TKR The hardest part is not knowing where you're supposed to be

[RobinEH1]

Well everyone.....The Dr. Was much better than the PT. he said I am right where I should be in all areas-recommended 6 more sessions of PT. I also asked about meds. He said that I should stay on the gabapenton but try to get off th heavy duty stuff like the Percocet that I am taking twice a day.5mgs. He Reco tramadol. He said it helps with pain but not as heavy duty as Percoset. He said I should try it with something like Advil for pain. Does anyone know anything about tramadol? Does it work?
I was so happy that I am doing well. He let me take a picture of my X-rays that he took today. He said healing is not a straight path up....there are some ups and downs....he was very nice.let me know if you want to see it
Thanks guys!!

 

[Pumpkin]

Glad you had a good visit with your OS, Tramadol is considered a good step down pain reliever. If you take tylenol for pain be sure to add all sources together, so you do not exceed the maximum daily dose of 4,000 mg.

 

[Gigi32]

Tramadol helped me but you need to take it with another pain reliever like Tylenol for it to really be effective. The nice part is you can take it and still drive because it doesn't make you loopy like the narcotics do. At least I could. So you should be able to take it during the day and still function. I would probably try it over the weekend to see how you do with it and then you'll know. I'm glad your doctor gave you a good report.

 

[Celle]

Tramadol is a synthetic narcotic, not as strong as the narcotics you are prescribed initially.
When using Tramadol to step down from the stronger narcotics, taking Tylenol as well can be useful initially. However, Tramadol doesn't need the addition of Tylenol.

 

[referee54]

I can echo what others have said---this recovery is much different than any other orthopedic surgery that many of us have had. It is not about working harder---it is about working smarter and taking it gently and slowly.

It is also not about "no pain, no gain"---it is all about "no pain, more gain. The harder you work your knee---the more you put pressure on it and cause pain---the more your will fight back, swell, and stiffen up. While it is contrary to everything that we have been taught, a TKR recovery is taking it slowly and taking PT only to the point of discomfort and no further.

There is nothing that you can do to speed up recovery, but there is plenty that you can do to slow it down.

He said healing is not a straight path up....there are some ups and downs....he was very nice.

He is absolutely correct---it is not linear---there are ups, some downs, and some plateaus. I gave up trying to figure out what I did to cause my knees to hit plateaus or a regression here or there. Recovery is like a roller coaster ride---but in the end, you will reach your destination of being fully recovered.

Recovery can also look like this---

While the general trend is upwards, there are few bumps along the way.

 

[RobinEH1]

So here is my dilemma that I would appreciate a little help with. I think I have been overdoing this last week up until Monday with the physical therapy and exercise. And now after reading about losing the work ethic and going slower and not pushing yourself....read all your wonderful articles..... I have been hurting all this week more then I have during my recovery. Monday I had a hard physical therapy session where I may not have allowed anyone to hurt me but I really pushed through a lot. Tuesday I was exhausted and my knee was really hurting me more than it has in a long time. Wednesday I went to the doctor got a good report didn't think much of the fact that my knee hurt more than usual. Then after the doctors appointment I went to physical therapy again. And this morning, Thursday, my Knee felt even worse. I said to myself I'm doing exactly what all of the article said not to do! And it just snuck up on me I didn't even realize it till I just read it again. My knee hurts so much now that I can't even exercise and I'm back to using three pain pills Instead of 2. I didn't even get the prescription for the tramadol yet I'm still with the Percocet and the gabapentin. I also didn't sleep last night.Please help me figure out what I should do next? Should I cancel physical therapy for the next few days and just take it slowly? I am taking off of work tomorrow....yes I also went back to work.
What does slowly mean, don't do any exercises just elevate ice take my pain meds or do I do something? this is territory I've never been in my life and just what you said in your articles I think is happening. Thanks all!

 

[KarriB]

If you're working I definitely wouldn't do pt, you must be exhausted! Usually TKRs take 12 weeks from work. I took 12 weeks and went back to half days for 6 weeks, per my Drs. script. He let me drive when I wanted, but not go back to work. But I did have 180 sick days going into the TKR.
Take it easy over the weekend and next week to see how you feel. Rest, ice, elevate, fall asleep in front of the tv and assess the knee next week. Take walks around the house and do some gentle heel slides in the meanwhile.

 

[Celle]

Please help me figure out what I should do next? Should I cancel physical therapy for the next few days and just take it slowly? I am taking off of work tomorrow....yes I also went back to work.

I would cancel the PT for a few sessions until your knee settles down again. You may not have done too much for it at any one time, but the amount of over-doing can be cumulative - and you've gone back to work much earlier than we recommend (12 weeks minimum). It's not just doing the work, but the additional work imposed by getting ready and travelling to and from work.

Most people find that when they go back to work, even if they wait 12 weeks or so, their knee does suffer increased pain and swelling.

Rest, ice and elevate your knee and do very little else. Walking to and from the bathroom, doing some ankle pumps and maybe one or two heel slides a day will be enough exercise for now.
Heel slides and how to do them
Don't go to PT on days that you work - your knee has more than enough to contend with.

 

[RobinEH1]

Ok...I just cancelled PT for today and Monday.....taking your advice and taking it easy. I had to go back to work...I had no choice but staying home today. Will do exactly what you are advising and I will report back in a few days. I can't tell you how much it means to me to have friends out there with experience that are willing to help me. I felt so lost and on my own before I found this group. You people are wonderful.
THANK YOU !

 

[Celle]

We're here to help.

Don't try to rush your recovery. With work as well, PT once a week is probably plenty.

 

[RobinEH1]

Hello friends! I have a little update on my progress in recovery. Remember how much pain I was in at my last post?
My Last formal physical therapy session was last Wednesday. I went to work on Thursday, I rested, elevated, iced, Friday Saturday and Sunday. I did a few gentle heel slides.... And today I did my own gentle physical therapy session. I heated my quads with a heating pad first. It consisted of 10 minutes on my stationary bike, some gentle squats leaning on a giant, rubber ball. Then I did five gentle heel slides, leg lifts, some gentle quad sets. Then rest ice and elevate my new mantra for living
You folks just about saved my life. I didn't exactly tell the truth to the physical therapy place when I called and canceled Friday and Monday. I just said I wasn't feeling well.
Should I keep going as I'm doing? Is there anything I should be doing that I'm not doing? And I have to figure out what I do for next week because I have appointments at the physical therapy place.

Drug update. I had been down to one Percocet in the evening with gabapentin and the same in the morning. Yesterday morning, for the first time, I felt that the Percocet made me a little too loopy. I called the doctor today and asked for the drug he recommended when I saw him last Wednesday, tramadol. I picked it up tonight and just took it in the hopes that I can sleep. Because I can't sleep without anything yet. Sound ok? Without the Percocet I wake up in the middle of the night three or four times achy and uncomfortable. Hoping the tramadol will help me sleep without having to take the Percocet. Today is six weeks!
Thank you ALL!
Robin


Sent from my iPad using BoneSmart Forum

 

[Celle]

Yes, keep doing what you're doing. It's all you need to do for now. You could even cut out the squats - they put quite a strain on a new knee and you're already doing the heel slides to help with bending your knee.
walking is the best exercise of all so, in a couple of weeks you could gradually increase the amount of walking you do. Don't be in a hurry to walk long distances, though. Little and often is the rule there.

It's up to you what you decide to do about PT. Remember that you're the boss, so you can decide. I suppose, if you decided not to go back, you could just tell them that your knee is getting plenty of exercise as you're back at work.

Yes, it's OK to take Tramadol to relieve pain so you can get to sleep. When you decide to stop taking it, cut down the dose gradually.

 

[karol723]

Hi, So glad you're doing better. I feel he same as you, this forum helped me keep my sanity many times. I agree with Celle, when you cut down on the Tramadol , do it very gradually. I went a little too fast and my stomach has been a mess. I think because I don't usually take alot of medication I'm overly sensitive in that way. So just be careful when the time comes. Sounds like you're on the right track now. It's a long recovery, try to be patient with the process. Every day is one day closer to totally feeling like your old self. Stay well.

 

[referee54]

I am very glad to read that things are going better for you. Keep listening to your new knee and take things as you are---gently and slowly.

It's up to you what you decide to do about PT. Remember that you're the boss, so you can decide. I suppose, if you decided not to go back, you could just tell them that your knee is getting plenty of exercise as you're back at work.

I agree---since you are back at work, your knee is doing a great deal, and there comes a time when "life becomes PT"---so if you do decide to go back, set limits and draw that line in the sand and let them know exactly what you will tolerate and what you will do---and strongly inform them of what you will not tolerate and what you will not do.

 

[RobinEH1]

7 week update. It is 7 weeks on Monday. Been doing PT on my own with all of your instruction. It's gentle and it seems to be working. My pain level is so much better than it was even a week ago. The last three days I've taken two advils in the morning with breakfast and taking nothing else until I go to bed with the tramadol - only one pill. Wow!!
I stopped using the gabapentin about 4 days ago and I seem to be doing OK without it. Is that Ok to stop? What is it supposed to do anyway?

I did get six more sessions for PT approved besides the eight I've already had and I think what I'm going to do is go back once or twice a week starting next week and make sure they listen to what I want them to do.

I am still waking up three or four times during the night trying to get comfortable. I am tired all day because of that. I normally sleep on my right side which I can do for short period time with a pillow between my legs but it wakes me up after while and I go on my left side.....all normal folks? I am still icing,elevating, resting as much as I can in between going to work full-time and running a 10 mile marathon ....only kidding if I could even walk in the mall again I would consider that a big accomplishment Thanks again everyone !

 

[Timetolive]

It all sounds normal and like you are doing great! If you don't need the pain meds, weaning off them by forgetting or not needing them is wonderful. As long as you are comfortable with your pain level, you are fine. Sleep is elusive for quite some time for many. It took 3 months before I gave up my pillow at night for my knee. Just rest when you can. It will catch up to you eventually if you don't.

 

[jarabas]

Hi Robin. Just got caught up on your thread. You are doing a great job with your new routine.
I take gabepentin for two different conditions--restless leg syndrome, and neuropathic pain-- and it works really well for me. I'm not really qualified to say, but perhaps it is for nerve pain that your os prescribed it?
I think it was right about 6 weeks that I started sleeping through the night some. I still have nights where I wake up early and can't get back to sleep, but the trend is definitely in the right direction.

 

[sleepilu]

Sounds like really good progress. I have no idea how anyone works so early on, I was such a mush brain as well as in pain.
It's a great feeling when you realise you didn't need so many painkillers but don't be afraid to hop back on them down the line. I went back to 4 hour meds last week (15) and it really helped me through a few bad days.
Old cliche holds firm ..... One day at a time.


Sent from my iPhone using BoneSmart Forum

 

[Dmlove]

I feel the same way! I am 4 weeks out tomorrow. I have 120 ROM and 8 on my flexion. Therapy twice a week plus I own my own business so I had to go back to work part time. I too have no idea where I'm suppose to be at. I have found that if I'm up on it for more then three hours it hurts like a person! Then I have to rest ice and elevate. Just read through all the forums. I know I'm probably over doing it!

 

[RobinEH1]

Update eight weeks out and a question.

Remember how I was getting beaten up in physical therapy… with everyone's advice here I stopped going for two weeks and was doing great. Then I went back a week ago last Wednesday and they were appropriate with me. My rom was up to 105 and my extension was pretty good- does 5 -7 sound right....and then I couldn't get another appointment till the following Wednesday which was last Wednesday.
I should've known better but they stretched me and hurt me, but this time it was not more rom but a greater extension! She had my leg up on her shoulder and then had it back down on the table pressing on it. The next morning I could barely walk but got myself up and went to work and iced at work. At least I knew what happened, I was pushed too far at physical therapy! The thing is I told them they should not be doing that to me while they were doing it. I asked them if you've ever heard of our website and they said no that they hadn't. I told them that their way is not the only way to recover from a knee replacement. What is with these American physical therapists. I was again threatened that I'm at eight weeks now and I have scar tissue building up and that's why I can't straighten my leg completely. I was also told that if I don't stretch now through the pain that I'll have to go under anesthesia and have the MUA done. Stood up for myself and told them no one can make me do that. They said That my leg will always have a bend in it always when it should not. I see the doctor on the 27th for my 12 week check up and I'm worried if I leave physical therapy completely at what he will say as the physical therapy is connected/owned by the practice. I can go up to 15-20 minutes on the bike now I'm starting to feel so much better.
PTs are incorrect right? Worst part is that they make me doubt myself and that little voice in my head says what if they are right?
Before last Wednesday, although today I'm feeling better, I'm only taking two Advil's or one Aleve in the morning. And one tramadol when I go to bed and one gabapentin. I was only taking the tramadol and I was waking up every two hours at night. When I read this site about nerve pain I realized that I had stopped the gabapentin too soon. I started taking the gabapentin about five nights ago, and I have slept every night it's been heavenly to sleep again!
I saw the extension exercises on the site. What's the best few that I should be doing.
Am I ok guys? Thanks everyone!!

Josephine......I love your kitty!