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TKR My journey to recovery<

Josephine

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I do get pins and needles in my toes, does that mean my stack is too high?
In which one do you get pins and needles?

I wanted to get a lounge doctor pillow, but they are not for sale in the UK and the postal charge from the USA is massive!
They are available in Amazon.co.uk and if you order from Amazon.com (the US site) they refer the other to Amazon.co.uk so your shipping should be as per local anyway.

But to be honest, I'm not so keen on the LD as it's too high. These are available on Amazon.co.uk

lounge doctor uk.JPG




But this one is just as good and half the price!

leg rest pillow.JPG
 

lisabl

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I can vouch for the second one that Josephine posted. I have it and if I need my leg higher I actually put a normal pillow ontop so I can raise both legs as I find it more comfortable to sleep with both legs up. The leg raiser is fine for 1 leg on its own but a bit narrow unless you have skinny legs (I don't!!!!).
 

Josephine

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Try putting the extra pillow underneath the rest. I do that all the time. It's so much better because the shape of the rest means you don't have any pressure on your calves.
 
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dogwalker2

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Great idea, thank you for posting the link. Will look at getting the cheaper one as that seems great. Thank you all

Josephine, you asked which foot got the pins and needles, it is the operated leg foot. I reduced the stack height and that seems to have solved it. Thanks.

Josephine, just one question. Would the better life leg raiser be ok with my left THR (same side as my TKR)?

As well as heel slides I have now added in the flexion exercise shown on the bonesmart link. Aim to do both 5 times over a day, along with some gentle ADLs and 2× 5min walks round house and garden.

Swelling is better but pain is definitely focusing on the inside side of the knee, on the edge, to the side and below where the kneecap must be. Sharp shooting pains and a strong pain that comes on when sliding back from a heel slide (I am reducing the angle back to about 50 degrees and helping my foot back rather than sliding it.).

Anyone know whether it is a cut tendon healing, a bit of muscle or the actual knee cap causing this???
 

Josephine

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I reduced the stack height and that seems to have solved it. Thanks.
Jolly good!
Would the Better Life leg raiser be ok with my left THR (same side as my TKR)?
I would imagine so.
I have now added in the flexion exercise shown on the bonesmart link
What link is that?
Aim to do both 5 times over a day
Much better to aim to do none!
Anyone know whether it is a cut tendon healing
No tendons are cut during this surgery. But I can hazard a guess what is causing it.

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 
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dogwalker2

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The link is the "how to do heel slides properly". There is the bit about heel slides and if you scroll down there is the flexion one on the chair. When should i be doing these ones then?
 

Celle

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I only ever did the heel slides while sitting on a chair - it's much easier than doing them on the bed.

In fact, I often didn't use a chair. I used to do them while sitting on the "throne" in the bathroom. We had tiles on the floor and I used to measure how much my bend was increasing, by seeing if I could move my foot closer to the next join of the tiles.
 

Josephine

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Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?
ai63.tinypic.com_eta39s.jpg


4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.
 
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dogwalker2

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1. Varies. Much of the time it is about 3 (mostly stiffness, swelling and hypersensitivity on skin below, on and to medial side of kneecap), but between 4-7pm it peaks to about a 7 with pain below, on and to the medial side of the kneecap with strong burning feel on skin.

2. 4 × 1000mg paracetamol at 6am, 12 noon, 6pm, 12 midnight; 2 × 400mg ibuprofen at 9am, 9pm and 1 × 200mg ibuprofen at 2.30pm (it was 3 lots of 400mg ibuprofen, but I am trying to cut down slowly as suggested by hospital). I cannot take Tramadol or codeine.

3. Slight to moderate (varies during the day). I attach a picture taken at 10pm, pretty much peak swelling as it feels very tight.

4. I don't really know about my ROM. At my one and only PT session on day 12 my flexion was 85 and my extension +5. However, I am no longer doing my PT quad and stretching exercises or any flexion ones either so now both legs are +15 for extension (using your diagram/instructions in another thread) and I don't know what my flexion is now, but I am sure it must have gone back to less than 80.

5. I ice my leg for 40mins a session between 4 and 6 times in 24hrs

6. I elevate my leg at least 6 times a day (approx 40 mins) and in bed at night.

7. My ADL has become my PT. I feed the dogs, wash up (I limit myself to sessions of 10mins at a time), iron (again 10mins a time), share cooking with my husband (try and limit standing to 10mins at a time), make the beds (very simple), do light laundry. I walk for 5mins twice a day outside, I find that really easy. I go up and down the stairs as needed.

8. I am not doing any PT exercises at home now as I have got totally confused about what I should be doing and when. I seem to keep getting it wrong.

Two days ago my regime was:
laying down heel slides x5 times a day, but this began to give me sharp medial knee pain on straightening)
seated flexion x5 times a day to the top end of discomfort but not pain
hip abduction x10 my left THR was complaining and this helped 3 times a day
short quads x5 3 times a day
bending knee behind to raise heel towards bottom x5 3 times a day
gentle lunge on stairs x5 3 times a day

Currently no outside PT.
 

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Josephine

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1. Varies. Much of the time it is about 3 (mostly stiffness, swelling and hypersensitivity on skin below, on and to medial side of kneecap), but between 4-7pm it peaks to about a 7 with pain below, on and to the medial side of the kneecap with strong burning feel on skin.
And evening peak points to two things: either inadequate medication or extra activity during the day.
2. 4 × 1000mg paracetamol at 6am, 12 noon, 6pm, 12 midnight; 2 × 400mg ibuprofen at 9am, 9pm and 1 × 200mg ibuprofen at 2.30pm (it was 3 lots of 400mg ibuprofen, but I am trying to cut down slowly as suggested by hospital). I cannot take Tramadol or codeine.
Oh that's a shame because you need something else extra.
3. Slight to moderate
okay
4. I don't really know about my ROM. At my one and only PT session on day 12 my flexion was 85 and my extension +5
got it
5. I ice my leg for 40mins a session between 4 and 6 times in 24hrs
That's good.
6. I elevate my leg at least 6 times a day (approx 40 mins) and in bed at night.
And this
7. My ADL has become my PT. I feed the dogs, wash up (I limit myself to sessions of 10mins at a time), iron (again 10mins a time), share cooking with my husband (try and limit standing to 10mins at a time), make the beds (very simple), do light laundry. I walk for 5mins twice a day outside, I find that really easy. I go up and down the stairs as needed.
Jolly good routine and control.
8. I am not doing any PT exercises at home now as I have got totally confused about what I should be doing and when. I seem to keep getting it wrong.
Well I think you know by now that we recommend no formal PT.
laying down heel slides x5 times a day, but this began to give me sharp medial knee pain on straightening)
seated flexion x5 times a day to the top end of discomfort but not pain
hip abduction x10 my left THR was complaining and this helped 3 times a day
short quads x5 3 times a day
bending knee behind to raise heel towards bottom x5 3 times a day
gentle lunge on stairs x5 3 times a day
Yeah,specially like that!
 
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dogwalker2

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@Josephine. Thank you.

I was thinking of looking at co-codamol. I know it has codeine in it but I think it would be ok combined with paracetamol (which really suits me) as I agree it seems that the 2.30 half-dose of ibuprofen followed by a 4 hour gap till my 6pm paracetamol, combined with a peak in activity, is just not cutting it.

My worry is that the hospital wanted me to reduce my meds starting day 8 and I have failed pretty dismally in that regard. I would like to reduce the ibuprofen as I took them for so many years that I now have to have lansoprazole to protect my stomach and even then I get some stomach discomfort.

What would you reckon to losing the 2.30pm ibuprofen and trying a co-codamol, though I would need to look into the paracetamol limits of course.

Do you have an idea what the cause of the strong pain beneath, to the medial side and on the kneecap when straightening leg from a bent position can be? It is also the same area that gets the weird hypersensitive, burning skin feeling? Earlier you said you could hazard a guess, what do you think bit can be? It is my main pain area.

Glad you like my ADL routine
 

Josephine

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I would like to reduce the ibuprofen as I took them for so many years that I now have to have lansoprazole to protect my stomach and even then I get some stomach discomfort. What would you reckon to losing the 2.30pm ibuprofen (and) trying a co-codamol, though I would need to look into the paracetamol limits of course.
I thought I'd already cautioned you off the ibuprofen. And if you are getting break-through gastric reflux, then you need to switch to Omeprazole which is stronger. And don't think that because you stopped the ibuprofen you can stop the PPI because you will need to keep taking it for another year or two minimum. I've been on it for about 20 years!

As for the co-codamol, there is nothing magic about this preparation. You'd be much better getting a script of codeine and paracetamol separately. Also because you can then take the paracetamol according to limits which is 4,000mg per 24hrs (1,000mg 4 times a day at 6hrly intervals) and take the codeine in varying amounts and times according to your needs.
Do you have an idea what the cause of the strong pain beneath, to the medial side and on the kneecap when straightening leg from a bent position can be?
How about it being post-op pain?
Earlier you said you could hazard a guess,
Yes, my 'guess' was post-op pain!
 
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dogwalker2

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@Josephine. You did indeed say about the ibuprofen but I was not sure what to put in its place. Your idea of paracetamol and codeine as separate tablets is a good one. It takes ages for me to get a GP appointment so I will see if I can get codeine separately at the pharmacy. I won't be able to get a prescription for paracetamol anyway, our surgery won't do that. I will try low strength codeine first to mitigate the side effects.

I didn't realise about having to take the PPI for so long, glad to find that out. Thank you.

Post-op pain, absolutely! I just wondered what part of the implant or what particular part of the structure of the support muscles were in that area as it is very specific pain and I like to get a mental picture of what hurts, so to speak!!
 

Josephine

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From 1 February 2018, all formerly over-the-counter (non-prescription) codeine-containing medicines for pain relief, cough and colds are available by prescription only. So you wpn't be able to do that.

I suggest you try and get your GP to prescribe 15mg tablets so you can take one with two paracetamol generally or 2 if the pain is bad. But don't forget that codeine has a tendency to cause constipation so be ready with some stool softener! I preferred Fybogel!
 

Celle

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I won't be able to get a prescription for paracetamol anyway, our surgery won't do that.
You don't need a prescription for Paracetamol. It's available without prescription and you can even get it at the supermarket.
 

Josephine

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I get my paracetamol on prescription! Have done for years and I get them in a pot of 100 at a time! It depends upon the doctor!

It's also an annoying fact that when we buy them over the counter, we can only buy 16 tablets at a time.
 

lisabl

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@Josephine You can get larger quantities of Paracetamol from pharmacies at supermarkets, and as a pay for prescriptions gal its so much cheaper.

@dogwalker2 If you ring reception of your GP and explain about post-op and codeine, if they have copies of you hospital discharge and medication, you may not actually need to see a doctor, they will just get one to sign the script for you. At leasts that's what they did at my GP coz I tried to get an apt for 2 days and failed when ringing for emergency apt at 8am each day (held in queue and by the time I was near front all apts had gone!).
 

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