TKR Worried Sick about Progress

[Jamie]

I am working like a dog on my poor ROM and getting nowhere: now the PT is talking about a CPM machine for me. Does that make sense?!

This is a problem. Stop "working" on your ROM. Pushing like this will only make your pain and swelling worse. Please go back and read your thread again and you'll see all the advice you received to take things easy. You don't need more exercise with a CPM either. You need to slow down and let your "poor knee" recover!

I am now using tramadol for the night

I'm glad you have the Tramadol, but at this point in your recovery given the pain you have, you should be taking it on a regular schedule throughout the day and night. Get back on set times so that you have pain medication in your system at all times. This is the only way you will settle the inflammation down so you can start feeling better. Remember that you can also take Tylenol with the Tramadol. You would take 1000mg doses of Tylenol no more often than every 4 hours and no more than 4000mg total in any 24 hour period.

Should I be taking an anti-depressant?!

I don't think you need an antidepressant. You have had major surgery. You are recovering. You're in pain and frustrated. If you get the pain under control, you're going to feel better. Also, you need to get approval so that you're not trying to go back to work until at least 10 weeks out....12 will be better. More than likely you're stressing over having to go back to work before you are ready. And even at 10 or 12 weeks, be sure to phase in your time at work. Start with half days and maybe even every other day for a while. Remember energy drain? You're going to be very tired very quickly as you gradually increase your activity.

I want to just quit formal PT and follow Bonesmart's gentle and commonsensical way but what if my ROM remains awful and I am basically crippled for life?!?!?!

Then do it! You are not going to be crippled....you know that. This is a long recovery and you're actually still in the early stages. I can promise you, though, if you don't at least slow down your exercises and activity a bit, you are going to continue to have pain and that might lead to a chronic pain problem. Please allow yourself to scale it back and get the pain under control. Then gradually (over weeks) start adding more activity back into your life.

And of course EVERYBODY, including people that had TKRs themselves tell me that PT is crucial?

With knee replacements, what you DON'T want to do is compare your recovery to anyone else's. You and your body are unique. You will heal on your own schedule and no one should try to force you into something you're not ready for or that causes you pain and swelling. PT is not "crucial." While we certainly don't mean for a person to be immobile, one can do just fine with gentle bends and stretches throughout the day and movement from room to room around the house every hour or so.

I hope by this time you are feeling better. Please know we are here for you.

 

[kneeper]

I lost my appetite for several weeks too--and like you, that never happens to me. It will get better. in the meantime just try to eat little bits throughout the day.

I was slower than some to gain ROM, but you know it's not going to happen when the knee is swollen. Once the swelling began to decrease, bend followed. It doesn't even have to look that bad to be swollen.

Like Jamie said above--gentle bends and stretches and so on throughout the day is enough.

Recovery feels long, but it will come bit by bit. You can't exercise it or will it to happen faster. Hang in there.

 

[Walkingon]

Hi PoorKnees, I remember those early weeks so well. Let's see, running a low grade fever in the afternoon with a very hot new knee. I also had the tight band feeling which they say is caused by scaring under the skin but it goes away after a month or so. Sometimes I would just start crying and I didn't know why. I'm a very positive person but the crying went away after about 4 weeks. I never realized how tough this surgery was going to be either. I could never get comfortable at night but at your stage, you should probably be taking one pain pill when you go to bed and another one or a half a pill when you wake up during the night. At three weeks I was taking half a pain pill every 2 - 3 hours during the day and icing it a lot. I couldn't take the full amount or it made me feel sick. Like everyone else has said, pain management is really important for your healing. My Mom had cancer and I always remember her saying when I asked her how she was doing, she would say, "I'm doing alright, but I know tomorrow will be even better." then she would say, "If tomorrow isn't better, I know next week will be even better." Just set your vision for getting better a little more into the future. It does take time so pamper yourself as much as you can. My OS is kind of intimidated by me I think. When I tell him I need more pain meds, he gives them to me. I haven't taken any for almost a month but I have had a little set-back so I want them now

 

[Cflower]

I hope your tightness goes away. Mine has not. First knee done 6/27/2012 with MUA about 7 weeks after that, then second RTKR done 10/1/2012 with MUA on that one at 12 weeks and at that time they also "cracked as I call it" the first knee, then at three months on last TKR they did another MUA and at that time also did left knee again. I don't know if the MUA's caused this feeling or not. I actually just did therapy again last fall 3 years later because another knee doctor said I wasn't walking correctly and that could be causing it. After about 10 sessions, nothing was really changed. I do have 130° range of motion so I don't have stiffness. It just bothers me that the tight feeling never goes away 24/7 it is always there. Not pain but annoying as heck. Does anyone else still have a tight feeling after years of replacement?

 

[LFitz]

Hi there, just wanted to check and see how you are doing. I saw you were having a very hard time emotionally and having concern over ROM and PT. Seeing you are 6 weeks today and hoping you are feeling more settled with your progress. Just wanted to reaffirm that ROM is different for everyone and stress and depression from this recovery is very real. I have struggled with all of this as well but I am much more settled in my recovery because I am trying to concentrate on progress in my daily living and not the numbers. I am hoping you are having a better day and that your pain is being managed.

 

[PoorKnees]

Here I am back with problems. I changed PTs to see whether that would help with the bend and although she was painfully hands on, and made me self-torture at home as well, my bend did progress (or maybe it was simply time, I'll never know) and now at 9 weeks, it is at 105 and my OS said that there was no need for a MUA and I should continue with PT, etc. and to see where I am at at 12 weeks. So that is a positive. Another positive: my almost clinical depression disappeared overnight about a month ago, so something chemical must have just clicked. Now for alarming developments that perplex me. The PT was focusing on the bend acquisition but a week ago we restarted strength building - nothing crazy or anything that I have great difficulty (seemingly), but I developed symptoms that not only drive me to despair, but really cut into my sleep, which makes me depressed, particularly since I am to ramp up my work schedule (was 4 hrs/day from home starting at 6 weeks). On both sides, my (large) bottom is burning, tingling, and occasionally my right hip (note, I am RTKR) experiences a sharp pain (when bending at waist, for example). The sides of my upper thighs are also burning and are a bit tender to the touch. I am a back sleeper (because of bum knees) and sleeping with burning/tingling buttocks and saddlebags is difficult. Sitting is also not comfortable and I feel it standing too. What do you think this could be and what can I do about it? All my muscles are tight on the right leg and I still have the tight band feeling around the knee (but not as pronounced as before, to be fair) but this butt/thigh issue is both new and bilateral.

 

[beaglador]

Hello Poorknees, I am two weeks ahead of you in recovery and just felt I had to respond to your last post. I experience the same pains in my hip and buttock areas on my tkr side every time I go back to trying exercises to strengthen my hips and glutes. When I let up on the exercises the pain goes away. Hence I have concluded that it is still too early for me to be doing these exercises and I have stopped completely. Your rom has improved. You are two weeks behind me and have gone back to work. You don't need to be doing pt now as well. Please, please give your body a break and let it continue to heal. Later, much later, if you find you need to strengthen certain muscles you can look at things again. please listen to the excellent advice you have received on this forum. Otherwise you will just delay your recovery, and keep experiencing pain.

 

[mbouck3]

I just had mine 2 weeks ago but this is my second so I know the drill, Im a 200 lb bricklayer and 3 weeks out my first time I cried. I thought I would never get better, the harder I tried the worse it got. Its all about the swelling and healing. This time im not doing any formal PT and the difference is night and day. I stopped using my cane yesterday. do some light stretches during the day, and be aware when you get back up after sitting you will feel like you have lost mobility but this will pass. For me anyway less is more. As far as that tight band goes we all get this and after time it fads away. Just remember you have had your knee assaulted with a meat clever, it takes time to heal and you cant speed it up but you can slow it down. Im not trying to hijack the thread talking about myself just trying to show that it does get better and we all have had those same thoughts, hang in there

 

[Celle]

@PoorKnees
I'm glad to hear that you achieved a ROM of 105 and that the spectre of a MUA is past.

However, I really think that your therapist are encouraging you to do too much - and your body is protesting.

Now that the ROM hurdle is passed, why not take at least 3 weeks off all PT and allow your body to rest? You wont lose the ROM you have achieved, as you'll be using your leg during your everyday activities. Your leg strength will increase gradually, as you use it more and more in normal activities. Let life itself be your PT.

 

[KarriB]

I'd say the burning and pain are from strength building. My PTs wouldn't start strength building until I was 3 1/2-4 months out. Your knee is still healing and not ready for strengthening exercises. They may not hurt at the time but will hurt later.

 

[KarriB]

I just read a few of your prior posts and can tell you that no pt did not leave me crippled. I wasn't allowed to bend my knee for a month, but once I was given the ok my knee began to bend. Five months after the TKR I was riding four miles a day on my bike and at 6 months began swimming 20 laps as well. It's all about letting the knee heal before asking so much of it. Patience is the key, it won't happen over night.

 

[PoorKnees]

Thank you all for your words of sanity! I am done with strength building for now - will stick to regular heel slides and some mild extension exercises and just daily activities. Any advice on sleeping through the night? I have no trouble getting to sleep, but I am now waking up after 2 hrs and it takes me a long time to get back to sleep, while I fend off waves of anxiety about not getting enough sleep and not being able to work effectively... I am using one tramadol (1/2 when I go to sleep and 1/2 when I wake up in the middle of the night, plus tylenol (500 or 650 mg) with each dose). I am used to waking up 2-3 times a night for a trip to the loo, but the panicky not being able to fall back asleep is worrying me because I don't cope well with sleeping less than 6.5 hrs/day. Any advice? Should I be looking at sleeping pills too?

 

[KarriB]

Try switching your Tylenol to Tylenol pm. It helped me get back into a sleep rhythm.

 

[Celle]

The correct therapeutic dose of Tylenol is 2 x 500 mg (1,000 mg) four times a day, to a total of 4,000 mg in 24 hours. You can safely combine this with Tramadol.
I followed the Tylenol and Tramadol regime recommended by Josephine and it worked well for me.

If you'r not sleeping well at night yet, try taking a few daytime naps, because they also add up to your daily need for sleep. It does take quite a while for most people to settle back into a good sleeping pattern, so sleep where you can, when you can and how you can.

 

[Tabbycat]

Hi @PoorKnees
I'm sorry the sleeping is a problem. You could try searching for sleep music on YouTube, look for music with binaural beats (delta or theta). Even if you are not asleep, listening to these on headphones will help you to be deeply relaxed. There are so many to choose from, you should be able to find something you like. Sleep/healing meditations are nice as well, I like Jason Stephenson and Kelly Howell.
Love, Tabby xxx

 

[Suz]

Sorry you're having such a challenging time in recovery @PoorKnees. We had our surgeries on our right knees on the same day! I can tell you, the folks here at BoneSmart know what they're talking about! I was apprehensive in the first weeks of my recovery wanting to follow all orders my OS gave me but found the BoneSmart mantras were definitely more effective. I hope you soon are able to sleep better and improve in your recovery~

Try switching your Tylenol to Tylenol pm. It helped me get back into a sleep rhythm.

This helps me immensely! Still! When I wake up to go to the loo I'm right back to sleep and always get at least 6 full hours taking one Tylenol PM a night!

I followed the Tylenol and Tramadol regime recommended by Josephine and it worked well for me.

I too followed Josephine's Tylenol/Tramadol protocol and it took care of my pain needs!

Let us hear from you as you feel like posting! We're definitely here for you~!

 

[uva55]

Not being able to sleep is our daily struggle, I even took benadryl last night and only slept 3 hours...things will soon get better for all of us...patience is the name of our game

 

[sistersinhim]

Yes, you're in good company in your sleepless nights. It is quite normal to not have a normal night's sleep after this surgery.

 

[PoorKnees]

Do you think it would be OK mix Tylenol PM and Tramadol? I had another absolutely hellish night and I was a complete zombie at work - so frustrating. I wake up with a fast heartbeat and a wave of heat - maybe it's some form of a panic attack?! I am a basket case: my knee is hurting more than it has before, my hips are aching, my bottom is burning, and, don't laugh, my neck is going tingly and numbish during sleep (I have to sleep on my back because of my knees), all this even though I totally stopped the "strength-training" my PT prescribed. It just seems crazy that after finally starting feeling somewhat better and finally achieving some ROM progress, I am now in more pain than before! And sometimes it feels as if I had muscle spasms or some strange twitching sensations inside my leg!

 

[sistersinhim]

I am so sorry you're having such a horrible night. Your knee is still a baby and you're already back to work? It sounds like you're stressed out along with your knee. Please contact your doctor. You need to find our what's going on.