TKR Yorkimom is ready to go...LTKR

I haven't been to outpatient PT yet, but I haven't had that issue after home PT. It could be a stress response to your trauma, as your son guessed. Does it start after you start icing? Sometimes I get chills after I start icing. Maybe you could call the PA and ask.
Your back of knee pain and inability to put weight on it sounds like what happened after my Baker's cyst ruptured (post THR and Pre TKR). Once again, Christine sounds great! I hope you get some answers soon. :console2:
 
Your son may have a reasonable idea, but let's tag @Josephine . I know I had some temperature control issues after this tkr. I know in general I often get cold when fatigued...:scratch:
 
I was talking to my son about it last night and he thinks that with my body going through major trauma of the surgery and then the exertion of PT, it's the way my body deals with it.
It doesn't baffle me in the least and I am in 100% agreement with your son. It's the Energy drain which can take the veritable stuffing out of you! I remember experiencing this the first few weeks every time I had a shower. I would be trembling and shaky and weak for a couple of hours afterwards and feel cold. And oyu are experiencing the same as confirmed here ...
when getting home from PT naturally I'm exhausted and I always rest laying down in the recliner. Within a couple of hours I get the chills and body aches.

So I'm going to ask you some questions and it would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery!
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)
Also don't forget to include other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how often are you icing your knee and for how long?

4. are you elevating your leg, how often and for how long?

5. What is your ROM - that's flexion (bend) and extension (straightness)

6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

7. what kind of PT exercises and exercises at home are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)

Note:
If you're not familiar with this, it goes like so:
1 lift of a 500kg bell bar = 1 rep or repetition.
Doing 5 reps and then a brief rest = 1 set of 5.
And doing 5 sets and finishing = a session.
 
@Josephine, thank you so much for answering. Finally someone understands and now I don't feel like I am crazy. Although I do have to say today was the first time I didn't have the chills or body aches after PT.
I will try to answer all your your questions.

1. Normally my pain levels are around a 1-3. In the past two weeks I have been hit with horrible pain, just out of the blue. I would wake up and could hardly move my leg. Putting any weight on the leg was very painful. I would say it was between 7 and 8. After taking pain meds, except for one time it was under control within an hour. The pain was in the back of the knee. I talked to my OS about this on Tuesday and he thinks that I had blood pooling in the back of my knee. I'm keeping my fingers crossed that this doesn't happen again.
This is in addition to the normal stiffness and burning that I feel of and on and occasional stabbing pain in the knee cap. I have also had pain on the side of the knee located on the inside of the knee and it hinders my ROM.

2. I have been prescribed 300 mg. Gabapentin (Neurontin), one capsule at night for 30 days.
5mg. Ozycodone, one to two tablets every 4-6 hours. I was trying to cut down my dosage a bit and it
backfired. For the last week, I have been taking 2 tablets, then 1 tablet. Alternating this dosage every 5-6
hours and It seems to be working. Often times when I take the one tablet, I also take 1 Extra Strength
Tylenol or sometimes 2 but I keep track so I make sure not to exceed 4000 mg in 24 hours.
When I am hit with the horrible, pain I keep taking 2 every 4-5 hours until comfortable.

3. I have a polar machine and I ice my knee pretty much all the time. The machine runs cold water through the part I put on my knee so it doesn't get as cold as if it were ice. I find that the incision area is often times warm, so I will put an ice gel pack on it (always having something between the knee and whatever form of icing I use) for 20 minutes, 20 minutes off.

4. My leg is elevated constantly except for when I am walking, exercising, etc. In the recliner I have two pillows under the leg to make it higher than my chest. At night I have an adjustable bed and have the foot of the bed at the highest setting it will go.

5. This past Monday my extension was a 5 and my flexion was around 82. Two weeks ago when I was first measured after leaving the PT from h@$$ I was at 7 and 62.

6. My activity level is low. In addition to PT three times a week, I do light exercising on days off. I might do a few dishes here and there and have done a load or two of laundry, but that's about it. From the first week I have been pretty much alone during the day as my husband works. My neighbor fixed me breakfast the first week. Otherwise, I get myself something to eat, etc. I also take the dog out once a day, just for a short walk to the end of our walk for him to do his business.

7. I go to PT three days a week. My exercises are:
10 minutes on the NuStep, which is a recumbent cross trainer. I do this at my own pace with no resistance
Heel slides, 2 sets of 10, holding each rep for 5 seconds.
With the back of my leg on a cylinder, lift my leg and hold for 5 seconds. 2 sets of 10.
Hamstring stretch - with loop of cord around foot, pull leg straight up and hold for 30 sec., 3 times
Thigh squeezes with towel under knee, 2 sets of 10, hold each for 5 seconds.
Straight leg raises. With opposite leg bent, tighten quad muscle and do 2 sets of 10 raises
Calf stretch- with foot on slanted wood, stand at bar with body straight until you feel stretch. Hold for
30 seconds 3 times.
Prolonged knee stretch. I sit in chair in front of wall with my toes up against the wall. Each time it gets more
comfortable, I scoot up in my seat a little bit to make the bend harder. I do this at my own pace for three
minutes.
Knee straightening stretch. Sit in a chair with my leg extended on a table of same height for 5 minutes.
Sliding knee bends - lay on a table with feet on wall. Slowly slide knee down until I feel stretch. Hold for
5 seconds, 10 times.
All this is in addition to the therapist working on my extension and bending. She pushes for each but stops when it becomes too uncomfortable.

My at homes exercises consist of heel slides, leg raises, thigh squeezes and walking around the house practicing walking heel to toe.

Thanks again, Anne
 
I would wake up and could hardly move my leg. Putting any weight on the leg was very painful. I would say it was between 7 and 8. I talked to my OS about this on Tuesday and he thinks that I had blood pooling in the back of my knee. This is in addition to the normal stiffness and burning that I feel of and on and occasional stabbing pain in the knee cap.
Maybe but my bet is on doing too much exercising.
2. I have been prescribed 300 mg. Gabapentin (Neurontin), one capsule at night for 30 days. 5mg. Ozycodone, one to two tablets every 4-6 hours. I was trying to cut down my dosage a bit and it backfired. For the last week, I have been taking 2 tablets, then 1 tablet. Alternating this dosage every 5-6 hours and it seems to be working. Often times when I take the one tablet, I also take 1 Extra Strength Tylenol or sometimes 2 but I keep track so I make sure not to exceed 4000 mg in 24 hours. When I am hit with the horrible, pain I keep taking 2 every 4-5 hours until comfortable.
Don't try and reduce so soon and 4 weeks is way too soon. TKRs need meds for around 10-12 weeks. I took mine for 4 full months.
3. I have a polar machine and I ice my knee pretty much all the time.
4. My leg is elevated constantly
Good
extension was a 5 and my flexion was around 82. Two weeks ago when I was first measured after leaving the PT from hell I was at 7 and 62.
Considering all the exercising you were and are doing, I am not at all surprised by this.
Too much exercise = swelling = reduced ROM.
6. My activity level is low. In addition to PT three times a week, I do light exercising on days off. I might do a few dishes here and there and have done a load or two of laundry, but that's about it.
That's good.

You exercises - my comments in bold
7. I go to PT three days a week.
My exercises are:
10 minutes on the NuStep at my own pace with no resistance - okay
Heel slides, 2 sets of 10, holding each rep for 5 seconds - do 1 set
With the back of my leg on a cylinder, lift my leg and hold for 5 seconds. 2 sets of 10 - do 1 set
Hamstring stretch - with loop of cord around foot, pull leg straight up and hold for 30 sec x3 - hold for 10 secs and do 1 set
Thigh squeezes with towel under knee, 2 x10, hold for 5 seconds - okay
Straight leg raises 2 x10 - do 1 set
Calf stretch hold for 30 seconds x3 - okay but 2 sets only
Extension stretch - sit with leg extended on a table of same height for 5 minutes - don't hold so long if it hurts

All this is in addition to the therapist working on my extension and bending. She pushes for each but stops when it becomes too uncomfortable - this shouldn't be necessary but don't even let it become a bit uncomfortable.

Sliding knee bends - lay on a table with feet on wall. Slowly slide knee down until I feel stretch. Hold for
5 seconds x10 - an odd version in my opinion, but don't let it get the tiniest but uncomfortable. Heel slides are best done at home, frequently and in small amounts
Prolonged knee stretch - sit in front of wall, toes up against the wall. Each time it gets more
comfortable, I scoot up in my seat a little bit to make the bend harder. I do this at my own pace for 3 min
- a seriously weird version! I suggest you drop it.
Well, the last two are novel! And overall it seems quite a lot for only 4 weeks out. To be honest I can never understand the need for all this activity as it really isn't necessary and can cause more problems than it resolves. and you don't need anyone to push on your leg for bending as once the swelling has subsided, you'll fine all the bend you could want is already there. I was going to ask if you read your recovery articles but having check, I see nobody left them for you. This PT might be better than the previous one, but you are still being asked to do TOO MUCH! I've crossed out things I think should be avoided.

My at homes exercises consist of heel slides, leg raises, thigh squeezes and walking around the house practising walking heel to toe
Now you've disappointed me - you gave such lovely and informative answers up till now. Honey, I need details! Just like you gave for your PT sessions. Pretty pwease?
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Oh, almost forgot - here are the recovery articles. Better late than never! I've emboldened some I think you should make particular note of

First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

Next is a FAQ (Frequently Asked Questions) thread.

And here are some very crucial articles
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Activity progression for TKRs

Healing: how long does it take?
Chart representation of TKR recovery
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling

Home physio (PT) and activity progress: suggestions
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

And then some wise words from members who have shared their experiences ...
Where are you in recovery?? (TKR)
Five “P’s” of knee recovery
TKR: work “smarter” and not “harder”
Recovering a knee - from one who knows!
It's never too late to get more ROM!
It's worth the wait for ROM

Also, you might like to read the potted version of my recovery to see how little exercising I did! Knee recovery - UK style
 
I had a low grade fever for several weeks after surgery, longer than I would have predicted. The fever hit every afternoon around four. I knew that low grade fevers sometimes follow surgery. Maybe you have something similar and it's worse after the activity of PT? I'm not a medical professional, but I've been a mother for a long time. Have you taken your temperature when you have the chills?
 
Don't try and reduce so soon and 4 weeks is way too soon. TKRs need meds for around 10-12 weeks. I took mine for 4 full months.

Josephine can I arrange a conference call between you, my OS and myself? He seems to think 4 weeks of pain meds is more than enough.

Have you taken your temperature when you have the chills?

Good idea! Have you?
 
The fever hit every afternoon around four.
Interesting - and just what had you been doing during the middle part of the day? :wink:
Josephine can I arrange a conference call between you, my OS and myself? He seems to think 4 weeks of pain meds is more than enough.
Aaww, sweetie - if only that were possible. I really, truly feel for you. :console2: Though just wait until he has his knee done - he'll sing a different tune then!

However, have you tried approaching your GP and see if s/he will be more helpful? If not, how about a pain clinic?
 
@Josephine thank you for all the answers. I'll try to incorporate them and will do the reading you sent.
As far as my home PT, sorry my answer wasn't as in details as the others. The reason being is that I have been lax on my home PT as I have been so tired from my regular PT.
When I do my home PT they are as follows:

Heel slides - 2 sets of 10
Leg raises -2 sets of 10
Thigh squeezes - 2 sets of ten
I also do ankle pumps, usually 20 or so all through out the day
Walking - I just walk into the kitchen, through the laundry room, down the hall i to the dining room, walk around the dining room table and back into the kitchen and so it all over again. I do this 3 or 4 times. This usually only takes me around 5 minutes to complete. If I feel up to it I'll do a couple do times a day or else only once.

I feel a though I have been lazy in this recovery compared to my first in 2012. Then I would go to PT three times a week as well. In addition to that I would do my home exercises (even more than above) twice a day and once a day on days having PT and I did this faithfully for three months.
But as everyone says, every knee recovery is different and I'm certainly finding that out this time. Anne
 
@madinana, thanks! I don't want to jinx myself but I am feeling really good. I feel as though I have turned a corner....keeping my fingers crossed!!! Anne
@Jane B., @gr82cu2, I have never taken my temperature. I would feel my face and it would be warm, but taking my temp never occurred to me. Yesterday was the first time it didn't happen after PT, so I'm hoping this is the end of it. Thanks again, Anne
 
Heel slides - 2 sets of 10 - heels slides are best done about 5 every couple of hours during the day. Do then to the point of discomfort only, NEVER cause yourself pain
Leg raises -2 sets of 10 - do about 5 of these first thing in the morning and that's it. No need to do more.
Thigh squeezes - 2 sets of 10 - I'd leave these out.
I also do ankle pumps, usually 20 or so all through out the day - at 4 weeks out these are now unnecessary

Walking - I just walk into the kitchen, through the laundry room, down the hall into the dining room, walk around the dining room table and back into the kitchen and so it all over again. I do this 3 or 4 times. This usually only takes me around 5 minutes to complete. If I feel up to it I'll do a couple do times a day or else only once - limit your walks to visits to the bathroom and kitchen as required. You don't need more and certainly not this amount.
I feel a though I have been lazy in this recovery compared to my first in 2012.
Actually you're not. By my book, you're still doing too much, far too much and it accounts for the pain you are experiencing.
 
Aaww, sweetie - if only that were possible. I really, truly feel for you. :console2: Though just wait until he has his knee done - he'll sing a different tune then!

However, have you tried approaching your GP and see if s/he will be more helpful? If not, how about a pain clinic?

I'm ok now with just Tylenol and Aleve, for the most part. I have my next knee coming up in a little over 2 weeks though. We'll see how the next one goes with the pain. My OS claims his patients use 2/3 less pain meds because of his protocols. Pfftttt! I think his pain med protocol is to intimidate his patients into not asking for refills. If I have to I'm sure I can go to my regular family doctor. I have a 20+ year relationship with him and he knows me and my family well.
 
@Josephine, I will definitely do the heel slides as you suggested. Heel slides seem to be very hard for me and I can't go back very far. Doing 5 several times a day sounds like it might work well for me.
I know that you had said you thought the heel slides down the wall were an odd way to do it along with me sitting with my feet against the wall and slowly scooting to have more bend. My therapist said that she noticed they when I would do heel slides sitting on the table she could see that when I was sitting upright or when I did the slides on the wall, it seemed that I got more ROM, so she incorporated them into my exercises.
I also once again want to thank you for all your help in answering all of our questions. You are always there to offer your expertise and give so much of yourself to help all of us. And I'm sure everyone feels the same way as I do. Thanks again. Anne
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Well since I am four weeks out, I thought I would post a picture of my knee. I think this one looks better than my first one. The incision is knitted close together but my skins feels hard and is like leather. As you can see, it is
Still swollen. Anne

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