TKR Jodingers recovery thread<

[Celle]

@Josephine ,
I think that Jodingers is doing too many exercises, according to her responses to your questions, in Post #21.

You asked for her extension number, which she has now given you (+10), but please can you advise about her exercises now?

8. These exercises 4 times daily, 2 x 10 reps of each,
Leg raises 2 x 10 reps
Gentle squats 2 x 10 reps
Standing side + back leg raises 2 x 10 reps
Standing on tiptoe 2 x 10 reps
Sliding knee flexes 2 x 10 reps
Standing bend heel towards bottom 2 x 10 reps
Seated knee flexes (extending leg under chair) 2 x 10 reps

I saw a physio on discharge on day 3 but not since , now day 10. Due for PT in 9 days.

There have been so many posts since Jodinger answered your questions and her post is now not very noticeable.

 

[Josephine]

I hadn't answered her responses yet, Celle!

1. Pain 3 at rest , up to 7 at night when it burns/ stings. Some stiffness after exercise

3. Moderate swelling

If your swelling is moderate, that adds at least 4 points on your pain score, making your pain score 7-11.

2. I take paracetamol 500mg x2 4 times daily and ibuprofen 400 mg twice daily am and pm

Well to start with, I recommend you don't use ibuprofen for the following reasons:

It's a very poor pain killer
It has bad side effects like these

Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers
NSAIDs Diclofenac. ibuprofen increase risk of heart problems: new study​

You are taking a good dose of paracetamol but you need something else besides that. What were you prescribed?

4. Flexion just over 90° Extension +10 degrees

That's not bad for 12 days out. Things will improve in time.

5. Icing 4 times daily religiously for 30-40 mins each time

You accomplish little or nothing in 30 minutes. Ice for at least 40-60mins and more than 4 times a day.

6. Elevating above hip height all the time, other than short periods doing exercises or toileting/ washing

You never told me how often and how long for? So I will just say elevate while you ice!

7. Just gone onto x1 crutch, fully self caring, walking in house and garden. Making drinks, prepping foods.

Perhaps doing a little too much. Did you read the articles left for you in post #3 of this thread? Point 5 in the starters was Activity progression for TKRs. You really must go back and read it again.


These exercises 4 times daily - too much. Once a day would be plenty
Leg raises 2 x 10 reps - too early to be doing these and then, once you can do them, you don't need to do them any more
Gentle squats 2 x 10 reps - NOT at less than two weeks!
Standing side and back leg raises 2 x 10 reps - nor these
Standing on tiptoe 2 x 10 reps - worst thing you can do ever!
Sliding knee flexes 2 x 10 reps - do you mean heel slides? Your flexion is fine, stop these
Standing bend heel towards bottom 2 x 10 reps - not these either, very bad!
Seated knee flexes (extending leg under chair) 2 x 10 reps - not these either
You should read this (also in the Recovery Guidelines) BoneSmart philosophy for sensible post op therapy

I saw a physio on discharge on day 3 but not since , now day 10. Due for physio in 9 days.

That's usual in the UK. Do NOT agree to do exercises when you go to physio, you don't need them. I never did any and when I called in at physio every 6 weeks (only for first knee, second knee never did any reviews at all!) just to be measured and check I was doing okay.

It's not the exercising that gets you your ROM, it's time. Time to recover, time for swelling and pain to settle and time to heal. One thing that seems to be missing from all the PT's protocols is that all your ROM is there right from the start, just waiting for all that to happen so it can show itself. In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

In summary:
1. speak to your GP about changing your meds. I suggest you ask him for some Tramadol. But you do need more than just paracetamol.
2. stop using ibuprofen
3. cease all exercises. There are many of us on this forum who never did any exercises at all and yet came through with excellent outcomes. I was one of them!
4. If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?

 

[Jodingers]

Oh no :-( I feel so stupid now, I thought I was doing so well. I'll stop doing the exercises and just stick to walking around the house a few times daily.

Tonight my knee feels tight and hot and painful though the wound looks absolutely fine, so now I'm worried I've messed up and made things worse, I was so determined to do well.

I was sent home on paracetamol, ibuprofen and dihydrocodeine though I don't remember having dihydrocodeine in hospital and haven't had any since discharge on day 3. I was so nauseous for the first week that I struggled to take anything other than paracetamol and added ibuprofen after food twice daily on around day 5 when I realised I could tolerate it. I can't tolerate Ttramodol, it makes me vomit violently. I'll try dihydrocodeine tonight + see what happens.

Thank you for your advice, I had read the articles when you sent them but didn't realise how far over I had gone as I felt I was doing good. I think I read so much initially that I obviously hadn't taken it in, how foolish I am. I just hope I haven't messed up so much I have delayed/damaged my progress too much :-(

 

[FCBayern]

@Jodingers I doubt you have done any real damage, just prolonged the pain and swelling a bit. We all want this to go faster than it really does and also have a tendency to do too much the minute we start feeling better. That's common theme in most of the threads on this board. Ice and elevation are still my best friends in week 9 of my recovery.

 

[Celle]

I hadn't answered her responses yet, Celle!

Sorry. I thought they'd got lost, hidden by all the other posts after them.

 

[Jodingers]

I'm so sorry too, it looks like I had disregarded all of your advice, nothing could be further from the truth, I'm so grateful for your help. I just want to do well. :-(

 

[CAdesgirl]

Don't feel too badly about overdoing it. We all have at some point. I found this group weeks before my surgery and still pushed myself too far several times with PT. It's a long, slow recovery which will only be longer and slower if we (talking to myself here, too) try to hurry things along.

I'm sure you'll notice in another week or so that you're doing things that you can't now. Give yourself time to heal. The best thing you can do for yourself right now is to spend a LOT of time icing and elevating. I spent more than ½ my days hooked up to my ice machine for the first 4-6 weeks. I still use it every evening (using it as I type) and more on the weekends. During the week, I use ice packs at work several times a day, too.

 

[henrietta]

Thankyou all, so interesting. Here in France I had a male nurse who spoke good English. Lovely person. Took my 38 stitches out in 2 sessions, while my husband held my hand. Got me breathing in and out for each one. 'souffle'
Not too bad. I now use Bio-oil on the scar every day and will continue to do so. Hope it's helping.
One side of my knee is numb? That doesn't seem right?

 

[henrietta]

@Jodingers I've read this information with interest. Here in France no one has given me any advice about exercising! I see a kinésithérapeute (physio) once a week who gets me doing range of motion exercises (no pain) and recently time on a walker (left knee hurts, not right!) thinking i should be doing more, I of course looked on line, and found sets of exercises from a renowned hospital, to do 3 times daily- (just like the ones Jodingers is doing!) started doing them, feeling anxious I hadn't done enough. Then I found this site, and began to relax about it. Now do some heel slides and similar when I feel like it but no longer so anxious. Thank you!

 

[Jodingers]

Hi henrietta, yes, I'd found the exercises online and thought I was doing right, I'd read so much that first week that I'd ended up veering to doing too much. I do ice and elevate all the time.

I'm struggling to sort out my pain control as I was using paracetamol and ibuprofen. I've stopped ibuprofen on Josephine's excellent advice, I took x1 dihydrocodeine lat night and just now but I already feel spaced out and dizzy. I'll speak to my Dr this morning and see what else I can try. Tramadol has made me vomit previously but I may try again.

I feel as thoughI've gone backwards. I'm so cross and upset with myself. My emotions are all over the place. I've put a brave face on until my husband has gone to work and now I'm in tears. I'm usually such a strong positive person. Thank you all for your help and guidance

 

[Jockette]

I've put a brave face on until my husband has gone to work + now I'm in tears, I'm usually such a strong positive person.

It’s very normal to be very emotional after this surgery, I think it’s a side effect of major surgery.

I feel as tho I've gone backwards, I'm so cross and upset with myself,

Please don’t be so hard on yourself. It’s very early days and you haven’t done yourself any actual harm. Most of us in the US are told to do all those exercises you were doing. But they are truly not necessary, I don’t know why they are recommended.

There will be ups and downs to your recovery for quite a while yet. We call this recovery a rollercoaster, but things even out eventually.

 

[Jodingers]

I tried dihydrocodeine which helped the pain but has made me so nauseous + dizzy. My Gp has ordered some tramadol, hopefully I will tolerate this better. If not then she offered naproxen, I don't kniw what opinion is on this?

I've stopped all exercises and sat doing elevation, ice and just moving to get drinks/toilet stops/food.

 

[Bionic]

I seem to feel better on tramadol. Although it does make some people nauseous it doesn't me.
I hope it works ok for you

 

[Jodingers]

Thank you, fingers crossed

 

[sistersinhim]

Be sure and eat something with protein in it about 20 minutes before taking your meds. Protein takes a little longer to digest so stays and protects your stomach longer. You can also get some meds for that nausea. I took it for the first few weeks. It, along with the protein helped a lot. Tramadol worked well for me.

 

[Jodingers]

Thank you, that's great advice, I'll try that tonight.

 

[henrietta]

When I woke early in the first few weeks my husband got me a Weetabix to have with the meds. I took Naproxen (provided by hospital) for weeks before the visiting nurse said, no, that's only for just after the op. Only take paracetamol now, but as sometimes it's my other knee or hip hurting I wonder what's best.
Before the op I had diclophenac and PPI but don't really want to go back to that. I've avoided Tramadol, as friends say they got hallucinations.
What do people advise?

 

[Jodingers]

It's so difficult. My Dr offered Naproxen too, I might take her up on that. I took a Tramadol last night and slept for a few hours. I daren't take it when I get up in case it makes me nauseous and dizzy. I'm concerned about its addictive effect too.

Any advice gratefully received.

I've completely stopped the exercises now, staples out today.

 

[Bionic]

I've not had hallucinations with tramadol and if you are only taking it as recommended I think it's unlikely you will get addicted.

 

[Jodingers]

Thank you Bionic. Feeling more positive today.