Knee recoveries UK style Parts I & II (Josephine)

[Josephine]

I think I'm going to stop telling people about my recovery because every time I boast about a good day, it's followed by an absolute nightmare of a night! To related the sorry tale, was up late until about 1am and my knee started being painful - about 6-7. I took 50 Tramadol but after an hour, no effect so tried some ice which made things worse. Walked around a bit which seemed to make things ease so I went to bed. Once in bed it got worse again - by now it's getting to 8-9. Despite using ice and taking more Tramadol, by 4.30am I came downstairs and made a hot wet towel which was blissfully effective. Did this 3 times and then settle down on the settee and slept until 11am! Today I have mild discomfort but nothing more. Strangely this is only when I'm sitting. When walking, the pain is zero!

I think I'll take your advice about my neighbour. I want to shop afterwards so she might like to as well. Plus she just passed me a meal over the fence - steamed meat and vegetable pudding and a big jug of gravy! I have enough for at least 3 meals! Isn't that kind?

 

[Josephine]

Well, I did my first drive. I did take my neighbour who admitted she would enjoy the trip out. I was a barrel of nerves beforehand but, as I had expected, once I got on the road I was fine! Got to the chiro in good time and found a parking spot right outside his door! He has a big ol' flight of stairs up to his rooms which I took really slowly and carefully. My neighbour stood on guard by me the entire time, bless her!

Well, I told Greg my problem was all down the rear/outside of my leg from hip to ankle and then surprised myself by getting onto his couch face down! Didn't think I'd be able to do that but it was easy. Then he got to work! Heaven's above - he found tender, painful sites the entire length of my thigh, calf and even into the sole of my foot! It was like Chinese torture but in some strange way, you just know it's doing you good. The entire area was in a really bad state and I have to go back next week for another session.

I then went on to Asda and did a fair shop. I used an electric kart while my neighbour went on fetch and carry expeditions! Bless her heart! I got home about 2.30pm which means I has out nearly 4 hours. Not bad for a first trip out and I have to say, I feel so much better already except I've been really, really cold - wrapped myself up in blankets for most of the afternoon! Seems I can't get a happy medium - I'm either roasting or shivering.

Oh yes, and I haven't had any pain meds since 4am yesterday morning! Not bad for 4½ weeks out!

 

[Josephine]

Well, 'rough start' continues. Last night I got quite bad pains around my knee.

So:
took Tramadol - 1 hour later no change
rubbed on Volterol gell - 30 mins later no change
tried ice - made it worse
then I remember Poppet telling me that the Chinese preferred heat for pain that wasn't immediately post-surgical so sat myself beside the microwave and rotated two damp cloths. That help a lot but the heat wasn't persistent enough so I got a hot water bottle and treated the back and sides of my knee with it - result

SUCCESS!!

I also came to the conclusion that this pain is nothing to do with the knee surgery but all to do with the muscle spasms in the biceps femoris and hamstrings which, as I said before, have been plaguing me for almost a year.



So, I retired to bed at 2am, slept right through to 9am and woke pain free.
Not only that but ROM in my left leg is now equal to that in my right leg!

Also, appetite has returned about 90% and the pain is still very low.

Just in case you are interested, this is the pattern of my tendinitis pain - in blue

 

[Josephine]

Could have been related to massage/leg-tenderizing yesterday?

Any chance some of your pain was due to the big day you had yesterday?

Thank you ladies but the answer is definitely no. I've been suffering from this pain for over a year now and Greg has treated me for it many times before. The aftermath of the surgery just made it worse. I should have realised and not got it mixed up with post-op pain. Silly me!

I also measured by ROM today 123/0! Not bad, eh?

 

[Josephine]

You know, whenever I post about a good day or progress, it is then followed by an absolutely abysmal night. And last night was no exception. I retired at 11.30pm and after only 30 minutes my knee started raging. This is not pain, I promise. It's a raging heat included with a kind of tightness along the scar like a cheese wire being pulled ever and ever tighter! I tossed and turned for ever and finally, at about 2am, I gave up and came downstairs to try the hot towels and hot water bottle again. This time it didn't work and I finally tried the last thing on my list which was the Gladwrap. That worked too! Wonderfully well. But now I tried to settle on the settee and though I had several blankets on me, the room seemed cold and I got totally chilled. I slept until about 8am and woke even more cold than before. And feeling sick and ill.

Imagine my surprise when I went into the conservatory and found it was roaring hot in there! The sun was shining and people outside were out and about in just cardigans! It took me ages to warm up.

I do hope tonight will be a better night, please God.

 

[Josephine]

I had a lovely night past night. I've actually found it unnecessary to actually wrap the Gladwrap right round the leg. A patch of it, sufficient to cover the wound and both sides of the knee, is quite enough. And since somebody kindly sent me a box of Gladwrap (we don't have it in the UK) and Gladwrap is lightly self-adhesive, the patch stayed put all night! So I slept from about midnight to 9am - long old night for me! But when I got up, I had a whole array of discomfort, hot wound, feel out of sorts generally, foul taste in mouth so no appetite, feeling really chilled so wrapped myself in blankets and about 20-30 minutes later, had a hot flush and threw them all off again! It's only settle down when I replaced the Gladwrap. Hope this means I shall have another good night tonight.

 

[Josephine]

Well, I got to see my GP today. My leg has been burning and driving me potty.

I've tried everything: Tramadol, paracetamol, ibuprofen (singly and in concert), ice, heat (moist and dry) and diclofenac gel. Nothing touches it. The GP felt it and said 'it's not really that warm' to which I replied, you should try being on this side of it! It HOT!' and burst into tears. I never realised till then how much this is getting me down.

So I told her all the rest of it: not being able to eat or drink because of the foul taste in my mouth and feeling generally unwell and grotty. She assured me it wasn't infected (think I knew that but it was a relief to have it confirmed!) and asked me to prioritize the issues. Without hesitation I said the knee.

I also pointed out that this was NOT post-op pain as I'd had a few days without that and on no pain meds very satisfactorily. Then this suddenly flared up for no apparent reason. Her opinion was that it was nerve pain. Well shoot! - why didn't I think of that! It would fit in with the extra trauma done by the split in the skin at the bottom and that flap being everted in order to access the patella. Nerve pain - who'd have thunk it!

So long story short - I'm on gabapentin. I had one tablet as soon as I got home and have had a lovely restful sleep for about 1½hrs this evening! I just hope I can repeat it tonight. She also did a whole slew of blood tests just to make sure nothing else is going on.

I'll keep you posted.

 

[Josephine]

Well, the doctor was right because the gabapentin has worked wonders! Such blessed relief. But I am to take only one yesterday and today, twice daily the next two days and three times a day from then on. Jeepers, I shall be sleeping morning noon and night! However, I slept like a baby last night and felt well on waking.

Does this resolve after a while, or is that a "maybe"?

Eeh, God, Chris - I sincerely hope so! It crossed my mind this morning - would this go eventually or have I got it for the duration?

I also saw my chiropractor this morning for round 2 and asked him to do a little work on the back of my knee as I appear to be loosing extension. I told him I'd been putting my heel on a stool and letting the leg hang which that it was rather too tight and painful to do. When he got to it, he said he was not surprised as the hamstrings and calf muscle leaders were very tight and angry and what I was doing was just making them even more so.

He then spent about 5 minutes working on them after which I was already back at 0, I felt he knew more than I did about this and I should stop always banging on about swelling being the culprit because, as the song goes, "in ain't necessarily so"! To be honest, it has tightened up again since but still not as bad as it was last night.

I have also decided to go see Greg on a weekly basis for the time being as this treatment does me so much good.

I think maybe you should get on a regular pain med schedule again for a few more weeks even though you may feel you don't "need" it.

Toni, I have tried all the pain meds are my disposal and not one of them works on this pain. It's not 'pain', it's heat, like someone has a blow torch on it. Not pain meds, ice, heat, diclofenac gel or anything works on it. Glad wrap does up to a point but the gabapentin has been like magic!

What do you do with GladWrap?

See here Night pain solutions using moist heat and clingfilm though I don't wrap it round my leg as in the video, I just apply a patch to the area. I've explained that in the article.

 

[Josephine]

Well, I was too clever by half last night and decided not to take a sleeping pill as my knee had been pretty good during the evening. So another bear of a restless night. Took a gabapentin around 4am and finally got to sleep.
Lesson learned! I'll be glad when I'm on this stuff 3 times a day.

 

[Josephine]

perhaps a little nap today?

Indeed! Slept from 2pm till 5.30. Loverly!

Is it possible that, before surgery, this second knee was in worse condition than the first knee?

You hit it right on the button, Caryl! Shaun said it was bone-on-bone in October 2012 and wanted to do it then but since I was asymptomatic, I declined. So consequence was that I ended up needing a patellar button.

Now when you do that in a nice big fat knee, it's a problem. The skin, quads ligament and other tissues have to be folded back (see picture) so he can get to the patella. In a nice skinny knee it's easy but the more fat there is the tougher the flap is to fold over and the more likely it is to keep flipping back which causes a lot of stress/trauma to the area, including the nerves which, as you can see, are many at that point.

I think this is what may have happened to me as the skin tore about 1.5cms at the bottom of the incision which was an additional trauma.

However, on the plus side, I did lose about 20lbs between July 2014 and the surgery! So that would have made it a smidgen easier!

 

[Josephine]

It's plateaued out and though it's now roughly 40% less than it is during the day, at night it's a nightmare. I have to keep my leg out of bed as the duvet stokes the furnace, so to speak. But I can only stay like that by laying on my back so it's a toss-up between sore knee or sore back! Usually the knee wins!

So I took the advice of a US doctor on www.justanswer.co.uk and explained my problems to him. I got an almost answer and very detailed and fulsome advice but the bit I really didn't want to hear was that there was a risk that this could develop into complex regional pain syndrome NOOOOOO! Not that this hasn't been rolling around in the back of my brain but being told it is a whole other thing! However, he also said I was on a very small dose of gabapentin and it should be increased weekly until it took effect. He also said I should consider going to a pain clinic as well. Hmmm knowing our pain clinics, you can wait 3-4 months for an appointment! But I shall hold it in consideration. This is the third time I've used this website (once to speak to a vet!) and have always had excellent advice and information.

 

[Josephine]

Well, latest report: I saw another doctor at the surgery yesterday. I've seen him before and and kind of like his wry sense of humour but he has a tendency to type as you talk and then he misses things which is both annoying and disconcerting! But he examined my leg thoroughly, which neither of the previous doctors had, and made up his own mind for a change! He decided to increase the gabapentin from 100mg 3 times a day to 300mg twice a day. As a result of this, I had an absolutely fantastic full night's sleep! When I woke, the knee had lost about 90% of the heat that was in it! I hope this continues. I'll let you know.

 

[Josephine]

The trots appeared to be a one off and unconnected with the medication, thank God!
The neuropathy is settling down very well, leg is almost a normal colour and nearly all the heat has gone. Next question is - how long do I have to keep taking them and will the neuropathy come back when I do.

Yesterday I managed a walk around Sainsburys but when I went to Asda I used a martkart which then went out of charge as I left the check-out to take it back! After this my leg was quite tired so I left the rest of my plans and came home. Hence my absence from the forum on Monday.

But I have to report that I am walking about quite normally now, no limps or anything, and doing stairs normally. No aches or pains most of the time except occasionally at night when I might have to take a couple of paracetamol (Tylenol) but that's not every night. I have told my manager I am available for telephone clinics if the need should arise and can return to work in the beginning of April. Yippee!

 

[Josephine]

Well, had a teensy bit of a scare last night. Knee got a bit swollen, painful, red and hot. Couldn't tell if it was the neuropathy, something else or both! Went to see the GP and she said yes it was hot, swollen and red and though she wasn't convinced there was any infection she wasn't prepared to say it for definite. So she wanted me to be seen by my surgeon. She was about to send me to A&E but I wasn't prepared to go on that particular merrygoround and said I'd phone the man direct. She was curious why I hadn't already done so and I explained that I didn't like to take advantage of contacts like that! She said she felt after all the years I'd give to the NHS, I'd earned a few 'strings' to pull and packed me off home to try my luck.

Rang a few places and discovered he was on leave as was his secretary but I spoke to his colleague's secretary, told her my woes and she said she'd have a word with him and see if he'd see me in that afternoon's clinic. She said she'd ring me around lunch time. I thought 'yeah, yeah, that's the last I'll hear of that!' but at 1320 she did ring and asked me if I could get to the hospital by 2pm.

I made that and actually got seen by Shaun's Fellow who examined my knee closely and declared that it was just about the same as any other TKR at 7 weeks! But he did order some bloods, just to be on the safe side! Good man!

He was also in admiration of my 123/0 ROM whereupon I confessed to him that I had done zero exercises. He looked aghast and wanted to know how I'd got that ROM if so and was I going to declare this at the clinic at the end of March when the physio and others would be there. I told him, I can't wait!

So I'm home and relatively happy. Next appointment is with the boss on 31st March.

 

[Josephine]

Now back on the Tramadol in small amounts which appears to be helping thus far. Tomorrow I shall be taking the gabapentin thrice daily instead of twice. I shall be sleeping for the Olympics!

 

[Josephine]

Blood tests: I'll be most surprised if they show anything! But I have noticed a pattern in these bad days. Each one that has happened seems to have preceded an overall improvement in my condition. So today is much better than it was before these things boiled up! Go figure! Now all I need to do is remember that next time I have a bad day!

 

[Josephine]

It's 8 weeks tomorrow!

I've finally conceded the need to go back on some pain meds and am taking 1,000mg paracetamol and 50mg Tramadol at night and 1,000mg paracetamol in the morning. That seems to make things more comfortable.

Latest report:
ROM: 125/-5
Stairs: doing them normally most of the time
Walking stick: only used outside 'just in case'
neuropathy: appears to be under control with the gabapentin
sleeping: soundly!
appetite: okay most of them time!

Anything I've missed?

 

[Josephine]

I finally got my phone and my computer talking to each other again - don't know if they've had a falling out or something but it was very inconvenient!

So here is my knee on the 21st Jan just after the staples had been removed.
Narry a pinch or yelp from me - that nurse really knew what she was doing!
I think it looks pretty darned good for 14 days out!

 

[Josephine]

Forgot to update on here. Blood tests all normal - phew! But I still have a strange soreness across the base of my leg, just above the ankle. I was suspicious it was a resurgence of the cellulitis so went to see the GP. He hummed and haaed about it and finally opined that it was a low level thrombo-phlebitis. I was a bit sceptical but left it at that anyway and this morning, getting plain daylight on it, I had to agree.

Now I had a really severe dose of cellulitis back in 2003 and as it settled down, I noticed I had a really deep pit just above and behind the outer ankle bone. In fact, it was so deep, I could lay my little finger in it. It was mildly purple and an area around it was bright pink indicative of infection/inflammation or something. I was seeing one of the orthopods about the cellulitis and he surmised that this was most likely the cause of the infection, a fairly minor vein had thrombosed and since I'd had a sore throat a few days before, quite likely the bugs had settled in the clot.

So imagine my surprise this morning to see that I had a similarly depressed area, now darkly coloured and the area around it being bright pink. I asked when in hospital if they wanted to know about this episode of cellulitis 12 years ago and they dismissed it as inconsequential ................... NOT!

So now I ask myself, was this the cause of the cellulitis I had after the surgery.
I think I was lucky to get away with it!



Another sad tale: GP decided I should have some compression stockings for the cellulitis but my leg was so swollen (and I'm big anyway) it had to be custom made ones. But - I had no-one to measure me. Eventually a nurse turned up at the door to do that. She had no idea what was really needed and didn't even have a chart to fill in. Luckily I did so I gave her one and then had to explain how she filled it in! Measurements done, now she wanted to know what she should do with it! I told her the pharmacist had the prescription (his shop is attached to the surgery) so she should give it to him so he could send it off to the firm.

This was on Feb 2nd. Yesterday, I called in for something and was just about to ask if the stockings had come in yet when she waved a prescription at me and asked what should she do with it! It was my stocking prescription, dated January 27th! They hadn't had the form! I went into the surgery - they hadn't had it either and knew nothing about it. I'd have to phone the District Nurses and find out what she's done with it. I was supposed to hear today but no go!

Looks very much like I'm going to have to have these measurements done all over again!

 

[Josephine]

Well, the measurements turned up. Seems that, instead of handing the chart in to the pharmacist as I asked her to, the nurse just handed them to the surgery receptionist, who, not knowing what should have been done with it, just filed it away in my notes! I shall be pursuing this.

I also thought I'd post a synopsis of my recovery as there were some things I think I missed out. So here goes:

Jan 7: had no less than three blocks!

1. a spinal which was a bit testing as the doctor couldn't get in and kept calling for a longer needle! Once she got it, she was in and done very quickly.
   
2. a femoral block
3. a popliteal block (they called it something else but I've forgotten what!) which consisted of injecting a quantity of lidocaine (or something) in and around th4 back of the joint

The surgery went fine, I was very comfortable after with the blocks though my blood sugar took a nose dive to 5.4 in recovery. The nurse went and asked the anaesthetist about it but he said it was okay. By the time she came back I was feeling decidedly unwell. I explained to her that 5.4 was very low for me and I was having a hypo. She got me some disgusting glucose gel and squirted it in my mouth. It was effective but when she asked me if I felt better, I told her I'd much sooner have had a Mars bar!

Jan 8: was okay, comfortable. Given oxycontin and oromoprh. Didn't like them, made me feel :rolleyes:

Jan 9: physio came and check my ROM which was about 90. Then she got me up to walk but fem block still working a bit so had to be careful to take the weight on the walker instead of the leg. Of course there had to be a moment when I forgot and ended up almost on the floor! I think the shock must have been too much as when I got back to bed, I was horribly sick over everywhere!

Jan 9: was supposed to go home but owing to my living on my own, was kept in an extra night.

Jan 10: went home, slept on recliner settee as planned. Neighbour was unexpectedly helpful which was nice.

Jan 11: carer came and saw me up the stairs where I had an absolutely wonderful shower in my new walk-in shower! Worth every penny!

Jan 13: nurse came and change the dressing

Week 2
Jan 15: NOT a happy bunny. Leg was as hard as a rock and I ached from the hip right down to mid-calf. GP came to visit and declared I have cellulitis. Actually in two sites, one at the side of the knee and another at the ankle. So was back on antibiotics and feeling grotty again! GP ordered some custom made compression stockings as the ones I had worn in the hospital were no longer big enough!

Jan 17: dispensed with the carers as I can manage stairs and shower on my own

Jan 21: staples out. I was relieved to find that the nurse really knew how to remove them and I had not one nip or pinch while she did!

Jan 27: had two nurses come and do a Doppler test for the compression stockings but they wouldn't measure me for them.

Jan 29: Had to go to hospital for a 'review'. My first outing and I drove! My neighbour came with me, bless her. The person doing the review turned out to be a a nurse practitioner I knew quite well but that didn't stop her complaining that I wasn't wearing my TED stockings!

Week 4
Feb 5: a nurse turned up unannounced to measure me for stockings. But she had no form and didn't really know what it was all about. Luckily I did have a form but I had to explain to her how she used it and then that she needed to hand it in to the surgery pharmacist as he had the prescription and was waiting for the measurements.

Feb 6: been having a lot of pain up and down the back of my leg so made a trip to dear old Greg, my chiropractor. He worked wonders on those muscles as they were really, really tight. Arranged to go back again next Friday. Approved of my 'no exercise' plan!

Week 6
Feb 18, 19th, 20th: bought a new settee, had hair done and saw chiro again!
Am now taking no pain killers and ROM is about 120!

Feb 27: have a horrible burning on the outer side of my scar. Saw my GP who immediately declared it to be nerve pain and put me on gabapentin. We also discussed the slight possibility of infection so I decided to phone the hospital and see if I could get seen ASAP. As it happened, I spoke with a secretary who told my my surgeon was on leave but his colleague who was then in theatre, had a clinic that afternoon and she would speak to him and see if her would squeeze me in! She called back a couple of hours later and said could I be there by 2pm - giving me about 15 minutes to get dressed and drive to the hospital! As it happened, I was seen by my surgeon's registrar which was fine by me but he affirmed there was no infection.

March 3: had to start taking pain meds again but infrequently as my knee is aching and doesn't like doing stairs sequentially. Obviously I've been pushing it a bit! But it has to be said, I now have a ROM of 125/0 and this with doing absolutely NO exercising at all! I kid you not - not a single heel slide or anything else. I think I shall write a paper!

March 10: saw GP because the neuropathy appears not to be being held by the 100mg gabapentin and he increased it to 300mgs twice daily which worked very well. Also appears I have a low grade thrombophlebitis in my left ankle which is causing a sensitive area around the leg. Apparently no treatment required but the compression stocking.

Coincidentally, I had to call in to the pharmacy for something and was told that they are still waiting for the measurements that were taken on Feb 5th. Turned out she hadn't given them to the pharmacy as requested but given them to the surgery receptionist who simply filed it in my notes! Took me another week of telephone calls and inquiries to discover this.

March 20: maybe now might be a time to start titrating off the gabapentin so asked GP for some 100mg ones so I can play around with the doses. Dunno - it's still a bit sensitive but worth a try.

Have an appointment with surgeon on 31st and start back to work on April 1st. Only working one day that week so that's okay. So far so good!