TKR Acceptance and Understanding<

[Mutti3]

What? No refills? Are you absolutely certain that is their policy? I live in a state that tracks all narcotic ordered for an individual, so you can’t hop around. Maybe you can call your PCP office? Surgical pain is real. Praying for you,

 

[Needhope]

My prescription is Hydrocodone-acetaminophen (Norco) The quantity in the bottle is 20. I don’t need to be a mathematician to understand 20 pills aren’t going to get me through the toughest part. I’m trying to ration them so I’m not in agonizing pain.

My physical therapist was all business yesterday. I’m hurting today. When I told him no more, he said just 5 more. “Memories....light the corners of my mind” That’s a Barbra Streisand song.

I’m all over the map because my knee really hurts. I’m ice/elevate/took my ration of pain meds. Now I’m gonna pray.

 

[Jockette]

I’m hurting today. When I old him no more, he sad, just 5 more.

Right now you are going to hurt with or without the exercises. But, you will hurt more doing things your knee is not ready for.

You don’t have to do 5 more. You don’t have to do any. When you say no, stop, that’s the end of it. Refuse to do anything you don’t want.

Some surgeons don’t require exercises. Some actually say don’t do any exercises. Some push exercising. Some PTs are gentle, some are forceful.

This tells me there are many approaches to recovery and no one way to do it.

So you get to choose how you want to recover.

My choice, if there is another knee surgery for me will be NO physical therapy, either at my home or in an office. Been there, done that, and they hurt me. Why should I allow them to force bend my knee when it is not necessary. Not next time. We feel bad enough at this early time and with inadequate pain control, I will not add to it because of someone else’s opinion. And that’s all recovery approaches are, just opinions.

If it hurts, don’t do it and don’t let anyone else do it to you!

All your knee needs right now is very gentle movements, like little walks around the house. It needs lots of rest, ice and elevation.

 

[Josephine]

When I told him no more, he said just 5 more.

That's a direct violation of your rights of consent. Consent is a very precise thing, very exacting in law, You should read this Saying no to therapy - am I allowed to?. Do not, under any circumstances allow them to do that to you.

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?

 

[kayow11]

I feel fortunate to not have had too severe of pain with any of my surgeries, more the nagging dull ache or throb, with occasional jabs of sharp pain. For all 3, I have only used Oxycodone, one every 3-4 hours, and this time at 12 days out, have been pretty good with only a half tablet. Have you tried this drug?
When I would exercise too much, I guess, or be too active or force bending, my knee would feel extra painful and swollen for days. Are you pushing too much exercise?
As we have all mentioned, this first month is the worst for everything. You just need to get through it by doing what is recommended here. I have needed, and received many "lectures" about this, from wonderful and caring people on this site. They are correct, listen to your knee, and if your knee gets unreasonable, you still have to cater to it.
You will survive, but indeed, there may be some unexpected suffering.

 

[Needhope]

@Josephine please ask the questions. I know you have my best interests.

@kayow11 Ive had multiple surgeries in my past and OxyContin became very intolerable to me. Vomiting, chills, you name it, I got the side effects. So I will never take that again.

 

[Mutti3]

Norco provides adequate pain relief for post knee replacement surgery My husband used it when he had his replacements. . Sleep, elevation,ice, nutrition, hydration, will help you progress in your recovery.

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[kayow11]

Forgot to mention this, I usually use a wide ace wrap, approximately 6 inches wide, and diagonally wrap starting just below the knee, and going upward to approximately 5 inches above my knee cap.
It's important to not wrap too tightly though, but enough to just cause a little extra compression and reduce swelling. If your knee starts to ache more, then try a little looser.
I personally found that wearing a ted stocking knee high also helps. After 2-3 weeks, I start wearing a thigh high compression stocking instead of the Ted sock, along with the ace wrap over the top.
You may want to consider these options. I know they have helped me tremendously and that my knee would hurt me much more without this.

 

[Jamie]

Please don't try to ration your pain meds when you are hurting like this. Once you get into a pain cycle, it is much more difficult (and takes more pills) to get it under control. Until you are more comfortable, you need to be taking the maximum prescribed dose of your pain meds on a set schedule through the day and night. Once the pain is controlled, you could try dropping back to less than the two pills every 4 hours. Use ice constantly, as it truly helps with pain as well. Just be sure you have a kitchen towel between the ice source and your skin so that you don't damage your tissue.

Narcotic pain medications are more closely managed right now, but that doesn't always mean you cannot get any refills. The bottles always will say zero refills and that just means you need to contact your surgeon when you are running low. You'll need to explain your pain problems most likely, but I cannot imagine that you wouldn't get a refill this soon after surgery.

Computations for the pills you have (assuming you take the maximum prescribed dose) would be 12 pills (2 every 4 hours) in a 24 hour period. So that 20 pills won't last you very long. And now it's the weekend, so it may be a bit more difficult to get a prescription filled. Please try to call your surgeon. They should have and "after hours" number available for you. If you are under Home Health, you can also contact your Home Health Nurse to assist you in getting pain relief. It is very important that you not suffer in pain!

 

[Needhope]

@Josephine
1. Usually 2 but if walking around or PT 4-5

2. Acetaminophen 325mg 2tablets every 4 hours needed for mild pain - only took 1 325 tab if I took 2 Hydrocodone.
Been rationing my Narco because I was only prescribed 20 pills).
Hydrocodone-acetaminophen 7.5-325mg ev 4 hours for moderate pain. Max daily 12 tabs
Aspirin 81mg 1tablet 2x daily
(I was only prescribed 20 pills upon discharge from hospital) right now I have 4 pills left

3. My knee/leg is moderately huge. I’ve never seen it this big before.

4. ROM In hospital it was 185/0 yesterday PT measured 180/0

5. Icing 5-6 times daily 20 min.

6. Elevating 4-5 times daily, ½ hour

7. Walking inside house at least once an hour. Don’t stand on it too long it gets uncomfortable

8.
Heel slides 3 sets 10 2x day
Butt clenches 10 sets 2x day
Ankle pumps 10x of 3 sets

PT started last night,
My knee feels like it could explode it’s firm skin, not much room in there to bend it.


@Jamie I called my surgeon, he said 20 pills is enough to get me through the worst of the surgery pain and to take otc acetaminophen when I run out of Norco.

 

[Celle]

Oh, your surgeon is mean! Would your own doctor (PCP) be willing to help? Some doctors will prescribe Tramadol, which is a useful step-down from the Norco?

If not, make sure that you take the extra-strength Acetaminophen (Tylenol), 500 mg in each tablet.
You need to take 2 x 500 mg tablets 4 times a day (4-6-hourly), to a total of no more than 4,000 mg in each 24 hours.
If you take any Norco, or any other medication that contains Acetaminophen, such as cold cures, add that amount into you daily dosage calculations. That means you will need to reduce one or more of the other Tylenol doses.

4. ROM In hospital it was 185/0 yesterday PT measured 180/0

I don't think you quite understand how to state the ROM. The first figure is how much your knee bends (flexion) and the second one is how far it is from straight (extension). So a bend of 185 or 180 isn't possible.
This picture explains:

 

[Pumpkin]

Obviously your surgeon has not had a TKR. You should have been informed prior to surgery about the pain protocol, it is cruel to be blindsided 3 days after surgery.
You will be better served to stop all PT, you do not need someone messing with your knee and cause more inflammation, pain, and swelling.
Celle left you excellent advice about Acetaminophen and how to take it.
Call your PCP on Monday, hopefully they will be able to help. You can ask for a step down medication such as Tramadol.

 

[ATHIKER]

I think your surgeon needs to be tarred and feathered. At 3 months I'm still taking a little pain meds at night

 

[Needhope]

@Celle my apologies ROM measured at hospital was 85/0. ROM measured by physical therapist yesterday was 80/0. I added an extra number by mistake.

My surgeon was the on-call doc today so he had to call me back himself. My last TKR, I was prescribed by same doc 10 days worth of pain meds. And I still needed more time on them because OTC meds didn’t touch the pain. So I called the office and they finally agreed to prescribe 5 days worth of Tramadol.

I’m definitely calling him back on Monday requesting Tramadol because this shouldn’t end up being a pain marathon event. I’m sooo mad about this! Asking for pain relief so I can at least sleep a few winks at night isn’t much to ask for. I never took anything for my menstrual cramps when I had them. I’m not a recreational pill popper and don’t intend on starting now. Errrrrrrrrr!

 

[Celle]

A bend of 85 or 80 degrees so early is pretty good. Don't be discouraged if it drops back a bit now you're at home. That often happens, but your bend will recover again.

I'm so glad you got some more pain relief.

It's a great shame that the authorities are cracking down on the doctors, because it does result in people who genuinely need the narcotics sometimes having to endure more pain than they should.

 

[Jamie]

I understand your anger. This is a time when you'll need all your super assertiveness powers. It is mean and counterproductive to your recovery to have you in pain. I do agree that you might get more understanding from your GP. If all else fails, try that. I cannot understand why your surgeon is not agreeing to allow you Tramadol until the pain is under control. It can work quite well in combination with Tylenol.

 

[HoneyB]

It's good to hear from you, Needhope. So sorry your doctor was so restrictive with pain meds. That's crazy! I came home from the hospital with Percocet, and then stepped down to Tramadol 50mg in week 3. My doctor gave me 60 to take 3 times per day. When I had 2 days left on those and was having a particularly bad day, I panicked and asked for a refill. He gave me 60 more. I've been cutting those in half, but plan to stop taking them next week (with lots leftover). I can't take ibuprofen and can take only very little Tylenol so I had to hang onto the prescription stuff longer. Praying for relief for you and that your doctor will understand.

 

[Needhope]

I can’t believe I did this again

 

[Jockette]