THR Counting My Blessings

[Eman85]

No heat, just ice. For me the shocks, zips and zaps and tearing sensations were "normal" and did go away. But it did take quite some time to diminish and I still get an odd feeling or itching once in a while. Buckle in the ride isn't over yet. As far as creams it was probably around 3 mos that I used a cream for massage. Used it for muscle pain relief not about scar or incision.

 

[Josephine]

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?

 

[Debru4]

@Josephine
I am happy to answer specific questions. Thanks.

@Eman85 Thank you for you helpful response. I think you are describing part of what I am experiencing. I had asked about scar tissue formation as well as scarring a couple weeks ago. The topical cream I was recently asking about is for pain. I am trying to decide if I should resume taking acetaminophen again regularly, and/or do a topical pain relief. I don't want to mask pain, but I don't want to get behind it. I am uncomfortable---not in excruciating pain, just increased pain over a couple weeks ago, despite a similar level of activity. It's good to know it mostly works itself out on its own! Thank you.

 

[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 approach did you have for your surgery? Anterior, posterior, lateral? You can look here to see the various types THR approaches or incisions

2. 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).

3. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

4. are you icing your painful area at all? If so, how often and for how long?

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

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

7. 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.

 

[Debru4]

@Josephine
1. Anterior replacement

2.Pain: Overall little to no pain---1-3 EXCEPT :
a) Along incision site: outer thigh, stinging when touched or bumped (coupled with numbness in spots)
b) Stiffness after sitting: leg weak and sore when getting up, takes a couple minutes to be stable
c) Femur: outer still feels bruised and sore to the touch 2 months post surgery
d) Tearing/pulling/ripping pain around incision at times when I stretch, can be very painful. Not all the time.

3. Meds: Only taking acetaminophen at night 1000 mg. Occasionally in day if really sore. Unable to take NSAIDS due to autoimmune disorder (microscopic lymphocytic colitis) No Tramadol since 2 weeks post surgery. Am taking curcumin/tumeric with perrine. glucosamine, probiotics, calcium.

4. Icing for 15-20 minutes on thigh when sore. Not icing very often, should I do it routinely? It helps some, but not for the tearing or stinging pain and even after icing there is pain for the first minute or two when I stand and walk.

5) Elevating when I sit in recliner, multiple times a day.

6) Activity level is high, I do all housework, gardening, daily activities. No restrictions except I avoid carrying heavy things up and down stairs.

7) I am not doing regular exercises beyond the original ones assigned that I do in bed at night and in morning.

10-20 reps ankle, leg slides, drops to outside and inside
I walk 2-4 miles a day and that always feels good.
I garden, clean house, etc. and move a lot then.
I have wondered if I should be doing a more routine series of stretches or exercises.
My surgeon and Bone forum members did not recommend PT for recovery.


****After contacting you with my original concerns I did have an appointment at 6 weeks with my surgeon. He said everything I was describing was normal, and would take perhaps 6-12 months to resolve. He discharged me and said to return in a year unless I had problems. I may be overly concerned about pain I am having but when it increases or something new appears it's hard for me to judge if it's "normal" or something I need to attend to.

Sorry for my delay in answering your questions. Thank you for your support.

 

[Josephine]

2.Pain: Overall little to no pain---1-3 EXCEPT :
a) Along incision site: outer thigh, stinging when touched or bumped (coupled with numbness in spots)
b) Stiffness after sitting: leg weak and sore when getting up, takes a couple minutes to be stable
c) Femur: outer still feels bruised and sore to the touch 2 months post surgery
d) Tearing/pulling/ripping pain around incision at times when I stretch, can be very painful. Not all the time.

@Debru4 sorry, but I really don't understand all this. Nowhere (between a and d) have you stated a pain score!

 

[Debru4]

Sorry I missed that @Josephine
2.Pain: Overall little to no pain---1-3 EXCEPT :
a) Pain: 7-8 :Along incision site: outer thigh, stinging when touched or bumped (coupled with numbness in spots)
b) Pain 5-6 :Stiffness after sitting: leg weak and sore when getting up, takes a couple minutes to be stable
c) Pain 4-5:Femur: outer still feels bruised and sore to the touch 2 months post surgery
d) Pain 8 :Tearing/pulling/ripping pain around incision at times when I stretch, can be very painful. Not all the time.

 

[Josephine]

2.Pain: Overall little to no pain---1-3 EXCEPT :
a) Pain: 7-8 :Along incision site: outer thigh, stinging when touched or bumped (coupled with numbness in spots)
b) Pain 5-6 :Stiffness after sitting: leg weak and sore when getting up, takes a couple minutes to be stable
c) Pain 4-5:Femur: outer still feels bruised and sore to the touch 2 months post surgery
d) Pain 8 :Tearing/pulling/ripping pain around incision at times when I stretch, can be very painful. Not all the time.

Those pain scores are pretty high for 5½ weeks out.

3. Meds: Only taking acetaminophen at night 1000 mg. Occasionally in day if really sore.
No Tramadol since 2 weeks post surgery. Am taking curcumin/tumeric with perrine, glucosamine, probiotics, calcium.

I see none in there that manage pain. The glucosamine if well known to NOT treat pain.
Why aren't you taking Tramadol? With those pain levels, you need to. And you're not taking enough Tylenol. I suggest you look at this chart and see how it goes.

4. Icing for 15-20 minutes on thigh when sore. Not icing very often, should I do it routinely? It helps some, but not for the tearing or stinging pain and even after icing there is pain for the first minute or two when I stand and walk.

You accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day.

6) Activity level is high, I do all housework, gardening, daily activities. No restrictions except I avoid carrying heavy things up and down stairs.

That's rather too much for 5½ weeks out. I suggest you go back to the second post in this thread and read the Recovery Guidelines as I fear you probably missed them! One was this Activity progression for THRs.

I am not doing regular exercises beyond the original ones assigned that I do in bed at night and in morning.
10-20 reps ankle, leg slides, drops to outside and inside
I walk 2-4 miles a day and that always feels good.
I garden, clean house, etc. and move a lot then.
I have wondered if I should be doing a more routine series of stretches or exercises.
My surgeon and Bone forum members did not recommend PT for recovery.

As you can see, I have crossed out ALL the exercises and such. In the Recovery Guidelines was this paragraph entitled BIG TIP

Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

 

[Debru4]

Thanks, @Josephine.

For most things I feel great, walking and doing activities included! I have been doing these activities since about 3 weeks out, with no extra pain meds and 80%+ of the time I am fine. I understand the stiffness when sitting, but am most worried about when I bump the outer leg incision, or take a large step/stretch and really have a lot of pain---ripping/searing. Those are the high number pain levels.

I imagine it is nerve damage from the surgery. Does icing help that? I will increase the icing for sure and make myself sit for longer spans. My doctor felt I was doing so well I should stop the Tramadol which I did after my 2 week appt. Mentally, and physically in general, I feel better off it. I will increase the Tylenol.
Both my surgeon and Bone Smart are in agreement on the exercise---I just asked because I wondered if there was something I could/should do to address the pain around my incision. It has healed well externally.

It sounds like you believe I am still dealing with a lot of inflammation which is what he commented on also at my final 6 week appt. Is there a time limit when if the burning is still there I should go back?

I appreciate the resources you shared and will reread everything now that you have responded. Thanks again.

 

[Josephine]

I imagine it is nerve damage from the surgery. Does icing help that?

No it won't. In fact, ice can make neuropathy worse.

My doctor felt I was doing so well I should stop the Tramadol which I did after my 2 week appt. Mentally, and physically in general, I feel better off it. I will increase the Tylenol.

Well I don't agree with him. I think you should at least be taking 50mg 3-4 times a day because your pain scores are far too high. A fact I think you may have underplayed to him, yes?

I just asked because I wondered if there was something I could/should do to address the pain around my incision. Is there a time limit when if the burning is still there I should go back?

If you are having such a pain (though you never cited a pain score number) then perhaps you should be prescribed gabapentin for a short period, may be about 6-12 weeks as this clearly appears to be nerve pain rather than the usual post-op pain.

 

[Debru4]

Thanks for your thoughts. I have increased Tylenol and icing. I was pretty specific with my doctor at my six week appt, but he saw how well I was moving and functioning and said my concerns were normal. I am feeling great the majority of the time, so maybe it is the contrast between no pain, and the stinging that has caused me to feel the pain level is high. I struggle with reporting pain levels in general. I will check back in with my doctor soon if the burning and stinging continue to ask about the gabapentin. Thank you.

 

[Debru4]

Just wanted to update---since my last post, I have been doing much better. I began taking tylenol twice a day, elevating and icing more often, and giving myself a few seconds after I stand up before I try to walk. I still am uncomfortable when I stand after sitting a bit, but with the pause, it isn't as painful. I've also been doing epsom salt baths, and massaging the area around the incision a few times a day. As a result I am not having the same ripping, searing pain I was having previously. I will still get a sting or pulling at times, but nothing like I was. I appreciate your advice to slow down and attend to the symptoms. I have been so lucky in general , and have felt so good that I don't think I accepted that this is a process, and it will be several months before the internal swelling and adjustments have resolved. Thanks!

@Josephine

I am two and a half months out from anterior hip replacement surgery. Is it too late to start creams to reduce incision scarring? I asked this question previously, but didn't get any responses. Thanks

 

[Pumpkin]

Most creams won't make a difference, some members like Active Scar Shield for their incision scar.
Your scar is still maturing and healing, possibly creams may help.

 

[Debru4]

@Pumpkln Is there a "magic time" when it is too early or too late to use a cream? When I was discharged by my surgeon at 6 weeks, the dr. said it was too soon. However, I've recently read that 10 weeks is "too late". It isn't a huge deal, but if there was something I could use to reduce the appearance I would, IF it actually was helpful. About half of the scar is pretty smooth----purplish and visible. The top 2-3 inches are still ropey and raised.

 

[SurreyGirl]

@Debru4 thanks so much for posting your questions. I am one week before you op wise and have similar issues with the tearing burning pain. I stopped using ice so much and massaged the area gently twice a day. I was also more careful with stairs and steps and reduced my stride when walking. All of this helped. I ice a bit at work but not constantly and when I get home from work and that helps with temporary swelling.

I now mainly get the tearing burning sensation when sitting sloppily at breakfast and leaning forward for too long! . My op was Posterior and I noticed that sleeping too far over on my op side caused things to stretch too much and then I would get the pain.

Your recovery seems to be going very well. You paid attention to the warnings about execessive PT and it seems to have worked out.

Hope it all continues to go well for you.

 

[Debru4]

SurreyGirl---I think I am a bit paranoid about pain. Now that the horrible debilitating pain from my hip is gone, I am so aware of any other unusual pain in the area. Plus, I feel great most of the time, so when I do get the searing pain, it catches my attention. I have always had a high pain tolerance level, many times to my detriment. I think maybe I am going the opposite direction with this hip, due to uncertainty about what to be worried about and what to ignore! It sounds like what you and I both are experiencing is normal (as my doctor suggested) and with some modifications in our activity and other minor adjustments, things will improve. I appreciate your response, and am hopeful you and I both will see a decrease in our ripping/tearing pain, and more pain free days ahead

 

[Josephine]

I am two and a half months out from anterior hip replacement surgery. Is it too late to start creams to reduce incision scarring? Is there a "magic time" when it is too early or too late to use a cream?

Why are you worrying about how your scar will heal? In my experience, incisional scars usually heal up pretty well when left alone. See these examples

 

[Layla]

Hi there, Happy Monday!
I'd try not to worry about minimal discomfort, or fleeting sensations. You'll have many.
Unless something is unrelenting, or escalating, I'd try to just carry on.
I hope you have a good day and a great week!
@Debru4

 

[Debru4]

@Layla---I always appreciate your positive, encouraging messages! I did so well initially, and think that I assumed that if I kept up at that rate, by now, I'd be totally pain-free. Unrealistic, I now realize. My goal was to get off of all medications for pain relief, including tylenol. (I can't take NSAIDS.) However, I have begun taking tylenol a couple times a day, and realize it helps. So I am trying to be flexible and more responsive to my body. Once again, thank you for clearly understanding the challenges and offering support.

 

[Debru4]

@Josephine --I have not had a surgery with this type of a scar before, so I do have a lot of questions about what to expect, what is normal. I have read/heard a variety of things about dealing with scars, and just wanted to ask the folks on Joint Forum for their advice. Thank you.