TKR Anxiety about TKR - now it's done!

[jenng2003]

And I went into it educated and knew it wasn't going to be easy. I actually had good days in the hospital minus the pain management issues. I knew I would have a tough time with pain meds since I don't react favorably to them (most don't do a thing for my pain). It's hard to fight a pt when you are screaming and on pain meds. My husband thinks she is an expert and knows what she is doing. He doesn't want me to fight her. He says my doctor might be too soft. I defend my os because he is amazing. He knows what he is doing. I don't trust the pt. She was talking about being in pt for close to a year. I told her my goal is 8 weeks (I know it is lofty and I am willing to change it, but ya gotta have goals!). I understand pushing me to do my best but screaming in pain and tears streaming down my face seems to be excessive.


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[Josephine]

My os doesn't believe in pushing at this point. The pt is taking it upon themselves.

Good for him! Have you told him how the PTs pushed you? I think he should know they are contravening his protocols.

They tried to put me in bio-something machine and I screamed in agony. I understand pushing me to do my best but screaming in pain and tears streaming down my face seems to be excessive.

Let me put this into context for you - just suppose you walked up to a person in the street and did something like that to her. What do you think would happen? I would expect you'd be in the custody of the law in no time flat! Just because these people have a 'professional' standing does not give them carte blanche to abuse you in any way they deem fit, particularly as you have clearly objected and denied them the freedom to do it. In legal terms, that is an assault. If your PT behaves in this way, complain to the facility manager/owner and ask for different PT or leave and find somewhere else that is going to show you some respect.

I cannot take advil since they have me on aspirin as a blood thinner for 6 weeks.

And you don't want to. They're not appropriate for this anyway.

They are gone two days later and now I can't get them filled again

Why not? Are they refusing to fill them? Have you thought of approaching your GP for help?

 

[jenng2003]

I did speak with my OS and he recommended resting, elevating and icing to see if we can get the swelling down. He does not like to correct other professionals, but if she continues the abuse, he will send over careful directions for rehab. I told him I don't want to do this very long. I want to get to the point where I'm rehabbing myself. He agreed. It is silly to expect rom when there is so much swelling and bruising. He wants me to wait until my appointment in two weeks to talk about reducing the aspirin. I think it is contributing to the excessive bruising. I'm hoping I am wrong, but I am bruising quite easily in other areas. In my leg it keeps pooling in areas (if I am walking it drains to my lower leg/foot, if I am elevating and icing, it drains to the back of my leg. If I roll to a side, it drains to that side). Depending where it is pooling, determines how much I can bend or straighten my leg.

As for the pain meds, they will only prescribe one narcotic. According to them it is the rules of the practice. I know that the hospital doctor sent me home with two narcotics because it was the only thing semi-controling the pain. I did go today and pick up another round of nucynta, but noticed they reduced the dose and the frequency. It was 100mg every 4-6 now it is 50 mg every 8-12 hours. I have had moderate pain today so I spaced about every 8 hours. We shall see what happens on pt days. I'm thinking about adding extra strength tylenol to help out a little. My level is currently about a 5. Last night, it was an 8. In the hospital, there were times it was a 9 and I was in tears. I don't respond to most pain killers. It's weird. Percocet helps but only in combination with the nucynta.


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[Josephine]

I want to get to the point where I'm rehabbing myself. He agreed.

Absolutely! I rehabbed myself and did just fine. Almost everyone does in the UK.

I think it is contributing to the excessive bruising.

No doubt about it! However, have you dipped into this article? Bruising after surgery Some people have had quite dramatic bruising!

I'm thinking about adding extra strength tylenol to help out a little.

Don't think about it - do it! Use 1,000mg up to 4 times a per 24hrs. BUT if you are taking Percocet, do remember to subtract the acetaminophen in those tablets from your daily amount of Tylenol so you don't exceed 4,000mg per 24hrs.

 

[kneeper]

It is hard but you need to sometime just be up front with your pt about what you will and will not do. It's not that you're not willing to work, but you're not willing to be hurt again.

We have had people tell their PTs that pushing on their leg is unacceptable--and guess what? It worked--no pushing. I told mine I was not comfortable with the idea of doing squats--and sure enough we didn't do them.

 

[jenng2003]

After a weekend of icing and elevating, today has been much better. The knee cap and medial side are still throbbing, but I have been able to nap (even after pt) with only one pain pill all day. My knee looks almost normal. Today, the silver strip was removed and I got to see the incision for the first time. It is quite large (about 65 staples/about 8 inches in length). The incision looks great. It is mostly healed. There is only one oozy spot. I have rom of 62 and 0 extension. There really wasn't any forcing today. It was achieved with gentle stretching/heel slides. The stiffness has decreased. I even made it to Walmart for about 15 minutes (I had to pick some wound care stuff up). I had enough after 15 min. I have had 8 knee surgeries, and this is the only one where I have no desire to leave the house. I am content staying jn the house in my pjs and napping in my recliner. I understand it was major surgery, but it is still not like me to sit and do nothing.


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[Josephine]

with only one pain pill all day

What? At only one week? Girl don't be so hard on yourself. Take those pills as prescribed!

 

[jenng2003]

I am taking them as prescribed. The os refilled my script but changed the dosage from 100mg every 4-6 hours to 50 mg every 12 hours. Nucynta is what was prescribed. He doesn't want me on the higher dose anymore. Although, this weekend I followed the old prescription.


LTKR. October 27th 2014

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[kneeper]

Hopefully it's a long acting dose...
It's perfectly ok at this point to want to hang out in your jammies.

 

[jenng2003]

I was hoping that as well, but I asked the pharmacist and she said nope. It is the same as the original script. I have a call into the office, but they are in surgery all day Mondays. I'm taking extra strength tylenol and icing and elevating in between doses and I am taking a pill every 10 hours today. It takes the edge off but it is not fun times.


LTKR. October 27th 2014

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[jenng2003]

After another sleepless night, I called the OS office to find out what else I can take. The pain was at a 7 last night again. Icing helps bring it to a 6, but that is still too much pain for being at rest.


LTKR. October 27th 2014

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[Jane B.]

People on the forum say sometimes your primary care physician can be better about pain control than orthopedic surgeons. Maybe call them?

 

[jenng2003]

No help from either doctor. I'm ready to stop going to PT if I can't get some pain relief! I am fairly tough about pain. I expected muscle/soft tissue pain, but the newest pain concerns me. The newest pain is medial bone pain every time I move the joint. I am having a heck of a time putting weight on the leg. I also get a deep bone ache with icing. I wasn't sure if I am icing too much or if this is normal. PT is getting the ROM she wants, but at the expense of extension and pain.


LTKR. October 27th 2014

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[Minnie's knees]

@jenng2003 I am so sorry to read of your pain control issues. I am only a few days ahead of you so can't offer much advice other than that PT was out of line. Don't let them hurt you. My ROM is slightly less than yours. I wish it was more but it will improve over time. Rest, elevate, ice and pain control are our priorities for now. The ice really does help with the pain. ((Hugs)) hope it gets better soon.

 

[Josephine]

I'm ready to stop going to PT if I can't get some pain relief!

I never did any PT. My surgeon forbade it! He said first three weeks, no exercising at all except heels slides and a little walking, and then maybe a little use of a stationary bike and that was it. You might like to read the potted version of my recovery to see how little exercising I did! Knee recovery - UK style

 

[jenng2003]

Well today's pt was not good. Tears a plenty! Pt even threw out the word manipulation saying it will have to be done if we don't get the results we want. Here are the results I want...mo more pain and ability to work and live comfortably. I know my hip flexor hates me. I know my medial joint pain is quite severe with weight bearing right now. I don't see how this approach is helping.

Pt took 2 hours today because I couldn't do anything. I do 60-90 different heel slides (lying down, sitting up, sitting in a chair). Straight leg raises standing in three directions (10 reps 2 sets), straight leg raises lying down (5 reps/4sets), quad sets (30 reps), hang over the side of the table for bending, straighten leg over a foam roller for extension, standing marches (10/2), heel kicks (10/2), toe raises (10/3), "ankle pumps" 30 reps, and bike for 10 min (rocking). This is the only practice in my area.

I am unable to drive so I can't go out of the region. When I can't get at least the same measurement as last time, it is forced to get the measurement. I am so fed up. I can't stop it. Pain med situation is not resolved. I am tired of being in pain. I can't help to think that if I were older, they wouldn't expect this much out of me. I wish I never did this. I would rather hurt and have no quality of life than continue to experience this "recovery". I will never do any joint replacement again. Ever.

My hip, sciatica and other knee are very angry about this as well. Pt had the nerve to ask me where my sciatica is like I was just making it up when I told her I can't lean back to do an exercise because it flares my hip, low back and sciatica. I poked my behind and told her "it's right here and makes my feet tingle".

Extra strength tylenol is a joke right now. I would love to be able to take Celebrex but I can't take any NSAIDs until middle of Dec (stupid aspirin). Oh and the bruising changes locations and colors daily. Today it is on the left side of my leg. Yesterday it was on the right side.

I just want to know when the joint pain will stop. That's what is making everything miserable. The hip isn't helping matters, but I don't think there's anything wrong with it (I was seeing a chiropractor before the surgery for my left hip/low back/sciatica pain). It's just not thrilled with all the extra pt nonsense. I do not believe I should have pt until week 3. Oh I was told today that I will have 90 degree rom by Friday. Not happening. If that's what they want, then do the manipulation under anesthesia so I don't feel it. I am so over all this.


LTKR. October 27th 2014

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[kneeper]

This sounds like WAY too much. My PT never kept me more than 1/2 hour in the first weeks and some of that was just gentle warming up motions.

 

[jenng2003]

Today is. A much better day. I spent most of the day icing and elevating. I did some gentle heel slides and easy walking. I am using extra strength Tylenol for pain management today. It is rainy and cold outside which is making the knees stiffer than normal. I plan to take a pain pill for tonight and tomorrow for pt.


LTKR. October 27th 2014

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[Josephine]

Honey, you're not even 2 weeks out yet so still in the worst of things. I certainly wouldn't let anyone make you do all that at two weeks. My surgeon forbids all exercising for the first three weeks and after that it's just gentle heels slide, some straight leg raises and walking around the home for necessary things like bathroom and the kitchen. So you don't need the PT. Fire her and do it on your own. Later when you feel better and are out and about, perhaps you can sign up for some if your really want to. Until then, you might like to read the potted version of my recovery to see how little exercising I did! Knee recovery - UK style

 

[jenng2003]

I go to the OS tomorrow. I cannot wait to talk to him about PT and the lack of a bend and my pain levels. My levels reached a 9 again today after PT. I have had enough. I was in tears most of the day. I know I will eventually be happy that I did this, but right now is not that time. I told a fellow pt patient about my experiences. He is impressed with my progress (while I am seriously frustrated and in pain). He is considering getting his knees done after seeing my progress. I told him that the first couple weeks have been no joke, but that I know I will eventually be happy with my decision. I am still not back at work and I don't know when I will return.


LTKR. October 27th 2014

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