup of coffee with my Coach (Wife) without spilling it on myself in bed. It's the simple things for sure.

For anyone that might be following behind me and find this thread useful, here's what I know five days out.

• No one can really prepare you for this. Not even a previous horrific accident. It's not that people are hiding anything from you, and it's not that they didn't want to tell you the 'truth' because it would scare you away, it's because you just cannot describe the Hero's Journey that this act of taking care of yourself represents. I waited at least 2 years past when I should have done my TKN, two years of sacrifice in the life of myself and my wife, that's painful my friend, this is nothing in comparison. I could not really see that until I crossed the Rubicon that the last five days have been.
• Heat vs no Heat. A tricky issue and I get the reasons to not use heat as the vast majority of the time it is NOT what you need. I was able to text, send pictures and video to my surgeon and talk in detail about what I was experiencing, and his suggestion to see how some warmth would help was based on his 30 years of experience and a good bit of data from me in the moment. Honestly, the heating pad was exactly what I needed at that moment to loosen up some of the stiffness and relieve some of the distress I was experiencing. My suggestion is to not use heat unless your surgeon and you discuss your situation in-depth.
• Berg ice machine - my health system gave me the machine the day I got out of the hospital. If your surgeon doesn't give you one, then get one, it's amazing. I will say that for me the idea of putting frozen bottles of water in the cooler instead of ice proved inferior to ice, even though it's a common suggestion. Using a RayTek MiniTemp infrared thermometer I recorded that the surface temp of the Berg's bladder was 5-8 degrees cooler with ice as opposed to the frozen bottles. I'm thinking that the surface area of the crushed ice is greater therefore more conduction of cold happens.
• Don't hurt yourself, attempt to stay pain-free, sleep as best you can and don't get consumed by pushing yourself to recover. Get up and move around. Be kind to those helping you whomever they are.
• Last but not least, on day 5, whether it's a good day or not it's not over. Try to keep learning whatever you can about caring for yourself and those caring for you, it's no doubt going to be a few steps forward along with some steps backward. That's one thing that I did learn while recovering from my previous accident that has helped me here.

 

[sistersinhim]

I used the frozen bottles some, but mostly large ice chunks made from water in a Cool Whip tub. I had four of these that I would switch out as needed. These large blocks would last for about 4 hours or more. It worked well at night while trying to sleep.

 

[SQL_Mark]

UPDATE - 8 days out from TKR, continue to work the plan. First rehab appt tomorrow.
Thoughts from this vantage point.

• Bruising and stiffness still have major impacts on stretching and sleep, although improving, in a minor way each day.
• Something that I could see being very discouraging and is probably the cause of A LOT of post-surgery depression is that the darn reality is that one can make good progress on any given day, feeling like you've made 4 steps forward for instance. You go to sleep with a sense of accomplishment and then wake up stiff, sore, and maybe even hurting (again), feeling like you've taken 3.5 steps backward. Despite taking a half step forward overall those 3.5 back are mentally challenging, to say the least. Only right action is to keep getting up and keep moving forward along with giving yourself room for your own humanity, including being discouraged and feeling challenged. Take that next step is the plan.
• Another great item to have available is a good headlamp for reading and getting around in the dark. I bought myself a Klein Tools 400-lumen headlamp (HSA ?) and wow what a treat.
• I have a new appreciation for pillows, of all shapes and sizes ROFL. My wife loves pillows and now we share this, shall I say, understanding. I can now imagine the next time we replace the pillows on the sofa (again ;)) I'll be able to engage and wade in with my own thoughts and feelings. Getting that knee just so, above the heart, as well as supporting the ankle has been a real pleasure thanks to pillows of all sizes, compressibility, textures, etc... Who knew! :D
• Medication management - Wow! I'm a pharmacist and this was tough. Between the daily, twice daily, three and four times daily, every three hours, and the as needed instructions, your head or that of your caregiver just spins at how to keep it organized. My suggestion, most important is to write down what you take and when, as nothing is worse than two hours later wondering what you did or didn't take 'last time'. There are A LOT of last times each day. Once you get that worked out, the next thing you can do to organize is work out some kind of overall schedule starting at some time each day. Then work out each time of day something is due, it's not rock science but it will take a pencil and paper and an eraser to get a sense of things. I might write more about this in another post. One other thing to be clear about is that your medications are vital to a good recovery, don't skip them or not take them simply because you feel ok, many of the medications you will be given won't provide any notable feeling of their impact, some are designed to make the other meds (like pain medications) work better and others are designed to protect you from side effects (like stomach problems) of other meds that are critical to your recovery. So, take them as prescribed, and if you are ever confused call your pharmacy and or your provider, they'll be happy to help.

 

[SQL_Mark]

UPDATE - 23 days out from TKR. Five of Twenty rehab appt under my belt. ROM 1st day of PT 92 degrees, 4th day of rehab (7 days later) 117 degrees. Couple of things to share at this point in time. Lots has happened since my last update on day 8.

• Pain and Discomfort - Pain definitely decreases over time, although distinguishing pain from discomfort is important. Pain is one thing, it's debilitating and a sign of something is either wrong or your body is still healing. Discomfort is expected as one retrains the body in the recovery process. Moving a knee, when the muscles and tendons connected to that knee are inflamed and sore will be uncomfortable, but it should not be painful.
• Medication - I'm still using Tramadol once daily in the morning as a precaution prior to my beginning the stretching and recovery regimen that my PT has given me. I'm also using Tylenol 4 times a day. I've stopped using Ibuprofen due to its impact on my stomach (despite taking it with food). This along with the prolific use of ICE during the day and my Polar Berg machine at night has me pain-free and is working to manage the discomfort.
• Sleep - I normally sleep like a rock, I can sleep almost anywhere. I think some of this is my ability to relax, to find comfort through relaxing my body. Right now I cannot roll around in bed, or shift from lying on one side to the other for instance, in short, I cannot relax and therefore I don't sleep well. it's OK, it just means I need a bit more rest worked into my day. This too shall pass. I'm also finding that using my Polar Berg machine each night all night is beneficial to adding comfort to the sleeping process.
• I'm fortunate that my employer has a substantial FMLA program allowing me 12 weeks off work for recovery. This has allowed me to play the Long Game as it were. Although a 'full recovery' will take months I have a solid 12-week plan and 3 weeks in I'm comfortable that things are working well so far.
• Home schedule - looking back I can say that following my surgeon's and PT's instructions from day one seems to have been key. I get up in the morning and stretch and do whatever else I can moving about. I am on a roughly 2 hour cycle that looks like laying down for 80-100 minutes, leg up, ice (and small heat) sometime napping, up for 20-40 minutes doing my stretching and moving about. Right after surgery this was 100-110 and 10-20 minutes for sure, now closer to the 80 down and 40 up, although it varies. This disciplined schedule, day after day, means that I'm stretching and RESTING, a lot; truth is those are the only important things in these weeks. It can seem kind of silly and it can even be tedious but it's what I'd suggest has had me confidently where I am; my PT guy would suggest that this too is what others find.
• PT pain-free - my PT folks are superb. Honestly, the most significant part of it so far has been the massage and its impact on swelling and movement, which have along with my stretching at home given me a lot of improvement in ROM. I'm doing some stair step work, very small step, and today did a stand on one leg trick; called a trick because it's really hard to do. Last week I started some recumbant bike work, maybe 3-4 minutes; feels good but wares out the muscles quick. Again, discomfort is one thing and it takes time to separate it from Pain, but my PT guy always says don't do anything that is painful BUT recognize that recovery, what he describes as the process of helping your body heal, will include discomfort. I can attest to this, it is uncomfortable.
• Walker to Walking Stick - last weekend, a little shy of 2 weeks post-surgery, I migrated from using my walker to using a walking stick to provide some support to the walking process. Steps are still a beast, having to step with strong leg first both up and down and then bring recovering leg behind. Now about 6 days into the stick I'm able too with some nuance walk without the stick and I can stand and make dinner (say 30-40 minutes) without difficulty.
• Driving - I've a 1985 VW WestFalia camper, stick shift, and this past weekend I was able to drive a short distance, maybe 20 minutes in city traffic successfully. I've also driven to PT twice this week so far. I think I'm able to call myself self sufficient in getting around.
• Quality of Life - here's where the rubber hits the road. Let's face it, I'm going through this process such that I can get to a better place than I was in before I started. Am I there yet, no. Three-plus weeks in, I cannot walk even as far as I could before I had surgery. But when I am walking now I can tell that what's hard right now is my muscles are sore from the trauma of the surgery whereas in the past the challenge was that my bone-on-bone knee wasn't working. This allows me a glimpse of where I'm heading as I know my muscles will heal themselves, my knee wasn't going to heal itself.
• Overall challenges remaining ahead - swelling is much improved but really is a major contributor to difficulty with ROM, that's going to be around for a while. Pain is feeling like it's on the verge of leaving the playing field; hoping in next week I can stop the Tramadol. Remain in any one position too long and my knee gets stiff, again I'm imagining this will retreat as my muscles and tendons heal. In a few weeks (4-5) my PT guy says I can start some strengthening exercises, I'm almost certain those will be tough. Note that I'm not being cynical here, only speaking to some realities. Overall assesstment; best thing I've ever done.
• Most important note - big praise, thanks and gratitude to my wife. The person that cares for and supports you in this process will, by the time this is over, have heavenly wings for sure; truth is they have them when you start you might not have seen them as clearly. Having someone that can hold your vision for the future, doesn't have to be your intimate partner (probably helps though), by your side in this endeavor is key. Whomever that person is, thank them regularly, thank them from your heart, deeply; even if you are paying them. Gratitude does everyone involved a lot of good.