TKR February Fifth firestorm

[Jockette]

There are lots of reasons we can’t sleep after this surgery. Here’s an article from Bonesmart’s Recovery Guidelones:

Sleep deprivation is pretty much inevitable - but what causes it?

Time and again members complain about not being able to sleep and after a while, that it gets to making them feel frustrated, despairing, depressed and even ill. I thought perhaps a short treatise on the reasons for disturbance of sleep patterns was long overdue. It won't help you to sleep but...

bonesmart.org

 

[MSPS]

Thank you jaycey, I will do that. The bathroom trips have slowed a bit but raging cotton mouth has not, I think it's from tramadol, which I'm not quite ready to quit, so drinking tons still (with electrolytes!) But losing the walker to make bathroom trips speeds it up and, more importantly, I'm not waking my poor sleepless spouse bumping into very narrow doorways and jarring me too. I bought Biotene spray yesterday and it also helped me not drink so much. The night pain comes regardless of how good I feel at bedtime, how good/bad/overworked I was, or how much I make bathroom trips, although interrupted sleep will always start it up again, too early for anything to help (if I could just train my darn bladder to wake me each 4 hours so I can also take meds, it would be most splendid! But nooooo....)

 

[MSuki]

I’m so glad you changed your PT and found someone better, the first one sounds like someone who has no business doing this!

My husband moved into the guest room during the first 8 weeks - he is a very light sleeper and also I needed to move to his side where it was easier to set up the ice machine. First few weeks I slept on one side and had the CPM on the other. So I just leaned into my sleep maybe 3 hours, get up and read/play a game for an hour of two, sleep 3 more hours routine. I still had to be careful to be fairly quiet because if he heard my walker moving he would get up to make sure I was OK. Sleep will improve but for me it was around week 7.

He moved back in when I was ready to sleep without the ice machine next to the bed. Now it still stays by the easy chair. I have a Polar Ice (large size) and he can change out the water bottles morning and night and it stays cold and ready to use at any time!

 

[benne68]

The night pain comes regardless of how good I feel at bedtime, how good/bad/overworked

Yes, we all struggle with this. My PT told me that he read a study that it takes an average of eight weeks for TKR patients to get over this nighttime sleep disruption.

It does get better -- it just takes time.

 

[Layla]

quit using Benadryl to help sleep (it worked some, but exacerbated the dryness/water cycle). Melatonin makes me hot flash, unfortunately

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

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

Wishing you some restorative rest over the weekend!

 

[MSPS]

Beginning week 4, walking about house without aid, doing laundry (not carrying basket), walked a quarter mile Saturday with cane and/or spousal unit as support...but not one night's peace since surgery. Seems I'm only halfway there, from my reading, so I'll be patient. Only doing pain meds at night, with acetaminophen and Celebrex 2x daily.

Question: when is it OK to put something soft under my knee for longer than the few minutes in PT to do leg lifts (ouch)? Getting comfortable is 8/10ths the battle at night, and the attempts start up the pain. I tried both sides for a while...strangely, laying with surgically beaten leg on bed was less painful (for a while!) I can bend it quite well when propped on my recliner footrest (maybe > 90 degrees) so resting it over a big soft pillow sounds good...but I keep seeing not to, but not for how long. If it doesn't hurt? Or will I stick like that?

Also, I can flatten my knee to the table at PT with no real effort, but those extensions and quad flexes pushing down still make me howl...and huets more because I'm not sure of purpose of them...anyone that can explain? I usually don't walk or even sit with my leg bent backward!

 

[benne68]

those extensions and quad flexes pushing down still make me howl

You should never push yourself -- or let your therapist push you -- into pain. That is not okay and it will not help your recovery. It's okay to work on quad flexes, but only to the point of slight discomfort -- never to pain.

If your therapist is pushing your knee down, tell him to stop immediately! You might want to re-read this article: Myth busting: no pain, no gain

 

[mendogal]

For sleeping comfortably... Part 1!
Oh my YES!!! I don't think any of us could have slept without our legs elevated!!!! The pillow or pillows go under the whole leg as long as there's nothing placing direct pressure under the knee! Some of us use lots of pillows.
Here's an article about how to safely elevate.

 

[mendogal]

And in case you missed it, a list of sleep aids.

Icing, elevating, napping.... All help, but for some of us insomnia was endangering our mental health. Before it gets there 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.

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.

 

[MSPS]

Almost one month out! I quit PT during my 4th week. Even 'kinder' people seem to have an agenda and make snarky comments, like "for someone in pain you're..." whatever, not crying hard enough? Enough! I was at 0 extension from the start and can bend, when swelling low, beyond 90. I just went through the seeing stars thing @Bfan noted, getting up off the loo hands free and onto my surgery leg...knee did not feel good all day after, but it does tell me I've made progress, I never could have done that a few weeks ago! So a small victory (like I put on my shoes myself today for the first time!) I stopped tramadol 2 nights ago after tapering down to a few at night only and woke up with knee on fire...but slept more than I had since surgery 2/5! Ironic...! Tylenol and Celebrex not quite enough right now, ice helps but tired of being tethered...growing roots and flab feels so unhealthy, but drat, it works! And a little pain acceptable if another hour of sleep is in the offing. I also was too afraid of the gabapentin after reading up, so stopped before I had to withdraw. It surely made me sleepy, almost non-functional the following day, so it is there if desperation occurs. Am talking with PCP Monday for a sleep aid, or maybe cyclobenzaprine, which I used to take long ago for fibromyalgia. This body pain feels like that pain, which I conquered with exercise...but I can't just pop up and walk 10000 steps to push it back! I did not even consider that diagnosis from over a decade ago, it's old news...but maybe surgery did set it off?? Or does everyone suffer deep twisting body aches all night (and why not in the day so much)?? Anyway I'm seeing a little light now and grateful for small victories...new thing for me, the poster child for "Impatience" (at almost 70, getting on with life is ever more important!!) Thanks for listening!

 

[MSPS]

And thanks for all the hints and helps! Benadryl did work for a few nights but tolerance happened fast and dry mouth actually woke me up to remove my tongue from my teeth with a gallon of water, which was a bathroom trip...so back to not much help at night!

 

[Layla]

Nice update! You are making progress. Patience is hard to come by when we’re antsy to get back to living, but you’re on your way!
@MSPS

 

[benne68]

Or does everyone suffer deep twisting body aches all night (and why not in the day so much)??

Sleep issue are very common during the first couple of months post-op. My physical therapist said that almost every one of his knee replacement patients has complained about it, so he did some research. Apparently someone did a study and found that TKR sleep problems resolve about 8-9 weeks out!

I think they are worse at night because we don't have the distractions that occupy our minds during the day. At least, I know that was true for me!

 

[mendogal]

Two things are true:
1)TKA people have weird aches and pains and sleep issues.
2) The physical trauma of surgery and the metabolic changes during recovery can indeed trigger latent fibromyalgia.

It's good you considered that and will discuss with your primary care doc. Getting that addressed will help with your recovery!

Oh and HOORAY FOR GETTING YOUR SHOES ON!!!!

 

[kiwicurls]

Hi @MSPS
I’ve been reading your thread and want to say good on you for quitting the physio! I had a great recovery last time by just doing things slowly and never pushing it to the point of pain.
I am 5 days out after my second tkr and I understand about the sleepless nights. I try not to worry as things will get easier. Just take it one day at a time. You’re doing well.

 

[sistersinhim]

I was at 0 extension from the start and can bend, when swelling low, beyond 90.

This is fantastic for being less than one month out from your surgery.

Even 'kinder' people seem to have an agenda and make snarky comments

I wonder if these therapists think that these remarks actually help someone in their recovery. IMO, it's just plain mean! Thank God they're all not like that. Finding a kind, gentle therapist is a blessing!

 

[Layla]

Happy One Month Anniversary!
All the best as you continue healing.
Keep us posted on your progress and have a great week!
@MSPS

 

[MSPS]

Quick update at almost 3 months. I'm still not glad I got this surgery. I still await thst day. Im much better. Everyone was right, things coming back well on their own, BUT the Oops days where I do too much doing almost nothing

 

[MSPS]

And apologize for typing...I have essential tremor so I miss a lot!

 

[sistersinhim]

And apologize for typing...I have essential tremor so I miss a lot!

That is fine, don't you worry about it!

You are just 1/4 of the way into this recovery and what you are experiencing is completely normal. This is a year-long rollercoaster ride of a recovery. In the early days, which you are still in, sometimes there are more down days. As time goes on, and you heal more, those bad days will become fewer and fewer. It's a time thing, not an exercise thing.