THR Hip #2 Detours, Roadblocks, With a Dash Of Hope^

[Daffodill1]

Can anyone tell me if the psoas muscle down the leg in the front should be aching non stop

 

[Josephine]

I take ALL of the meds as described

I didn't say "as described" I said "as Prescribed! Big difference!

Jo, here in the US we really don’t have a choice about PT.

No you don't. No-one can take your rights of consent from you. It's illegal and has been stated in, to mention one, the Supreme Court of California which I quote. So the answer to this question Saying no to therapy - am I allowed to? is most definitely yes! If they are blackmailing you to do exercises against your will but withholding your pain meds, that's against the law. Now your rights.

the psoas muscle down the leg in the front should be aching non stop

No it shouldn't. Show me the site of your pain using this chart.

 

[Daffodill1]

@Josephine

Sorry, but at 5:30 in the morning it can be challenging to type, sometimes, especially with very little sleep.

I take the medicines as prescribed, don’t miss a dose. I don’t think the description of the medicine would tell me how often to take it, I believe the surgeon does that and it is then then put on bottle.

Now as far as opioids are concerned, and anyone from the states including North Carolina has an opioid law which I believe you are familiar with. It came into effect about 2 years ago. In the beginning the only way you could receive opioid meds after the initial prescription from hospital was to schedule appt with a Pain Management physician and first visit was interview, signing a legal; document stating you would not get or try to get opioids from another physician. If so you would no longer be a patient at said facility.

You also had to come in every month for urinalysis to make sure you were not taking any other opioid. The reason I know this is that I was a patient, because I had to have pain meds. However, once I got my bill for the visit, which would be the same every 2 months, I stopped immediately. Each visit was just under 600.00. Oh and each prescription was not a full prescription, only about half.

Fast forward. You go, home after surgery, given 2 weeks of meds, and call for refill, which they now can do. The law really hurt a lot of people who need medicine, while those that used them for recreational purposes were having a ball. Nowadays you get refills but each time it is a little less.

And one of the rules is in order for opioids you have to participate in your recovery. That means, and lord I have been down this path, unless you help us help you, there will be no opioids given. California is a tad different. After all hemp is now available for medical purposes while NC is left with the stigma of taking 1 too many pills for your pain.

Along with so many others that need these meds follow the legal process to try and get us access to medication that is not addictive but helps us with our pain.

Josephine, it is true that if you don’t take your PT then physicians can and do only give you enough medication to last 3-5 days. I have pamphlets galore explaining how this system works. Or, in my review doesn’t work. Sorry for the off topic regarding this. It is a very important issue.

I do thank you for going over my list of concerns l do have one question about psoas. Since I am using a cane I am doing a lot better except for one thing. I find that I cannot bring my leg down and put pressure on it without it pinching. I think this is where the new hardware comes up to the old bone. Then that pinch travels down and around groin. Make sense? And if so, is there anything I can do to alleviate that? I would be in a very happy place.

Thank you again for taking your time with not only me, but everyone else here in this forum. I look forward to hearing your thought on this pinch.

Daffodill1

 

[honeybeast]

I'm in Boston and have never experienced this. As a matter of fact, I got less PT than my first hip replacement less than a year ago. Back in 2018 they sent a visiting nurse twice and 10 home PT sessions. This time they said they don't do that anymore and that if the OS determines at my 2 week post Op visit that I need it, he will prescribe it at that time.

As far as your psoas pain - I had some persistent pain in that muscle after a bad nighttime cramp around the 2 week mark. I lost about 75% of my function in my hip flexor. My doc thinks i had tendonitis in that muscle from it rubbing over and catching on the hardware. I got a steroid injection and had some gentle pt which helped me rehab it. I also drink a sports drink with magnesium, which helps with cramping.

 

[Layla]

Unbelievable and unfortunate they make you jump through all of those hoops.
Unless I'm misunderstanding, I've never heard of what you've described above.

In Minnesota, they sent me home from the surgery center with an Opioid prescription, in addition to another written script I could fill in the event I ran out and needed more, this was because we were coming up on the Fourth of July holiday. Not only did I not finish the first prescription, didn't need it thankfully, but I had another prescription in my hands which seemed rather odd to me. I had PT scheduled to begin three weeks post op but never signed any type of document. I went to three PT sessions because I decided I'd give it a try, then came to the conclusion I didn't need it and cancelled my remaining sessions.

I agree with whoever mentioned above that your OS doesn't know what you're doing, or not doing, in the privacy of your home. I'd stop those exercises and if the OS asked me if I was doing them, I'd simply say, "yes, I've done them." And you have! They won't ask for dates, times and number of reps performed. I think you'll lose the pain and excel without them. I suggest you at least give it a try for a couple weeks.

I hope your pain eases soon, wishing you comfort and a nice Sunday!
@Daffodill1

 

[Daffodill1]

@Josephine

Pain according to chart,
T-R2f, v-r3f for the psoas I think, then quad area is
V, W, X-r2f hope I am doing this right.

 

[Josephine]

Well, tell me this is right then!

Before I can opine on that, 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?

 

[Daffodill1]

@Josephine

Except for the fact I have the chart backward, (everything is actually on the left side) not the right like I have the chart showing. Keep forgetting medical charts are left on chart is right in reality and vice versa.

Of course you can ask me questions.

I need help, pain should be greatly improved, not totally, but enough that I don’t wake up every night with spasms and 6-7 pain. I answered questions several days ago, and have been reading up on what I am feeling trying to get an idea of normal. Am on cane still, can’t put any weight on the leg without it.

Thanks for your help..

 

[Mojo333]

Hi @Daffodill1
I know Jo will be along soon and hopefully you can get some helpful advice.
I do want to tell you that I had both hips replaced but the anterior "minimally" invasive surgery almost two years ago.
I did not have the uncontrollable spasms you describe so I certainly can understand your concern.
But I CAN tell you that the places you describe pain were the same for me. My quads were ridiculously sore and sensitive...and when I went to PT one week after surgery ..and also tried to do leg lifts etc. at home between times...things got bad. All of that trauma done did not need any additional stressing and I just decided it was too soon for asking my body for more than walking while I was healing. The groin felt tight and painful like I was engaging those muscles to do the exercises since my quads weren't strong enough.
If you have been trying to do right by following this protocol...it MIGHT be the reason things aren't settling.
Don't know that it is, just saying might.
I told my OS that when I laid off PT things felt better...so he said to drop it if I didn't feel it was helpful.
I thought I might have nerve damage or any matter of collateral damage...but slooowly all got better.
They stretch those muscles and tendons Waaay out to be able to excise your femer...insert a cup, ball, and stem.
This forum has seen PT protocols cause ongoing issues with recovering hippies alot so please don't think that we are not taking your condition seriously.
I do hope things settle soon.

 

[SE Florida]

 

[Daffodill1]

@Josephine

Pain according to chart T-L2f, v-L3F for the psoas I think, then quad area is
V, W, X-L2F

 

[Layla]

Hi Daffodil,
Happy Tuesday to you. I hope your pain is easing a bit.
Wishing you comfort and a sunny day in your neck of the woods.
@Daffodill1

 

[Daffodill1]

Beginning last nite at 9pm until,4:30 am spasms reached a 9. Could not walk more than 2 steps using walker and husband to support me. My insurance has a service I can call 24/7 with nurse hotline that have patients records through hospital and surgeon, and husband called due to spasms being continuous, non stop and pain level was worse than having a 10.5 pound baby natural childbirth which I have done.

Advised then to stop meds, and contact surgeon in morning as it could be allergic reaction I was experiencing.

8 am this morning surgeon was called by my husband, and a discussion was had regarding medications I had been taking. Josephine had asked for the medication I was taking, I told her, she made sure I knew to take them as Prescribed, which I was.

Unfortunately there is now the possibility that medication is the cause of the spasms. While the prescribing stated “as needed” in some cases, I was taking the medication every 4 to 8 hours depending on how it was prescribed. I was taking the medication even when I didn’t feel I needed it, but that, according to surgeons was incorrect, it was to be taken only when needed. I was overdosing.

I have been advised to stop all medications, a new prescription is being filled which will be picked up by my husband within the hour. Spasms are light now, but still there, no meds since 4am this morning.

I have never been as out of it as I was last night. While it may not be the meds, both medical opinions point in that direction. Will keep everyone posted how this turns out. I need to go lay back down again and try to sleep.

Thank you for all your well wishes, thoughts and prayers.

 

[Layla]

Prayers will continue as will support through the forum. I'm sorry you're in such pain. I hope you find relief soon so you are able to rest comfortably.

You'll be in my thoughts. Please stay in touch so we can follow your progress. As you know from past experience....it will get better.
@Daffodill1

 

[Jamie]

Daffodill1....I do hope you have gotten things squared away by now. I must tell you that in more than 10 years of helping people here on the forum I've never heard of someone having the kind of reaction you're talking about from pain medication. That's not to say it's not true, but I'm just saying it is not at all a common situation.

Most of the time people do quite well when taking their pain meds on a set schedule. This is what many surgeons tell their patients to do. Granted, there are some surgeon who don't abide by this protocol, but I've never understood why. When you have pain after major surgery, it is much more difficult to play "catch up" if you wait until you hurt to take the medication.

That said, Oxycodone can be a bit strong for some people and they do report feeling "out of it." I hope your surgeon stepped you down to another pain medication such as hydrocodone or possibly even tramadol. It may be that you also need something to calm the nerves down like Gabapentin. These are things you can discuss with your surgeon if you're still having issues.

I must say that it's been some time since I've heard of a patient being required to sign a contract about pain meds. I'm sorry you live in an area that is still employing those draconian measures. That procedure is not required by any law. It's something that popped up years ago as a knee-jerk reaction to the FDA guidance regarding opiate pain medications. I thought it had pretty much disappeared, but I guess not. It's a sad situation for patients like yourself who need relief from post surgical pain.

I do hope you get some relief from those spasms. Please let us know how you're getting along.

 

[Mojo333]

Have the spasms eased at all @Daffodill1?
I read that you had a horrid time with your TKR and that you used to be on the forum at that time? Is this the same leg that had TKR?
I'd like to read your recovery thread but guess you had different username?

Please let us know how you are!

 

[Daffodill1]

https://www.webmd.com/pain-management/pain-management-pain-treatment-agreement#1-1

Hello Jamie,

You are def not the first to say they have not heard of this agreement, so I decided to make it easy on everyone and send a few links to show you what it is. The first link is the easiest to read and understand, it doesn’t have all of the information in it, I haven’t figured out how to copy and paste more than one at a time, so just going to send another link in my reply in my next post in just a moment. Thx
Daffodill1

 

[Daffodill1]

One other link. Make sure you get to the part about patient having to partipate in certain requirements or they are dropped from program. This is from another physician office that abides by the Agreement.
https://www.acsh.org/news/2017/07/30/pain-time-opioid-denial-interview-aric-hausknecht-md-11628
AH: I am definitely more cautious about prescribing opioids, but I have always been very careful in my office and have adhered to strict guidelines. All patients sign a pain management agreement. All patients are subject to random urine toxicity testing. All patients are required to engage in adjunctive treatment such as physical therapy and non-opioid medications. My approach has not changed too much, and I have been steadfast in my commitment to provide pain relief for my patients. But for sure, I don’t write as many opioid scripts as I used to. And for sure, all of these regulations have significantly increased my workload and overhead.

There are hundreds of sites, just look up Pain Mgmt Agreement Contract in USA.
So you see there is indeed such a thing over here, and everyone who does have a medical forum no matter where, should be at least informed of this topic.

Daffodill1

 

[Jamie]

Thanks for the links. Of course I knew that these things existed, but they are not required by any laws. It is a doctor's choice to use these methods to protect themselves against the fear of lawsuits and patients who might abuse the opioid pain medications.

I wasn't saying they didn't exist in the US. My point was this type of program is not a requirement for treatment after joint replacement and it's not in use everywhere in the country. I'm just sorry you must try and deal with it. It makes recovery more difficult for everyone.

Also, it's important to note in any discussion of opioid pain medication use, the difference between treating acute pain (pain following surgery) and chronic pain (pain lasting more than a couple of months). The surgeons I work with in regard to joint replacements will provide a patient having joint replacement surgery with medications for several weeks following surgery. Then at that point if pain is still a major issue they work with the patient to determine what is appropriate - either a bit longer on the opioid or possibly a step down to tramadol and Tylenol. I've never known a surgeon to make a patient sign a contract or tell them their pain meds won't be issued if they fail to do physical therapy that is painful. Quite the opposite, these surgeons believe pain is detrimental to a successful recovery and work with the patient to keep pain minimized. But this is strictly a treatment protocol for acute pain that can occur after joint replacement surgery.

I haven't worked with pain management centers in quite a while, so I can't say whether or not any of them near me require a written contract with their patients. It may be that's used here for people in chronic pain.

I would like to read your other recovery thread and get your two accounts here on BoneSmart consolidated. Can you please tell me your previous username or your old email address?

 

[Daffodill1]

Update:

First, let me start by saying that most everyone here will be a tad shocked, if not a lot shocked at what has been going on. At least I think so, have learned through life lessons that things are usually not what you think they are. Ok, here goes.....

All opiods have been stopped, totally and completely. My body had several very bad neurological/physical episodes that almost put me back in the hospital. First, after taking all of the meds as directed, I began to experience double vision, extreme spasms, could not walk on a walker without help of husband and even then he had to keep his arms around me to keep me upright. You may ask why I kept using the walker in that condition and my answer would be I HAD to move....My personality went from normal me to screaming, crying, slurring words incoherently, passing out while trying to talk. At one point my husband told me that I demanded my hydrocodone, even though I already had it, and would not believe that it had been given to me. I became a raving crazy madwoman. While I may have a small temper, I was told that I said things to him and at him that were horrible. This went on for hours. Surgeon was called first thing in the morning, dosage was decreased, but was still told to take it. That night everything happened again. My brain could not keep up with my mouth, and I again went into a foggy nightmare, unable to remember what I said or what I did.
Last Friday morning at 1 am, I took 2 hydrocodones, and the spasms had become unbearable. In the morning, my husband and I decided no more. Something was not right. For the next 3 nights I still had spasms, but after that they leveled off, and now, except for a few during the night, I am mostly spasm free.

Surgeon visit was needed, and we discussed this, and he said while he had not heard of this happening before doesn’t mean it can’t or won’t happen. The only pain meds I am on are tramadol.

I am going to PT, started last Friday, and it is going very well. Still have the pain in the area where leg Meets body, we are working on hip flexors, and things seem to be getting better. Go back again on Friday to learn more exercises and to have medical deep tissue massage.
Last night I slept with a heating pad and apparently it was a little too warm, woke up to this (see photo). Need to be putting lotion on that area, did not realize it was so very dry.

Anyway, sorry for this long post, but I did want to post this update. I have had a very difficult time with this surgery, be 5 weeks tomorrow, and I am past the point of wanting this to be over with. I hope you guys understand about the opiods, at least with me Jekyll and Hyde did happen.

Here is the photo of where I apparently was on heating pad too long or too warm. Scared me when I saw it, but then I remembered about the pad. Heat is the only thIng that helps that groin area. If anyone thinks that this isn’t from that please let me know ASAP. There are a few little blisters as well. No fever. Going to keep an eye on it and see if rednedd has gone down by lunch.
Thanks everyone!