TKR Kneeophyte’s Left TKR

[Layla]

Tylenol 3 makes me drowsy, so without it, falling asleep and staying asleep were both challenging last night.

If discomfort is waking you, consider icing and elevation right before bed and see if it helps.
Try pillows also, various sizes and degrees of firmness. They are great for support and comfort. I surrounded myself with them so I could rest a leg, or arm easily enough, whatever felt comfortable. Doing whatever you can to basically "set the scene" for sleep may be worthwhile as your body re-adjusts. Make up the bed with your most comfortable bedding. Try to block out the light if it's daytime. Minimize noise unless you feel listening to calming relaxation music, a fan, or white noise may help lull you to sleep. Make sure the room temperature is not too hot or too cold.
Try to disconnect from the devices at least an hour before the targeted nap or bed time, so it's easier to wind down. Limit caffeine throughout the day and consider natural sleep aids such as Valerian, Chamomile or, Magnesium, my personal favorite, which can assist in muscle relaxation and nerves and promote healthy sleep (falling asleep and staying asleep) Try some relaxation techniques if you feel they may work for you such as deep breathing, prayer or meditation or even some gentle stretching may help relax your body and mind.

Also, consider Magnesium
Magnesium supports 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/

Have a great Friday and weekend!

 

[Kneeophyte]

Thanks @Layla, I'm checking with medical team on possible use of magnesium glycinate.
I normally have a pretty vigorous exercise schedule and am sure sleeping will get easier again once I'm able to return to more of those activities.

BTW, that physician's assistant stayed silent after I asked him to correct the after-visit summary (though he made the correction). During the appointment that was the subject of the summary, he said he'd be calling me to check my progress, but that never happened.

My only contact info for him is an email address, but meanwhile both he and the surgeon are among the people I'm scheduled to see for my 6 week check up November 17. There may be some interesting conversations.

 

[Kneeophyte]

Today I’m at 5-weeks post TKR.

Sleeping: The surgeon said it was fine for me to use magnesium glycinate (or melatonin, or other sleep aids). I’ve now used it a few nights and it does seem to help (thank you @Layla ). I’ve also started using an extended-release formulation of acetaminophen, 650 mg. It’s meant to last eight hours, but I’m waking with a throbbing knee after six or seven hours and needing to take more. Not perfect, but it could be lots worse. Meanwhile I’m tracking my acetaminophen use and making sure it stays under 3000 mg per day.

Physical Therapy: I had my final in-home PT session and evaluation today, all good. I have my first PT session at our local medical clinic on Monday. Until then I’ll continue the twice daily exercises I’ve been doing. In-person PT with a good therapist sure beats the telehealth iPhone type sessions I had for knee #1 (COVID)!

ROM: Good (0-128 degrees)

Walking: SLOW! Exhausting! But except for today (when we’ve had a very welcome rainstorm), my hiking pole & I have managed a 20- to 30-minute neighborhood walk these past few days.

Driving: I went for a short test drive yesterday. I was concerned the stiff left knee would make operating the clutch difficult. But really, the toughest thing was getting into and out of the driver’s seat. Hearing about it, the therapist reminded me to scoot the seat back and also adjust the seat tilt before getting in and out. Seemed obvious, once he said it…

Swimming: I still have scabs, but maybe they’ll be gone by the time I see the surgeon on Monday. Regardless, it will be a while before I can re-join my gang for noon lap workouts. But as I know from my knee #1 experience, just getting back in the pool will be fabulous and swimming will help in recovery.

 

[Jamie]

@Kneeophyte …. I think you will do better with Extra Strength Tylenol rather than the extended release type. It’s formulated differently and designed to work with post op pain from surgery. You take 2 of the 500mg tablets every 6 hours on a schedule through the day and night. That gives you the maximum of 4000mg per day, assuming you don’t have other meds with acetaminophen in them. You always need to stay at 4000mg or less in any 24 hour period.

You’re doing quite a lot of exercise and activity for only a little more than a month out of surgery. Just be sure you aren’t doing too much. If you end up with pain or swelling the day following exercise, it would be good to scale back just a little. Exercises twice a day plus a 20-30 minute walk each day may be part of why your pain medication isn’t getting the job done for you.

 

[EalingGran]

Like @Layla suggested above I found icing just before bed helped.
I also slept with my knee resting on the open ice- cold cool jacket of my Aircast Cryocuff and refreshed it up I woke from the ice chamber.

 

[Layla]

Hello and Happy Friday,
You're welcome! Glad to read that you feel the Magnesium Glycinate may be helping you sleep.
I am sorry your waking with a throbbing knee after six or seven hours of sleep. Your body is still healing and the swelling happening overnight while your leg has been immobile for a stretch of time, is likely contributing to that throbbing pain. If you're not already, you can try gently and slowing bending or straightening your knee upon waking before getting out of bed and see if that helps. Icing for a time may bring some relief, or if its time to start your day, a warm shower can help the muscles relax. It's still early into the process, but you seem to be doing great! An idea that may make the walks less exhausting at this stage is to take two 10-15 minute walks in the neighborhood rather than one longer one as your strength and stamina continues to increase.
Best Wishes for your PT session on Monday! Have a nice weekend!, Kneeophyte.
@Kneeophyte

 

[mendogal]

Another vote, with Layla, for two shorter walks rather than one long one. Same with exercising; I broke things down to shorter sessions.

I also found with both knees that I did much better with a more active walking/exercise day alternating with a less active day, especially if I'd achieved a new time or distance milestone.

 

[Kneeophyte]

This morning, I had my 6-week checkup AND my first out-of-the-home physical therapy visit.

The Physician’s Assistant apologized for the untrue statement in his previous after-visit summary and for failing to ask the questions the statement covered. Ideally, he would have contacted me after right I asked that the summary be corrected, but so be it.

More importantly, this time he and the surgeon agreed the knee’s healing and ROM were fine. And they also said I could shift to taking ibuprofen and acetaminophen on an as-needed basis, rather than following the detailed medication schedule they requested for the first six weeks. Taking fewer NSAIDs sounds good to me. (@Jamie -- for night time use, the extra-strength acetaminophen you suggested earlier seem to be helpful.)

The new physical therapist modified a few of the exercises I’ve been doing and added a couple new ones. As my Good Spouse (who has seen the same woman for a shoulder issue) said, she seems excellent.

I haven’t been out of our immediate neighborhood much since my TKR, so this was an action-packed morning for me. I’m happy with how it went.

 

[Jamie]

I'm glad to hear that switching to the 1000mg doses of the Extra Strength Tylenol is working better for you. I thought it might because it's specifically made for post-op surgery pain and not arthritis pain.

 

[benne68]

Glad to read that you are doing so well!

The new physical therapist modified a few of the exercises I’ve been doing and added a couple new ones. As my Good Spouse (who has seen the same woman for a shoulder issue) said, she seems excellent.

Also, happy that you found a good therapist. It makes such a difference when you are able to work with a PT who understands joint replacement recovery.

Best wishes for continued progress.

 

[Kneeophyte]

Today was a special day – my incision was finally healed enough for me to return to the pool. I’ve been a lap swimmer for years and was persuaded to join a local Masters’ team a couple years ago. I’ve always been among their very slowest swimmers. And, of course I’m even slower now and definitely nowhere near ready for a full-length Masters’ workout! But I timed today’s pool visit so I could at least say hello to my buddies.

But just being back in a pool and swimming slow laps – heaven! Definitely a morale boost.

 

[Jamie]

This is a milestone to celebrate for sure! Congratulations and it’s just one of many more to come.

 

[mendogal]

Congratulations!!!!

 

[sistersinhim]

I remember how great it felt to get back to swimming. Good for you!

 

[Layla]

I'm happy for you, Kneeophyte. You're getting back to what you love and I'm sure with time you're rebuild your stamina and endurance. Enjoy swimming those laps and have a lovely weekend!
@Kneeophyte

 

[Kneeophyte]

Limping... assuming the TKR is the only reason for limping, will it just gradually improve & go away? Though my leg can bend, it doesn't seem to flex on its own when I walk, at least not yet.

I'm quoting what I wrote in March 2021, when my right knee was a couple months post-TKR. It is exactly what I'm experiencing now, a couple months+ after my left knee's TKR. This time, I have in-person physical therapy sessions (unlike in 2021 during Covid) and the benefit of my therapist's comments. The hamstring of my latest TKR leg has WAY less strength than the hamstring of the other leg. So I'm trying to work on that -- glute bridges, hamstring curls, etc. I take comfort that -- even without in-person PT or targeted hamstring exercises -- my right leg eventually recovered and I wasn't left with a permanent limp. Just hard to stay patient...

 

[benne68]

Just hard to stay patient...

Yes, it really is -- even when you've been through a recovery before and know that it's a marathon.

My surgeon likes tell his patients: "The most important muscle to exercise during this recovery is your Patience Muscle."

You will get there!

 

[Jamie]

I hope while your therapist is helping you work on strengthening your hamstring muscle, they also are advising you to use a walking aid as long as you have the limp. You really need to do this. Limping is hard on your body and can impact other joints and muscles. Please use a walker or cane or crutches so that you don’t limp. If the limp is significant, I recommend that you use a walker for at least a while until it improves. The walker gives you the best support as you work on a normal gait. You should walk slowly with it and concentrate on a proper heel, roll onto the ball of your foot movement with each step.

 

[Layla]

Patience is difficult to come by once we're feeling better and making progress, but not overdoing it on the good days and accepting that complete recovery can take a full year are useful reminders when we're feeling impatient.
Your knee is still healing deep inside. Celebrate the great gains you've made and know that you're on track. Three months is still early, but you're on your way! Keep up the good work and stay in touch!
Happy New Year, Kneeophyte!

@Kneeophyte

 

[Kneeophyte]

On Tuesday I had my last scheduled physical therapy session. It’s been 16 weeks since my TKR. The knee is still quite stiff and grumpy. And I definitely have a way to go to re-build muscles, especially the hamstring, which seems to favor hibernation. But my ROM is fine and I trust my regular activities (lap swimming, strength class, walking) will eventually get me there….