THR Joint Replacement #3 -- Getting Discouraged<

[Figment826]

Hi Fellow Adventurers!
Could really use some support and advice fellow bone-smarties. RTHR Jan 2017, LTKR July 2017 and now LTHR 4/4/18. Thanks to insurance changes this time around, I came home 32 hours post op. Glad to be home but kinda scary even though I am a physician myself. Pain is pretty bad but I am very sensitive to the side effects of narcotics so am unsure of how to handle this. Still have a good deal of trouble getting up and down -- in and out of bed. Over the 3 surgeries (and a few other non-related procedures over the years) I have tried several narcotics and have significant nausea, vomiting, cognitive impairment and anxious/depressive symptoms after 4-5 doses of all of them. Tylenol does nada. I can't take any NSAIDS until I am off Lovenox in 2 weeks. I am icing. I am taking Vicodin 5 mg about 3 times a day -- Im afraid to use more than that due to side effects. My surgeon told me that last time I tried to get moving too fast, so I also trying to really slow it down. Im getting tearful -- it feels like this will never end. Any advice?

 

[Layla]

Hi @Figment826
I am so sorry for your pain and suffering. You've experienced a great deal of major surgery over the past 15 months. One would assume that would make for a prolonged recovery. I think struggling to get up and down and in and out of bed, at two days post op, is completely normal. Aside from rest / sleep, elevation and large doses of patience I can't advise. I'm so sorry you can't find the right pain cocktail to bring relief.
Prayers for your comfort as you move forward. Hopefully you notice some improvement soon.

 

[RSC]

You said you are icing, but are you using an ice machine? I was given an ice machine that continuously circulates ice water over the area, and I think that it was more effective than just a pad coming out of the freezer. Rather than use ice cubes, I filled the reservoir of the machine with water and four 12-oz frozen plastic water bottles. I forget how much, but they told me to ice many hours per day.

I can relate to your feelings about Tylenol. I never used to think it did anything! But it takes a LOT of Tylenol (acetaminophen) to work. I can't really do narcotics either because of the nausea, so I didn't take any during my recovery. I was only on Tylenol for pain. I bought a bottle of 100 500 mg capsules and took two spaced every six hours until the bottle was empty. So that's 4 grams per day for 12 and a half days. This along with the ice worked pretty well for me.

It has been brought to my attention that Vicodin contains acetaminophen, so that you wouldn't want to take the Tylenol on top of this. Also, I think that 4 g per day of the acetaminophen is the absolute maximum you would want to take and still be safe, and personally I would get off it as soon as I could. I almost deleted this post because I thought that it might be taken as offering medical advice. This is just my experience.

 

[Jaycey]

@Figment826 Welcome to the other side again. You might want to talk to your family doctor about better pain management. Tylenol at this stage really isn't enough. Do get that icing and elevation going.

I'll leave your recovery articles here for you to refer to if needed.

Hip Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:

rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for THRs​

Pain management and the pain chart
Healing: how long does it take?
Chart representation of THR recovery
Dislocation risk and 90 degree rule
Energy drain for THRs
Pain and swelling control: elevation is the key
Post op blues is a reality - be prepared for it
Myth busting: on getting addicted to pain meds
Sleep deprivation is pretty much inevitable - but what causes it?
BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[Jamie]

Some people can get by with only ice and Tylenol like RSC, but as Jaycey says....it's not for everyone. We all recovery differently! If you're in pain, you need to get back with your surgeon and ask for help adjusting your medications and/or trying something different for the side effects of the narcotics. If he is not willing to work with you on it, contact your GP for help. But what you do not want to do is to continue in pain! That is counter productive to your good recovery.

I'm sure you know, but I'll remind you and put this out there for any others who come along and read your thread and RSC's post about his Tylenol regimen. Vicodin has 300mg of acetaminophen (Tylenol) in each dose, so if a person wants to consider adding more Tylenol to some narcotic pain medications like Vicodin, the maximum dosage RSC took would take you way over the limit. It's always best to talk these things over with your doctor before making any medication changes.

I hope you can get this resolved quickly. Keep trying to find a solution and don't give up. Sometimes with these sensitivities, you have to try a number of approaches to find one that works.

 

[Figment826]

Thank you all so much! The support and advice really help. I do have an ice machine from my knee replacement and just ordered the hip pad for it. Im doing my best with the knee pad on my hip for now. Im actually finding that a small dose of Xanax helps, especially with the crying and hopeless feeling. Looking WAY ahead -- how much time do people take off work? I took 8 weeks with the first one and it was not enough

 

[Lucky man]

@Figment826

Sorry to hear about your struggles, especially given your intolerance to pain medication. Keep focused on that point in the future when you’re healed, and walking around without pain!

 

[Layla]

Hi there again,
I'm leaving an article about phasing back into work as a guideline. I'm sure others will come along and offer
advice, or share what worked for them. Hope this helps -
http://bonesmart.org/forum/threads/phased-return-to-work.5696/

Please know you're not alone in feeling down or depressed. We've all been there, usually more than once and even laugh about the craziness of it all afterward. Seems to come out of nowhere and hit you! Crying one minute, laughing about it the next. We've admitted here to crying over some of the silliest things.
We're here if you ever need to vent, lights never go out, there's usually always someone around to offer comfort and encouragement. You're not alone here.

Read "POST OP BLUES is a reality - be prepared for it". Under No. 5 of the Recovery Article, Jaycey left you above.

Hope you feel better soon and have a peaceful weekend!

 

[Eman85]

Ice machine is the berries! I didn't have any problem with pain meds and used Hydro but for only the first week or so, then went to tylenol. I took my full FMLA time of 90 days.

 

[Figment826]

So I am flat unable to slide my surgical leg into or out of bed. Somebody has to manually move it. It just feels like those muscles aren't working anymore. Yesterday I could move a little but today... nothing. This did not happen the last THR -- is it normal? What do I do?

 

[Layla]

I would say normal. You're only two days post op. Do you have a leg lifter?

If not...they are under "general aids" in the article below.
http://bonesmart.org/forum/threads/recovery-aids-a-comprehensive-list-for-hospital-and-home.12499/

I recently read of someone using the belt from their robe, if you don't have a leg lifter and need something in the interim.

Hope your pain is well managed and you're resting comfortably.

 

[Josephine]

I can't take any NSAIDS until I am off Lovenox in 2 weeks.

Just as well you're not taking them. Most doctors in the UK are actively discouraging the use of them. Besides which, they are very poor as pain killers. You should read this Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers

Im actually finding that a small dose of Xanax helps

I take it then that you are unaware how truly addictive Xanax is? You should read up on them. I wouldn't take it if you paid me!

Pain is pretty bad but I am very sensitive to the side effects of narcotics so am unsure of how to handle this. Tylenol does nada.

And I bet you only take one 325mg tablet, yes? If so, then you're doing Tylenol an injustice. It's actually a pretty good pain killer provided it's taken in the proper dosage. Here in the UK, our paracetamol is issued in 500mg tablets and we normally take 2 at a time which is 1,000mg. The safe level of this is 4 times a day. Yes, I know your FDA has dictated that the safe daily amount to be 3,000mg per 24hrs but that was clearly stated to be a cautionary ruling on account of the fact that a person might be taking some other product containing acetaminophen which I think is in the realms of 'nanny state'! Given that the person concerned knows they are not taking it in any other product, it's perfectly safe to take 4,000mg per 24hrs.


Have delivered my lecture (sorry about that!) I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[BeBe]

@Figment826
Welcome to Bonesmart! So happy you found your way here.
I know what you are going through. I am two weeks post op today.
I had to take zofran with the oxy 5, for vomiting and nausea. One of the biggest
helps as a medication was Valium to alleviate the major muscle spasms of whole hip and thigh,
that was my biggest pain issue. I also started the 2 Extra Strength Tylenol every 6 hours. Huge help together.
I quickly learned within days of surgery the Tylenol with the low dose Valium was doing as good a job relieving pain as the narcotics.
Oh and I use ice 24/7, using the wrapped gel packs for around 30 min each area and I rotate 15-20 min off. Works better than anything so far.

I had log leg too. Mine lasted around 7-8 days. Use a strap to lift your leg around. I would just look at my leg and couldn't comprehend that I couldn't make it move, then when I could move it minimally after a couple days that it would makes my muscles spasm like crazy. Even though I could not move my leg in bed I could walk with the walker. Very slow going though.
I have been walking around the house with walker for 10-15 minutes out of every hour I am awake. That seems to help the most to wake the leg up.

You're only a couple days post op. Some of these joint replacements seem to get the short end of the stick
and we have to muddle through. I can only tell you what helped me and here two weeks later all I'm thinking about is driving by next week!

 

[TinyMom]

Welcome @Figment826! Sorry to hear you are having a rough go of it. The first week can be so tough - hang in there. It will all be in the rear view mirror before you know it! As others have said, what you are going through is normal...doesn’t make it any less difficult or scary! As you are feeling up to it, read through some of the recovery stories here. I found reading about others’ experiences to be reassuring and helpful to adjusting my expectations.

Hope you are able to get your meds squared away, and that you are able to get some restful sleep. Take care!

 

[Eman85]

Everyone is different and from reading it looks like even on the same person no 2 legs are the same. I couldn't lift my leg at first, after the 2nd day of doing my PT I could easily lift my leg into bed. Worked for me, might not for you.

 

[Jamie]

I can only tell you what helped me and here two weeks later all I'm thinking about is driving by next week!

I do hope you are off the Valium if you are planning to drive. Right?

 

[Figment826]

@BeBe: Thank you SO much! Very useful post and it seems we have similar issues. I think the Xanax does the same thing for me that the Valium does for you and makes very good sense. Maybe tomorrow I will try Tylenol and Xanax and see if that does the trick. (Tylenol alone -- even at higher doses did nothing the previous surgeries). When I had the other hip done last year, I was able to "scoot" the operative leg off and on the bed right away with n problems so this has been challenging. I guess every surgery is different! Which makes sense.

@Layla Thank you! I appreciate knowing knowing Im not the only puddle of tears in the group!

@TinyMom -- I agree! reading through everyone's experiences really helps/ So nice to have this community

 

[BeBe]

@Figment826

How we experience pain is just so individual! Prior to surgery when I was ODing on Aleve, which did help the pain but destroyed my stomach, I would take Tylenol and get little help with pain. Post op I have used oxy but sparingly due to gastric issues. But I did use it with the full gram of Tylenol, then I just started leaving off the oxy when it was time to take the Valium, just at night now, and combined that with Tylenol. Since I am using aspirin for clotting morning and night I take the Tylenol with that too. I must say I am surprised it holds the pain as well but I do think it's at a higher dosage and I take it regularly.

And yes @Jamie since my leg spasms have settled down quite a bit, but not gone completely, will have to evaluate this week before my appointment with the OS on Thursday. That and I have to lose the walker! Goals!

 

[MajorHeidi]

Hi @Figment826 and welcome here!
I, too had log leg. You can use a strethchy theraband to help raise and lower the leg into bed.
On your question about work time off....
My corporation had a special form for the surgeon to fill out, and he specified 'up to 12 weeks' off.
Much to my surprise, my corporate 'casemanager' RN knows more than the surgeon, and authorized
me for only 8 weeks off.
Now that is annoying!
However, after one week, I am doing really well; and will likely be satisfied with the 8 weeks off.
My job is very stressful. I know I could come back sooner, but really would prefer to have some
time chilling out.

 

[Figment826]

@MajorHeidi Thanks so much for the encouragement! I am going to try using a yoga strap tomorrow. As for work -- that happened to me the first time also and 8 weeks was much too soon. I think Im going to shoot for 12 weeks this time.