Revised PKR to TKR 12 months later but can’t find my thread

[shelli22]

@Josephine definitely well protected icing. The ice packs all have covers on them. I certainly did mean extension.


I know I have three major pain meds and that the Oxycodone and endone are the same. One is slow release the other for break through pain. The Tramadol is also slow release. Problem is the slow release seem to ‘run out’ in their effect before the next one is due. The idea with giving Oxycodone slow release three times a day was to wean me off the Endone, which hasn’t worked yet because it’s still really painful. None of them have Panadol in them but I wasn’t keen on taking Panadol as well as my LFTs were whaky. I’m going to stop the Endone and hope the slow release cover it now.

I am definitely well protected when icing. The ice packs all have covers on them. I certainly did mean extension. And yes the ice packs are all covered and I ice a lot because it helps with the pain, which is real even with all the meds. I’m aware that Oxycodone and endone are the same. I know one is slow release the other not. The idea was to wean off the endone. If this painful swelling would go down.

Maybe I should stop taking one of the slow release and see if I need it. Neither has paracetamol in it, but as my LFTs were abnormal I didn’t want to take it but perhaps I’ll try it. I’m seeing the surgeon on Monday. I won’t be allowed the Endone anymore as it was only for breakthrough pain which I shouldn’t be having anymore with the oxycodone prescribed three times a day.

I’m starting to feel like a wimp not being able to cope with this pain even with the pain meds I’ve been prescribed. Sigh. I don’t understand why I’ve always been able to stand the pain no matter what but these last two ops have just thrown me with the level of pain.

 

[Celle]

Teds are to be worn for six weeks, that’s his rule. I sneak them off for an hour or so to breathe

I had Teds like those. They were uncomfortable and I felt that they were contributing to my knee swelling, so I took them off. My surgeon didn't say anything.

They're of doubtful value in preventing DVTs anyway - TEDs Negative Research: Lancet 27th May 2009
As long as you do ankle pumps while you're resting and you walk around the house a bit, you probably don't need them.

In spite of what your surgeon advises about wearing the TEDS for 6 weeks, you do have a choice.
Saying no to therapy - am I allowed to?
If you feel they're doing more harm than good, take them off. That's just common sense.
It's your life, your knee, and your decision.

 

[Josephine]

Teds are to be worn for six weeks, that’s his rule. I sneak them off for an hour or so to breathe

I never wore mine for more than a few days. If they are making deep groves in your knee they are probably more of a hazard than a safeguard.

Maybe I should stop taking one of the slow release and see if I need it.

I don't think that's a good idea. You're only 4 weeks out yet so slap bang in the middle of the 'angry tissue' stage. I suggest you ask your surgeon or GP, whoever is appropriate, if you could switch to Tramadol instead of the oxycodone. It's worth a try.

FWIW, oxycodone never suited me at all. I might as well have taken saccharine!

I won’t be allowed the Endone anymore as it was only for breakthrough pain which I shouldn’t be having anymore with the oxycodone prescribed three times a day.

I don't think that's a wise attitude either. If you have pain, you need pain meds - period!

Did I see you said you'd tried a TENS machine? Have you tried it on your knee?

Neither has paracetamol in it, but as my LFTs were abnormal I didn’t want to take it but perhaps I’ll try it.

It should be safe if you take a moderate dose. The safe maximum is 4,000mg per 24hrs so I would suggest perhaps trying 1,000mg 3 times a day and see how you go. Maybe ask your GP to check your LFT ina couple of weeks to make sure all is well.

I’m starting to feel like a wimp not being able to cope with this pain even with the pain meds I’ve been prescribed. Sigh. I don’t understand why I’ve always been able to stand the pain no matter what but these last two ops have just thrown me with the level of pain.

Oh please don't say that. At your stage, you're bound to still be in pain.

 

[shelli22]

@Josephine I’m on the maximum dose of tramadol as it is 400 mg. 200mg in the morning and the same at night. I could ask the surgeon to drop back down to 100mg morning and night and leave 200mg of short term tramadol for breakthrough pain instead of the endone. Then take paracetamol 1000 mg 3 x day with the short release tramadol. Then just keep the Oxycodone slow release at three times a day. That might work and I’d be dropping the endone.

Yes I bought a tens machine but haven’t yet been brave enough to put it on my knee. I did use it on my back and that was great while it was on, then followed with heat packs (I’d use ice on my knee afterwards if I used it on my knee). Thanks for all your help and ideas. I’m trying desperately to get this pain under control and every suggestion helps.

 

[Jamie]

The Tramadol Jo is recommending is different from what you have now. You have a slow release medication and what you need is just the regular Tramadol that you take every 4 hours if needed. It may do a better job managing your pain.

 

[shelli22]

@Jamie that is what I’m saying. If I drop down the slow release to 200 mg a day then I can take 200 mg of short term tramadol over the course of the day.

 

[Jamie]

I think you'd be better off to drop the slow release Tramadol entirely and go with scheduled dosages of the regular Tramadol. You might discuss that option with your surgeon or GP and see if they would let you try it. That way you are getting a steady dose of the medication all through the day and night. I know that "slow release" medication is supposed to work that way, but with pain medication it just doesn't always do the job.

 

[Josephine]

I’m on the maximum dose of tramadol

Jamie's right. I've never known slow release anything to be particularly effective in these situations. You need standard Tramadol and to take paracetamol with it. This was the schedule I used in both my TKRs

Yes I bought a tens machine but haven’t yet been brave enough to put it on my knee.

Why ever not? Have a look at this article - this was how I did it!
TENS machines for pain management

 

[shelli22]

I’ll ask the surgeon today

 

[shelli22]

@Josephine. I know I’m tagging you again and I’m sorry to bother you, but I just want to update you on today’s visit with the surgeon. The aspirate taken from my knee last fortnight came back with a different bug to the frozen section. Confused. How? What does it mean?? Surgeon sent me for new bloods to check markers. Having an MRI to check sciatica cause. He agreed the knee was huge and something is going on and no wonder I can’t get on top of the pain.

I asked him if I could have standard tramadol and continue with the slow release Oxycodone. He agreed so I will follow your tramadol plan but won’t take paracetamol until bloods come back because we’re checking LFTS again. Also doubling the lyrica dose. I asked if I could take the teds off to which he replied I don’t see why not. You can take them off at night at least. They’re off.

He will be writing a note to the physio to tell him he wants absolutely no exercises done on my knee. The physio can work with the sciatica but not the knee as he wants the knee swelling to reduce. He doesn’t want me doing the exercises I’ve been doing, just to do ADLs and necessary movement and a bit of walking otherwise stay off it as much as possible and ice, ice, ice and elevate. I have MRI booked for two weeks and see surgeon the same day.

Thanks for your help.

 

[Josephine]

Well, Shelli - that's what I call movement!

The aspirate taken from my knee last fortnight came back with a different bug to the frozen section. Confused. How? What does it mean??

It means that different bugs respond to different mediums in different ways. That's all.

I am very pleased with the pro-active way your surgeon has delved into this: no exercising, Tramadol, MRI - excellent!

 

[Jockette]

 

[SusieShoes]

So sorry to hear you are still dealing with all this, but I think you’ve gotten wonderful support from your surgeon. He’s really on top of this. I hope you get better results soon!

 

[sistersinhim]

Things are looking up now and you and your OS are on the right road!

 

[shelli22]

@Josephine one more. So does that mean doing bloods to check markers is all we should be doing to make sure the antibiotics I was prescribed were successful? I was extremely happy with the surgeons responses to all the issues today and his willingness to try alternatives (pain relief) and look for answers. I also told him about the gp wanting me to see an endocrinologist however I don’t think he was convinced the sweating and heart rate is related to that but more so that it is pain related or possibly infection. Once again thank you for your help Josephine.

 

[shelli22]

@SusieShoes thank you. I’m really thankful I have a surgeon who listens. When he walked in the first thing I said ‘ please don’t get cross with me or I will cry. I’m not coping with this pain’. He was amazing. I thought he’d be cross because I couldn’t even do one extension exercise and struggled to do heel slides. He was the opposite. Once he saw my knee which at 11 am was huge he just said stop all exercises. He was great. Each issue, he dealt with while throwing in a joke here and there so I didn’t cry haha. I didn’t.

@sistersinhim I agree. The surgeon was great.

 

[Josephine]

So does that mean doing bloods to check markers is all we should be doing to make sure the antibiotics I was prescribed were successful?

Not being experienced in haematology, I'm not sure what you mean by 'markers', so cannot comment on that point. Sorry.

(Hey, at least I admit it when I don't know something! )

 

[shelli22]

@Josephine haha so do I. I mean CRP, ESR etc. infection markers. Funny how we all speak the same language but we all have different words for things. I am by no means a haematology specialist either. That’s why I don’t get how one person can have three different ‘bugs’ but it’s still not an infection because it’s not the same bug in two or more sites. That’s why I’m confused. So he’s doing these bloods which will determine if I have an infection but they always come back negative. Yet there were still three different bugs, two on culture and one in aspirate. Surely all three can’t be contaminants. Then I’d sack the person testing these samples haha.


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[Josephine]

That’s why I don’t get how one person can have three different ‘bugs’ but it’s still not an infection because it’s not the same bug in two or more sites.

Who ever told you that? Of course they can be! It's just the bugs show up under different mediums. Like using normal camera, night camera and so on. Sounds to me like you need to see a revision/infection specialist but you probably don't have such a thing in Oz. Shame.

 

[shelli22]

@Josephine I had never heard of that specialist until I came on here but I shall investigate before saying we don’t.

The surgeon said that because they are different bugs he can’t say I have an infection he said it’s more likely the first two were a contaminant, he said if it were the same bug in the first two sites and the third site, then there would be no doubt it’s an infection.