Bilateral TKR Bubbles BTKR 9 November 2015

[Timetolive]

Bubbles, I am glad you got home and are doing reasonably well. Do be careful and hug those chairs! I can't help you with the Celebrex, but just wanted to wish you well.

 

[newlybionic]

Welcome home! I think that when we all come home we seem to lose some ROM and/or experience more swelling. In my case it was because I was up and doing more at home than I was before. I experience low BP post op for a couple of days immediately after surgery. The doctors thoughts were that it could be a reaction to the epidural/conscious sedation or to loss of blood during the surgery. I also had problems with low sodium levels which throws off the body's ability to maintain enough fluid volume which can be a cause for low blood pressure also. As far as the Celebrex vs Ibuprofen, both are NSAIDs and the doctor would have to adjust the dosage for you. Where you told to take the Celebrex after the surgery? I only ask this because NSAIDs can cause some thinning of the blood and lovenox does that too. This is another question that only your doctor can answer.

 

[Celle]

I'm also taking 600 mg of gabapentin and lovenox shots daily. I'm supposed to be taking Celebrex but my insurance says to use ibuprofen instead. The pharmacist couldn't tell me what dose or even if it's okay with the lovenox. So I guess I'm not on any anti inflammatory. I've used Tylenol in the hospital. So is anyone familiar with Celebrex and how, or if I should, substitute ibuprofen. I'm confused. I was waiting for the pharmacist to appeal the decision not to cover Celebrex and should have called the doc. Now the weekend is here. I feel I need an anti inflammatory.

Am I hearing right? Your insurance company is over-riding what your doctor ordered?
That is ridiculous and dangerous.

Or is it that the insurance company just won't cover the cost?

It isn't safe to take any medication that is not prescribed by your doctors and it should be only your doctors who say what the medication should be.

For goodness' sake, don't go substituting any medications. Phone your doctor first thing on Monday morning and get this sorted out. No one should be suggesting alternatives, - not your insurance company, not your pharmacist, not anyone here on BoneSmart. Only your doctor should be saying what medication you take.

Meanwhile, I'm afraid you'll have to go without any anti-inflammatory for the rest of the weekend. That's not the end of the world, because countless people manage without them. Concentrate on doing as much rest, ice and elevation as you can, to help relieve some of the swelling, and take your other, prescribed medications on time, on the prescribed schedule.

 

[newlybionic]

@Celle Unfortunately here in the U.S. The insurance companies have started to routinely decide on what medications they will cover. It causes a lot of delays and extra paperwork for the doctors. The only other thing that we ( the patients) can do is pay full price. It is totally crazy because the prices for medications are too much for any of us to pay.

 

[Celle]

It's really good to hear that insurance companies are playing at being doctors! (Now, where's my sarcasm smiley? )

 

[PolarBear60]

Bubbles, does the insurance company need an extra form filled out by the doctor to verify why he's choosing that medication over others? If so, that's a pretty simple (but extremely annoying) thing to resolve. I've had to do that for my cholesterol medication.


Jean

LTKR (Stryker Triathlon): 21 April 2015
Right Knee Arthroscopy: 25 July 2006
Left Knee Arthroscopy: 10 February 2005

 

[kayak59]

Bubbles, I agree with Celle, but regarding your question about Celebrex. Although an NSAID, it does not act as a blood thinner. I'm on 400mg a day and I was allowed to take it right up to the surgery. An additional benefit is that it reduces pain as well. I am almost reduced to an invalid if I have to go off it as it works on all my arthritis all over. There is now a much much cheaper generic for Celebrex which I am taking without any noticeable difference. Given that, I'm surprised your insurance won't cover that. Mine forced me to switch when the generic became available, but thank fully there was no noticeable difference. One time when I changed insurance companies, the company did not want to cover Celebrex. The doctor gave me a month's worth of Mobic samples -- which we already knew was not as effective -- but after the month was over, the doctor wrote a letter saying Mobic (and other substitutions) didn't work and then the insurance company approved the Celebrex.

 

[kneeper]

The insurance company probably flags celebrex as more expensive; not paying attention to whether it medically makes sense. As someone said, don't substitute without talking to your doc.

Also, people can recover without an anti-inflammatory. After I had an ulcer I can't take NSAIDs anymore. Just narcotics and then plain acetaminophen for me. And lots of ice and elevation.

 

[Jamie]

I agree that you should get in touch with your surgeon's office Monday to get your medications sorted out. You also might want to think about taking a look at your insurance policy. It's Open Season right now and it's possible that you could change to a policy that better suits your health needs. There are offices with insurance agents who will review your particular needs and recommend policies for you at no cost to you.

Many people recover just fine without using NSAIDs after surgery for inflammation. If you decide to use Tylenol, just be mindful of the 4000mg limit of acetaminophen (the active ingredient in Tylenol) in any 24 hour period. Many prescription pain meds also contain acetaminophen and that should be counted in your dosing. You should never take more than 1000mg of acetaminophen at a time, doses no more frequent than every 4 hours with a total of no more than 4000mg per 24 hours.

 

[newlybionic]

If you are taking percocet 5-325 it's the 325 that is the amount of acetaminophen. If you are not sure check with a pharmacist or MD.

 

[Bubbles]

Thanks for all the replies and info.

@newlybionic I'm thinking the low blood pressure may be anemia from loss of blood. Maybe it isn't that uncommon.

Yep @Celle the insurance companies have a little too much power here in the states. I could pay for it myself--$300. I didn't have the opportunity to get my doctor involved because of the weekend. I won't be taking anything that's contraindicated with the lovonox like ibuprofen.

@kayak59 thanks for the info on Celebrex, I see why my doc prescribed it instead of ibuprofen. The pharmacist was new and young, I'm sure my regular one would have handled it better. Also my husband is who went into the store so didn't have a good opportunity to question the decision. Hope your recovery is going well!

@kneeper I believe you're right, Celebrex is flagged for being expensive. Hard to believe they'd recommend ibuprofen while I'm on lovonox.

I'll get this sorted out tomorrow. I'm seeing my primary care doc in the morning. He should be able to help. If not, my surgeon will.

I'm doing well, not much pain. Using only 10 mg of oxy a couple times a day. I'm sleeping surprisingly well just get tired and lightheaded easily forcing me to take it east--a good thing I suppose. This is temporary!

 

[Bubbles]

@Jamie for the important information. You're right, it is time for new health insurance contracts. I just signed our small business's contract before my surgery. I do use a broker who is a large full service company--extremely helpful and your advice to use one is excellent. They know what's out there and can help compare different offerings by different companies and policies. They save me countless hours of research when comparing insurance. I totally agree that people take advantage of the free services. They have helped with Medicare too for employees and my husband. My surgery will cost me nothing. I'd already made my $500 deductible. My rehab doc wanted me to stay longer in in the acute rehab hospital setting but my insurance wouldn't agree. I could have moved to another non-acute rehab facility but I was ready to go home.

Thanks also for the info on Tylenol. I'm not one to use Tylenol much, I prefer ibuprofen. After years of osteoarthritis in various joints in addition to my knees it would have been easy to use too much and potentially cause damage to my stomach, kidneys or liver. I'm still a little hesitant but know that this BTKR recovery is not a time to be skimpy on pain meds. My pain has been well controlled with oxycodone which I only use as needed and I don't need much. I'll use it for my PT sessions and I take 5 mg before I go to bed at night. I find icing and elevation very useful for pain and swelling plus it won't cause any organ damage. Thanks BoneSmart. I don't think I would have used as much ice without this site.

I'm a little disappointed in my ROM at this point, 90 right knee, 83 left, that was last measured five days ago. Maybe I'm nuts. I'll have my first outpatient PT tomorrow. I decided to go to a PT facility rather than in-home PT at the advice of the therapists in rehab plus I think it will be good for me to get out. I've been doing lots of gentle stretching exercises per instructions sent home with me from rehab. Maybe slacking a little but nonetheless keeping things moving without pain. I'm able, for example, to lift my legs onto and out of bed without assistance of my hands or leg lifter. I wasn't able to do that well just a few days ago. I rarely use my leg lifter now. That's progress. I'm walking around the house with a walker and can stand to do a few dishes here and there. No stamina, keep a chair near! Next goals include driving and going downstairs to do some laundry. No big rush but I'd sure like to drive soon. Doc says as soon as I'm off the oxy and can hit the break hard I can drive. Don't think that's very far away.

 

[referee54]

I'll get this sorted out tomorrow. I'm seeing my primary care doc in the morning. He should be able to help. If not, my surgeon will.

Many OS's and GP's have folks in their offices that no the ins and the outs of different insurance companies and coverages. Talking to your GP is a great idea and he/she should be able to get this sorted out for you

I'm a little disappointed in my ROM at this point, 90 right knee, 83 left, that was last measured five days ago.

Speaking as a BTKR alumnus, you are doing fine---remember, patience is the key here---and these recoveries take longer than we would like them to and longer than we would expect them to---upwards to a year.

It took me six months after my BTKR to get to around 80%-85%, and it was around eight months when I was at 90%- or close to 100%, so you have quite some time to get there. Remember, also, that you have had two bones sawed off in both legs, and that they surgical trauma can take quite some time to subside.

Patience, Grasshopper, Patience!!

Maybe I'm nuts.

Nope---you have what all of us had---impatience---and we had to reach deep down inside ourselves and find the patience that we did not know that we had.

Please take a look at this article:
Life in the slow lane

 

[Bubbles]

Thanks @referee54 thats just what I needed! Great article, I'm climbing into the conestoga wagon and noticing a particularly old grey mare who will also need lots of rest on our journey west.

Just talked to my OS's nurse. She will have my Celebrex approved by my insurance company within the hour. Should have called her Friday--20/20 hindsight.

 

[referee54]

I am not sure if you had arthroscopic surgery, but many of us have had it and we feel pretty good within days.

We do tend to not realize the serious trauma that has been performed on our knee or knees, and we do not understand how devastated our surgical knees can be.

It does take some time for this to actually sink in.

 

[NightQuilter]

Glad you are home, getting your Celebrex, and sleeping as well as you are! I'm fighting back the jealousy here! It took a long time and the assistance of Advil PM for me to start to get any rest - you are so far ahead of the game! Tim is so right about the recovery taking time. I was adding ROM up until 18 months after! And we all heal differently. What part of PA are you in? I grew up in Erie and went to school in both Philly and State College.

 

[Bubbles]

Hi @NightQuilter, sleep is so important for healing, I do feel fortunate that I've been sleeping well. Sorry you struggled. I'm from the Pittsburgh area. Did you go to Penn State? State College is such a nice town. What part of CA are you in? I was born in St. Helena and spent time as a kid there and Calistoga. Never lived there but my grandparents did.

I did get some Celebrex. When I saw my family doc today he gave me a 30 day sample. He also told me my OS is who replaced a poor fitting knee replacement in his mother. He thinks highly of him. Apparently he is the go-to guy to fix other OS's shoddy work. Too bad we need docs to do that.

After the trip to the doc's office I was exhausted so now I'm icing, elevating and resting like a champ!

 

[NightQuilter]

How fortunate you got the "go to" guy and likely will have no need for a revision! Glad your doc could take care of the Celebrex - I have had to live on it at various points and found it very helpful.

Yup - I'm a Penn Stater, but now live outside of LA, between Santa Monica and Malibu. Which means we are in the throes of the drought and praying for El Nino! The Sainted Joe (hubs) and I celebrated our 30th anniv. near Calistoga two years ago. The Napa region is amazing. Joe grew up not far from Pittsburgh! Small world.

 

[Bubbles]

WE ARE PENN STATE! Well not me but my daughter. She had a great experience there and got a very useful education.

The severe drought out there is awful and here we got way too much rain this spring. I love golf and the club I belong to had some of the worst rain damage we've ever seen. What a mess. We need to share some of the rain with you. My paternal grandparents had 40 acres in Calistoga, much of it in vineyard but some in forrest. They had a huge water tank (thousands of gallons) on the hill behind the house in case of fire. They saved their home from being burned several times with that water, there were burned fence posts I recall seeing as a kid. Not something we need to worry about in PA.

The area you live in is lovely, and a way of life you don't get in PA. The weather lets you enjoy the outdoors so much more than here. My daughter and I were out there a couple years ago and I loved it. The coast is spectacular, I could spend days just poking around the beaches and little towns along highway 1. I want to go back! I'll be able to navigate the tide pools better with new knees.

I spent lots of time doing research on OS's in the area. I saw five or six before I picked him. So far so good but Pittsburgh does have lots of great doc's and hospitals from which to chose.

It sure is a small world. What took you from PA to CA?

 

[XKV8R]

WE ARE PENN STATE!

That's a pretty appropriate smiley for Penn State, isn't it?

@NightQuilter, I probably missed you there by a year or two. I was there for a couple of terms, late in 75, before I figured out that my heart wasn't really in academic pursuits.

I grew up in the city of Pittsburgh, and now live about ten minutes past Pittsburgh International Airport.

@Bubbles, I've been following your recovery more closely than many of the others, since I'm having a bilateral myself, on Dec. 14. Good luck, and keep the updates coming, as you are able of course.