43 right knee replaced 4 wks post-op w/pain

[amyk]

Hi All:

I wrote over a month ago about double knee replacement in late September. All this talk about pain is starting to make me mad! Here's why: In Dec 2005I had a total Ankle replacement by a well known hot doctor. On discharge he gave me a half a script of codeine and said the pain would be my guide for activity. Let me say that in fact ankles are a little scary and you can mess them up with too much activity. But please, this was not adequate. I have another OS who had done my husband's knee and my sister and mother's hips with great results (Also Arthroscopic on me earlier). I had been seeing him for Sinvisc shots on my knees and a semi-annual ankle shot of cortisone. I went to him and said "you know, I think this ankle guru might be an ----hole. Can you give me a prescription of hydrocodone in case?" which he did. He trusts me, I trust him completely. Turns out, I don't know what I would have done without it. The hip/knee OS has this attitude towards pain: GET RID OF IT, IT ISN'T HELPING ANYBODY DO ANYTHING BUT SUFFER.
I think my ankle man did a barely passable job (another story) on the ankle, and is a sadist about his patients' pain issues. He also said "I am not in the business of pain managment". What doeos that mean? He does the big money stuff and to hell with you later. Chaulk it up to concern over addiction. You know what I think? I think it's a pain in the neck for his office to administer because he is doing SO MANY procedures. So he says "no" to his suffering patients.

My situation with my knees and an empathetic doctor is that I am 9 weeks past double TKR. I went back to work after a month. I did well in therapy and did not hold back on anything. Because I had no pain in the hospital (high as a kite, but doing my excersizes), I came out with great motion. I stopped outpatient therapy last week and do it at home between workouts at the pool. I still take hydrocodone. I don't take eight a day like before. MAybe none one day, two another. Four on a really big walking or working day. But basically, not much. I am not addicted, do not think about it, and am feeling better every day. I am SORE when I stand up from sitting. Sore going down the stairs. I am sore at night, and I use dramamine or Advil PM to sleep, and SOMETIMES pain killer if it is bad. I really think it is because my doctor is willing to be my doctor UNTIL I AM WELL, that I have been able to work through this agressively.

I think a doctor who won't help with this is insensitive at best. When I got through with the ankle guy I went to my family doctor about it. (He works out of the same hospital) He actually told me that several post-op patients of his came to HIM, rather than the surgeon, for help with pain, because the surgeon just wouldn't give them anything. What a jerk.

I resented the fact that he didn't care and that he was willing to let me and his other patients suffer. I do not see how that is helpful. I would go to another doctor who IS willing. It doesn't mean you are doing a RUsh Limbaugh. It doesn't make you dishonest. Doctors are hired by you - you ultimately are paying them. I think people are too intimidated by these guys and get to thinking they are the answer to all questions. If a doctor isn't helping you, get another doctor! I don't see the point of suffering.

You are VERY brave and probably have a big pain threshold. But you deserve to be taken care of not cut off, for goodness sakes. Sorry for the diatribe but this subject really needs discussion. May I add, next time I go to anyone other than my knee doctor I will find out what their attitude is towards pain. I wish I had for the ankle. (I was 48 for the ankle)
Good luck and here's to a painless future!

 

[Josephine]

Can't add anything to that - you spoke my mind exactly!

 

[Josephine]

Gee, I am now going to tell you something that might upset or encourage, I don't know but I think you should hear it. My sister - the one who had her knees done 22 and 14 months ago - is still in extreme pain with both her knees. We (that is she, her surgeon, her GP and I) are all perplexed. I have worried my head around this all ways come Christmas and cannot come up with a single answer. Initially I thought it was due to the fact that she had so much deformation and shortening in her knees that the ligaments and general structure were having a tough time adjusting to the restoration of the natural length and structure. But were that so, it should be diminishing by now, I would have thought. My latest 'theory' is that she is having some kind of hypoallergenic reaction to the metal but that is so rare as to be unlikely and anyway, she's not the allergic type.

She also has an old lumbar injury (at 16 - she is now 75) for which she has taken dihydrocodeine for years as a result of which, her GP has decided that she is addicted to them! So, though she has discovered that diclofenac helps her greatly, he won't prescribe them and dihydrocodeine! Sympathetic, huh!? So I managed to wangle her some over the internet (ssshhh!!) and she now has some relief. (Doubt I will be able to do it a second time, though)

I advised her to keep a journal some months ago and to grade her pain scores 1-10 each day.She has done that and says that over a period there seems to be a marginal improvement but then it goes right back to square one again for no apparent reason. She has a dog that she walks 4-5 times a day and has never let pain stop her from doing anything. She still acts as a labourer for her son when he is working on the extension to their house!

But you are right, doctors are not at all helpful sometimes and I might suggest that, in the case of your os, it's probably because he's at a loss what to do! I do know of others who have long term pain for a whole variety of reasons known but many, many more unknown.

It's a real mystery that almost never happens in any other joint replacement.

An update on my sister's condition. Seems she has been actually getting worse over the past few weeks and in a night of extreme pain at 3am she zapped off a letter via fax to the surgeon in which she was very explicit about her suffering and misery. So he called her into the outpatients and saw her himself. After only a couple more questions he announced that he doesn't think it's anything to do with the knees at all but a condition of compressed nerve roots from the old spinal injury!! He was very confident of his preliminary diagnosis and has ordered an MRI scan.

During the journey home we talked this over and realised that all these years of being labelled 'addict' by various doctors, all totally focused on her supposed drug addiction, not one of them has ever suggested looking into this back problem. Most she ever got when she raised the issue was that she should lose weight!

I find this singularly ironic that this very day another member here has posted on much the same topic. It's a sad state of affairs ....

 

[torktoo]

I'm in agreement with the pain pills. My surgeon just refilled my pain pills at 5 weeks post-op.

This is the issue I am dealing with. I am now 6 weeks post-op on a right TKR (43 yrs. old). I am having quite a bit of discomfort in my right foot. Sometimes it is the tingling that you get when your foot has been asleep and sometimes it is a pretty strong dull pain like a sprain. It doesn't matter if I am standing, sitting or elevating it. It really started a few days ago and now it lasts all day long.

I'm wondering if anyone else is dealing with this type of pain. Because it aches all the time and keeps me restless I am afraid to start driving yet. When I am a passenger I get so restless and have to keep moving my foot because of this pain.

Any ideas???

 

[Josephine]

I'm tempted to say, after my sister's experience, that not everything you have will be related to the surgery. I know people get this a lot when they have a serious illness or have had major surgery - it's easy to see every ache or sniff as being a by-product of it.

I would think that your foot pain could be a different problem altogether like arthritis in the hind foot joints. The only way you will know for sure is to have it xrayed. It's likely that it could be temporary and that some NSAIDs would help to settle it down but you should really see your doctor and get it investigated.

 

[Sue]

Something similar happened to my best friend some years ago when she had a TKR. Afterwards she had a different sort of pain, and it turned out she had developed tendonitis, which had to be treated separately. The thought at the time was that perhaps she had been doing more walking than she was really ready to do, after her knee had kept her sedentary for a long time.

 

[torktoo]

Josephine,

What are NSAIDs?

Of course I just assumed my foot pain was related to the TKR since it started after the surgery and on the same leg. I'll have to follow up on it as a separate issue if it doesn't calm down soon.

Thanks for the reply.

 

[Josephine]

Sorry! I usually put a footnote and I forgot! NSAIDs stands for Non Steroidal Anti Inflammatory Drugs. Most would say that Ibuprofen is the most well known and widely used one but there is one that is even more common and that is aspirin!! Diclofenac is also in that group. I found this explanatory note ....



NSAIDs work by affecting some chemicals in the body which cause inflammation, the prostaglandins. Unfortunately the same group of chemicals are involved in the stomach, and so the NSAIDs tend to cause indigestion, and may even cause duodenal or stomach ulceration.

As a result of this side-effect they cannot be used in someone with a history of peptic ulcer, except in exceptional circumstances, under close medical supervision. Also they would rarely be used in somebody with heartburn or indigestion. In general, the more effective an NSAID is at reducing inflammation, the more likely it is to cause indigestion. Sometimes they will be prescribed along with something to cut down the risk of ulceration. There is even one medication that contains both components together. There have been recent advances, in that some NSAIDs are said to be more specific in dealing with inflammation and less likely to irritate the digestive (gastro-intestinal) system, but nothing has yet overcome this problem altogether.

source: https://www.medinfo.co.uk/drugs/nsaids.html

 

[Cheryl]

Hi there, trust me it will get better. I am not younger than you but older, sorry. I had my right knee done in May of this year which is 8 months ago. I had pain for many months and took meds until only recently. You need to take it easy and have paitence. You have to remember what was done during surgery and it can take up to a year to heal fully. Do not push it you will do more harm than good in the long run by pushing yourself. As for your rom it will improve as well. Physio is no fun at all and it will be tough but do the excersies they want you to do, it will be worth it. As for the depression, I am wondering if you are maybe alot bored and want to get moving and back to normal. I know it is real..real hard to lay around when you aren't sick feeling so useless, been there lots mostly in the beginning. I was wondering if the pain would ever go away.. But it did with alot of ice packs, rest, excersize and more paitence than I thought I had. Take it easy please....Cheryl