TKR October 6, 2016 2½ weeks post op'

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little red canoe

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In 1971 they took all the medial meniscus out due to a ski accident. I was told that I would suffer from arthritis in ten years but there was nothing that could be done. 45 years later I found myself needing two canes just to walk to the street and in pain all the time like knives. So it was time. I had to go through the hoops of cortisone shots and Synvisc before Medicare would cover TKR.

I was in the hospital 2 days for PT and OT and then home. PT started right away . I have had it in home every day the first week and three days the second week. I have some 20 exercises to do twice a day. None are to hurt. The PT says if it hurts stop. I have 105 degree flexion and complete extension. Before TKR I could only straighten knee to 20 degrees. Next week I get discharged to outpatient PT and a bike (I hope)

I am some 17 days in and use a cane outdoors on uneven surfaces. Inside I work on doing a good heel toe walk at slow speed and usually forget where the cane is. I am working on my gait as my bad knee forced me to limp. The TKR made that leg 1½ inches longer so it matches the other leg

The things that hurt are weighting both legs to get up off the toilet or a low chair (so I try not to yet). I can do small stair with bad leg ahead. But that's not a normal stair rise.

I was prescribed Oxycodone as needed The first week I was nauseous and had no BM. Finally it came. Colace made me have diarrhea. I don't tolerate Smooth Move. I remember that from chemo last year. I can't use Smooth Move ever again.

I am impatient to get going. I usually get out once a day to go to one store for ten minutes or so. Last year was spent in bed suffering from chemotherapy. I can't do that again. I am impatient.

My main gripe is that my gastrocnemius on the bad leg atrophied over the year and these stretches that I must do to regain a gait make it hurt at night. It does feel better stretching it. It's funny to watch me in the morning... .streeetchhhh and then pee.
Also my thigh hurts probably from the tourniquet and my shin feels like its got shin splints

The knee? Doesn't hurt at all at rest. Pain meds? Only 30 min prior to PT and again prior to bed (Tylenol 1000mg). But the upshot is I can't sleep. That muscle has a deep nagging ache. I hate to go back to Oxycodone as it plugged me up and the nausea was worse than any ache.

I try to ice often but the swelling is minimal. When is heat on that stretching muscle a good idea?
 
I usually get out once a day to go to one store for ten minutes or so.
That is not a good idea at only 2½ weeks out. Not good at all.
these stretches that I must do to regain a gait make it hurt at night. That muscle has a deep nagging ache.
Also my thigh hurts probably from the tourniquet and my shin feels like its got shin splints
the upshot is I can't sleep
The knee? Doesn't hurt at all at rest.
Oh yes? What about all those points above?
And tourniquet pain does not last that long!
Only 30 min prior to PT and again prior to bed (Tylenol 1000mg).
Again, ill advised at only 2½ weeks. You need regular doses of something. If you cannot tolerate oxycodone, ask if you can try something else like Tramadol. But you have to accept that constipation is inevitable with any good pain med. You just have to use something regularly to counteract it. Prunes are good! Read this too Constipation and stool softeners.
I try to ice often but the swelling is minimal.
Icing is very little about swelling - it's also about pain. Or aching, or whatever. Ice is nature's most excellent pain management device!
When is heat on that stretching muscle a good idea?
Never! It just draws fluid to the site and thus pain.

You really need to read all these recovery articles - read and digest each and every one!

Here are the BoneSmart mantras ....
- 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!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

Next is a FAQ (Frequently Asked Questions) thread.

And here are some very crucial articles
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs

Myth busting: no pain, no gain
Activity progression for TKRs
Heel slides and how to do them

Extension: how to estimate it and ways to improve it

Elevation is the key
Ice to control pain and swelling

Healing: how long does it take?
Chart representation of TKR recovery
Myth busting: the "window of opportunity" in TKR

Myth busting: on getting addicted to pain meds

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?
 
I tried Tramadol. Does nothing. Two does nothing. At some point I have to stretch the gastrocnemius.. which is my main point of discomfort lest I go to gimp again. Its really remarkable how my right leg is much less muscular than my left.
I suspect that my year of chemo has really spooked me from constipation and all that discomfort. and I am just sick and tired of being sick.. though I did paddle Lake Superior for three weeks this summer.

Stool softeners I know from experience give me horrid diarrhea that someone has to clean up.
 
I tried Tramadol. Does nothing.
Did you take Tylenol with it? I used this routine which was very effective. Tylenol and Tramadol enhance each other nicely.

aa Tramadol routine 1.JPG
 
Hi and welcome, little red canoe... wow: it sounds like you have had one heck of a couple of years! I would probably be impatient, too...but, really, think about your knees again... If, for many years, your knees were in terrible pain to the point that you lost major muscle volume, you need to back off from your impatience a bit and give your poor leg some grace around getting well again. I think you had only one knee done; am I correct? Please reconsider how hard you are being on your new baby knee and treat it a bit more gently... I think Josephine makes this case above about how much activity you're doing, and how hard you may be working on your exercises, etc., as they may just be too much just yet and your leg, in its own wisdom, is telling you to back off, perhaps...

That's a drag that you can't take stool softeners and can't also take some pain medications, but at least you do know that about your body! The Tramadol-Tylenol combo has worked very well for me starting about the 6-7th week until I was able to discontinue the Tramadol completely at about the 11th week. Now I just take Tylenol, and even if I skip a dose at night, I'm none the worse for wear. That combo might be worth your try?

Josephine's recommendation to continue to ice is smart I think, too. It seems to quell pain as well as decrease swelling, as well, which for me has been an annoyance... where your calf aches at night,can you apply ice there? That might help that area and give you more relief...

I would highly recommend you peruse the reading material, too, and when I was sent my copies, several of the pieces I read several times...for reminding & encouragement! I also had some odd other aches and pains too, and am relearning a proper walking gait as well, but my PT group didn't start with that until about week 6 or so, until I had good basic strength back and was better able to control my muscles, instead of them controlling me....

Good luck as you make your way through everything, and let us know how you do... we're all here to help each other out!

PS: I have many fond memories of Maine as a young person, spending several summers there many years ago...
 
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I had a great sleep last night. My doc said that the first two weeks are hard on circadian rhythms and I should expect another week of wacked out sleep cycles. I did go to bed with ice and elevation and slept just great for ten hours. I had two Tylenol before bed. Nothing till..well this am before exercise.

Knee still does not hurt. My PT said never to do anything that hurts. I am working on my quads and hamstrings and gastrocnemius and stretching feels SO GOOD!

My point is to get up and at em if it doesnt hurt. I am trying to pay more attention to icing when watching TV but I am having trouble knitting with my knee up and head down!

I'm a hiker and want to be ready for when the ice hits. That will be soon. Just having weak muscles with ice and snow is going to be dangerous so that is motivation for me..

I think that aches are worse at night and worse of all when one cant sleep. The immune response works overtime so it's a balancing act of not upsetting it while maintaining some mental sanity.

Next week I am in outpatient PT and have not met the provider. If it's a PT Nazi I am out of there.
 
Wow, you are expecting to do a lot so soon. I am at 4 and 10 weeks out on my knees, my PT says I am doing better than her other knee patients, and I wouldn't even consider being ready for hiking "when the ice hits." I'm hoping to be able to walk around fairly comfortably by Christmas at which time I will be 3 months out from my last replacement. If experience is any indication, I will still be a bit stiff and sore, and my knees will be very unhappy if I spend a lot of time on my feet. If you push too hard, you will pay the price.
 
bed suffering from chemotherapy

I Can so relate to how badly chemo wreaks havoc on a body. 2013 was like a lost year of my life due to the mysery of chemo.

Welcome to bonesmart. sounds like you are doing mostly good. Just be careful not to overdo
 
@kayamedic
I understand your desire to get active as soon as you can, but do remember that your knee has been through very major surgery. It still needs lots of rest, so that it can recuperate. You can't heal it by rushing.
Activity progression for TKRs
 
My PT said never to do anything that hurts.
That is very wise and a somewhat rate response---the PT is a "keeper." All too often, PT folks want to either push you through the pain or have you work until it hurts. Taking it gently is the way to go.

My point is to get up and at em if it doesnt hurt. I am trying to pay more attention to icing when watching TV but I am having trouble knitting with my knee up and head down!
Where you are in recovery, I believe that you are expecting too much and doing too much, too soon. This will test one's patience, but it is important to remember how much surgical trauma your knee has sustained, and that a recovery can be slower and longer than we are prepared for---a full recovery can take up to a year---and longer---and the more you work on it, the slower your recovery may be.

If its a PT Nazi I am out of there.
Excellent decision!!:thumb::thumb:
 
I'm waiting for my hot date. He is late. (PT) I haven't walked today. I have slept with Jerry Springer (ugh) in the background I am about right on length of walks save the grocery store. Like old people I lean on the shopping cart like a walker.

My knee is 0 today. Gastrocnemius is better . Its not shortening overnight
 
Hi little red canoe, welcome to BoneSmart.

Sounds to me like (a) you're doing it pretty much right (b) your recovery is as good as it gets.

But as Josephine and everyone says, you can easily overdo things, which can set you back. Underdoing things won't.

The mantras are the distillation of what all of us here have learned. Summarised but Rest, Ice, Relax.
 
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Welcome to BS, it seems like you are doing well...

I understand your desire to get your life back, but sometimes in our eagerness to hurry things along we end up causing ourselves unnecessary pain and discomfort, I am sure you don't want to slow down your recovery...take things slow and you will be able to do all of those things you are looking forward to once your knee is healed.

Good luck!!
 
Today some PT assisted.. On my own to 107 and with assist 114 I am a wimp with pain and asked him to stop.
Also walked 10 minutes outside which felt wonderful
PT says no lateral motion much yet so no raking leaves.
No pain but off to Tylenol and bed.. Three ice sessions today. Swelling minimal. Can see kneecap.. Scar almost not there... wonder how they did that.
 
Please don't let PT assist with your ROM by pushing on your leg at all. My OS has indicated rule that I should never do anything that hurt me at PT. I can bend my knee to 130 while I could only bend to 95 before my revision and I did it with very minimal therapy.
 
PT hurt but stopped hurting right away.. Nothing lasting. I'll back off in the future

It sure didnt hurt as much as when my good leg slipped out from under me and bent my bad knee to at least 145.. dont want to do that again!

I have also had a heart attack ( luckily with no residual damage) and movement and cardio workout is very important... Bed rest could literally kill me.

I understand mantras. I also think you have to listen to your body and mine is screaming for walking to get the pulse rate up.

Yes all this joy happened in 2 years
 
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You really have had a difficult two years. Hopefully this is the beginning of a new and healing phase for you.

I hear you on the body crying out to move. I find that 5 minute walks every couple of hours keeps my heart pumping without rushing my knee (I'm at 2 weeks). It's a fine line between resting enough to let knee heal and cardiac deconditioning. I do some upper body exercises while lying with my knee elevated. I know if I give my soft tissues time to heal right now, I'll be able to get back to "normal" more quickly.


Shelia
RTKR - 8/23/16
LTKR - 10/11/16
 
In those two years yet I have found that I have spent 100 days camping. Sometimes in a tent ( canoe camping)and sometimes in a trailer. I can't imagine crawling out of a tent today....yet..
After bone on bone for 45 years or most of ( all the medial cartilage removed in 1971) my decision was made on a rock in the White Mountains. I was sitting there whimpering when a hiker bounded down the trail and asked if I was ok We got to chatting. He had a bilateral knee replacement last year..

Time to walk.. and maybe one or two of my library of exercises. I am learning that you don't do them all at once. I'm learning that if it hurts swelling happens. My husband is confused. He has always done as the professionals have dictated. To him my skipping PT is a no no. if the dr says you must do it you must
 
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