TKR ROUND 2: MotownGirl made it to the other side

[MotownGirl66]

@Josephine
1. Pain level right now: 4 with the addition of two Ibuprofen on my own.
2. Was prescribed 2) 2mg. Dilaudids every three hours with 1 Fentanyl patch every 3 days. This afternoon, I added Ibuprofen because my pain was never controlled and I am very sensitive to most painkillers (nausea, vomiting, itching, sweating).
3. I have the Vital Wrap ice kit so the 1st time I ice it when I awaken is for about 1 hour, then I switch the wrap to ice the back of my leg and knee for about 20+ minutes. I do this 5-6 times while awake.
4. I have a Temperpedic Adjustable Bed so elevating my leg is easy. I do it 5-6 times during the day and at least once or twice while dozing (I wake up in pain so I raise my feet over my heart). I lay with the body flat, my head on no pillow, and my knees and feet over my heart for approx. 45 min. to 1.5 hours 5-6 times a day.
5. At leaving the hospital the PT girl pushed my knee till it hurt so badly but she got it past 95. I think she said 110. I wasn't paying attention because I was trying to calm down from the incredible pain she caused. I have no idea what my range is now. I sit on the side of my bed and side my heel up to what looks like to me to be about 90 degrees. Yesterday's ROM was much better than today's. I don't know what my extension number is. I frequently use a small, decorative, pillow under just the heel of my surgical leg in an attempt to push my leg to be as straight as possible.
6. My activity level since coming home from the hospital has consisted of icing, elevating, stretching, sleeping, and taking pain meds on schedule. My husband is taking care of all those household chores and providing me with meals. We have a 2-story home and I am upstairs w/ plenty to do to occupy myself.
7. My PT regime at the hospital consisted of 30 reps of EVERYTHING - they were broken down by either 2 sets of 15 or 3 sets of 10. It was too much and it didn't matter if you were a 1st day patient or a 3rd day patient. We did the heel slides, the bent leg lifts, the ankle pumps - there's a lot more but I cannot remember. We were in the PT room for a solid hour. I was not given a list of the exercises to do @ home.

Since I have been home, I've only had one PT session and that was yesterday. We did two sets of 10 of every exercise instead of 15. When he saw me struggling, he said to do 8. We did pretty much the same as the hospital but not near as many. He was more concerned about my pain and my form. He also had me walk w/ the walker.

I think the main problem here is pain control...they couldn't make me comfortable in the hospital with the A/C nor could they successfully get my pain TOTALLY under control. I've never been this uncomfortable, for this long, with any surgery that I have had.

Thank you for inquiring!

Robyn

 

[Jozilla]

Wow seems like a lot going on @MotownGirl66 It is great to get real medical advice on a Sunday!

My pain today is probably down to a one or two with the highest dosage of medication I am allowed. At its worse today it has been a four. If you are taking the max dosage already I would call my OS and insist he needs to try something else. Your pain level should not be that high especially if you have the correct pain medications at the correct dosage. If I were not medicated or was using half of my medication I know I would be in pain. My bottle for percoset says take one or two every 4-6 hours. I take two every four hours around the clock. I have not even attempted to take it less yet.

The second thing I would ask him is if you should be wearing that knee brace. In my opinion (obviously not medical) I would be very hesitant to wear it until he told me so. I would think it can affect your tkr results and your leg from strengthening. But if your OS says to use it there must be a reason and then I would want to know why.

A lot of your pain sounds like nerve pain to me. My neuropathy is treated by a neurologist with the medications gabapentin, a muscle relaxer and Vicodin normally. As I am on the percocets I am not taking the Vicodin.

I did have leg jerks and twitches with my first tkr but so far not with this one. I also have major back issues. If you are not doing so make sure you are wearing new shoes. A lot of times your gait changes with this surgery and old shoes will affect your back.

I hope you feel better soon and know once your pain is controlled you will feel much differently.

(((Hugs)))
JoAnne

 

[MotownGirl66]

@Jozilla - it certainly is wonderful to get medical help on a Sunday!

Thanks @Josephine. When I was in the hospital, everyone knew my pain was not controlled, but they kept telling me I was on the high, most potent, painkillers available. That's not what I meant - I meant that we should try different combinations. I cannot take Percocet, Vicodin, or oxycodone. For my hip replacements, I took Nucynta, Tramadol, dilaudid, and some others whose names I can't recall. I think maybe we need to think out of the box. Thank goodness tomorrow is Monday.

Robyn

 

[Josephine]

Robyn, you don't need to quote a post every time to reply to it, so please don't do that.
Just scoot on down to the bottom of the page and start typing!

 

[Jozilla]

Just wanted to let you know a couple of things. I ice with my ice machine all night long - 7 hours straight. My OS also had all his patients do the same. During the day I ice almost as much as I am sitting.

Also wonder if you have been using your walker at home. I have used mine any time I walk - even if its two feet. My PT said we will transition to a cane this week.

My first tkr I iced probably for 7-8 weeks all night long and during the day. I used my walker until I was comfortable with my cane - about 10 days. And I used my cane until I felt safe walking without one - probably 3 months. If it snowed or I was doing more walking then usual I used my cane.

Glad the Tylenol is helping and hope you have a better day tomorrow!

 

[Josephine]

1. Pain level right now: 4 with the addition of two Ibuprofen on my own.

okay

2. Was prescribed 2 2mg Dilaudids every three hours with 1 Fentanyl patch every 3 days. This afternoon, I added Ibuprofen because my pain was never controlled and I am very sensitive to most painkillers (nausea, vomiting, itching, sweating).

How are you with Tylenol? It's much more effective than ibuprofen which has some rather nasty side effects (NSAIDs, acetaminophen (Tylenol, paracetamol) differences and dangers) Try taking 1,000mg instead of the ibu instead making sure you don't exceed 4,000mg per 24hrs and that you also include any that is added in your other medications.

3. 1st time I ice it when I awaken is for about 1 hour, then I switch the wrap to ice the back of my leg and knee for about 20+ minutes. I do this 5-6 times while awake.

You accomplish nothing in 20 minutes. Make it an hour at least. Any time you are resting and elevating, ice too.

4. I have a Temperpedic Adjustable Bed so elevating my leg is easy. I do it 5-6 times during the day and at least once or twice while dozing (I wake up in pain so I raise my feet over my heart). I lay with the body flat, my head on no pillow, and my knees and feet over my heart for approx. 45min-1½ hours 5-6 times a day.

Okay

5. At leaving the hospital the PT girl pushed my knee till it hurt so badly but she got it past 95. I think she said 110. I wasn't paying attention because I was trying to calm down from the incredible pain she caused. I have no idea what my range is now.

That is outrageous. No-one should ever allow themselves to be treated like that. Not for any reason.

I sit on the side of my bed and side my heel up to what looks like to me to be about 90 degrees. I frequently use a small pillow under just the heel of my surgical leg in an attempt to push my leg to be as straight as possible.

Well, there wouldn't be much point in putting it under your non-surgical leg, would there!
You'd be better doing heel slides while sitting on a chair. Pull your foot back until it's as near under the chair as you can manage without pain. Then pull it back just a teensy bit more and hold it for about 10-15 seconds. Do five about 5 times during the day. If you have trouble sliding your foot on the carpet, put a paper plate or plastic bag under it.

7. My PT regime at the hospital consisted of 30 reps of EVERYTHING - they were broken down by either 2 sets of 15 or 3 sets of 10. It was too much and it didn't matter if you were a 1st day patient or a 3rd day patient. We did the heel slides, the bent leg lifts, the ankle pumps - there's a lot more but I cannot remember. We were in the PT room for a solid hour. I was not given a list of the exercises to do @ home.

Yeah, ridiculous and far too much.

Since I have been home, I've only had one PT session and that was yesterday. We did two sets of 10 of every exercise instead of 15. When he saw me struggling, he said to do 8. We did pretty much the same as the hospital but not near as many. He was more concerned about my pain and my form. He also had me walk w/ the walker.

I really do need to know what these exercises are. Are you also doing them on your own at home?

 

[trailspud]

@MotownGirl66

...just catching up on your recovery thread. You've dealt with this stuff before, and I'm sure you will be where you desire soon, albeit soon is slower than desired.

Best wishes.

 

[MotownGirl66]

@Josephine - Thank you for your assessment and recommendations. I am doing PT on my own but I cannot remember what the exercises are called, just the movements. I am feeling MUCH better today. The swelling is about 20% less than yesterday. (I think it all drained into my face from laying with my knees higher than my heart for so many hours last night.)

Robyn

 

[Jozilla]

Oh so good to read this Robyn. I do think most of the pain is from swelling. Get rid of that and you will have less pain. I can slowly see my swelling disappear. It is also easier to properly elevate at home than in the hospital. My hospital was great with the icing - as much as I could - but no so much with the elevating.

We are one week out! Things will improve and the end result is so worth it!!

 

[Josephine]

That's not what I meant - I meant that we should try different combinations

Indeed. And that is a well known protocol called the the multimodal approach.

I am doing PT on my own but I cannot remember what the exercises are called, just the movements.

That doesn't matter, just describe them to me and tell me how many you are doing at a time and how many times a day.

 

[kaw205]

Good morning Robyn,
Just wanted to stop in and wish you a good day. Hope all is well.
Karen

 

[MotownGirl66]

@Josephine - the exercises I am doing:
Self-assisted Heel slides- 1 set, 10 reps, held for 10 seconds - 3x day
Standing Ham String Curls - 2 sets, 10 reps, hold for 1 sec., 3x day
Seated Quad sets - 1 set, 20 reps, hold for 5 seconds, 5x day
Laying Down Heel slides - 1 set, 10 reps, hold for 10 seconds, 3x day
Straight Leg Raises - 4 sets, 10 reps, hold for 1 second, 3 x day

 

[MotownGirl66]

@kaw205 - Good evening! Hope your co-worker's recovery is going well. Getting ready for yours?

Robyn

 

[kaw205]

LOL, He is my guinea pig. I spoke to him today and he is doing great.
He is 3 weeks post op and ROM is 110. He saw the doc last week and is released to return to work on 9/29. That will be 5 weeks post op. He is still taking pain meds, but is out and about every day. He's a big guy and the doc said he has the second largest knee bone he's ever seen and an off the shelf knee would have been very difficult to fit.
I am doing everything I can to prepare for my new knee. Losing weight, biking every day and learning everything I can from all the bone smarties!
Hope you are doing well.....Karen

 

[Josephine]

As I thought and said previously, you're doing far too much. My comments are in bold

Self-assisted Heel slides- 1 set, 10 reps, held for 10 seconds - 3x day
Laying Down Heel slides - 1 set, 10 reps, hold for 10 seconds, 3x day
You don't need to do two exercises for heel slides. And I'd not sure what you mean by 'self assisted' - does that mean you have a strap round your foot to pull on? If so, then stop it.

All you need to do heel slides is to sit in a chair, forward on the seat (more so than in the picture) with your foot a little forward. Then slide your foot back until it's as far as you can manage it but only to the point of discomfort, not pain. At this point, lean forward to increase the pressure on the bend an hold for a count of 10. Slide it gently out again and rest for 5 seconds before doing another. Do this about 5 times every couple of hours during the day.

Straight Leg Raises - 4 sets, 10 reps, hold for 1 second, 3 x day
Do about 5 of these in the morning and that's it!

Standing Ham String Curls - 2 sets, 10 reps, hold for 1 sec., 3x day
Seated Quad sets - 1 set, 20 reps, hold for 5 seconds, 5x day
I have no idea why these are necessary but in any case you shouldn't be doing them at only one week out! Wait till about 6 weeks at the earliest.

BTW you never answered my question about Tylenol

 

[MotownGirl66]

@Josephine - I can tolerate Tylenol. I'm sorry I didn't respond earlier...it got caught up in all the other info. The last few days my pain has still been between a 6 & 7...I called my surgeon and got an RX for Norco. The Dilaudid has not been successful in providing me with relief. I wake up @ night with my knee just burning and throbbing. I started taking two Norco's (5-375) earlier today, every five hours, with a Demerol at about 2.5 hours in. Finally this evening, it feels like my pain is down to a 2 or a 3. I have been an ice maniac the last few days and spend hours each day with my leg elevated. The swelling in my foot and calf has subsided substantially since Monday. (I've been MIA on this site since Monday because my son, who is away @ college, was hit by a car on his scooter. He broke his left femur in three places and remains hospitalized 4 hours from home). Anyway, I know my swelling is directly related to my pain and I dread my PT appointment tomorrow. My staples are being removed by the home health nurse and I hope the removal of the staples addresses the sensation I have that my knee is about to burst through my skin w/ the PT exercises.

 

[MotownGirl66]

@Josephine-Self assisted heel slides was me sitting on, trying to pull my knee as close to the chair as I could go, with my assistance. VERY PAINFUL!

 

[Jamie]

I'm so sorry to hear about your son's accident. My prayers are with your family and hope that he is okay and out of the hospital soon.

Please consider not going to therapy if your knee is really angry and swollen. That activity could make things worse and it will not hurt at all if you take some down time for yourself so that the pain can settle.

Getting the staples out will help with your comfort level. But that tight feeling with your knee is the pain and swelling you have and the only way to fight that is with a schedule of pain meds and almost constant icing of your knee (even while you sleep).

 

[Jozilla]

So sorry to hear about your son. This is hard enough to go thru without anything else happening!

I have also been missing due to fatigue. I really did forget how tough this is! Trying to get everything right - icing, elevating , resting and pain meds is not easy. I have very little concentration left even for bad tv.

I am waiting for a call back for my meds. They do not give you a weeks script and you have to get more!

Here is hoping you have less pain! Things do improve just slowly!

(((Hugs)))

 

[Josephine]

@Josephine-Self assisted heel slides was me sitting on, trying to pull my knee as close to the chair as I could go, with my assistance. VERY PAINFUL!

Then stop doing it! Did you forget numbers 2 and 3 in our mantra?

- 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

I'm serious about this - doing things like that only causes your knee to swell and get more painful, which in turn blocks for ROM. You're only 1½ weeks out. You should do nothing but rest, elevate, ice, take your pain meds and do the heel slides I described before. Certianly do not pull on your foot like that. VERY VERY bad!

Anyway, I know my swelling is directly related to my pain and I dread my PT appointment tomorrow.

Now I am going to give you a very important bit of advice - do NOT allow your PT to do anything that causes you pain. Say no and say it firmly and loudly. This means that you have withdrawn your consent to do such things. Medical treatment is all about consent and if you do not give consent and they do it anyway, technically, that is assault. You have the right to say no. It's not necessary and it's an abuse. Be strong and tell her no. She may not like it and may come out with all sorts of threatening stuff like the "window of opportunity" and the "no pain no gain" nonsense. Take no notice. It's your right to say no and it won't do you any harm to have at least 3 weeks or more before you start doing more demanding stuff. Just not now. it's far too early.