TKR Biggest issue - discouragement/pain

[amab]

Was on Lovenox (self injections) with my LTKR in 2/2013.....no problems. Was rx'd Xeralto with my RTKR in 9/2013.....it must have worked too well on me; swelling of the knee was much worse; surgeon took me off that med and put me on regular aspirin as he used to do years before; problem was solved!

Each of us are different so some may or may not have a reaction; I actually ran across the remaining pills of tha fx the other day. I need to properly dispose of them....

 

[icep707]

I was on Xarelto i believe for 14 days after my surgery. With no side effect. However oxycontin and oxycodone gave me side effects. I got by great with just tramadol ,celebrex and tylenol. I stopped oxys after week 1. I increased proper elevation and iced 16 hours a day. Pain was kept minimal. Best wishes Iceman

 

[ridgetop01]

So far (8th day post-op) I think my biggest issue is discouragement over the level of pain. Someone here posted "Is it really supposed to hurt this much" quite a long time ago, and I can only echo that. I knew coming into it that it would hurt like the devil, but that doesn't make it any easier. Every time I get onto the leg from sitting it catches me again just how painful it is, and just contemplating doing my PT exercises is incredibly daunting. Just writing about it now is enough to make me tear up?!?!?! I am taking 7.5 mg oxycodone plus one tylenol (500 mg) every 4 hours during the day, don't dare take more because still struggling with constipation issues. That's enough to take the edge off for about an hour or so, but then you are left with the remainder of the time to get through. Honestly, I know I'm doing well - icing, elevating, walked to end of driveway and back twice yesterday, swelling generally controlled, it's just that it seems like it is SOOOOOO PAINFUL ALL THE TIME and it's hard getting past that to do what needs to be done to heal.

Thanks for "listening" - I suppose this is a common complaint, and I guess it would help me to read how others have gotten through this part???? Thanks, folks.

Judy

 

[Legin]

I know mine is hip but at about same time as you I had to get the dr in to reassess my pain management. This helped and I spoke with my physio it was agreed most was soft tissue damage, (muscles like rocks, unfortunately not the norm). I know its difficult but it will get better check out josephines regime for tablets wish I had as it includes night which was worst for me. Take heart it will get better try resting it more

Legin THR Sep 14

 

[ljrfrm]

I wonder if there is another medication you can try? I had both knees done at the same time, and I was lucky enough to have sufficient pain management, but it didn't happen right away. I was very uncomfortable the first few days and called the doctor. We added Tramadol to my prescripted meds, and that really helped. I hear you about the whole constipation thing, it's very hard - but it's also very hard to recover and rest when you are in pain. For me (everyone is different), I found that a mixture of Tramadol and Hydrocodone worked best. It might be helpful to at least call the doctor and see what they recommend and if they can add another med so you can be more comfortable. I was definitely feeling discomfort, but once on the right meds, I wasn't miserable and I truly felt my pain was managed well.

 

[fiberlady]

If your pain is not under control please call your doctors office and ask for something else. I was taken off all pain meds after three weeks because it was making me ill. I took the "cocktail" that Josephine talks about, that and icing a lot, I hardly ever was without ice and elevating was my only relief. It does get better when the pain would get the best of me, icing was my relief. I am looking at my second knee replacement in about a month and I am prepping my medicine cabinet with the necessary meds just incase I encounter another episode. It does get better hang in there.

 

[Legin]

Call your dr there is no reason for you to be left in such pain

Legin THR Sep 14

 

[happymum]

Hi
Yep I recon you need to take more pain relief as mentioned and also ask the dr about medication to manage constipation . I used movicol for four months for constipation and it worked well. You can't possibly keep going in so much pain nor should you have too.
Good luck, from Deb

 

[Legin]

Didnt have constipation just lookednin mirror. Joking aside please call dr

Legin THR Sep 14

 

[appaloosa girl]

Hi @ridgetop01
Welcome to bonesmart. Sounds like you need to get hold of your os and see about tweeking your meds to control your pain. You shouldn't have to struggle with it and you don't have to. There will be others on that will give you some info to read. Small articles with lots of good information that helps so much!!


Sent from my iPhone using BoneSmart Forum

 

[Roy Gardiner]

and just contemplating doing my PT exercises is incredibly daunting

So don't contemplate them, MUCH LESS do them. Never exercise when the pain is too much, nor make it hurt by exercising.

As everyone has said, get to your doc as quickly as possible for more pain medication.

 

[Celle]

Welcome to BoneSmart, @ridgetop01

First of all, no, it should not hurt as much as you are hurting. You need to take your full dose of medication, as prescribed, and on time. It's no good playing catch-up with the pain all the time. If your surgeon will not prescribe adequate medication to control your pain, ask your regular doctor.

Yes, constipation can be a problem, but you can deal with that too. try this:
Constipation and stool softeners

Physiotherapy should never hurt as much as it seems to be hurting you. Only allow your therapist to work you tot he point of discomfort, never pain. remember that you are th boss there, so speak and and say no if it hurts too much.

Here is our recovery reading list for you. These articles should help you to understand more about what goes on in recovery.

First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

Next is a FAQ (Frequently Asked Questions) thread.

And here are some very crucial articles
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Activity progression for TKRs

Healing: how long does it take?
Chart representation of TKR recovery
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling

Home physio (PT) and activity progress: suggestions
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

And then some wise words from members who have shared their experiences ...
Where are you in recovery?? (TKR)
Five “P’s” of knee recovery
TKR: work “smarter” and not “harder”
Recovering a knee - from one who knows!
It's never too late to get more ROM!
It's worth the wait for ROM

 

[mom2fencers]

@ridgetop101, I concur with all that has been said. Constipation was an issue for me; my doctor recommended Colace and it helped within the day I started on it. My body responded like clockwork. It was very gentle too. Constipation is no fun.

 

[Josephine]

just contemplating doing my PT exercises is incredibly daunting

I agree with Roy - don't do them then. You're only 8 days out and should be doing nothing but rest, ice, elevate and take your pain meds!

I am taking 7.5 mg oxycodone plus one tylenol (500 mg) every 4 hours during the day, don't dare take more because still struggling with constipation issues.

For pity's sake, don't reduce the pain meds - treat the constipation! There's heaps of advice here Constipation and stool softeners.

I'm also going to ask you some questions and it would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

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!

) Also don't forget to include other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness

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 knee and for how long?

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

5. What is your ROM - that's flexion (bend) and extension (straightness)

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

7. what kind of PT exercises and exercises at home are you doing? How much and how often? (and detailed details would be appreciated, please! **Reps, sets and sessions** and all that)

** If you're not familiar with this, it goes like so:
1 lift of your leg = 1 rep (repetition)
5 reps and then a brief rest = 1 set
5 sets and finishing = 1 session.

 

[ridgetop01]

Dear Josephine - thank you for caring and advocating. I feel better today than I have till now - I was depressed the last few days, and the pain is improving, as is the constipation. I will reply to your questions...
1. Pain levels right now are only about at 3. By evening it'll be 6 or a bit higher.

2. Pain meds:
7.5mg oxycodone
50mg tramadol (from before, surgeon said I could use it up, not sure if he'll re-prescribe)
500 mg Tylenol
I am taking 7.5mg oxy + 500mg tylenol every 4 hours during day, 50-100mg tramadol + 500mg tylenol every 4 hours (or when I wake) at night)

3. I'm icing for 1-2 hours at a stretch, while elevating, throughout day.

5. My extension is about 175, my flexion just got to 80-85 today, up from 74 yesterday - swelling seems to be improving.

6. Hubby is caring for me. I'm just going for a few laps in driveway each day, and walking around the bottom floor of house to care for personal needs.

7. ankle pumps - 30 - twice a day
quad sets - 20 - twice a day
glut sets - 20 - twice a day
straight leg raise - 20 - twice a day
short arc quads - 20 - twice a day
heel slide stretch - 20 - twice a day (these are the worst!!!!)
heel slide stretch in chair - 5 - once or twice a day
stretch knee on 1st step - a few daily, for now

need to go ice/elevate - can't sit in chair for long. Bleah. Will be so happy when this is over!!!!! Thanks all for your responses.

 

[SuperSnapper]

@ridgetop01 hope you are soon feeling easier. The constipation sounds grim, prunes work for me! Glad your depression is lifting a bit. It seems to be a pretty common occurrence but that's no help when it's you its happening to! Having read a few posts on here , I've got this teeny feeling you might be overdoing the exercises but what do I know! That's a long list and you are not far out from surgery. Hope Josephine has some great advice for you.
Best wishes
Mary

 

[Roy Gardiner]

ankle pumps - 30 - twice a day
quad sets - 20 - twice a day
glut sets - 20 - twice a day
straight leg raise - 20 - twice a day
short arc quads - 20 - twice a day
heel slide stretch - 20 - twice a day (these are the worst!!!!)
heel slide stretch in chair - 5 - once or twice a day
stretch knee on 1st step - a few daily, for now

Too much at ten days! The ankle pumps, quad sets, glut sets, leg raises, short arc quads are all training. You don't need training, you need healing. I suggest that you stop all bar the last three, and do NOT do any of them to the point of pain.

 

[Legin]

Agreed body needs movement to promote blood supply but that puts strain om you.

Legin THR Sep 14

 

[Josephine]

1. Pain levels right now are only about at 3. By evening it'll be 6 or a bit higher.

I would imagine!

2. Pain meds:
7.5mg oxycodone
50mg tramadol (from before, surgeon said I could use it up, not sure if he'll re-prescribe)
500 mg Tylenol
I am taking 7.5mg oxy + 500mg tylenol every 4 hours during day, 50-100mg tramadol + 500mg tylenol every 4 hours (or when I wake) at night)

Well, it seems a fair quantity but your not even 2 weeks out so you need to be more structured. All your doses are quite small. Better you take larger doses like this which was the routine I used for my surgery

3. I'm icing for 1-2 hours at a stretch, while elevating, throughout day

good,good

5. My extension is about 175, my flexion just got to 80-85 today, up from 74 yesterday - swelling seems to be improving.

That can't be right. Look at this as see that extension must be in the negative above 0 as per the blue and red flags.

6. Hubby is caring for me. I'm just going for a few laps in driveway each day, and walking around the bottom floor of house to care for personal needs.

good

Your exercise - my comments in bold
ankle pumps - 30 - twice a day - these are just anti-clot exercises so you should really be doing them throughout the day, every 15-30 minutes. After another week, you can do them every hour
quad sets - 20 - twice a day - do 5 once a day
glut sets - 20 - twice a day - do 5 once a day
straight leg raise - 20 - twice a day - do 5 in the morning only, once they are easy, there isnot need to do them any mroe
short arc quads - 20 - twice a day - do 5 once a day
heel slide stretch - 20 - twice a day (these are the worst!!!!) - much better to do these 5 every couple of hours throughout the day - read this Heel slides and how to do them
heel slide stretch in chair - 5 - once or twice a day - either do this exercise or the one above, not both
stretch knee on 1st step - a few daily, for now - these are extensions stretches - do them about 2 or 3 every couple of hours during the day. And much better to try it this way Extension: exercises for improvement.

I was instructed by my surgeon that the first 3 weeks is for healing and nothing else. He is right. You might like to read the potted version of my recovery to see how little exercising I did! Knee recovery - UK style

 

[kneeper]

I'm thinking you mean extension of -5?
I agree that you have given way too many exercises already, based on my experience. You can work up to most of them later. I think they had me at your point doing some heel slides and maybe a couple of quad sets--like 5, twice a day--certainly not 20. And maybe 5 leg lifts (just getting the leg off the bed at all was sufficient).