Tykey
big-cheese
Jamie, do you still have lions and tigers in the circus, or are these metaphorical cats?
Good morning new friends
- Thread starter maryo52
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PhoenixS
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Jamie, do you still have lions and tigers in the circus, or are these metaphorical cats?
We have it all Tykey! And then some.
Maryo:
Recovery from this horror show of a surgery is harder than it needs to be. I know from where you come because, I felt alone and abandoned because my recovery wasn't on my (ex) Os's timetable.
I am also ashamed that this country, with all it's richness and advances in medical technology, seems to come up short on one simple thing. Compassion.
Unfortunately, we must get our nerves soothed by others who have gone through this and survived. We are a great support group and we all have had the same frustrations and worries that you have (and will have).
PT is pushed on us way too hard here. DO NOT LET ANYONE PUSH YOUR LEG!!!
If your PT isn't listening to you, find another one. If your OS thinks you are a pain in the a$$, tough for him or her.
Put your needs first. If you need more narcotics, and your OS starts to treat you like a junkie (mine did), get them from your PCP, who likely has heard this story before (mine has).
The sad part is that as Medical Professionals, it is hard to actually believe we can be treated in such a manner.
I sure got a wake up call! (This guy was my longtime OS and a Colleague with whom I share OR block time)
My (ex) OS is simply like a mechanic. The part he put it in ("is fine according to the X-ray")....But the leg itself, the WHOLE leg isn't functional. For some reason, he sees that as my problem because his job is done. (I would call him a bad name here but I'm being 'professional'.:hehe:
My advice is to come on here with questions, rants, whatever. Support is everything, and so is assurance from people you have never met that what is happening to you is OK.
Best,
Sandy
Josephine
NURSE DIRECTOR EMERITA
Sandy, spot on as usual!
Mary, you have a whole new family here so we're going to keep you going on the straight an narrow, have no fear! And you know, we(I) can relate to the American way of things, probably from watching too much American TV and movies(!) but also from talking with numerous American members these past four years. As a result of which, my way of talking has altered somewhat;
~ pain meds, not pain killers
~ OS not orthopaedic surgeon
~ PT not physio
~ Tylenol not paracetamol
:hehe:
I've also merged your two threads together, hope you don't mind. I did it for two reasons: 1) to help those trying to help you keep in touch with your progress and events and 2) to make it easier for new members and guests (lurkers!) to read your 'case' through from the start. It makes a kind of story for them - see what I mean? A kind of blog, if you like.
Mary, you have a whole new family here so we're going to keep you going on the straight an narrow, have no fear! And you know, we(I) can relate to the American way of things, probably from watching too much American TV and movies(!) but also from talking with numerous American members these past four years. As a result of which, my way of talking has altered somewhat;
~ pain meds, not pain killers
~ OS not orthopaedic surgeon
~ PT not physio
~ Tylenol not paracetamol
:hehe:
I've also merged your two threads together, hope you don't mind. I did it for two reasons: 1) to help those trying to help you keep in touch with your progress and events and 2) to make it easier for new members and guests (lurkers!) to read your 'case' through from the start. It makes a kind of story for them - see what I mean? A kind of blog, if you like.
OP
OP
Thanks everyone for your input.
With your help I am being easier on myself, and most of my dread and anxiety is gone. I've done the piddly PT I was assigned and it's raised my pain level so I am at almost a double dose as before. I'm OK with that. I touched base with my primary and he says if I don't want to deal with the OS office for refills he'll refill my percocet. That gives me peace of mind. My husband was away today for a while so I got up to get my afternoon snack and experienced quite a surge in pressure in my knee and took that as an indication that I'm not gonna be up and around anytime soon except for my excursions for little things and bathroom and such. I have my leg elevated all the time that I'm not doing something, and I'm icing a lot.
I watched a bilateral knee replacement when I was a nursing student. The patient happened to be a neighbor. It was quite a comfort to him that I was there. I was not that physically close to the surgical area because that's a super-sterile area. They wear space suits so they're not even breathing near the wound. I was by the patient's head. They did the left knee first and then the right, which went easier because they'd figured out the correct components on the left which means there was more tourniquet time, more putting on and taking off of components, and generally tweaking of the artificial joint on the left. So it was no surprise that the patient's right knee recovered more easily and with less swelling. Who knows how much each of our knees get tweaked and manipulated during the surgery, resulting in more tissue trauma?
Tomorrow I go to outpatient PT. Will be taking my cryocuff and my percocet, keep my leg up in the car, and medicate adequately. My physical therapist had BTKR with slow progress on flexion so he's sympathetic.
With your help I am being easier on myself, and most of my dread and anxiety is gone. I've done the piddly PT I was assigned and it's raised my pain level so I am at almost a double dose as before. I'm OK with that. I touched base with my primary and he says if I don't want to deal with the OS office for refills he'll refill my percocet. That gives me peace of mind. My husband was away today for a while so I got up to get my afternoon snack and experienced quite a surge in pressure in my knee and took that as an indication that I'm not gonna be up and around anytime soon except for my excursions for little things and bathroom and such. I have my leg elevated all the time that I'm not doing something, and I'm icing a lot.
I watched a bilateral knee replacement when I was a nursing student. The patient happened to be a neighbor. It was quite a comfort to him that I was there. I was not that physically close to the surgical area because that's a super-sterile area. They wear space suits so they're not even breathing near the wound. I was by the patient's head. They did the left knee first and then the right, which went easier because they'd figured out the correct components on the left which means there was more tourniquet time, more putting on and taking off of components, and generally tweaking of the artificial joint on the left. So it was no surprise that the patient's right knee recovered more easily and with less swelling. Who knows how much each of our knees get tweaked and manipulated during the surgery, resulting in more tissue trauma?
Tomorrow I go to outpatient PT. Will be taking my cryocuff and my percocet, keep my leg up in the car, and medicate adequately. My physical therapist had BTKR with slow progress on flexion so he's sympathetic.
OP
OP
I am supposed to go t outpatient PT this morning. Not feeling positive about it.
I had a good night, but yesterday from about 4 pm on was low. My husband was out of the house yesterday afternoon, so I got up to fix my afternoon coffee and snack. I found having my leg down intolerable but I got through it. I was so uncomfortable that I skipped my 6:30 pm routine (feel slides, short arc quads, quad sets, stuff like that). The pressure in my knee was intense. Plus the neurological symptoms in my foot seemed worse. I had only brief moments of relative comfort until turning in for bed at 9:30.
The neurological issue in my foot: I awoke after surgery still under the effects of the spinal. As it worse off, I was unable to dorsiflex my foot. That took a day or more to return. A partial numbness on the bottom of my foot involving mostly my big toe has remained. It can be uncomfortable, and yesterday when my knee pressure went up, the numbness in my foot increased. Not feeling great this a.m. either.
Re the neuro issue, my ortho hypothesized that the anesthetist nicked a nerve root when the spinal went in. But it seems to get better when the swelling is down, and worse when the swelling pressure has increased.
I had to wonder before going to bed last night about compartment syndrome. I didn't settle down until I aggressively iced my knee.
The last thing to mention . . I think I have a lot of inflammation going on. When I get up in the middle of the night to pee, not only is the right TKR leg stiff, which I'd expect, but the left one hurts is just as stiff and painful. Unfortunately I cannot take NSAIDS because I'm on coumadin for another week. I'm thinking once I can NSAIDS I can progress a little faster.
Thoughts?? Thank you!
I had a good night, but yesterday from about 4 pm on was low. My husband was out of the house yesterday afternoon, so I got up to fix my afternoon coffee and snack. I found having my leg down intolerable but I got through it. I was so uncomfortable that I skipped my 6:30 pm routine (feel slides, short arc quads, quad sets, stuff like that). The pressure in my knee was intense. Plus the neurological symptoms in my foot seemed worse. I had only brief moments of relative comfort until turning in for bed at 9:30.
The neurological issue in my foot: I awoke after surgery still under the effects of the spinal. As it worse off, I was unable to dorsiflex my foot. That took a day or more to return. A partial numbness on the bottom of my foot involving mostly my big toe has remained. It can be uncomfortable, and yesterday when my knee pressure went up, the numbness in my foot increased. Not feeling great this a.m. either.
Re the neuro issue, my ortho hypothesized that the anesthetist nicked a nerve root when the spinal went in. But it seems to get better when the swelling is down, and worse when the swelling pressure has increased.
I had to wonder before going to bed last night about compartment syndrome. I didn't settle down until I aggressively iced my knee.
The last thing to mention . . I think I have a lot of inflammation going on. When I get up in the middle of the night to pee, not only is the right TKR leg stiff, which I'd expect, but the left one hurts is just as stiff and painful. Unfortunately I cannot take NSAIDS because I'm on coumadin for another week. I'm thinking once I can NSAIDS I can progress a little faster.
Thoughts?? Thank you!
It sounds like you may be undermedicated. What are you taking for pain and on what schedule? I know you increased your dosages here recently, but remind me exactly what your schedule is.
OP
OP
I take my percocet q 4 hours. I'm taking 3/4 of a 5/325 percocet at night, which is enough. I try to keep it minimal because of my cluster headache issues. Clusters come at night. Daytime I'm usually taking one whole percocet. I was getting by on a half for a while. I just find that with the few minor PT exercises I do, my pain level is elevated.
Today I took 1.5 tab an hour before my PT appointment. I had greater strength today than at last appt. (Friday) but my range was unchanged. Actually, he had to push my leg painfully to reach the 88 degree mark he measured on Friday. He talked to my OS while I was still there about the increased pain, a slight fever, etc., to see if they might want to do a blood test to check for infection. I don't have any overt signs of infection. It's just that with the increased pain and unchanged ROM the PT wondered about infection. I do have slight fevers (lower 99 degree range).
Did talk to my primary and he's good with prescribing whatever I need. I'm thinking that next week when I can get going on anti-inflammatories things are more likely to change.
So what do you think?
Today I took 1.5 tab an hour before my PT appointment. I had greater strength today than at last appt. (Friday) but my range was unchanged. Actually, he had to push my leg painfully to reach the 88 degree mark he measured on Friday. He talked to my OS while I was still there about the increased pain, a slight fever, etc., to see if they might want to do a blood test to check for infection. I don't have any overt signs of infection. It's just that with the increased pain and unchanged ROM the PT wondered about infection. I do have slight fevers (lower 99 degree range).
Did talk to my primary and he's good with prescribing whatever I need. I'm thinking that next week when I can get going on anti-inflammatories things are more likely to change.
So what do you think?
Well, I think that is a VERY low dose of the percoset if you are only taking one pill. It sounds like you could do with more (usally the dose is 1-2 pills every 4 hours). But....given your headaches, you have to find a balance.
Have you thought of trying another pain med? There are quite a few to choose from and maybe another would not activate your headaches. I'm so sorry....you seem to be between a rock and a hard place here. But it might be worth trying other pain medication options.
I agree that once you can add in an anti-inflammant it may help with the swelling. You could also add in some more Tylenol. Just be sure you monitor the accumulated dosage. Your pain meds have 325mg in them too. If you take Tylenol, the maximum in 24 hours is 4000mg. They last about 4 hours and you would want to maybe take one extra strength along with your percoset which would get you close to the 1000mg recommended dose of Tylenol at a time.
Have you thought of trying another pain med? There are quite a few to choose from and maybe another would not activate your headaches. I'm so sorry....you seem to be between a rock and a hard place here. But it might be worth trying other pain medication options.
I agree that once you can add in an anti-inflammant it may help with the swelling. You could also add in some more Tylenol. Just be sure you monitor the accumulated dosage. Your pain meds have 325mg in them too. If you take Tylenol, the maximum in 24 hours is 4000mg. They last about 4 hours and you would want to maybe take one extra strength along with your percoset which would get you close to the 1000mg recommended dose of Tylenol at a time.
OP
OP
Jamie,
I notice that your TKR was on my 56th birthday.
I prefer percocet because I get more pain relief with fewer side effects than, say, vicodin.
I can probably up my daytime percocet without a problem. But I thought PT is supposed to reduce pain. OK, I guess I just have to accept the facts. I'm having more pain. Or possibly growing some tolerance to the percocet. Probably 1.5 during the day would work fine.
I will keep the pain control conversation going with my primary. It has not so far been area my ortho has helped me with.
Any other thoughts?
I notice that your TKR was on my 56th birthday.
I prefer percocet because I get more pain relief with fewer side effects than, say, vicodin.
I can probably up my daytime percocet without a problem. But I thought PT is supposed to reduce pain. OK, I guess I just have to accept the facts. I'm having more pain. Or possibly growing some tolerance to the percocet. Probably 1.5 during the day would work fine.
I will keep the pain control conversation going with my primary. It has not so far been area my ortho has helped me with.
Any other thoughts?
PT, like any increase in activity following joint replacement surgery, INCREASES the potential for pain.....not a decrease. That's why we recommend taking pain doses right before any PT sessions or an especially active day. Most people must rest, ice and elevate like crazy following a PT session. Remember you are still very early in recovery and it is perfectly fine to NOT do exercises other than heel slides and ankle pumps a few times a day. This is the norm in some countries (unlike the USA) and patients heal just fine.
Remember that any pain med only lasts about 4 hours. That's why we tell people they MUST stay on the schedule of taking them every 4 hours at the beginning of recovery and possibly every 6 hours if things are improving several weeks or months down the road. Pain management is SO IMPORTANT!!!
I would be very surprised if you were developing any tolerance to the meds after this short a time. It's just that you're not taking enough of them to get ahead (and stay ahead) of your pain.
Do stay with your GP on the pain meds. It doesn't matter where you get the help...just that you receive it so you can heal properly and comfortably.
Remember that any pain med only lasts about 4 hours. That's why we tell people they MUST stay on the schedule of taking them every 4 hours at the beginning of recovery and possibly every 6 hours if things are improving several weeks or months down the road. Pain management is SO IMPORTANT!!!
I would be very surprised if you were developing any tolerance to the meds after this short a time. It's just that you're not taking enough of them to get ahead (and stay ahead) of your pain.
Do stay with your GP on the pain meds. It doesn't matter where you get the help...just that you receive it so you can heal properly and comfortably.
OP
OP
Today the ortho told the physical therapist the goal is to get me up to 95 degrees. I am starting to get cranky about the fact that no one seems concerned about my level of pain or have offered to help, except for my primary. The day the ortho's office called to report my INR level, you'd think they could squeak in two questions, those being "How are you doing?" and "How's your pain?" My primary says he hears a lot of patients complain about surgeons not being helpful regarding pain management.
Josephine
NURSE DIRECTOR EMERITA
Whoever told you that little gem of nonsense? It's quite the reverse. Have you been reading around the threads in the Knee Recovery Area? You'll find umpteen threads in there of people bewailing their post-PT pain!
And surgeons are a bit like motor mechanics - they do the servicing but aren't the least bit interested in how you're driving the vehicle afterwards!
Finally, remember who's in charge during the PT - YOU ARE! Do not let them push you to the point of agony. It benefits nothing, certainly not your knee. And you certainly shouldn't permit a 'goal of 95*' in any soon time. Let it come when it comes. There is no rush. You're not even 3 weeks yet. In the UK, we don't even start PT until 3 even 4 weeks and we end up with a very satisfactory ROM. FWIW, I did hardly any exercises apart from a few heel slides and some brief time on my exercise bike. Since you have these difficulties with the pain meds, I really think you should not let them push you with the PT. Controlling your pain and swelling (which go together) will be far more productive than aggressive PT.
OP
OP
I have been using a cryocuff. It's not an automatic one. It's manual. You raise the jug and the cold water goes into the cuff. When it loses its cool, you lower the jug, drain the cuff, shake the water around the ice in there, and refill the cuff. It doesn't really offer much cooling to the back of the knee, or the lower anterior knee. So I added a cold gel pack to my routine today so that I had cooling all around. My knee seems happier (although colder . . . brrr . . . we live in Maine!)
I am hearing from you guys that the PT may be aggravating my angry muscles, and the PT and ortho say that PT is necessary to move me forward. I'd like to get off this merry-go-round but lack confidence. Maybe I should just modify the routine, go very very gently.
Has anyone found that anti-inflammatories make a significant difference? I have 6 more days of coumadin and then it's NSAIDS for me!
When I stand up the pressure builds quickly around my knee. It's unpleasant. Would compression stockings help?
I am hearing from you guys that the PT may be aggravating my angry muscles, and the PT and ortho say that PT is necessary to move me forward. I'd like to get off this merry-go-round but lack confidence. Maybe I should just modify the routine, go very very gently.
Has anyone found that anti-inflammatories make a significant difference? I have 6 more days of coumadin and then it's NSAIDS for me!
When I stand up the pressure builds quickly around my knee. It's unpleasant. Would compression stockings help?
madlobster1
junior member
Re: guidance, tips, support sought
Mary, I had my BTKR on 10/19/2010 and like you felt i was going backwards sometimes. I am 7 weeks today and had PT as well, my right knee flex was 119 with some help and left was 115, I feel the knees are full of fluid every time they are down. My PT gave me these "ace tubes" to pull over my knees while they are down and they feel better because if the support. I too have "Cluster Migraines" which I had for 10 years and they had stopped back in 1989. Some how my headaches have come back in the last 2 weeks or so and decided to stop all my meds to try and figure out what is the cause, so for to no avail. I would love to know where you found this "Headache group" as I can't take them every day any more. Feel free to PM me too if that works so not to take away from this sites purpose.
Mary, I had my BTKR on 10/19/2010 and like you felt i was going backwards sometimes. I am 7 weeks today and had PT as well, my right knee flex was 119 with some help and left was 115, I feel the knees are full of fluid every time they are down. My PT gave me these "ace tubes" to pull over my knees while they are down and they feel better because if the support. I too have "Cluster Migraines" which I had for 10 years and they had stopped back in 1989. Some how my headaches have come back in the last 2 weeks or so and decided to stop all my meds to try and figure out what is the cause, so for to no avail. I would love to know where you found this "Headache group" as I can't take them every day any more. Feel free to PM me too if that works so not to take away from this sites purpose.
madlobster1
junior member
I would try the tubes unless the stockings go above the knee, mine in the hospital did not
Josephine
NURSE DIRECTOR EMERITA
It's always a fact that when you stand up, the discomfort increases. Mary, do try to remember you are only about 2 weeks post op. These are the normal things that happen.
For the time being, apart from normal 'getting around the house' exercises, heel slides and leg raises, an exercise bike if you have one or can borrow one, I'd spend all your time with your leg up, iced and taking your pain meds.
You should also read these threads (sorry if I've posted them for you previously but they are important topics)
The importance of managing pain after a TKR and the pain chart
How Long Does Healing Take ......
Elevating your leg to control swelling and pain
Discussion on managing pain in TKR surgery
Using ice
It's never too late to get more ROM!
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Not maybe - IS. Let me repeat thisMaryo52 said:
So do cut back on your activity. Be prepared to stand up for yourself with your PT and your OS.Josephine said:
For the time being, apart from normal 'getting around the house' exercises, heel slides and leg raises, an exercise bike if you have one or can borrow one, I'd spend all your time with your leg up, iced and taking your pain meds.
You should also read these threads (sorry if I've posted them for you previously but they are important topics)
The importance of managing pain after a TKR and the pain chart
How Long Does Healing Take ......
Elevating your leg to control swelling and pain
Discussion on managing pain in TKR surgery
Using ice
It's never too late to get more ROM!
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
madlobster....don't worry about discussing the cluster headaches here on BoneSmart. We welcome that type of discussion because it is likely to help others out there who have similar issues. We don't consider that off topic at all because it is all related to a person's recovery!
OP
OP
Megalobster, it's kinda cool to think there's someone out there who knows TKR and cluster pain. Talk about double whammy!
Well yesterday proved you guys to be 100% right. I got pushed in PT. After all, when we chose professionals to work with, we give them a certain level of loyalty, and was "compliant" even though I've been reading on this forum that PT can have opposite results. So guess what? Last night I paid the price. I hurt so so much. I felt as if knives had been stuck through my knee. Had to double my dose of percocet.
I'm gonna call my OS today and say, what's the deal? And most likely cancel PT on Friday because obviously that's counterproductive. And take a new tact that I (and my leg) can live with.
I'm sure I'll be watching this forum all day, trying to keep my spirits up.
Have a good one!
Well yesterday proved you guys to be 100% right. I got pushed in PT. After all, when we chose professionals to work with, we give them a certain level of loyalty, and was "compliant" even though I've been reading on this forum that PT can have opposite results. So guess what? Last night I paid the price. I hurt so so much. I felt as if knives had been stuck through my knee. Had to double my dose of percocet.
I'm gonna call my OS today and say, what's the deal? And most likely cancel PT on Friday because obviously that's counterproductive. And take a new tact that I (and my leg) can live with.
I'm sure I'll be watching this forum all day, trying to keep my spirits up.
Have a good one!
Tykey
big-cheese
It's difficult to accept the "experts" are actually incompetent, isn't it!
It's amazing how many we hear of on here, so you are not alone. We all go through the phase of pushing ourselves too hard, but patience is the key. I wish we had a pill for that as well.
You have a good, restful, one as well:flwsm:
It's amazing how many we hear of on here, so you are not alone. We all go through the phase of pushing ourselves too hard, but patience is the key. I wish we had a pill for that as well.
You have a good, restful, one as well:flwsm:
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