TKR Dr. vs Ins on pain meds

[ks1960]

And yet , all I really want is to be able to cut my toe nails!!!

 

[newlybionic]

You will get there hopefully before they get out of control!

 

[KarriB]

Get a pedicure! After a TKR you deserve to be pampered.

 

[ks1960]

Well ****, I have been feeling pretty smug and pleased with my progress and today my "other" knee (the knee formerly known as the good knee) announced it has had enough and would like a few days off. Much foul language and whining met this announcement.

But, at the three week mark my ROM was 85, I am able to walk without the cane although I keep it with me for balance, and I was able to make it to the chicken house to collect eggs. Sure, this may be a pie euphoria, but I'll take it!!

 

[Pumpkin]

ks1960,
Sounds like you are on your way to healing, and figuring out what to do with your formerly good knee.
Hope all settles down and you can enjoy your new knee.

 

[ks1960]

Day 26 - I decided today was the day I would give up pain medication and shift to Tylenol. Because, well, because there are other people who seem to be able to get by with Tylenol at four weeks.

Fine, I am not one of them. Made it 14 hours and have taken a hydrocodone. Not beating myself up about it, well, not much. The relief from the pain is enough to keep me from feeling like a medication failure.... honestly, I am not sure what Tylenol is good for!!

 

[FlaGranny]

I have been off hydocodone since week 3 for my first and second kneesl. I stopped Tylenol a few days ago and found there was no difference so I stopped that too. The Tylenol did help at first, but recently not so much. I'm now on occasional naproxen. I guess most of my pain is now coming from inflammation.

 

[KarriB]

Stopping pain medication all in one day isn't good. It's best to cut back slowly. I found that after 3-4 weeks I didn't need a full dose of the oxy I was prescribed. First I forgot a dose, then went a bit longer each day between doses. Because of my second surgery I went back to 5mg of oxycodone, but realized after a week that I didn't need it as I was just sitting all the time with my leg elevated. No bending etc., but once I began bending again I started taking the 5mg of oxycodone again and later cutting back slowly.

You can call your OS to ask for tramadol which is a step down medication, or just cut down slowly, but don't stop all meds in one day. You might try cutting a pill in half to see if that manages your pain and would be another way to cut back slowly.

Remember everyone is different, every knee is different. Don't compare your recovery to anyone else.

 

[Celle]

The time to cut back on your pain medication is when you find you are forgetting doses and not feeling any increase in pain -and not before then!
Then reduce the doses gradually.

 

[Sheepdogn]

Kate - funny to read through your thread. I'm 2 weeks behind you, my "good" knee sounds about as happy as yours (can't wait to get it replaced), I'm in NC and sitting here looking out the window over my sheep pasture and wishing i could get out there. One thing i read on here that helped me a little bit was an explanation of the difference between being dependent on pain meds vs addicted. We aren't past the pain and taking drugs to "feel good" (addicted), we need them (depend on them) to rightfully manage pain. And pain slows down the healing process. I've had a hard time internalizing that, and still have to have a little conversation with myself about it when i think i can "go a little longer" before the next dose.

 

[kneeper]

Day 26 - I decided today was the day I would give up pain medication and shift to Tylenol. Because, well, because there are other people who seem to be able to get by with Tylenol at four weeks.

It's not a contest We are all different. I found the best way was to gradually try to spread out doses. I don't think I switched from every 4 hours to every 5 until about 4 weeks. It is somewhat trial and error.

 

[Jamie]

@Sheepdogn .... you have it EXACTLY right about the reason for taking prescription pain meds after a TKR. Most people really need the help of this medication and it's important to give ourselves permission to do everything we can to help our recovery. Should dependence occur (and it doesn't for everyone), the phased withdrawal from pain meds when needed is a small price to pay for the benefits of proper pain management in those first few months. Keep having that talk with yourself.

 

[ks1960]

I did do this gradually, not always by choice though. I am extremely organized, so it is tough to deal with progression that is not linear. I guess we will call it a growth opportunity.

Week 1 - 10 mg oxycodone every 4 hours
Week 2 - 5 mg oxycodone every 6 hours (10 at night)
Week 3 - 5 mg hydrocodone every 6 hours; this was not working and I flipped back to oxy, 5 mg every 8 hours
Week 4 - 5 mg hydrocodone twice a day, 5 mg oxy at night (except last night when the shooting pains were so bad they pushed me to 10 mg). So far this morning, the 5 mg of hydrocodone is working well and managing the pain. I may have done too much yesterday and am taking it easier today. Well, that is the plan - but it is only 9:00 a.m. so we will see how it goes!!

 

[KarriB]

Love your new pic!

You'll find that in most cases TKR recovery isn't linear. It tends to be more of a roller coaster ride, with the ups and downs that come with it. Did the plan work or were you still in pain after cutting back?

 

[ks1960]

Today was actually great (in a "I wish I had never done this" kind of way).

7:00 a.m. - 5 mg hydrocodone
8:00 a.m. - 5 minutes of exercise bike (can't go all the way around yet); 3 sets of slides, lifts, flexes, and stretches
9:00 a.m. - processed loofah gourds for an hour (sitting); washed bedspread
10:00 a.m. - made breakfast and ate at the table like a real person
10:30 a.m - recliner and ice
2:00 p.m. - 30 minutes of spinning wool into yarn
2:30 p.m. - 5 mg hydrocodone; sets of slides, raises, flexes
3:00 p.m. - ice and elevate
5:30 p.m. - walk to the hen house with chicken snack, collect eggs
6:00 p.m. - make a smoothie for dinner
7:30 p.m. - 5 mg oxycodone. Enjoying a few crackers and will call it a day in an hour

 

[KarriB]

Just think, Kate, three weeks ago you were wishing you could walk down to the hen house and today you did it! This recovery is sloooooow and patience is required. Now, imagine what you'll be able to do in another three weeks.

 

[Jamie]

Week 1 - 10 mg oxycodone every 4 hours
Week 2 - 5 mg oxycodone every 6 hours (10 at night)
Week 3 - 5 mg hydrocodone every 6 hours; this was not working and I flipped back to oxy, 5 mg every 8 hours
Week 4 - 5 mg hydrocodone twice a day, 5 mg oxy at night (except last night when the shooting pains were so bad they pushed me to 10 mg).

One suggestion when you devise a schedule like this. Don't cut two things at once as it can be too much at a time. Week 2 should have been something like 5mg (down from 10) every 4 hours. You want to stay with the 4 hours doses at the beginning of withdrawal because all prescription pain meds usually last about 4 hours. This gives you the best opportunity for success.

When stepping down from a stronger drug like oxycodone to hydrocodone, the same applies. For Week 3 you should have done 5mg hydrocodone ever 4 hours for a week before trying to extend the time to every 6 hours.

You don't always have to wait a week before making a change, but obviously the slower the better. Do at least 3 days at each level. Nights can be much worse, so using something stronger at night is fine. Also, don't forget to ice when you sleep. It works wonders for pain.

 

[ks1960]

Week 6 - tomorrow starts my sixth week.
Work - disability insurer still says I to back to work at 6 weeks, and my dr. Says 8 weeks, so not really sure what's up with that
Pain - so much better, but I thought by now it would be gone, so I am still whining about it. Pretty much down to pain meds on demand, which typically is 5 mg hydrocodone at 9:00 a.m. and 5 mg oxycodone at 7:00 p.m. I am out of the oxy so will drop back to the hydrocodone. Pain is much worse at night. Tried dropping to tramadol, which is pretty much like taking M&Ms as far as I can tell.
ROM - 0 extension / 90 flex.
PT - I think this week will be my last PT. I can do all of the exercises at home, and am satisfied with my progress.
Life - i still spend more time sitting than I would like, elevating and icing. More than 10-15 minutes on my feet is painful; sitting more than 30 minutes is painful. I am walking okay, still stiff on the bend, use the cane for balance outside. Doing alternate steps in the stairs about half the time, but have to use the rail to support myself.
Attitude - still regret having the surgery as I am still worse off than before, but I acknowledge it may get better at some point!!

 

[KarriB]

It will get better. I felt very lazy while recovering from my TKR. I spent the first 4 weeks doing a lot of sitting/elevating as that was the least painful option. Then a second surgery which meant more sitting. But I came to realize that it was what was best for my body and knee. Here's the activity progression chart, just yo remind you what you can be doing and it's ok to relax.

https://bonesmart.org/forum/threads/activity-progression-for-tkrs.14334/

Can your OS write an 8 week return to work that would satisfy disability?

 

[ks1960]

I will not be competitive
I will not be competitive
I will not be.....

I was very pleased at PT today, when I discovered I could make the whole rotation on the bike, and that I could flex a full two inches more on the passive stretch machine. And then my ROM measured at 87, and made me feel inadequate. Well, it was more the happy man next to me talking about how thrilled he is with the surgery, with the almost invisible scar, who walks without a cane or a limp, with an ROM of 115, who had his surgery two weeks AFTER me.