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TKR Toni Lee Recovery Thread

tlfiore

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Had my Right TKR completed Wednesday morning 10/30/19 @7:45 am. Home from the hospital Friday afternoon 11/01/19 after a two night stay. I must start by saying without the help of the wonderful Bone Smart members, I'd be LOST! So much to say but I will start with a heartfelt THANK YOU to everyone here who absolutely helped me with all the wonderful information, help and advice.

Covering all the minutia that transpired up to this point would prove tedious for one to read, so I'll try covering the highlights that may prove beneficial for others (as well as beneficial for me...venting). So, here I am beginning my 5th post-op day (only 3 nights home, 2 nights in hospital) and this is my experience:

1-Many folks I spoke with in passing totally minimize the surgery, others do not. Folks, this is ABSOLUTELY MAJOR SURGERY and I am absolutely feeling it. The BoneSmart "mantra" of rest, relax, elevate, treat pain, ice, sleep, etc is 10,000% true and positively necessary. My first night home, Friday night was my WORST night. I literally feel that I've been hit by a truck. I was kept in-hospital x 2 nights due to post-anesthesia vomiting & dehydration, along with hypotension and weakness, blackout, falling, vomiting, etc during first attempts at sitting upright, walking and first PT attempts...awful.

2-Pain control is an ABSOLUTE MUST and mine started out rough. The protocol consisting of the standard "start low-go higher" regime, which my nurses seemed to live by, proved disastrous. The Saphenous and Femoral Nerve Blocks were good, yet relieved only about 40% of the pain in very specific areas. The post-op pain is EVERYWHERE and oral narcotic analgesia is definitely required. So, I'd say I lost some recovery time during the first 24-36 hours with the Tylenol (really??) to Torodol to Tramadol to Celebrex (really??) to Norco to Oxycodone 5 mg po every 3-4 hours plan. REALLY? My anesthetic pain pump infiltrated on Thursday evening and my eyes were nearly swollen shut with tears from pain. TYLENOL??? My pain was barely manageable when I left the hospital around 1:00 pm on Friday. Pain management is a joke, IMHO, especially how it's "rated." Disasterous, actually. Sparing the obnoxious details, I'm managing pain with a STEADY and RELIGIOUS regimen of Oxycodone 5 mg q 3hrs...non-fail. And rest, relax, ice, elevate, nap, doze, sleep.

3-PT...sigh...don't even get me started. So, my first in-hospital PT session was shortened when I fainted at the parallel bars. My second session wasn't much better. I've had one home PT with a second scheduled today. I've been approved for 3 weeks of home-based PT, 3 times a week.

4-Surprisingly, sleep has not been horrible and if anything, sleep and rest have been much better than anticipated. Eating is predictably way off. I've not had a stool since Tuesday morning...no big deal. My entire right knee & upper thigh are the color of an eggplant. My incision looks pretty good and is about 8 inches in length. Swelling, discoloration and edema of my right knee, thigh, etc are EXTREME! Despite diligent icing & elevation, I am horrified by the degree of discoloration & swelling in my right knee & thigh. My right thigh (no lie) has TRIPLED in size over the past 48-72 hours.

5-I'm realizing ANY FORM of over-stimulation (bickering with husband, listening to barking dogs & whining cats, constant television, the occasional neighbor banging on the door to chit-chat, USPS, UPS/FedEx deliveries, etc) is MIND-BOGGLING and immediately worsens physical and emotional pain. It's incredible. Realizing I truly do not have the resources, or capacity for such stuff (certainly not now) is enlightening. Chaos and superfluous stuff triggers an immediate pain frenzy.

Oh...one other thing...for me, I'd like to list absolute MUSTS and the BEST helpful aids, along with the most USELESS:

BEST aids
-ice packs, ice, ice and more ice
-Lounge Doctor for proper elevation
-reacher, or grabber
-bath tub slider bench
-walker
-Land's End rubberized fleece slippers
-pre-planned microwaveable meals, served on paper plates

USELESS aids:
-motorized Aircast CryoCuff Ice Machine
-elevated toilet seat with handles

So, friends...that's about it for now. I'm trying to read the post-op recoveries of other October surgeries. Posting is hard...I've been at this post since 8:00 am this morning, Eastern Time USA...can you imagine?

Any comments would be welcome! I'll reply when I can, so forgive me if replies are not timely.
 
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Jaycey

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@tlfiore Welcome to the other side. Yes indeed - this is major surgery. Many down play the impact. But those who have been their confirm - it's major trauma.

Sounds like you are finally on the right track. Keep that icing and elevating going. It will ease all that swelling that is causing you pain.

Please go very easy on the PT and do not let anyone push you. Your knee is in recovery - not in training.

I'll leave your recovery articles here for you to refer to.
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
ice
take your pain meds by prescription schedule (not when pain starts!)​

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

5. At week 4 and after you should follow this Activity progression for TKRs

6. Access these pages on the website

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.
 

Roy Gardiner

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USELESS aids:
-motorized Aircast CryoCuff Ice Machine
-elevated toilet seat with handles
You didn't like the machine, even though you like ice :scratch: ?
I found an elevated toilet seat essential to minimise the pain of sitting and, worse, getting up again.
 

Sara61

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The first couple of weeks are not the best, but it really does eventually get better, pain control is a vital part and taking a gentle approach to PT is a must.

As our toilet seats are extremely low having a raised one is godsend as the pressure trying to get yourself up is quite hard on ones knees - mine doesn't have handles but there is no need as it is quite high.

If you get sleepless nights you'll always find interesting posts and someone to chat to on BoneSmart, any medical queries you can tag one of the moderators - Jamie is excellent and has helped me enormously.

Wishing you a good recovery and just remember to stay positive as it really does help.
Sending get well hugs:console2:
 

Starsfan22

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The elevated toilet seat was important for me as I am tall and standing up from most seats is coming up from bottom below knees. That's tough on a new knee, almost impossible for me. Only needed for two weeks but was a Godsend.

If no grabber is available, tongs work! I also tied a plastic grocery bag to my walker, spouse is not helpful in keeping things tidy. I also bought a roomba pre surgery, another Godsend. Whatever it takes!
 
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tlfiore

tlfiore

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@Roy Gardiner THANK YOU for contacting the appropriate people and for having my recovery thread "unlocked." I feared I already upset someone and broke forum rules :happydance:

Also, I want to respond to your comments about the elevated toilet seat and the AirCast Icing Machine. I did not intend for my comments to come off as negative, or critical. I became a bit fatigued while posting after trying to write something coherent for hours-smile.

-Raised Toilet Seat
Most certainly my error, not the seat's! So, after receiving last minute hospital social services info about an elevated seat, the only seat my husband and I could locate was one with about a 4 inch rise (versus 2 inches)! During trial runs, the seat was nifty, if not wobbly (universal attachment/lock of sorts). So, at a wee-bit over 5'2" in height, while using the elevated seat, my operative leg (as well as the good one) dangles OFF THE FLOOR about 3 inches and gets hung-up on the edge of the raised seat. PAIN!! Utilizing my walker and my side wash basin/commode dresser for leverage, gently lowering myself down onto the toilet seat and guarding my right knee/leg at the same time prove more beneficial. At least I have both feet firmly planted on the bathroom floor.

-AirCast
After holding such high hopes for this, wow was I disappointed. So if the set-up with two bottles of frozen/ice water, water added, more ice to bury bottles, insulating top, fill cuff (15 inches) attach tubing, mold cuff, etc, etc isn't cumbersome enough, toting the machine from place-to-place, spot-to-spot is. Searching for electrical outlets. Getting the height adjusted properly (mechanized auto water return). On and on... All irritating, right especially when one is not feeling well.

So, after all of it (which I could tolerate if the machine worked), I just could not seem to get a comfortable, reliable water flow into and out of the cuff. For starters, I find the intermittent cuff pressure/water flow extremely uncomfortable and bulky...nearly painful. I am a very small woman; however the cuff does not seem to cover my knee properly and seems to dig into my knee in all the wrong places.

More so, the actual water temperature in the cuff is impossible for me to accommodate. If placed directly on my skin, I find the coldness of the flowing water absolutely impossible to tolerate...yes, it burns. However, if I place even the slightest barrier between the cuff and my knee and I've tried ALL different types of barriers (cheese-cloth, cotton cloth, cotton sack, cut up cotton tee-shirt, waffle cotton wash cloth, flannel cloths, microfibre cloths, etc), I feel ZERO cooling effect. Zip, zero, nada.

Perhaps I am doing something wrong??

So, I'm using the good ol' gel packs issued me by the hospital.

I love the concept of the icing machine. I just don't seem to like the intermittent massaging of the AirCast cuff, nor do I like the way the cuff wraps the knee. And the inability to control/regulate the water temperature renders the machine useless for me.
 

Sara61

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A bag of frozen peas are also a good cheap alternative they mold nicely around your knee just remember to have a cloth in between the bag and your knee - and they re-freeze perfectly time after time.
I found placing my good leg under my bad leg was a good way to lift it on to the bed, soon you will be able to do this on your own, I didn't purchase any extra aids other than the elevated seat.
If you have to use compression stockings a easy way to get them on (if toe area has an opening) is place a plastic bag on your foot it then slides on easily.:ok:
 

Starsfan22

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@tifiore, I didn't take any offense at your toilet seat comments. Sounds funny huh? My situation, being tall, is totally different from yours. Dangling leg early on sounds horrible, makes me cringe. My legs never dangle, ever Lol
 

Roy Gardiner

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I did not intend for my comments to come off as negative, or critical.
You did not at all come across as negative or critical, and it's my fault and I apologise if my reply made you think so.

BoneSmart respects and indeed encourages reporting personal experience; it's how others gain insight to the experience (we don't like people who turn into Dr Kildare or Dr House after a surgery, but you're absolutely doing it right). Your explanations of the toilet riser and ice machine are highly illustrative of 1st hand experience.
 

CricketHip

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Hello @tifiore I really enjoyed your recovery update, it's honest, detailed and funny, too!
Your comment about being unable to go with the flow of things like doorbells ringing, dogs barking, etc. is so true. I noticed this clear into the 2cnd month of recovery.
You are in the early days but you sound great, congrats on your new hip! :flwrysmile:
 

Macknit

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Welcome @tlfiore , I have to agree, your post had me laughing...then crying, because I could relate to so much of it.

I promise you will see change, but it can be pretty subtle at first. Please just heed all the advice and enjoy the recovery articles that @Jaycey has sent you they help so much!

Know that this too shall pass (though everyone of us has a different rate and tolerance of this journey). Best of luck, we are all here to listen, mutually vent, and send hugs your way!
 

Tykey

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Hi! In your original post you mentioned problems with PT, but we haven't followed through with this very important aspect of recovery.
How's it going? What's the home PT doing with you.?
 

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Hi @tlfiore,
Thank you for your post on how real and brutal the TKR post op and recovery is.
My right TKR was done on 10/18/19 so I am on post op Day 18.

I was in the hospital for 2 nights. My pain was at times unimaginable and unbearable. It was so important for me not to get behind on the pain med schedule.

Good news - I turned a corner on day 12. I remember this day distinctly. Needing less pain meds. PT seemed easier.

I have had home PT 2x a week but have graduated now to out patient PT starting tomorrow. Nervous about that.

Sleepless nights and stiff painful mornings are my biggest challenge at 2 1/2 weeks.

It will get better,
 
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tlfiore

tlfiore

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Hi everyone and thank you all for stopping by and taking time to read my posts. Your comments and replies are very important to me. In the most therapeutic way, posting is akin to JOURNALING and helps vent my victories, as well as my sorrows and set-backs. Replies demonstrate how you care; reading the replies is as therapeutic as my posting, if not more so. I'd feel completely alone if not for this wonderful Bone Smart community.

I enjoy reading the replies. I ALSO enjoy making others laugh, especially if doing so is occasionally at MY OWN expense! A sense of humor, especially an occasional self-deprecating one, is important to me and has been a great coping tool my entire life. I love to laugh and I love making others laugh.

Okay...so with all that said, once again BoneSmart RULES and you all are 1000% correct. I got a bit over-confident yesterday and decided to take advantage of my "good" day. Yes, I OVER-WORKED. Yes, HUGE MISTAKE.

The real decline started when after I putzed around all day, DH decides we should resume home-based administration of prescribed subcutaneous fluids to our 18 year old cat (who I love and adore...the cat, that is-HA!) versus parceling it out to our Veterinarian's Office (which we've been doing since I had surgery). My cat is in Stage 4 Renal Failure, so we administer 200 cc of Lactated Rnger's to him every other day. This procedure consists of me STANDING at a high-top counter, preparing everything, prepping the cat, administering the 200 cc, blah, blah. HUGE MISTAKE!

HUGE MISTAKE! Within minutes, I knew I was in trouble. By the end of the 15 minute procedure, I was in excruciating pain and tears. No weight bearing, large swelling, stiffness, redness, pain. So, of course the cat debacle set off a cascade of events. This recovery is a roller-coaster ride for sure, ups 'n downs, ebbs 'n flows. This is all the good that followed:

1- On Monday, I attempted to "space" my q 3-4 hour oxycodone further out and "push-through," or tolerate the pain. I will be taking the med more religiously...too soon to space, or taper anything.
2- To ease the pain Monday night, I self-added Tylenol 650 mg q 6-8 hours PO to my pain management regime. Much to my surprise, adding the Tylenol with/just after oxycodone has helped my discomfort quite a lot...
3- I intermittently (due to bathroom, icing, elevation, meds, fluids, etc breaks) managed a total of 12 hours rest last night (11:00 pm Monday 'til 11:00 am today, Tuesday). Really needed to rest after Monday evening...
4- Yesterday, I self-administered Senokot to my stool softening regime and around 5:00 am this morning (Tuesday, the 5th), I finally had a BM. Well, I've had about 5 BMs. Senna and Senokot are one-in-the-same. Difference is the dosing in Senokot, the "laxative" form is about 4-5 times the active ingredient dosing in the "stool softening" form...
5- If DH and I cannot construct a more suitable set-up for my Rex's fluid administration, I'll need to convince DH to pay-up the $24.99/fluid session and continue vet office treatments, until further notice...
6- PT phoned earlier today. Therapist is coming for Session #2 tomorrow, Wednesday @ 2:45 pm.

This is Day #6 post-op. These are the highlights.
Thank you for caring and reading this!
 

LindaO

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I enjoyed your detailed report and I feel it will be beneficial to so many people who may be experiencing the same thing.

I see you have learned the hard way of staying ahead of the pain but you have indeed learned and figured out how to improve your system! Great info!

I ended up putting my ice machine pad underneath my knee and my gel packs on top. This helped me ice all the way around without the pad constantly coming undone.

I totally agree with the raised toilet...I do have a raised toilet anyway so it was a bust for me having it.

Let us know how your PT goes and remind them to be gentle!

Bless the poor fur baby....I hope they get better with your help!
 

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I do appreciate what you and DH are doing for your Rex. I've been very attached to my animals and we're at a point with no animals, which is really different for us (but adult children and grandbabies do visit often!)

It sounds like your nursing skills put you in a rough place with having to do the IV treatments? I hope you recovered from that episode!?

Best of luck with PT tomorrow...I'm still going to mine 1x per week and I've had great session! Plus, I get a 1 hour massage every 3rd session! Since returning to work full-time (I'm at a computer 90% of the time not counting my breaks) I get so stiff and the PT is just enough to get my circulation moving slightly and any swelling I have seems to decrease!
 

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@tlfiore
I am wishing the best for your recovery. I'm still in the research stage, checking out bonesmart and trying to find surgeons for consult but you have me really scared about pain meds right after surgery.

I mean, Tylenol????? Who in the world would prescribe tylenol for major surgery where bones are sawed off and drilled and cemented and pounded? Is this where we are in the US because everyone is so afraid of opioid addiction? Tylenol hasn't helped my oa knee pain in nearly a decade and nsaids barely barely help a bit. I'm serious about the question. What hospital has that for a protocol and do I have to worry about it? I know that 4 years ago when I had rotator cuff and bicep tendon surgery (3 full thickness tears) the pain was SEVERE and I needed oxycodone (10mg) for at least the first week and a half at home and then at every outpatient PT for a couple of months.

TKR is a big deal surgery. I've watched videos of the surgery (maybe stupidly, but I can't help it, I don't want any misconceptions about what will happen to me). Yet many people who have talked to others who have had the surgery come away with the idea that it's no big deal. I don't know why this is so.

I guess it's important to ask the surgeon ahead of time about what is done for pain management post surgery. Hoping you and your cat are both doing ok today.
 

newlybionic

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I'm glad that adding Tylenol has helped with your pain. Just be sure you are not taking any more than 4,000mg a day total. Make sure that any of your other meds do not contain acetaminophen (Tylenol) and put you over that limit.
 
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tlfiore

tlfiore

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Hi everyone and thanks again for following up with me about my progress and all. I appreciate all the input and feedback, all the kindness and support.

@pipn PLEASE PLEASE NO! Pease do NOT let my pain medication and my pain management experience frighten you. I would feel terrible if backing away from helpful surgery was your take-away from my individual experience and perspective. Everyone's situation is unique and overall, I believe I've had a relatively positive journey so far. Read on and I hope my experiences over the past 24 hours will be encouraging.

So, after my brilliant idea of preserving my measly oxycodone supply, last night was my worst night yet since surgery. I overdid it during the day, under-medicated myself at night. With increasing pain all day, I was awake in tears the entire night with pretty unbearable pain.

Finally, around 7:00 am I caved and took oxycontin 5 mg and Tylenol 650 mg...fell off to sleep around 7:30 am with icing, elevation, etc.

When I woke around 10:00 am this morning, my husband and I said, "We've gotta get some clarification on this narcotic deal 'cause things are way off track and PT is coming today (and 5 additional days over the course of the next 2 weeks)...this is not good...we've gotta figure this out."

I put a call into my OS around 12:00 noon and one of his assistants returned my call. After being drilled about "who told me it was okay to do whatever it is I was doing, wasn't I directed to call them with anything (?), etc etc," the summary was, "You (me) are in no position to be doing anything with Tylenol right now...continue utilizing the oxycodone as prescribed and when you are out, you will be re-evaluated and refilled with an "alternative" narcotic analgesic, if required." Okay...had I been taking the oxycodone "as prescribed," I would have run out of the med sometime today (my 5th day home), right? I called, right? :scratch:

I guess I was supposed to be more proactive and communicate more often, more clearly with the office. So, I take full responsibility for my lack of communication.

My home-based PT came by today and our first full session went relatively well. According to her and her measuring rulers, I am doing okay. I felt very encouraged. My BP today, which usually runs 100/60 was 158/98, my pulse (usually runs 72 bpm) was 138 bpm. I was once again light-headed, diaphoretic, pale, clammy... Things settled down a bit, we discussed the pain issue. Jennifer states she'll report all the findings to my OS.

@pipn yes, the pain control issues are real, they are. I'm not sure how things with narcotic administration got this insane. Well, of course I know why & how things have gotten this botched; however seems like the solutions in place (at least here in Michigan) need improvement.

@pipn I'm not sure I have the best relationship with my OS. I also have lots of issues speaking up, asserting myself, relying on others. :tantrum:

But, I am NOT discouraged. Determined not to be. I believe a positive & grateful attitude with pretty much EVERYTHING in our lives is key, critical, #1 must have.

Discussing pain management is an extremely important part of the surgical process, an important step. Your OS and others will positively plan-out this part of recovery. You can do it. Just know the USA is on tilt right now regarding the opiate epidemic and be proactive, advocate for yourself. It's okay to feel fear, which is normal but make the best decisions for yourself and unlike me, please do not be fearful about speaking up.

You are VERY WISE to do your research and take your time picking the right OS. It will be okay. People here are very kind and beyond willing to help. I'm finding the information provided here is pretty spot-on and real. You will be alright.

And THANK YOU for inquiring about my precious Rex.

Today despite it all, I am GLAD I made the decision to have the TKR. Recovery is a long road but I knew that going into this and it factored into my decision.

TBC...:scare:
 
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Jaycey

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Sorry you are having a bit of a rough ride these early days. Yes, we do recommend taking your meds as prescribed, around the clock in the beginning. When you start forgetting doses it is a sign your body is weaning off your meds.

Hang in there - everyday it will get better.
 

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