Bilateral TKR Rhody on the Road to Recovery

[Rhodyrhody]

Post op Day 4, here I come!

Noticing it's important to have a 'plan' for sitting down and standing up. Gotta have good supports available for both. Our doc said I wouldn't need a toilet riser, but my one attempt at that activity...might have been a contributing factor to the constipation situation - (I sat there for a while thinking I may never ever get up again). Riser has been procured.

Question about icing...I have read/heard everything from "no more than 10-15 minutes per hour, every two to three hours" to "minimum 45 minutes at a time" to "20-30 minutes per hour". Is there such a thing as "too much" or "not enough"?

Noticing there's lots to keep track of, too. Almost like a part time job. Right now, I have 7 different meds and a bunch of different times. Had to whip up a spreadsheet to track. Not supposed to sit down for more than 45 mins at a time, plus 5 different exercises to do 3x per day...'nother spreadsheet. At least the spreadsheets are good practice for RTW.

Sleeping. Can't really keep anything under my legs (they said nothing under knees, if anything, pillow under ankles). Doesn't bother me that much. The 'problem' comes when I wake up, sometimes my legs don't hurt and I try to shift, move, or even flip over like a normal person. Then...I get a quick and painful reminder. Am I better off in a recliner with more restriction to movement?

Last thing...I have 3 steps to get in/out of my house. They showed me at the hospital how to do it, but my memory isn't that great. I do remember good leg up first and bad leg down first... I'm going to look for more specific instructions on this board, but if anyone quicker than me can locate and post that would be awesome.

Have an awesome day, everyone!

 

[Desertgal]

Hi @Rhodyrhody, the best thing I found for the medicine schedule is an app called “Round Health”. It lets you set multiple medicines and an alarm for each one. It was a life saver for me, especially in the beginning when my brain just couldn’t focus. I don’t think I could have created a spreadsheet early on!

 

[sistersinhim]

Remember that everyone of us has been through a knee replacement. You can't ice and elevate too much. As long as you have a thin cloth between your knee and the ice pack, it's fine. I iced the whole time I was down, including all night long while sleeping.

5 different exercises to do 3x per day.

This is totally unnecessary. Your getting up every hour and walking around is all the exercises your knee needs. Doing too much keeps your knee inflamed and swollen. This slows down your healing and recovery. Please read our articles again. They were created by years of experience and thousands of recovering knee patients.

 

[Jockette]

Also keep in mind, it’s not exercising that gets our range of motion back, it’s Time:

Time to recover.
Time for pain and swelling to settle,
and 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. Exercise as in strength training is counter-productive and in the early weeks does more harm than good. Normal activity is the key to success.

 

[Mutti3]

I iced the first few weeks 24/7, with exception of walking around, and daily adl’s. Stairs, non operative leg up first going up. Down, operative leg first. I used a mediplanner to organized medication, except for pain pills. I used pillows to elevate my leg toe above nose.

 

[Rhodyrhody]

Thanks @Desertgal - I have what the rest of my family refers to as a dumbphone and probably couldn't use that. I'm having no problems with the spreadsheet. It gives me something to do and not having any problems with it. Exercises are another thing that give me something to do. Not going to do any that hurt though, which is why I just did my last heel slide (for a while anyway) about an hour ago.

I like the approach my home PT guy used when he was here. Some of the exercises where 'the sheet' said do 2 sets or 3 sets...for some he said, just do one set. I'm much more likely to do one set, if I think I can do it, than I am to even try to do any if it says to do two sets and I know I can't do two.

Able to get comfortable pretty easy...not a fan of the 'don't sit for more than 30 to 45 minutes at a time' direction though.

 

[79newknees]

I didn't do any icing when I got home, and only a few times in hospital, mainly as an excuse to get back to bed, as they wanted you to sit out most of the day, despite feeling the swelling mounting up in my feet! I was told no more than 20 minutes at a time for icing, as there are numb patches that won't feel if you are burnt!I found elevating the best thing of all, and moving around at least once an hour, out of bed.

 

[beachy]

Does “don’t sit for more than 30 min” mean with legs down or elevated?

 

[Laurenkate]

Insofar as steps are concerned, it's up with the "good" leg and down with the leg which has had the knee replaced but not sure what that means since you had a btkr.

As long as you aren't "burning" yourself with the ice, you can't ice too much and 15-20 minutes isn't enough. Each knee and recovery is different but I iced much more with my second tkr and the leg isn't nearly as swollen. If I was sitting or laying down, I had ice on the knee until the gel pack or machine wasn't cold anymore. Only went to half the recommended p.t. sessions so that may have something to do with the lack of non-swelling too.

Sleeping is difficult for a couple of months with one tkr - can't imagine what it must be like with two replacements. Life is a little easier if you can accept that sleep will be elusive for a little while and that you'll have to sleep/nap when you can. Like everything else, it'll slowly get better but lack of sleep is about the worse part of the process. I suspect that's one of the reasons it's suggested people don't go back to work for a while. Sleep deprivation makes things like driving, concentrating, etc. another challenge in recovery.

 

[InkedMarie]

I just had my TKR almost three weeks ago. At the hospital, I had the ice machine on constantly, unless I was walking or in the bathroom. I spent the afternoon/evening in the hospital icing in the recliner. Went to bed with the ice machine, at 9:30pm. Was back in my recliner, icing, the next morning at 5 am.

I’m surprised a recliner or chair with stool wasn’t offered.

 

[Celle]

I didn't do any icing when I got home, and only a few times in hospital, mainly as an excuse to get back to bed, as they wanted you to sit out most of the day, despite feeling the swelling mounting up in my feet! I was told no more than 20 minutes at a time for icing, as there are numb patches that won't feel if you are burnt!

I guess they feel they have to take extra precautions in hospital.

However, you won't get "freezer burn" (frost bite) as long as you put sufficient material (such as a tea towel or dish towel) between your skin and the icing medium.
You accomplish very little if you only ice for 20 minutes. You need to ice for at lest 45 minutes at a time. As long as you have protected your leg adequately, you can ice all night long without doing any damage.

Does “don’t sit for more than 30 min” mean with legs down or elevated?

I'm not sure where you read that, but it's not what we advise.

We advise getting up and walking around every 45 minutes to an hour. It's always better in the first few months to have your legs elevated when you're sitting down. Sitting with your feet down on the floor does tend to increase swelling.

 

[Rhodyrhody]

Thanks @Celle ! My hospital instructions say not to sit for more than 30-45 minutes at a time. I've been pretty much taking one hour blocks of sitting, with most of that time icing. The hospital gave me enough freezer packs to build an igloo, I think. I understand that sitting with feet on the floor is not the optimal recovery position, so trying to minimize that. But, when I am sitting with feet on floor, is there any benefit or detriment to icing while I'm doing that?

Post op Day 5...
SLEEPING. Sleeping, itself, is not the problem. I'm a really good sleeper. If there were competitions on ability to get to sleep and stay asleep, I'd probably be really competitive. Same is true even now. Getting to sleep is not the problem. The problem is, I usually move around/shift positions a lot when I sleep. And it's when I go to move around that the Pain Train returns and wakes me up. I'll be lying there, pretty much no pain, and then if I try to roll over, or get a pillow between my legs...we're up to pain level 8. And after a couple bouts of that through the night, I wake up and it feels like both knees are extremely swollen and painful. But I'm still able to get a pretty much full night of sleep.

After the sleeping ordeal, I pull myself out of bed, get my coffee and take my meds (oxy, omeprazole, meloxicam, aspirin, and acetaminophen)...sit down in the recliner and grab a bunch of ice packs for my knees - they hurt and feel miserable at this time - and within 15-20 minutes...I'm completely completely comfortable, I mean, like almost no pain at all. My concern is, when I first get up, it feels like there's a lot of strain on my incisions. They aren't bleeding through (just a couple dots in a couple places...well below the threshold of when they told me to call), but it feels like they are really stressed. But again, after the meds and ice sit-down...no real pain. (I feel very fortunate in that regard). I'm just wondering about all that first thing in the morning stress and if there's anything I can do about that.

As y'all can see, I have a lot of time on my hands and don't mind typing this stuff out. Sorry it's so long.

I have a home PT visit this afternoon and mean to ask for some stairs practice. Anyone think of any questions I could/should ask the PT?

 

[Celle]

I understand that sitting with feet on the floor is not the optimal recovery position, so trying to minimize that. But, when I am sitting with feet on floor, is there any benefit or detriment to icing while I'm doing that?

I don't think it will matter if you ice while sitting with your feet on the floor. Do whatever feels best for your knees.

 

[beachy]

@Celle
I read it in the last sentence of rhody’s post from yesterday.

 

[Rhodyrhody]

PT visit was interesting. Attitude toward ice was, I could if I wanted to, but no more than 20 mins at a time. They said I 'didn't really need to ice much at all now if I didn't want to." For me...kinda quickly helps get into that comfort zone, so, I'll still be doing it.

They also said that the heel slide pain I had was a 'good pain'...and started telling me about 'how' it was a good pain. My eyes just glazed over and I said "ok", but in my head, I was saying, "ok, but I'm not doing them if it hurts"...which I won't. Both good though, neither forced me to do anything.

The unbelievable news is I managed to crutch it from the doorstep to the street and back. My awesome wife, the best caretaker ever, would never have let that happen. But, did it. No concerns or problems with the stairs. Of course, only did the three in and out of the house. In and out of our SUV as well. Smaller car might be a problem.

 

[Rhodyrhody]

OT here today. They had a few questions, but other than that, pretty much told me to get up and take care of myself. She basically told my wife to make me come to the dinner table instead of bringing it to me. That's fine, I have an awesome wife and when my knees really hurt, I know I can count on delivery. I think the way I've started looking at these therapy folks is, the main thing they can do is assure that things 'look' right. Because, if the exercises hurt, I'm not doing them and if it feels good to ice...that's what I'm doing.

They seemed to like the idea of using the pain meds to be able to get through the pain of rehab. I think I'm down for some healing right now rather than rehab. Taking a regular cycle of several things and oxy 5mg (1 or 2) as needed.

Has this ever happened to anyone else?
I've been icing a fair amount the last couple days. I use a pretty good thickness face towel between the pak and my skin to avoid freezer burn. What I've noticed today is...sometimes right as, or right before, I put the ice on my knee, it's like it's suddenly already numb or cold. Like the knee knows what's going to happen and just does it beforehand. It's strange.

 

[Celle]

They seemed to like the idea of using the pain meds to be able to get through the pain of rehab. I think I'm down for some healing right now rather than rehab.

Taking pain meds so you can get through PT therapy is a really bad idea. Pain is a warning sign that you are doing too much for your new knee. Mask that pain and you lose the warning sign and, consequently, you might overdo things and suffer later.

It's still very early days and your nee does need time to start healing before you stress it with exercises. For now, just a gentle walk around, to the bathroom or kitchen, every hour or so is enough.

My surgeon doesn't allow any PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house.
After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.

 

[Mutti3]

She basically told my wife to make me come to the dinner table instead of bringing it to me.

My husband brought every meal to me in bed! It is helpful during recovery to rest, elevate and ice. As for icing my knee it was a 24/7 for me! I did accidentally freezer burn a numb area.

 

[Rhodyrhody]

1 week post surgery (and, it's still a miracle). Still very glad to to have done both.

The worst pain is on waking up in the AM...like "9+" pain. I wake myself up at night (in pain) by trying to re-position like a normal person, but once settled, am able to get back to sleep pretty easily. I'm just wondering if I'm causing unnecessary damage or stress by sleeping in bed 'normal'-like? Been sleeping mostly on my side with a pillow between knees and able to get pretty comfortable, but gol-lee, that wake up pain is something. Really wish I could get rid of that somehow. Any tips/pointers? Some of it might even be from just staying on the same position too long, but appreciate any insight anyone else might have.

@Celle I'm not going to do pain meds for the purpose of getting through PT. I feel like the non-narcotics are doing a good job keeping almost all the pain away and am only taking the oxy if I feel like there's bad momentum on the pain train. Thanks to this board, my PT approach has been that, if it doesn't hurt, that's fine, if it does hurt...not doing it. As I mentioned before, I think, I'm mostly relying on the PT folks to keep me grounded as to what looks "normal"...because...lol...to me...this bruising does NOT look 'normal', even tho' I've been assured that it is.

 

[SusieShoes]

The worst pain is on waking up in the AM

Yep. That's when it's the worst. At first. Later on what's worst will change to specific movements or lack of movement.

I'm just wondering if I'm causing unnecessary damage or stress by sleeping in bed 'normal'-like?

No. You're not hurting anything. It's hurting you because... surgery. Swelling. Angry knees. Sleep in whatever position you find 1) most comfortable and/or 2) allows you to get some quality sleep.

Some of it might even be from just staying on the same position too long

Bingo! That's it exactly. Your new knees don't like staying in just one position too long. Doing so allows fluid (swelling) to accumulate in the tiny spaces inside the knee and, boy, do they hurt when they finally move again, moving that fluid around and pushing on still-not-healed soft tissues.

You may encounter the situation down the road where one knee hurts from not moving for a while while the other doesn't. It'll be tempting to think there's something "not right" with the still painful knee. It's fine. It just hasn't gotten to the same place as its twin.

For what it's worth, your PT plan sounds like a good one. Sensible is the way to go.