TKR Tabbycat's Recovery<

[Keen Skier]

Amen to that!!


Sent from my iPhone using BoneSmart Forum

 

[Tabbycat]

I've just come across a website which might be useful, it's UK based and a lot of it is common sense, but if you are in chronic pain (as many of us are), you might find something helpful. It's www.paintoolkit.org
Love, Tabby

 

[Dawni]

@Tabbycat very intresting podcast

LTKR 11 May 2016

 

[birdwatchr]

@Tabbycat
How are things with you? Hope you are feeling much better. Keeping you in my prayers.

 

[Tabbycat]

@birdwatchr
Thanks for the kind thoughts. I'm improving bit by bit, not so much from day to day, but looking back over the last couple of weeks, I can see some progress. Still in a fair amount of pain on and off but definitely sleeping better, I'm getting about five hours a night. I hope the 2am cup of tea is a thing of the past.
How are you now?
Love, Tabby xxx

 

[tjcteacher]

Good progress Tabbycat

 

[mamazipp]

@mamazipp I just put a link up for you there is a short video explaining what radiotherapy ablation is I had nerve damage after my 1st TKR just over 4 years ago in January 2012 then had the ablation done 10 months after and since reciving that my right knee has been perfect. Hope that it is informative.

LTKR 11 May 2016

@Dawni. Thanks for posting the link to radiotherapy ablation. It does sound a bit scary! Did it relieve the pain without affecting your function?

 

[Dawni]

@mamazipp it was releef straight away, I have had no more pain from that knee and it's been nearly 4 years, function was not afected at all, my mother has had it for back pain and a friend has had it for pain he's having after a stroke, you are sedated but it is uncomfortable but only for a short time.

LTKR 11 May 2016

 

[mamazipp]

@Dawni. Sounds fascinating! I'll have to research this. I've not heard of it. How wonderful that you derived immediate pain relief.

 

[Dawni]

@mamazipp are you needing this treatment, I am hopeing my new knee heels well.

LTKR 11 May 2016

 

[beaglador]

Just a thought, Tabbycat. You have been taking cocodamol for pain for some time now. Are you tolerating it quite well? Two tablets contain 16 mg codeine, so perhaps you would now be able to tolerate one 30 mg tablet after 8 weeks or so of use. Might be worth a try. On the other hand you may not want to risk it.

 

[Tabbycat]

I could tolerate the 16 mg of codeine with the paracetamol, but really dislike how it makes me feel and the pain relief wasn't very good. The 30 mg caused a lot of vomiting which I don't want a repeat of. I do have quite severe pain at the moment. I thought it would be getting less as time goes by. I don't know what's normal. I am getting fearful of this turning into a chronic pain condition and the stress is not helping the pain. Am going to try Amitriptyline, though I took it for several years for sleep, and tried 5 or 6 times to get off it, failing each time because stopping it caused insomnia. Also if I take it and don't get a good nights sleep I feel awful the next day.
Ok, it's way past my bedtime, I better settle down. Hope everyone has a good night.
Love, Tabby xxx

 

[sistersinhim]

I pray you have a really refreshing night's sleep and that your pain is less and less each day.

 

[Josephine]

I am getting fearful of this turning into a chronic pain condition and the stress is not helping the pain.

You're not even 9 weeks out yet so it's a bit early to be worrying about that. It really is.

I thought it would be getting less as time goes by. I don't know what's normal.

Honey, there is no such thing as 'normal'. Everyone's experience is unique to them. But it should be slowly reducing and because of this, I am going to ask you my (in)famous questions!

I'd like to ask you some questions if you don't mind, and 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?

6. are you elevating your leg, 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. what kind of PT exercises and exercises at home are you doing? How much 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: (enter number) of sessions each day
enter exercise + enter number of reps and sets
etc., etc.

At PT
enter exercise + enter number of reps and sets
etc., etc.

 

[Floridagal]

It must be so hard to stay positive when you want to be pain free so much faster. I like what your PT said. I'm glad you have someone who understands that slow and easy is the way to go. You will arrive at the end and be happy this is all behind you.

 

[Tabbycat]

@Josephine,
Ok here goes:
1. Pain levels
Usually at rest about 2, but in last two weeks have had increasing a sharp stabbing type pain, (not confined to one spot) lasting several hours at a time, level 5-6. This pain is not related to movement or weight bearing.
Pain on standing initially 6-7 in one specific spot (left of kneecap where most inflammation was pre op). This pain usually eases some after walking about a bit. Always pain on moving the joint in any direction (a deep ache, between a 3 and 7, noticeably worse with drops in air pressure).
Soreness and sensitivity on and around the scar and electric shock type pains which I believe are normal.
Since I slipped and overextended my knee (4 weeks post op) I have increasing pain the further I try to extend, or bend my knee.

2. Medications
Sent home from hospital with Paracetamol 2 x 500 mg four times daily. Took these for a while then switched to Cocodamol (8mg codeine/500mg paracetamol) four times a day, the most codeine I can tolerate without vomiting. Pain control 80% of the time not adequate.
Have also tried Nefopam Hydrochloride 2 x 30 mg 3 x daily (no noticeable effect on pain).
Just started Amitriptyline 10 mg at night prescribed by pain specialist. Too soon to notice a benefit.

3. Swelling
Moderate to look at.
TKR knee is one inch bigger than the other, exactly the same as pre op.
I do not notice a difference in the size depending on whether I have used ice, or done more activity.
Knee feels tight and unable to bend beyond a certain point.

4. ROM
3 days after surgery: flex 85 ext 5
After I slipped: flex 65 ext 15
Measured by physio last Tuesday: flex 75 without pushing, 80 when pushed, ext 15

5. Icing
I am icing with 2 or 3 ice packs three times a day until the cold wears off (about an hour) and again at night. I occasionally find the ice causes more pain.

6. Elevation
I elevate on 3 stacked pillows on the recliner except when moving around the house, bathing or attending appointments. I sleep in it too, I have not been able to sleep in bed. The recliner does not go horizontal at the back but I have ordered an adjustable bed so will be able to elevate better.

7. Activity
Limited due to pain and the continuing need to use 2 crutches (since I slipped the TKR knee feels unstable and quads are weak though the implant is OK).
I go up and down stairs a couple of times a day, manage to shower (on bath bench) and feed my cats. Hubby keeps everything ticking over. I am not strong enough to stand without the crutches so am limited in what else I can do.

8. PT
At the last PT appointment (last Tuesday) this is what I did, and am supposed to continue doing at home 5-6 times daily:
1) Knee bend holds 2-3 mins gradually increasing bend
2) Bent knee foot lifts (quads) x 20 -30 moving to near extension
3) Extension holds 2-3 mins (rolled up towel under ankle).

I did above exercises ONCE a day for 2 days and found they caused increased pain at the time and the following day.
I have now discontinued all but some heel slides for a minute or so a couple of times a day, and an extension stretch, once or twice a day, which I continue to find painful, but the poor extension is really hampering my ability to walk.

I hope I have given enough information, and I am very appreciative of your help.
Tabby xxx

 

[newlybionic]

I'm sorry that you are still having pain so much pain with your knee. Have you seen your OS since you slipped for an examination? I hope you were able to get some sleep last night. I'm praying you will start to feel some relief soon.

 

[Tabbycat]

Hi @newlybionic,
Thanks for your concern. Yes I saw the OS on 7th June. He checked my knee, and said the implant is ok but I have pulled ligaments. He wants me to continue with physio and see him again in 6 weeks on 19th July. Physio is getting a bit more intense and I'm getting stressed about it to be honest. I obviously want to improve ROM but don't think pushing my knee beyond its limits is the way to do that. I'm still exploring pain relief avenues, it seems I have to do the digging myself, but I refuse to believe I have run out of options.

 

[uva55]

Tabby, I'm so sorry you still see no improvement, I know it's hard to stay positive when you are in constant pain, but a positive frame of mind is so important and you know you will get over this hump, it's just taking longer than it should...keeping you in my prayers

 

[Josephine]

Usually at rest about 2, in last two weeks level 5-6 Pain on standing initially 6-7 Always pain on moving the joint in any direction, a deep ache, between a 3 and 7

Well, that's certainly significant.

Paracetamol 2 x 500 mg four times daily
switched to Cocodamol (8mg codeine/500mg paracetamol) four times a day
Pain control 80% of the time not adequate.

You are taking one co-codamol at a time? Or two?
If there's nothing much else you can tolerate, I don't know what else to suggest.

Swelling- Moderate to look at.

Yes, I would imagine that.

ROM: 3 days after surgery: flex 85 ext 5.
After I slipped: flex 65 ext 15.
Measured by physio last Tuesday: flex 75 without pushing, 80 when pushed, ext 15

Never, ever allow them to push on your knee. It's a false measurement anyway. The ROM is supposed to be what you can achieve on your own. But there's no doubt your ROM is limited for a little over 8 weeks.

I am icing with 2 or 3 ice packs three times a day until the cold wears off (about an hour) and again at night. I occasionally find the ice causes more pain.

I hear you.

I elevate on 3 stacked pillows

Good

Activity Limited due to pain. Hubby keeps everything ticking over

Good ol' hubby!

At the last PT appointment (last Tuesday) this is what I did, and am supposed to continue doing at home 5-6 times daily:
1) Knee bend holds 2-3 mins gradually increasing bend
2) Bent knee foot lifts (quads) x 20 -30 moving to near extension
3) Extension holds 2-3 mins (rolled up towel under ankle).

I did above exercises ONCE a day for 2 days and found they caused increased pain at the time and the following day.
I have now discontinued all but some heel slides for a minute or so a couple of times a day, and an extension stretch, once or twice a day, which I continue to find painful, but the poor extension is really hampering my ability to walk.

(OS) wants me to continue with physio and see him again in 6 weeks on 19th July. Physio is getting a bit more intense and I'm getting stressed about it to be honest. I obviously want to improve ROM but don't think pushing my knee beyond its limits is the way to do that.

I'm a bit confused by this surgeon. On the one hand he says you have damaged ligaments and then he tells you to exercise it! I have never felt that the way to treat injured tissues is with exercise. Stretches, yes but things like heel slides, leg lifts and that extension stretch is so counter-productive I can't even begin to define it!

This is entirely up to you, of course, but were I in your shoes I would flat down refuse to do any of those until he has worked with you to manage your pain. You have the right to refuse, you do know that, I hope? Consent and all that. And if something he's told you to do is causing you pain, then say no!