TKR CME's recovery thread<

[CME]

Hi Benny. I massage Vaseline over scar and leave for about 30 minutes. Then I get double the amount of cling film you would think you need and just wrap it around it so scar is covered. It’s made the biggest difference for me.
Just wondering at just 9 weeks what pain relief you are using. I’m in such pain last night and tonight. Taking ibuprofen and paracetamol. Any advice would be great.

 

[Jockette]

Just wondering at just 9 weeks what pain relief you are using. I’m in such pain last night and tonight. Taking ibuprofen and paracetamol. Any advice would be great.

Give that, I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

If you agree to answer Josephine’s questions, she’ll be able to advise you.

 

[CME]

Yes please - I would appreciate that

 

[Josephine]

Here y'go then!

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 forget to factor in 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 swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

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

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[CME]

Hi,
I’m answering these as best I can. I am away on family holiday and know I have been doing a lot more.
1 - my pain level at 8 at night. Not too bad during the day but has become very bad early evening into night
2 nun y o

 

[Josephine]

Then answer them when you get back home. There's no rush

 

[Benay]

Thanks for the cling wrap info. It's helpful.

 

[CME]

I answered all questions but not sure if post went through

 

[Celle]

Your post seems to have got lost somewhere.

Please will you try answering Josephine's questions again?

 

[CME]

1. Pain level at 8 right now which is 11pm. It starts to get bad early evening and worse at night.

2. I was on Solpodol and Tramadol after the initial post op medication but had reduced down to ibuprofen 400mg 3 times a day. In the last few days I have had to take Solpodol x 2 twice a day to try and reduce pain. I tried to sit out the Solpodol as thought it was keeping me awake at night. However, I lasted just a week and back on it. I’m still at level 8 pain right now. I never felt my pain was managed. Surgeon said avascular necrosis at stage 4 and sudden onset is extremely difficult and the level of surgery for knee and adjoining bones was very complex so pain has been extreme.

3. I think moderate mostly.

4. 100 ROM and I think about -3 flexion

5. Was icing my knee 3 times a day for about 20 minutes. I had reduced this as my knee had improved. I’m back icing 3 times a day now.

6. I do elevate leg as often as possible but as have been on holidays - I have been out to dinner and not raising leg as much. I also have been walking much more.

7. I only am doing a little in house, my husband is doing almost everything. I have been walking more and trying to see what I can do. Where I was on holidays meant walking up steps quite a lot which I don’t do at home.

8. I do 15 knee slides and leg lifts and flexibility stretches only once a day.
I attended PT in hospital for knee replacement group but I couldn’t do exercises as pain so bad and PT recognized my surgery more complex and did say to do what I could.

Surgeon very pleased at progress at 6 weeks as he said the progress would be slow. He didn’t comment on pain management though. He has recommended aqua physio and I start that next week.

Even writing this I can see I probably over extended myself on holiday and need to rest my leg. However, I have no idea what medication I can take when it feels this bad. I have very little sleep due to pain. I will go to GP again but would like to hear your advice because they don’t seem to really know what will work.

Thanks, in pain,
Clodagh

 

[Josephine]

I was on Solpodol and Tramadol
In the last few days I have had to take Solpodol x 2 twice a day

CME, I do need to know what doses you were taking please

 

[CME]

Solpodol 30mg x 2 twice daily
Ibuprofen 400mg twice daily
These are the amounts I took today and still have a lot of pain this evening.
Thanks,

 

[Josephine]

1. Pain level at 8 right now which is 11pm. It starts to get bad early evening and worse at night.

3. I think moderate mostly.

Moderate swelling adds about 4 points to your pain score since it is, itself, a form of pain. Therefore I make your pain score at least 12! Swelling/pain comparisons

2. I was on Solpodol and Tramadol after the initial post op medication but had reduced down to ibuprofen 400mg 3 times a day.
Solpodol 30mg/500mg x 2 twice daily
Ibuprofen 400mg twice daily
In the last few days I have had to take Solpodol x 2 twice a day to try and reduce pain. I tried to sit out the Solpodol as thought it was keeping me awake at night.

Ibuprofen, an NSAID, is actually an anti-inflammatory and not a pain killer. Besides which it has some rather nasty side effects Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers
Solpodol has 30mg codeine and 500mg paracetamol in each tablet. I've never found codeine to be that effective as a pain killer for TKR. But only taking it twice a day is not an effective way to take pain meds. You need to take them throughout the 24hrs, usually being 2 tablets every 6hrs. Tramadol is a much better medication which can also be taken with paracetamol in the same was.

4. 100 ROM and I think about -3 flexion

That is excellent and tells me that you no longer need to do any exercising whatsoever.

5. Was icing my knee 3 times a day for about 20 minutes. I had reduced this as my knee had improved. I’m back icing 3 times a day now.

You accomplish little or nothing in 30 minutes. Ice for at least 40-60mins and more than 4 times a day.

6. I do elevate leg as often as possible

Elevate when you ice, always.

7. I only am doing a little in house, my husband is doing almost everything. I have been walking more and trying to see what I can do. Where I was on holidays meant walking up steps quite a lot which I don’t do at home.

Jolly good!

8. I do 15 knee slides and leg lifts and flexibility stretches only once a day.
I attended PT in hospital for knee replacement group but I couldn’t do exercises as pain so bad and PT recognized my surgery more complex and did say to do what I could.

Don't do any of them. You've achieved your target ROM and there is no more need for them.

 

[CME]

Thanks you for this advice. I did take tramadol but it made me very nauseous. I also think I have been too ambitious trying to cut down on medication as afraid of side effects of drugs. Avascular Necrosis was caused by prednisone so it’s made me very anxious about drugs. I will take the Solpodol more regularly and also discuss the tramadol with my GP.
Thanks again.

 

[kneeper]

Even at 8 weeks or so you will it when you increase activity. And sometimes for no apparent reason you can still have a bad day. And I know I might feel pretty good during the day but by the end of the day I was pretty sore.
hang in there.

 

[Josephine]

I did take tramadol but it made me very nauseous.

You need to make sure you never take it on an empty stomach. And while I understand your feelings in regard to the prednisolone, don't blame all drugs for the work of one.

 

[CME]

Hi there. I’m 13 weeks tomorrow. I went back to full time with this week and have got on well. However, each evening back to swelling of knee and a lot of pain. I guess it’s being overworked again as driving also in traffic. I’m walking well but still not able to go downstairs one by one. That’s impressive. Well done and an inspiration

 

[CME]

Hi. Can I ask you about pain management at this stage. I’ve had to increase again in the last few days. I’ve never managed the pain well except for first two weeks after surgery as an quite anxious about using too much.

 

[Celle]

HI @CME , I have copied one post and moved one post from Glosnana's thread to your own thread.

If you're still having trouble managing your pain medications, please don't ask another member. Only staff are allowed to advise about that.

Have you been to see your own doctor, to discuss Tramadol yet? It does make some people nauseous, but you could be prescribed an anti-nausea medication. I now that all those medications make me feel sick and I always have to have something prescribed to combat that nausea.