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TKR One month out from surgery, what should a typical day look like?

12 hour shifts at 12 weeks? Don't do it!!! I am a healthcare worker at a large, busy hospital, I have the same schedule (except night shift), and I speak from experience. I was supposed to go back at 12 weeks, but I wasn't ready so I extended my medical leave. Now I'm scheduled to return to work next month at 18 weeks post op. Even then it will be rough for a while- I went through this last year after my LTKR and it was not fun. Eventually I got back to something approaching normalcy, then my right knee deteriorated and was replaced almost exactly one year after the left one. I have had several conversations with my supervisor about my progress this time around. She says she'd rather see me smiling than crying. :egypdance:

Your OS won't give you any grief about needing more time off. If anyone does, tell them it's a safety issue. Hospitals are all about safety. Best wishes on your recovery. Keep us posted!
 
It is amazing to have someone to talk to who has been there. I am so grateful to each one of you! My boss is not the compassionate or supportive type. She thought I should be back in 4-6 weeks. The folks I work with are hating covering for me - they all normally work M-F and I am the person who covers the department on the weekends. I have up to 12 weeks of FMLA. I cannot afford to lose my job and I love what I do. So it's a bit frightening being out... And I'm never out unless it's a planned day off.
 
It is astounding to me that your boss would hassle you about returning from surgery. And, if they need someone else they should get a locum tenans nurse for the weekends. Really---maybe they will appreciate you a little more when you come back, after 12 weeks.

Don't let the problems of other people make you risk your own health and recovery.
 
Knee2016 said:
I have not been taking Percocet on a regular schedule, normally one before bed and one in the morning when I wake up.
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What you have to remember is that each dose of any pain meds - apart from extended release or prolonged release - only stays effective in your system for about 5 hours. So assuming you take your morning dose at about 8am, by 1pm it's gone and you have no more pain meds working in you until you take your second dose at bedtime. Get the picture?

As for Motrin, as newlybionic pointed out,it is an NSAID or Non-Steroidal Anti-inflammatory Drug. These do work on pain to a small degree because, as the name suggests, they help reduce inflammation which is the root cause of swelling. So it's the lessening of the swelling that reduces pain, that's all. Apart from which, NSAIDs also have a very serious side effect this is thoroughly explained in here Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers. These hazards are not to be taken lightly. There have been reports in the UK of escalating cases of gastric bleeds requiring emergency surgery as a result of which there a growing reluctance on the part of GPs to prescribe or recommend them. I for one, wouldn't touch them with a barge pole any more!

So I think if you take the Percocet on a regular basis - meaning as prescribed '4-6 hourly' or '4 times a day' - you will find your pain even better managed without the ibuprofen.

As for the swelling, it's a temporary issue and it will go down as the pain goes down and you will find your ROM and general function improves (Swollen and stiff knee: what causes it?). You see, you don't have to fight or work hard for your ROM. It's there right now, just waiting to show itself once the swelling has abated. That's why I always advocate NO exercises. Stretches yes, but no exercises. If you want confirmation that this approach works, I recommend you read my recovery threads to see what exercising I did!
First knee. Knee recovery - UK style
Second knee. Josephine's 2nd knee story - short version where I did even less!
 
I'm almost 4 weeks out and have battled from the beginning on what and when to take it. I was prescribed Tramadol and Percocet. Initially, I was alternating the two. It seemed like the Tramadol did not help relieve the pain. Now I have been taking the Percocet - usually 3 tablets a day - one at breakfast, sometimes one midday, and one before bed. My doctor seems reluctant to prescribe it which makes me feel as if I shouldn't be taking it. The Tramadol would be his choice. Am I taking too much? Is there another medication I should try? Should I not be taking narcotic pain meds during the day? Thanks in advance for your advice!
 
Knee2016 said:
I keep hearing of people who go back to work in six weeks and I don't know how I would do that.
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I had 12 weeks off for both my knees and even so it was a struggle when I did go back. Though to be fair, I work in an occasional fashion, kind of subcontracting!

But I notice that no-one has give you this Phased return to work
 
I am almost 4 weeks out as well and take Percoset now just before bed. However, during the first week I took it every 4 hours like clockwork to keep ahead of the pain. I set an alarm .


LTKR-12/6/2015
 
Knee2016 said:
Am I taking too much?
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That's a bit difficult to answer as you haven't actually said how much you are taking and how often! Kind of makes us blind, if you know what I mean!

So let's start again
I'd also like to ask you some questions if you don't mind, and 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 compare this with the bone-on-bone pain you had before surgery! :no-fin:) Also don't forget to include 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?
In regard to the Tramadol and Perocet, how much (mgs) did you take of each and how often

3. are you icing your knee, how often and for how long?

4. are you elevating your leg, how often and for how long?

5. What is your ROM - that's flexion (bend) and extension (straightness)

6. how swollen is your leg?
[Bonesmart.org] One month out from surgery, what should a typical day look like?


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

8. what kind of PT exercises and exercises at home are you doing? How much and how often?

Can you describe them like these examples ....

Exercises done at home: 3 sessions a day
Heel slides x10 (reps)
Straight leg raises x10
Steps x10

At PT
Squats x5 (reps) x2 (sets)
Wall slides x5 x2
Clamshells X5 x2
 
If you are on FMLA and your OS says you need to be out from work then legally there is no way you can be fired. It's very unfortunate that your boss and your co-workers have no empathy for you. I agree with ski girl that a local staffing company could be used to fill your shifts on a temporary basis. It has always amazed me that the medical community seems to be so uncaring about their employees facing medical problems.
 
Jo is right on the money---we don't know what you are taking when.

I will give you my own history: when I came home from the hospital, I took oxycodone for 10 days. I could take 1 or 2 5MG Percoset. I found taking one every two hours for the first three days did the trick. Then, I began taking one every four hours. At two weeks, I switched to one Lortab every four hours. At 3 weeks, I began taking tramadol---every four hours or Tylenol 3.

Right now, ice is a great pain reliever. Also, staying in one place with your leg elevated on three pillows will help you get rid of the swelling. My doc told me two hours down for every one hour up at this stage.

Elevating your leg to control swelling and pain
Using ice
 
At 4 weeks I was down to hydrocodone (Norco) which is a bit weaker than percocet, 4 times a day. As you've already seen, everyone is different and doctors have their preferences.
Is what you're taking controlling your pain--knocking it back?
 
It's so hard for me to describe pain. When my leg swells, it is uncomfortable. Like pressure and it makes it difficult to walk. If it's swollen and I try to bend it, it's painful. My groin will hurt if I'm sitting or laying down and the leg is swollen. If I sit anywhere and the seat hits me behind my knee, it's painful then. My leg had started to bow out and the surgeon told me he did some work on my leg. The outside of my thigh from my hip down to my knee is sore. Bottom line is that I just can't seem to get comfortable. How long do you sit or stay in one position?
 
I have (with both knees) been told that I am unusual by the nursing staff, as I really didn't need any pain meds in the hospital. (So think of me at one far end of the spectrum...not the norm.) When I got home and started moving around more (and whatever the surgeon put inside the knee wore off), I took hydrocodone (Norco) 7.5 every 4 hours for the first few days (maybe 4 or 5 days). By day 9, I was down to 1 pill. Sometime during the 2nd week, I was off everything. But with a MAKOplasty (what I had-- a partial knee replacement using a robotic arm and CT scan), there is less bone taken away and there isn't any sawing and such to add extra trauma, so I suspect there is less pain and swelling afterward. You said that the doctor did extra work as your leg was bowed, so I suspect you are also having some tendon and muscle stretching pain (I had that with my 1st knee, which was hard to get comfortable for about 4 to 5 weeks, until PT helped with some stronger stretching). It takes longer to get things stretched to fit, if your leg was bowed, from my personal experience.

BUT what you are describing is a normal feeling for a swollen leg. I mainly control pain by making sure that I am sitting in a recliner (with a cushion on the footrest to keep the knee from bending... or with a foam wedge to elevate the leg) or by laying in bed. Icing helps with pain also. If the leg is swollen, it hurts and can't get comfortable. If the leg is elevated after it is swollen, then it will feel like a painful burning sensation as the fluid slowly tries to drain out. The side of the knee where the joint is (I am a partial) is hard to put any pressure on. With a total, I would expect it to be hard to put pressure on both sides, which would give you fewer options for comfortable positions. As far as sitting, I do not sit with the leg bent or hanging. I recline, or I prop the leg up so that it isn't hanging down. Sitting with the leg bent is a big no-no the first month or so, as it leads to swelling.

I would suggest looking at your activity levels first (see Josephine's questions above about activity levels and icing, etc.) before anyone can advise about meds. If you can control the swelling, then you will help your pain levels...and which makes it easier to get comfortable. For the first 2 months (at least), it is all about controlling your activity levels, which then control the swelling. Because swelling leads to pain and inability to bend the leg or get comfortable. Control the swelling, and you might need fewer pain meds.
 
I am a retired nurse, had to in my late 40's. My legs were always an issue, but Nurse Mates support pantyhose helped tremendously.
I have sadly always found that others in healthcare are the least sympathetic to their own coworkers, which is ironic. Sometimes I felt that all they cared about was having a warm body on duty, just as long as they didn't have to cover for you.
Even with support hose 12 weeks to return to 12 hr shifts is optimistic. Recommend starting back part time.
Hang in there.
 
I don't seem to know what to do with myself. The posts here have been so helpful and it seems I am doing too much at times, but then I feel as if I'm not doing enough throughout the day at other times. I seem to go from one extreme to the other. When I rest and keep my leg elevated and ice frequently, I don't have swelling. But when I get up and start walking around, my leg begins to swell. I don't know if that means I should sit back down or if I should stay up for a while despite the swelling. If I sit in the car or in a chair, my leg swells almost immediately. It doesn't seem like a good idea to sit with my leg elevated all day and do nothing else. How long should I be staying up? If I sit in a chair and get used to that, will the swelling subsided? What should a day look like at this point? how much do you leave the house?
 
I am a social worker in a hospital, not a nurse. I work with fantastic nurses and am so appreciative of all they do. Neither of us could do our job without the other. Yes, it certainly seems to be the case that we have a little compassion for our fellow healthcare workers. I don't understand that either! I posted another thread asking about what a typical day should be like one month after surgery. Whatever I do causes swelling. Should I stop that activity and sit down and elevate and ice when the swelling starts? Or should I be active for a period of time? I noticed that both my foot and my groin bother me when I'm up for a while which seems to be related to the swelling. How long should one sit at a time before getting up? What about sitting in a chair with your feet down? I feel as if I don't do that some, I won't be able to comfortably sit in the car or in a chair at a doctors office or therapy appointments.
 
It would be best to try to elevate and ice your knee as often as is feasible at your job. It is also better to put it up than to leave it done. My first two weeks at my new job was doing learning modules on the computer. I found it better to get up at least every hour. You will be able to find what works best for you.
 
@Knee2016
We will be combining all of your threads, so when that's done it would be a good idea if you look back at all the pages for all the advice you've received.
We prefer that, once you have had your knee replacement, you keep everything in one recovery thread. That makes it so much easier to see all your history and questions, and to advise you appropriately.

If you look back at Post #8 on the previous page of this thread, you'll see that I left you the recovery reading list. Amongst those articles was this one, Activity progression for TKRs , which suggests what your activity should be at various stages in your recovery.

Right now, at just a month after surgery, your main job should still be to rest, elevate, ice and take your pain meds by the clock. Many people have been told that for the first two months they should spend two hours lying down for every hour that they are up and about. You are bound to still experience swelling, which can take several months to go away completely.
 
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