TKR low energy months past TKR

[hegel]

Another thing: I get a 'funny feeling' starting about 7:00 p.m. My body feels a bit cramped up and I notice I'm tired. Now, I'm still only sleeping in about two hour shifts, with a little nap in the afternoon. And I'm fairly active and out and about during the day (light gym today). But I wonder if this weird feeling is an artifact of the pain meds? I mean, I don't usually feel this weird feeling when I'm just tired. I'm taking 600mg (or 400) Ibuprofen and 1000 mg. acetominophren every 7 or 8 hours with 1 1/2 5 mg. ocycodone at bedtime and one in the morning. Is this related to taking so many drugs over six plus weeks? Or is it just typical for a knee that's still healing to drain my energy a lot at night? Or even my weaning off Oxcodone?

Or nothing much and it will go away? I understand that this too vague! I sometimes think too much about things.

 

[beachy]

I think you answered your own question.
Your body has had major surgery. MAJOR. You're active during the day. You're 6wks post op in a year long recovery.
I can't speak to the drugs having an effect, but I'm 7 1/2 wks post op and I get the same way in the evening. And my knee aches in the evening. Not much, it just has to let me know it's there. Because it's a diva and wants all the attention. Hang in there it gets better!

 

[hegel]

I'm sure that you're right Beachy...

I realize that what I'm asking is this: I take 5 mg. of oxycodone around 5 a.m. and then nothing until 10:45 p.m., when I take 7.5 or 10 mg. before bed.
Around 7:00 p.m. I start to get that 'funny feeling', which includes almost flu like body ache (milder than that) and then a runny nose. I was wondering if I'm experiencing mild oxycodone withdrawal. I was taking 5 mg five times per day, and 6 for the first week or so, for almost five weeks.
I'm surprised in the morning when I don't have a cold, because I'm sure that I'm coming down with one at night!
(and maybe I am, and it's just taking its time.) This seems to be consistent with oxycodone withdrawal.

 

[Celle]

It could well be Oxycodone withdrawal.
Perhaps you're trying to cut down too quickly?

When the time comes to wean off pain medications, this is what Jamie suggested:

Here is a suggested schedule for cutting back on prescription pain medications. Stay at each level for 3-4 days or even longer if you notice the pain symptoms increasing. This schedule assumes you are starting with one pill every 4 hours before beginning the reduction process.

1 pill every 6 hours and 2 at bedtime
1 pill every 6 hours and 1 1/2 at bedtime
1/2 pill every 4 hours and 1 1/2 at bedtime
1/2 pill every 6 hours and 1 1/2 at bedtime
1/2 pill every 8 hours and 1 1/2 at bedtime
1/2 pill every 8 hours and 1 at bedtime
1 pill if you are really doing something active during the day and 1 at bedtime

It is usually better to wean off these meds over several weeks, not several days. But.....if you are still having pain, then your body is healing and you still need pain relief. And in this case, I would discuss your pain management with your GP instead of your surgeon.

 

[hegel]

Thanks Celle. Maybe I should consider a half pill in the afternoon. I've been trying to manage with ice and over the counter stuff, which is working!
I'm about to head out to my second outside PT--I skipped last week--maybe I'll need that oxycodone!
l

 

[hegel]

Interesting pt today. I asked about my 'new' post surgery straighter leg resulting in stretched and tight calf muscles, as well as the band on the outside of my right leg. The pt said that it might take around six months for these to stretch out (grow?) to where they feel normal. The band (I'm forgetting its name) especially is made of tough material. And then the question became, is it scar tissue in my knee or these taut muscles that are restricting my extension? As it turns out, pt's can get a good sense of this. The woman that I worked with today felt/pressed around on my knee and said she couldn't feel much scar tissue--so it's the muscles primarily. This is good news. In any case, she was able to get my extension to near zero, which I allowed because I'm now dismissed from pt if I wish. The class was full and everyone there had far more pressing issues (not just knee replacement people) than mine to deal with. Good wishes to them.

And so more evidence that the scary two or three month window for restoring range of motion doesn't really apply in all cases. I still need to work on stretching those muscles now, and use the bike and then work into regaining strength. Some other home pt as well.

I was able to do a pretty long workout today,with some manipulation, and so far my pain level is minimal. I spoke with a guy on the way out who was using a walker but had reached zero extension through manipulation last week; he was really proud. But he said that he didn't get any sleep because of pain the night . Hmmm...

 

[hegel]

On my first out of home pt I refused to allow much manipulation and was o.k. pain wise afterwards. I skipped last week. Yesterday I had a new pt and allowed more aggressive manipulation. And paid for it with more pain last night through today.

It's not terrible but it is a step back. If there's any good news it's that my surgeon will see a good report when I see him on Thurs. since my extension got to zero.
That's it for me with PT--more or less with the blessing of the PT's. My rom is just fine and they know I have a gym membership; plus my numbers showed good improvement from last visit, as did my stride.

I've done pretty minimal pt at home, having decided to get the pain and swelling down first. I've focused on stretching and lately the bike. I was lucky that my rom was good coming out of surgery. Following the recommendations here, and my own sense, has proven to be the best way for me. The pain has been bad enough without following the more aggressive pt approach that was recommended.

There may be others who have a lot of scarring that would require more aggressive bending early on. I'm lucky again in that I'm told my scarring is minimal.

I've exercised for decades and have a good sense of my body. I know the routine that I have planned from here on out will work to hit my goals and that I can do it without forced pain--except as I feel better I'm almost bound to overdo things!

 

[Kiwigirl62]

the band on the outside of my right leg. The pt said that it might take around six months for these to stretch out (grow?) to where they feel normal

@hegel gosh i dont want to hear that today. ........nearly 3 months and sick of it -IT Band. Always stretched but have recently started doing massage on it each night -it helps but still hangs around mildly each day

 

[beachy]

I've had left side IT band issues ever since my knees began deteriorating. The limping messed up my hips and the stupid IT band is affected. Hip and glute strengthening helps, but I had to do it daily.
Can we start calling it SITB? (Stupid IT Band) lol

 

[hegel]

@hegel gosh i dont want to hear that today

I also massage the it band and my calf. It helps a little. The PT also suggested a roller for the IT band. I haven't done that yet but I'll try today. In my experience rollers can be painful but they do help.
Frankly I'l take this stiffness over post op pain any day! and in fact I'll take it over the bone on bone pain that I was experiencing pre op. A little discomfort and awkwardness seems like a piece of cake compared to the pain I had for the first four weeks after surgery! I still have some but I've thankfully turned the corner...

once I recover from seeing my PT two days ago...

p.s. I can now go up AND down stairs foot over foot!!! but was advised to take it easy for a while as the muscles involved have deteriorated over the last two years when I couldn't do that.

 

[beachy]

I only say this because of my experience with IT issues. And foam rollers. Check with pt about using the foam roller directly on the ITB. I was shown to roll on the glutes. Too much pressure on ITB can be bad. The rollers are great if used correctly....It hurts so good!
Totally agree the the stiffness/pain we feel now is so much better than bone on bone and those first few weeks post op.

 

[kmak81230]

Great report -- I'm sure that is a big relief! SFR (stupid foam roller) for the SITB!

 

[Celle]

I asked about my 'new' post surgery straighter leg resulting in stretched and tight calf muscles, as well as the band on the outside of my right leg. The pt said that it might take around six months for these to stretch out (grow?) to where they feel normal. The band (I'm forgetting its name) especially is made of tough material. And then the question became, is it scar tissue in my knee or these taut muscles that are restricting my extension? As it turns out, pt's can get a good sense of this. The woman that I worked with today felt/pressed around on my knee and said she couldn't feel much scar tissue--so it's the muscles primarily.

Those large muscles and tendons at the back of your leg do need time to stretch. It's not unusual for that to take several months.

There may be others who have a lot of scarring that would require more aggressive bending early on. I'm lucky again in that I'm told my scarring is minimal.

And no, you probably don't have any scar tissue that is holding you back. That "scar tissue" they go on about is actually quite rare. It's not just sitting there, waiting to develop.
Actually, aggressive bending and aggressive PT is the one thing most likely to cause the bad scar tissue - more properly called adhesions.

Yesterday I had a new pt and allowed more aggressive manipulation. And paid for it with more pain last night through today.
It's not terrible but it is a step back. If there's any good news it's that my surgeon will see a good report when I see him on Thurs. since my extension got to zero.

Lesson learned, I hope? Aggressive therfapy is counter=productive. Don't allow it.

I also massage the it band and my calf. It helps a little. The PT also suggested a roller for the IT band. I haven't done that yet but I'll try today. In my experience rollers can be painful but they do help.
Frankly I'l take this stiffness over post op pain any day! and in fact I'll take it over the bone on bone pain that I was experiencing pre op.

We do have this article about IT band issues:
ITB (ilio-tibial band) issues and treatments

 

[Jockette]

And so more evidence that the scary two or three month window for restoring range of motion doesn't really apply in all cases.

It doesn’t apply in anyone’s case.

 

[hegel]

Saw my surgeon on Friday. Took xrays before and saw the images on the screen--holy cow! that's some serious hardware!
Anyway, my surgeon was pleased with my gait, extension, flexion, everything. He said that I was well in advance of where people were typically at this point and that in fact I should cut back on pt, including walking. He said that my main priority now was to get off oxycodone. And he emphasized that recovery is long--a year, really--and I need another month and a half to heal my soft tissues (three months approximately.) He suggested that I try really staying off my leg for a day or two to see if my pain at night especially got better.

I didn't tell him that I haven't done much pt at all. It is true that I've probably been walking too much.

I'm taking 1 1/2 5 mg oxycodone at night before bed and one in the morning; but this week I was back to having to take one more in the afternoon due to one PT session and doing the bike, apparently. I thought that 2 1/2 over 24 hours wasn't bad but he said that I should be at 1 oxcydone at night, period, at this point.

In any case, I did take it easier yesterday and in fact my pain was less last night and today. I'll continue like this for a few days and see if it works.

 

[traceys]

Thanks a great checkup!! Coming off the meds is always the telltale sign how you are. I wish you success and ease in the process.

Way to go!!!

 

[hegel]

Sorry if this comes off like I'm bragging! I had nothing to do with having a good check up really--other than NOT doing a lot of pt, apparently! Simple luck and/or having a good surgeon, or maybe not needing a lot of work done on my bone.
I thought it was interesting how my surgeon was more concerned with my becoming addicted to oxycodone than anything. Ain't gonna happen--I hate the stuff. At the same time, I'm going to run out in about four days and I don't think that I won't still need it at night at least. I'll see if I can start to get by with only 1 1 /2 at night and nothing in the morning but acetaminophren.

 

[traceys]

Nooo. Didn’t take as bragging at all. We are here to cheer on each other’s victories!

I stopped my meds at week 6-7 but was only taking one a day anyways. May have been under medicating due to fear of them hence why I didn’t stretch as much.

Everyones journey is different so I love living vicariously thru those that are excelling! Gives me hope still.

 

[hegel]

One a day! Wow, I definitely needed more than that. Still do! And I ice at the drop of a hat.

As far as excelling: I'm still limited as to what I can do--like walk in the wooded park nearby, or down by the shore--or even hit the bike for an aerobic workout: I'm really out of shape! And I still only sleep an hour and a half at a time for some reason, and need a nap in the afternoon. So it's all relative.

It's not a race, but you're ahead of me in what I need to do next vis a vis pain meds. Everything comes at its own pace.

 

[hegel]

I'm under pressure to travel this Christmas. This would involve an hour and a half plane flight and then a three hour drive one way. I would be the passenger (if I have to drive there would be no way I could do this.) I'm divided on this--mostly reluctant but I don't want to offend people.

I'm just shy of two months out from surgery. I still need over the counter pain meds and a half oxycodone at night. I ice several times a day and night. I'm out on short trips to the grocery store etc. and on my feet in my small apartment. Two days ago I went on a flat 20 minute walk and it was overkill--I had pain for two days. I was back to icing a lot from that. So I have limits for sure.

Any thoughts?