conflicting instructions

[hopefaith]

Today I went for a class at the hospital I will be at about TKR's. There was no discussion about ice, elevation or rest. I asked a couple questions about pain management and anxiety. The instructor said that they try to keep a person's pain 5-7 as long as it is not increasing.....(very disconcerting) Also, they won't let a person out of the recovery area if they still need I.V. pain meds. Their goal is to get the person out of the hospital in 2.5 days to avoid "hospital acquired infections." If I hadn't been on this site I would be running walking for the hills. I AM however very concerned about pain management/control while in the hospital. I also am having the "wow, my knee has never felt so good" syndrome. I am just having a small big freak out about all the conflicting information I am receiving. The discussion about P.T. was concerning too.

 

[msmechanic58]

Was this with your doctor or someone else? I would call your doctor and ask for clarification.

 

[hopefaith]

This was the nurse who has worked with these OS for years. She teaches this class on a regular basis.

 

[Tykey]

Hi Hopefaith, let's try to put another slant on it, because what you learnt isn't really conflicting with what you see on here. The rest, icing and elevation are post-op issues, and will probably be addressed at a later date. Besides it's something you do to yourself, you don't need any help. Do it or don't do it?, it's your choice, but I know what you'll choose to do very quickly

I'm certain they won't be keeping your pain levels UP to 5/7. There's no sense in having a target, it'll be just a maximum. It's so subjective anyway, one person's 5 is another's 1 or 10. The reality is that if you feel in pain, then pain killers are required, and you get them. I gave my pain levels as 1 or 2 at the highest, it wasn't an issue. Are you having a spinal block? If you are seriously worried about pain, that's the way to go, because you feel NOTHING for several hours until the other pain meds are established

I don't understand the query re the IV, because they normally stay in place for a day or two, almost until you go home.

Please stop analysing everything, this normally results in everything metamorphosing into everything negative.

Just go with the flow, there are tens of thousands of these ops each year, the vast majority of us just take it day to day, resolving issues as we go on.. We have a nice helpful thread recently on Mindfulness in the Social Section, I'd recommend it to you.

Finally, don't think that what you read on here is typical, remember the vast majority of people join a forum like this because they are having problems, so it's far from being representative. The silent majority don't even bother because they just get better, which is the normal way of these things.

 

[skigirl]

I agree wtih Tykey---no need to get upset at stuff that may or may not matter. I think it is better to go in with the idea that you know yourself and that you are able to care for yourself. If you have someone to go to the hospital with you, you could talk in advance to them and let them know you are concerned about pain management.

That person would be your advocate in the hospital and it is always better if they know exactly what you want in advance.

 

[hopefaith]

it is my nature to analyze before such a huge decision is made. That's just me. I think I was not clear in my post. They won't take you to the FLOOR with any IV pain med.s. "Go with the flow?" Sounds like that is what this site is about being your own advocate and not getting sucked into "the flow". My need is to be encouraged to speak up and not just go along with things because that happens to be the thinking in the US to push push push.

 

[Karringtyn]

I had my TRKR 7 weeks ago today. (WOW!). I analayze EVERYTHING. I questioned everything and I did ALL th research I could. Had I not had surgery...I most likely would be wheelchair bound by now. I had the same apprehension as you. It's not a "go with the flow" mentality.....but more of....trust what is to be done.....these surgeries are performed daily and they do know what they are doing. 5-7 pain wise? Dang I wish I could of had that! People's perception of what a 5 is varies.

Just do what needs to be done...talk to your OS...read everything available on here and know that there is LOTs of support on here. If you want to read my journey...it's in my signature. I don't sugar coat anything.

Best wishes.

 

[hopefaith]

Thank you!!!! (I am not a sugar coater by any means either)

 

[Tykey]

They won't take you to the FLOOR with any IV pain med.s.

If you have a spinal block (ie a local anaesthetic) , you won't feel anything anyway. The benefit of these is that you can spend just a few minutes in recovery (to make sure you are awake, and your BP isn't a problem). Then it's off to the general ward, where the IV is put in and has time to work before the spinal block wears off a few hours later. We normally have a femoral block as well, which also stops pain as the IV, then pills take over the job.

The short time in recovery is normally a wonderful, calm yet euphoric, pain-free and placid experience and is to be enjoyed.. It's like what I imagine a heroin smoking den is like

What anaesthetic regime are you having? Getting that right in the first place is probably the biggest influence on pain control in the early days. If you/they get that wrong or inadequate, you might have to play catch-up on the pain.

 

[Florida 1]

Although I was in a "specialty" wing of the hospital for knee and hip replacements, I was surprised that icing and elevating weren't standard protocol. I knew from reading here how important it was so I made sure to ask for ice regularly and to have my leg in the CPM (which provided the elevation). I was also surprised that I didn't hear much about it from my OS's staff, but once I re-read the handout they had given me, I found it in there. When they first gave me the handout I was so overwhelmed having learned I needed TKR that I didn't pay too much attention to the "after" instructions.

 

[hopefaith]

Spinal block and G.A.

 

[Josephine]

The instructor said that they try to keep a person's pain 5-7 as long as it is not increasing

Well, in order for them to know that, they have to ask you first. So knowing this might be the protocol, just be very careful you are honest with yourself about your pain levels. I have often observed people saying they have a pain score of 5 when they are sweating and their pulse is high! On the other hand, I've had people say their pain score is 10 when they are sitting up on the trolley chatting with nurses and the monitor shows a perfectly normal heart rate! But don't say 5 when it's really a 7. Besides which, if you need the meds, you can insist upon them regardless.

This was the nurse who has worked with these OS for years. She teaches this class on a regular basis.

It doesn't necessarily mean she is an expert!

Also, they won't let a person out of the recovery area if they still need I.V. pain meds.

Well this is true. A person receiving nartotics via an open IV infusion needs constant monitoring just like in ICU. I would never allow such a patient to be sent back to the ward. However, they could still be receiving morphine via an IV cannula. That's different and she should have explained the difference. She didn't which confirms my comment about her not being an expert!

 

[Celle]

I think it's possible for someone having IV patient controlled analgesia via a PCA pump to be cared for on the ward.
The pump has a safety setting, which prevents over-dosage. It doesn't deliver any analgesic if you push the button too soon. With this machine, I've twice been cared for back on the ward.

 

[referee54]

I think it's possible for someone having IV patient controlled analgesia via a PCA pump to be cared for on the ward.
The pump has a safety setting, which prevents over-dosage. It doesn't deliver any analgesic if you push the button too soon.

Bingo!!! I had the PCA pump and they instructed me on how to use it, when to use it, and also the idea that it would not administer doses within a certain time period. It heped my pain levels immensely.

 

[Loislu]

The pain comments are interesting. My TKA is June 23 by a doctor that my other dr. (Limb Dr.) says is wonderful. If I hadn't scheduled a special consultation, the plan was for him to perform surgery on me when he hadn't seen me in over 7 months, no pre-op with him, and outdated xrays. He started our converstation with : You've been asking too many questions." I couldn't even reach anyone in his office--either him or any other medical person, so how could I have been asking too many questions? Then I ticked the knee dr. off by explaining to him that I was concerned about xrays being over 7 months old and the ones on my patient record were not weight-bearing ones. The knee dr. ordered new xrays, then we talked. I've been told my dr. is a "wonder knee surgeon".
I"m puzzled by the whole "what is your pain # question". Most of the time I make up a number since I'm not sure what any individual # means. It would make sense to me if the medical person asking this question would give me a diagram to illustrate what the numbers meant. One hospital did that so the numbers started to make sense to me. They had a diagram with Happy/Sad faces to show what the pain level numbers meant. I wouldn't have a clue what the numbers mean at my knee doctor's office. ??
I went to a joint class a week ago and I feel much better about the whole surgery. After the class the lady leading it let me talk to her privately. She assured me of how competent my surgeon was. She said the hospital had "pain med protocols" in place. I'm not sure exactly what that means, but I'll ask for pain meds if I need it.
My husband said my knee dr. should wear a shirt that says: "Trust me, I"m a doctor".

 

[Pumpkin]

@Loislu Here is a link to a pain chart that may help you.
https://2young2bold.wordpress.com/2010/06/25/the-concept-of-pain/

 

[Celle]

Here's a picture for you!

I hope that helps.

 

[Loislu]

I'm going to print the pain chart and keep it with me. My other problem with the whole "what # is your pain?" is that it appears that I'm supposed to only rate the pain on the part of my body that is what the orthopedic dr. is treating that day. Meaning: if I"m at the knee Dr. and my knee isn't so bad, it may be a 3. But my spine (even after spine surgery) is a 6. My deformed ankle may be a #5. SOOOOO--what is my actual pain level? It ticks off nurses when one tries to explain this concept to them and all they want is a # to meet the type of orthopedic issue THEIR doctor treats. In my real world: everything needs to be somewhere around a #3 for me to walk across the room.

 

[Pumpkin]

Here is a link to a thread in the social room for a humerous take on the pain chart.
No body likes the pain rating system, but it is better than not asking at all.
https://bonesmart.org/forum/threads/pain-chart-humor.13648/

 

[bottomshollow]

@Loislu, you report your highest level of pain no matter what part of the body it's coming from.