TKR beth1954's Recovery Thread

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Beth, I am pre op so I cant speak from experience but I have read bonesmart extensively. I dont recommended this to someone if they havent researched post op recovery techniques. But im seriously considering doing my own PT. Particularly after the one month mark and if my in home therapist insist on no pain no gain well than ill show them the door. Do not let them hurt you ! There has been too much damage done to your knee very recently! Best of luck Beth
 
I know what you mean. I would consider that also but I don't know if I am disciplined enough to do what I need to do. I have to think long and hard about all of this. I'm still having so much trouble with swelling. After about 5-10 minutes of elevation and practically my entire leg hurts. Kind of an all over achiness. My flexion is really poor at this point. I'm so frustrated, depressed and ready to just give up. I have been reading articles that explain in detail why we swell up and that many times the best thing to do is just to let it rest. I'm just having a real hard time right now. :-(
 
Bonesmart staff: could you please change my thread title to "beth1954's recovery thread."
Thank you very much!!
 
At the risk of upsetting the apple cart by not putting this on my recovery thread, I really need some answers. I wanted to be sure that a lot of people see this question so that I can hear from (hopefully) several people.
I have had much more swelling with this knee than my first TKR. I can only get about 10 minutes into elevating w/o fairly bad pain that involves most of my leg from above the knee to my foot. It's very uncomfortable and the pain level creeps up the longer it goes.
I have tried everything that I have found on bonesmart but none seem to help. I can ice, but can only elevate for short periods of time and each time gets extremely painful.
Also my back is killing me because I have had to sleep on my back since my surgery. Last night I wanted to sleep on my side SO bad so my daughter helped me with a pillow between my knees and also a small pillow between my feet so that everything seemed to align nicely. After about 5 minutes of this, horrible pain! Similar to the same type of pain with elevation.
Frustrated and discouraged......Beth
 
At the risk of upsetting you by merging your threads, I need to be able to read back in your thread to remind myself of your history! Be back in a moment ....
 
I know this sounds silly but there is so much pressure to do PT and to really go at it HARD that it's difficult for me to be able to tell her that I want to "chill." I think she will peg me for being lazy and uncooperative. They expect us to just work through the pain.
Then you must be strong and assertive and insist on what you know is best. Remember that you are paying them so you can call the shots.
My surgeon wanted me to start cutting back. I saw him at 2 weeks post op. I am 3 weeks post op and I am taking one oxycodone (10/325) every 7 hours. In your opinion(s) have I cut back too much?
Yes you have ... more on this later ....
I have had much more swelling with this knee than my first TKR
That's simple - it's because this surgery is not the same surgery as last time. No two surgeries are the same, not even when they are on the one person!
I can only get about 10 minutes into elevating w/o fairly bad pain that involves most of my leg from above the knee to my foot. It's very uncomfortable and the pain level creeps up the longer it goes.
There is a fairly simple reason for this - you are under-medicated for only 3½ weeks out. If your surgeon won't prescribe more for you, try your GP, get referred to a pain clinic, but you must have an adequate amount of pain meds for at least another 3 weeks minimum.

I also have some questions to ask you:

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery!
[Bonesmart.org] beth1954's Recovery Thread
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2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how often are you icing your hip and for how long?

4. are you elevating your leg, how often and for how long?

5. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

6. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please!)
 
Beth, please listen to Jo. Her words are exactly what I was going to say. You have fallen into the trap of trying to compare your current recovery with others' and with your other knee. But it's a UNIQUE surgery and you must look at it that way and deal with what is.

And what is......is that you are in too much pain right now. And the pain is resulting is swelling in your knee and leg. Once you get the pain under control, you can deal more effectively with the swelling (ice/elevation/rest). There are no other solutions. You need to take adequate amounts of a prescription pain medication on a regular basis.

My suggestion is to go back up to your regular dose of the oxy until you have at least two entire days where you feel your pain was managed. Take the pills on a set schedule (whatever the maximum dose is on the label). Along with this, you'll need to get plenty of rest with ice and elevation. If you start feeling a bit better, this is NOT the time to increase activity. Your goal is to simply get on an even keel again.

Once you have a couple of good days under your belt, you can better judge what level of the medication you need. BUT....whatever that dose is that keeps the pain at bay, take it on a set schedule whether you hurt or not. Don't try to cut yourself short.

As Jo says, if your surgeon wants you off the oxy, ask for a step down drug like Percocet, Hydrocodone or Tramadol. There are many options. And if he won't agree, then Jo's advice is right on target. Get to your GP and get help there. Your number one priority is to get your pain managed. All else will follow once you have that going for you.
 
Thank you so much. All of you have such patience! I know that you deal with the same questions from dozens of different people yet you always answer in such detail and with such compassion. I had my daughter read this thread so she can see my concerns and see how different your views are than the "normal American" views are on the subject of pain control and PT . She was very impressed.
To answer your questions:
1. My pain level at rest is somewhere close to 2. When walking or moving about it can be between 2-4. While elevating it gets above a 4.
2. I was prescribed Percoset 10/325's, 1 every four hours but at my 2 w/o visit he encouraged me to start cutting back. As of last night I was taking one 5mg every 7 hours. As of right now I'm taking one every 4 hours like you suggested.
3 and 4. I have been icing about 3 times a day. Elevating when I can tolerate it but as you know it's very painful!
5. I have not done much for activity because of swelling. When I get up to use the restroom I usually walk around the house a bit just kind of a little walk. Sometimes I use my grabber stick to tidy up. I vacuumed my bedroom today.

6. I do some of the standing exercises-- walking heel to toe, a side step, etc. Very small knee bends from a standing position don't seem to bother me. I have done some extension blocks since I have gotten so stiff. My extension was at zero when I left the hospital so I haven't been too concerned about it but I realized that could go the other way. It actually felt good once I was done. The things I mentioned: I would say only twice a day.

I have done very little that involves flexion because of the swelling.

Thanks again Jo, Jamie and everyone else.
 
Are the pain meds helping now that you're back on a realistic dose and on schedule? You should begin to feel more comfortable.
 
Well I just started taking a whole 10mg Percocet a couple of hours ago.
 
Oh.....okay. We'll see how it goes in the next day or so then.
 
Beth, I see you mentioned above that your back is killing you too..... so got me thinking maybe you're having sciatica in addition to your post-op pains.... I get that from time to time because I have bad L4 L5 & S1 discs, and it's exacerbated by lying on my back with my legs straight, so my preferred sleeping position is on my side with a pillow between my legs..... But when my back gets a little off-kilter the side position is no good either; I get shooting pains down my left leg that deny me any kind of rest until I get out of bed & straighten out my back.... Over the years I've learned to do a bit of self-chiropracty that relieves the pain tremendously. What works for me is I lay down on my back on the carpet (yep it's a big deal to get down there!) so I can put my hands under my knees and pull up a bit to put my whole back in flexion..... it's easier if I cross my ankles. Then I roll back and forth as much as I can from buttocks to shoulder blades, while shifting my weight from side to side. More often than not I feel a couple of mild pops in my spine and the sciatica drops down to 1/10 of what it was. After that I get back in bed go to sleep!
 
Salty: I have had sciatica pain before-a short bout of it probably close to 20 yrs ago. That isn't what I'm feeling. I would try the stretch you told me about but I haven't been able to get on the floor and back up again for MANY MANY years!!
As far as how I'm feeling, I can actually feel improvement already!! I don't hurt as much so I'm not so scared about moving! During the night I had to use the bathroom and my walk was just a little smoother and not such a horrible limp. It's not like my flexion magically got better but nothing hurts as much as it was! Being in less pain has improved my mood and my outlook too.
I think this is going to help so much!
In your opinion how long should I stay at this dosage? I'm taking 10mg of Percocet every 4 hours. I am going to call my surgeon tomorrow because I know he will give me Norco (10's). So at some point I will start taking those instead of the Percocet. I'm feeling more hopeful today!
 
I'm glad to hear you're finally getting some pain relief! ..... I can't provide much informed advice about percocet vs Norco but if you do some Googling you'll find the hydrocodone formula (Norco) is designed for much milder pain than the oxycodone formula (Percocet) .... so if I were you & just now found the right drugs for effective pain management I wouldn't change anything at all for another 2 or 3 weeks. ..... and when you figure it's time to start tapering off the opiods, you might start with cutting your alternate doses of Percocet down to one 5 mg tab augmented with one regular Tylenol...but really you'll need to get a little pushy with your docs to keep your pains at bay. Like most everyone else here I had to push against my doctor's advice on the drug subject, and I'm glad I did!
 
Beth, if your pain is managed for 24 hours, try taking one of the pills every 5 hours for a day. If that works, you could either go to one every 6 hours or try splitting the pill in half and going back on the 4 hour schedule (1/2 pill every 4 hours). You will know if it's not working and then you can go back up to the dose that was doing the job for you.

Whatever changes you make in any medication you take, you want to do them gradually and allow at least 24-48 hours on that new dosage to be sure it works with no pain problems.
 
As far as pain meds go....that will be a problem. When I went for my 2 week post open I got a prescription for Percocet for 10 days. I got the distinct impression that when those are gone he will give me Norco--not Percocet. I still have quite a few left because I was using the RX that the rehab doc gave me. I have seen it suggested that I get pain meds from my family doctor. Fat chance! The doctor/clinic that I have been going to is TERRIBLE about giving scripts for pain meds. It's like pulling teeth. So I think I'm kind of screwed there.
 
If that's the case, you could try a pain management clinic, Beth.
 
A good pain management clinic is hard to come by around here. I will just have to see what happens. I am now BROKE. I owe everyone money. To go to a pain management clinic would mean yet another co-payment every month. My ins changes like the wind lately and I'm just barely hanging on. I seriously start bawling every time I think about the mess I'm in. Could I be worse off than I am? Of course. But I'm headed for serious problems with no way out.
 
So sorry. Just try to focus on one thing at a time and don't try to project too far into the future. You can drive yourself crazy with the "what if's." Do the best you can to rest and keep your pain under control. Right now that's the most important thing.

I'm not sure why your insurance policy would be changing constantly. Don't you have a specific contract with your company for a year at a time?
 
Well yes and no (insurance.) Our flex pay runs from March to March. Our deductibles start in January and run for one calendar year. Last year our deductibles went up (almost doubled). But they went up in April. Our co pays almost doubled too. Now at the last minute there have been some changes that ended up making a doctor of mine be out of network. Something is always changing.
By the way I forgot to mention my knee has been swollen --really tight and stiff--almost all day.
 
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