Bilateral TKR I had both knees tkr and am struggling

[hopefaith]

@Perry
"buyers remorse" very normal. I had have that at times still. That feeling will lessen with time, I believe.
Are there any milder pain meds.? I got very depressed on one of the long acting ones, so I got off that as soon as I could just go to the short acting.
~hopefaith

 

[Perry]

Hi Quasi, really liked your post and the fact that we are on the same time schedule of our surgeries. I think you are like me in I despise being inactive and this is driving me crazy not to be able to do everything I wish and need to do in my life and business. But also as with you I find that if I can occupy my time and mind with some work or activity, I can temporarily escape concentrating on the surgery and slow recovery.

Please stay in touch.
I hope and pray for your continued progress.
Thanks

 

[Josephine]

Hello Perry and welcome to BoneSmart. I see you've had oodles of good advice and information but I'm going to go a few steps further. To do this, I'm going to ask you some questions and it would be very helpful if you would answer each one individually in as much detail as you can then I'll come back as see where you are ....

Please answer this for the first 3 weeks of your recovery, NOT where you are now. We'll get to that later!

1. what were your pain levels? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery!

)

2. what pain medications were you prescribed, how much were you taking (in mg please) and how often?

3. how often were you icing your knee and for how long?

4. were you elevating your leg, how often and for how long?

5. What was your ROM - that's flexion (bend) and extension (straightness)

6. what was your activity level? What did you do in the way of housework, cooking, cleaning, shopping, etc., and

7. what kind of PT/exercises were you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)

Note:
If you're not familiar with this, it goes like so:
1 lift of a 500kg bell bar = 1 rep or repetition.
Doing 5 reps and then a brief rest = 1 set of 5.
And doing 5 sets and finishing = a session.

 

[Perry]

Thanks for the offer of help ----Here are my answers as best I can recollect :::::

Please answer this for the first 3 weeks of your recovery, NOT where you are now. We'll get to that later!

1. what were your pain levels? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery!

)
***As the days went by the constant pain seemed to build (real and in my mind?)to constant throbs of 4-5 ,
and maxing out at 7-9 at my most desperate time

2. what pain medications were you prescribed, how much were you taking (in mg please) and how often?
**** Hospital I was taken off Oxycodon because of nausea
****I was sent home with Diluadid (2mg) every four to six hours which seemed to do nothing
**** Then went Hydrocodon (7.5mg) every four to six hours somewhat better results & Celebrex (200mg)
****(Fourth Week) Then went to Oxycodon (5mg) four to six
Better results but Destroyed my stomach to the max with ulcer or erosion ?!

3. how often were you icing your knee and for how long?
****Maybe 20 minutes times - four times a day

4. were you elevating your leg, how often and for how long?
**** Setting and sleeping in Lazy boy chair, but legs were not high enough I now know.

5. What was your ROM - that's flexion (bend) and extension (straightness)
***** 85 left & right 90

6. what was your activity level? What did you do in the way of housework, cooking, cleaning, shopping, etc., and
**** I was able to start walking with no assistance by 5th day after surgery. I could do any choirs I selected, but motivation was poor. I walked constanty to get away from paind of laying flat , not being able to sleep, and not being able to set with bent knees due to right leg tendon pain.

7. what kind of PT/exercises were you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)
*** Toe lifts, leg lifts, leg sideways movements, pulling leg backwards in chair, stand and march mostly 2 reps of 10 each.

 

[referee54]

@Josephine, our forum Mother Hen, will be the best at getting you squared away, but I will toss in my two cents worth.

**As the days went by the constant pain seemed to build (real and in my mind?)to constant throbs of 4-5 ,
and maxing out at 7-9 at my most desperate time

You should not be in this much pain---I am not sure what pain meds you can take---Josephine can certainly help you out there---but I might suggest that you see a pain specialist----you need to get on something that will work that will alleviate your pain. You should not have to suffer through that.

3. how often were you icing your knee and for how long?
****Maybe 20 minutes times - four times a day

You should be icing for longer periods of time and more often. I would recommend icing and elevating for at least 45 minutes or so---and five or six times a day. Twenty minutes is not getting it done, and this is not the normal, "20 minutes per hour" type of icing. Do not be afraid to ice for an hour or so.

4. were you elevating your leg, how often and for how long?
**** Setting and sleeping in Lazy boy chair, but legs were not high enough I now know.

Yes, please use the "Toes above the nose" and let gravity help to alleviate your swelling.

not being able to sleep,

This is absolutely normal and very frustrating---and very common! Just nap when you are tired and as often as you need to.

I walked constanty to get away from paind of laying flat , not being able to sleep, and not being able to set with bent knees due to right leg tendon pain.

I would say that you need to cut back on your activity---if it hurts and you are doing it, do not do it. Cut back on the activity and let the knees become "happy" again.

You should not have to suffer---again, Josephine and others have much more expertise at this---but you need to get that pain taken care of.

Ice and elevate more and longer---let gravity and the ice do teir jobs, and the swelling---and the pain---should subside.

Cut back on your walking and activity---again, you are causing inflammation in both knees, and you need to get that under control. "Less is more" in this case.

 

[scaredinCA]

I can't add much advice after all the good responses you have gotton. I too had a bilateral and I had alot of problems with pain meds.. I was on diluadid and it made me see things that weren't there and I was really mad while on it. I was furious that I had done this to myself, I was mad that nobody told me how horrible it would feel (which wasn't true at all, I had read a book and this forum beforehand). I remember feeling like I had been tricked, which was paranoia of some sort & certainly not true!! I was just mad and miserable...Switched to Morphine and I was a bit better emotionally, but felt sick all the time. So I stopped pain meds and recovered on extra strength tylenol. Thats when my mind cleared up and stomach issues stopped.. But of course I hurt more, but it was managable. I can promise you one thing though. YOU WILL FEEL BETTER over time.. You will start noticeing small improvements that will surprise you. It happens so slowly that you don't notice the improvements at first, & then suddenly you will do something that you haven't been able to do in months & THEN you will know you are getting better... Thats when your moods will improve also. Its slow, but you have made it this far and you will recover sooner or later. Recovery happens no matter what you think on your bad days. One day you will be happy you did this surgery.

 

[Perry]

To ScaredinCA,
Thank you for your comments that are "Right in Line" with what I am going through.
I felt my doctor had lied and withheld important information about the difficulties I would face
and that I had made the worst decision of my life and had ruined it forever.
I felt betrayed by people I trusted, my own decision making, and wallowing in self pity and despair.
This site and people like you have been so so helpful in giving me the answers and hope that I have been so desperately seeking and needing..
Thanks to all the people who took their time to offer help, advice and hope ....Love you all !

 

[scaredinCA]

Isn't it irksome that some people can do well on pain meds, while others like us don't handle them well at all. Its the pain meds that made me paranoid, mistrustful, and angry, thinking I had been lied to when in reality I had informed myself very well by reading a book and reading this forum... It was the meds! Nobody knew it was the meds causing this until I stopped taking them & was suddenly better. When I read other members posts that are sent from their bed in the hospital right after surgery and they are doing so well, I remember back at how mad I was in thinking I would never walk again, I would be paralized for life. Thank God thats over with!! Unfortunately my legs didn't turn out as straight as we wanted them to be, but still, I am very glad a year later that I had the surgery done and can walk without arthritis pain. My daughter no longer has to push me in a wheelchair when in the mall... I have to use a walker with a seat on it so that I can stop and rest when necessary due to back problems.. But my knees are fine! I think some of us recover in spite of ourselves.
Its a long road, but a good road with a light at the end of it.

Everytime you get depressed & have negative emotions, now you can come back to this thread and read all the encouraging messages posted just for you. And you can reread us telling you that you WILL recover and be glad you had it done. It will help you to know that some of us take longer to heal than others, but we DO heal.. So take heart and listen to us who went before you.

 

[icep707]

Im glad you are now on track to some relief, remember to ice alot ! use a ace bandage if you need to hold the ice pack snug around the knee. The colder the ice the better . You will see improvements soon . Best of luck , Iceman

 

[Josephine]

1. As the days went by the constant pain seemed to build (real and in my mind?) to constant throbs of 4-5 ,
and maxing out at 7-9 at my most desperate time

No it wasn't in your mind - it was in your knee!

2. what pain medications
**** Hospital I was taken off Oxycodon because of nausea
****I was sent home with Diluadid (2mg) every four to six hours which seemed to do nothing
**** Then went Hydrocodon (7.5mg) every four to six hours somewhat better results & Celebrex (200mg)
****(Fourth Week) Then went to Oxycodon (5mg) four to six
Better results but destroyed my stomach to the max with ulcer or erosion ?!

Did you ever take ibuprofen or similar? That's what wrecks your stomach. And Celebrex, though gentler than most, is still an NSAID NSAIDs, acetaminophen (Tylenol, paracetamol) differences and dangers.

3. how often were you icing your knee and for how long?
Maybe 20 minutes times - four times a day

you accomplish nothing in 20 minutes. You need to ice for an hour at least and often.

4. were you elevating your leg, how often and for how long?
Setting and sleeping in Lazy boy chair, but legs were not high enough I now know.

Gotcha!

5. What was your ROM
85 left & right 90

That's not at all bad.

6. what was your activity level?
I was able to start walking with no assistance by 5th day after surgery. I could do any chores I selected, but motivation was poor. I walked constantly to get away from pain of laying flat, not being able to sleep, and not being able to sit with bent knees due to right leg tendon pain.

Of course motivation was poor, you'd just had TWO very major surgeries! It's also a myth about never being able to sit with knees bent. Of course you can. What you shouldn't do is sleep with them very bent as per this article elevation is the key.

PT/exercises - my comments are in bold
- toe lifts 2 reps of 10
- leg lifts 2 reps of 10
- leg sideways movement 2 reps of 10
- pulling leg backwards in chair 2 reps of 10
- stand 2 reps of 10
- march 2 reps of 10

You didn't say how many times a day you did them but I am assuming twice a day. In any case, all of these were too much activity for the first 3-4 weeks - far too much. So I am not at all surprised you were in so much pain. What with that, poor medication and insufficient icing and elevating, it's all not wonder.

Anyway, let's move on to the present. So would you be a dear and answer the questions now as things are for you right now? Sorry for all this, but we will get there in the end!

 

[Perry]

Thanks for the offer of help ----Here are my answers as best I can recollect :::::

Please answer this for where you are now. Week 7

1. what were your pain levels? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery!

)
***My average pain is only 1-2, as stiff knees and burning I do not count as real pain, only annoying discomfort.
My lower tendon (which is not knees I know, but was not present prior to the surgery) sometimes hits 4

2. what pain medications were you prescribed, how much were you taking (in mg please) and how often?
**** I take no drugs for knee pain except moltrin 3 per day
**** I rub pennsaid on my tendon, I was putting this on my knees which works find for a couple of hours relief, but then I started loosing feelings and sensitivity up and down the body from the rubbed area. so stopped the knee rubs.
*** I take Zanx some nights , and always some type of sleeping pill - average sleep is 3 hour intervals
My pain is bearable, but the length of the stiffness and burning is frustrating.

3. how often were you icing your knee and for how long?
****Every time they stark making me aware they are stiff and / or burning 6-7 times average 30 minutes

4. were you elevating your leg, how often and for how long?
**** No elevations during the day and some elevation at night

5. What was your ROM - that's flexion (bend) and extension (straightness)
***** Now 105 left & right 110 Both legs are close to laying flat but not yet.

6. what was your activity level? What did you do in the way of housework, cooking, cleaning, shopping, etc., and
**** I try to stay busy during the day to get my mind off the knees. I have found that curiously NOW more than before, I have less stamina to walk long periods due to the tightness of the knees ?
I walk one flight of stairs up and down 2 times per day.
I took a long (but slow) 40 minute walk today felt ok.
I take regular breaks and ice but putting the legs out into a straight elevated position is VERY uncomfortable.

7. what kind of PT/exercises were you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)
*** PT 3 times a week at clinic. 20 minutes recumbent bike, leg push maching with light weighs 3 10ct reps.
Machine leg curls and lifts light weights 3 10ct reps.
Gravity leg hanging forward and backwards 3 30 second reps (Left the upper leg and let the lower hang free)
I time of routine in pool each week.
** I was told to slow down and not to do so much exercise on my days off to allow the legs to recover from the prior day's exercise.

 

[Phil75070]

Josephine will get back to you with professional advice based on your answers. The one thing that stands out to me, though, is that even though at 7 weeks you think you should be off any prescription pain meds, that burning and stiffness you feel are both forms of pain. I think you are under medicated.

 

[RestAssured]

Stiffness is swelling of the underlying tissues. We can't see what is happening under the surface of the skin, just like the burning could be where all the little nerve sensors that were cut all the way from your skin to deep down to the knee are "waking up!"

Experiencing these means you are trying to under medicate most likely. I have been through 4 knee surgeries, and every time, my body started forgetting to take pain pills when it was time to drop down. The body is amazing; if if needs help it will ask, and I when the time is right it starts making decisions for itself again.

 

[Texan]

@Perry, Welcome to BoneSmart! I'm sorry to hear you are still in so much pain. I understand your feelings of depression. That is part of recovery unfortunately. Cabin fever really gets to me so I try to get out of the house every chance I can get. I look forward to p/t just for the change of scenery! My sister-in-law has us over for dinner a couple of times a week which is wonderful. I went to Lowe's with my husband today and rode in an electric cart. I didn't think I would ever do that but desperate times call for desperate measures. Like others have said, you are doing too much. After my first TKR in January, I seemed to turn a corner at around 7 or 8 weeks. The knee just started feeling better. I said I wouldn't have the other knee done, but when I got to where I could do more activities, the right knee started complaining even more. I had the second knee done 4 1/2 months after the first one. Pain pills tear up my stomach so I have been trying to stop taking them. Easier said than done. I'm not taking as much but still have to take some. So far, my stomach isn't complaining. It is all trial and error. Good luck with your recovery. Hopefully things will greatly improve now that you have gotten so much great advice!

 

[Perry]

Hi Texan,
Thank you for your writing with your experiences.
This is a wonderful support site....I wish I had found it earlier. Great People & Great Advice !!!

In the earlier weeks I went through a deep depression and I think because of the hard drugs was real emotional.
I walked into a store and saw the electric cart and thought that was my future and started crying.
But now I am off the hard drugs and still tear up easily when I see others in pain or distress but emotions are
under better control.

The reason I did both (of course they both needed doing) was because I did not think I would have the courage to go back in for the second one .
I really admire you and the courage it took to go back in for your second one. It also tells me the first one must have improved to the point you could do this.
I am almost to the end of my 7th week and yes things are improving and I no longer view the light at the end of the tunnel an on-coming train. "ha ha"
Best of luck with your recovery

 

[scaredinCA]

I think you may need to remind members that the pain meds caused you stomach problems and thats why you are under-medicated as they say.

 

[Perry]

Thanks ScaredinCA,
You are right ... It is like choosing the lesser of two evils.
The knee tightness and burning are at a level I can now tolerate with no hard drugs.
But when I was on the hard drugs I had awful drug head fog, bad emotional and depression spells, and developed an ulcer or erosion in my stomach causing me to become completely incapacitated when the gut pains maxed out, and am now treating this problem.....
""BIG YES"" I am afraid of the hard drugs and am willing to bear the knee tightness and burning as long as I know this will be ok and my recovery will progress as it should.

 

[Josephine]

My average pain is only 1-2, as stiff knees and burning I do not count as real pain, only annoying discomfort.

Ah but they are! Pain comes in many forms including soreness, burning, stabbing, throbbing, aching, swelling and stiffness. All need medicating.

My lower tendon (which is not knees I know, but was not present prior to the surgery) sometimes hits 4

Lower tendon where - never mind, I'll ask you in the next post!

I take no drugs for knee pain except moltrin 3 per day
I rub pennsaid on my tendon, I was putting this on my knees which works find for a couple of hours relief, but then I started loosing feelings and sensitivity up and down the body from the rubbed area. so stopped the knee rubs.
I take Zanx some nights , and always some type of sleeping pill - average sleep is 3 hour intervals
My pain is bearable, but the length of the stiffness and burning is frustrating.

Moltrin is ibuprofen and contrary to the advertising hype, a pretty useless pain med.
pennsaid is a topical form of diclofenac, another NSIAD and you shou,d not be using tow NSAIDs at the same time. a) because of the reason I gave above, b) because topical applications are largely ineffective and c) because even topical gels can get to your stomach - read this NSAIDs, acetaminophen (Tylenol, paracetamol) differences and dangers.
Zanx, Xanax or alprazolam is a benzodiazepine which is one of the most addictive of drugs. It is normally prescribed as an anti-anxiety drug so I don't recommend it for pain management. I take it your doctor has prescribed this for an anxiety issue?

You cannot do this without proper pain meds. Even at 8 weeks it's impossible.
You would be much better using your prescribed medication which would be hydrocodone or oxycodone.
You should also be taking Tylenol instead of the others, up to 1,000mg per dose, 3-4 times a day. Maximum daily dose, including anything added into other drugs (in the form of acetaminophen).
But the basic line is that you are risking a lot by not medicating yourself adequately.

icing every time they start making me aware they are stiff and/or burning 6-7 times average 30 minutes

First, you should use ice as a preventative and not wait until you have pain. Secondly, you accomplish nothing in 30 minutes. Ice for an hour at a time and even more but do make sure you have a cloth between your skin and the ice pack. No freezer burn please!

No elevations during the day and some elevation at night

Then elevate lots. Remember the mantra - rest, elevate, ice and take your pain meds by the clock!

Now 105 left & right 110 Both legs are close to laying flat but not yet.

That's fantastic at 8 weeks out!

I try to stay busy during the day to get my mind off the knees. I have found that curiously NOW more than before, I have less stamina to walk long periods due to the tightness of the knees?
I walk one flight of stairs up and down 2 times per day.
I took a long (but slow) 40 minute walk today felt ok.
I take regular breaks and ice but putting the legs out into a straight elevated position is VERY uncomfortable.

This is not the way to do knee recovery. For the first 3-4 weeks you should have been doing NOTHING but rest, rest and more rest! But it's not too late - get off your feet, get those legs up and follow the mantra!
You've also been fed a favourite myth about not being allowed to bend your legs when resting. Of course you can as legs weren't designed to be kept straight all the time, specially when sitting. Look in this article and see the right and wrong ways of elevating legs Elevating your leg to control swelling and pain. Besides which, you have already got great ROM so what is there to worry about?

btw, did you ever read those recovery articles that Tim left for you in post #11? Did you even notice them?

Your PT - my comment in bold
(I am assuming that 3 10ct reps means 10 reps x 3?)
PT 3 times a week at clinic
20 minutes recumbent bike - okay
leg push matching with light weighs 3 10ct rep - NO weights of any kind, not till at least week 12
machine leg curls 3 10ct reps - same again, not till week 12
lift light weights 3 10ct reps - and again
Gravity leg hanging forward and backwards 3 30 second reps - do less
I time of routine in pool each week - okay but be careful how much you do. It's all too easy to over do it in the water.

I was told to slow down and not to do so much exercise on my days off to allow the legs to recover from the prior day's exercise.

Exactly! The biggest problem in knee recovery is people labouring under the impression that they have to work hard and fight to get a good outcome when the opposite is actually true. Please read the articles as they explain it all very well.

I just know I have seen all too many people who have wrecked their lives by trying to be an in charge kind of person instead of accepting that we all have to just rest and allow the knees to heal and recover at their own rate. I promise you that you will get much better results in the end. Since your ROM is so good right now, you've nothing left to fight for anyway so just take it easy, take your pain meds and rest it away!

 

[Josephine]

developed an ulcer or erosion in my stomach causing me to become completely incapacitated when the gut pains maxed out

The prescription 'hard' drugs don't do that, the NSAIDs do - including that gel you rub on your tendon! Read the article I left you.

I am afraid of the hard drugs

Don't be - that is assuming you don't have 'prior history'! See if you'd read those articles, you would have read this too Myth busting: on getting addicted to pain meds

am willing to bear the knee tightness and burning as long as I know this will be ok and my recovery will progress as it should.

But that's the point - the entire point. You run a very real risk of ending up with a permanent, chronic tendinitis over all your knees which can be disabling and the pits to live with. I have seen it myself, people who refused to take pain meds, insisted on doing too much of everything, activity, exercising and ended up (one man 5 years down the road) with swollen, stiff legs, limited ROM and untreatable pain.

Please, please listen to me - I don't want that to happen to you.

Why do you think I just spent almost 2 hours composing that last post to you at 3.20am when I really want to be in bed?

 

[Perry]

Hi Josephine,
Thank you for taking up so much time in trying to give me sound advice and guidance.
I have been trying to read "all the links" that the wonderful folks on this site have been so
kind in providing. Wonderful sources of advice !

I respect your opinions, but if I said I absolutely want to make it from here on with No Hard Drugs
would you say I can do this and what over the counter drug (s) would you recommend ?
Tylenol instead of the others, up to 1,000mg per dose, 3-4 times a day ???

The reason I have resorted to alprazolam is because this is the only drug I have found that will relax me to the point a sleeping pill will allow me to sleep 4-5 hours. Yes it is one I had irregularly used in the past for anxiety.

You said I could wreck my new knees by not allowing enough rest and too much exercising with physical trainers. Is this true.... this does scare me as I assumed these were professionals who know what they are doing ?

Also, when the gut and stomach pains reached the 9-10 point, I was on Oxycodone,
Celebrex, & Cymbalta ..... as soon as I stopped these and got them out of my system, the pains stopped - period!