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TKR 6 mos: Great knee, bad quad

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@referee54 Thanks!

@Jane B. My husband is beginning Week 4 of his recovery. He is walking only with a cane now and walking much straighter. He's receiving physical and occupational therapy at home and doing very well with both. The incision looks great. So, all positives, but he is still focused on the pain and this prevents him from appreciating all the good things that are happening. We give him so much praise - but he always feels the need to qualify it. "I might look good, but I know how it really FEELS" or "Sure, I'm walking with a cane but I'm in a lot of pain." He's very negative. I fear he will only be satisfied with a completely pain-free knee. How are you doing? You're about two weeks ahead of my husband in your recovery journey. How are you dealing? I understand your husband's exhaustion. Besides caring for mine I have to keep the house in order (there' a therapist here every day), do all the daily chores, shopping, etc. I'm so tired by evening. It's thoughtful of you to give your husband some relaxation time. Mine would panic if I left him for even a day.
 
Your husband is really early in his recovery, and it is painful.

I am now able to reduce my pain medications. At three weeks, forget about it. I didn't miss a single dose. I know I am a little afraid of my new knee and reluctant to feel discomfort thinking it will become pain. That is another adjustment as we heal, getting more comfortable with The Knee.

As time goes on I hope that your husband forgets a pain pill, simply because he is more comfortable.

Today was rainy and cold, I didn't get out for my walk and missed it. I'm about ready to drive, I've been moving standard shift cars in and out of the driveway. This morning I was able to play with my toddler grandson for an hour or two and not think about The Knee every single moment. We had to crash toy cars, and it was important business.
 
OK, dumb question here, is he taking enough pain medication? Men are strange creatures. Mr Jeano threw his back out, refused my offers of every opiate under the sun, gimped around like he was 90, and after the spasm resolved slapped his forehead and said 'gosh, maybe I should've taken that tramadol the doc gave me the last time this happened!' Well, duh.

And is he icing and elevating that knee most hours of the day? Because if he's not... well, duh.
 
@jeano Re pain meds, from what I know of his pain tolerance, no, he is probably not taking enough pain meds. The doctor started him on vicodin, then he asked for something stronger so PA changed it to Percocet. (Seemed a little reluctant to do that.) He's starting fourth week post-op...it seems a little late to change or add a med. I don't know if my husband would even call to request this.
 
Now I am starting to think something is amiss here. My husband is just entering Week 4 of his recovery. He complains constantly of the pain...I mean constantly. He has been taking Percocet (7.5/325) and today called the doctor for renewal. They questioned him about his pain relief with Percocet, he said mild to moderate...now they are thinking about something else since they are concerned about the acetaminophen. Just now, after elevating and icing for 2 hours, he got up to walk around and told me his pain level is 7 or 8. How can this be? I would think, at Week 4, he should be winding down with the meds. Yes, the whole leg is swollen, but the therapists say the swelling is "not severe." They feel he is doing very well. I know my husband is not good with pain (low tolerance) but I honestly don't know what is the right thing to do at this point. Anyone still have this much pain, with meds, at the start of Week 4?
 
Are they thinking of tramadol instead? Some people find that more helpful. @Josephine will likely be along to ask some specific questions about prescribed dose and activity level.
 
@kneeper No, because he has high blood pressure and they don't want to give him anti-inflammatories. The doctor's nurse was consulting with the recuperative pain team at the hospital and will get back to us tomorrow. She had a Lidocaine patch in mind as a possibility but she really prefers that he stay with the meds he has and begin to taper soon since he is beginning his fourth week post-op. When he is off Coumadin (Nov. 3rd) he can start Motrin - always been my husband's pain reliever of choice. Interestingly, she said that sometimes prescription painkillers are not always effective when taken continuously. I think I read that somewhere else. The nurse will speak with my husband tomorrow. He has really iced and elevated a lot today - I don't think he's been doing this often enough. When he's just laying down or sitting his pain is about a 3.
 
It's so hard to know what levels of pain are appropriate. I can still get very uncomfortable even with narcotics. I hope he feels better each day. You must have your hands full!
 
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Anne27 said:
No, because he has high blood pressure and they don't want to give him anti-inflammatories.
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Tramadol isn't an anti-inflammatory, it's a synthetic narcotic-type drug.
Anne27 said:
and begin to taper soon since he is beginning his fourth week post-op.
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Eh? My worst pain didn't occur until six weeks out.
Anne27 said:
Interestingly, she said that sometimes prescription painkillers are not always effective when taken continuously
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Tis true that all prescription meds don't suit everybody but I can't agree with the essence of her comment for someone who is only 4 weeks out. It's more applicable to those who've been on it for a year or more but even then not inevitably. I've known people who've been on a pain med for years and it's still effective as they soon know it when they happen to miss a dose.
 
How OFTEN is he taking the percocet? How many pills total in 24 hours? How much Tylenol total in 24 hours, from all sources? In the US the FDA went crazy and recommended a ceiling of 3000 mg a day because there's 'hidden' Tylenol in stuff like cold medicines and people are too clueless to figure out when they have exceeded 4gm total acetaminophen from all sources. If you can read labels and do simple arithmetic the old total of 4 gm. in 24 hours is still as safe as ever it was, which means you can improve the performance of opiates by adding Tylenol. If I were on percocet 7.5/325 I'd add a couple of 325 Tylenol if I were taking one Percocet. You'd be safe doing that every six hours round the clock. If I were taking two Percocet I'd add one 325 Tylenol to it. Tylenol works better when you take a 1000mg dose. Honest.
 
@Anne27 I really feel for your husband. Pain during recovery is the worst part of this. I know it might seem that he should be tapering off the meds but TKR recovery takes a lot longer than most of us expected. Even if his scar looks good, it doesn't mean healing is done, far from it! The swelling is going to last a long time (I'm at 10 weeks and my knee is still swollen). At 4 weeks I was still taking pain meds by the clock, and I was taking two pain pills every four hours (Oxycodone at first, then Hydrocodone); one pill didn't give me enough relief and Rx was written for 1-2 pills every 4 hours. Even though we're cautioned not to compare ourselves to others, it might help you to know that his having pain at week four is not unusual at all. I'd say, in fact, that it's common.
 
@sunny-island Thank you for asking about us. According to what I see and more importantly, according to what his physical therapists say, my husband is doing quite well. Yesterday he was told he has full range of motion in his knee. He is walking with a cane and he performs his exercises well. (I hear lots of "great!" and "excellent!" from the therapists). He will be starting outpatient therapy soon. Unfortunately, my husband will rarely, if ever, make a positive comment about his recovery or how he feels in general. Lots of negativity...his focus is always on what's "not" right, hurting, concerning him, etc. This has been going on for about 2 and a half years, ever since he herniated a disc which eventually led to his limited mobility and knee problem. So, I was already worn out before the knee surgery but I am doing my best to help him through this. By the end of the day, I am exhausted and often out of patience. I have to be honest about that. I'm trying to get him to take over the posting here..so far, no luck.
 
Anne has your husband been put on a trial of an anti-depressant? I'm not talking specifically of depression, although that may be the case, but there are anti-depressants that help treat chronic pain quite well.

Please know, that I'm not a health care provider. But I'm married to one, and therefore know just about everything.

All my best.
 
@Anne27, I think @Jane B. has given you some good advice. I'm not in any health care field at all, so I can't give advice. But I kind of do understand the negatives he feels. There's a lot about this recovery that's very hard and only people who have actually gone through it really understand. Having said that, I will quickly add that caregivers can also understand quite well as they are witness to the whole long process. It can be hard to focus on the positive for some people, we're not all going to approach this the same way and the amount of pain being experienced has a huge bearing on it. My pain level is low now and I'm feeling very upbeat and positive - I believe he will reach that point but it might take a while. It might be a good idea for you to get away for a few hours each day. Caregivers go through a lot of stress and you need an outlet of your own.
 
No. Something to think about in the future. He's always been exactly the opposite of how he is now - always been outgoing, talkative, funny, optimistic. The initial disc injury completely threw him for a loop. He says that if he can just get his mobility back he'll be thrilled. He wants to be himself again. We've waited this long...looks like he will be getting his mobility back...we'll have to see.
 
He's concerned about clicking and snapping sounds in the knee. The surgeon's nurse says some implants do that - I'm thinking that nothing has yet grown over the joint to "soften" it. Anyone have this?
 
@Anne27
I agree with them. He has gone thru chronic pain for a long time and it sounds like a person who might not be able to be positive right now.That doesn't mean he won't be at some point. When we are negative for a long period of time they will continue it. They don't project the positive even when there is positives. I have a feeling that once the pain is gone he will be his old self again. @Jane B is right there are certain anti depressants out there that help with the pain. And it would also help him if depressed.
You have a tough job right now and I understand where you are at. You need to take care of yourself too. And getting away from the house and doing you time would be great!! It would give you a boost. Each week doing that will be a healthy way to regenerate yourself.
I'm not a mental health person. But I do suffer from a panic disorder and dealt with depression. It's going to be ok.


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You will get the clicks. And from what I've read it'll ease up.


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