TKR Desperate for recovery advice<

[buddydog]

1.level 8; stabbing, pounding, throbbing, stiff, aching

2. please note that I have not been sent my script so I have been off all codone since 7/21 Saturday cold turkey.
Have taken some gabapentin for what feels like nerve pain, very severe.
Hydrocodone/acetaminophen 5-325 mg 1-2 tabs every 4-6 hrs; discontinued because of pain
oxycodone acetaminophen 5-325 mg 1-2 tabs every 4-6 hrs;
methylprednisolone 4 mg dose pack; titrated for 6 days. finished no longer taking
gabapentin 300 mg 1 capsule 2x day; not consistently taking

3. swelling moderate

4. 120; extend almost to surface (not given a number)

5. icing 8x day 30 mins; at night, most of night

6. elevating 6x day, hour

7. Not much activity. Light dusting; making bed; cleaning bathroom; haven't really been out. Walk in back yard and sometimes down the sidewalk.

3 a day x 2 hours
glute tightening 50 reps 2x day;
quad tightening 60 reps 3x day;
heel slides 20 reps 2x day
bike for 10 mins.
5 standing adductor press out
toe raises 2 min
5 step up with calf stretch tool
heel slides 20 2 sets

art (active release?) 5 min
press downs on leg (leg extension machine) to stretch flat 5 min
small leg press 2 min
hamstring curls 20 reps

I don't have camera but will submit photo asap
please let me know if i did this correctly. thanks!

 

[buddydog]

By the way, I am rather stuck. The primary doc does not want to get involved with this surgeon at all. Puts me in a grim position.

Mumu, your experience is unbelievable! I could cry! That's the way this facility made this sound, especially with their 'diamond care coordinators'. not for me.

Spex10, pass? Like a kidney stone? Ha! I wish I had the courage to tell the doc a few things, especially when you realize they are young enough to be your kids! I would slap my son silly if he ever treated someone like this.

Thanks Celle! I just meant relief for the hip flexor.

 

[lovetocookandsew]

i wish i had the courage to tell the doc a few things, espec when you realize they are young enough to be our kids!

I'm not afraid to tell my doctor anything-he works for me, I don't work for him. Granted, he's a gem, but I have let him know my feelings and thoughts many times. He's always been patient, isn't afraid to kindly let me know if I am getting something wrong, has never given up on me, and what's even more important-he hasn't strangled me yet. Now, that's patience! And, he's only a few years younger than me, even though he looks a lot younger. I really had thought he was in his mid forties at most, until he told me how old he is-I was so surprised. Of course all the gray hairs I've given him have made him look a little older lately.

But seriously, don't be afraid to stand up for yourself and refuse to be treated that way. If my doctor berated me for anything at any time, I would not allow it. If he has something to tell me or disagrees with me, he is welcome to sit down and tell me calmly like an adult during an office visit, or by phone or email if needs be. No one likes confrontation, but we must stand up to bullies of all kinds, otherwise they will only get worse. As for his office assistant-tell her your pain levels and meds are the business of the doctor, and you will speak to him about it only. If she berates you again, let her know you don't allow children to speak to you that way and if she wants to have a respectful adult conversation you're happy to speak with her, otherwise she may be silent.

 

[HoneyB]

@Celle - The items @buddydog asked me to provide are stretches that have nothing to do with the knee. They are a hip flexor stretch (done lying on my back while completely still) and a piriformis stretch (which requires the knee to be bent to do the stretch, but does not stress/exercise the knee). I don't think they have anything to do with the more "athletic" type physical therapy I'm doing for my knee. I'm doing hip flexor stretch on my right side because my right hip is rotated slightly forward due to muscular imbalance, most likely caused by the way I've sat at a desk for 30 years. I'm doing the piriformis stretch on both sides to further loosen that same area and to guard against sciatic nerve issues.

 

[Celle]

@HoneyB and @buddydog - I understand both of you. However, I'm trying to advise buddydog to stop all exercises until his pain settles down.

 

[buddydog]

Thanks! and wow! You're right and I hope that's how I handle it tomorrow! You should be a medical advocate - we need them!!

 

[pacosmom]

I’m sorry you’re in such pain! I started going to sn absolutely wonderful chiropractor at about 6 weeks out. Changed my life lol not only did I find I had issues with my back & neck that I was not aware of, he has been awesome with my knee/leg. Just the first couple of adjustments to get my pelvis lined correctly helped with walking even though I didn’t have great ROM. He gets in & massages the leg muscles that aren’t working very well much harder than my PT and it feels so good. I think honestly it really helped me with the “blues” also. I feel much more like myself mentally. Maybe worth a try.

 

[arizonaone]

Omg. I have to tell you that I have been through a lot since my surgery so I haven't posted at all . Just been reading others on the forum.

But when I read your story I felt so badly I had to respond. How dare he!!!??? I'm so sorry. I can't imagine. I remember crying in pre op with my doctor and he was so sweet about it

I know when we are in pain it is so hard to advocate for our self.

Is there someone that can for you? Can your primary care Dr refer you to a pain management Dr. ? When my pain became unbearable to on day two my OS had a pain MGMT doctor come to see me in the hospital and he really helped . Unfortunately with all the changes in the opioid laws doctors are really skittish in prescribing pain meds. Which after surgery is ridiculous .

Your story reminded me of my mother's surgeon she had for emergency gall bladder surgery. To make a long story really short I wasn't happy with her care before surgery so I called his office and he called me back. Talk about a holier than thou complex he was so nasty he went up one side of me and down the other screaming ranting and raving . NEVER been spoken to like this by a doctor before. When he was finished I screamed right back at him . Guess he wasn't used to that because he threatened not do do my mother's surgery but he did .

Please don't let your OS or his unprofessional assistant bully you. And please continue to let us know how you are doing .My thoughts are with you and I hope you feel better.

 

[Josephine]

1. level 8; stabbing, pounding, throbbing, stiff, aching

And don;t forget the swelling! AT 5½ weeks that's a LOT of pain!

2. please note that I have not been sent my script so I have been off all codone since 7/21 Saturday cold turkey.
Have taken some gabapentin for what feels like nerve pain, very severe. gabapentin 300 mg 1 capsule 2x day; not consistently taking
Hydrocodone/acetaminophen 5-325 mg 1-2 tabs every 4-6 hrs; discontinued because of pain
oxycodone acetaminophen 5-325 mg 1-2 tabs every 4-6 hrs;
methylprednisolone 4 mg dose pack; titrated for 6 days. finished no longer taking

What 'codone' have you been off? Is that hydrocodone or codeine?
Gabapentine: is meant to be taken on a regular schedule not just now and then. It's very important you stick to the prescribed schedule.
What do you mean that the Hydrocodone/acetaminophen was discontinued because of pain? I don't understand that.
If you can't get any other pain meds, I suggest you try Tylenol 1,000mg 4 times a day (every 6 hours). It's not the best but it's better than nothing.

3. swelling moderate

oh dear!

4. 120; extend almost to surface (not given a number)

Well all things considered, that's not at all bad.
As for the extension, you can estimate that yourself using this technique

1. put your leg on a bench, seat, bed, floor or anything similar but preferably something fairly firm.
2. with not too much pressure, press the back of your knee down - use your leg muscles, not your hand!
3. slide your hand, palm down, under the back of your knee

a) if you can get your entire hand under easily, it's probably about +10 degrees
b) if you can get just your fingers under, it's about +5
c) if you can get your fingers under but it's a push, it's +0
d) if you can't get your fingers under at all, it's -5 or more​

Here's a graphic to explain the degrees involved

5. icing 8x day 30 mins; at night, most of night

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

6. elevating 6x day, hour

Elevate when you ice

7. Not much activity. Light dusting; making bed; cleaning bathroom; haven't really been out. Walk in back yard and sometimes down the sidewalk.

Jolly good!

3 a day x 2 hours
glute tightening 50 reps 2x day;
quad tightening 60 reps 3x day;
heel slides 20 reps 2x day
bike for 10 mins.
5 standing adductor press out
toe raises 2 min
5 step up with calf stretch tool
heel slides 20 2 sets
art (active release?) 5 min

You don't need to do any of these. They are what is causing your swelling and pain - though not having any pain meds doesn't help either, of course!

press downs on leg (leg extension machine) to stretch flat 5 min
small leg press 2 min
hamstring curls 20 reps

You should NOT be using gym machines. They will only make things worse.
I suggest you quit all this stuff and allow your leg to settle down which should help the swelling to settle down too.

I hope that's how I handle it tomorrow! You should be a medical advocate - we need them!!

We are always advocating this. With a vengeance. If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?

 

[buddydog]

My legs are so awful looking - they have been rather swollen and flabby for years, so if it's adequate for you, my operated leg is 2 inches larger than my good leg (good leg 17"). This operated knee has also been swollen for years.

What 'codone' have you been off? Is that hydrocodone or codeine?

Well, I have been on oxycodone since my second or third week - 8-12 times a day! But on Saturday I ran out and have been without anything since. However today, they now want me back on hydrocodone 5-325mg 1-2 tabs every 4-6 hours.

Gabapentine: is meant to be taken on a regular schedule not just now and then. It's very important you stick to the prescribed schedule.

ok!

What do you mean that the Hydrocodone/acetaminophen was discontinued because of pain? I don't understand that.

When I left the hospital, they had me on hydrocodone but it wasn't helping so they switched to oxycodone. This is what I ran out of and the script just got here 6 days later. but they are trying to wean me down onto the hydrocodone. The PA said if it didn't work, they would arrange for the oxycodone again.

Just had my husband try it and he said D. I know the PT has said that there is no problem with extension but I will ask for her number also.

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

My bad! I ice for a good 45 mins to an hour.

Elevate when you ice

ok

You don't need to do any of these. They are what is causing your swelling and pain - though not having any pain meds doesn't help either, of course!

OMG so discouraging that I did this to myself!

Josephine, what about the at home exercises? Are those ok that I do?

I have to tell you that after traveling 2 hours to see the 'doctor' today for 6 wk check up, I didn't even get so much as a hello from him and the PA was sent in. He was nice. They took xrays and he said all looks good. Any of my concerns about aggressive PT, nerve pain in my lateral side and foot, he said not to worry about and the nerve pain should pass with time.

My leg looks so swollen to me but he said he thought it looked good and that I was ahead of the game as far as flexion. However, he never measured me. Just went with what I told him my PT said the numbers were. As far as the pain, he asked if it was better than right after surgery - of course it is but it is still rough. He said that everyone heals differently.

This is a difficult journey to say the least; I don't know what I would do without this forum.

As far as PT goes, you're saying just dump it for now? And yet you should hear how the PA the PT and others terrify me with this scar tissue that forms like a monster and takes over your every ability to move!

I will read 'saying no to therapy'.

Thank you Josephine and Celle and everyone.

I did go for a massage and it was great but very pricey. Will see chiropractor on Monday.

 

[buddydog]

arizonaone, thanks for your kind words. I am so dismantled that its tough to know what mistreatment is - even though my heart tells me otherwise. I have a sports med doctor and I think I will ask him if he will advise about pain management but I am going to lay off PT as advised for now. My family doctor is rather useless.

 

[Dizzy]

First of all, we TK R patients are really getting screwed over because of this whole opioid issue! I'm my opinion, this surgery REQUIRES oxycodone or any other narcotic because of the unbelievable pain we have to endure. These doctors that are so reluctant to prescribe it certainly have not had this procedure done to them!! Very cruel to leave a patient hanging and in pain!

Secondly, too much emphasis is put on the need for PT. And we, the patients, do and overdo because we are told it's necessary to do this to be better and out of pain, which is our ultimate goal. Common sense tells us we are doing too much but we want to rush to get the end result, which is a normal, pain free life.

I have realized that when they say a year of recovery, it means a year and maybe then some!!!! I think we feel that we'll be the exception to that rule so we push but we are not in charge!!! The knee is!!!!

It's frustrating beyond belief but that's just the way it is. So I think the moral is stop punishing yourself with all the exercising and PT. You're not helping your recovery. You may be hurting it. Take all the meds they are willing to give you and ask for more. As my OS told me "this is when you need them, you will know when you don't".

This experience has been the most challenging of my life and I've got the other leg to do. I thank God we only have two legs!!!

 

[Josephine]

Just had my husband try it and he said D

So that would be minus 5 or more.

what about the at home exercises? Are those ok that I do?

Honey, I don't differentiate between PT and exercises at home. It's all one to me. And when I suggest you stop it all, I'm referring to both PT and home exercises. Look at it this way - your knee doesn't know the difference either!

 

[buddydog]

OK. I canceled my PT and haven't done anything at home. The only concern I have is that my quads are very lax and not firing. They weren't good beforehand either. Also, I am not sleeping due to pain - especially in hip. If anyone has suggestions please let me know.

On top of all this my cat bit me so they now want me on Keflex. It never seems to end!

thanks for all

 

[Spex10]

Naughty puss! As if you don't have enough to worry about.
Just walk up and down as you live your life. That's good exercise and will involve quads without stressing them. Build slowly.

 

[buddydog]

this is not pretty in the least as my legs are large and not toned but would like your assessment on the swelling

 

[buddydog]

That's what I've been doing... it's just the PT put a heel lift in my shoe because she says my gait is so off. However the docs office says not to use it! ughhh. I will continue to walk as much as possible. The other knee being so bad is definitely not helping. Thanks!!

 

[Jockette]

It’s so hard when trying to help one body part it upsets a different one!

 

[Josephine]

Also, I am not sleeping due to pain - especially in hip.

Take a look at this and see if it fits - let me know if it is or not Trochanteric bursitis

would like your assessment on the swelling

It looks a bit swollen but it would have helped if you're have shown both legs!

 

[buddydog]

ok. . . let me see if I can get that pic to you.

I looked at the hip link - it sounds right but I can't tell you how many times I have had it injected with no help when they said trochanter bursitis. This is deep in hip towards the groin and boy do I have a lump on my buttock muscle too - it all feels like bundled tight muscles. I have been told it is more piriformis but no one knows what to do with it.and I will tell you this - I laid off PT for about one week to test your theory and was feeling good. Then went back and felt horrible.

But my concern is that the PT says that my quad is not firing and I have to get it stronger. I notice even the other knee is declining quickly and as you can tell by my leg pic, my muscle tone is severely lacking.

The PT feels that the hip and groin pain is coming from the back or hip and that my gait is so off that it is causing more pain which I don't doubt because I am really waddling. I am barely using a cane now.

Also, please let me know if you have ever heard of foot shaking after surgery. At first I thought it was because I just had surgery but now, with so much pain still, although it has declined, I'm wondering if I have some nerve damage or irritation. I notice this even at rest.

And if I'm not panicking enough, after PT, my leg has this awful grind each time I extend it. sighhhh.

sorry if i have already asked some of these questions! thank you for everything again! and your patience