Too much time on feet / swelling?

[maggy]

Hi everyone! I've been "lurking" for quite some time and gathering all sorts of info and encouragement from you wonderful people. What a great support! Many thanks.

Now my time has arrived and I too am on the other side. I had my TKR Jan 6 and came home yesterday. My extension is 0 and my ROM is 100 and I think I'm pretty pleased with that so far. I exercised like crazy for the last few months in preparation and I think it has paid off.

My issue is that I seem to be up and about doing all sorts of things (cleaned out the fridge today etc.) because if I'm busy and moving my pain seems to be less. However, the swelling and bruising are quite bad and this seems to be making it worse. If I settle down and try to read or watch TV I'm up roaming again in 10 min. I'm taking one Percocet and one 500mg Tylenol every four hours and have realized that it's all about managing and timing your meds. I'm still figuring all that out. Sleeping is definitely not fun.

Am I overdoing it and is this bad for my knee? Perhaps I need to up my meds, I rarely take anything so this is all new for me and I'm afraid to take too much, although I do understand about taking enough to be able to do your exercises. I finally have a good excuse to sit and do nothing and lo and behold I can't do it.

Mag

 

[Gretchendz]

Welcome Maggy!

Your range of motion is excellent for this early! Be proud

You are correct about finding the rhythm of staying on top of your pain medications. I suspect Jo will be adding her famous (and excellent) pain med chart here soon.

It does sound like you are doing a bit too much for this early. Try doing something like watching t.v. or reading a book that takes your mind off your pains instead of cleaning the fridge for awhile

Also, are you icing and elevating? It's really important to get the swelling down. being on your feet too much at this point can make that worse. And when you elevate, try to get your leg above your heart. I used to lay down on the couch and put my operated leg up on the back of the couch; this worked great.

Keep posting and let us know how you are doing.

 

[kipper]

Hi Mag
You're doing incredibly well! I think what you say about exercising BEFORE TKR was a very good thing to do. Maybe you are doing too much though - cleaning fridge - are you at eye level or are you bending right down to go it? The tissue has to heal and I thought that rest was important for that process but you sound like you have tons of energy and cant sit for long! Dont forget though to elevate - with ice. It helps to get the swelling down.
Best of luck Mag

kipper

 

[JenniferG]

Hi Maggy. Great numbers! Yes the exercise before is crucial. Makes all the difference, did for me at least. I agree with the other 2. Too much, too soon. You may feel OK now, but sometimes it boomerangs in some way. Are you sure you are taking enough pain meds? Maybe the need to get up and move every 10 mins or so is actually masked pain. The percocet actually causes drowsiness and will knock you out to some extent so you stay put. The rest is as important as moving. I think at your point the direction I got was to be up for 10-15 mins every hour. Sounds like you are doing the reverse.

 

[Josephine]

Some tips about recovery ...
PAIN
- pain consumes energy which is needed for healing and makes you overly tired and feeling exhausted
- lack of energy also diminishes the body's ability to heal
- pain causes your body to increase the production of adrenaline and corticosteroids.
- increased adrenaline and c/steroids diminishes your immune system and healing processes
- a subdued immune system also affects the healing process
- diminished healing makes you vulnerable to infection
- finally, pain prevents you from getting the most out of your PT and general activities

Management of your pain is therefore crucial. Many people wait until their pain is really bad before they take some medication. But this is counterproductive as the delay between taking the pill and it kicking in is very affected by the amount of pain you are experiencing. This chart demonstrates what I mean. It's not intended to be statistically correct, just to give you an idea how it works ....

Another chart explans how the various issues interact to make your recovery better or worse.

Hope this helps some.

 

[maggy]

Thanks so much for the responses. I am indeed elevating and icing. I do this after I exercise (about 3 times a day). Putting my leg up on the back of the couch is a great idea and I'm going to do that as soon as I post this. I think I'll up my meds a bit as well. You're right about my energy level being high and I think I need to direct it differently for a while. Good advice. It's difficult when one works in an active job and comes to a full stop in one day.

I'm curious to know whether anyone else slept in a leg brace for the first little while. They told me it is to keep my leg straight at night so that I don't lose extension by sleeping with my leg bent, especially if I want to sleep with it on a pillow.

Josephine, the graph and chart made things very clear. Thanks for posting it here.

All your encouragement and advice is so helpful

Mag

 

[kipper]

Mag - I also asked the question should i sleep with leg straight - because I find that difficult. I go on my side and have my RTKR bent. In fact this bending at night has been good for getting my 116 bend without trying. I wake up each morning with a better bend. This hasnt stopped my knee from straightening at all.

At PT today I was talking to a man who used a memory foam knee pad and he said he could sleep on any side and in total comfort. YOu find out all sorts of things from other knee people!

You're doing so well!

keep the faith
kipper

 

[jacques1]

Hi Mag
I had my surgery on the 7th and came on on Sunday.
Yesterday was a horrible day for me. I was icing my leg often but
I definitely did not elevate my leg enough. I guess reality really set in as to how much work this is going to actually be. My sleep hasn't been very good.
I have been sleeping with a pillow between my legs because I like to sleep on my side. I think tonight I am going to try and lay on my back with my leg elevated and see the difference.

 

[maggy]

Hi Kipper, thanks for the encouragement. I'll think about the memory foam thing. Sounds too good to be true. I just love how your ROM increases overnight...just what the heck are you doing in your sleep! Nice to know that you aren't losing any extension by having your knee bent.

My doctor said that to up my meds to 1 percocet and 2 tylenols was too much...so much for that. I'm interested to hear what others are using for pain.

Jaques1, you're one day behind me and I absolutely understand about reality setting in. I try to get all my exercises in before dinner because after that I'm good for nothing. The exercise seems to loosen things up and ease the pain a bit afterwards. I did take it a lot easier today and elevated more. It helped somewhat. I'm a side sleeper too but it's just too painful so tonight I'll be on my back again with my leg on a pillow. I try flipping for a while but I always end up on my back. Hang in there Jaques, every day that goes by is another one we won't ever have to see again.

I have my first PT tomorrow morning. I'm dying to get back to my yoga and tai chi so I'm anxious to get going on it. When are you starting your PT Jaques?

Mag

 

[Roof1]

Hi Maggy & Jaques1
Firstly Maggy I would refer to Google to research my Meds !!!
We are in Australia and so our Med Names are sometimes different to yours. However Percocet is used here under another name that begins with "o". You will see it listed under "percocet". Tylenol I think is like our Panadol. Please look all of these up, this is very important. My husband was on 2 x Panadeine Forte 4 hourly and at night a Valium was thrown into the mix. Look these up also. By the way he has always been deadset against medication but he realises that there is a time for everything and TKR's are one of those times.
The other problem is that not all Meds suit all people. Just today my hubby saw his OS (3 mths out) and I asked about tramadol which was recommeded to us. He explained that this Med suits approx 70% however the other 30% think it is just awful, no help and makes them ill. So ???????
As for comfy sleeping this is a problem for the majority of TKR's. Since about
8 weeks, unfortunately a bit of a way off for you 2, my husband gets the most comfort on his tummy. Took time but it works for him. Maybe it will be worth trying in the future. Good Luck to You Both

 

[jacques1]

It took be a long time to fall asleep last night. I was trying to fall asleep with my leg elevated but I started to have this pain at the top and under my foot of my operated leg. I used to get this pain prior to surgery. I gave up after a couple of hours and placed a smaller pillow between the legs. It is a very disturbed sleep but they say it is not forever.

I go next Monday to have my stitches removed and I start physio on the
Wednesday.

I have heard that some people have to go back in the put to sleep so they can manouver the leg. Does anyone know if this is done often. \\

Deb

 

[Josephine]

Yes, Jaques - you are speaking of a manipulation under anaesthetic (MUA). This where the surgeon forces a reluctant joint into flexion to overcome adhesions (often called scar tissue). Quite a few people on here have had MUAs and if you have a hunt around, you'll find old threads about their experience.

If I remember correctly, you posted elsewhere about your lack of range of movement (ROM) but you are still quite early in your post op period, I think, so you will have plenty of time to overcome any stiffness before you need to worry about that.

 

[Nursepair]

Glad to hear your op is over Jaques. Now the fun begins...lol...
I had an MUA in July, it isn't a bad experience and you do get more ROM out of it. I may need another one done this year as I still have only 110 or less.

Maggie, welcome, you are doing well if you already have 100 ROM. With regards to sleep your meds I was on 2 Percocets 4 times a day at your stage, my OS didn't think it excessive. Was it you OS or your family doctor said that you don't need more? My family doctor told me Percocets weren't addictive!!!! If it was your family doctor, talk to your OS, he knows you need strong painkillers for such traumtic surgery.

With regards to comfort while you sleep, try a body pillow, this will give you a lot more stable support, I used one, I draped my whole leg on it, I sleep on my side.

By the way Maggie, where are you in Canada? There are a few of us here (I am originally from the UK though).

 

[maggy]

Thanks for the info re meds Roof1, I'll be Googling.

Nursepair, thanks for the welcome, everyone is so supportive! You may be correct about the OS vs GP. I'll give my OS a call.

After being a puddle of pain and discouragement this morning I went to my first PT session and now feel great. My physiotherapist is passionate about her program which consists of 2 to 2 1/2 hours of physio and a Knee Class combined (twice a week). She said to do two major and one lighter exercise sessions daily. My hard work has paid off and I now have 122 ROM. Yay! I'm starting to do "reciprocal" stairs and she said I can dispense with the cane for some of the time. Actually, I think it had caused my lower back to hurt and I feel much more "symetric" walking unaided.

Every day (or should I say every hour) is a whole new ballgame right now. It's so crazy.

Hang in there Jaques. Are you finding that you feel better when you do lots of exercise, as that's what seems to be happening with me. Sleeping is getting a little better but I wait until I'm very tired before hitting the sac. The pain is no less but I seem to be able to sleep through it a little better.

Btw I'm in Toronto but please don't judge me on that

Mag

 

[Linda2]

My doctor said that to up my meds to 1 percocet and 2 tylenols was too much...so much for that. I'm interested to hear what others are using for pain.



Mag

Percocet contains Tylenol (aka acetaminophin)--that ingredient might be what he thinks you're overdoing.