MUA My unresolved TKR issues!<

[Freesia]

Surgery went as expected, after spinal wore off, was in a lot of pain, all the meds they gave me only quietened things down by day 3. I cannot take codeine and oxycodone made me sick, so ended up on tramadol and paracetamol with oxymorph at night and gabapentin for the nerve pain. Since home, the neuro pain is going through the roof and the tramadol does not even make any difference, but that is all I came out with. I'm planning to see a doc tomorrow to try and get something else as I'm not coping with the searing pain, can hardly write here and can't remember what sleep is. I'm walking ok on crutches, if a bit unsteady, bending and leg lifting set off the nerve pain. Any other ideas please?

 

[Celle]

Hello @Freesia I'm sorry you're in so much pain.

It should be possible to get some pain relief that works better for you.
If the narcotics make you sick, ask to have an anti-emetic, such as Zofran, prescribed for you to take regularly. All narcotics make me vomit and that is what I have to do, so that I can achieve pain control.

You can (and should ) take Tylenol in combination with Tramadol, to give a better effect.

If you end up having to just take Tramadol and Tylenol (Paracetamol), try taking them according to one of these regimes that Josephine has worked out. The first one is for 4-hourly doses and the second one for 6-hourly.

In both cases, make sure you limit your Tylenol to 4,000 mg in 24 hours.

 

[ACDCJen]

Sorry to hear about the nerve pain @Freesia

I had something similar after my arm surgery. It felt like my arm was on fire! I was put on gabapentin, I think 2700mg a day. It worked for a while and got me out of the worst part of it. I found that pain meds didn't really work for me. I remember being told that the therapeutic level of gabapentin for neuropathy is different and higher than it is for seizures, but don't quote me on that!

Good luck and keep us posted!!

Jen

 

[Grammy211]

So sorry to hear you're in such bad pain @Freesia. My nerve block wore off on day 2 post op and all I could do was cry because the pain was so bad. My doctor did increase the pain med dosage and added another which helped a lot. After a couple weeks I was only taking Tramadol with Tylenol which helped control the pain. I think the first 3 weeks are the very hardest. Your doctor should be able to give you something to make you comfortable. I agree with @Celle regarding the Zofran, it can. She a huge difference for you!


Sent from my iPhone using BoneSmart Forum

 

[newlybionic]

I hope you can get some other pain medications and a prescription for Zofran to help with nausea. If the Zofran doesn't help there are others for nausea including one that is called scopolamine. It is a small patch that goes behind your ear and only needs to be changed every three days. Let us know how you do with the doctor tomorrow.

 

[DebM]

I had bad nerve pain post op and found relief with gabapentin. It did take a few dose changes to get to the ideal dosage for me. I found too pain killers did nothing to help. Hopefully your dr can guide you to increase your gabapentin to a level that helps.

 

[Celle]

@Freesia

I also have the BoneSmart recovery reading list for you. Lots of useful information in these articles.
Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now; they are almost certainly temporary
2. Control discomfort:

rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.​

3. Do what you want to do BUT

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy​

5. Here is a week-by-week guide for Activity progression for TKRs


The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?

Energy drain for TKRs
Elevation is the key

Ice to control pain and swelling
Heel slides and how to do them properly

Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[Freesia]

I'm in the UK so things are different. I agree they have to get us up and ambulant early on and some basic moves, but there is an expectation for us to do "pushing through the pain" in the days post op.
As I have had some very severe neuro pains all down leg, strong exercises just land me in tears and then I have hours of searing nerve pains, esp. at night. Their approach is very definitely if you don't do this, you will never bend your leg and it will be a MUA! When the pain is bad, I do not care about ROM, I just want to be free of the pain. I am listening to my body for clues and I know I need rest after this op, I am not lazy or a scaredy cat, so I am grateful to find this group for reassurance, although I am required to go to physiotherapy as part of my treatment on the NHS.

 

[Celle]

@Freesia - I have copied the post you made in the pre-op area, so that @Josephine can advise you.

Being forced to have painful therapy is not part of the NHS requirements.

You have the absolute right to refuse any painful treatment.

 

[Josephine]

Freesia, it most certainly is not the NHS protocol, only your physio's ignorance. Apart from the article Calle left you, you should also read these
Saying no to therapy - am I allowed to?
BoneSmart philosophy for sensible post op therapy
As a matter of fact, my surgeon doesn't allow his patients to do any exercises for at least three weeks after surgery. He also just has his patients have check-ups with the physio at 6 week and 12 weeks but this is just for a check-up to make sure they are doing okay..

As it happens, I did so okay I never did any exercises at all for either knee (I've had both done as you can see in my signature.

Even before I ask you for more detail, I suggest you cancel any physio appointments you have and don't do any more exercising at all. However, this doesn't mean being a couch potato all the time! You need to walk around the house a bit (follow these guidelines Activity progression for TKRs) and make sure you do all the icing and elevating too. When you've responded here, I might ask you some more questions,

 

[Freesia]

OK Thanks. I have an apt to learn stairs since I never did that as an in pt - living on ground level at home. I will go for that as it may be useful and refuse any pulling and pushing etc. It was stressing me as I do agree with the info on here, not aggressive stuff. I see it is like a tick box for NHS targets to reach all these stages quickly.
Happy to answer Qs.

 

[KarriB]

Try leading with "up with the good, down with the bad". This is what my PTs gave me, but I had already been doing that pre-op because the knee hurt so much.

 

[Josephine]

I have an apt to learn stairs since I never did that as an in pt

It's not rocket science but we have a video! Stairs: how to cope with stairs after surgery


Here are the questions. It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine)

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[Freesia]

OK.
1. Pain levels are across the numbers really, sometimes when sitting elevated, with ice, etc daytime can be 1 for short spells - nights can have phases of hitting 9-10 due to nerve pain shooting through the whole leg. In between about a 5 some movements push it up.

2. Tramadol 50 mg 1 four times
Paracetamol 500 mg 2 four times in 24 hours
Amitriptyline 10 mg 1-2 @ night
3. Knee probably moderate swelling now but I have lipoedema so legs/ knees are large for my frame. I did not get any TED stockings as, on the op day, my ankles had swelled and they decided against.
4. Bend on discharge was 75% but now down to 35
Extn I cannot recall number but was told it was good - not been able to straighten the leg for many months pre op.
5. Icing whenever possible and comfortable, about every hour or so daytime and always after any moving about. Also if cannot sleep.
Elevation - keeping elevated as much as possible and comfortable as leg very restless.
7. Activity - Currently just walking around home on crutches. Suffering from low BP and light headed so taking it slow. Washing, dressing, getting in and out of chair bed OK.
8. Hospital exercises given 3x5 sets, not sure of correct terms but
Leg lifting
Pulling heel back toward body
Raising foot - knee over rolled towel
Sit in chair, knee bend
Sit in chair - leg raise

I tried these when feeling up to it, as directed.

9. PT - once weekly
Walking around corridors
Leg slides using a board
Leg raises incl over rolled towel
Pushing knee back into bed
Working on firing quads

The PT wants me to go on extended outside walks, but I'm not ready as having very low BP at times and quite unsteady on uneven ground.

Also having chills and sweating, shakiness and weakness. I feel these are likely due to meds and pain. Planning to get review by GP on these, as they are not really right I know. They are defensive about giving strong narcotics. Codeine does not suit me.

I hope this makes sense as I am tired now, up with the pain a while and had to call out of hours for my poorly mother last night. (My daughter is here to help.)

 

[kneeper]

Sweating, shakiness and weakness could also be partly from the fact that you aren't that long out of surgery.
You're right that you don't want to try uneven ground if you are unsteady. You can work up to that or walk only on even ground. I found getting outside nice, but started with very short walks--less than 10 minutes.

 

[Josephine]

1. Pain levels are across the numbers really, sometimes when sitting elevated, with ice, etc daytime can be 1 for short spells - nights can have phases of hitting 9-10 due to nerve pain shooting through the whole leg. In between about a 5 some movements push it up.

Okay ....

2. Tramadol 50 mg 1 four times
Paracetamol 500 mg 2 four times in 24 hours
Amitriptyline 10 mg 1-2 @ night

At 1½ weeks out, you need more than 50mg Tramadol. I have a chart which would be much better for you

3. Knee probably moderate swelling now but I have lipoedema so legs/knees are large for my frame. I did not get any TED stockings as, on the op day, my ankles had swelled and they decided against.

Okay

4. Bend on discharge was 75% but now down to 35
Extn I cannot recall number but was told it was good - not been able to straighten the leg for many months pre op.

75%? 35%? I don't understand these numbers. Usually when talking about ROM, we talk in degrees rather than %. Look at this ROM (range of motion) information.

5. Icing whenever possible and comfortable, about every hour or so daytime and always after any moving about. Also if cannot sleep.
Elevation - keeping elevated as much as possible and comfortable as leg very restless.

Good!

7. Activity - Currently just walking around home on crutches. Suffering from low BP and light headed so taking it slow. Washing, dressing, getting in and out of chair bed OK.

Okay

Hospital exercises given 3x5 sets

Not sure what "3x5" actually means and I think maybe you don't as well! So let me explain because I really need this information.

It usually goes like this:
- a repetition, more commonly just called a 'rep' is one movement of an exercise, like one lift of the leg
- a set is a few reps, so you lift your leg 5 times and that is 5 reps. Then you rest a few seconds and do another set of 5 reps
- I need you to tell me how many reps and how many sets of each of these exercises you do.

That's what I'm after, okay? How many reps and set you do any how many times a day you do all these exercises.

 

[newlybionic]

Your shakiness and light headed feeling could also be caused by not eating or drinking enough. If you are having problems eating full meals eat 4 to 6 small meals having protein of some form with each one. Drink enough water too. If you are nauseous ask your OS for something to help with that such as Zofran. You can also drink a bit of Gatorade too

 

[Freesia]

@Josephine
4. Meant 75 degrees and 35 degrees
8. Meant to say they asked me to complete 3 to 5 reps of the exercises at least 3 times a day
I'm doing trying to raise leg off bed, pulling back heel towards body, trying to raise leg with rolled towel under knee
pushing knee down onto bed, sit in chair knee bends and leg lifts. Not going well so far!

 

[newlybionic]

Don't worry about having difficulties with those exercises right now. You will be able to do them after you give your knee some more time to heal. Some walking to the bathroom and kitchen will be enough for you right now. Your range of motion is very good for only 2.5 weeks into a 52 week recovery.

 

[Josephine]

Meant 75 degrees and 35 degrees

So you mean 75 degrees of flexion and 35 degrees of extension, yes?


My comments in bold
3 to 5 reps 3 times a day - I suggest you only do them once a day and none at all at the weekends
Leg lifting - straight leg raises: it's not at all uncommon for people to find difficulty with this. You can, however, use a belt or a leg lifter to help. And only do 2-3 at a time. And another tip - once you can do them, you don't need to do them any more!
Raising foot - knee over rolled towel - these are half leg raises and an excellent half way step to doing full leg lifts.
Pulling heel back toward body - I think by this you mean heel slides. Doing them like this is not the way to get best effect. I suggest you read this Heel slides and how to do them properly.
Sit in chair, knee bend, leg raise - don't do either of these. Unnecessary.


PT - once weekly
Walking around corridors - but not too much - you only need to do a very few minutes each time
Leg slides using a board - please note the article I gave you earlier about heel slides, It applies here too.
Leg raises incl over rolled towel - don't try too hard at PT.
Pushing knee back into bed - again, just a very few - two or three at most.
The PT wants me to go on extended outside walks, but I'm not ready as having very low BP at times and quite unsteady on uneven ground. - it also depends upon what she means by 'extended walks. You're only 10 days out so should be even thinking about doing more than is described in here Activity progression for TKRs.

You can say no to any of these, you know - Saying no to therapy - am I allowed to?

Working on firing quads - which involves what, exactly?