TKR Something isn’t right..

[dotski]

@dotski Please continue the deep breathing with the hand compressions as @Layla mentioned on post #44. Most of our body’s lymph nodes are in our abdominal area and doing this is much less traumatic than trying to did rotations on the bike pedals.
Gently massaging with light compressions over the lymph nodes in your inguinal/groin area helps too.
I hope this helps!!

Thank you for this. I’ve given up on trying the foot peddler until it doesn’t hurt. I still can’t extend my knee against gravity.
I dug out my compression pantyhose - what a comedy act that was putting them on! (Thankful for flexibility). Something I wonder about is if the thigh high compression was resulting in pooling/blockage above the top elastic cuff. I’ve been very careful to ensure no creases, etc (otherwise it isn’t “graduated” compression), but I wonder if the compression just needs to extend up into my abdomen so it is “graduated” all the way there with no sudden decreases in compression that could result in pooling. The pantyhose feel better than the thigh highs. They are 20-30 mmHg compression.

 

[mendogal]

@JusticeRider when I worked in physical medicine where folks were at risk for heel sores we used cushioned open top heel protector boots - cotton fabric sort of like shaped padded pot holders with velcro across the top. They run $10-20.

 

[dotski]

@mendogal, great idea! @dotski I relate to much of what you’re going through. The opioids made me very sick also, and I think like you my body was just angry about ALL the drugs and trauma. I couldn’t keep anything down for the first week, was sick, blacking out, and hallucinating. The nurse on call the second evening had my husband call 911 because she thought I may be having a stroke! My first time having an ambulance come to my house…yikes! Fortunately I was not having a stroke. The very kind and handsome EMT’s determined I was very dehydrated and weak and my blood pressure was quite low. They advised changing medications but two other drugs we tried also made me sick, so I had to bare knuckle it on Tylenol.

I also struggled with sore heels lying on my back in bed. They would hurt so bad at times it was almost worse than my knee! Like you, I could only tolerate lying on my side for 5 minutes or so the first few weeks. I hope you find a solution to your sore tailbone. If you do, please share! Maybe I can try it for my heels next time. Tylenol PM helped me quite a bit, how I wish you could take it! Although it sounds like you have a med combo that is helping with sleep at least somewhat.

As for the ice, I too read (somewhere?) about the possibility that ice could delay healing due to suppressing the natural inflammatory response that aids in healing. In my case, I had no problem deciding to use ice copiously because it was my main pain killer in the absence of opiates. The risk vs benefit for me tipped heavily in favor of ice! Based on your sensitivity to drugs, it seems like it makes sense for you too.

Also, it is an unpopular opinion, but I don’t believe being younger is necessarily helpful in joint replacement recovery. It certainly didn’t help mine, and I was very conservative with my activity, etc. I also think we are given unrealistic expectations, ie. “You’re young! You’ll heal quickly!” Then if you don’t you feel something is wrong and there are even more people ready to tell you that it’s your fault you’re not doing better. We all get enough of that as it is, and it is very harmful to mental health. Anyway, so sorry to leave you a novel, but I just have so much sympathy with what you’re going through. You are not alone. This community is amazing and you can always come here with your highs and lows and find support. Rooting for you, @dotski !

Thank you so much! I’m a bit drugged/impaired and having trouble finding the right words to say to all these supportive responses. I read your entire thread yesterday and am grateful for your candid sharing of the emotional experience.
I use this product a lot for heel pressure sores in healthcare. Funny I just noticed that it has the calf contouring that the lounge doctor product has. I’d probably want to remove the wipe-able (sweaty) cover and put a cotton jersey pillow case over it instead. There are also heel boots that offload heels, but that would be a PITA as you can’t walk to bathroom in them. There are even small foam donuts that go around ankles to elevate heels off bed. Mine are sore also and it’s always a challenge to get it in just the right spot hanging off end of pillow.

Not sure if I can post links, but just in case not, just google “heelzup cloud” cushion.

 

[dotski]

I used ice 24/7 the first 2 weeks. Do you have a foam layer on top of your mattress? Like a pillow top mattress? That might help the sore tailbone.

I have a pretty good mattress with top layer of foam, but might try adding a memory foam topper.

 

[wilsonma]

I agree with the idea of "not icing" to allow the body to heal naturally...however, like you, ice has been my go to for my recovery. It is the only thing that allows me to sleep at night. Could you perhaps, take a cooler to your bedroom and have several frozen wraps or bags of peas, at hand? In that way, you could swap out, when needed.

 

[JusticeRider]

@dotski and @mendogal great suggestions for the heel pain! I’ll have to check these out…that would help so much with sleeping. I had my legs (and heels) up on a regular pillow but it didn’t do the trick. Now they just need to make one for the tailbone!

Something I wonder about is if the thigh high compression was resulting in pooling/blockage above the top elastic cuff.

You know, I wondered about this too. I always felt as if my legs were being cut off at the thigh by those awful thigh high sleeves. Could it be preventing the lymph fluids from reaching the lymph nodes in our abdomen? What do you think @CricketHip ?

 

[dotski]

Got these compression pantyhose about 12 years ago and this is the first time I have worn them….they are actually pretty comfy! Toileting isn’t much fun but I have these textured rubber gloves that help to adjust them without having to pinch. I’m a huge fan of compression to help the veins and lymph vessels work more efficiently (one way valves only work if the vessels aren’t overstretched by backflow). I see it help a lot with swelling….but dang it why won’t it get rid of mine!!?. Probably it would be worse without them...but I don’t want to experiment and increase swelling. I suppose the angry tissues are just making a big cytokine storm and keeping it swollen….

 

[CricketHip]

@dotski Those hose are pretty unique! Do they have the graduated compression like what is recommended?
I agree with you about the value of compression hosiery- as for your swelling, I saw this same thing with my own mom- it took forever for hers to fully return to normal. Just as you said the cytokine response (inflammatory response that our bodies initiate to help us heal), may be more ahem, robust in some people!
By any chance are those pantyhose crimping you in your groin area? The lymph nodes there get overwhelmed easily, too.
@JusticeRider , Both you and Dotski are having the same ruminations as me! That tight band at the thigh area can't be very helpful, can it?
What I recall from MLD classes is that when there’s true lymphedema, bandaging is used to get more control with a smoother compression for whatever extremity is affected. That is referred to as Complete Decongestive Therapy. It's like MLD on steroids.
But that would be overkill for most of us after a joint replacement.
I was content with doing some daily exercises similar to what I put together for BoneSmart.
It can help with moving some of the inflammation and edema but since it's a milder version of the MLD techniques it should be done daily. That and the elevation and icing.

 

[dotski]

Those hose are pretty unique! Do they have the graduated compression like what is recommended?
I agree with you about the value of compression hosiery- as for your swelling, I saw this same thing with my own mom- it took forever for hers to fully return to normal. Just as you said the cytokine response (inflammatory response that our bodies initiate to help us heal), may be more ahem, robust in some people!
By any chance are those pantyhose crimping you in your groin area? The lymph nodes there get overwhelmed easily, too.
@JusticeRider , Both you and Dotski are having the same ruminations as me! That tight band at the thigh area can't be very helpful, can it?

Yes, graduated medical grade (20-30). They can crimp if I’m not careful, but so far much better than the thigh highs. Compression eases up at top of thigh where it turns black colour.
I often see Ted stockings on patients(Teds are for bed, the white ones). one of our surgeons orders them routinely. Others order the sequential compression machine for high risk patients. As with any medical device (that often do no more than create a false sense of security), it really depends on how it is used. I end up spending a lot of time straightening these things out, showing patients where to watch for creasing - as it totally defeats the purpose of the stocking if it ends up creating a blockage of flow!
My leg got wrapped in a bulky dressing after surgery (called a Jones Bandage in my OR report). I actually think it caused harm as it was putting too much point pressure in certain spots. There was no drain. I’m sure my vessels are a hot mess right now after all that!

 

[dotski]

POD11 today. Still having rotten, broken sleep and relying on Tramadol/gravel/cyclobebenzaprene at night. PT will visit again today.
Heartrate still elevated at least 10-15 beats above my normal (it was normal the first 3 days after surgery. I get bloodwork done Thursday just before I see OS and then I have a phone appt with my GP the following week. I’m really hoping the liver enzymes go down as the Tylenol clears from my system.

I want to try Celebrex to see if it will calm my inflammation. Anyone have luck with it? Hoping the OS will prescribe. And I’m wondering if clonazepam might help with sleep and loosening off tight muscles. The cyclobenzaprene makes me sleepy but I can’t say I notice it relaxing the muscles. Anyone ever tried clonazepam short term as a way to get muscle tension down?

I used to rely on manual therapy/massage to release muscles (stretching doesn’t cut it). Hate the idea of more drugs but I’m feeling a bit desperate. Have reverted to using naproxen to try to reduce inflammation but have to be careful as I’ve had inflammation in bowels before and tendency towards what seems to be autoimmune over-reactions with inflammation (why I thought Celebrex might be better).

I basically spend all day and night with foot up and icing, getting up to walk and go the bathroom. The swelling just won’t come down!

 

[Jockette]

The cyclobenzaprene makes me sleepy but I can’t say I notice it relaxing the muscles. Anyone ever tried clonazepam short term as a way to get muscle tension down?

At less than 2 weeks post op you will have a hard time noticeably and quickly reducing swelling and tightness because it is a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You're tight because your tissue has been disturbed and is healing...and healing takes Time.

 

[Cinders2023]

I want to try Celebrex to see if it will calm my inflammation. Anyone have luck with it?

I have had a good response to celebrex. Wish I could remember who on here suggested it. I had terrible swelling for months and tried meloxicam, Aleve and only started to see inflammation calm down after starting celebrex. Worth talking to your Dr. About it. As with any nsaid, it can be tough on your tummy. I tolerate them, and have no problem. I also used ice much longer than most. It helped, and my body needed it.

 

[dotski]

only started to see inflammation calm down after starting celebrex.

This is what I’m hoping, thanks for sharing and giving me hope.
It really is a roller coaster ride and I just never know when the crash is going to hit. I feel just so ill and weak all the time - takes so much effort just to tap these words out on my phone. Still nauseous. Tonight I was so out of breathe crawling up the stairs to go to bed. No one seemed that concerned about my hemoglobin in the 90’s (a drop of 30), nor that my heartrate awake at rest is 20 beats higher than my normal. I gave up caffeine after surgery because of the heart. I really hope it’s just the low iron that’s knocking me out and there isn’t something bigger medically going on. I know it’s major surgery…but I see people going home after surgery looking a lot better than I feel at almost 2 weeks!
Has anyone experience with an iron infusion - wondering if I just need a boost? I’m too high for transfusion. Am taking iron supplement.

 

[Jockette]

I really hope it’s just the low iron that’s knocking me out and there isn’t something bigger medically going on. I know it’s major surgery…but I see people going home after surgery looking a lot better than I feel at almost 2 weeks!

They probably seemed better at the time they left the hospital because the full onslaught of recovery hadn’t hit them yet. The energy drain of healing is very real, and that is a lot what you’re feeling.

Energy drain for TKRs

Here are some facts regarding bilateral TKRs During a bilateral anything you get 1. double the length of anaesthetic this is significant because the stress on heart, lungs and body generally from being sedated and receiving amounts of drugs for the period of time involved can be problematic. A...

bonesmart.org

 

[Layla]

Good Morning dotski,
I am really sorry you are struggling with some of the issues you mentioned as you're recovering from your TKR. Feeling so ill, weak, nauseous and out of breath with an increased heart rate is a lot to endure. Are you able to get together with your Primary Care Physician, if even only a phone consultation for some direction? It is difficult to think of you in such a state. I certainly hope things begin to level out for you soon. Hugs and best wishes!
@dotski

 

[dotski]

Are you able to get together with your Primary Care Physician, if even only a phone consultation for some direction? It

Yes thanks. Phone appt next week - soonest I could get after my bloodwork. It will be a very short 10 minute appt. The problem with healthcare is that no one has the adequate amount of time it takes to truly understand the patient history, time to listen and ask questions. My PCP is a lovely caring soul but has too many patients. It would be the same thing with any other PCP, except they might not be as kind as her.
This forum fills that gap.

 

[Layla]

We're glad you're here, dotski.
I hope by some miracle your PCP finds the time to hear you out and has some sound advice that leads you to brighter days. Hang in there!
@dotski

 

[Cinders2023]

@dotski I’m not sure how many others experienced an elevated heart rate, but mine went up right after surgery and stayed up for months. I noticed this week that I a finally back to my pre-surgery ”normal” range. I wondered if it had to do with medications (but I’m still taking most except opioids now) or could have been my body’s reaction to pain. Are you still having pain? I mean pain that is not managed, I know it still hurts

 

[dotski]

Hi @Cinders2023 yes still having pain but it’s getting less each day. Still taking tramadol and gravol at night and a muscle relaxant, and after the Tylenol was not allowed, I switched to naproxen (aka Aleve) twice/day. Still not sleeping more than an hour stretch at a time, maybe 4-5 total? What’s odd to me is that the first few days I was having a tonne of pain and nausea, unmanaged…but the heartrate didn’t rise until several days after surgery. I wonder if opioids are also contributing, as I don’t notice I feel relaxed after taking them. I’d hoped they would put me to sleep!

Had an aha moment today. I’ve discovered a PT’s you tube channel called Total Therapy Solution - Physical Therapy. His opening line on introduction is “ physical therapy should feel good when it is done right”. He has a few short videos about manipulation under anaesthetic and other knee topics. I’ve only watched a few but so far I’ve picked up some tips. One of them was to use a small hand massager over sensitive areas to desensitize the tissue so I tried it and lo and behold my knee bent with less pain in that previously painful spot. He also has a video on compression wrapping to decrease edema prior to exercise.
His take on scar tissue being cause of low ROM - he doesn’t buy it! Otherwise the knee that bent 130 in the OR would still bend post op. It’s impossible to scar so fast you are down to 50 next day. He does have lots of insights about it actually more likely being a tight joint capsule that limits ROM. He says better too tight than too loose though, but those with the tighter joint capsule may have a more stable knee but regaining ROM will take more time.

 

[sistersinhim]

His take on scar tissue being cause of low ROM - he doesn’t buy it! Otherwise the knee that bent 130 in the OR would still bend post op. It’s impossible to scar so fast you are down to 50 next day. He does have lots of insights about it actually more likely being a tight joint capsule that limits ROM.

Now, there is someone with some common sense! A little bit of fluid in that tight joint capsule inhibits the bend. Getting the fluid out helps the bend come.