TKR Gingerbread's RTKR Recovery Marathon

[Gingerbread]

I am 49, 5'5",145 lb female. I have a history of breast cancer, hypothyroidism, Anemia, several other minor & major surgies. Nothing compares to this. My MD wants me off Oxycodone and weaned to Tramadol. I am trying, the more I try the worse it gets. Is it supposed to be this way? I have never had pain like this. My poor husband is having a heck of a time caring for me. I can barely walk more than to the bathroom and back. I go to PT and can do those exercises but those seem to make it worse. The worst time is between 8 pm- 8 am. I am terrified as I am going backwards not forwards and I am afraid my doctor isn't going to give me the meds I need to make it through. 7 out of the past 11 nights I could have gone to the ER it was so bad. Please, does anyone have any helpful advice or stories for me? I'm so distraught right now. Do doctors just deny medication to patients now? I cant fathom it and don't know what I'll do.

 

[Rain Dancer]

I am sure that the moderators will jump on soon with additional advice. Since day 2, I have been taking only Advil and Tylenol because of issues with Tramadol. I was under medicated and developed the following strategies. I ice and elevate (toes above nose) whenever I am not walking about. I experimented with not icing for several hours, and it did not go well. I permit only gentle PT—no one touches my knee except me, and I don’t use any devices to force a better bend. Finally, I walk and do housework in 10-15 minute chunks of time. It sounds counter intuitive, but the longer I stay on my feet, the less pain I feel. I am sorry that you are in so much pain. I hope that you get relief soon.

 

[Sisterpat]

@Gingerbread, relax! This is a major, traumatic surgery which you have had just over a week ago! Like most of us, you were totally unprepared for the challenges of this recovery. And let me say at the outset, this is an average full year’s recovery. The first 3 weeks are very tough. Things will get better, I promise. Sometimes, according to what I have read here, Tramadol works better than opioids. It’s a trial and error thing.

Is PT working your knee too much? If so, you need to say NO to any exercises that cause pain. At this point, gentle stretching and walking around your house is all you need.
Next, are you elevating and icing MOST of the day? You should be.
Nights are difficult for all of us for many weeks. Try to nap during the day to get some rest.
Do not panic! The stress is not helping. You will get through this.
Here are our guidelines.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
4. PT or exercise can be useful BUT take note of these
the BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy
5. At week 4 and after you should follow this
Activity progression for TKRs
6. Access these pages on the website
Oral And Intravenous Pain Medications
Wound Care In Hospital

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds


We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[Jo Wo]

Your body has been through so much before this surgery! It needs extra TLC and just getting the pain under control so you can walk about and get some healing good sleep perhaps.

 

[Pumpkin]

Gingerbread,
Call and let your surgeon know the amount of pain you are having. In the meantime you have been given good advice to ice and elevate most of the time. A walk around the house every hour or so will help.

If you have seen a pain specialist in the past call and make an appointment, then may be able to help you with better pain management.
Ask your PT for help with the swelling, retrograde massage, lymphatic drainage, or other gentle manual therapy.

A cookie cutter approach to pain management does not work for everyone, be sure your surgeon knows the pain you are having is setting back your recovery. Let him know if you have increased swelling, decreased mobility and ability to exercise, and tell him the pain is so bad you cannot make it to the bathroom in time.

 

[Gingerbread]

Thank you everyone. I am a nurse btw who took care of sub-acute rehab THR, TKR, wounds, cardiac, etc.. That was over 10 years ago and the protocol I remember was everyone had a Fentanyl patch along with hydrocodone. So if someone was in agonizing pain there was something extraneous going on and our doctors took care of it right away. I don't ever recall our doctors declining a patient in agony that's why I'm floored at what's going on. In my time of need I have to be terrified of not having what I need. It's a scary feeling. Your responses are very helpful. It's hard to nurse myself in this condition.

 

[MonarchMama]

Gingerbread: You absolutely should not have to endure this much pain. Call your doctor and insist that s/he give you something to relieve your agony. I am so sorry that you are suffering so. It's not right!

 

[kneeper]

I agree that you should talk to your doctor about a regimen. It's one thing to to want to reduce the narcotics and another to not offer a plan such as adding in an NSAID etc.

I was lucky because when I had mine they were conscious of the problem of opioids in this country but had a reasonable step down protocol that was largely done in consultation with the patient. I can tell you that at 10 days I was not tapering down yet. I think it was around week 3 that I started spacing out doses. My OS would prescribe short term refills. I basically talked to the nurse about my symptoms, how often I was taking the meds etc.

At 10 days my main activities were taking a shower, doing a little walking in the house and doing a few heel slide. The rest of the day it was icing and elevating.

Even on decent meds, evenings tend to be when all the activities of the day tend to hit us and the pain may go up. What are you doing re: icing? I tended to do a really good ice session right before going to sleep (as well as during the day).

 

[Gingerbread]

Hi! I am icing frequently with the ice machine I came home from the hospital with. It does make a big difference. I was of the old school thought of on for max 20 minutes...2-3 times/day. I can't imagine holding to that protocol now; thank goodness I found this forum where sanity meets reality!

 

[Gingerbread]

Is it normal to cry everyday? It is happening when I feel pain coming on and also because my daughter is due with my granddaughter any day now & I won't be able to be there bc of my recovery. I truly thought this would be a piece of cake....funny only bc I watched ppl take weeks to rehab just to go home. Ugh I haven't had a good night's sleep since before surgery too.

 

[Vinca]

I know how you feel, @Gingerbread. Tomorrow is day 4 for me and I am so tired I can’t think straight. That’s gonna make it challenging when I call the doc tomorrow and try to put together a coherent explanation for why I need more or different pain meds. I’ll probably cry.
One night I slept two hours straight, last night I had 1 hour. Other than that, it’s 15-20 minutes here and there. I took a unisom last night- that just made me more tired, still couldn’t actually fall asleep and stay there.
So sorry you won’t be able to be with your daughter. That’s gotta be disappointing. Do they live close enough that you’ll be able to see the baby soon? At least you’ll be in good shape when she’s a little older and you have to chase her around!

 

[Jockette]

Here are some articles from the Recovery Guidelines that might comfort you.

Post op blues is a reality - be prepared for it

Post op blues is feeling depressed, weepy, nervy, shaky, fearful of the future, anxious, overwhelmed by what is happening to you, convinced it's never going to get any better and finally, uttering that most intense of all cries "I wish I never had this done!" It arises out of a variety of...

bonesmart.org

Sleep deprivation is pretty much inevitable - but what causes it?

Time and again members complain about not being able to sleep and after a while, that it gets to making them feel frustrated, despairing, depressed and even ill. I thought perhaps a short treatise on the reasons for disturbance of sleep patterns was long overdue. It won't help you to sleep but...

bonesmart.org

 

[Gingerbread]

Thank you @Vinca for the kind words & @Jockette for the articles. I just left a message for my doctor. Let's pray we (Vinca & I) get what we so desperately need-pain relief and rest.

 

[Jellyfingers]

Hang in there @Gingerbread, hope you get some relief soon.

 

[kneeper]

Periodic tears are very normal during this recovery @Gingerbread

 

[Gingerbread]

Thank you @Jellyfingers & @kneeper .
My update:
Went to PT yesterday afternoon to discover the PT thought my knee may be infected. She tried to call my surgeon but they close at 4, She suggested we go to an "Immediate Care" location, as this could not wait. After an hour at Immediate Care, the NP there said I needed to go to an ER, as I may need IV antibiotics...so my husband then takes me across town in rush hour traffic (stuck on the highway of course) to the hospital where I had my surgery. After 4 hours there I finally got an x ray (after some morphine-finally-where i almost passed out) and IV Vancomycin. They sent pics to my surgeon who believes it to be a delayed allergic reaction to the dermabond. So home at midnight-back up this morning to see the surgeon at 9:30. He was beyond apologetic and admitted he did not get my message from yesterday until this morning. Believes this to be a true allergic reaction-gave me refills on Tramadol and Oxycodone, starting me on a Medrol pack (which I questioned because steroids impede the healing process-but he said we need to control the allergic reaction so my body can heal-makes sense) and Benadryl. He also said if it is a true infection it will definitely show s/sx within the day. Gave me & hubby his personal cell # and said to text him anytime and to please send him a pic of my knee in a few days so he can see how it is progressing. Follow up in one week.
To anyone reading this questioning their instincts about their healing process-don't. Call your doctor and keep calling. The squeaky wheel gets the grease. Even if you think you know things, you are not in a state to fully comprehend or care for yourself. I know I wasn't and still need much TLC.

 

[Jellyfingers]

Hope you've got to the root of the problem and things are looking up

 

[kneeper]

Great that your doc is keeping an eye on things now just to be sure what's going on. A good surgeon would rather you check it out with him or her than just wondering. The OS has so much experience in seeing the post surgical situations that they are the ones who are best able to tell what's going on.

And good point about being the squeaky wheel!

 

[jaspa]

@Gingerbread I'm so sorry for all you had to go through but thankful that you kept at it to get relief, I hope the meds and allergic reaction i s getting better and you are now on your way to recovery.

 

[Jo Wo]

How scary and exhausting! Hope you see improvement soon.