TKR Rodney's TKR recovery

[AussieRodney]

Today, I'm whingeing. That's Australian for whining. I'm tired, cranky, not concentrating (so what's new, says Julie) and flat.

I just re-read the article on sleep deprivation and said, "Oh, yeah."

My right knee hurts, my back hurts, my left hip hurts, I'm getting shooting pains in the knee. I was talking in person to my PCP when one of those triggered and his first response was that it looked like a nerve ending sounding off. It seems that they started once the main pain had just started to diminish, and they are multiple times nastier, we're talking an 8 here, but only for a few seconds. Still, it's just as intrusive and just as demoralizing. Did I say I was tired and trying not to be cranky?

 

[Jaycey]

@AussieRodney We call these pain zaps "zingers". Nerves are waking up and whingeing (very familiar with this term). The good news is all this is temporary. Ice like crazy. This too shall pass!

 

[AussieRodney]

@AussieRodney Ice like crazy.

Ah! And that's what I haven't been doing as much. Been too busy feeling sorry for myself.

And just for clarification, should icing necessarily be combined with elevation? Or is it simply a better use of the time. Got plenty of that anyway right now!

 

[FCBayern]

Icing is usually more effective with elevation as there is also usually swelling even if you can't see it @AussieRodney.

 

[AussieRodney]

Icing is usually more effective with elevation ....

@FCBayern Thanks and duly noted.

Last night I slept much better:
Is the leg elevated? Yes? Good, go back to sleep.
No? Is it comfortable? Yes? Good, go back to sleep.
No? Get comfortable & go back to sleep.

Even better. I received an email from the people at PFMLA (Paid Family and Medical Leave Act) here in Washington, to say: "Thank you for contacting the Paid Family and Medical Leave team and thank you for your continued patience. Based on the information that you provided we cannot locate your account." So I immediately logged into my account, to find that my application has finally been approved! After the qualifying first week, which was surgery week, I'll get paid for the next 3 months!

 

[NightQuilter]

All these payment programs have been so overwhelmed by Covid. Congrats getting through to yours - it must be quite a relief. In California, they are months behind in processing.

I love your formula for sleep! But you are right on. Glad you got some better sleep.

 

[AussieRodney]

6 weeks: Still swollen, but finally going down a bit. Still hurts.

Because anything over my knee tends to scrape and irritate the surface, I mostly wear running shorts. Sometimes, for example for a doctor visit, I wear sweats (track pants or "tracky dacks") over them, so that I can look presentable but still take them off for closer inspection.

I know it must look pretty weird going for a walk wearing just shorts, and then bundled up with multiple layers to keep the top half warm.

In bed, I also try to keep the knee uncovered. That must look pretty weird too, with the right leg poking out upwards onto the elevation pillows and everything else warmly covered.

So my question: Do you cover up your knee?

 

[Jockette]

Wearing shorts and keeping covers off the knee while it’s so sensitive is just good thinking. I did the same. We have enough discomfort in the early weeks without adding unnecessary discomfort to it!

 

[BBCG]

Love your journal, Rodney! I bet your clients really love your sense of humor!
My first TKR was 5 years ago and it took me a year to get your bend! But I also tried weaning off pain meds too soon and paid for the effort in pain. I did truly find that I naturally tapered them off when I forgot one due to feeling lack of pain at the appointed hour. I spaced doses out as a result and that was how I got off the meds. I did have a reaction to the oxycodone, in retrospect, as I did not sleep for about 2 weeks except very fitfully, had high anxiety and my digestive system hasn’t been the same since. I finally did discover that Tramadol helped the pain and didn’t cause the other awful side effects.

Thanks for sharing and I’m still jealous of that bend!

 

[AussieRodney]

@BBCG Well thank you ma'am. You're almost my next door neighbour.

I do try to connect with my clients in a way that will have them looking forward to seeing me "the next time".

 

[AussieRodney]

A little over 6 weeks, and I'm posting a summary for myself.

Upper leg: Swelling has gone, the leg shows normal elasticity.
Lower leg: Showing some elasticity, but still swollen, compared to the other one.
Incision: Has healed extremely well.
Knee area: Still substantially swollen. Some parts showing minor depressions where they should be. Top half has some feeling. Lower half has no feeling.
Pain level: Underlying pain is 2. While walking unassisted is 4-5. Walking while leaning on frame is 3. Generally in the range 2-5. Zingers are 8-9.
Other: Sometimes feels like a clicking sensation, sometimes I can hear a low volume clicking.

 

[BBCG]

Ah, I see: a fellow Pacific Northwesterner!

I also found that this time I returned here to reread my notes from last time for my own edification and sense of the timeline. This time since I’m a caregiver, knowing when I’ll be back to near normal is more critical! I think my husband hasn’t much sense of all I do and I may need added help. So, I’ve got someone on board for the first few weeks at least...

 

[AussieRodney]

Howdy, neighbor.

I have 5 weeks to go being paid to stay at home, sitting on my bum. After thinking it through over the past few weeks, my main concern is being able to put my weight plus someone else's on the leg and the knee. I called in at the company office yesterday and was assured that I do still have a job to go back to, which is encouraging.

 

[AussieRodney]

7 weeks today. Picture showing the area starting to shape nicely.

 

[sistersinhim]

I couldn't even carry a case of water at 4 months and you're talking about 3! Hopefully, you can get an extended time off with pay or be put on light duty for a few months.

 

[AussieRodney]

Ouch! I guess I'm just naturally optimistic. The good news is that the company wants me back. It should be feasible in the short term to put me with clients who don't need lift support. I had one of those recently, and I'll be looking to start slowly.

 

[sistersinhim]

Good deal. It sounds like a good company you work for.

 

[AussieRodney]

Yes, they are private franchise of Home Instead, so the owner is actively involved.

I had a bit of a breakthrough this week. As someone mentioned recently, I would know when it's time to back off on the meds when I forget to take doses. For me, I woke up today and felt like the pain wasn't so severe and 1 instead of 2 Dilaudid would suffice. It might have something to do with being almost out of them, or maybe just "brain wins".

I'm still in a losing battle with my care team and my pharmacy for approving more of them, and remembered a mention of Acetaminophen being an alternative, so I have now started on 1 x 100mg, plus 1 of the last of the Dilaudid, every 4 hours, followed by 2 of them every 4 hours when the Dilaudid runs out today. With doses at 4,8,12,4,8 - that's 5 times a day, I'll stay well under the daily limit of 3,000mg, and I'll keep an eye on side effects. Hopefully I can scale that down quickly.

 

[Celle]

remembered a mention of Acetaminophen being an alternative, so I have now started on 1 x 100mg, plus 1 of the last of the Dilaudid, every 4 hours, followed by 2 of them every 4 hours when the Dilaudid runs out today. With doses at 4,8,12,4,8 - that's 5 times a day, I'll stay well under the daily limit of 3,000mg, and I'll keep an eye on side effects. Hopefully I can scale that down quickly.

I'm not pushing pills, but I don't think your planned regime of Acetaminophen will be enough to deal with pain once you've stopped the Dilaudid.

The most effective way to take Acetaminophen/Tylenol/Paracetamol is 2 x 500 mg tablets (Tylenol Extra Strength) 6-hourly, to a total of 4,000 mg (4 doses) in 24 hours. You need to take it regularly, to keep up the levels in your bloodstream. If you just take the odd dose now and then, it's far less effective.

Check all other medications you're taking, to make sure there is no Tylenol/Acetaminophen/Paracetamol in them. If there is, scale back one or two of your regular doses, so you stay within that safe 24 hour limit of 4,000 mg.

The US recommendation of limiting intake to 3,000 mg each 24 hours is because the FDA is being cautious and assuming that people won't check their other medications. In other countries, such as the UK, NZ, and Australia, the recommended safe daily total is 4,000 mg.

 

[AussieRodney]

Thanks, Caryl.

My bad. What I have is 500mg. Duly noted on the need to avoid the presence in other meds - not a problem for me. My complication is that I need to take a thyroid med during the 24-hour timeframe, which binds to ANY food in the gut, so it needs to be at least 4 hours after, AND at least 1 hour before, any other food or drugs. That usually happens in the middle of the night, when I wake up and take it, away from everything else.

And my math is wrong too! 2 x 500 = 1,000, Rodney! 5 times a day is 5,000! Wow, that's really bad for someone with a degree in Applied Math! Just shows how much my head has been scrambled.

So here's the plan: 2 x 500 at about 6am, 11am, 4pm, 9pm. And sleep.