Bilateral TKR Where to begin, did too much?

[Tmgrl3]

Been reading so many threads.

Had my BTKR March 21, 2109. Had to have 4 blood transfusions at hospital, so battled anemia . I am now 10½ weeks out from surgery. No PCA for pain, only two shots in hospital for severe pain, first two days, then switched to Tramadol 50mg and took 2 to 3 a day till April 21st then stopped.

At 6 weeks I had 130 degrees flexion in both knees, walking without cane in house. April 24th started PT outside house. Now I am driving, up on my feet for hours and day and running up to 4 or 5 errands some days.

Problem I created for myself is just what my surgeon warned me about. He said between 8 and 16 weeks is the biggest challenge because I will feel I can do so much and so I do it and then pay the price at night.

For past 6 to 8 weeks, with no pain meds but Tylenol, I have developed severe insomnia, because I get in bed and no position is pain free enough for me to sleep with or without pillows. I ice like crazy during the day.

I also have bipolar 2 disorder and have been under psychiatric care for much of my life and for past 25 years have been managed with clonazepam for sleep and low dose Remeron as antidepressant.

As insomnia got worse, my doc said to keep my clonazepam dose at levels it has been for sleep for past two months. Increasing it slightly didn’t help. Yesterday, I had a full blown panic attack and went to cardiologist. They suggested I go back on Tramadol 50s, just at night instead of just Tylenol. I can’t take any NSAIDs, and even Tramadol interacts with both my psych meds.

So last night I took one Tramadol at 11:30 and slept two hours, woke up at 2:30 and took one Tylenol and slept from 3 to 5 and then couldn’t get comfortable so took second Tramadol 50 (since it had been six hours) slept 4 more hours. But I woke up weak, shaky, anxious, irritable. Worst day yet but I did get sleep at last. Also depression after surgery was bad, little to no appetite. Had 32 pounds of edema, lost all of that and another 8 pounds of pre-surgical weight.

So my dilemma, 10½ weeks out and going back on pain meds at night, seems like the wisest thing to do. Psychiatrist agreed clonazepam didn’t help with sleep since night-time pain was the issue, so going to stick with the Tramadol and hope that as I heal, the night-time pain will get better and maybe lessen the number of activities I do. As I said, I started driving at 8 weeks (as per surgeon’s ok) and running errands and doing household things require standing sometimes hours in different parts of the day.

From those of you who have had BTKR, does it make sense to go back on pain meds to get sleep I need? I don’t drink alcohol (29 years now) and hadn’t taken a narcotic pill in 30 years prior to this surgery.

I think I pushed myself too fast too far and the pain increase was to be expected.

I am on total rest at home today. I have no energy and somehow feel that now that I finally got some sleep one night my body is letting down and the fatigue is depletion.

Depression too is depletion. I think the intermittent nausea is also from that. I felt as though I was better 3 weeks ago than I am now in terms of energy, like my engine just stopped!!

 

[Pumpkin]

@Tmgrl3
You'll notice that I have moved your newest post and started your recovery thread. For several reasons, we prefer that you have your own recovery thread:

• That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
• With your own recovery thread, you will see the posts and advice others have left for you.
• Having only one thread will act as a diary of your progress that you can look back on.

So please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.
How to tag another member; how to answer when someone tags you

Here are the instructions on finding your thread, How can I find my threads and posts? . Many members bookmark their thread, so they can find it when they log on.

 

[Pumpkin]

Tmgrl3,
I agree with your assessment that you did too much, and your knees are letting you know loud and clear.
Spend as much time as you can Resting, icing, elevating, and medication as prescribed.
It may take a some time for your knees to settle down.
Here is your copy of the Knee Recovery Guidelines, everyone gets one, the articles are short and will not take long to read.

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
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.​

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

the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

6. Access these pages on the website

Oral And Intravenous Pain Medications
Wound Closure​

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.

 

[Tmgrl3]

Thank you so much, Pumpkin! I will read through all the suggestions and articles! This has been some journey!

 

[Josephine]

Sounds like it has. I don't envy you, juggling regular pain meds with your psych meds. That really can be a nightmare. However, it has to be said that disturbed sleep patterns such as you described are invariably due to undermedicated pain.

But have you thought of using a TENS machine? I know an orthopaedic surgeon who had a BTKR and he used very little in the way of pain meds but used a TENS machine instead and swore by it. I am also a bit fan of TENS but don't think I'd ever be brave enough to depend on them like he did! But your choices are limited and this, as a non-medicated option, could be just what you need. So long as you don't go to bed with it on and running. THAT would be a big no-no!

 

[Tmgrl3]

Thank you so much for the suggestion. I did have a TENS machine at one time. I am only taking 1 to 2 tramadol and only at night and I hope that within a week or two I will taper this down to nothing again.

Also, on and off since the surgery I have been very depressed and had no appetite and intermittent nausea when I do eat. Recently the nausea has gotten much worse. My appetite has been getting better and then about a week ago it got worse and I started having bouts of nausea every time I ate. But I do understand that nausea can be connected with anxiety and depression. In my whole life time I have really had nausea as a symptom, except when I was hospitalized with C-Diff or 30 years ago when they gave me codeine narcotics. I will see my gastroenterologist Hopefully this week. I really don’t want another upper endoscopy at this time but wondered if anybody else experienced I’m going nausea connected with post surgical symptoms

 

[sistersinhim]

Pain meds made me nauseous so I always made sure I ate or drank something with a lot of protein in it. That helped the nausea a lot. Are you always eating something before taking any meds? If not, I suggest you try that.

 

[Tmgrl3]

Thanks so so much, sistersinhim. The nausea has been there for weeks and then off since I have been off pain meds from April 21 until just three days ago June 5. I do have GERD and a hiatal hernia. Have been treated for that for over 30 years. I’m guessing that this is more connected to stress from the surgery. Great suggestion about always eating protein. I do make an effort to do that. Also my breath shows that the Gerd has been kicking up. Last night I did the “Eat an apple “suggestion in the bad breath one way. As my anxiety goes down and the depression gets better my nausea seems to be improving. The last three nights I actually slept 7 to 8 hours, using the tramadol 50s. Last night I was awake a few hours after taking the tramadol but didn’t have pain so finally fell asleep. I always need to remind myself that these are all temporary stages of a long process of healing.

 

[Benay]

Hope you're feeling better soon. I love your comment "temporary stages in a long process of healing". Must be my new mantra.

 

[sistersinhim]

I always need to remind myself that these are all temporary stages of a long process of healing.

That is the perfect way to look at this recovery. Lots of baby steps that will lead to a bigger step. Then more baby steps and maybe two bigs steps. Truly an up and down thing. But, the ups will start to stay there a lot longer than the downs!

 

[Tmgrl3]

Nausea down tonight finally. Exhausted. But rested since Friday. Really rested. Too tired and worn out to do much anyhow. Plus my Prius is having electrical problems and or computer display problems and once woudn’t Go into Drive last week. So Toyota on Wednesday. Don’t want to drive and get stuck! Going to make concerted effort to slow down going forward. I really walk as though nothing was done to either knee. 130degrees flexion and and stretch out both flat, so reached ROM goals some weeks ago. Strength work now. Maybe a visit to the gastroenterologist to update him and see what he says. Taking those iron pills for 4-5 weeks wasn’t easy on my stomach, so could still be healing from those. Looking forward to sleeping again tonight. I was beginning to hate looking at my bed when nighttime came because it was insomnia city!!

 

[Jockette]

I did not like those iron pills, they seemed to bother me from the very first one.

You did get your ROM back very well! Mine took a very long time.

 

[sistersinhim]

My stomach doesn't like taking iron pills either. Jockette is right. Your ROM came in really quickly. You are blessed!

 

[winemama]

Wow, reading your struggles, my hat off to you. Keep fighting the good fight

 

[Atlas_aus]

@Tmgrl3

Sorry to hear of these issues you are having.

From those of you who have had BTKR, does it make sense to go back on pain meds to get sleep I need? I don’t drink alcohol (29 years now) and hadn’t taken a narcotic pill in 30 years prior to this surgery.

I am no expert but SLEEP plays such a big role in our lives and I can't help thinking you are caught in a vicious cycle at the moment. Perhaps if you can get your sleep sorted then the other issues will reduce also.

Before my surgery I was taking sleeping pills to get me through the night, not only have I had knee problems I have had 2 lower back surgeries and between the 2 sleep sometime eluded me.

But I came to the conclusion a good nights sleep is so helpful with every other aspect of my life it has to be a priority. Luckily I have had only a couple of bad sleeps since my op and believe that is why I am recovering so well.

Wishing you a good nights sleep and hope things fall into place for you soon.

 

[Tmgrl3]

Thanks Atlas! I did start back on tramadol. Working. Each night a little more sleep. I can’t take sleeping pills with my psych meds but nighttime pain from overdoing activities was the issue needing treatment. Thanks for your support. I just got back here. In a few more weeks the healing itself will reduce the pain.

 

[Tmgrl3]

I did not like those iron pills, they seemed to bother me from the very first one.

You did get your ROM back very well! Mine took a very long time.

My iron levels are normal but my serum ferritin is abnormally high. Iron in the blood should be no higher than 150 for women an mine was 208. Have to call the doc back and seeing the gastro tomorrow.

 

[Tmgrl3]

That is the perfect way to look at this recovery. Lots of baby steps that will lead to a bigger step. Then more baby steps and maybe two bigs steps. Truly an up and down thing. But, the ups will start to stay there a lot longer than the downs!

After my meltdown I went on tramadol 50 at bedtime. Each night better sleep. Better now but have to sort out intermittent nausea and high serum ferritin. Step by step. I also went back to my deeper roots of Buddhism, mindfulness and CBT practices. Easier to do once they are established practices. This just all got away from me. Now I am back in the moment. Thanks for the encouragement.

 

[Tmgrl3]

Slept 9 hours last night! 1 tramadol 50 with tylenol at bedtime and at 5 am ½ a tramadol and more tylenol. Longest and best night of sleep since surgery March 21st. So going back on pain med just at night was best thing. Soon I won’t need them again. I feel like a new person. See the gastroenterologist today to give him overview of issues with nausea, GERD, appetite...don’t expect any changes in meds and hope he doesn’t want/need to do upper endoscopy at this point since nausea is less and am eating my small healthy meals.

 

[Benay]

I'm doing the same as you at night one Tramadol and one Tylenol PM, I'm sleeping so well. During the day just 6 hourly Tylenol. Feeling good, might've finally got the meds right.