The TKR Experience (or...Wish I Had Another Kidney Stone)

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Most Important...  Everyone heals at their own pace.  Don't judge yourself by anyone else's progress.  This is between you, your PT and your doc.

That being said...here are some "ballpark" estimates...

1. Medication...  Take your pain meds.  This is not a test of endurance.  Need 'em?  Take 'em.  Ballpark... Most people are off the the opioids in 4-6 weeks; some need them longer.  800mg Ibuprophin or Tramadol (both RX) after that if you need it.  The opioids will make you constipated and possibly dependent.  Nobody wants something highly addictive in their medicine cabinet; toss them as soon as you can.

2. Pain... A TKR is really, really, really, really painful...no getting around it...especially the first month.  Don't measure your pain levels daily...monthly is better as you'll see dramatic changes from the longer time span.  Ballpark... The worst of the pain will probably be gone within 90 days...but again, everyone's different.   

3. Assistance...  Crutches, walker, cane...whatever you need for as long as you need it.  Ballpark... Most people are off of all those items within 90 days but the sooner the better.  Gotta start to learn how to walk on your own again...sometimes, you have to push it. (NOTE: This may not apply to people with previous hip/knee/leg problems or to the elderly.)

4. Pysical Therapy...  Gotta do it.  Your therapist will work with you to both straighten and bend your knee.  Full range of motion is zero degrees straight and greater than 120 degrees bent ( 0 / +120 ).  I started at -14 / +84 and finished 9 weeks of PT at -1 / +128.  Ballpark...  Depending on age, previous conditions, individual circumstances, you should shoot for the full range of motion goal.  If you can't get there at PT (I was still one degree from straight), finish the work in the gym or therapy pool.  The closer you get the better...but again, everyone's different.  You should consult with your doc and PT.  Who wants to walk with a limp or a cane the rest of their life???

5. Exercise...  After PT, ya gotta rebuild the muscles in your leg, especially the quad.  Walking, swimming, stairs, whatever.  You have to rebuild your strength to support the knee.  Ballpark...  Since it's during and after PT, this work usually falls within the 3 to 6-month range for most people.  My daughter has been an ACSM- and ACE-certified personal trainer and graduate nutritionist for the past 16 years.  Her recommendation: Build endurance before strength.  Warm up on a bike for 30-45 minutes (set the seat high enough for full leg extension)...then do your stretches.  For your exercises, start with NO weight but perform 3-4 sets of 12-15 reps each until you are at ease with every exercise and are not tired out by them.  Use your good leg to stabilize yourself during the the exercise...don't use the good one to fake the reps.  The idea is to get the bad leg as strong as the good one before you fully exercise them together again or even isolate the bad leg for exercise.  Once you can't tell one leg from the other (feeling balanced and not relying on the good one), start adding weight...slowly....like 5 pounds at a time, again using the good leg to stabilize yourself.  Any pain, strain or swelling means you did too much too fast.  Back off...you'll eventually have equal strength in both legs.  PS: I guess people with BTKRs can do both legs together...I'd have to ask her.

6. Swelling...  This is the knee's way of telling you that you overdid it.  Back off, ice, elevation, rest.  Ballpark...  Everyone does this at one point or another.  Listen to and learn from your body.  Avoid pushing it too far.  There's a fine line between progressing and heading off the cliff.  Everyone has to find that sweet spot for themselves.

7. Sensations...  There will be numbness at the incision site.  Nerves have been cut.  Ballpark...  Crapshoot; normal feeling may come back or it may not.  Some people have an uncomfortable sensation of the knee rubbing against clothing or sheets.  Hint: Wrap the knee loosely with an Ace Bandage or buy a "knee sleeve" and slide it on over the knee.  Easy Fix.

8. Sciatica...  If you've never experienced this intense pain from your back, through your hip and then running down your leg, be thankful...be very, very thankful.  On occasion, the sacroiliac (SI) joint on one or both sides of your hip will lock up and pinch/inflame the sciatic nerve.  This happens because we change our gait to compensate for the knee pain.  In layman's terms, "you threw your back out."  Ballpark...  Some people get it, some don't...another crapshoot.  Possible solutions: steroid injections, Celebrex, Lyrica, 800mg Ibuprophin, chiropractic, therapy pool, accupuncture.  Whatever works; talk to your doc.  It's temporary but painful; cross your fingers and toes that you don't experience it.

9. For simple discomfort that doesn't need RX painkillers...  Aside from the standard OTC pain meds, here's a suggestion: Voltaren Gel (diclofenac) is a nonsteroidal anti-inflammatory drug (NSAID). It works by reducing substances in the body that cause pain and inflammation.  Voltaren is used to treat mild to moderate pain, or signs and symptoms of osteoarthritis or rheumatoid arthritis.  I use this almost every night; just rub it in.  Works in 10-15 minutes. RX only.  Get your MD to write a script for lots of tubes (I got five right out of the box.).  Checked with a few pharmacists about an OTC pain relieving cream...they all told me to get my doc to write a script for Voltaren.  Don't think about it; just do it.

10. Post-Op Depression...  No one..NO ONE...talks about this, not even the docs.  Found out the hard way when I had my hip replaced in 2009.  Hospital, rehab facility then home.  Started crying and couldn't stop for three days.  Called my MD cousin.  Told me that it was Post Operative Depression.  This is a KNOWN condition that occurs frequently in people who have had an operation that removed an original part of their body.  Not so bad for appendix, gallbladder, etc.  Moderate to severe for hips, knees, shoulders, etc.  Really bad for heart transplants, traumatic brain injury, etc.  For us, it's a definite possibility so be prepared.  Blown away for three days with the hip until I knew what it was.  Gone in 24 hours because I was now aware of it.  For the knee, I was totally prepared.  Kicked its butt.  Remember...this is a definite possibility so be prepared.  If you start feeling really sad and you're crying all the time post-op...now you know.  Get out of the house into some sunshine.  Take extra Vitamin D.  Eat healthy; hydrate.  Do not let this get to you and do not start anti-depressants.  This is a temporary condition.  Concentrate on pain management and rehab...PT and gym...endorphins do wonders in combatting depression.  Get on top of it, wrestle it to the ground and beat the everlovin' crap out of it.

11. Long Recovery...  That "swollen look", popping and clicking sounds, stiffness...all normal.  Ballpark...  All of this should resolve in 12-18 months...or maybe it won't.  Who the hell knows...I'm just thankful that I'm walking again and not in a wheelchair for the rest of my life.  Goal...get back on my skates again.  After 44 years playing hockey, it's been too long.  I'll never play the sport again but just skating would be soooooo great.  Just have to see what happens.

12. Goals...  This is easy.  SHORT TERM (3-4 months): Get off the opioid pain meds; switch to non-addictive pain killers if you need them.  Use the Voltaren Gel.  Go to PT and get your full range of motion back (0 / +120).  Toss your walking aids.  MID-TERM (4-12 months): Rebuild your leg and core strength.  Complete any range of motion therapy/exercises so you are walking normally, especially up and down stairs.  Start adding close-to-normal activities, like walking a mile every day if that was your "thing".  Begin with a lesser distance and increase without any knee swelling.  LONG TERM (12-18 months and beyond): Set realistic goals for leading a fully normal life again...as if the TKR had never happened.  However, there may be activities that you once did and must now avoid.  For me, I can skate but not play competitive hockey ever again.  For others, running may be bad because of impact issues while speed walking might be a good substitute.  There are plenty of on-line resources that list OK, possible and "never again" activities for people with knee and hip replacements.  Your doc will probably have his/her own ideas but this is from The Mayo Clinic: "After you've recovered, you can enjoy a variety of low-impact activities, such as walking, swimming, golfing or biking. But you should avoid higher impact activities — such as jogging, skiing, tennis and sports that involve contact or jumping. Talk to your doctor about your limitations."  I saw one site that listed singles tennis as a no-no but doubles was OK becuse there was less movement and impact.  It's all very individual but the ultimate goal is to lead a healthy, active, productive life again...a far cry from lying in bed in utter pain one week post-op.

Did I miss anything?

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  • Posted

    Brilliant Chico, wish I had known even a third this 18 weeks ago. Very informative and helpful for anyone starting this journey xx
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  • Posted

    Incredibly helpful, thank you

    Susie

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  • Posted

    This is so helpful Chicco, thank you. i am 8 months post op and still have a few issues, but this as well as helping me to know what to expect for the next few months has also shown me how far I have come.

    A brilliant post!

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  • Posted

    Thank you Chico. I want to be able to regain my balance, slowly it's happening. I much appreciate your input and the information here. X

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  • Posted

    Don't know how I missed this the first time around...think this is a re-post.  Thank you for covering every aspect of this surgery.  You nailed it!!  Funny how comforting it is when you read about people having gone through the same issues as you have.  Thanks again Chico Marx!!

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    • Posted

      I posted parts of this before but decided to finish the whole thing and put in one document.  Consulted with my daughter on the exercise tips too.  Made sure they were correct and directly from a certified pro...not one of those "certified trainers" at a gym.  American College of Sports Medicine (ACSM) is the gold standard certification.  Took her two years of study and exams to get it.

      Will we all feel like the op never happened?  No idea...but I'm hoping and working for it.  Some people feel stiffness 2-3 years later.  Not sure what to do about that.  I'm just thankful that we live at a time when this can be done.  Else, we'd all be in wheelchairs popping pain meds 'til we die.  This is waaaaay more preferable regardless of any lingering issues.  

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    • Posted

      I totally agree. I can live with whatever lingering minor issues that come with this surgery than how I felt before surgery. But as we all know, everyone is different. I am just so thankful that my post op issues are minor and definitely something I can live with. I feel for all those who still have major problems. When we can give support or empathy to others, then it's all good.

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  • Posted

    WOW Chico! Excellent post!! Thank you for sharing it! cheesygrin

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  • Posted

    Hi Chico,

    I have been following your messages from the first week of my TKR.  It is now 7 weeks post op and most of my questions have been answered by your great posts.  Of course there is always another issue that comes up along this journey.

    I have been working hard to do my PT at home and go 3 times a week to outpatient PT.  I have a lot of swelling and continue to ice during the day and evening.  I still have not had a good night sleep.  My bed looks like a war zone with ice packs, pillows and aids I need for PT exercises.  I can't find a comfortable position for sleep, so I wind up doing my PT exercises hoping they will help relax the leg.  I can't sleep on my side for more thant 10 minutes.  I finally wind up stacking pillows and sitting up.  It is almost a feeling of insanity.  I can't read because I can't concentrate.  I put the tv on and set the timer for 120 minutes and then get up again.   My doctor doesn't want any pillow under the leg.   Any suggestions?

    Question:  It is common after 6 weeks to still have a tightness in the shin and ankle area.  It's very difficult to move.  I still feel that tight band around my knee.  Just when I think it is easing up, it comes back.  Got any answers?

    Oh, one more thing.  For those of you like myself who can't take opoids or  antiinflammatory meds, I read about foods that are very good for inflammation.  One of them is celery.  I just bought a large package of organic celery and started to eat a few stalks a day.  Will let you all know.

    It's great that your daughter has so  much professional information that you have passed on to us.

    Thank you again,

    Marilyn

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    • Posted

      Seven weeks is still early so the pain and stiffness are no surprise.  A lot of people on the forum have the same issues...I did too.  I am very resistant to opiods; the only one that works for me is Dilaudid which the docs refuse to prescribe.  So I did the Percocet for pain and Flexeril for the muscle tesnsion.  Got off them in four weeks.  Hate the constipation and feeling buzzed.  Rather deal with the pain.

      Sleep...  Also tough.  Pillow under the knee?  Yeah, I know what the doc told you/me/us...but I did it anyway.  It was the only way I could find some comfort and get to sleep.  I am NOT recommending that you go against your doctor's order...however, you have to find out what works for you.  To sleep on my side, I put a pillow between my legs.  

      Try the Voltaren Gel for pain and then put a knee sleeve over it.  That could help.  I'm 18 weeks out and my knee still feels stiff.  I expect that will be going on for a while.

      My biggest challenge is getting strength back in my quads...both of them.  Too much sitting around...not enough movement.  Hoping that the therapy pool starting next week will help.  Did wonders for my hip replacement.

      For sleep, try 50mg of diphenhydramine 1/2 hour before bed.  This is the same stuff in Benadryl, Excedrin PM, etc.  It's an antihistamine that makes you drowsy.  By the generic cheap at Walmart or wherever.  Another alternative is Melatonin...nice sleep aid.  Add the Voltaren and lay back, read a book, buy a "diffuser" and some lavendar oil, white noise or some soothing flute music.  Make it a routine.  If none of this works, Call Wiley Coyote...have him bring over that huge rubber mallet he tries to use on the Roadrunner.  Guaranteed to work...

      This is definitely not easy but it does get better...not day to day but on a longer time span.  A month from now, you'll wonder how you ever got through it.  Be creative, not mad.  Redirect that energy toward healing, not frustration.  Recovery is NOT a linear process...there are a lot of ups and downs.  Depressed?  Kick its ass!!! 

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    • Posted

      Hi Chico,

      Thanks for your response. I am on my second tube of and it does give some relief with one Tramadol. Now with your suggestion, I can add a sleeve to the cocktail. I have lavender massage oil which I use after a shower. Last night was the second night I took a progesterone troche that is an Rx from a homeopathic doc along with the other cocktail, put my leg on a doft pillow and it was the first time I slept for 5 hours in seven weeks. I figure you can make a trade off for using the pillow and do more exercises of bending and straightening the knee.

      You mentioned you have to strengthen your quads. Is there a time limit like there seems to be with straightening and bending to prevent scar tissue?. The PT's have all been pretty clear on that. I am not depressed but sometimes I have visions of the operating room before they put me out and it looked like a hardware department at Home Depot.. No wonder we are in pain. I don't know how you managed a hip and now a knee.. Such brave people on this site.

      I will hang tough with all of you. Better days ahead.

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    • Posted

      Oh forgot to mention sleep aids. I get migraines and melatonin gives me a headache. So does Benadryl and those kinds of OTC remedies. I just remembered that Linden tea is good for sleeping. At least my memory is coming back.
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    • Posted

      RX Fioricet for the headaches.  Give that a try.

      Getting the knee to 0/+120 breaks down the bulk scar tissue that's forming.  That's PT work...a lot of it.  Full range of motion.  That's why it's the first thing you do in rehab.  Rebuilding your muscles is secondary to breaking down the scar tissue although it probably helps early on after the PT does his/her work.  You need strong muscles to support the new knee. So, while it can be argued that squats, leg presses, leg lifts, etc. help keep the scar tissue at bay, the PT has done most of that work already while the exercises are more for endurance and strength.

      When you're at the gym, don't ignore your core.  Kate suggests core and leg work one day, upper body the next...then alternate.  Never do any one body area two days in a row.  The muscles need time to heal and strengthen from the previous day.  

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    • Posted

      Thank you.  I took Fioricet years ago.  I have been through every medication including shots of Imitrex.  The final answer to preventing the migraine is, as soon as I see the aura, I take Maxaalt (Sumetriptin) in sublinguel form.  My daughter also takes Maxaalt when she feel it coming on.

      I appreciate your suggestion in building core muscles.  That is way down the road now.  My doctor wants me to walk a mile a day.  I am afraid to walk out on the streets or on the track so I am going to do a video I have with different miles of walking.  I am soooooo tired.  You are right, your whole life revolves around this surgery.

      Be well,

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    • Posted

      I just read a post from Iris who had a partial knee replacement and wants to fly for a special occasion 4 weeks post op.  I can't offer information to her since I don't know the difference between the two surgeries.  My neighbor across the street had a partial around the time I had my TKR.  Like you said, everyone is different.  I haven't see her outside at all when I take out my garbage, water my flowers and get in the car to do my pt and food shopping....Thene again, she has a husband who helps her...I know my husband would help if he were alive....I guess this makes me even stronger ..so it goes the way you say...EVERYONE HEALS DIFFERENTLY.

      However, I have a special occasion in CA on Sept. 1 and will be flying FROM NY....5 hours FLIGHT.    I have arrange for a wheelchair and will be traveling with my granddaughter.  I didn't ask my doctor about this at my post op appt. Do you know if there is a problem with clotting post op 3 months.  Any suggestions?  I will call his office anyway but I'd like your input.  

      Sorry to bombard you with so many questions, but you have the experience and professional advice available and so willing to share.

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    • Posted

      I already am.  Look at my avatar.  Hip, knee and four fused vertebrae.  Over 4 1/2 pounds of titanium in me already with at least one more knee to go.  I'm soooooo looking forward to that...  44 years playing hockey will do that to a human body but I wouldn't exchange all the pain for one extra minute of ice time...

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    • Posted

      Getting to the airport, walking (or wheeling) to the gate, boarding the plane...no problem.  But sitting in a cramped, tiny seat for five solid hours?  Ouch...  If I had to do it, I'd probably have my Voltaren with me and use it as often as prescribed.  There's a great gel out there called BioFreeze!!!  Makes the joint nice and cold.  Then I'd have an ice bag with me and have the flight attendants refill it as often as needed.  Keep the ice on it the whole flight.  Also, get up and stretch the knee out on a regular basis, maybe every 20-30 minutes.  I'd ask a doc but these seem like reasonable steps to take.

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    • Posted

      We are so honored to have a real jock on this blog.  OMG....you are a strong   guy.  It's such a shame...the surgery only takes a little over an hour and some of us struggle up to a year to recuperate....

      I wouldn't be taking the trip for anyone except it is my granddaughter's bat mitzvah and my son would never forgive me.

      Thanks....I will get bio freeze and renew the Voltarin and call the airline.  will bring  a few of my icebags and ask airline to freeze them. One of my ice packs has a bag with a velcro closing that straps on to the knee.  I will bring my cane for support...even though I only use a cane outside to keep people and cars away fro  me.  I have an end seat so that should help.  I was  concerned about blood clots.

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    • Posted

      Thank you shan...my doctor gave me the letter at my post op appt.  I already called the airline and changed to aisle seats.  For my flight going home they gave me (Jet Blue) a handicapp seat and an aisle seat (I have a layoff for two hours going home)....I hope I survive this....don't want to sound like a victim but this is what we do for kids.....

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    • Posted

      I recommend you request wheelchair assistance on your outbound, connections and in your destination city.  TSA lines can be long and standing for long periods of time makes my knees swell.  They will meet you on the jet ramp and you can tell them you want to walk if your next gate is close and you want to stretch.  I purchased compression socks for the flights and they helped reduce swelling.  I travelled for over 16 hours 3 months after bilateral TKR.  We upgraded but you should be good with a aisle or ask for bulkhead due to your medical condition.  I didn't need a note for security.  I just told them I have titanium knee replacements and I was sent to the body image scanner.  Take your time and be patient with yourself.

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    • Posted

      Hi and thank you for your suggestion. I called the airline and changed seats to aisle. On homebound flight they gave me a handicap seat for the 5 hour flight and an aisle seat after layover. That flight is an hour. i requested a wheelchair, have letter from doc and all I pray for now is getting the swelling down and a normal bend. I will also be flying one way with my sixteen year old granddaughter and Velcro closing icepacks. Chico suggested bio freeze.

      I love this site and thank you all for great suggestions.

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    • Posted

      Hi Marilyn, I was told by surgeon definitely not to fly for at least 12 weeks due to clotting and lack movement. Others here have given you excellent advice on ice etc. I admire Chico and his advice. But check about flying. Def get help. I got assistance before my op and was excellent. I am 18 weeks now and flew first time this week only 3 1/2 hours from uk to Spain, was ok except rather irate security person with my knee. I got an extra leg room seat and just kept moving legs. Got quite stiff after a while but was fine. Take care xx
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    • Posted

      Hi Marilyn, hope your feeling somewhat better from this date of today from when u originally posted.  I hear you and feel your pain,  u sound like me in many of your scenarios,   Ahhhhhhhhhh!!!   May I ask, how's that celery working out for u? I myself am not supposed to take nsaids, so will be open to natural remedies.  Thanks for any info, best of health to you, kathy p.

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    • Posted

      Hi Mkhp....Thank you so much for your post.  Yes, celery,  ( keep a bunch in cold water in fridge and eat about 3 a day.  I make an elixer of Apple Cider Vinegar, honey, cayenne pepper and turmeric with a cup of water.  Mix it all and heat it up like a tea.  Put it in a shaker bottle (salad bottle) and drink a tablespoon everyday.  It can stay in fridge for a week to 10 days. These are my remedies that help with inflammation.  Also, my naturopath gave me a supplement called Cucurcumin which is turmeric root and liquid turmeric in a capsule.  That is for pain and inflammation.  I mentioned in a previous post that I get very bad reactions from narcotics.  I later found out that Tramedol is a narcotic.  I was down to one at night at 7 weeks and woke up shaking.  When I mentioned it to my son, he didn't believe that tramadol was a narcotic.  He looked it up on Google and it is definitely a narcotic.   He had several spine fusions and surgery and became addicted to pain killers.

      Hope these little bits and pieces help you.  I'm up for all.

      Feel well, M

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    • Posted

      Hi Sue et al:

      Hi Sue...I called my doctors office about flying at 3 months post op.  As mentioned before I am traveling from NY to LA; a five hour flight going and coming home a layover at JFK and then upstate NY.  These are the suggestions docs office gave me:

      Flying after TKR (3 months should get clearance from doc

      Three months is the miniumum time for flying

      Should drink lots of water

      Get a handicap seat and call ahead to get a wheelchair

      Wear a compression sock  to prevent blood clots. I went to medical supply where they measured me

      Get up and walk around every 30 minutes

      Do ankle and foot pumps during the flight

      Don't forget the surgical report or card on prothesis

      It won't be till Sept. 1 and I will let you all know how it went.  

      Have a great weekend everyone.....M

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    • Posted

      hi marilyn, thanks for addtional info.  i too didnt know tramadol is a narrcotic, thanks for the heads up.  ive been taking turmeric for a while, however will try your other home remedies, sounds yummie (i think??). ill try just about anything for the "Victory" or Team !!, feel better as well, best ... kathy

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    • Posted

      Sorry to tell you this but I saw a news clip about diphenahydramine that turned me away from going to it as a sleep aid whether it's taken by itself or in something like excedrin PM.  This substance causes an increase in altzheimers/demensia.  There was a night when valerian root and the other sleep ease herbal blend didn't work so I did help myself to some demensia down the road because I desperately needed to sleep to be awake for what was coming in the morning plans.  Otherwise I never use it now.  If you doubt it, just google diphenahydramine, altzheimers and it will probably bring up the research.  Sure glad I heard that clip because I don't know if it came out in other news media.  Your post was VERY helpful BTW.  I have to tell my therapist I still need the cane, because he thinks I shouldn't need it.  It gives me more time on my feet if I don't put my weight on my TKR side.  Too much even with the cane on my feet also still sidelines me for a day.  I was nearly walking with out aid right after surgery but I think all the pushing to get ROM makes the knee very unhappy .

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