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[TKR] DebCoz's recovery thread<

Discussion in 'Knee Replacement Recovery Area' started by DebCoz, Dec 17, 2018.

  1. DebCoz

    DebCoz junior member
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    I had my right knee done this afternoon. I’m staying overnight, doing the foot pumps and tightening my thigh and butt as directed. I haven’t gotten up yet because the spinal hasn’t quite worn off enough but the pain from the tourniquet and surgery is starting to get bad.

    I got oxy which didn’t do squat so they gave my IV morphine. It didn’t get rid of the pain but did dull it. I’m not looking forward to this recovery, remembering the recovery in March from the left TKR.
     
  2. Pumpkln

    Pumpkln FORUM ADVISOR Forum Advisor

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    @DebCoz,
    Welcome back to the other side!
    Hope you have better pain control tomorrow, stay on top of the pain.

    Here is your copy of the recovery guidelines, the articles are short and will not take long to read.

    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

    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.
     
  3. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Well it often depends upon the doses you are taking.

    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?
     
  4. DebCoz

    DebCoz junior member
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    I’ve read these threads and have your app. Yes, I’ll answer questions. Thank you.
     
  5. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    @DebCoz how are your pain levels now? Are you icing and elevating as much as possible? Hang in there - as you know it does get better with time.
     
  6. DebCoz

    DebCoz junior member
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    Pain is about a 6. I’m elevating but my OS says no ice once you’re discharged.
     
  7. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    Ice is a wonderful pain reducer. If you keep a cloth between your knee and the ice pack, you knee will be fine. I iced the whole time I was sleeping or sitting. It really kept the pain and swelling down!
     
  8. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    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?
    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? 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.
     
  9. DebCoz

    DebCoz junior member
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    1. Pain is 4-5 most of the time but goes up to 8 if I’m on it too much.

    2. I was taking Hydrocodone and Tramadol but am now taking Tylenol.

    3. Moderate


    4. flex is about 80 extension I’m not too sure, maybe +10

    5. No ice, my OS says no.

    6. I elevate whenever I’m in bed and about half the time I’m sitting.

    7. normal house work, vacuuming, laundry. Nothing too outrageous.

    8. I’m doing the straightening while standing, heel slides, quad tightening, and walking.
     
  10. DebCoz

    DebCoz junior member
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    At almost three weeks out of surgery I think im doing better with the right knee post surgery than I did with the left back in March, I’m just concerned at how little I can bend it, I’m at about 80.
     
  11. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Some detail you left out Deb

    I actually asked "how much are you taking (in mg please) and how often?"

    The question here was:
    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

    Did he say why?
     
  12. DebCoz

    DebCoz junior member
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    I’m not sure how many mgs of Tylenol I’m taking, perhaps 3000 mg a day, 1,000 three times a day.

    Heel slides four times a day, sliding five times and holding for a ten count.
    Straightening while standing, hokdingvto a five count, five times a day
    Leg hang from bed morning and night
    Quad tightening to a five count for five sets, four times a day.

    And I don’t know why my OS says no ice.
     
  13. Jayla

    Jayla junior member

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    Holy cow Deb. You’re doing housework? I had a bilateral knee on 12/18 and have not done any housework or cooking. My husband is taking care of the basics. Should I be doing housework and the like? My main goal has been to get my stretching and icing done and to have a shower or a good sponge bath every day. I was thinking to get a good rest so I can get back to work as strong as possible when the time comes. Geez. Maybe I am milking this and didn’t know it. What do you think?
     
  14. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    Why all this when you have just had major surgery. Did you read the articles Chris left for you earlier in this thread? Maybe you missed the activity progress?
    No, you are not milking this. You are allowing those knees to recover. You should not be doing any chores this early out.
     
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  15. kmak81230

    kmak81230 post-grad

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    Not "milking" it -- less is more at your point in recovery! Messy house = happy knee in my book. :snork:
     
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  16. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Oh gosh. That's high!
    You need to be taking the hydrocodone as well. You are barely 3 weeks out yet, much to soon to be just going on Tylenol.

    And you need to keep a record of how much you are taking of what. It's all too easy to take to much. You also need to note if the hydrocodone has Tylenol (acetaminophen) in it as well and take that into account.
    And you did note that swelling is also pain, yes? So did you include that into you pain score?

    Well he was probably one of those old-fashioned types who thinks that it will damage your circulation which is rubbish. I suggest you get yourself a couple of ice biggish bags and get icing. You will need to have a towel or something similar to protect your skin from freezer burn though! Look at this article for more information Ice to control pain and swelling
    hmmm - okay.
    At 3 weeks? ABSOLUTELY NOT! Read this Activity progression for TKRs where you will see that is says

    Walking and other activity
    Walking is about the best exercise you can do but again, you need to moderate your time and distance.
    Always use your walker, crutches or canes as appropriate, only moving from one to the other as you gain confidence.
    Don't be despondent if you have to go back once in a while in the early days.

    Week 1
    Just walking around the house - trips to the bathroom and kitchen are included!
    Be up on your feet several times a day as you need to but don't get obsessive about it
    A 5-6 minute walk every 3-4 hours is plenty
    Spend most of your time resting and elevating

    Week 2 - add this to previous instructions in Week 1
    Start on a plan of walks around the house 3-4 times a day for about 5 minutes but don't

    a) get obsessive about it
    b) get into too much pain and
    c) get too tired. Stop before you get to that point.

    Week 3 -
    add to all the previous
    Lengthen the walks to about 5-10 minutes as before
    Activity: prepare yourself a small meal or a snack


    You are doing far too much!


    Sessions 4 times a day - try once a day, that's plenty. But none at all at the weekends
    Heel slides x5 and holding for a 10 count - that's not a good routine. I suggest you read this Heel slides and how to do them properly
    Straightening while standing, holding to a 5 count - you'd do this whil walking so knock these off
    Quad tightening to a 5 count - I don't recommend these
    Leg hang from bed morning and night - and certainly don't recommend these.
    Both those last too are for extension and you'll get that with walking



    You really should read those articles that Pumpkln left for you in the second post of this thread. All the articles I left for you here are in those so now I know you never read them!!

    And if it's suggested you do more PT, or outside PT, I suggest you say no! If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?
     
  17. grandma chris

    grandma chris graduate

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    @DebCoz you are getting some excellent advice here. I've been reading these recovery threads voraciously (as many of us do when we can't sleep!) and the common thread that runs through them is that too much exercise, the wrong kind of exercise, cutting down on meds, not getting enough rest, ice, or elevation leads to much more pain and in the long run a slower recuperation. Please do read and pay attention to the recovery articles - they do help immensely.
     
  18. DebCoz

    DebCoz junior member
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    Thank you for the input and advice. In ways this knee doesn’t seem as bad as the left one was when I had it replaced in March, but in other ways it seems worse. I’ll cut back a bit on what I’m doing. The soft tissue pain is awful and my OS won’t prescribe any more narcotics for pain.
     
  19. grandma chris

    grandma chris graduate

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    Can you ask your PCP for more meds? Three weeks seems awfully early to cut out the big guns!
     
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  20. donnag1108

    donnag1108 senior

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    So sorry you are having such trouble getting pain meds. I'm 4 weeks out and my Doctor is still prescribing with no problem but I guess the guidelines may vary from state to state. I have had hard to control pain from the start which kept me in the hospital an extra day. Hope you get relief soon.
     

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