TKR January 4th ltkr

[mendogal]

Thank you. He pointed out that it is prescribed "as needed". I think I'm going to need it especially at night and before PT.

Pain medication is not effective " as needed" during the initial post op period - this is because a steady state of blood levels needs to be maintained in order to have effective pain management. Once the pain starts up, it's because the blood levels are no longer therapeutic and it takes hours longer to stabilize.

The need for scheduled pain meds is highly variable. Some members taper totally off the stronger meds in a couple of weeks. Others legitimately need them a couple of months.

At any stage of post op recovery, we don't recommend taking "as needed" pain meds before PT. It makes it too easy to overdo exercise, creating rebound swelling or injuring healing tissues.

 

[MSuki]

They usually work better if you take on a schedule vs waiting on pain to set in. At least at first.

 

[Tgmaine]

Thanks to everyone for the support. He definitely means well and he is a former hospital pharmacist so he does have the relevant training, though it's been many years. I want to make one correction. The med the doc prescribed is Hydromorphone 2 mg. I am not a pharmacist so I'm not sure of the difference. I am going to take it every 4 to 6 hours along with my ibuprofen and acetaminophen for now. Because those are alternating every 3 hours (every 6 hours for each) the stronger med is not always with the same companion. Does this make a difference? I took your advice and spent most of today resting and icing. I did have two visitors but stayed on the couch and made it shorter. Every hour or two I get up to pee, walk around the house a few times to stretch and do the mild exercises. I refuse to push the knee lifts with a pillow under because it's just too painful. I'm still cramping a bit but I can feel the levels beginning to even out a bit better. You guys are the best. Thanks for holding me up. Special call-out to my knee buddy, @rlwintin . Happy one week from Maine!

 

[MSuki]

Sorry @mendogal I did not see your note, maybe I didn’t refresh. As to taking it with the tylenol vs with the ibuprofen I would not think that would make any difference.

 

[Tgmaine]

Just checking in on day 12. Thanks for all the advice on meds. I feel like we have a better handle on it now. Acetaminophen about every 6 hours and hydromorphone every 4 to 6 but trying to make it in the 5 hour range. We were also alternating ibuprofen in between those acetaminophen doses but my husband was concerned about heart attack risk so I've transitioned to naproxen instead. Thursday is my appointment with the PA to remove staples (goodie!) so we'll go over it with her. PT is going well but slowly. I love the Bonesmart philosophy of going slowly and stopping if things hurt and have communicated that. She says the remnants of the nerve block are keeping my muscles from being able to lift my leg much yet. I get maybe an inch and we're not pushing it. But I am trying to gently bend more. I still have significant swelling so we took out my wedge pillow to help with elevation. I won't win any contests for ROM! Sleep had been a real problem. I welcome any tips. Thanks for all your support.

 

[Layla]

Hi on Day 12 post op!
Dedicated Icing and elevation should help with the swelling.
It is our lymph system that rids the body of fluid (swelling). So you want to get the fluid to the lymph nodes in your torso area so your body can more quickly process it. The lymph system works rather slowly on its own and much more efficiently with the assistance of gravity. The fluid isn’t draining into the hips, but contained with the lymph system and moving to the torso and lymph nodes located there.

If you haven't yet for this recovery, check out the articles on ICE and ELEVATE that, mendogal, left you in the Recovery Guidelines.

Sleep is a problem for many, thankfully it normally regulates with time as you likely recall since this isn't your first rodeo. Your best bet is to sleep when you're able even if it's napping during the day. Also, consider Magnesium which can support 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/

Something that really helped me get comfortable for sleep was, and still is, pillows!
Lots of bed pillows of varying lengths and weights. Most are soft and squishy and always include an inexpensive Body Pillow which I purchased at Target for approx $10. Actually I have two of those and often find surrounding myself with pillows, provides a softer surface to rest an arm or leg on and often brings comfort and sleep. Gather up some extra bed pillows and give it a try! Best Wishes for some restorative rest.
@Tgmaine

 

[Tgmaine]

Thank you @Layla ! I will read the article on magnesium and get that. A pillow under my legs really helped last night. It's impractical to bring the ice machine to bed but I have it on all the time while resting and elevate during the day. I'm going to have my husband search around for she smaller throw pillows too.

 

[sistersinhim]

We were also alternating ibuprofen in between those acetaminophen doses but my husband was concerned about heart attack risk so I've transitioned to naproxen instead.

Ibuprofen and Naproxen are both NSAIDs and can be a heart attack risk. Acetaminophen is a safer alternative.

Thursday is my appointment with the PA to remove staples (goodie!)

You will feel better with those staples out, I sure did! Bending my knee didn't pull on them like they did with them in my knee.

 

[Tgmaine]

Yes, removing staples isn't pleasant but I think it will make it easier to bend. It just works better for me to combine the different actions from the two meds. The doc approves so I'm doing it for now.

 

[mendogal]

Yes. For those who tolerate NSAIDs it's100% safe to take with acetaminophen.

For sleep, if you find you need something more than magnesium (which also provides the benefit of reducing leg or foot cramping), some OTC remedies I have found helpful include

- diphenhydramine (Benadryl), the antihistamine that is also sold as a sleep aide because it's mildly sedating

- valerian root, an herbal remedy and active ingredient in some - not all! - herbal "sleep tea" blends

- low dose sustained release melatonin, the "sleep hormone" - only effective if you also remain in a dimly lit area after taking it.

None are recommended for regular ongoing use. When I was desperate I would use a sleep tea with valerian, then take melatonin, and relax in the recliner with only indirect light for an hour before going to bed - yes, with legs up on pillows!

 

[Tgmaine]

Thank you! At this point, "whatever it takes" comes to mind. Thanks for all these great suggestions.

 

[MSuki]

Would your ice machine go onto one of those small folding luggage carts like this? Just a thought. I still take my ice machine to the bedroom every night. Or actually my husband does. A few times he has left it in the bedroom instead of moving it back to the living room in the am, and I have moved it myself. Luckily mine has a handle and wheels so it’s pretty easy.

 

[Tgmaine]

Great suggestion but my bedroom is upstairs. I've found with my legs on a pillow I can sleep 2 or 3 hours at a time. Big improvement. Still a work in progress. Enjoying the snow to look at out here!

 

[AnnYo]

Hi @Tgmaine --I just wanted to tell you that the leg raises were probably the most frustrating thing I tried to do early on and I was so concerned....until one day (when, as you said, the nerve block was completely gone and my quads began to wake up) I could do them easily. It wasn't like I built up some ability to do them by trying hard; one day they were a struggle and then I could do them. and I'm sure the same will happen for you. Best of luck!

 

[Tgmaine]

Thanks @AnnYo . You know this in your head when you read the wonderful Bonesmart materials but believing it is another story! Unfortunately my PT found the dreaded foam roller on my bedroom and wants me to use it for those under the knee lifts. I get 2 reps about a half inch with pain. Forget it for now!

 

[Tgmaine]

Two week post op update. I saw the PA on Thursday and all looks good. Removing the staples wasn't pleasant but didn't take long. She gave me a new NSAID to use that may provide more relief than the ibuprofen or naproxen, which I've been taking with acetaminophen and hydromorphone. It's a pill form of Voltaren. I find I can stretch a good 6 hours between the narcotic now but she isn't rushing me to wean off yet. Nights are still the hardest. When I do sleep (heaven) the second I become conscious my leg is on fire again. Stiff, sore, overstretched. Ugh. Sorry to rant. At least with the hydromorphone I can fall back to sleep and thank goodness I have no place to be during this recovery so I can sleep as long as I can. PT is going well, slow but sure and I can do more for myself, like dressing. And I can do my leg lifts now! @AnnYo you were right, suddenly they work . As always thanks for the support and an shoulder to lean on.

 

[mendogal]

Glad you are finding improvements!

You mentioned that you sleep better with your leg on "a pillow" so I just want to note that some of us found more elevation to be very helpful for sleeping better and longer.

Here's our guide.

 

[MSuki]

You are doing great for this early in your recovery. The Nsaid sounds like what I take - mine is diclofenac but I believe it is the same as Voltaren. I’ve never used the Voltaren topical stuff.

I think stretching out the pain meds very gradually like you are doing is the way to go because you can quickly recognize if it’s too soon. I stretched mine out to a morning and a bedtime pill ( later in recovery) and then stopped. I would also strongly recommend you try to have some leftover in case of emergency- like if you way overdo it, or if you have to do any travel before you’re really recovered. My surgeon thought that was a good idea too.

 

[rlwintin]

I wake up a lot to pee. (It seems like all the water drops in the night). I’ve been walking each time each time I wake up, about 2-3 laps up and down the hall. That seems to loosen up the sore leg and the pain pill that I took at bedtime lets me get back to sleep. Sometimes I will take a Tylenol then if I’m due for one, or an ice pack. Those things help, I think.

 

[Tgmaine]

Yes @MSuki the new med is diclofenac. Just 2 pills a day. I can't say if it's making a huge difference or if my swelling and pain are naturally going down a little. Last night for the first time I felt a little better for the first leg of the night. Not quite so tight in the muscles. Once I had my midnight meds I was able to sleep until 3.30, a record. Then the pain and stiffness set in, I got back on the pillow (thanks for the tips) and took a second melatonin to get back to sleep. I wasn't due for meds until at least 5 am. After those I fell into an exhausted sleep until 7.30. PT was at 10 and I was plenty stiff. One day at a time.