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[THR] Fiona UK recovery<

Discussion in 'Hip Replacement Recovery Area' started by Fiona444, Jul 8, 2019.

  1. Ptarmigan

    Ptarmigan senior

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    @Fiona444 What a relief to hear you are having moments of comfort at least between those upsetting bad episodes. So, it sounds like your medications do work some of the time.

    I also see you are very concerned- and understandably so - about the potential for developing a drug dependency. The BoneSmart Library has an excellent article about this, and it was in the group of recovery articles you’ve received, too.

    Until I had to taper off a drug to avoid “withdrawal”, I didn’t understand how this worked. The drug was an antidepressant, and I got brain “zaps”, sudden bursts of dizziness so intense I couldn’t stay on my feet. Yet we don’t say antidepressants are addicting, we say that you may need to taper when you stop taking them. I found the correct taper schedule for this drug, and was successful getting off it quite easily after I knew what to do. That’s the key: I just needed to learn how to taper correctly.

    I send you my best wishes for good communication with your doctor. I am so sorry that your nurses restricted your access to pain management so inappropriately. I know you can get this corrected with some effort; it’s just a challenging time to have to make that effort.
     
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  2. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    No, I just think you were unlucky in the doctors and nurses you were allocated. My GP prescribed me a whole box full of Tramadol for my knees and made no bones about it!
    This is always the case. Mostly it's because we tend to do more during the day and the consequences accumulate during the night. It happens to everyone.
    Read these
    Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers
    NSAIDs Diclofenac. ibuprofen increase risk of heart problems: new study
    Fiona, did you ever read the articles that were left for you in the first page of this thread? I think you should go back and read them now - or again, if you already did.



    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?
     
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  3. Fiona444

    Fiona444 member
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    @Ptarmigan thank you for your post it made lots of sense. My husband is picking me up a new prescription tomorrow for the tablets I already have. I will ask him to ask what i can do if i need additional meds.

    @Josephine thank you. Yes i did read the articles and have since reread them as it was a lot to take in. I would be very happy for you to ask me any questions
     
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  4. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Jolly good! 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.
     
  5. Fiona444

    Fiona444 member
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    @Josephine
    1. Posterior

    2. Lying still in bed I ache a bit. Possibly level 2.
    Lifting my leg to get out of bed level 7.
    Once I am moving on my crutches level 5.
    Certain movements like getting down onto toilet increase to level 6.
    Last night I woke up in pain with any movement causing 8/9

    3. Codeine 60 mg x4 per day. Nefopam 60mg x3 per day. Paracetamol 4000mg per day.

    4. I have cool packs on my hip all the time. Although at night they melt and I spend some time without

    5. I am in bed with my legs on 1 pillow constantly, 2 pillows made my leg ache after a while.

    6. I am only taking trips to the bathroom. I walked about 20 steps round my bedroom but got light headed

    7. Standing movements x 5 -
    knee lift about 45 degrees.
    Heel lift 45 degrees.
    Adduction 10 degrees.
    Straight leg out behind.
    Bed movements x3 -leg out to side (same movement as getting out of bed) lifting knee upwards with heel on bed.
    Pressing leg into bed.
    Squeezing buttocks.
    I did the above 3 times today

    I hope that is all the answers you need. Many thanks
     
  6. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Well gosh, you're only 4 days out! All of this is very par for the course.
    I'm not sure these meds are best for you. I'd recommend Tramadol 50-100mg every 4-6 hours along with 2 paracetamol each time. If you feel up to it, I suggest you see if your GP will accept your suggestion.
    Yes, it's not easy that.
    Okay
    That's a correct amount of ambulation at this stage. Did you read the "Activity Progression" article?

    Basic rule (as explained in the Recovery Guidelines)

    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.

    If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?
     
  7. Fiona444

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    Thanks @Josephine. I will see if I can speak to GP tomorrow. The nefopam I really don't think does much for me. I have read the activity progression article. Can you tell me why they give all the exercises when they are not in everyone's best interest?
     
  8. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Tell him you don't think it's helping you and can you please suggest Tramadol instead.
    Because they don't know any better, think they know best (they don't) and are stuck in a rut of 'this is the 'good' advice'!
     
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  9. Fiona444

    Fiona444 member
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    Thank you very much for your advice @Josephine
     
  10. Calgal

    Calgal member

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    Fiona Im glad Josephine stepped in to reassure you that, at only 4 days out, things are rough. I re-read my own journal of my first days at home and although I got my pain cocktail ok, my leg was stiff and swollen and yes uncomfortable, and every movement was a major effort. I spent a LOT of time in bed, catching sleep whenever. It was a challenge to find a comfortable position, but the moments when that happened it was bliss...only to be interrupted by having to get up to pee! Things will get better. Have faith. Hoping you find more and more moments of minimal pain bliss. :yes!:
     
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  11. Fiona444

    Fiona444 member
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    Hi @Calgal thanks for dropping by and offering some reassurance. I dont think I realised how tough this would be. Yes getting up to pee takes guts and planning ! I didnt wake myself in the night in agony which was lovely but i did take an extra dose of codeine at 11.30 and went through to 4.30. I am quite comfortable in bed but the pain is bad when i weight bear and get out of bed. Was that the same for you ?
     
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  12. Calgal

    Calgal member

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    I was awake every 4 hours early days and inevitably it was time for another codeine and/or paracetamol, so that took me through the nights. Good to hear your night was more bearable. Yes it was more uncomfortable when my log leg went vertical. Are you using those TED compression stockings? I had them on all the time (even overnight) except about 45 minutes off when I showered in the mornings. Some docs don't prescribe them but mine did (I lasted 4 weeks out of 6) and to be honest, they felt good and like they prevented fluid pooling in my lower legs. Now that I think about it, Im sure I really babied my op leg the first week, and although I remember I did put weight on it I relied on the crutch a lot so was probably not putting full weight on it.
     
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  13. linette333

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    Pleased to hear that you had a better night @Fiona444 . It's such a shame that you have had these problems with the pain management. No, I never expected recovery to be this hard either! Every day seems to bring a different problem! But at the same time, I certainly don't regret having the op. I only have to think back to how I was the week before and how limited my life was becoming to know that it was the right decision. The improvements will soon start to show up for you too.
    @Calgal I only wore the hateful stockings for 2 weeks out of the 6! My leg was massively swollen and the swelling disappeared without them. I am a little worried about what my surgeon will say when I turn up without them in a week's time !
    I really hope that you can finally get the medication on track today. I see the jury seems to be out on Tramadol .... :umm:
     
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  14. Elf1

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    @Fiona444 sorry you're still trying to get the meds sorted out. I'm not real familiar with the nefopam, looked it up the other day when you were talking about it. Have no personal experience to add though. I do know that Tramadol has been a mainstay in my pain management regime over the years. Even though it's not technically part of the plan from my OS I do believe he factored it into my meds. Yesterday early in the day I switched from the Hydrocodone to 1 50 mg Tramadol with 2 500 mg Tylenol and it made a world of difference. 6 hours later took another round of the same only switching back to the hydrocodone at bed time. Added the acetaminophen with the hydrocodone into my daily totals so I wouldn't go over. Had a lot clearer head during the day and am working on doing as little as possible. Still having some incision/surgery pain but it's doable after what I was having prior to surgery. It's going to take us time, slow time. Sounds like you did great on the sleep side though. I actually managed to sleep in the bed last night and be able to get up to go pee unassisted. I'm taking that as a win! Gentle hugs coming your way! :friends:
     
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  15. Fiona444

    Fiona444 member
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    @Calgal I am lucky as no stockings needed. Apparently NICE have decided that they are not beneficial. I feel blessed! I am also lucky in that i don’t appear to have any lower leg swelling although i have a bottom like Beyonce :rofsign:

    @linette333 it is comforting to know that I am not alone in finding the recovery a bit tough. I think the pain from the outset being so severe has had an impact. Thankfully today the pain is much more manageable. As I seem to have worked out a good routine with the medication I have I decided not to ask the GP for Tramadol at this stage but what I did ask for was extra codeine. Today hubs went to pick it up and they have dispensed co-codamol which is codeine and paracetamol together. This made me angry as I want to be able to split the codeine and paracetamol doses throughout the day to make sure I always had painkillers on board. Plus I explained all this on the phone and they didn’t listen. I am now waiting again for a call back to see if they can do as I ask.

    @elf I was given Tramadol when I broke my leg and it really is effective. I am sure I would have been better off if they gave me that from the start. I am delighted your head is clearer and hope that you are managing to rest fully. An unassisted pee is huge success. Dignity reclaimed :loll:

    My incision doesn’t seem to hurt it’s inside the hip and groin that give me most pain. Like I said though it's more manageable today although I still have not moved from my bed
     
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  16. Calgal

    Calgal member

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    I didn't wear mine to either PT or OS at last week's 6 week appointments and ....they didn't even notice!!! So we did the right thing listening to out bodies and deciding when it was right to ditch them. They only felt good for me the first week or so anyway. Sorta like 'spanx' control underwear! :rotfl:
     
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  17. Calgal

    Calgal member

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    I did too! I said mine was Kardashian! Good thing they are so fashionable these days, although only having it on one side was realllllly weird!!! :flabber:. I am happy to report that the Beyonce butt does go away! I've now just got sort of a saddlebag on my right outer leg that thankfully isn't on the left. I had to go out and buy some soft loose shorts for comfort.
     
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    Last edited: Jul 12, 2019
  18. Fiona444

    Fiona444 member
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    So I asked my GP to prescribe extra codeine and my hubs went down and gave them the slip from hospital showing dose on Wednesday. They told hubs to get me to call the following day to see how they were getting on. When I called they had no clue about the request. So I went through it all, explained I wanted codeine 30mg. Today they have prescribed co-codamol. Totally angry, I called them and explained again why I wanted straight codeine so I could manage my pain and doses of paracetamol etc. They assured me they would speak to GP and call me. No call and now they are closed for the weekend. Beyond annoyed at this total incompetence and lack of care.

    On the plus side my pain is much better. I managed to sit downstairs and have dinner like a normal person :loll:
     
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  19. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    I am at a loss as to why you asked for codeine when you already admitted that you found Tramadol a more effective pain med. Besides which, they will always prescribe you co-codamol because it's a much cheaper medication than prescribing codeine and paracetamol separately. You'll never win this one, I'm afraid.
     
  20. Fiona444

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    I had already requested codeine phosphate prior to our tramadol discussion and given that my pain was easier yesterday i thought it would be ok. I did not ask them to prescribe paracetamol.
     

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