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BCSAnna's TKR Prep

Discussion in 'Knee Replacement Pre-Op Area' started by BCSAnna, May 13, 2019 at 2:17 PM.

  1. BCSAnna

    BCSAnna junior member
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    In preparation for my RTKR on June 12th, my spouse and I made the three hour trip up to the city to the medical center where I will be having my surgery. First up on the agenda was my medical clearance physical exam...no problem there. Next was pre-admission testing...no problem there. Finally, we went to the "Joint Replacement Class" and that is where the warning bells went off in my head.
    An RN from the Orthopedics Department conducted the session via a PowerPoint presentation and everything was going along smoothly until we got to the section on pain control. A review of the "step pain control" methods used - beginning with Tylenol and working up to oxycodone -was discussed and then we were instructed as follows, "Don't let your pain interfer with your activities."

    Now, I am not naive insofar as not expecting pain, perhaps unbearable pain, following this surgery. However, I know myself and I know that if my pain is great enough it will most definitely interfer with my activities. And so, I am asking for some feed back on how to best handle this situation before I get into a major head butting stand off over this issue with the medical staff at my chosen hospital.
     
  2. Celle

    Celle FORUM ADVISOR Forum Advisor

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    I don't think there's any need to get into arguments about this. Maybe all the nurse meant was not to let your pain get so bad that you can't do anything, rather than keep doing lots of physical things.

    We recommend taking your pain medications on a regular schedule, so that you don't have to play catch-up with the pain, and controlling your activities so that they might cause discomfort but not actual pain.

    Find out when your pain medications are due, and ring for pain relief about 10 minutes before that time.
    Never minimise your pain. If it's between 5 and 6 on the pain scale, for example, be sure to tell them it's 6.

    It's your body and your knee and you have the right to choose what happens to them. Listen to the advice you're given, but you have the right to choose whether or not to accept and follow that advice.
    CONSENT: what it means and how it can be used
    Saying no to therapy - am I allowed to?

    If you encounter a physical therapist who wants you to do more than you think you should, just say something like "Not right now. Maybe later?"
    You'll only be in hospital for a couple of days. After that, you can do things your way.
     
    • Agree Agree x 1
  3. Celle

    Celle FORUM ADVISOR Forum Advisor

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    This is the approach to recovery that we recommend, together with some useful and informative articles:
    Knee Recovery: The Guidelines
    1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
    2. Control discomfort:
    rest
    elevate
    ice
    take your pain meds by prescription schedule (not when pain starts!)
    don't overwork.
    3. Do what you want to do BUT
    a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
    b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​
    4. PT or exercise can be useful BUT take note of these
    5. At week 4 and after you should follow this
    6. Access to these pages on the website

    The Recovery articles:
    The importance of managing pain after a TKR and the pain chart
    Swollen and stiff knee: what causes it?

    Energy drain for TKRs

    Elevation is the key

    Ice to control pain and swelling

    Heel slides and how to do them properly

    Chart representation of TKR recovery

    Healing: how long does it take?

    Post op blues is a reality - be prepared for it
    Sleep deprivation is pretty much inevitable - but what causes it?

    There are also some cautionary articles here
    Myth busting: no pain, no gain
    Myth busting: the "window of opportunity" in TKR
    Myth busting: on getting addicted to pain meds

    We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

    While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
     
  4. Bebob

    Bebob new member

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    Correct me if I'm wrong, but I believe you are not concerned so much with too much activity, as you are with adequate pain control. In spite of the hospital's policies, it is the surgeons duty to prescribe the meds. So I would recommend discussing it with him first, before the surgery. If you don't have a visit scheduled, at least see if you can talk to his nurse by phone. Tell them what the joint class nurse said, and say you need some clarification. That lets them know you are concerned, without sounding like you are disagreeing. Let him know what meds have worked for you in the past, and anything you have had problems with. My experience was that things have changed due to the opioid crisis. For example, they would only give me one dose of IV med when oral was not working. However, they did not start with tylenol and expect it to work, right out of surgery. Also, ask your surgeon if he uses a nerve block at the end of surgery, that can often bring relief for a couple of days. It is always my experience that things are a lot easier if I know what to expect. Like the other poster said, be proactive in letting the nurses know your pain level.
     
  5. rosieNZ

    rosieNZ member

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    This site had excellent info on pain management that you will find helpful. No need to stress. Pain management is part of your rehab. This is how I coped.
    1. Regular as prescribed medication (you will soon know when you no longer need it).
    2. Rest, rest and more rest. That first few weeks are all about rest and healing. Activity is limited usually.
    3. Ice is your best friend. Learn about how to use ut. Its reduces swelling and will be helpful. I had an ice machine but many people manage with ice or gel packs. If you use packs be sure to get lots. They only stay cold for about 20 mins and then take about 2 hours to freeze again.
    Everything you need to know is on this site. Expect post op pain but remember we are all different (but generally after the first few weeks it is plain sailing).
    Best wishes. Rosie.
     
  6. BCSAnna

    BCSAnna junior member
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    Thank you Celle and Bebob for your responses.

    I assure you I am not looking to engage in any arguments with my medical team over this issue. I am, however, looking out for my own best interests and will strongly advocate for myself in that endeavor. We were advised in the class today that we will have pain, expect it even with pain control medications. No instructions were given today about keeping ahead of our pain. Which I know to do after undergoing extensive surgery for breast cancer. What was clearly indicated today was to keep up our mobility in spite of having some pain. Even my spouse, who is normally oblivious to such things, picked up on that part of the class and said to me, "I thought you said that website you are on advises the RICE method and to take it easy on the activities?" Amazing, he does listen to me sometimes!:)

    I plan to be hospitalized for two nights. Prior to the surgery I will be given a spinal and twilight sedation and also have the option of receiving a nerve block with a pain pump which I will be able to control for the first 24 hours should I chose that option. Lastly, my OS has already told me that when I am discharged from the hospital I will be sent home with a prescription for oxycodone with one and only one refill. I will also have home health care consisting of a nurse and a physical therapist. My major concern is that my medical team is going to expect me to just "push through the pain" so that I maintain mobility and that I won't have sufficient pain control for as long as I need it and/or my knee will not be given sufficient time to properly heal.

    I was prepared for this surgery prior to today and now I have a knot in my stomach and the thought in my head of, "What am I getting myself into with this elective surgery?":scaredycat:
     
  7. Celle

    Celle FORUM ADVISOR Forum Advisor

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    Your medical team may expect that, but it doesn't mean they have to get it. You are in charge of your recovery, not your surgeon, not your physical therapist, not anyone else. You get to decide how much activity you will do.

    Don't ever allow yourself to be persuaded to "push through the pain".
    Myth busting: no pain, no gain

    Don't be intimidated into doing lots of exercise by threats of bad "scar tissue" or a MUA (Manipulation Under Anaesthetic).
    There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
    Myth busting: the "window of opportunity" in TKR
     
  8. kneeper

    kneeper FORUM ADVISOR Forum Advisor

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    Take it easy on activity doesn't mean no activity. I think sometimes these medical folks think we all want to loll around eating bon bons after TKR. :oyvey:You will be getting up to use the bathroom, walk to the kitchen and such even early on when you first come home. As things progress you will do more. There is info on activity progression in the Library.

    It is true that even with pain meds you will not be without all discomfort. But it can be managed pretty well. As you said, you are experienced in how to stay ahead of the pain.

    While they may send you home with limited oxycodone, many doctors have other things they can give you.
    And as Celle said, PTs may want you to do certain things, but you know how you feel and decide what you will or won't do. I had good luck simply saying "that's enough" or "not today." Or with the second knee an outright "no" to squats. :)
     
  9. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    These are very legitimate concerns.

    But as Celle said, it is your knee and you gave the right to take control of your recovery and decline anything you don’t feel is in your best interest.

    Where are you having your surgery? 3 hours away is quite a trip, but well worh it for a doctor/hospital that we have confidence in.
     
  10. BCSAnna

    BCSAnna junior member
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    Thank you all for your encouraging words. It is much appreciated. After a good night's sleep, I feel much better about moving forward with this much needed surgery.

    Jockette, I see you are a "1st Stater" like me. I am down at the beach area and am having my surgery up in Philly at the same medical center that I was treated for breast cancer. Yes, there are hospitals closer to home that perform TKR and I suppose that some people have good results at those hospitals. However in my case, I was misdiagnosed at one of those hospitals when I had breast cancer. That misdiagnosis ended up costing me a bilateral mastectomy; reconstruction; and two years out of my life for treatment up in Philly. As a result of that God awful experience I stay away from the local community hospitals and prefer to travel the distance to be treated in a ranked major medical center up in Philly.

    PS Your kitty is so cute. I have two Siamese, a brother and sister. My husband calls them "the mental health coordinators" as their antics provide much comic relief and distraction from the medical woes.:catdance:
     
  11. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    I agree with going up to Philly! I had my surgery in Dover and I’ve had a very poor outcome. I had a partial and learned after my surgery that it was a controversial procedure, which one of my second opinions won’t even do.

    While I did have an excellent experience in the hospital, it was only 36 hours of my recovery. I’m sorry I trusted the first and only surgeon I saw.

    My husband is having back issues and after seeing a surgeon in Newark we went on to a second opinion in Philly and surprise, he didn’t agree with the first and has ordered more tests.

    Delaware is a small state with a small population. For big stuff like this, better to go to a busier area for doctors who see a lot more cases.

    My kitty in the picture passed away 7 years ago at the ripe old of almost 19.
     
  12. Cynof4

    Cynof4 junior member

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    @BCSAnna,
    Hello surgery buddy! Seems like we are rolling along to the 4 week out mark! It's getting closer and closer!

    I have the same concerns as you about post op pain management and activity expectations. I will definitely go with the nerve block and pain pump/ ball if given the option- and then have a plan for when that wears off. There will be no pushing through pain here.

    Looking forward to having this behind us!
    ~Cynthia
     
  13. BCSAnna

    BCSAnna junior member
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    Jockette,

    I am sorry to learn your surgery fell short of the outcome you anticipated. It is difficult enough to get up the courage to move forward with major surgery, but; then to have a poor outcome to the surgery can truly be very disheartening.

    It does not surprise me one bit that the second opinion of the Philly doctor is different than the doctor up in Newark.
    Your husband is wise to go to the "big city" where they know how to practice medicine. Best of luck to him.

    I am originally from the Philly area and my husband and I moved down to "slower lower" Delaware over twenty years ago. One of the first things we learned was that the medical care provided was substantially lacking compared to what we were use to. Fortunately, my PCP graduated from medical school at my preferred medical center in Philly and truly understands why I travel up to the city for any specialist care and/or surgery. Simply put, I have heard too many horror stories about the local community hospitals in my area to ever again trust them with my life!

    I am sorry your kitty has gone on to the "Rainbow Bridge." I lost my first Siamese to CRF at the ripe old age of 18. That, without a doubt, was one of the worst days of my life.
     
  14. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    I’ve only been living in Delaware for 4 years. I’ve heard the term “slower, lower” and I’ve taken up the other term “small wonder” with the emphasis on “small!”

    Best wishes for your surgery. Plan carefully for that 3 hour drive home.
     
  15. BCSAnna

    BCSAnna junior member
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    Cynof4,

    Hi surgery buddy!:wave:Yes, we are getting closer to that OR. I guess you can tell I left my "joint replacement" class a bit rattled yesterday. The statement kind of threw me and I wasn't expecting to be told "push through the pain." Well after sleeping on it, I realized that's not going to happen...not with me!:bignono:

    I can now hardly wait for the physical therapist to show up:nah:I don't have a good track record in that area. After my BC surgery I was prescribed physical therapy to help prevent lymphedema and to help get my arms to fully extend again. Following surgery I could only lift my arms to chest level. Well at the first home visit from the PT, she comes in barking orders like an Army drill sargent and proceeds to instruct me on doing leg exercises like the pre-op ones I am now doing for TKR!:scratch: She was dismissed before the end of the session and I then informed my surgical oncologist that I was not doing any more physical therapy. I have a feeling that in the near future I might be telling my orthopedic surgeon the same thing if they start pushing too hard.:no-fin:

    One other thing that was mentioned in the class yesterday was the fact that we will be wearing, thigh high, compression hoses for six weeks after surgery to help prevent DVT. Cynthia, do you know if this is the norm for TKR. Yesterday was the first I heard about that requirement. This is going to be a long and uncomfortable summer!:boohoo:

    Have you completed all of your pre-op requirements? If so, how was your class?

    Anna
     
  16. Jockette

    Jockette FORUM ADVISOR Forum Advisor

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    If you read enough Recovery threads will find many many different opinions between surgeons and PTs about this recovery.

    My surgeon told me I could take off those stockings after about a week and a half. (But it was March, and I must have had the correct size, because I wasn’t bothered by them.)

    So just because the hospital tells you 6 weeks doesn’t mean your surgeon will. And it’s anazing how some people put those stockings in the wash and never see them again. :scratch:
     
  17. Celle

    Celle FORUM ADVISOR Forum Advisor

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    My hospital also said I was to wear compression hose for 6 weeks. Whether they do any good or not is debatable: TEDs Negative Research: Lancet 27th May 2009

    I lasted for about 4 days at home before removing my stockings. They were so tight at the top that they made my knee swell more and I considered they were doing more harm than good.

    My surgeon didn't comment when he saw me without the TEDs when I had my sutures removed at 10 days post-op.
     
  18. BCSAnna

    BCSAnna junior member
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    @Jockette

    :heehee: Kind of like the mystery of that one disappearing sock that goes into the washer and is never seen again.
     
    • Agree Agree x 1
  19. Cynof4

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    @BCSAnna,
    My pre-op joint class is May 21st. I’m very interested to hear what information they have for me. The hospital itself has very good reviews from patients and other reporting agencies so I’m expecting top notch care. :giggle:

    I am an established patient with my OS’s PT group so I know who/ what to expect at home and back as an outpatient. We have discussed in detail my participation in PT and my boundaries. :loll:

    As for compression hose, my information folder says they will be worn in the hospital and as tolerated for 2 weeks until my zip line is removed. After that they are recommended for swelling if needed. The specific DVT prevention protocol my OS uses is post- operative XARELTA for 10 days.

    I’m teaching until May 31st so the time is passing quickly for me. The end of the year is a whirlwind of activity and mad dash to the finish :yes!:. I’ll keep you posted as I work my way through appointments. Thanks for being my surgery buddy!

    ~Cynthia :flwrysmile:
     
  20. BCSAnna

    BCSAnna junior member
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    Hi surgery buddy!:flwrysmile:

    It is a gorgeous day here at the beach in coastal Delaware. I am enjoying it while I can as I am pretty certain that the beach; boating; and the backyard pool will not be on my agenda this summer. :bawl:

    Like you, I feel extremely comfortable with my chosen hospital and my surgeon. The hospital is a major teaching hospital up in Philly and I could not have asked for or expected better care during the times that I have been a patient there in the past. As far as the physical therapy goes, I will be using a local rehab agency rather than drive up to Philly for that. My husband used the same facility when he had rotor cuff surgery and had excellent results. Hopefully I will have the same results.

    Yes, I know about the end of the school year. My late sister was a department head at a suburban Philadelphia high school and I knew better than to call and request a portion of her time during the month of May. Because the answer always was, "No, I can't I am too busy with school work right now!":sigh:

    Please let me know how your pre-op class goes. I can't believe that we are now down to just four weeks away.:scare: I really need to get a move on it as far as finishing the job of getting my house post-surgery ready. I started the job, but; then told myself that I had
    plenty of time to do it. Then this past Monday came and I realized then that this ride towards the OR is really picking up speed!:yikes:

    Anna
     

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