[TKR] My RTKR journey

I am at the point in my recovery (4 wks post-op) where I feel ready to accelerate the weaning-off-opioids process. (Doesn't mean anyone else ought to). At 2 wks pre-op, my surgeon took me off the 2 Aleve BID I'd been taking and switched me to Celebrex (1 BID). On Day 1 post-op, I was put on a loading dose of 2 Celebrex, with one a day thereafter; and prescribed Norco 10/325 "one or two q.4-6 hrs PRN." I needed 2 of them every 4 hrs until the day after I returned home from rehab (Day 14 post-op). I began tapering down--first to 1.5 tabs every 4 hrs., then every 5 hrs.; then 1 tab every 4 hrs. (at that time introducing one OTC time-release 650mg. acetaminophen BID), then every 4.5 hrs/, then every 5 hrs. and today every 6 hrs., with two of the OTC time-release generic Tylenols this morning and one tonight at bedtime. My surgeon's office says I'm okay as long as my total daily acetaminophen doesn't exceed 4000mg. This combination dosing regimen gives me only 2600/day. Since my last Coumadin was on 7/19, I have been given permission by my surgeon's office to start NSAIDs tomorrow.

My questions are: is it unwise to continue a cox-2 inhibitor like Celebrex while taking an NSAID? (I plan on resuming 2 Aleve BID). If so, how many here who've been able to wean off opioids have found that an NSAID works better for them than a cox-2 inhibitor? (Though I have GERD, I do take an antacid and a PPI, so that shouldn't be an issue). I suspect that if I can begin to manage my pain with non-narcotic meds, I can more quickly wean off the Norco. I also have some topical NSAID (Flector, which is generic Voltaren) patches. Not that I MUST get off opioids, but I'd like to if I can.

It's interesting to find your question today. I am six months post op and am faced with a change in meds because my doctor won't refill my Celebex perscription. I went from Percocet to Celebrex plus Tylenol at about six weeks. Just Celebrex at ten weeks. Celebrex has been terrific... No pain, no stomach problems, and Celebrex was great at keeping the swelling to a very minimum, no matter how active I was and I am very active now, golf, lap swimming, walking. My knees almost looked the same!! Shorter skirts and all!

I have GERD, on Nexium, and in the past have had ulcers.... I cannot do ibuprofen. Three days and I get nauseous. I started Aleve about two weeks ago, one a day. I have no pain, my stomach is fine, but the swelling, gone when on Celebrex, is back on Aleve when I am active. Nothing I couldn't live with, but boy do I miss my Celebrex!! It was the perfect maintenance drug.

So,if you have a choice, my recommendation is Celebrex for your next course of pain and swelling management

My question for the members: has anyone been on Celebrex long term? Have they experienced any heart related symptoms that have been related to the drug's long term use? I want to convince my doctor to provide me with refills of Celebrex.

p.S. I was back to 100% active lifestyle at four months. I love that I don't think about my knee! Knee replacements are a miracle!!!

Interesting thread which leads me to wonder, and ask, what is the long term outlook for needing pain control of any kind, Ibuprofen, Tylenol, ect. After say a year does the need dimmish? Or is this something to contend with from now on out?
I hope I'm not hijacking the thread but thought it was a natural progression of the pain meds discussion for us (me) uninitiated TKR's.

D Diva,
Be sure not to take Celebrex and NSaid together. Both are blood thinning and do not mix well. Read back on Rest Assured posts and see what happened to her with this combo. (around page 18/19 in her thread. Sorry I can not answer your question about cox-2 vs. Nsaids, I have never taken a cox-2. It probably just depends on what works best for you, kind of trial and error to figure it out.

Right now I see swelling as the main reason for pain meds. For instance, without swelling ( on Celebrex ) I can get bend down on the heels of my feet to see a putt on the green. ROM Is normal. On Aleve, it's a bit more stiff. Can't stoop as low....

I've read on BoneSmart that the swelling can last for a year or more.... Thus, my expectation is to be on anti-inflamatories as a maintenance drug for at least six more months.

Hi all,

I prefer Celebrex ( 100 2x day or 200 day) for joint pain. It was the only med that helped quiet my OA pain, however it does have side effects. The most common is gastric upset just like the NSAIDs. The side effect that I have to deal with is EDEMA, yep swelling due to water retention is a side effect. It is also a side effect of Alieve and the other NSAIDs. Last year my swelling was so bad my primary thought I might have blood clots in both of my legs...fortunately a Doppler study ruled that out.

Why some people get edema to cox 2 and NSAIDs is not well understood. I subscribe to the capillary bed hypertension theory but who knows. Anyway for me I got stuck in this predicament...take Celebrex and chase the edema side efects away with daily lasix and potassium or hurt. Neither was preferable which is why I choose BTKR.

Celebrex is the least bad for tummy. It is not understood if it has cardiac side effects but other Cox 2 meds did and were taken off the market. Limited use would be preferred over long term use.

This is how I approached my med choices post op...
Got off narcotics because I had to, the were causing me to throw up constantly. ( I was off narcotics by week 2 1/2)
Got off neurontin because I had to, same reason.
Took Tylenol in divided doses, 4000 mg since comming home. It doesn't seem to work for me, except it takes some of the heat out of my knees. Why it takes the fever from my knees I have no explanation.
Tried extra strength Excedrine for Migraines it has Tylenol, Aspirine and Caffene but had to stop due to nausea, vomiting and severe abdominal pain.
Tried Motrin 400 mg 3xday and just like the Excedrine, I had to stop due N/V and belly pain.
Tried Alieve and in just a matter of days i had Lower extremity edema big time! Had to take Lasix for three days to get rid of the edema.

So I'm 8 weeks out on Tuesday, and this is what I do. 1000 mg Tylenol in am with 200 mg Celebrex and a protonix for my gut. At night I take 1000 mg Tylenol and 1000 mg of Tums for my gut. I watch my weight and if I see ankle swelling and weight gain I take 40 mg of Lasix and some potassium to counteract the Celebrex edema. I'm right back at the same spot I was in medication wise as before my BTKR! Boy am I frustrated because my knees still hurt, I have two kinds of swelling issues ( knees and edema) and I'm tired of waiting to get better. Plus, I still on occasion have N/V and abdominal pain.

I sure hope that some day I get off the meds as this was one of my motivating factors.

Chris

Everyone here gives their own experiences with pain management and we all benefit from reading the different stories. My story is unusual but it does happen . After surgery, I was on Norco , one aspirin a day, and I believe the doctor had added Celebrex to that. In the hospital, the nurse would come in and ask what my pain level was...I have a hard time giving an answer to this but I was following the Bonesmart clock and I managed to convince the nurse to give me the next dose ...nurse, " there is no need to give it at 2"...me"well then it is level 3" No smile from nurse. I didn't care. I never had a TKR and I wanted to to stay ahead of whatever was to come. When I got home,I was doing very well...I was walking unassisted at 8 days and I stopped all pain med at day 12 ( except the one aspirin to prevent clotting I guess and I stopped that at 6 wks. After 12 days on Norco and Celebrex, I just decided to stop taking them. I guess tapering is the preferred method but when I just stopped taking them. I felt fluish so a couple days and then I was fine. The knee felt fine and I felt better with the pain meds out of my system . I resumed driving ( that was one reason I wanted to stop the pain med ) and all normal activities at 3 wks. So, Kaye, no you will not necessarily have to contend with any type of pain med for months or long term. Diva, I left a message for my doctor, before I decided to stop the meds to tell him what I was doing and I certainly would have called him if I had any problems with this. Always go through your doctor concerning pain medicines. LCR...at 6 mo. This is just my my opinion, but I believe that after the initial recovery from the surgery trauma, pain and swelling are trying to tell us something.. pain must be investigated as a revision might be needed. Also swelling might mean overuse or misuse. You might try keeping a chart of you swelling what you were doing that day and for how long. Ice and a simple change of activities might be all that is needed instead of Celebrex. The same for Aleve...try the same for this and maybe you will only we'd one occasionally, not everyday..Hope this helps

I'm at 15 weeks today, and I have had some days where I haven't taken anything at all for pain. Many days I still take Ibuprofen once or twice, sometimes for the knee, sometimes for the hip that got out of whack from limping for so long. So, I have hope that I will be pill-free before a lot longer. I know Tylenol is a better pain-killer for many, but it doesn't work as well for me as Ibuprofen, and Aleve upsets my stomach.

I am ONE YEAR out, and still take on occasion, sometimes 1x a day, Jo's ADVIL COCKTAIL... 2 500mg Tylenol AND 2 Advil together... if I need to repeat, it's 6 hours later.. I try to hold off until the afternoon, then just take it 1x.
I still have issues with my tendons in my TKR leg... it's not the knee, but they are trying to figure out what it is.. meanwhile the advil/tylenol cocktail works. I got off the narcotics as soon as I could, about 1 month out, and started tramadol/tylenol, was on celebrex for 5 months... with tylenol, bur found advil worked better...

My non-pain meds, which I've been taking long-term are Benicar Hctz (a potassium sparing ARB+diuretic) in the morning for hypertension and Dexilant (a divided-release version of Prevacid) at night plus a Tums EX for GERD. I have a call in to my surgeon's office (the nurses are MADDENINGLY tough to get ahold of) asking whether to switch to 2 Aleve BID, stay on Celebrex (for which I'd need a refill) either 100mg in the morning (current dose since 2 weeks pre-op) or BID, and get a scrip for Norco #1 (5 mg, splittable) so I can taper down in 2.5mg increments every other day until I am narcotic-free. Currently not getting breakthrough pain with one Norco#2 (10mg) q. 6 hrs, so that's a good interval. Though the regular or rapid-release 500mg. Tylenols don't seem to help at all, I find now that one 650-mg. "arthritis strength" time-release Tylenol at bedtime and one after breakfast is keeping the pain from breaking through, after Sat. night's loading dose of 2 of them. I'm 4.5 wks post-op, using a cane only for stairs or uneven terrain (afraid to cross major streets because I walk too slowly to get across before the light changes), and at 124 degrees flex. I don't have a follow-up appt. with my surgeon till Aug. 16. I would really like to be able to drive by 6 weeks but don't dare if I'm still on Norco, and have been warned not to stop it abruptly. Am also beginning to get lateral condyle pain in my L knee (medial condyle's been painful for 5 yrs now and I can hear it crunch), but that's another subject for another thread. Hoping to stall replacing the L knee till my surgeon moves next spring to a cheaper fully-in-plan hospital (I'm out-of-pocket on this TKR big-time, even with 60% of my hospital being paid by insurance).

LCR - I have been taking Celebrex for years (LTKR coming up next week) as it's the only thing that works for me. NSAIDS upset my stomach too much. I have not had the edema or any other side effects. Every now and then my doc switches me to something else "like" Celebrex but mostly just because it's so darned expensive, not that he's worried about the cardiac issues. I always go back even though the Celebrex costs me $100/month versus $4/month. My doc is not convinced the other Cox-2s were really causing heart problems, which may explain his willingness to let me keep taking it all this time. I am otherwise healthy and a stress test 2 years ago confirmed no cardiac issues with me. I took it for another reason, but it was good to get the confirmation. We all now know that the same medications affect different people different ways, but it does sound as if your doc is being a bit overly cautious on the Celebrex. Even several months of it is not the same as "long-term" use. See if you can find some research to show your doc to support the claim that it's not the same as those drugs that shall not be named that were removed from the market. Celebrex is still there for a reason.

Actually, the anti-inflammatory that worked best for me (first for dysmenorrhea and later for arthritis) was the cox-2 inhibitor Vioxx, which was pulled from the market (along with its sister drug Bextra). When my peri-op doctor (the internist the hospital assigned me in preparation for my TKR) took me off Aleve and put me on Celebrex, I mentioned my experience with Vioxx and expressed regret that it was no longer available. She grinned and replied "that's why I stockpiled a whole bunch of them." Still waiting to hear from my surgeon's office. (grrrrr).

Now 10 weeks out and taking 2 or 3 tylenol a day for pain, and they give me stomach issues so try and keep the dose small and with food.

The morphine type meds made me throw up and so dizzy I couldn't stand. Had to stop the codeine type because CNS depressants give me depression (duh, wish I'd worked that out earlier). Then found I couldn't tolerate ibuprofen either, and so am assuming that aleve will have a similar effect - may not, but I'm too scared to try after the GI issues I've had in the past 3 weeks. I do seem to finally have the Baker's Cyst and shin bursitis under control with ice and a tensor bandage.

Sleeping, which was easy with 50mg of codeine is now very difficult, and the pains in my back, neck and hips from all the PT are tough to cope with, but if you've never really taken pain meds before tkr, there's no way to know how you'll react. I do use voltaren, but not convinced it does much.....

Voltaren Gel did nothing for me, never took the pill. I did use a gel called IBULEVE which can only be bought in the UK. It's an over the counter 10 Percent Ibuprofen in gel / cream form, that you rub on the sore areas (knees, hips, arms) and it does relieve the pain .. at least it did for me.

Finally spoke to my surgeon's RN. She said to finish my Celebrex; then switch to 2 Aleve BID, because in her experience patients reported it was stronger. Once I start the Aleve, I am to cut my Norco dose in half: 5 mg. q. 6 hrs for two days, then q. 8 hrs. for 2 days, and if not getting breakthrough pain, BID for two days, once in the morning before PT twice, and then stop.
Before my surgery, I was taking Arthritis-Strength Tylenol BID most of the year and then adding Aleve BID during the 2 months of rehearsals leading up to and including the one-week run of the Bar Association B'way-style revue I do each Christmas (my surgeon is the wife of a castmate who noticed me wearing the brace at rehearsals and having to ice down at the cast party after every performance). During rehearsals, I would sometimes rub in some Voltaren gel at break time; during the run of the show I cut a Flector (Voltaren) patch in half and apply each half to the front of each knee (keeping them in place with knee-sleeves), discarding the patches when I got home. And for the past couple of years (ever since trigger-thumb release surgery) I would sometimes take 2.5 mg. of Norco to get to sleep. I also had a stress fracture of my L foot 3 yrs. ago. (which is how I got the Voltaren gel scrip). So if I can ditch the Norco, I wouldn't mind having to take a modest amount of OTC painkillers for maintenance, until both knees are healed. I also got green-lighted to use Arnica gel on the bruises, and Bio-Freeze on the L knee (my naprapath used it on my back and it's great)--nothing topical on the R knee yet, except Aquaphor moisture ointment or olive oil, till the scar is fully healed.

Wow...How do you keep track of it all?

I marked it on my wall calendar AND in iCal on my computer and cell. At 61, memory needs all the help it can get! ;-)