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TKR Word from the Other Side

Everyone has different pain so there is no set time to cut back on pain meds. Only you know what your pain level is. I agree with Celle when you forget to take a dose and pain doesn’t flair up on you it is a good indicator that it is time to adjust. You are very early on so don’t be in a hurry to cut back. Do yourself a favor don’t buy into the opioid hysteria. You underwent a very invasive and painful procedure taking pain medications for a few weeks or months as prescribed will not cause you any issues.
 
Day 3 Afternoon wrapped my knee dressings very carefully under one double/triple wrap of Glad Press and Seal wrap to ensure water-tight seal and with daughter hovering by for safety and took a shower. Exquisitely delightful! I have a 3" step down walk in shower with hand hose. Entered with walker, sat on stool, put walker aside so it stayed dry, shampooed, showered & rinsed. Tried my best not to direct water onto the dressing wrap and kept shower quick not leisurely. Dressings seemed dry when wrap removed. Patted legs dry. Dressed; insert injured leg first. Short warm up exercises then immediately outside for 50' walk with daughter. Felt wonderful! Then elevation, ice, pain med for (#6 exercising prior to walk and 2 at rest.).

For dinner sat with leg down at dining room table with family for dinner; ready to elevate after 20 minutes as discomfort a 4. Then to couch, elevation, ice and Percocet ii due so taken gladly. Enjoyed the Game with the gang. To bed after 4 hours with Percocet ii again as still achey #4 discomfort. Asleep shortly with elevation and ice Cryo Wrap. Awoke 4 am; took Percocet ii and right back to sleep using pillow between legs tipped to right side so operative leg was up for some back releif. Tried to position self to keep knee straight, not flexed.

Day 4 Morning Awoke 7:30. Up and did very basic exercises in bed, then when sitting up and finally did ADL's. (washed up) Feels so good to stand on my new knee!Then Percocet ii taken as it's been 4 hours, discomfort 8 working, 2 at rest. Coffee made & to couch with elevation & ice wrap on. System of frozen 16 oz water bottles working very well alternating them into/out of freezer in left to right order so you're always reaching for the "coldest" ones. 10:30 exercises, short outdoor walk 75' on paved parking area, then time for Percocet ii. Noon feel somewhat fuzzy from ii of Percocet but will take everyone's wise advise and not reduce it to one just get. At least until I meet up with PT in morning to find out if their agenda matches ours/mine. Taking two every four hours makes me just want to dose off; but that's resting, right?
 
Smurph said:
Tried to position self to keep knee straight, not flexed.
Click to expand...

Keep up those walks, sounds like you're doing well!

Hmmm...I haven't thought about that 'knee straight for sleeping' at all. Once the OS folks told me in the hospital that I could sleep on my side, I never gave a thought to sleeping with my legs straight. Have been totally sleeping on my side since I got home, with a pillow between legs and knees are bent pretty much the whole time. Maybe once or twice a night if I think of it, I'll stretch/straighten them for a few seconds. No complaints and not going to change it now since it seems to be working. It almost seems to me that I'm better off 'moving' than to have tried to keep them straight all night?
 
Rhodyrhody each of us is individually different. I've had flexion contractions pre-op for a long while now; and it's a condition I need to avoid. Pre-op I would wake up with my knee locked in a flexed position (I'm a side sleeper) and unable to straighten my knee fully at all; I'd have to lie on my back and let gravity gently stretch my knee down flat onto the bed before I could roll over, sit up, and be able to stand. If I sat too long or drove too long it would contract and I'd have to stretch it out before weight bearing and walking off.
 
Wow Smurph sounds like you are doing great. With the amount of activity you describe and current pain levels listed I think you would regret cutting back on pain meds right now. Just my opinion. Those nice short walks pay big dividends. Good luck with PT tomorrow.
 
Ok Larryhg3 thanks for the confirmation to carry on carrying on with the Percocet ii every 4! I will continue these "restful" doses. And go for a short walk right now.
 
Smurph said:
Rhodyrhody each of us is individually different. I've had flexion contractions pre-op for a long while now; and it's a condition I need to avoid. Pre-op I would wake up with my knee locked in a flexed position (I'm a side sleeper) and unable to straighten my knee fully at all; I'd have to lie on my back and let gravity gently stretch my knee down flat onto the bed before I could roll over, sit up, and be able to stand. If I sat too long or drove too long it would contract and I'd have to stretch it out before weight bearing and walking off.
Click to expand...

Omigosh @Smurph ! Thanks for posting this. I had the exact same issues pre-op. Am a side-sleeper and I would wake up, or do a lot of driving and my leg would like freeze, bent. It would take some time, and sometimes pain, to get it loosened up or straightened out. Now that you've mentioned it, I remember those exact same symptoms, but...the GREAT news is...I had actually forgotten all about that! I hope soon you are able to also!
 
Dinner and a Game. Perfect evening Sunday Day 4: Red Sox Won! I continued with home exercising every 2-3 hours throughout the day to discomfort level of 8; discomfort 2-3 at rest., then Percocet ii after a walk about followed by elevation, ice, and rest. Long afternoon nap. To sleep after final game & slept well. Awoke and took pain med in middle of night.

Monday Day 5 Bed & sitting exercises, then up for washing up & dressing, breakfast. It's been 4 hours since pain med so I took Percocet ii just as Chris my Physical Therapist arrived for his initial eval so it really hadn't kicked in yet. I showed him my notes to review and your ground rules Larryhg3 :

1. I will work as hard as my knee allows without pain (not discomfort which is part of what you sign up for with TKR) or swelling.
2. I will not measure my success based on a ROM measurement
3. I will not allow anyone to push or pull my knee for any reason
4. If any of those are violated at any time I will be leaving for a new practice

He was aware of the Bonesmart site and supports its philosophy and was in agreement to these working parameters so I'm thrilled we're on the same page.

Worked on sitting, standing and lying exercises to 8-9 level of discomfort, then outside walking on paved lot 800'. Fabulous being out and about! Back to couch nest to elevate, put knee wrap on, and ice. Discomfort 2 at rest.
 
Smurph said:
Worked on sitting, standing and lying exercises to 8-9 level of discomfort
Click to expand...
I'd call an 8-9 level quite severe pain. I think that's too high for your knee right now. Try to cut back the exercises so your pain level is no more than 5.
[Bonesmart.org] Word from the Other Side


[Bonesmart.org] Word from the Other Side
 

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You sound like you are doing great. I think you chose a great facility! Sounds like you got excellent care. Your recovery sounds like it is ahead of the curve!
 
Thanks Celle,. I'll have to pay more attention to my efforts. When trying hard and challenged, the effort does affect my breathing and I have to remember to take some deep breaths, and my scalp gets all hot and diaphoretic; and then I back off; if I were to continue I'd look like I've stepped out of a shower absolutely soaked. I would say my 8-9 interferes with concentration. So I will try to find my 5 before it makes my eyeballs go all googlly.
 
Day 5 Monday Evening. My bad. You're so right Celle. You saw it coming.... At bedtime my left ankle (that needs fusion) was 1+ pitting edema, left knee moderately swollen for first time, and echimosis blooming medial inside of knee. Am sure it was going to bloom no mater what I did but it's a bit swollen and tender. In spite of all my reading here I believe I OD'd on my tolerance to exercise levels and PT. Working to discomfort of 8-9 was so wrong. So not only was Yesterday my first day of Pt it was also my first day of leg down for three 20 minute meals at table. Rest of day was spent icing and elevating. Discomfort a 4 at bedtime. Percocet ii and to sleep with ice and elevation.

Today Day 6 Tuesday Morning Awoke with yesterdays persistant edema to L foot and ankle and knee moderately swollen. Updated Physicians Assistant with photos and he encouraged ice & elevation to ease swelling. Wasn't concerned re scant wound drainage that appeared yesterday.

When PT arrived I updated him on my issues of overdoing and we backed down on reps and I kept my effort minimal to a 3-4. Shorter walk 300' as it was hot. Have also added a towel with gel pack to area behind my knee that's swollen.

So todays goal is to be more sedentary and keep ice bottles to Cryo Cuff fresh with wraps on and elevated properly. Do scant exercising, get up for BR breaks every 2 hours and rewrap, elevate and ice up. Continue pain med every 4 as discomfort seems to be a 3-4 at rest.
 
Smurph most of us have over worked our knee at some point in early recovery. Learn from it, give your knee a couple of days to calm down and take a much gentler approach. I hope that today is better for you.
 
Thanks Larryhg3. PT's not scheduled to return until Friday so I'm just going to step back from that, give tincture of time a chance to work, ice, elevate continue being mobile for short short periods. Be more Queenly. Listen to the music as I wander down this bumpy wandering road.
 
Wednesday Day 7 Can't believe my surgery was a week ago. Time/days are flying by. Awoke 7 am without usual middle of the night Percocet feeling pretty good, swelling down a bit, pitting edema L foot persists but less. Did some mild in bed PT exercises to discomfort of 3, ambulated to kitchen, breakfast sitting with leg down pulls on the incision dressing a bit more than I like. Uncomfortable; looking forward to its removal at 2 weeks. Did some flexion exercises standing at sink with gravity, gently up to 3 discomfort; tolerated well. Ready for a rest; took Percocet i, elevated with ice Cryocuff wrap and rested. The support of the wrap feels wonderful. No additional drainage on dressing. 11:30 time to get up and about, dress and so for short walk outside.
 
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