Bilateral TKR Superior and Inferior Patellar Enthesophytes

[GratefulNana]

Surgery was scheduled for 11:20 this morning, but was taken in at 10:30 and was in recovery at 12:30 p.m. I was originally scheduled for a 3-1/2 hour time slot. Since this is a teaching hospital, he must have had help.

So far, I have had minimal pain and discomfort. Percocet 10mg has been ordered for pain every four hours. The Recovery Room RN suggested to me that, in the first days, I should ask for the maximum dose, otherwise the dosage will be cut n half and, if the pain gets worse, I will have to get the dosage changed back, which is not always easy.

The downside of having the surgery now is that the hospital appears greatly understaffed. My ice machines were turned off and disconnected at 6 P.M.so that I could walk to a chair to have dinner. The left me there for over an hour, and kept running in and out as my IV alarms kept going off. I made use of my time by doing a couple of heel slides and ankle pumps.

My alarms were going off for about 20 minutes, when someone finally came in again. I requested help back to bed, while I had someone's attention. I was surprised when my ice machines were not reconnected as she ran out the door. When my alarms went off again, the RN came back in and apparently turned the pump off, so now I am not getting fluids or antibiotics. As I was looking at my ice pumps sitting on a table in the corner f the room, I asked if the ice pumps were supposed to be running 24/7. She said yes, as she walked out of the room. It is now approaching 8 P.M. and no ice. Time for pain meds. I am going to ring for them. Just wondering how long it will take tote a response.

I am a very patient person, but this is not setting well with me. I don't need a major setback within hours of surgery. Very disappointing... Time for action!

I dislike being dependent....




BTKR 12/28/2015

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[skigirl]

And yet, dpendency is part of having surgery and needing help. I suggest you press the call buttons early for your meds so that you don't have to wait too long at the other end. I have always had problems with the ice machines at the hospital--the staff don't know how to run them and they are always late with the ice.

But, things will perk up soon. I was so happy to get home where everything was set up for my convenience!!

I will give you the articles from our library that we recommend to new knee owners. they are all short and informative.

First are the BoneSmart Recovery Philosophy. . .

- rest, elevate, ice and take your pain meds according to your prescription, don't wait for pain to occur, don't overwork.
- If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
- If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it.
- Take note of the BoneSmart view on exercise and how exercise may affect pain and swelling.
- If you won't die if it's not done, don't do it; if you must do it, short and sweet, not hours on your feet.
- Don't stand if you can sit; don't sit if you can lie down, don't stay awake when you can go to sleep

And here are some very crucial articles
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Activity progression for TKRs

Healing: how long does it take?
Chart representation of TKR recovery
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling

Home physio (PT) and activity progress: suggestions
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it

And wise words from members who have shared their experiences ...
Where are you in recovery?? (TKR)
Five “P’s” of knee recovery
TKR: work “smarter” and not “harder”
Recovering a knee - from one who knows!
It's never too late to get more ROM!
It's worth the wait for ROM

 

[GratefulNana]

@skigirl...Thank you. I did ring early. When the call was picked up, the ward secretary listened to my request, which was politely stated, and just hung up. It was about 20 minutes later before meds were brought. I had to request ice again. RN was clearly flustered. She took the machines and came back and put water and ice in them, and set one on each side of the bed, plugged them in, and left. After 30 minutes they were not working. In Recovery, the machines were on a table. I struggled for 15 minutes and finally got one onto a chair next to the bed and the other on the bedside table. They are gravity fed. Success! I learned something new, and was able to educate two RNs. Tomorrow will have one less frustration!


BTKR 12/28/2015

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[New England Librarian]

Where's the "dislike" button? Sorry you are not getting the attention you need! That is really frustrating when you are the patient and they are supposed to be taking care of you! Fortunately you know what to ask for (thanks to BoneSmart!), but having to ask repeatedly is a waste of your very precious energy. Hope things are better tomorrow

 

[GratefulNana]

The night shift was wonderful and responsive. All that was not done on the evening shift was corrected on the night shift. The spinal is wearing off, and the stiffness and pain is beginning to set in. I had two knowledgeable RNs. My compression bands were restarted, and they knew how to work the ice machines. Pain meds were given on time, and IV antibiotic is back on schedule. It appears that the RN looking after me in the evening was a "traveling nurse" who received only four hours of orientation and is expected to float from area to area with no particular expertise. She was trying, but clearly flustered.


BTKR 12/28/2015

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[Vangheluwec]

Glad to hear the night shift was better for you. I know how you feel with the waiting part during the day. If you have a nurse like that again talk to the nurse supervisor and request another. You should not have to wait that long for help. Hopefully your day nurse today is much better.


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[skigirl]

I found that a letter to the ceO of the hospital was rewarding for me. They did answer but it was a relief to "get it off my chest"!

 

[KarriB]

Weekends and holidays are difficult in hospitals. Both my surgeries were in the middle of the week, so I was in transition care unit by the weekend and needing less help. But I was thankful my nurses were in top of my pain meds, always making sure I was right in schedule until I had the where with all to be responsible for them myself. Brain fog...

 

[newlybionic]

Every hospital will give you a survey to fill out concerning everything during your stay there. You can be very explicit about what was good and what wasn't. The hospitals are rated by the results of these so patients can compare different hospitals. You can also call to talk to a patient advocate. While in the hospital if you are having problems with your care you can ask to speak to the nursing supervisor. There is at least one in every hospital 24/7. That usually will take care of any problems.

 

[GratefulNana]

Today I had another awesome RN. Ortho floors are difficult because we are so needy. My quads and hams are so sore that it is the most difficult and painful thing I have ever done getting up from the chair they insist that I sit in for meals. I am only 5'2" and the chair is too low for me. I have been asthmatic for many years and have never had an asthma attack until today--I had two. One after lunch and one after my PT session while he was trying to show me how to get up from the chair. It was so scary not to be able to get my breath. They had to call Respiratory Therapy both times. All the doctors, practitioners and nurses are very happy with my progress. I know that I have a very long way to go to work the pain out of my muscles and tendons, but there is no turning back now. I have waterproof dressings on both knees that will be removed in seven days. I am sutured from the inside out with dissolvable sutures. Yeah, no staples. I am told that this closing procedure will only leave a very thin scar.

Tomorrow I will be trained on climbing stairs. We have three going up to the front porch, and three going down into our family room. We also have 13 very steep stairs going up to our second floor. The PT said that training me to climb them is beyond his scope. I am being sent home with a walker, two Aircast Ice Pumps, and a CPM Machine.

I am having pain in my right calf that I brought to the attention of the evening shift RN. Unfortunately, he is one of the "problem" RNs from last night. He looked at my calf and said it was not warm, and he will probably bring it to the doctor's attention. Probably? I rang last night for my OxyContin, and was given Tramadol. He told me that he could not give pain medicine unless a patient specifically asks for it. That is why I did not get it last night. That was one of the most lame statements I have heard in a long time.

It looks like I am not going home until Thursday. I am ready now. I have yet to get any rest because of all the activity and alarms going off Right now they have a guy riding a very noisy floor cleaner up and down the corridor.

Home sounds very good right now


BTKR 12/28/2015

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[Vangheluwec]

Ask for a different rn if he is one of the problem ones. You are going thru to much right now to deal with a bad nurse. Sorry to hear about the nurse problems I know how it is.


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[referee54]

Welcome to the "Other Side" and welcome to the highly Renown World BTKR Club!! I will be sending you the DVD of the super-secret handshake!

I am sorry to read that you are having pain-management issues. You need to have your husband or speak up for you and act as your advocate---they need to know what pain meds you are on---you do not have to ask for them---they are on your chart!

Home sounds very good right now

It is indeed a psychological lift to get home.

Here is your reading list for all new TKR's or BTKR's---

First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

Next is a FAQ (Frequently Asked Questions) thread.

And here are some very crucial articles
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Activity progression for TKRs

Healing: how long does it take?
Chart representation of TKR recovery
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling

Home physio (PT) and activity progress: suggestions
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

And then some wise words from members who have shared their experiences ...
Where are you in recovery?? (TKR)
Five “P’s” of knee recovery
TKR: work “smarter” and not “harder”
Recovering a knee - from one who knows!
It's never too late to get more ROM!
It's worth the wait for ROM

but there is no turning back now.

I kept thinking the very same thing!

 

[KarriB]

Ring for your meds until you get them. Tim is right, if you have someone to advocate for you let them, if not tell the problem nurse you want to see the nurse manager or floor nurse. Wish I could come through the screen for you.

 

[kneeper]

You might be able to ask for ear plugs. For my first knee they offered them to me and I used them on occasion. For my 2nd knee it was much more quiet. And they'd close my door when I was resting.

 

[referee54]

The hospital at night seems noisier than during the day. I just had the door almost closed completely---at times I would use my IPod and listen to very quiet, calming music.

 

[KarriB]

If you're close to the desk area ask for the door to be closed. With my TKR surgery I was right outside the desk and if I hadn't been highly medicated the noise would've bothered me. My infection surgery found me at the far end in a huge quarantine room that also had an anteroom connected in case staff needed to scrub or change when coming and going. It was very quiet.

 

[GratefulNana]

The hospital where I had the surgery was admitted is a Level 2 Trauma Center. I noticed that all of the RNs were wearing badges identifying them as ICU nurses. I was told that there are no speciality units, such as Ortho. I had a psyche patient next door that constantly rang for the nurse. The nurses had never cared for a BTKR, and it showed. The chair that they insisted that I sit in was a regular hospital chair, too low. I have never had an asthma attack, but I had of them each time while trying to lift myself from the walker to the chair and from the chair to the walker. They made me wait 15-20 minutes for a Respiratory Therapist to be notified and come to my room. The fact that I could not breathe was not an emergency. My heart rate is normally 62, and it would go up to 110 during these episodes. I am not a demanding person. The doctors and nurses were amazed that I could get up and take short walks. The incompetence of the RNs was rampant. As the RN was going over my discharge orders, when it got to the medications, I was told to continue my home meds. They had taken me off blood pressure meds while in the hospital because my blood pressure was too low (112/34). When I asked about this, I was told that they did not worry about the diastolic number. The Hospital Based Doctor told me that I was at extreme risk for a DVT. They gave me baby aspirin in the hospital, but was not discharged with any, or told to purchase any. I was also discharged within 48 hours of surgery with no pain medications. When I questioned this, they sent the head charge nurse to see me. She said I was to take what I had at home. Everything is computerized, and, if you read my medical chart, it is clear that I never had, and do not have, a prescription for pain meds, or non-inflammatory meds. After the prescription was written, it took three hours to get it filled. While talking to the head nurse, I told her about the asthma attacks, and felt that they were caused by the Percocet. I asked to have a prescription written for Tramadol, so I could take less Percocet and I asked for a resque inhaler, which I do have a prescription for, in case I had another asthma attack getting into and or out of the car, since we had to drive 35 miles home in extreme traffic. I didn't get it. My poor husband had to take the Tramadol prescription to the local Kaiser Pharmacy and wait another hour and one-half for it to be filled. I know this story sounds unbelievable, and there is more, but it all happened. The good news is that I am doing remarkably well. My husband is amazed! I know the right thing to do is to file a complaint, but, I honestly don't think it would matter.


BTKR Scheduled for 12/28/2015

 

[newlybionic]

I'm so sorry that you had such a bad experience in the hospital. I'm a RN and when I hear stories like this I wish I could just go and shake the RNs that you encountered. I hope that you have given your OS a call and have it straightened out what to take at home. I hope now that you're home you can be the rest you need and have an uneventful recovery.

 

[New England Librarian]

I am so sorry also, and think that you should make sure your OS knows how you were treated. Surgeons work hard in the operating room to give their patients good results, and they certainly don't want their brilliant work undermined by poor post surgical care. They often have a lot of influence at the hospital, as they have access to the top administrative and medical staff, and might be able to address the problems you encountered.

Are you home now? I hope you are more comfortable and can move forward with your recuperation - happy new year!

 

[GratefulNana]

I have been home since Wednesday afternoon. Was discharged with no pain meds or blood thinners. Discharge orders did mention to expect a blood thinner, but said nothing of pain medicine. I questioned the discharging nurse about both of these items and was told to contact the OS. I have not seen or heard from the OS since before surgery. It was such a surreal situation that I found myself in. I actually felt like I was in the Twilight Zone. So, I am on 10mg of Percocet every four hours in the hospital and Tramadol every six hours, and am discharged with no meds, especially pain meds. Everything I read here indicates people are fairly heavily medicated, in the beginning anyway. After being officially discharged , I had to wait two hours to get a Percocet prescription filled and my husband had to hand-carry a Tramadol prescription to our local Kaiser Pharmacy and wait 1-1/2 hours for it to be filled. Needless to say, my pain management was nonexistent. So much for staying ahead of the pain.

Except for a great deal of stiffness and stomach discomfort from meds, I am doing well. Because of the poor care that I received, I cannot honestly say that I would recommend BTKR to anyone. You require a lot of trust in your caregivers to do this, especially in the first few hours. Unfortunately, i did not receive the level of care and pain management that was discussed as normal protocol. I do have a CPM Machine and two ice machines at home. It has been so cold here that I get exceptionally chilled from the ice. I try to ice the back of my knees a few times daily, but I do find that icing the tops of my knees causes the knees to stiffen. Will just have to continue to experiment to find out what works,

I emailed my OS about the blood thinner on Wednesday. I have not heard from him, nor has the hospital called to check on me or given me a contact name or number. Kaiser is a HMO, so there is no direct phone number, and the facility has been closed from NewYear's Eve until Monday. Is this the new norm for hospital care? I am very disappointed in this facility, which is a Level Ii Trauma Center. I would love to be called to review my "stay."


BTKR 12/28/2015

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