TKR GlideFloss TKR Report - from Dec 06 '21 on

[glidefloss]

ANYTIME, i was getting out of bed at night i would do 5 or so foot pumps plus a few glute squeezes before standing

Wow, @LTsailor ! What a great idea!! Now that you mentioned it, it seems like so obvious a tactic! I'm going to give it a try this afternoon after I elevate my legs.

Just out of curiosity, why'd you decide on a different tactic for recovery , exercise wise?

One of the points stressed by bonesmart folks has been that knee movement will be a lot easier with a lot less inflammation around the knee. And based on my own experience, that made total sense. So with knee #2 my week one goal was to control swelling and if and only if exercises don't cause pain I'll give them a go.

So far I think the tactic is working great. I just got back from the gym where I sat on a stationary bike (seat set at its highest level), rocking the pedals forward and back. At the 6 minute mark, I accidentally pedaled backwards a full revolution! With no I'll effects! At the 12 minute mark, that happened with my forward pedal - a full revolution! (By contrast, it wasn't till day 15 or 16 before I got a full forward revolution.). I was in the bike 30 minutes before moving on to the treadmill where I walked at .5mph, holding on to the sides of the machine as I stared at my feet, focusing on a straight footed, heel to (sort of) toe movement. Towards the end of the 20 minutes session, I was able to introduce a modicum of bend. It's now close to an hour after getting back home and so far the signs of having overdone things are still non-existent (although I wouldn't be surprised if they showed up later.). To head it off, I'll very soon be elevAting and then use your pre-getting up technique.

Thanks again!!

 

[kiwicurls]

LTsailor, I do exactly the same thing; it really helps. During the day I never sit for more than 45 minutes either.
Glidefloss, you really must write a book. it would sell well. I mean it.

 

[jtrahan]

Hi Glidfloss,
I remember that dreadful pain in my leg when I had my ACL surgery thirty years ago. Whenever I would get out of bed the blood would rush to my lower leg causing an intense pain lasting for
about a minute. I prayed I would never experience that pain again. Unfortunately, I was wrong. Like you, I experienced that pain during my second and third week of recovery after my knee replacement six weeks ago. It must have to do with the swelling in the knee. Perhaps the fluid is being restricted which causes the pain. All I know is it hurts. Thankfully it won’t last forever.

 

[glidefloss]

Hi @jtrahan , yep, that pain is no fun at all! Good to know that you're past that now!!

I've been following @LTsailor 's suggestion to to heel pumps and glute squeezes before getting up and that seems to somewhat help. Sort of getting some of the fluids circulating before getting up, thereby minimizing the effect of the gusher!

All the best!

 

[glidefloss]

Day 8 Post-LTKR - 12pm (April 22, 2022)
Despite the choppy sleep the previous night (night 6 into day 7) mainly due to an achy back, yesterday (day 7) I had a significant accomplishment - I went to the gym and did 30 minutes on the stationary bike and 20 minutes on the treadmill without any resulting ill effects (i.e., I’m not on the ODIC bench … yet.)

On the exercise bike, I set the seat to the highest level and started rocking my legs forward and back. At around the 6 minute mark, I “accidentally” backward pedaled a full revolution and I did it a few times to gauge whether it felt forced and potentially premature at this time … but the leg felt good. At around the 12 minute mark, I “accidentally” forward pedaled a full revolution and again, gauged whether it was a motion that the leg was ready for - without pain or discomfort. It wasn’t till day 15 post-op that my right leg was able to complete a full revolution. (I credit the left’s improvements on better swelling/inflammation control vis-a-vis the right.) One of the many things I love about going to the gym is that there are so many distractions around that when doing repetitive motions, like the rocking forward/back on the pedals, the body’ll occasionally take the motion to its natural conclusion, i.e., completing the pedal revolution instead of stopping short.

After the bike session, I did standing leg extensions, knee forward, knee back (while holding onto the bike). It seemed like I was achieving close to full extension. Then I went to the treadmill.

On the treadmill, I held on to the sides, started the machine at 1 mph … but immediately had to drop the speed down to ½ mph! I then focused on trying to achieve a heel to toe straight footed stride – all the while firmly grasping the sides of the treadmill and staring down at my feet. I eventually worked my way up to .8 mph towards the end of the 20 minute session.

Back home, after lunch, I spent most of the afternoon elevating my legs, vigilant for any signs that I might have overdone things at the gym. To my delight, none was forthcoming.

Day 8 (earlier this morning), I again went to the gym and spent 20 minutes on the bike and 15 minutes on the treadmill. Very slow movements, nothing jarring, nothing forced. I also used the leg press machine as well - setting the seat back so as when my legs are on the platform they’ll be bent around 100 degrees. Super light weights and a couple of sets of 15 reps - just to start the left quads/glutes working.

Here are observations after a week post-LTKR -

• My trying to finesse pain management hasn’t been great … I often have 3-4/4-5 pain in my thigh. I’m always a little behind the pain curve and the routines I’ve tried have all too many points of failure. My latest - 2x500mg Tylenol at 6am, 12noon, 6pm, 12am; 2x200mg Advil at 9am, 3pm, 9pm, 3am; 1x200mg Aleve at 8am, 4pm, 12pm. I suspect that by the time I hit the “right” schedule, my leg will already have healed sufficiently and pain no longer an issue … which could lead me to conclude erroneously about the efficacy of the schedule.
• Stomach management has been a great success! Kombucha, yogurt, high fiber protein bars, keto bars, prunes, Miralax (which I’ll be stopping tomorrow) and Smooth Move tea - along with lots of veggies - have kept my gut microbiome a happy bunch.
• Inflammation/swelling control continues to be my primary focus these first days post-op and I credit it to what feels like good flexion/extension (e.g., when seated, I can easily pull my left leg in, in what seems to be a deeper bend than 90 degrees). It probably also explains why I’ve been able to get a full bike pedal rotation a week earlier than I was able to with my right knee. I’ve stopped using the ice machine after day three and rely primarily on elevating my legs with the occasional massaging … and an ice gel wrap after gym.
• “Healing” management is just a guess on my part … I think it’s coming along nicely. The Aquacel bandage remains completely blood stain-free. The huge black and blue marks around my inner thigh and hamstrings are fast fading away. I’m sure my processed proteins intake (protein drink and bar, yogurt, keto bars) coupled with real protein (pork loin, chicken breast, salmon) are providing my body the right stuff to repair itself. (Hopefully that’s really the case and not just wishful thinking on my part!)

So far, I’m pretty pleased with how things are going. That said, recovering from TKRs are NOT easy!!! Definitely not a cake walk. Lots of pain and discomfort, lots of work, emotional ups and downs, etc. But, hopefully, completely well worth it all in the end!

Have a great day and weekend!

 

[hawk2go]

@glidefloss, I'm glad you're finding what works for you this time around. You're experiencing what I learned that no 2 knees are alike not even when they're on the same body. Keep a close watch on pain management. Ice is really a wonderful natural pain reliever, I still use it many evenings at nearly 7 months.

 

[Suzola]

@Jockette thank you! I’m trying to learn how to do this. It worked once

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@glidefloss Lounge Doctor? Sounds like this is another wedge? I’ll have to go look. I bought an adjustable base for my bed about 7 years ago. It helps me cope with all my surgeries etc. I seem to remember a post from you before my surgery about all the tools you had accumulated. Are there any you particularly recommend?

 

[Suzola]

Glidefloss you are so far beyond me in what you have accomplished and that’s ok. We all have different situations. If you have advice on either of these please let me know.

I have trouble keeping track of everything. Time I took pills. Have I really exercised? How much water have I consumed. How do you do it?

I got a Breg polar cube and I feel teathered to my bed. My PT said I would be happier with the cold pacs and I think she was right. What do you use?

Thanks for your input.

 

[glidefloss]

Hi @Suzola , first, please remember that we all heal, recover, respond to things differently ... which is even true with one's own knee surgeries. I'm finding that out as I go through with my LTKR.

In re keeping track of things, I have several ways. To track my meds in take, I use a notebook to do so. I have a column for Tylenol, another one for Advil, and a third one for Aleve. Whenever I take Tylenol for instance, I log the date/time, the number of pills/capsules, and the next time I need to take it. I've struggled to find a schedule that works but am now trying one that has me taking Tylenol every six hours, Advil every six hours (three hours after Tylenol), and Aleve every 8 hours. Please note that my combo meds are heavy on NSAIDs (Advil and Aleve) and could be a very bad combination for many people. For years, both Advil and Aleve have been my go-to antiinflammatories, so I know how they react with my stomach, etc.

I keep a daily log, recording pertinent info throughout the day, e.g., how I slept the night before, pain levels, concerns, activities, mood, etc. My log is currently set up with two columns (I use Google docs), the left column has my (skimpy) entries for my RTKR and the right column entries for my LTKR. This allows me to very quickly compare recoveries at a glance. I'm logging a bit more details with my left (something I wish I did with my right).

The third way I keep track of things is posting to bonesmart summaries/reports of how things are going. This is in large part for some friends and acquaintances who are considering replacements of their own in the coming years.

With regards to the cheap foam wedge I got to replace the cheap inflatable one, I think it's okay but probably not as good as the lounge doctor. I haven't been using it that much the past couple of days as my back has been killing me and the angle in of leg elevation vis-a-vis my back, isn't ideal. What I've been doing lately is using the back of a settee couch as shown in the picture. I have a heating pad soothing my lower back while the legs are elevated. From that position, I can straighten (or attempt to) my legs and occasionally I'd have a yoga strap on my left foot to pull the leg as straight up in the air as possible. I think others like @jtrahan have had great luck with the lounge doctor.

All the best on your recovery. Not easy at all but time and patience will help. All the best!!

P.s. I have a Breg ice cube as well but stopped using it, mainly because being tethered to the machine for long stretches haven't been all that good for my back. I haven't really found it useful as either a pain or inflammation management thing - even as almost everybody have (icing, that is.)

 

[Suzola]

@glidefloss oh right you are actually doing double duty. Sometimes I forget that. Your method of keeping track will be different than mine. Part of it might be my brain fog. I could not focus well enough to track things that closely.

I haven’t been using a wedge at all. After spending the money on the cube that I hardly use, I’m not anxious to spend even more. I’ll ask my PT.

Thanks for your help.

 

[Suzola]

@glidefloss just checking in. How are you doing?

 

[glidefloss]

Hi @Suzola! Thanks for asking. Am doing well despite constantly being behind the pain curve. I blame my stubbornness for this.

I continue to spend a lot of time elevating my legs and often doing my version of lymphatic massage. This has really been super effective, as the attached photo shows (after two hours of relatively high evelating) - my left leg almost as skinny as my right. This has made a huge difference in bending and straightening - even if I've done Zero heel slides. I've been to the gym the last five days, using the stationary bike to get my knee bent. Slow pedaling and lowering the seat as the quad loosens up. I've so far dropped the seat 5" and I suspect my ROM is over 100.

Tomorrow I see the surgeon for my first post-op evaluation. Hopefully I get the go ahead to drive, to start taking vitamins again, and to remove the aqualcel bandage.

That said, nights are HARD. Pain and discomfort - lower back included - make it really tough to sleep. Needless to say, spirits are lowest early morning. But as the sun rises, as the day unfolds and I get to the gym, spirits lift up again. Roller coaster !

I hope all's going well with your own recovery! All the best!!

 

[kiwicurls]

Hi @glidefloss
Are you sure you’re taking enough pain medication? Reading between the lines, sounds like you aren’t. None of my business I know,but please go easy on yourself.
Looking at your photo, you don’t seem to have any wound ooze on the dressing like I did( see my thread) so hope the suture line looks good tomorrow.
I went for a 15minute walk this morning around the neighbourhood and it felt really good… until my dressing fell off.
Keep smiling and look after yourself.

 

[glidefloss]

Hi @kiwicurls , I'm sure you're right in re the amount of pain meds I'm taking 2x500mg Acetominophen every six hours, 2x200mg Iburpofen every six hours (3 hours after the Acetominophen), 1x200mg Naproxen every 8 hours.

The troubles with this schedule include - I keep missing one or the other dose, so I fall behind, and I don't take more the next time around to catch up. Historically for me, Acetominophen never really worked well for me.

I'm lucky that my incision seems clean ... my right knee was similarly clean. Credit goes to the surgeon and the team. They did use a tourniquet which accounts, I believe, for most of the thigh pain. When the aquacel bandage is removed tomorrow, they'll put little butterfly tapes which I can remove a few days later. And since self dissolving sutures we're used, no pulling or yanking tomorrow!

Good for you and your walk! Did you use a cane? I'm still too chicken to walk in the real world and will stick to the treadmill at the gym for another few days.

And now, I'm going to start another night's adventure of trying to sleep! If it's even infinitesimally better than last night, I'll declare victory!

Thanks, stay well, and all the best!!

 

[kiwicurls]

Acetaminophen ( we call it panadol, easier to say and spell) works well for me but the anti inflammatories you’re on do not. I take diclofenac which is brilliant but not for ever. Sleep well.

 

[kiwicurls]

Not for everyone, I meant

 

[FourCats]

@glidefloss I had to set an alarm in the early days with pain meds because I would forget (brain fog). I used the alarm on my phone which I always had with me and the alarm showed which med I was to take.

 

[InkedMarie]

@glidefloss are you elevating while sleeping? I cannot sleep on my back otherwise. I use the Lounge Doctor.

Marie

 

[glidefloss]

Hi @InkedMarie , I start out in bed with a pillow underneath my legs and another smaller pillow underneath my back. I sleep pretty deeply for a couple or three hours then wake up to pee and take my next dose of Tylenol or Advil. More often than not when I get back in bed, I'd not find any comfortable or un-achy/painful way to contort myself ... leading me to transfer to my office and onto a settee where I raise my legs on it's back, heating pad 'neath my back and a throw blanket over me. I get another two-three hours of restless sleep - but very good elevation. By the time I either transfer back to bed or get up, my left leg feels swell free. I've sort of given up the wedge as it forces me to be on my back the whole time and my back has been killing me these first days.

Hopefully you're getting good quality sleep while elevating! I'm now really "big" on elevating as inflammation control.

All the best!!

 

[glidefloss]

@glidefloss I had to set an alarm in the early days with pain meds because I would forget (brain fog). I used the alarm on my phone which I always had with me and the alarm showed which med I was to take.

Hi @FourCats , setting an alarm is a very sensible thing to do but I'm not sensible . Actually the reason I don't set the alarm at night is I don't want to wake the Mrs up, so I try to rely on my useless "internal alarm".

During the day, I should set the alarm but since after week one, I've been out of the house quite often (gym, grocery, etc), the alarm goes off and I don't have my next dose with me. A sensible person would pack the next dose or two and take them with once out ... alas, I'm not a sensible person .