TKR Rockgirl4's Recovery---already full of surprises.

[Rockgirl4]

Does anyone else notice Acetaminophen (Tylenol) just seems to do nothing for them?

I'm still taking the prescription NSAID Arthrotec for swelling/stiffness, and didn't really need the Oxycodone (Percoset) any longer during the day (plus I wanted to be able to drive short distances if needed). I decided a small amount of discomfort is par for the course anyway to be off the hard stuff.

However, the deep ache in my knee just builds & builds through the day. It's at a very uncomfortable level by 7 PM. It's not even pain exactly, but completely distracting and uncomfortable. I tried 1000 mgs of Acetaminophen 3-4 times throughout this past week, but it was like eating candy. I didn't notice any improvement.

Does one need to take it every 6 hrs for a couple of days to get any benefit?

 

[Indygo]

Before I had my surgery, I went to a store that sold only canes and luggage because I wanted a cool cane. (Dumb, in retrospect. Not a priority!) The one I got has an umbrella inside, so I've been waiting for a rainy day when I can unscrew the handle and whip out the umbrella! That would really give kids something to laugh about!

 

[winemama]

Tylenol does nothing for me either

 

[kneeper]

I used to think NSAIDs were better--until my ulcer.

 

[Rockgirl4]

@kneeper and @winemama What'd odd isI know it works wonderfully if I have a fever and associated body aches from the virus or even a sinus infection, but nope---it doesn't touch this deep joint/bone ache.

 

[Rockgirl4]

@kneeper My son almost died from 1 dose of ibuprofen at age 2 and spent 3 days in the hospital, needing 2 units of blood. He can't take any NSAIDS the rest of his life unless it's deemed a medical necessity and would have to be paired with a strong PPI medication. NSAIDS just plain scare me now, though I know I needed it this time around and am super careful when/how I take it.

Now he's almost 13 and thinks he can get his own OTC meds from the medicine cabinet. He accidentally took one pill of my husband's OTC migraine stuff that had aspirin and something else in it. It was a migraine version of Tylenol. I was so angry and terrified at the same time, and called his Dr. They figured he'd be okay, told him not to lie down for a couple of hours, and to eat a huge snack..... but we have strict rules now and he doesn't rock the boat. I don't think he appreciated the fear until he saw me and my husband completely freak out in fear and anger. If that had been an ibuprofen tablet, who knows what could have happened.

 

[winemama]

Wow, medicine can be scary, I’m lucky, there are no meds that I have taken that bother me

 

[Celle]

Does anyone else notice Acetaminophen (Tylenol) just seems to do nothing for them?

However, the deep ache in my knee just builds & builds through the day. It's at a very uncomfortable level by 7 PM. It's not even pain exactly, but completely distracting and uncomfortable. I tried 1000 mgs of Acetaminophen 3-4 times throughout this past week, but it was like eating candy. I didn't notice any improvement.

Does one need to take it every 6 hrs for a couple of days to get any benefit?

Tylenol does nothing for me either

It's true that Tylenol/Acetaminophen/Paracetamol doesn't work for pre-op arthritic pain. But it's usually effective for post-op pain, if taken the right way.

The correct therapeutic dose is 1,000 mg (2 x 500 mg tablets) 4-6-hourly, to a total of 4,000 mg (4G) from 4 doses in 24 hours. You do need to take Tylenol regularly, to keep up its levels in the blood stream, because its effect wears off somewhere between 4 and 6 hours. If you only take it on an "as needed" basis, you end up playing catch-up with the pain and that is always difficult, because you'd need a larger dose to get on top of the pain.

The US FDA recommends 3,000 mg as a safe daily limit for Tylenol, because there are other medications that also contain Tylenol, such as cold cures, and they fear people may not know this and might unwittingly take too much Tylenol.
So check all the other medications you're taking. If any contain Tylenol/Acetaminophen, cut back one or two of your regular Tylenol doses, so that your total daily intake remains within the safe daily limit of 4,000 mg.

 

[Celle]

My son almost died from 1 dose of ibuprofen at age 2 and spent 3 days in the hospital, needing 2 units of blood. He can't take any NSAIDS the rest of his life unless it's deemed a medical necessity and would have to be paired with a strong PPI medication. NSAIDS just plain scare me now, though I know I needed it this time around and am super careful when/how I take it.

I'm sorry to hear this @Rockgirl4 . It must have been so frightening for you.

Has your son had blood tests, to exclude any disorder of his blood clotting mechanism?

I'm asking this because I have an inherited bleeding disorder and I am never allowed to take NSAIDS, including Aspirin. These medications act on the blood platelets, impairing their ability to agglutinate (clump together) in one of the first stages of bleeding control. For most people, this is relatively unimportant, although it's well-known that NSAIDs can increase the tendency to bleed. For me, taking NSAIDS could lead to severe bleeding.

 

[Rockgirl4]

Thanks @Celle . That was my problem then. I was only taking it as a one-off dose, so I'll start taking it every 4-6 hrs and let it build in my system.

 

[Celle]

THat's good. Remember, only 4doses in each 24 hours, so if you take the Tylenol 4-hourly during the day you'll need a longer gap between doses later - maybe in the night.

 

[Rockgirl4]

@Celle No, he hasn't ever been tested and it was never mentioned. You have me VERY curious though!!!!! They told us it was rare, and my question was always "Why him???"....

He has dealt with a host of allergy/immunology/respiratory issues in his 13 yrs and has had loads of unusual presentations and just "weird" stuff. I've always wondered if there was more of something going on, and if it would bite us in the behind later. Thanks for mentioning your history and for the head's up.

 

[BCSAnna]

Tylenol did nothing for my pain prior to my surgery or after my surgery. To me, it is like taking a placebo and a bad one at that.

 

[Celle]

Poor kid! I also have a son who seems to have inherited all the "poor health" genes in our family. He has asthma, eczema, and our shared bleeding disorder.

If I were you, given his history of severe bleeding, I'd ask to have his blood tested for bleeding disorders, particularly those affecting the platelets. There are several and they're all rare.
They're not as serious as haemophilia and they're treatable, as long as you know. For example, if I have any surgery (except minor ones) or if I have an accident, I have to be given an injection to help my blood to clot.

Mine is an inherited bleeding disorder and, although I have no idea which of my parents I got it from, my daughter and one of my sons have also inherited it.

 

[Rockgirl4]

I'm over-analyzing everything now.....

1) I'm at 6.5 weeks post-op.....can someone remind me the suggested advice for this time frame regarding how to alternate time spent on one's feet vs sitting with our legs propped up (meaning for every ____ hrs on our feet or sitting normally, then _____ minutes with legs propped up/elevated)....

My surgeon told me at my 4 wk follow-up to aim for "sitting with your legs down more than sitting with your legs up." I'm finding 3-4 hrs with my legs down is causing more swelling and pain. I think I'd be better with 2-3 hrs down, the 2 hrs up, keeping it equal.....thoughts? What's worked/working for others? I spent 4 hrs at a BBQ tonight doing mostly sitting, but by the 3.5 hr mark, I just needed my legs propped up horribly, even if not truly elevated. Gravity is just not kind!!!

Keep in mind I DO have the option to rest/elevate more as I'm not working. I'm struggling with being lazy vs being proactive. I do NOT want to set myself up for pain and reduced range of motion due to swelling and overdoing.

2) How long did people wait before seeking massage/chiropractic for any lower back issues created by or exacerbated by the weird walking and gait pattern during TKR recovery? I do have a chronic lower back issue that every knee surgery (11 total now!!) messes up again.

I've only been pedaling forward on my bike for 6 days. The first 2 minutes of my 12-minute, once-a-day bike ride, are ugly with a bit of hip-hiking. I'm afraid any $$ spend on realigning my back will be undone in a couple of days. Most of my stretching/exercises I've done for 8 yrs to keep L3/L4/L5 aligned require too much of my knee right now, so I don't know if I can maintain it. Thoughts?

 

[lovetocookandsew]

The info on activity is here in this article. https://bonesmart.org/forum/threads/activity-progression-for-tkrs.14334/

Continuing some icing and elevating is also a good thing, as long as you also move around as indicated in the thread. I'm going to tag @Josephine, our Forum Director, to answer your other questions and comment on the bike riding. My thoughts on the bike are if it is causing problems, put it off and try again at a later date, as it is still early days, but Josephine will likely have some helpful thoughts about that also.

 

[Josephine]

I'm at 6.5 weeks post-op.....can someone remind me thesuggested advice for this time frame regarding how to alternate time spent on one's feet vs sittin

So far as I am concerned there is no 'suggested pattern' in that way

How long did people wait before seeking massage/chiropractic for any lower back issues

Any time now.

 

[Celle]

can someone remind me the suggested advice for this time frame regarding how to alternate time spent on one's feet vs sitting with our legs propped up (meaning for every ____ hrs on our feet or sitting normally, then _____ minutes with legs propped up/elevated)....

It's true that there's no set pattern for it, but I believe Kelly (@skigirl ) was told by her surgeon to spend 2 hours down - resting - for every one hour she was up. That sounds reasonable for your stage of recovery.

 

[Jamie]

Every recovery is unique, so while guidelines and averages are helpful, you need to do what works best for you at each stage of your recovery to prevent pain and swelling. When you do something that results in either, that's your cue that your body is not quite ready for that activity level just yet. Scale back to a more comfortable level for 5-7 days and try again. If you listen to these signals from your body, you'll make the right decisions for yourself. f

You are still very early in this process. Patience is often the hardest part of recovery. We all want to be better faster. But your body will heal at it's own pace and it is in control.

 

[Rockgirl4]

Today's stationary bike ride was SOOO much smoother with an easier start than yesterday. I think this will also help my hip pain as things get easier.

I'm also scheduling a massage for Tuesday. She's wonderful and extremely knowledgeable, and I know it will make me feel better all over. My neck and shoulders are in knots. I'm booking her 75 minute massage so we're not rushed.