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TKR Aftercare issues

It's great to read about all your long term successes. Something to look forward to.

I need HELP!!!!! though.

Due to the recovery of my right TKR being delayed for one week it looks like my post-surgical pain is still totally unmanaged. I had my 2 week follow up appointment today and while PA refilled my short acting pain med, she only gave me 3 more days of long acting pain med. She even went over explaining how both go together and what an integral part the long acting med is, but then won't prescribe it.

I am totally confused. I woke up in the middle of the night again with 9/10 pain that refused to get under control for 6 hours straight (I took short oxy, long oxy, celebrex & gabapentin as prescribed - yet none would control the pain). How am I supposed to take the long term pain med if she won't prescribe it? What other option for long term pain control are there?? What other suggestions do members have regarding what I should do?
 
There are some non medication ways to help control your pain, icing, elevating, and not overdoing your activities/exercises. At this early stage you only need gentle movements and short walks, for mobility. These can work together with the medication you do have.

Also, ask your doctor about Tylenol, as that can help post op pain, if taken regularly.

This is from the Recovery Guidelines, if you haven’t had a chance to read them then I encourage you to do so:

2. Control discomfort:

rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)

don't overwork.
 
Thank you Jockette!

I have tried adding Tylenol to my pain meds. At the hospital it had no positve effect and gave me the worst constipation I ever had in my life. Eliminated it when I got home. However, when I talked to the home health nurse, she stated that the Tylenol would make the Oxies more effective, So put it back into the routine for 4 days. Result was that again I had Very bad constipation, but it definitely, beyond any doubt whatsoever did not reduce my pain by even one Iota.

Have been icing and elevating whenever I was not moving around :D (Also purchased the elevation device recommended here on Bonesmart)

On top of it, when my daughter confirmed that prescription was ready for pick-up, found out that she had not even called it in. Called back Stanford, left message. 1 hour later called pharmacy again: still nothing. At that point also checked the website: I have been discharged from hospital 11 days ago, but only been prescribed long term med for 8 days so far and managed to stretch it out.

I am totally confused at this point. Both my in-home nurse and surgeon PA confirm that I should be taking the Oxycontin ER 2 times per day religiously, yet the prescription is not coming forward. What am I missing? Where am I supposed to get the meds from then? I understand that doctors are under incredible pressure to not prescribe the needed Oxies at this time, but even surgeon PA stated that there are no alternative meds. I am so in tears at this moment. If we cannot get out pain managed post-op so that we can heal properly - why not disclose this to the patient Before the surgery?
 
I understand how upsetting it can be when we’re in a lot of pain and no relief. Keep calling your doctor’s office and tell them the prescription is not at the pharmacy.
 
Try to reduce your activities until your pain settles down. Your ROM won't get stuck where it is if you take it easy. Swelling, internal and external, is what slows down that bend. That will come all by itself. Your #1 job now is to heal and get that pain under control.
 
I never had long acting pain meds. Hopefully this new prescription, combined with icing and elevating will help bring your pain levels down.

Have you tried stool softeners and lots of fluids? My doc gives the stool softeners automatically because pain meds like oxy are known to cause constipation. And many people swear by good old prune juice too.
 
Or just plain prunes - 3 every morning helped me.
 
Yes, stool softeners and prune juice are definitely part of my diet right now. :D
That said, just cutting out the Tylenol has done wonders for my regularity. Anyhow, referring back to my last post, the part I was 'missing' was that the PA, while promising to do so during our meeting to call in a certain prescription, simply forgot to actually press the necessary buttons and the prescription dangled as pending in the record until today (when I suppose she was alerted by the many messages I had left). Amazing how what seems to have been no big deal to her can cause a mountain of anxiety and confusion in the patient...

I think I will have a much better weekend now.

@kneeper - yes, we all react differently to surgeries. When I had my bariatric surgery and my knee surgery in 2014 I didn't need long acting oxy either. After the bariatric surgery I even only needed any opiates for a total of two days and then was basically done with pain meds. However, a knee replacement is a big deal surgery indeed. I don't really care what kind of cocktail it is I am prescribed as long as my pain is controlled and I can heal. It was the designated pain team at the hospital that came up with this specific cocktail and after my first surgery in April I even had a designated pain nurse call me every week to check that it was working as well as modify as needed. Unfortunately that pain team is no longer available after my second knee replacement and I definitely miss their help.
 
This week a new issue has found its way into my recovery: Prior to my 2nd TKR, I dealt with major back pain due to my left leg now being longer than my right. I had told my surgeon over and again that this was a Major concern of mine. I may have mentioned in some earlier posts that after the 2nd TKR my right leg was now longer than my left :(. Who else here had to deal with differing leg lengths post-surgery? What did your surgeon have to say about it and how are you dealing with it?

A few days ago I started to notice some major cramping in my left ankle, which prevents me from walking around much. My PT showed me yesterday just how swollen the ankle had become and attributes this to the difference in leg length. I really don't know how to deal with this. Any input is appreciated.
 
So I have another wrinkle to add to my crazy journey to recovery:

If you have been reading my thread, you know that my decrease in pain after my 2nd TKR has been severely lacking as has been the support of my surgeon's PA. She appears to be practicing medicine according to a manual and my particular situation does not fit, so she had literally nothing to offer in the pain relief department.

Yesterday I talked about my concerns with my physical therapist and she suggested that I would Stop using my elevation device during the night, so as to enable me to temporarily roll to the side more easily. This would promote circulation and thus decrease the pain. Lo and behold, I did NOT wake up in pain during the night (as I had fully expected to do given how my puzzle pieces were aligned) and the pain in the morning was bearable.

Additionally, today I took advantage of some of the extraordinary resources the area I live in has to offer, namely a University of Eastern Medicine. I had an evaluation and first treatment session for pain relief. First off, the doctor was horrified at all the icing I had been doing. She stated that while icing is good and well initially after an injury or surgery, it is heat that promotes good circulation and with it healing. Considering that all the pill-popping I had been doing in the past few weeks did not render desired results (much the opposite!), I was open to anything and just went along. Now, 6 hours later, my knee is still in much less pain than it has been in a long time and the swelling has visibly decreased.

So- do I just have a body from Mars if icing and elevating is what everyone here needs and I appear to need the opposite? Who else here has used Eastern medicine during their journey to recovery? What has been your experience with it?
 
I stopped elevating overnight after a couple of weeks--like you it helped me sleep better. I'm a side sleeper--which has its own challenges after tkr, but still was better than being on my back all the time. But I elevated a lot during the day. I just made myself a "pillow ramp."

If something like warm compresses help your pain and doesn't increase swelling, then give it a try. Using compression might also help.
As the weeks went on, I iced for fewer minutes at a time. I did use warmth on my leg muscles, just not on the knee itself.
 
AfterCare said:
she stated that the Tylenol would make the Oxies more effective, So put it back into the routine for 4 days. Result was that again I had Very bad constipation, but it definitely, beyond any doubt whatsoever did not reduce my pain by even one Iota.
Click to expand...
It's not the Tylenol that makes you constipated. It's the Oxy. Constipation is a well-known side effect of opioid medications. They slow down your gut. While the Tylenol may have enhanced this. it alone is not responsible.

Are you taking your pain medications on a fixed schedule? That does make them work better.

Try to get on a schedule where you routinely have some pain medication during the night, even if it means setting an alarm to wake you up.
That way, you won't be trying to play "catch-up" with the pain, which is always a bad thing.

The other thing is look at the amount of activity you're doing during the daytime. Even just a little bit too much can bounce back on you at night, when your defences are low.
 
First off, I would like to take this opportunity to thank everyone for their support and advise as I was going through my initial knee replacements.

Unfortunately my story did not end there. Following my last post I had been in pain for a good several weeks more, but I eventually recovered. Add to that my body wanting to slow me down by giving me dizziness on exertion up until fairly recently... (My GP did state that this may have been a pain reaction).

The idea with the replacements had been that it should allow me to return to an active life, go back to work and all that. This has been complicated by my right knee frequently and my left one occasionally giving way. I have had many stumbles and numerous falls since then. Several twisted anckles resulting from my knee giving way slowed me down again, and demanded their own healing regiment, including PT and time off work. My replacement (Exactec) has been recalled and my surgeon wants to do revision surgery. I'm not ready to go through that excruciating pain again... What options do I have? Has anyone else gone through a replacement that has been recalled? How did you handle it (including legal - I'm in California, btw.)
 
Welcome back, @AfterCare. So sorry to read that you are dealing with this situation.

I'm not sure if we have any members who have been through this precise situation, but you can search for others who have had implant recalls with the Search tool at the far right of the blue tool bar.

I do know that we have many members who have been through revision surgery, so if you want more information about that surgery and recovery, you can find their threads using the search feature.

Hope you get some answers soon.
 
Thank you Benne,

Some things that made me very uncomfortable are that the surgeon has been so imprecise regarding what would be done. "Maybe just the insert would be replaced or maybe I'll replace the entire hardware. You'd have to agree to have me do whatever and I won't know until you're opened up."

Are there any other tests to let the surgeon determine ahead of time what will be needed? (I did have x-rays done last week)
 
AfterCare said:
Are there any other tests to let the surgeon determine ahead of time what will be needed?
Click to expand...
There are blood tests to determine if there is an infection. But this doesn't sound applicable in your case. There are times when the full story can not be determined until your surgeon has a full view of the situation.
AfterCare said:
How did you handle it (including legal - I'm in California, btw.)
Click to expand...
Please read our forum rules. Discussion of any legal action is not allowed on BoneSmart.
 
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