TKR Lee Marie's Journey

[LeeMarie]

@Josephine

I wrote a lengthy response to your email, but I didn't realize that I would have to tag it again. It is in my thread for you. Sorry! My brain is still foggy and I'm in a fair amount of pain most of the time, so I will have to look up the protocol for tagging.

Best,

Lee

 

[LeeMarie]

@tiredwife Thank you for letting me know. I still have many days of blood thinner ahead of me, so it helps to know that this may pass soon. I sure hope that it ends before the blood thinner discontinues in 7 days though. If not, the next 7 days are going to be very very long ones.

 

[tiredwife]

@LeeMarie I hope your issue ends before the blood thinner is done too, but you might need to tell your OS that until then you need a better pain pill! I know my husband had to add a 12 hour pain pill along with his 4 hour pills until the blood reabsorbed. Plus use lots and lots of ice.

 

[LeeMarie]

@tiredwife Well, he did increase my oxy and added Tylenol. While I am not pain free, it certainly stays between 0-4 pain level, which is fine by me. The only problem I have is standing stock still. The blood rushes and the pain gets so intense that I have to sit or lie down. Did your hubby have that problem too?

 

[tiredwife]

@LeeMarie Yes he did, until the blood reabsorbed he spent a lot of time elevating and icing, and not much time standing around.

 

[Josephine]

I wrote a lengthy response to your email, but I didn't realize that I would have to tag it again.

I'm so sorry my dear. I always watch threads where I post my questions so you don't need to tag me especially for that. But I was in bed when you posted your reply and have been out all day. Only just logged on again.

Also, just to get it right, these are not emails. We call them 'posts'.

I called the OS this morning and visited. Even with the 10 mg/3hours of oxycodone, I was at a constant level 5 of pain and could not stand up for more than a minute. He increased my oxy to 15 mg/3hours and 4 doses of 100mg acetaminophen per day, cancelled my PT for the time being, and told me to continue the CPM at 0-30 at the slowest rate. Now I am at level 0, using my CPM machine only as an effective elevation tool. I'm really too afraid to turn it on, despite his telling me to use it.

Sounds like you've not been adequately matched with your pain meds. If it's doing the job okay but it's not, ask your surgeon if you can try something else like Tramadol instead. These drugs don't always suit everybody all the time.

Off ice only 0-2 hours per day.

It's most unusual for me to say this but I think you need to space it out a bit. Do you have an ice machine or what are you using? How are you when you are not using ice? I really think you should let ice for a 2-3 hours and then take at least an hour's break.

The only time it isn't elevated is for bathroom trips and meals now. I used to walk about 5 minutes every 4-5 hours, but cut that out.

But are you elevating properly? I've known people think that 'elevating' is putting their foot on a footstool. Check out the proper ways in this article Pain and swelling control: elevation is the key

I'd have to guess that it's closer to 0 extension and between 80-90 degrees.

That's okay for one week. Pretty good actually.

no activities except for PT. I have 3 men in the house who work from home, so am able to rest.

good for you!

Your exercises: my comments in bold - first remember you are only one week out
ankle pumps x 20 x 3 daily - these are just anti-DVT exercises so that's okay but to be effective you need to do them every hour or so and just 5-10 at a time is plenty
leg lifts x 20 x 3 daily - much too much. Just do 3 first thing in the morning while in bed
towel under ankle then tighten quads and lower knee x 20 x 3 daily - you have no need to worry about these as your extension is already at 0

heel slides x 20 x 3 daily - heel slides are preferably done throughout the day, just 5 or so every couple of hours. Do them sitting in a chair and if you can, drag your foot so it goes under the chair. But never EVER cause yourself pain. Get to the point of mild discomfort and then lean forward to slightly increase the bend and hold it for 4-5 seconds, no more.

OS said that he thought the pain was a result of the blood thinner addition.

Well that might be so but I think all this exercising at only one week is primarily responsible for your pain being out of control.

Let me tell you how my surgeon works: he has NO exercises except heels slides and straight leg raises as I have described above for the first three weeks. Then he has his patients just a little bit of walking and a few more heel slides and use of an exercise bike if they have one. No CPMs and nothing else. His patients do extremely well and he does very, very few MUAs. You might like to read the potted version of my recovery to see how little exercising I did! Knee recovery - UK style

BTW did you read the articles Judy left for you in post #9? (just checking - I'm sure you did!)

 

[Nana Mo]

@LeeMarie I just read that you ar in,y icing 2 hours a day???? I iced almost 20 hours a day for the first month and continued to ice a lot up to the 3 month mark. Icing is a huge pain reliever! Do you have a cryogenic cuff? They are great as they provide constant cold water flow so not need to change ice. I only had to refill it twice a day. I even slept with the ice cuff on. Step up the icing and I bet you will see some much needed pain relief.

 

[LeeMarie]

@Nana Mo No, I was saying that was the amount of time I was off ice.

The problem is that as soon as I stop icing, the pain returns. Today is better, so I am trying to extend time between icing.

Josephine is saying that this is too much icing. At the hospital, they were saying the current school of thought was that constant icing is fine and beneficial as long as your skin is protected. (I have to say that I tend to agree that rests are better. As a first aid instructor, we were taught that there is a point of diminishing returns. After a certain period of icing, the body will struggle to heat up the area again via blood flow, etc. The net result would be that the injury site would end up warmer rather than cooler.) I went against my instincts/training as per the hospital, but now have reverted to 20-minute breaks between icing. Last night I put a cooler full of ice beside my bed and replenished the ice bags occasionally. I do have a cryocuff, but I cannot use it yet. My leg is severely bruised and the pressure is too much right now. The OS had to weigh the risk of blood clots against discontinuing the thinner and alleviating the bruising. He decided to up my painkillers and wait out a few more days. I wish I had a crystal ball that would tell me what to do b/c it's a guessing game.

Now it's Saturday. I will tough out 2 more days and talk with the OS on Monday.

Thanks, Nana Mo, for telling me what worked for you. I am looking foward to using the cryo cuff.

 

[MotownGirl66]

@LeeMarie I had that blood rushing "whoosh" feeling, too, upon standing. My PT said it is very common. When I stood, I would wait for it to pass and then I would walk. The whooshing sensation maybe lasted a week or two? In fact, I had forgotten it until you just mentioned it.

 

[LeeMarie]

Hi Josephine,


Also, just to get it right, these are not emails. We call them 'posts'.
You really felt it necessary to correct my mistake? It was merely a slip..

Sounds like you've not been adequately matched with your pain meds.
He only changed it Thursday morning, so we are still trying to figure out what it best, yes. It is marginally better, and the pain and immobility from the swelling is rather new. Tramadol would be contraindicated b/c of my asthma, I believe. Because my pain was very well controlled in hospital prior to the problems with the blood thinner, I am giving him the benefit of the doubt there. I think that we may discontinue the blood thinner a little earlier than planned. I will convey your comments though.

It's most unusual for me to say this but I think you need to space it out a bit. Do you have an ice machine or what are you using? How are you when you are not using ice? I really think you should let ice for a 2-3 hours and then take at least an hour's break. Here I went against my instincts and followed hospital (not doctor) advice, and have reverted to traditional breaks. It's been difficult because the pain is constant without ice. This morning I am attempting a couple of hours on and then 20 min breaks.

But are you elevating properly? I've known people think that 'elevating' is putting their foot on a footstool. Check out the proper ways in this article Pain and swelling control: elevation is the key I am very familiar with elevation techniques. Thanks for checking.

That's okay for one week. Pretty good actually.
good for you! Thanks!

Well that might be so but I think all this exercising at only one week is primarily responsible for your pain being out of control.
This was really interesting to me. I was feeling as though the exercises given to me were excessive, but had no basis for comparison. As well, I always feel worse after the CPM and will not use it again for the time being. Even the heel slides are too painful for me now. I have to do them hanging my legs off a table and going back ever so slightly. The bruising and engorgement are such that all movement is painful right now, however, I really feel that if I can just rest and get it under control, the mobility will return. I tried your suggested amount yesterday and even that was difficult.

Today is Saturday, and I am putting exercises off until Monday and will try again. Much of the blood has descended to my calf/ankle area, but I sill have a fair bit in the knee area still. I was taking sulfasalazine and methotrexate up until 2 weeks prior to surgery (stopped NSAIDs 3 weeks prior) and think that this bleeding is still far beyond the norm. Even the OS was taken aback when he saw my leg.

Josephine, in the hospital I had literally no limp in my gait and was past 95 degrees with no effort, so this is a bit of a quandary for me.

BTW did you read the articles Judy left for you in post #9? (just checking - I'm sure you did!) Yes

 

[LeeMarie]

@LeeMarie I had that blood rushing "whoosh" feeling, too, upon standing. My PT said it is very common. When I stood, I would wait for it to pass and then I would walk. The whooshing sensation maybe lasted a week or two? In fact, I had forgotten it until you just mentioned it.

Thanks for telling me this. Was yours very painful? Mine increases in intensity if I don't start walking, so I can't stand still long enough to brush my teeth. I have do sit down pretty quickly but can walk. I appreciate your telling me that I'm not alone here.

 

[Josephine]

At the hospital, they were saying the current school of thought was that constant icing is fine and beneficial as long as your skin is protected.As a first aid instructor, we were taught that there is a point of diminishing returns. After a certain period of icing, the body will struggle to heat up the area again via blood flow, etc

I know, I had the same conflict of training as I was a first Aid trainer too. But it would seem that an injury like a twisted ankle is somewhat different to a major trauma like this. I can't remember why exactly but about the degree of trauma.

You really felt it necessary to correct my mistake? It was merely a slip..

Sorry But we do get an awful lot of newbies here who get muddled between this and social media etc. I try to help them get forum savvy where I can.

He only changed it Thursday morning, so we are still trying to figure out what it best, yes

Jolly good!

Tramadol would be contraindicated b/c of my asthma, I believe.

Ah, I must have missed that you were asthmatic. That would make a significant difference of course.

 

[kneeper]

This morning I am attempting a couple of hours on and then 20 min breaks.

Just chiming in to say the way I iced was pretty much that way. With gel packs I'd ice until one warmed up, maybe take a 20 minute break and then put the next one on. With the polar ice machine I'd probably ice for 1-2 hours, take about a 20 minute break and then put it on again.

 

[MotownGirl66]

@LeeMarie - Mine went away after about 15-30 seconds of standing. But it was very warm, a sensation of warm whoosh coming from somewhere near my waist down to my feet. It didn't last like yours is. But I think we are describing the same thing, just each of us is different. I think, as we go about this journey of healing, that we are about to encounter a whole bunch of stuff we've never experienced before! Have a wonderful night.

Robyn

 

[LeeMarie]

Thank you for all the wonderful input. It is comforting to realize that these somewhat alarming side effects and sensations aren't all that uncommon. My doc called me today and now we've decided to reintroduce one of my immune suppressants and an anti-inflammatory so now I can drop the troublesome blood thinner. Hopefully, I will be able to put more energy into healing and regaining strength and flexibility.

I hope that all my fellow October people are doing well.

Best,

Lee

 

[kneeper]

Do you mind if I ask why you are on immunosuppressants? I ask b/c we have several people with RA who are also on them.

 

[LeeMarie]

Kneeper, I have psoriatic arthritis, which is extremely similar to RA. I am about to go back on the sulfasalazine, and hopefully that will take away some of the pain I have.

I am a little discouraged because I gave myself two days off the CPM and felt much better, but tried to go back on tonight and feel so sore and stiff again. I don't think that these things are for everyone.

The great news is that the horrific seizing pain I experienced when standing has calmed way down. I was actually able to go for a short walk today and get some fresh air and brush my teeth tonight. I will take the small victories!!!

 

[kneeper]

Thanks for sharing about the PA. You are only 10 days out so feeling stiff and sore is normal. You might try the cpm for very short sessions if long sessions make it worse. Or just don't use it. Generally I don't think they're used past 2 weeks anyway.
Congrats on getting out for some fresh air and teeth brushing. You're right--embrace these victories!

 

[LeeMarie]

Hi peeps,

I thought it might be helpful to find out out what positions you've found to be the least pain-inducing at bedtime. For instance, I have tried several elevation techniques that have me waking in agony and/or with a very painful headache, while the same position during the day works fine. I suppose that it is because we shift so often during the day.
At night I have tried:

• one pillow under the bad side foot
• Stacked pillows as shown in bonesmart in a gradual lift
• Lesser lift with same method
• Sleeping on good side with injured side on pillows
• sleeping using my CPM machine as an elated platform, turned off, course (because that doesn't move)

Nothing works, so I find myself sleeping on the sofa, much to my husband's chagrin. Between the weight of covers, pillows shifting, and being in the same position too long, I always wake in extreme pain. Has anyone found an ingenious solution? So far, using the CPM machine has yielded the best results, but I do get headaches if I don't elevate my head too. As well, I wont have the machine forever.

Thanks!

 

[kneeper]

One thing about covers is I wouldn't tuck the sheets and blankets in at the foot of the bed. That seemed to take some pressure off.