TKR ACIM

[Jamie]

Sorry to disagree with your surgeon’s PA, but what you describe does not sound like nerve pain at all. Nerve pain primarily comes as zingers that shoot through your body and then disappear. Constant pain like you’re describing is from overdoing things and it almost always shows up hours later or even the next day. You may not see swelling because the fluid can be contained within your very small knee compartment and the surrounding tissues. It’s frequently enough to cause pain but not enough to be visible from just looking at your knee.

I know it’s tough to figure out how much is the right balance for activity. That and patience are the hardest parts of recovery. Layla’s idea of journaling your activity and exercise as well as time spent resting, icing and elevating is a good one. If you’re planning on going back to work soon, it will be critical to take things as easy as possible when considering errands and extra activities now. Otherwise you might not be ready for work even in a week. You’re not quite one month out from this very major surgery. Normally we tell people they should wait 10-12 weeks before returning to work full time. Going back in one month is going to be rough, even if your knee is doing well. Your body needs time to recovery from the procedure and all that was done as well as the effects of the anesthesia. Your energy levels won’t be normal yet at one month and you’ll likely tire easily.

 

[ACIM]

Horrific night! I don't even know where to begin. My sister would have taken me to my doctors yesterday but I don't know that I could have made it. Intense nerve endings on the inside of my knee and now traveling down my calf. This went on for about 12 hours straight yesterday, despite icing and elevating. Finally was able to go to sleep at about 2:00 a.m. this morning and woke up at 6:00 a.m. hurting. Icing again now. Elevating too.
I must have taken about 15 acetaminophen yesterday, please don't freak but I was desperate. I don't plan on doing anything today. Nothing. Don't even want to call my doctor because I'm not sure I'm really feeling supported. I really like my doctor but my mention to his office of calling me in some Gabapentin went unheated. I will call again at 8:00 a.m. when they open and ask them to call in some Gabapentin. I genuinely believe it is the nerves starting to heal themselves but the pain is starting to make me go a little whacky in the head.

 

[ACIM]

Even the ice pack sitting on my knee hurts because of the weight of the ice pack on the skin overlying the nerves. It's a lightweight ice pack

 

[benne68]

I must have taken about 15 acetaminophen yesterday,

This is very dangerous. Even if those were 325mg pills, you have exceed the dosage limit of 4000 mg in 24 hour period. Please stop immediately.

People think that this medicine is very safe because it is available without prescription -- it is not.

It can be deadly if taken in large doses. Acetaminophen overdose can lead to severe liver damage and potentially be fatal.

Acetaminophen overdose is considered poisoning. If you have nausea, vomiting or stomach pain, please seek medical help immediately.

 

[Layla]

Good Morning ACIM
I am really concerned reading that you took so many Acetaminophen for knee pain because that's not safe and a sign you need some attention. Please do not ignore this pain, nor assume its nerve pain without seeing your OS. I feel you should see your surgeon as soon as possible. The pain you describe that barely allows you any sleep may be something that needs immediate attention. Hopefully not, and I don't want to alarm you, but your health and safety matter too much to take any chances. Please schedule an appointment.
Wishing you comfort and relief soon.
@ACIM

 

[ACIM]

Okay to all. I did get a script for Gabapentin and I truly believe that will solve the problem. The reason I say this is because there is no swelling around the wound, no redness, no stiffness, no nothing except the pain in my nerves. I knew I was going to get scolded by you for all of the acetaminophen I took yesterday. But it's important to be honest with you. I have had PTSD since about the age of 16, details not important. I should have explained to this surgeon more about the trauma I go through with surgeries. I know that he is hesitant to give me any more pain medication as he does not know my background and my low low tolerance for pain which breeds anxiety on top of everything else. I will not make an appointment with him today but see how I feel tomorrow. I am suggesting this only because I did speak with his PA yesterday who made it very clear to me that there did not appear to be anything wrong other than the nerves starting to heal, and common pain that goes along with it. I really do appreciate your concern. Blessings.

 

[Jamie]

I sincerely hope you can get some relief with the gabapentin. Should you still have this level of pain, my suggestion would be to either have your family take you or go by ambulance to the Emergency Room. Explain everything you’ve posted here about your history and ask for assistance. If PTSD is part of the problem it could be that some treatment for your anxiety could help. Are you communicating this pain issue with your family? Since you have a brother-in-law who is a surgeon, I would assume you could get some support from them. I am honestly concerned about what you’re going through and hope to hear some more promising news soon,. If you haven’t enlisted the support of your GP, that would be a good thing to do as well as he or she should have a better knowledge of your overall mental and physical health than your orthopedic surgeon.

 

[ACIM]

Okay, got my gabapentin and spoke to my doctor's office. I'm getting communication from his PA, not him, although I would assume she is running everything by him before responding to me. But she again stressed that the healing of these nerves can be painful, quite painful, and to continue to ice Elevate and take the Gabapentin. That was it. I must reluctantly admit that had he wanted to see me I would have been very concerned. But, according to her, (him), nothing out of the unusual is happening. I'll keep you apprised as I value your opinion so much.

 

[EalingGran]

I must have taken about 15 acetaminophen yesterday,

This is very dangerous. Even if those were 325mg pills, you have exceed the dosage limit of 4000 mg in 24 hour period. Please stop immediately.

People think that this medicine is very safe because it is available without prescription -- it is not.

It can be deadly if taken in large doses. Acetaminophen overdose can lead to severe liver damage and potentially be fatal.

Acetaminophen overdose is considered poisoning. If you have nausea, vomiting or stomach pain, please seek medical help immediately.

Absolutely agree with @benne68 on this.
I have seen people who have got jaundiced and needed transplant surgery with accidental or deliberate overdose of paracetamol/ acetaminophen.
The line between the safe dose and a dangerous one is very fine for this drug- especially if you are a small person.

 

[benne68]

there is no swelling around the wound, no redness, no stiffness, no nothing

Just because you don't see external swelling doesn't mean that your knee is not still inflamed inside. You are still less than a month post-op and it takes 12 weeks for all the soft tissues to heal. Even then, inflammation can continue for months.

I hope the gabapentin helps, but would also encourage you to cut back your activity level until your pain lessens.

 

[ACIM]

Well said. I have learned a very valuable lesson, painful but I have learned from this. Very grateful because of the Gabapentin has totally taken away the nerve pain. I really do appreciate the seriousness of the potential consequences with overdosing on acetaminophen.
Talk to my doctor's office again today after picking up the Gabapentin. As I stated earlier his PA reiterated that there would be some nerve pain and swelling for several weeks but that everything "appeared" normal. My 6-week follow-up is May 22nd but I have been told he may want to see me earlier given the circumstances of the last few days. I am genuinely grateful for your continued communication and honesty.

 

[ACIM]

Hi all, I got some Gabapentin for my knee and it has really quieted the nerves down. Huge deal for me. Unfortunately, lol, it also knocks me out and I end up going to sleep which I really don't want to do.
So I go back to work next week on the 14th and work only 2 days before having 3 days off and then returning for my full four day work week.
I must say that having some degree of pain everyday does have me somewhat angry and depressed. I know that this was to be expected but I don't think I was fully aware of how it felt day in and day out. I have a strong spiritual Support Program that has helped immensely with this experience of surgery. Thank God I am 4 weeks post-op now. It can only get better, right? Please tell me it gets better everyday, I'm really tired at the pain. And it's not intense pain it's just moderate throbbing all the time, 24/7 and I'm really tired of it. Hugs to all of you.

 

[benne68]

I'm sorry you have to go back to work so soon after surgery, @ACIM. Normally we recommend waiting 10-12 weeks post-op before doing so. I hope it's a job where you sit at a desk and don't have to be on your feet.

Please tell me it gets better everyday, I'm really tired at the pain.

Unfortunately, this is not a linear journey. It's more of a roller-coaster ride -- especially at your early stage of recovery. You should expect to have days that are harder than others, although, over time, you will continue to have less pain. Remember that you are only one month into this is a year-long recovery.

 

[ACIM]

I know, I know. Everything that you've said is a good reminder that this is what it is. Yes, I am in a very fortunate position at work. I work only 4 hours a day, 4 days a week. It is a desk job and a lovely quiet atmosphere. So next week I will be working only 2 days at 4 hours a day. I feel certain it will be just fine.
The despair, the depression, the hopelessness right now isn't so much due to this one surgery. I know a significant part of what I'm going through is due to the past four joint surgeries I've had and, of course, this one. I just want it to end. And I do see progress. It's in the little things I can do now that I could not do right after surgery. But my motivation to do anything at all has decreased greatly because of the depression. Thank you again for your feedback. BONESMART is really helping me to keep going forward. Like what other direction would I go, right? LOL

 

[Layla]

Hi ACIM
I'm sorry you are despairing, feeling hopeless and depressed. It is common and completely understandable.
Recovery can feel overwhelming some days. Your body has been through trauma, your schedule or routines disrupted and pain has a way of clouding everything. This is not the end result, you're in the messy middle, so to speak, thankfully with a month already under your belt. Possibly the return to work and your routine will help lift the cloud of depression. I'm sure your colleagues will be happy to see you back. I hope you have a peaceful relaxing Friday and weekend! Sunny too.

You're not alone - https://bonesmart.org/forum/threads/depression-post-op-blues.34456/

@ACIM

 

[Layla]

Good Morning!
It's a new day and one month to date since your TKR. Happy One Month Anniversary!
May this day be a good one.
@ACIM

 

[ACIM]

Thank you all so much. I've just finished reading all of the stories of those who have gone through post-op Blues. I have seen myself in many of their own experiences. I've expected more from my leg than it could give me. I still have 5 days before I go back to work for only 4 hours and only 2 days next week. My drive to work is about 7 minutes. It's all good.
But it has been hard in the respect that I worked out pretty much religiously five out of 7 days a week. Either the gym or walking 2 miles. I danced ballet for 20 years, jazz or size, aerobics, etc etc. I am happiest when I am moving my body. So the post-op Blues have got me sitting on my raised toilet seat and looking at all my floppy skin, LOL, in layers folding around my torso because of not having worked out. Now I get to start all over again with getting the body in shape. Remember, I have had Forge joint surgeries prior to this one being the fifth. So I have had to come back and Rehab the body four times before this. Kind of a drag but I find that if I'm not doing a regimented workout I become a total witch. Hoping for the best. Blessings to all of you.

 

[benne68]

My drive to work is about 7 minutes.

Has your surgeon okayed you to drive already? You may not be aware that, in event of an accident, many insurance companies will not cover you until your OS releases you to drive.

Either way, we recommend waiting until your surgical team clears you for driving -- which is usually at about six weeks post-op. Sometime longer for the right knee.

Once cleared, it's important to test your ability to safely control your car -- including making an emergency stop. Do this in a safe place without putting the key in the ignition. Simply sit in the driver's seat and practice pressing on the pedals. Build up gradually until you can put enough pressure on the brake for an emergency stop.

If you feel pain, stop immediately. If you feel sore afterwards, wait a day or two and try again. You want to be able to hit the brakes hard enough to do an emergency stop - without feeling any reluctance or inhibition - before you consider driving again.

 

[Layla]

Oh no! No witches allowed in this club, lol

I'm really sorry you feeling so low. Recovery can be hard in so many ways, but you'll be able to get back to all that you love soon. As you know from multiple recoveries, you can't rush the process, it takes time...so you'll need to add a BIG measure of patience to your witches brew.

Kidding aside, at one month in you're doing something huge, and that is healing! It can be frustratingly slow, but each step, every awkward limp and every shuffle somewhere IS progress, even if it doesn't feel like it right now.

So chin up, hang in there and try to have a lovely weekend! We're here if you need us.
@ACIM

 

[ACIM]

Thanks all. Do you want to hear something amazing? When I went to see the PA at my OS office, two weeks after my surgery, she told me I could drive then, anytime, as long as I was not on pain medication. You know it's crazy how many different types of information we get from whomever we end up speaking to in a particular business. I was shocked when she told me I could drive. And yes, I have been driving with no issues at all, quite possibly because my ROM is good. My knee is slightly sore today because I did a bit more driving than I usually do. Wow. Just took more acetaminophen and some Gabapentin. Also icing and elevating now.