TKR Getting somewhere at last!

[speccybecky]

If I ve already taken 4 doses in 24 hours I can t take anymore. Docs here advise no exercise bike for first 12 weeks. I try and do some bends in bed. But very stiff, hence pain I presume. I am a bit wary of going downstairs to get ice in middle of the night when it is so stiff. Would it he best to take one less pill at bedtime so I have one in reserve for 4 hours later?

 

[speccybecky]

If I ve already taken 4 doses in 24 hours I can t take anymore. Docs here advise no exercise bike for first 12 weeks. I try and do some bends in bed. But very stiff, hence pain I presume. I am a bit wary of going downstairs to get ice in middle of the night when it is so stiff. Would it he best to take one less pill at bedtime so I have one in reserve for 4 hours later?

 

[Jamie]

Becky.....are you still trying to walk 30-45 minutes twice a day? If so, you need to scale that back.

You are going to have to adjust your pain medication if you are consistently having pain during the day or night. It's pretty obvious that what you're taking isn't working.

Please tell me again what you are taking and when and we can go from there.

 

[speccybecky]

8 paracetamol. I can take 8 tramadol but doc said only take if pain breaks through after paracetamol doesn't t work so at 6 weeks should only have paracetamol. So usually ok in daytime. Walked 1 x 1/2 mile yesterday very slowly and with 2 sticks. Took 1 tramadol and iced afterwards. Usually take tramadol in evening and at bedtime . This is very confusing. Surely I have to follow surgeons instructions

 

[speccybecky]

Everyone I spoke to before op said exercises are hard and very painful but have to be done. Doc says it s impossible to overdo the exercise

 

[Jamie]

I'm sorry, but I wholeheartledly disagree with your doctor. It is VERY possible to overdo exercises, especially in the early stages of recovery where you are right now. In addition, you are undermedicated for the pain that is associated with this recovery.

I'm going to tag Josephine so that she can respond. @Josephine: She also is in Great Britain and will be more familiar with your health care system than I am. But I think you will find that she will echo what I am saying.

My feeling is that you need to be on that Tramadol on a full schedule all through the day and night for a while yet. And I believe you need to stop those long walks. You're keeping your knee inflamed and that is resulting in pain and swelling.

I don't know why your surgeon would tell you such a thing. But if you read the many, many posts and threads here from people who have been where you are, you'll find that pushing and undermedicating do not help you recover and actually can hinder a good recovery.

Please also take a look at this thread from the BoneSmart Library:

Chart of TKR Recovery

 

[Roy Gardiner]

Everyone I spoke to before op said exercises are hard and very painful but have to be done. Doc says it s impossible to overdo the exercise

I am not sure I have seen more errors in fewer words ever on here -- not having a go at you Ms Speccybecky (still love the name) but at those who said those things.

Your knee is damaged not unfit. Fitness training does indeed mean pain, but not recovery training. You don't run on a broken leg, for instance.

Your training is pain-free ROM and extension stretches only. You don't need to walk -- yes you will get weaker but so what? When your knee is healed, you can then train.

 

[referee54]

Everyone I spoke to before op said exercises are hard and very painful but have to be done. Doc says it s impossible to overdo the exercise

I do not believe that your OS ever had a TKR. Listen to your body---it is telling you to cut back. It is not "no pain, no gain" with a TKR recovery---rather, it is "No pain, more gain."

Please consider the surgical trauma that your knee has been through. You need to take it easy.

Recovery from a TKR can be a long process, and you cannot reach the destination of being totally recovered in a few weeks. Take your time.

You will dance at the wedding; you just have to be patient with your recovery; the harder you work with this, the more behind you may get.

Gentle exercises; rest, ice, then elevate as often as necessary; not just twice a day or so.

Your knee will thank you for it, and you will be less frustrated, less painful, and you will see more progress.
It is also important to note that progress may be slow and normally is not linear---you will have good days and some not-so-good days---but you will indeed dance at the wedding!

 

[Josephine]

I left hospital on 27 jan after op on 23rd taking 8 paracetamol and 8 tramadol and was doing ok . When I left nurse said not to try and reduce these. At 2 weeks, hospital phoned to ask after me. Told me not to take tramadol as routine, just to take paracetamol and only take a tramadol if after an hour I still had pain.

This is typical of nurses and doctors offering their own opinion rather than a departmental protocol on the issue. You get conflicting advice which is invariably at odds with your needs.

You should be taking the Tramadol and paracetamol thus:
50-100mg Tramadol + 2 paracetamol every 4hrs.

Though you shouldn't take more than 8 paracetamol per 24hrs, you can take up to 10 Tramadol per 24hrs but with doctor's advice of course.

My regimen in week 3, as permitted by my GP, was
0120 100mg Tramadol/2 paracetamol
0530 2 paracetamol
0915 100mg Tramadol
1315 100mg Tramadol/2 paracetamol
1710 100mgs Tramadol
2135 150mgs Tramadol/2 paracetamol
So as you can see, I actually took 11 that day but never came to any harm! But I did need them.

Have you discussed this with your GP and explained that what has been suggested is simply not managing the pain?
I suggest you do so and if he was the one that said only take it for breakthrough, do your best to get it across to him that broken through all the time! Cry if you have to - I've done that myself numerous times to get what I wanted!

Pain break through is something you must seek to avoid at all costs. This is because it takes a lot longer for the pills to work during which the pain is escalating out of control, like this

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The importance of managing pain after a TKR and the pain chart

By the way that book also says not to sleep during day which is not realistic if you've only slept 3 /4 hours in the night!

Absolute tosh and obviously a notion thought up by somebody who have never had any major surgery! Napping when ever and where ever you can is absolutely essential to your recovery and healing. Sleep is the greatest healing agent ever. Given that your sleeping patterns are disturbed anyway, the idea that not sleeping during the day will somehow magically make you sleep normally at night is, to put it professionally and politely, total codswallop!

Besides which the four absolute rules of knee recovery are
REST - ELEVATE - ICE - MEDICATE!
Rest - well you can take your naps while doing that but rest is the number one requirement for a good recovery
Elevate - toes above nose for many hours a day. Elevating your leg to control swelling and pain
Be a total couch potato and indulge yourself in what ever makes you feel totally and thoroughly spoiled! You deserve it!
Ice - I trust that the hospital started you off icing your knee frequently? Using ice Ice it all the time you are resting! NAP all the time you are doing these three things
Medicate - by the clock. by the clock. by the clock. by the clock.
did it say by the clock? :th_heehee:

Our bedrooms and loo are upstairs so I am up and down both to the loo and to lie on bed for exercises.

That's great! My bathroom is upstairs too and I was up and down them frequently. Great for exercise but I never fussed about doing the 'dot and carry one' routine. Don't you either.

In hospital I was told by physio that after I slide heel as far as I can to bum I should hook a sheet round my foot and pull up as hard as I can to extend stretch ? I can move it a bit further doing this

Read again what Roy suggested - great idea that. and this Some suggestions for home physio (PT) and activity progress But you really don't need to get manic about it. A few each day are quite enough. No need to make your life miserable. The more you try to beat your knee into submission the more it will rebel and make your life totally dreadful!

Walked 1½ mile yesterday very slowly and with 2 sticks.

Much too much, much too soon!

Stop that immediately. Read the article on physio above which contains a suggested progression of activity.

At 3 weeks you should only be lengthening walks to about 10-15 minutes once a day, maybe twice a day if it doesn't cause your knee to swell or become painful.

Everyone I spoke to before op said exercises are hard and very painful but have to be done. Doc says it's impossible to overdo the exercise

Well he obviously never had a knee replacement, did he! :wink1: Chalk that one down to the next answer ....

This is very confusing. Surely I have to follow surgeons instructions

Not at all! Or, to put it another way,

! You own your body and nobody can tell you what to do with it.

I figure it this way - have you heard of Chinese whispers?

Well in years past, when knee replacements were new, it was hard to get patients to commit to a routine of exercise, so doctors got to making these statements about 'it has to be done' and 'no pain, no gain' (thanks for nothing, Jane Fonda!) in an effort to stop them just sitting and doing nothing all day and ending up with a totally stiff knee. All well and good. But over the years it's become translated into this thing about 'it's got to be agony or it isn't doing any good' nonsense. Don't fall for it. Read my own shorted version of my recovery and see what I did, or rather didn't, do! My knee recovery - UK style

Now please go back to Jamie's post and read all the articles she has linked in there for you.

 

[Roy Gardiner]

Oh dear Ms Becky you must feel utterly shouted at by us...

https://www.youtube.com/watch?v=qzKTOUkroU0

...which gives me an excuse to post that again, one of my faves, I do tend to say things over and over and to repeat myself.

So, the key to recovery is to take it easy, relax, rest, watch telly. It's your time, enjoy every minute of it.

 

[speccybecky]

Thanks everyone! Haven't seen or spoken to a doc since I got home! will stepup the tramadol and see how that goes, if it doesn't help i'll try and speak to a doc about taking more

 

[sandyk]

Thanks everyone! Haven't seen or spoken to a doc since I got home! will stepup the tramadol and see how that goes, if it doesn't help i'll try and speak to a doc about taking more

Hey hun you sound like your having a rough time of it - today is my 4 week post op. today i went for a walk it was only 300 yards and took me 10 minutes to do but pre op i couldn't even do 100 yds without extreme pain - today was virtually pain free only started to twinge as i got back to the house.

Please please please listen to the people on this site they have been through it and come out the other side and they are the ones that know what it is like.

Pain meds - I take 1 or 2 tramadol every 4-6 hours, this seems to work for me and i am iceing twice a day too and doing my exercises (only the gentle ones) the minute the exercises start to feel painful i stop as i dont want to undo anything that has been done. i am having issues with the leg slides but am perservering and each day they are getting easier adn i stop once they twinge.

I hope you get some good advice and help from your gp all the best for a wonderful recovery xxx

Lots of love and gentle hugs xxx

 

[speccybecky]

Sandy, you must be walking fairly quickly as 300 yds in 10 mins is a good pace :yes 4: I am seeing a physio on Friday, he'll no doubt have a different opinion again

 

[sandyk]

Sandy, you must be walking fairly quickly as 300 yds in 10 mins is a good pace :yes 4: I am seeing a physio on Friday, he'll no doubt have a different opinion again

i didn't really think about the speed i was concentrating on not slipping/falling and just looking ahead to the gates then on the way back to my front door lol xxx good luck with the physio and remember what everyone is saying It's your knee you know your body xxxx

 

[kneeper]

Oh dear Ms Becky you must feel utterly shouted at by us....

We're just very protective.:th_heehee:

 

[Jazyb]

Hi Speccybecky

Take all the advice given by everyone, especially Josephine - she will always know what is best for you. You sound as if you are doing great but you really should calm down on your activities and try chill out - it will all work itself out. Your knee is in charge and will dictate your progress rate. I know it's easy to compare but try not to - we all get to the same point in the end. Take care.

 

[karmigirl]

Speccybecky,

Just to impart my opinion here, what I did was took the OS,PT, Books and Bonesmart advice (which I have to say was the best) weighed it all and made my own routine out of all the information I had gathered. Worked really well for me, by 4 mos I was out Christmas shopping 6 hrs in a day, decorating my house (and there is a lot) pretty much just living my life all with very little discomfort now and then.

I really listened to the low and slow routine and feel I came out way ahead. When I would go to my PT sessions they just couldn't believe how fast I was progressing and my OS was floored with where I was at 6 weeks so I must have been doing something right. What really got the OS was when I walked in at 2 weeks to his office and had my husband pushing my walker behund me, just to show hm I could do it.

You really will get there and you have plenty of time to dance at that wedding if you slow down now. The more you aggrevate that knee the slower progress will go.

 

[Jamie]

Speccybecky.....Roy is right...we, of course, didn't mean to shout at you. I know this is all something new for you and you logically think that what you are told by those in the medical profession should be absolutely the right thing to do. Unfortunately that isn't always the case and now you wisely know that the BEST course of action is to pay attention to what your body is telling you. I think you're now on the right course for a good recovery. Just don't let anyone make you do something that is not working for you or that hurts. We have many, many BoneSmarties who have walked this path before you that can tell you what we are saying is true!

Please continue to post and let us know how things are going! We're here for you.

 

[speccybecky]

Thank you all so much. I appreciate everyone s help and advice. I just had so much confusion! And I ve always been a worrier!

 

[referee54]

This is a journey that may take quite some time---this thing called recovery, that is. The more you attempt to rush it, the more frustrated you may get, as your knee will "go on strike" and not do much of anything.

Slow and steady---take it easy and gently---and listen to your knee---and to us.

You have to be patient and resist the temptation to try to move things along by working hard; work smart, not hard.

"Patience, Grasshopper, Patience!!!"
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