TKR Mystikfairy's RTKR August 21

[mystikfairy61]

Here I am on the other side!! Staying 23 hours. Already been up with PT and walked half way to the door and back. They put a scopalamine patch on me which I am sure it has helped since I have had no nausea. Will check in later.

 

[benne68]

Welcome to the Healing Side, @mystikfairy61! And congrats on your elite status as a double knee-double hippie member!

Even though you have lots of experience with recovery, I will leave you our Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind we are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

KNEE RECOVERY GUIDELINES

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
4. PT or exercise can be useful BUT take note of these
the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy
5. At week 4 and after you should follow this
Activity progression for TKRs
The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

Keep us posted as you feel up to sharing!

 

[mystikfairy61]

@benne68 Thank you for all of the helpful info. It has been a while and a refresher was really needed. I will wait til I get home tomorrow and read everything again.
I was a bit shocked that I was ordered a regular diet since I had general anesthesia. I guess they do it automatically since alot of his pts get epidural. To be smart I did not eat lunch but gave it to my hubby. I am attempting dinner but eating slowly. Have been up.and walking several times. Will update tomorrow.

 

[mystikfairy61]

Good morning all. Slept about 4 hours straight last night. Dr came in and took ace wrap off the leg and drain out. Left a little battery pack attached to a 2 inch wide strip down the length of the incision. Leg and down to ankles still numb feeling from the block but I'm walking good. Was told that everything went good during surgery and that TED hose will be put on the operated leg before I go home. PT came by and I walked and did steps since we have 3 at home. She also had me put my operated ankle on a pillow to allow it the use gravity to straighten the leg. Then the worst part, the bend. Of course on postoperative day, it is better at 75 on my own and 80 assisted. This morning since there is more swelling I was only able to get it to 60. She wanted to push on it and I politely told her that I had previously rehabbed a knee in 2014 without having alot of pain inflicted and that I would do what I had to do when I get home. She stated she had been doing this 30 years and that all TKR's hurt. I said I realized that it is painful but that I didn't feel it was necessary to make me cry. Hoping my home PT will be a bit less pushy.I am having issues doing heel slides at the moment but I am thinking it is due to the numbness that is still there. Will check in later.

 

[Layla]

Slept about 4 hours straight last night

Good for you, mysticfairy!

I am having issues doing heel slides at the moment but I am thinking it is due to the numbness that is still there.

Will they allow the old plastic bag under the heel trick to aid in this exercise?

I am glad you stood your ground as far as not allowing this 30 yr veteran to forcefully manipulate your leg,
aka inflict pain upon you. As you know from past experience, your range of motion is currently limited, but it will naturally increase as the swelling subsides and the pain eases.

I hope today is a good one! Congrats on your new knee.

 

[Jockette]

I politely told her that I had previously rehabbed a knee in 2014 without having alot of pain inflicted and that I would do what I had to do when I get home. She stated she had been doing this 30 years and that all TKR's hurt. I said I realized that it is painful but that I didn't feel it was necessary to make me cry.

You go, girl! Stand firm on how you want your rehab to go.

Regaining our ROM does not require forceful bending or painful exercises. That is counterproductive.

Regaining our ROM is more about Time than repetitions of a list of exercises.

Time to recover.
Time for pain and swelling to settle.
Time to heal.

Our range of motion is right there all along just waiting for that to happen so it can show itself.

In the general run of things, it doesn't need to be fought for, worked hard for or worried about. It will happen. Normal activity is the key to success.

 

[sistersinhim]

She stated she had been doing this 30 years and that all TKR's hurt.

Well, if she has been doing this for 30 years, then it is time for her to get more up-to-date training. The newer PTs and OSs mostly agree with the Bonesmart way of recovery, that the no-pain=more gain is the way to go! Good for you telling her no! Continue on with that way and your recovery at home should go fine.

 

[mystikfairy61]

Aug 23, 2023 post-op Day 3

Sleep- Last night wasn't bad as far as sleep. I took midnight dose of pain medicine and after 20 mins was able to doze off. Slept thru until around 2:45am. Went to toilet and repeated the cycle from 3am, waking around 6:30am, other than my pain med alarm waking me at 4am.

Pain/numbness-I still have numbness from behind my toes across the top of my foot. Feeling then comes back and about 1/3 of the way up my shin, externally, the numbness is there again til 1/2 way up my thigh, which if I remember correctly, is to be expected.

Moving about- When I am walking, I do my best to try to take normal heel to toe steps. PT is coming this afternoon for first visit. I had been trying to do heel slides but my knee does not want to do it yet so I just go as far as it will go. I can sit on the side of the bed and I can do a fairly good bend but I still don't push it to the point of pain. When I am laying down, I push my knee into the bed to strengthen my quad. I don't use my hands at all, just do what the muscles will do. And of course ankle pumps and rotations.

Appetite/constipation- My appetite comes and goes. Not pushing it. I am drinking yogurts with probiotics in it. I was able to poop on Sunday before surgery on Monday but nothing since. I have prunes, smooth move tea, milk of magnesia, exlax and miralax on hand plus Dr. Has me on colace. If anyone has suggestions on what and when to take things to get results I am open. Also drinking water as well.

Hope this made it a bit easier to read.

 

[benne68]

Hi @mystikfairy61! All sounds very normal for two days post-op!

but my knee does not want to do it yet so I just go as far as it will go.

Yes! Don't push into pain -- and don't let the PT push you!

Your poor knee is very, very swollen inside -- so, of course, it doesn't want to bend. Ice and elevate as much as possible. Stay on schedule with your pain meds. As you know from experience, the bend will come with time.

Sending hugs!

 

[mendogal]

From personal experience with both surgery and prescription pain meds: colace (which simply holds more water in the stool) doesn't do anything to stimulate peristalsis. It's a good thing but likely not quite enough. Even without taking pain meds, the surgical process will basically put your gut to sleep. With the meds yes some of us need more!

Smooth move has senna, which directly stimulates the gut. So that and prunes is a good start with the colace. However be prepared to need something stronger every few days for a while.

Miralax is safe and you can follow the directions. After my second replacement I ended up calling my ortho practice in desperation - they sent in a prescription for Lactulose. Safe and very effective.

 

[Layla]

You're an old pro at this, mystikfairy.
I hope the constipation ends soon and you'll be rockin and a rollin
You must have a ghost writer. Your posts are well written right out of the gate. No typos or sentences that make one scratch their head. Makes me chuckle. I hope tonight is a good one!
@mystikfairy61

 

[mystikfairy61]

Visit with PT was beyond my expectations. He said that he did not agree with forceful anything. He stated his measurements are done when I have gone as far as I comfortably can. Also said that if I continue to do as good as I am now, that I may only need 4 weeks at home and no additional. His philosophy is walking is the best therapy. He will be back on Monday. Just wanted to throw that in before I went to bed.

 

[Jaycey]

Sounds like your PT is a gem! Great attitude!

 

[mystikfairy61]

Aug 26th,2023 Post Op Day 5
Sleep- Sleep still hasn't been too bad. I still wake up to my alarm for meds but go right back to sleep. Occasionally I stay awake for a bit around 4am but usually only 20 mins or so. Nap a good bit during the day when the mood strikes.

Pain/Numbness- Pain has stayed at bay but I'm sure my icing and elevating has helped alot. Not much swelling or bruising at this time. No soreness/bruising where the tourniquet was either.The front of the knee is a bit sore below the knee itself but not severe. Numbness is annoying but I take it as a blessing too. Top of foot is still numb and external side of leg is numb. The most painful area is behind the knee where everything is painful and tight there when I attempt to use my leg lifter to pull my leg into a partial heel slide.So at this time not doing the heel slides, just trying to be being patient, icing and elevating. I am glad the head of my bed raises but I am ready to get some time in my recliner. I am also sitting in a chair in my bedroom that has straight back and arms. I have to be sure it's cool enough for my dogs to go outside before I attempt my recliner so they don't try to jump on me.

Appetite/constipation- Appetite not too bad today. I didn't want breakfast but did have lunch. Didn't have much of an appetite yesterday due to constipation. Yesterday I got my daughter to pick me up a bottle of mag citrate. Drank half of it along with a 20 oz bottle of water. This worked for me within 4 hours and today, I can say I am comfortable in that area. If anyone can give suggestions of what to do and how often to do it to keep it that way, I'd appreciate it.

Moving about- Doing pretty much the same thing. Walking to bathroom or to the kitchen several times a day. I can tell my energy level is still low since I am only a few days out, so not pushing myself.

 

[mystikfairy61]

Aug 29, 2023 Post op Day 8

Sleep- Last night was a restless night. That went over into today and I seemed to sleep alot more today. Overall I got in about 6 hours but it was in short bursts.

Pain/Numbness-Numbness has pretty much gone with the exception of still have it in the top of my foot and of course lateral side of leg. With the return of feeling comes the zingers and the burning from the nerves. That probably contributed to my restless sleep. Also had a bit of pain in my buttock that I am guessing was from the new addition to PT. All I was doing was shifting my hips a bit to gently stretch the outside of the knee. I have iced that area today and have not done that again at least for now. I spent some time in my recliner which felt wonderful. Was a nice change.

Appetite/constipation- Appetite still down. I have been eating small breakfast and dinner. Had not really been going to bathroom regular since I hsd the msg citrate. So I added exlax today and was able to go within 20 mins so everything good there.

Everything else is pretty much the same.

 

[sistersinhim]

It sounds like you're coming along normally. Can you eat nuts? They helped me with my constipation. Also, craisions.

When I had problems sleeping I went from the recliner to the bed all day and all night. Switching between the two helped me be able to relax different areas of my body. What a pain the first months can be when it comes to sleeping comfortably.

 

[Axx72]

Wish I could have slept as well at the beginning. I was up constantly, shuffling around the kitchen, trying not to wake anybody up. You seem to have that much more dialed

As far as the constipation goes, I ate at least 3-4 prunes in the AM and again in the evening to help with gut issues overnight.

Here is another constipation tip that may help you. During the early stages of recovery, once a day I would have a 16 ounce glass of water with 1 Tbsp of maple syrup and a quarter teaspoon of salt in it. it really doesn’t taste bad at all especially if you drink it at room temperature. Sounds kooky but the potassium, magnesium, sugar content in maple syrup and the quarter teaspoon of salt, enable your body to absorb the fluid much more easily rather than simply passing it through. Having that extra hydration helps a lot with constipation. As a relatively high-level athlete, by still use this for hydration.

Was never a big fan of ‘out of the box’ drugs if I can help it. I had very little back-up issues throughout the first 4 weeks.

@mystikfairy61 Your updates are super interesting. Those little victories are what get us through.

 

[mystikfairy61]

I can't eat nuts but I love craisins. May have to look into getting some. I normally don't have issues along that line but for some reason this time around has affected me more than usual.
I have been going from the recliner to the couch to the bed. Part of my problem at the moment is a move I did Monday with PT that I haven't repeated. He had me just moving side to side slowly stretching the outer part of my knee and it made my sciatic mad I think because it hurts in my right buttock. Been icing that area. I go to my post op appt tomorrow to get the PICO dressing off. It has been an annoyance because it had a battery pack attached. Will be glad to be rid of it. PT will be here in a few mins but I already let him know we needed to take it easy today. Sending healing thoughts to all who are in the same boat as myself and calming thoughts to those awaiting their turn.

 

[Layla]

Good luck at your post op appointment tomorrow!
Let us know how it goes.
@mystikfairy61

 

[EalingGran]

Here is another constipation tip that may help you. During the early stages of recovery, once a day I would have a 16 ounce glass of water with 1 Tbsp of maple syrup and a quarter teaspoon of salt in it. it really doesn’t taste bad at all especially if you drink it at room temperature. Sounds kooky but the potassium, magnesium, sugar content in maple syrup and the quarter teaspoon of salt, enable your body to absorb the fluid much more easily rather than simply passing it through.

Or you could try the rehydration packets ( Dioralyte in UK) used for fluid/ metabolite loss in diarrhoea in kids. They would ensure adequate potassium/ magnesium etc whilst drinking loads of fluid to improve constipation