TKR Second TKR Done, but still not very patient

[Josephine]

I do not like what Endone does to me - I am sleepy, dopey and unable to stay awake for more than about 20mins at a time. Another "mental" problem I am having is that I do not feel unwell, and yet am acting like a sick person with lying in bed, reclining in the lounge, not doing much etc. It is hard to do that when you do not actually feel "sick".

There is a good reason for the effects of the medication - it makes the recovery a little more tolerable and keeps you off your feet! As for the not feeling unwell thing, no you are not unwell as such, you are in recovery after a very major operation! So while you might not be sick your knee most certainly is and you have to do what's necessary for the sake of your knee. Knee is in charge, not you! You're only 2½ weeks out which is very early. You have at least another 8 weeks of this before you can start saying you are better.

I will ask you again - did you read the articles Judy left for you in her post? I would imagine not because the very first one explains all about the connection between swelling, stiffness and pain and the vicious circle they set up. Please go back and read all those articles now.

My leg is elevated with the knee a bit higher than the hip. Probably not high enough, but I have not been able to work out how to raise the leg using pillows/blankets/towels and stay reasonably comfortable

Again, in that list of articles is one that shows options on how to elevate your leg properly.

Activity level

And another article is about activity progression. You are doing far too much in terms of activity and need to read that article to see the best way to do this.

 

[TheHistorian]

You asked for a helpful tale. Well, if photos are worth a thousand words:

This is 12 hours after my bilateral knee replacement:

This is 18 months after my bilateral knee replacement. Four mile hike with 700 feet of climbing in the first mile. I'm on an overlook in central Pennsylvania, USA, called Pole Steeple.

I'm not a strong or able man. I'm sure you can do better once you are recovered.

 

[maryo52]

If the pain drug seems to be knocking you out, try a lower dose. You can cut pills in half.

 

[referee54]

I guess trying to come to terms with the fact that there can perhaps be "pain" without feeling pain.

Pain and stiffness are one in the same. While I understand what you are saying and going through, (many of us went through the same thing) that stiffness is a type of pain that prevents your leg from bending---and the harder you work to make it bend, the more you hurt, and the stiffer your knee gets---and then the vicious cycle kicks in. Working harder, stiffness, pain, etc.

ctivity level - I wander around the house, go out to the front to look at garden, have done a small amount of washing up, have put clothes on to wash, hung them out and brought them in.

This is too much, too soon. you are two weeks removed from your surgery, and your knee is still struggling to heaql---and large amounts of energy are being sent to your knee to heal it up.

Recovery can take quite a while---and, while you are anxious to get the move on things, the more you do at this stage of recovery, the slower your recovery will be (And more frustrating)

fter getting a post from a forum member saying that perhaps I was doing too much considering the amount of swelling, I have cut back to walking around the house and out to the front to admire the garden, heel slides and leg lifts about 4 - 5 times a day.

Excellent---relax and let things go/ you will have plenty of time to get things done and to work in your garden once yo are fully recovered.

 

[referee54]

I had a BTKR going on six years ago. My recovery was slow---I had several DVT's so I had to cut out almost any PT during the early days of recovery. I also had adhesions, which I worked to rid myself of---and that also took some time to deal with.

My recovery took months and months; while I went back to teaching at eight weeks, I found out that that was much too early. That also slowed down my recovery.

It took me a little over five months to lose a pesky little limp. At six months I was at about 80%-85%, and at eight months I was at 90%-95%.

I am back to umpiring HS and college baseball games; I cycle at least 120 miles a week in the warm months; I work part-time on a produce farm, and I fell trees, cut them and split them to heat my home.

My road was rough in the early going, but it was so very much worth it.

(By the way, I hope to cycle from Pittsburgh to Washington DC after I retire this May.)

 

[leejaa]

Netballs just a quick hello. Remember patience is the key to this recovery. You will get there and be able to do even more than before but it is a slow process. Take care of yourself and the knee now and you will get there faster and your knee will be good to you. Have a great day. Lee

 

[NetballKnees]

Thank you everyone for your posts = Historian, Mary, Tim. The photos were great Historian. You have certainly accomplished a lot since your TKRs. Tim, I am so envious of all your cycling and plans to cycle so far once you have retired. I love the bike and am so looking forward to getting back on it again. You have done so well.
I am still one step forward and 2 back. Every morning it is like I have to start all over again. I seem to swell and stiffen a lot overnight. I started physio this week and have had 2 appointments - Mon & Thurs. She massages my leg thoroughly - tight spots, muscles etc., then picks my leg up and moves it around herself. Then I do a set of 10 baby squats, 10 baby lunges and 10 heel raises x 3. I have to repeat this 3-4 times a day at home, with heel slides, leg raises and trying to flex the muscle on the inside of my knee.
I listened to those on the forum and started taking 1 Endone every 3 hours (dose is 2 every 6 hours). It sounds weird, but I was taking it because the non-operated knee hurts so darn much. I have strapped it for support. The Endone, unfortunately, does not even touch the pain of this knee and the swelling has not changed in the surgical knee, so I am not sure I want to continue taking it.
The physio did say that she had never seen such an amount of swelling or tightness after a TKR.
So with the pain in the non-surgical knee, exercising and even getting up and walking a little has been very difficult. I have even more admiration for those who have bilateral TKRs - they must be champions.

Lee - thanks for your contact again. I hope this week's return to work has not been too hard for you and everything has gone well.

Take care everyone ..
Ellen

 

[kneeper]

I had times too when I thought it wasn't "pain" so much as tightness and being uncomfortable--amazing how the pain meds really help that.
If the meds put you to sleep either take half or accept the guilt free nap. You knee will thank you.

 

[leejaa]

Netballknees, it is very hard to recover when the other knee hurts almost more. You are doing a magnificent job considering this situation. You will get there but it seems like it will take longer than not. You are a champion also, recovery from this is not for wimps. Just think if you have two knees replaced you have two strong knees to stand on I am sorry, you are having so much swelling. Hang in there, you will get there. Keep up with the pain meds and also remember to ice and elevate.

My return to work has been troublesome and very tiring but I come home and elevate/ice and take my meds throughout the day. Thank you for asking.

 

[mrs cricklewood]

Hi from another Aussie..way over here in Western Australia. Wow when I read all the things you were doing in a day I was worn out..for the first 5 weeks I did nothing except once a week my hubby drove me to physio..I couldn't have done anything else if I tried... I had heaps of emotional breakdowns along the way...interesting when you had your op I had a catheter and a drain yet my surgeon did not want me to wear the stockings..funny how they are all different in their ways..... I have a very low ROM only around 70 % ( at about 10 weeks ) and I too was threatened with a MUA and like you it scared the hell out of me...needless to say my surgeon booked me in for one but today I have phoned up and cancelled...After reading countless posts and articles on here I am quite happy to plod along and do it all in my own time..for some reason the surgeons seem obssessed with the amount of bend we should have at any particular time....well mine can jump in the lake ! I am on anti inflammmatories at the moment as I still have abit of a swollen knee and I know if I can get rid of the swelling that should help immensely. take care .

 

[Josephine]

Endone, unfortunately, does not even touch .... the swelling (which) has not changed in the surgical knee, so I am not sure I want to continue taking it.

But how long have you been taking it? You may need to take it for 2-3 weeks before you see any changes in the swelling and stiffness. It doesn't change in a short time.

Endone is also oxycodone. What dosage is in each tablet - 5mg? And is there any acetaminophen (paracetamol) in it too?

Re your family situation and your own reluctance to take narcotics, I thought you might like to read this which I just came across this comment in Drugs.com whilst looking up Endone!
The health care provider must assess continuously the psychological and clinical condition of a pain patient in order to distinguish addiction from pseudoaddiction and thus, be able to treat the pain adequately.

Physical dependence on a prescribed medication does not signify addiction. Physical dependence involves the occurrence of a withdrawal syndrome when there is sudden reduction or cessation in drug use or if an opiate antagonist is administered. Physical dependence can be detected after a few days of opioid therapy. However, clinically significant physical dependence is only seen after several weeks of relatively high dosage therapy. In this case, abrupt discontinuation of the opioid may result in a withdrawal syndrome. If the discontinuation of opioids is therapeutically indicated, gradual tapering of the drug over a 2-week period will prevent withdrawal symptoms. The severity of the withdrawal syndrome depends primarily on the daily dosage of the opioid, the duration of therapy and medical status of the individual. The withdrawal syndrome of oxycodone is similar to that of morphine. This syndrome is characterized by yawning, anxiety, increased heart rate and blood pressure, restlessness, nervousness, muscle aches, tremor, irritability, chills alternating with hot flashes, salivation, anorexia, severe sneezing, lacrimation, rhinorrhea, dilated pupils, diaphoresis, piloerection, nausea, vomiting, abdominal cramps, diarrhoea and insomnia, and pronounced weakness and depression.

Abuse and addiction are separate and distinct from physical dependence and tolerance.

 

[NetballKnees]

Hi BS world ... again, thanks for the visits, Lee, Kneeper and Mrs Cricklewood. Thanks for more knowledgeable advice Josephine. I am not just over 3 weeks post surgery and the bend has not increased at all. I am trying to relax and just go with it as advised but I guess being a patient 'patient' is something I am not too good at. Yesterday some of the girls from work came to lunch. they had also come in the second week and brought everything with them. This time, they brought the meat and I made a salad with sweet potato and feta (yum). Ex-husband took me to Woolies to get the stuff and by the time I had walked around a few aisles and made my selections and then came home and worked in the kitchen to make the salad (and a hazelnut slice for dessert), I was totally wiped out (as you can probably all imagine). So needless to say, a very quiet day for me today - just doing my PT exercises and icing and legs up the rest of the time (and taking my Endone regularly, so I keep dropping off to sleep). The pain in my non-surgical knee is unrelenting and is actually inhibiting my PT exercises. I think I need to go to GP just to ensure that I haven't over-stretched a ligament or something.

Lee - I hope you are taking it really easy when not working. It is such a shame that you had to go back to work. Luckily I have plenty of sick leave, so am having 6 weeks off initially and will review this if needed after I see the OS on 27 November. The OS did tell me to save some sick leave for the right knee, but I am in no hurry whatsoever to have another replacement. Make sure you take care of yourself Lee.

Hope all of you in BS world are taking care ... Ellen

 

[RestAssured]

NetballKnees,

Hello! You sound a lot like me in terms of thinking you need to get up and get going! Well, if you want a quicker recovery, then slow down! That's right, don't do as I did. I was my own worst enemy. Take pain meds ice elevate, and you will do well!

My pictures!

Before surgery 435 pounds

November 6th 154 pounds down and counting!

 

[Roy Gardiner]

I made a salad with sweet potato and feta (yum). Ex-husband took me to Woolies to get the stuff and by the time I had walked around a few aisles and made my selections and then came home and worked in the kitchen to make the salad (and a hazelnut slice for dessert), I was totally wiped out (as you can probably all imagine).

Absolutely; that is in fact a very considerable level of work for one less than a month out of TKR. Being wiped out is quite par for the course, your body is taking all the energy it can to heal.

I have even more admiration for those who have bilateral TKRs - they must be champions.

Not really; we have once what you must have again. If your right knee is now playing up, I'd schedule that surgery as soon as possible, to get your full recovery under way.

Every morning it is like I have to start all over again. I seem to swell and stiffen a lot overnight. I started physio this week and have had 2 appointments - Mon & Thurs. She massages my leg thoroughly - tight spots, muscles etc., then picks my leg up and moves it around herself.

Sounds good to me.

Then I do a set of 10 baby squats, 10 baby lunges and 10 heel raises x 3. I have to repeat this 3-4 times a day at home, with heel slides, leg raises and trying to flex the muscle on the inside of my knee.

Not so good, IMO. These put force through your knee, right? Which hurts, I'll bet. Remember the mantra, if it hurts, don't do it.

Doing stuff to extend ROM, gently, is good; doing stuff to attempt to gain strength is wrong at this stage, your knee is too damaged to attempt to train.

 

[NetballKnees]

Wow Sonya ... you have worked so hard and you look amazing. Congratulations. You, and everyone you know, must be very proud of what you have accomplished.

Thanks for visiting Roy ... I will mention to the physio on Tuesday that perhaps I shouldn't be doing strength exercises just yet and could we concentrate on ROM extension. It will be interesting to see the response.

Hugs to all ...
Ellen

 

[Roy Gardiner]

Yes, it will. If they try to make you train at this stage in your recovery, you can safely write them off. If this happens, pls see my exercises thread below for ways of doing both flexion and extension stretches at home.

 

[skigirl]

Ellen, when I was early in my tkr recovery I read an article written by a pt and he made a suggestion. Take one day and spend the entire day in bed, with your knee propped up with three pillows.

Elevating your leg to control swelling and pain
Using ice

Do nothing much---no pt, not walks around the house, no heel slides, nothing. Read a book, watch a movie. After that, see if your knee is less swollen. If so---you are doing too much and need to have more rest and elevation. Frankly, I think getting the swelling under control is more important than worrying about rom and doing all those exercises. You need rest and elevation. Boring? Of course---you are not on vacation, you are in recovery for a major surgery. Wandering around stores, making lunch for your friends---all help to make the swelling increase.

Instead, ask the ex to pick up a few things and have your friends stop at the bakery on the way to your house. Kelly

 

[leejaa]

Ellen, you are doing way too too much at 3wks Going to the store is hugely tiring and will get that leg swelling. Really, laying and resting or sitting and resting is work. As you see, it is the hardest work since we do not want to do nothing. Getting the swelling under control is a huge help to flexion and recovery.

My return to work at 6wks is challenging as the stamina is not there and I am exhausted. Also, the leg is swelling and the other one is aching a little. I am icing at work and also taking more pain meds than I would at home but I had to go back.

If your other knee is stopping your recovery, Roy's idea might be a good one to get it fixed also and have one large recovery sort of like bilateral. I had considered bilateral replacements at one point but could not take that much time off from work at one time and did not think I could return before 3m.

Ellen, be kind to yourself and rest and take it easy so that healing can happen and you will recover.

 

[RestAssured]

Thanks Ellen!

Please let others do for you and get those legs elevated w ice! Don't worry about housework, exercises, anything. Get the swelling down. By the way, the took the TED hose off when I got into recovery. They had latex in them and big welts were already forming. No TED hose for any surgery after that! They do make the non-latex, but I liked not having to wear them!

 

[Josephine]

Ex-husband took me to Woolies to get the stuff and by the time I had walked around a few aisles and made my selections and then came home and worked in the kitchen to make the salad (and a hazelnut slice for dessert), I was totally wiped out (as you can probably all imagine).

I know I'm repeating the message but this is NOT an activity for three weeks out! Read this again Activity progression for TKRs and see that for week 3 it says

Week 3
Lengthen the walks to about 10-15 minutes once a day, maybe twice a day if it doesn't cause your knee to swell or be painful.
Activity: prepare yourself a small meal or a snack
Increase the PT to 20 minutes 3-4 times a day, maybe add 5 minutes on an exercise bike; don't worry about full rotations yet

This does not include going to Woollies and walking round the aisles doing shopping and then preparing a meal for friends!