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TKR MB's road to recovery - 7th month update

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Post op day 6 is not starting out to be a good one. My knee is still swollen although the swelling in the upper thigh has gone down. I cannot do a leg lift to save my soul - horrible groin pain whenever I try to lift the leg from any position - sitting or lying down. The groin pain started in the hospital and has only gotten worse. I haven't read about this type of pain in any other post - does anyone have any ideas what could be causing this?

I know I'm under medicated - I slept for over 5 hours straight last nite & woke up needing my meds right away. I'll be sure to set an alarm tonight. The pain is mostly the tight band across my knee, although every once in a while, usually associated with moving my leg up & down, my kneecap feels like it is on fire. Just the kneecap - has anyone heard of this? When I woke up in recovery screaming in pain, it was all from my kneecap. In retrospect, I either got the femoral nerve block that didn't work, or the study drug, that also didn't work. My knee is tight, numb, & warm. And the only "sharp" pain is kneecap oriented.

Plus the meds are doing a number on my gut. I have no appetite at all, I took a laxative yesterday with poor results so I'll try again today. The visiting nurse & PT are due today & I don't think there is much I can do. Oh and did I mention I've already dissolved in tears once and more to come I'm pretty sure.

I know I'm whining and I'm sure this shall pass, but for right now I'm miserable. And my knee is angry & doesn't like me either!
 
Whine away!, you have every right to. You are at the most miserable part of recovery. And you are correct: this, too, will pass. Not that it helps when you are in pain.

It is of extreme importance that you set an alarm so you get your medication on a constant schedule. As you have found, it is better to wake up in the middle of the night to medicate, than to sleep through and wake up in pain.

Kneecap on fire tells me you need to ice it more - and elevate. Your tissues are hot from surgery and their scramble to repair.

As far as your gut, I kept mine in check with prune juice and bran cereal. I also took some probiotics to replenish the good gut bacteria. For me, that counteracted the effects of the narcotics.

I had groin pain occasionally as part of my arthritis but haven't since surgery. I'm guessing you are moving (or trying to move) muscles that haven't been moved in awhile. For sure, talk to your nurse and PT about it.
 
I'm so sorry you are in pain. It sounds to me like you are undermedicating. Are you taking the maximum dose that has been prescribed of your medication exactly on schedule?

Ice, ice and more ice will help with that kneecap pain. Also, tell me what you are doing in the way of activity and exercises. It's quite possible that you're doing a bit too much for this early stage of recovery.
 
@Jamie - I think I might be under medicating. Yesterday I went from 6mg to 4mg of Dilaudid, but keeping to an every 3-4 hour frequency. I seemed to do OK yesterday, but not today, so I went back up to 6mg every 3 hours. Everyone is telling me I'm on a high dose, but if that's what I need, so be it. I think I was on a pretty high dose after my hips also. Like I've said, I do pretty well with pre op pain, but I'm a wimp when it comes to post op pain. At rest my pain is 2-3, with walking about a 5, exercising or moving around a lot I'm at a 7.

For exercises I do 15 ankle pumps every hour. Then 3 times a day I do heel slides, quad squeeze, glute squeeze - 8 times for each one. Twice a day I do toe raises, hip flexion, knee flexion, & knee lunges on a step. 8 for each one of those. But I don't do the 3 a day exercises at the same time as the 2 a day exercises. And then I walk with a walker 3 times a day for 5-10 minutes each time. And that's only 1/2 of all the exercises they told me to do. I can't do straight leg raises at all. And I decreased the frequency of all exercises from 12 to 8 times each. I thought they went a bit nuts with the exercise program. Do you think I'm still doing too much? PT came today and thought I was doing good - she measured me at 85/0, which is better than what they got in the hospital.

@BigBend, the gut is making me very uncomfortable. I woke up from the OR very nauseous which lasted for 2 days, so I didn't eat or drink very much. I've got to get on a regimen that works for me so it's one less thing or me to dwell on. It's never good when I dwell - I can get myself so twisted real fast.

Everyone told me knees were worse than hips & they were so right!
 
@dtmbf Mary Beth

Are the pain medications making you nauseous? You could possible get something to counteract the nausea from your GP or primary physician. Also, sometimes it helps if you take them with a dry biscuit, or something like that.

Some people have thigh pain from when they put a tourniquet on your leg while they did the operation. Maybe that's the cause of your pain?

I hope you start to feel better soon. Getting the pain under control is a big part of that.
 
dtmbf said:
For exercises I do 15 ankle pumps every hour. Then 3 times a day I do heel slides, quad squeeze, glute squeeze - 8 times for each one.
Click to expand...

[Bonesmart.org] MB's road to recovery - 7th month update
@dfmbf, Mary Beth, the above are all you need to do each day; and definitely drop the knee lunges and don't worry about the straight leg raises---your quads are not ready for that yet and when they're ready you'll have no trouble at all. Whatever walking you need to do to get around the house from one spot to another--bedroom to living room nest, to the kitchen and back, to the bathroom and back, back to bed.

Your knee and leg need more rest than exercise. Be sure you are elevating and icing, icing, icing, and icing some more. And, yes, do get your meds straightened out and take them on a schedule. I think the constipation is the worse by product of this surgery. Do whatever you have to to get your bowels moving and keep it up until you can get off the pain meds.

The next three to five weeks will be the toughest, but if you follow the mantras (see below) things will be much better.
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!

Do not worry about ROM at this point in time. With proper time to begin healing and getting the swelling down by elevating and icing and staying off the leg as much as possible, ROM will come---and will probably surprise you with how good it is.
 
This is so right. You actually are doing too much. Other than ankle pumps a couple of times a day and gentle bends and stretches also a few times a day you really don't need to do any of this stuff. As bottomshollow says....just walking around the house as you go to the bathroom, kitchen and bedroom is fine. My gosh, hon, you're less than one week out from surgery!!!

Don't let the folks intimidate you. You know yourself and how you feel better than anyone. Take the pain meds. That's what they are for. Only exercise when you feel like it and concentrate more on resting and icing. I think you'll feel much better. You need all the rest and sleep you can get any time of day or night...go for it!!!
 
Right. you can work up to those other exercises in a few weeks.
 
Hello Dear dtmbf,
Thank you for noting your ups and downs. It helps us on the other side before surgery. I hope each day is a little better for you . Going to add somr things to my packing list, like the alarm.
Hang in there.
 
Since yesterday was such a bad day, I didn't know what to expect when I woke up this morning. In fact I was kinda dreading it. But I must be in some type of cyclical pattern - a bad day followed by a good day. I set my alarm throughout the night so I woke up & was not behind on my meds. I was quite stiff getting out of bed but my knee did get looser, faster after walking around for a bit. I've bagged all but the most basic exercises like ankle pumps & heel slides. I refuse to even try the dreaded straight leg raise - my quad won't fire up to lift the leg unassisted and since PT isn't coming back till tomorrow to assist - they're not getting done either.

I really do not know what I was thinking but everyone's responses to my whiney post made me realize I was going off in the wrong direction. So I'm thanking everyone for being gentle when pointing out the errors of my approach to getting back to normal. I had my surgery one week ago as of today & why I thought my recovery would be better or easier or different - I have no idea. I've had a traumatic injury to my knee - planned but none the less traumatic- so I have given myself permission to be selfish. I am catching up on shows I DVR'd, talking to friends, trying to read (concentration is still spotty!) and generally being a slug. My husband is relieved I've "seen the light". I will probably need to be reminded so please keep after me. I refuse to do myself harm by trying to prove I can do more than I reasonably can do. I still have a long way to go...
 
@dtmbf
I'm so glad you have eased up and decided to be easy on yourself! Your knee will thank you.

Yes, this journey is a roller-coaster ride, two steps forward and one step back - but it is all progress.
 
@dtmbf welcome to this side of recovery! So glad you have found Bonesmart. (don't know what I would have done without it) I did not have a good experience in the hospital, they really have an agenda, of what I am not sure. @dogwheels sure has a point. We, Americans are so over zealous (I'll put it that way) to push, push, push, and for what? It doesn't make for a quicker recovery. In a lot of cases it angers the knee and slows recovery down. So, be adamant about your pain levels. Ice, Ice, Ice. I am sitting here icing 6 weeks out and it still helps swelling and pain. I wish you wonderful healing and come back often and ask any question you have, I certainly have. (and I have done my share of whining too, and that is allowed.) :yes:
 
@dtmbf - sounds like you are turning one of the corners in your recovery. Take it easy and be good to yourself. Rest, Ice, Medicate and Elevate.
 
You have made a giant step forward!!! It's hard to admit sometimes that we need significant "ME time," but the reality is that after joint replacement surgery, you need and deserve it! I'm happy to hear you see that and it sounds like you're going to do very well going forward. You made me smile today!!!
 
We're here for you any time you need a "reality check." :wink:
 
Sometimes the emotional/psychological part of this journey is harder than the physical (which is no picnic!). Nobody gets healed as fast as they want to and most of us find that trying to go faster than our knees allow, set us back. Continue to be gentle with yourself!
 
I'm convinced I'm on an every other day cycle - one good day followed by one bad day. So today is bad - major meltdown this morning to the point where my husband did not attend a meeting cuz he don't want to leave me alone. I see my pattern - I can handle just about any of the pain except for when my kneecap feels like its on fire. I think it's a flashback to my awful recovery room experience. And even tho I set my alarm all thru the night & took my meds, the kneecap was killing me this morning. Hence, the tears. Didn't last long, but I am known in the family as a drama queen. At least I can still laugh at myself (after the meltdown!)

PT came for the 1st real session and she was impressed with where I was at. She wasn't Atilla the Hun, did focus on regaining movement, but backed down the rhetoric when she realized I was committed to rehab but within my limitations. She thought my walk was exceptionally good for only 1 week out. And she didn't even bother to measure.

I do have a question - I supposedly only lost 50cc of blood during the surgery but I don't believe that. I did need to get a unit of cells post op which does suggest a bit more. And right now most of the blood seems to be sitting in my calf, which is not only swollen but has brilliant shades of blue, purple, green etc. I know I'm not suppose to use heat around the knee, but do you think I could use some moist heat on the back of my calf? Mainly for comfort. Or is it too close to the knee?

I have some kind of very expensive dressing on my suture line - an AMD dressing that has silver in it? Suppose to be real good for MRSA. Does anyone know anything about it?

Thanks muchly and here's hoping for a brighter tomorrow!
 
I had a lot of bruising on one leg, hardly any on the other. My first two weeks I had terrible calf pain, especially when I first got out of bed. My PT said my bruising was minimal compared to what she had seen and that calf pain usually resolved within 3 weeks. I did put some arthritis type cream on the back of my calves to relieve the ache. My pt said it was OK as long as I didn't get near my knees. But I wasn't bruised there. I would worry about anything but ice on swollen, bruised areas. You might run that by your OS or regular doc.

I think your every other day pattern isn't unusual. Up and down is the name of the game now. As the days continue, you'll find more up and fewer down. It's just damn hard to get through the first weeks.

I didn't have the burning under the kneecap feeling until more recently. Lots of ice has relieved it for me. This, too, will pass!
 
The meltdowns seem to be part of our journey. I think part of it, for me anyway, is the helplessness at the beginning. I have read that the meds have something to do with it as well. Be kind to yourself and your body, let people help you and get the rest your body is telling you that you need. It does get better!
 
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