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[THR] AJinNH’s recovery RTHR

Discussion in 'Hip Replacement Recovery Area' started by AJinNH, Mar 18, 2018.

  1. Layla

    Layla FORUM ADVISOR Forum Advisor

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    That's some awesome sleep @AJinNH
    Live and learn with all of the rest. I think you're doing great!
    You seem to have a reasonable approach to all.
    It's easy to crack the door to the ODIC :scary:Slow steady progress will get you where you want to be.

    Take a peek at this article again -
    http://bonesmart.org/forum/threads/activity-progression-for-thrs.13187/
    I don't know about you, but honestly...I barely glossed over the Recovery articles early on. I couldn't concentrate or retain anything for several weeks it seemed. I'll bet by comparison you're ahead of the game.

    I hope your weekend is great!
     
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  2. AJinNH

    AJinNH senior
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    Thanks for the article @Layla I did glance at it early on but it was good to read it again. I even printed it out so that I can keep it handy, I’m still very fuzzy-headed.

    I hope that you have a great weekend as well!
     
  3. TinyMom

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    Just catching up on your thread, @AJinNH. I had a super itchy rash from the tape they put on my arm in the hospital where they drew blood. It hung around for over 2 weeks with no improvement. My PA recommended CeraVe itch relief lotion for the rash, which she said was contact dermititis. Not sure if yours is the same but the CeraVe has definitely helped me!

    Glad to hear you are doing well, overall!! :flwrysmile:
     
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  4. AJinNH

    AJinNH senior
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    Thanks for the tip @TinyMom! I’m still pretty itchy almost 3 weeks later, although it is a little bit better. I’ll check out the CeraVe tomorrow. I assume that you don’t need a prescription?

    And you’re right, it is contact dermatitis. I didn’t get it on the back of my hands from the IV tape, I’m assuming because it wasn’t on as long.
     
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  5. TinyMom

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    @AJinNH - no Rx needed, just got it at Target. I never even heard of it before yesterday, but am happy to have found it. After 2+ weeks of itching, my rash is almost completely gone in just over 24 hours. The active ingredient is pramoxine hydrochloride 1%. Hope this, or something else, works for you! Itching can be worse than pain sometimes!
     
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  6. Layla

    Layla FORUM ADVISOR Forum Advisor

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    Hi @AJinNH
    Hope the itching resolves soon...annoying! I like TinyMom's suggestion.
    Wishing you a wonderful weekend as you continue healing...and stop itching :fingersx:
    Hugs :friends:
     
  7. AJinNH

    AJinNH senior
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    @TinyMom thank you so much for the CeraVe suggestion, I got some yesterday and haven’t itched since! I’m so much more comfortable now, thank you.
     
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  8. AJinNH

    AJinNH senior
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    I’ve been sticking with taking my pain meds on a 6 hour schedule and that seems to be working for me. I also have been taking a whole prescription pain pill instead of alternating between a whole and a half. My husband pointed out that he could see a big difference in my activity level between the two and I appreciated his insight because some (obvious) details are still getting lost, I’m still a bit foggy headed.

    I did move about much more as well as much easier with the change. I also decided to try the cane again and it’s going much better this time. I’m actually standing and walking much taller/straighter with the cane. I’m resting more comfortably as well and slept another 7 hours last night.

    I’ve also continued to break up my activities so that I’m not doing too much at any given time, as well as icing and elevating after. This has all made an immense difference. I’m disappointed that I can’t cut back on the pain meds just yet, but I’m happy that I can move and rest so much better. And I would describe my pain as low level, which is why I think I fell into that trap of thinking that I could cut back.
     
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  9. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    My friend you are not even a month out of major surgery. And you are seeing the benefit of pain management. Just keep doing what you are doing. When you start forgetting doses (usually midday) it's a sign you are weaning off your meds. Until then, you need them to keep moving. Well done!
     
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  10. BeBe

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    @AJinNH
    Just catching up on everyone and reading up on your progress. You seem so sensible in your approach to
    the postop recovery process! Good for you!
    You said you are alone this coming week? You will do fine. Just keep your pinchers and phone handy at all times! Wishing you the best
     
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  11. AJinNH

    AJinNH senior
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    @Josephine I have a question for you about my prescription pain meds. Eventually I would like to start to taper off of my prescription pain meds, I attempted to do that once already and it didn’t turn out so well. I was wondering if you would be able to provide me with some guidance as to the best way to do this. I will outline for you what meds I was discharged with, as well as what I’m taking now plus frequency.

    I had RTHR on March 19th, mini-posterior approach, no restrictions (other than no extreme movements). I’m fully weight bearing, no limp, strong straight gait and currently using a cane without any problem. My mobility and flexibility are pretty good for 3 weeks postop.

    When discharged from the hospital on March 21 I was given 3 prescriptions:

    acetaminophen with codeine #3 (30 mg codeine with 300 mg acetaminophen) instructions to take 1/2 to 1 tablet every 4 hrs as needed for pain. I had 30 tablets that lasted until 4/3/18.

    Meloxicam 15 mg, 1 daily for 10 days, last taken on 3/31/18.

    Enoxaparin 40 mg/0.4 ml. Syringe (family history of PE) for 30 days.

    I was told that I could supplement the acetaminophen with codeine with additional OTC acetaminophen providing that the total acetaminophen stayed below 4000 mg (preferably no higher than 3000 mg). I don’t take any other medications that contain acetaminophen. During this time after discharge I was alternating 1/2 AwC#3 and 1 500mg Tylenol every 4-6 hours. Sometimes I took a whole AwC#3. Sometimes the time between doses was 8 hrs. My pain was managed well.

    I ice 3-4 Times/day from 30 minutes to 2 hours. I also elevate (toes above nose) a portion of the night and 2-3 times during the day. I walk some every hour, do light chores such as make the bed, add dishes to dishwasher or make a light meal.

    On Easter weekend I wasn’t thinking and made the mistake of cutting back on the AwC#3 at the same time that the Meloxicam prescription ran out (my pain level had been quite low, usually a 1, no higher than a 3). That didn’t go well and I called for a refill of the AwC#3, this time I was given 56 tablets with instructions to take 1 tablet by mouth every 6 hours as needed, not to exceed 4 tablets in 24 hours. After the Meloxicam ran out it also became obvious that 1/2 of a AwC wasn’t enough.

    This past week I have now been taking 1 AwC#3 together with 1 500mg OTC Acetaminophen 4 times/day (total of 3200 mg acetaminophen daily). Sometimes I will take one 325mg of OTC acetaminophen instead of the 500 to keep the total closer to 3000mg. My schedule is 4am, 10am, 4pm and 10pm. My pain is managed well.

    I am thinking that when I start to cut back on the AwC#3 that I should increase the OTC acetaminophen to 1000mg/dose but would like some guidance if that’s best as well as a recommended frequency. The only guideline I was given was to decrease the prescription meds at a rate of 20%/week, and then I may reduce more rapidly as healing progresses. There’s no guideline as how to safely add more acetaminophen as I decrease the prescription meds. Do you have any suggestions? I should add that I’m still a bit foggy headed since surgery and sometimes the obvious hasn’t been.

    I appreciate any guidance that you’re able to provide.
     
  12. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Well for starters, neither Meloxicam nor Tylenol require tapering off.

    Codeine might if you were taking a lot or for a prolonged period but in my opinion, neither of these apply to you as, according to your posts, you've only been taking quite small amounts for about 3 weeks. So unless you have a severely addictive personality (which I doubt) or have been taking it for other reasons you've not declared to me, I see no reason why you shouldn't just stop them if that's what you want to do. But mostly people have a tendency to decrease doses over a few weeks as their pain decreases.
     
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  13. AJinNH

    AJinNH senior
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    Hi @Josephine sorry for my long rambling post. I also apologize because I wasn’t clear. I don’t intend to taper off of Tylenol, my intention is to increase the Tylenol while decreasing the codeine, not now, but eventually. I tried once already but that was an error in judgment as my hope has been to manage my pain with just Tylenol. Also, I can’t drive until I’m off of the codeine. I’m looking for a suggestion as to the best way to increase one while decreasing the other. Also, I didn’t taper off of the Meloxicam, they only gave me a 10 day prescription on discharge, no refills. I suspect that’s because I have GERD that was caused by NSAID use in the past for which I now have to rely on omeprazole daily.

    The only pain I experience has been in my groin and I understand that’s not unusual this early after THR.

    When I do taper off the codeine, would it be reasonable to start with the same 6 hour rotation, but instead, for example, take 1000 mg Tylenol at 4am and 4 pm, and take 1 AwC#3 plus 500 mg Tylenol at 10am and 10pm for a total of 3600mg of acetaminophen daily?
     
  14. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    That's true
    Really? I know people who have been taking codeine for years for things like back ache and yet they drive.
    Very wise of her/him!
    Oh dear heart, you really are overthinking this! You're only 3 weeks out yet so pain is going to persist for a little while longer!

    It's usual that as the pain decreases, you will automatically find yourself missing doses here and there so will 'taper off' without even trying! In my experience, this usually happens at around 6 weeks and after another couple of weeks you will find you don't need the codeine any more and can manage with Tylenol which you should take 1,000mg 3-4 times a day.

    After 3-4 weeks of that, you will find you start missing doses again and eventually won't need them at all. So what I am saying is, be guided by your pain levels, experiment as little and substitute Tylenol for the codeine now and again to see how it goes.
     
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  15. AJinNH

    AJinNH senior
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    Thank you @Josephine that explaination was very helpful. I am an expert at overthinking things, my specialty actually! Combine that with this persistent foggy-headedness and you get my current state of craziness. And the sudden return of hot flashes hasn’t helped. It’s actually kind of comical, I’m piling blankets on while icing then tearing everything off five minutes later when I start flashing. Back and forth all day and night.

    To help put a point on your explanation I slept right through my 4am alarm for my meds. That hasn’t happened before. I will do my best to relax and go with the flow, and keep reminding myself that it’s still very early in recovery.

    Thanks again for your response you’re a gem.
     
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  16. Layla

    Layla FORUM ADVISOR Forum Advisor

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    Sending a warm hug your way @AJinNH :friends: A flower for you too :flwrysmile:
    Hope today is a great day!
     
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  17. AJinNH

    AJinNH senior
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    I’m doing great today @Layla thanks. How are you doing? How’s your mom doing? Is she still keeping you on your toes?
    This recovery is certainly a learning experience, trial and error. I learned the past two nights that my hip feels best in the morning if I’ve slept with my legs propped up on a wedge for most of the night. I’ve tried pillows, but the wedge seems to work best. No aches when I get up.
     
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  18. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Hey, I recognise that! :heehee:
     
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  19. Layla

    Layla FORUM ADVISOR Forum Advisor

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    I'm doing well, so is my mom @AJinNH Thank you for asking!
    She isn't keeping me on my toes as she's pretty much on her own right now.
    She's engaging in life but at a slower pace. Stubborn and strong willed but cautious.

    I'm glad you found relief with the wedge. Anything that helps us sleep more soundly
    and restoratively is a plus.

    I hope you have a great day!
     
  20. AJinNH

    AJinNH senior
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    I have a question about leg length after surgery. Did anyone who had to have their operative side lengthened feel like it was longer than the non-operative side after surgery? Did it eventually ‘even out’?

    I haven’t noticed any difference walking and around the house, but last night while I was out with some friends I felt like I had to bend my knee slightly on the operative side to be even. I was wearing new shoes that I’ve only worn postop. When I stand straight my operative hip feels higher. I realized today that I don’t do a lot of standing straight around the house, so wasn’t apt to notice before now.

    Also, I’m not limping, my gait seems pretty good. I have PT on Monday where they will analyze my gate, and I’m having x-rays on May 8th. Hopefully this is just a temporary sensation.
     

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