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TKR Boogaloo is back!

Boogaloo said:
I'm feeling a little better today, probably because I slept in.
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It could definitely be this. My stomach gets horribly unsettled when I reach a certain point of overtired. There's nothing for it but to get some sleep. Sometimes easier said than done.
 
I felt totally unsettled during my TKR recovery. It was my first surgery ever and nothing in my body seemed right for a while afterwards. So every weird thing I felt I put down to the surgery.
 
OS wrote me a prescription for Famotedine. It's a nausea medication. I take one tiny little pill at bedtime. I hope it takes care of my morning nausea.
 
He said it's probably the oxycodone. Too many pills. I take meds to manage angina and hypertension, oxycodone for the RTKR, tylenol 500 for pelvic and severe lower lumbar spine arthritis, vitamins and supplements. I try to space them out throughout the day but I still get nauseous in the mornings especially. I stopped taking gabapentin 400mg yesterday. Hopefully I won't need anti nausea medication when I stop taking the oxycodone. I started weaning off the oxy today.
 
Less nauseous this morning. I was able to eat a little breakfast. I'm feeling some discomfort at the incision though - mostly near the lower end of the incision. The burning, stinging pain surrounding the incision intensifies at times. Possibly due to cutting back on the oxycodone.
 
Not sure what's going on with me. It's been over 6 weeks since my RTKR and I feel so bad. I have no energy. Very little appetite. My lumbar spine arthritis pain is flaring up. The burning stinging pain around the incision is still a major issue. I can only sleep for 1 or 2 hours at night before the discomfort returns. Still icing my knee regularly and taking meds on schedule. I have a follow up appointment with my surgeon August 1st. I hope he can help me sort out the burning pain issue. I don't recall feeling this bad after my first knee replacement 8 years ago. Then again, I was younger and didn't have back problems back then.
 
I have arthritis in my back and it really flared up during my TKR. Sitting so much bothered it and sleeping on my back was torture. Let’s see what @Jamie says about the burning pain around the incision, but the good thing is you’re seeing your OS this week.
 
I'm sorry you're experiencing this continued burning pain around your incision. Is it accompanied by redness in the skin? Would it be possible for you to post a photo to show what your knee looks like?

That said, 6 weeks out from surgery really isn't very much. It's still possible to have all kinds of pain going on. Instead of trying to wean off oxy, why don't you ask your surgeon for a "step down" medication for pain such as Tramadol. You can combine the Tramadol with Tylenol and often it will work very nicely for pain management after the initial few weeks of recovery.
 
Hi @Jamie, Thank you so much for your advice. I will ask my OS about switching to Tramadol and Tylenol. I've uploaded a picture of my RTKR looking down from my perspective. The area to the left of the incision is where it burns and stings the most. You can also see just to the left of the incision the line burned in by the edge of the dressing tape. You can't really see it here but here is a matching burn line to the right of the incision. The skin all over my knee is definitely discolored, more purplish than red I think.

[Bonesmart.org] Boogaloo is back!
 
Thanks for the photo. Let me tag @Josephine and see what she thinks might be going on to cause that burning and stinging. I can see the irritation line you're talking about and your entire knee is definitely a darker color over a large area.
 
Boogaloo said:
but here is a matching burn line to the right of the incision.
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I see such a line to the left of the incision but not the right.

A burning pain such as you describe is most likely nerve pain and the usual treatment for that is Gabapentin.
 
Hi @Josephine. Yes, the line to the right if the incision is not visible in the photo but it is there.

I was put on Gabapentin 400mg 3x day before the surgery and I took it up until the 4th week post surgery. I had the burning pain even during the 4 weeks I was taking the Gabapentin.

The OS instructions were to stop Gabapentin after the 4th week so I'm not taking it at this time. Should I be on a higher dose of the gabapentin at this point? All I'm taking for pain is oxycodone 10/325 every 8 hours and Tylenol 500 in between for breakthrough pain.
 
Gosh, I took Gabapentin for about 4 months. Plus I was started on 200mg twice daily but that wasn't enough and it was increased in stages until I was taking 500mg 3 times a day. This is usual and was, finally, effective for me. I took that dose for about 2½ months if I remember correctly. I then titrated off it in a routine of my own making and it took me another 1½ months to do that. So I suggest you go to your GP who might understand the usage of Gabapentin a bit better than did your surgeon!

If you find a dose that works, you may not have to take your oxycodone any more anyway. And you could also supplement with Tylenol 1,000mgs 4 times a day.

And as far as the discolouration on your knee is concerned, I'd just call it blotchy and is a byproduct of bruising.
 
Hi @Josephine,
I had my 6 week post op appt today. The OS was very pleased with my ROM at 110/0 and he was surprised that I've done no PT since I was discharged from home pt 4 weeks ago. Thanks to the support and advice I've gotten here at Bonesmart! I showed him my poor discolored, burning knee and he said it looks ok to him. I also asked him about stepping down to Tramadol/Tylenol but he said he was going to hand me off to his pain management dept and gave me an appointment to be seen there tomorrow.
 
Okay. Personally I'd have sooner gone to my GP first. Don't Pain Management make you sign all kinds of waivers and agreements?
 
I was in pain management a few years back when I had severe tendonitis in my wrists. I didn't have to sign anything but I wasn't on any prescribed opioids either. Things could be different now. We'll see what they say when I go there tomorrow.
 
The forms depend on where you are in the country. Some states and even individual practices over-reacted to the opioid crisis by making people sign all kinds of pledges that they wouldn't be a drug seeker. Not all states have those draconian rules fortunately. I hope the pain management clinic works well for you. If it doesn't, you always can fall back on your GP. They're pretty good at these things to when it's not a chronic pain problem.

If you don't mind me asking, Boogaloo, what state are you in?
 
My pain management specialist has been such a blessing. I didn't have to sign anything weird, and she's helped me manage my pain for a few years now. The only bad part about getting my knees fixed is I won't be her patient any more.
I hope your experience is as positive.
 
@Jamie I'm in New York.
I went to pain management today. Had to take a drug test and sign a consent form for the drug test plus another form acknowledging that my oxycodone use is being monitored. No contract or anything like that.
The pm doctor renewed my oxycodone 10/325 and increased the Gabapentin to 600mg 3x a day. He said I'm allowed to renew the oxy for up to 6 more weeks if needed. He also gave me CBD oil to apply on the areas where I have burning pain. Overall I think it went pretty well.
 
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