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TKR Hopefaith's Ups and Downs of Recovery

hopefaith

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Hello everyone, I haven't checked in now that I'm on the other side. I've really dealt with some intense pain issues. I feel I was pushed too hard in PT at the hospital. Should I have pain after PT? The medication regimen is:
  • long acting Oxycotin 10mg 3 times daily (every 8 hours)
  • Dilaudid 2-4 mg every 3 hours as needed for severe pain (this is breakthrough med)
  • Mobic (meloxicam) 7.5 mg 1 per day
I'm still in a lot of pain and I'm having to use the breakthrough at maximum level to get me down to a tolerable pain level. The downside of this level of med is it makes me very sleepy and lethargic. I'm taking these meds on a timed schedule and I'm doing really short walks of no more than 5 minutes. I did 5 heel slides in bed yesterday. I'm icing, elevating, resting as the mantra stipulates. I'm starting outside PT on Friday 2 times per week, instead the docs orders to do it 3 times per week. I will not let the PT push me to pain.

I have compression calf cuffs that are hard to tolerate when pain is too high. Also I have a Continuous Passive Movement machine that I've not started to use.

I would appreciate any suggestions at this point.
 

Jamie

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The short answer to your question is....no, you should not be in pain after therapy nor should your pain be unmanaged the rest of the time.

Your prescription sounds just fine to me although I'm going to tag @Josephine to see if she thinks there is something else you can do. What I think is important is that you change your mindset about what you should be doing for the next few weeks. Activity and exercise should be no more than gentle bends and stretches several times a day. You do not need to be doing "walks" of any length other than what is involved with moving from room to room during the day and night.

Take your breakthrough pain meds! You hurt. You need them. That is why they were prescribed. They may make you sleep more, but frankly....that's the point! Your body needs LOTS of rest.

Be sure that you're keeping ice on your knee constantly when you are not up and around. You cannot over ice! Place ice all around your knee....even on the back. Just be sure you have a cloth in between you and the ice source so you don't damage tissue.

I'm glad you're going to stand strong with your therapist. They need to go slowly with you. Two times a week is plenty for outpatient PT. You'll be absolutely wiped when you go because you not only have to be there for an hour or so, but there is the getting ready and the drive there and back. If you find that's too much for you right now, ask for in-home therapy instead.

There is a fine balance between activity and rest. As you go through recovery, the scales tip more toward the activity side. But right now, you should be heavy on the "rest."
 

Jamie

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Ooops....almost forgot to post our basic recovery articles from the BoneSmart Library. Read these links and they will help you understand more about the recovery process.

First are the 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!

Next is a FAQ (Frequently Asked Questions) thread.

And then the articles in order of importance.

Group A
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?
Progression of activity for TKRs

Group B
How Long Does Healing Take ......
Chart representation of TKR recovery
Energy drain for TKRs
Elevating your leg to control swelling and pain
Using ice

Group C
Knee Replacement - Where Am I in Recovery?
So What Is It Going to Take? The Five “P’s” of Knee Recovery
Work “Smarter” and not “Harder”
About recovering a knee - from one who knows!
Some suggestions for home physio (PT) and activity progress
Myth busting: The "window of opportunity"

Group D
MUA (manipulation under anaesthetic) and adhesions
It's never too late to get more ROM!
It's Worth the Wait for ROM
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?
 

icep707

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Welcome to the otherside , you will have to make sure when you start OPT that you let them know you will not be pushed into pain ! Not all therapist are torturist but just in case , you would want to be prepared. Im wondering how often you are elevated and iced !! My first 3-4 weeks I literally iced 18 hours a day , along with my pain meds , it made my recovery minimally painful . Of course I never missed a dose and I laid in bed for a month , elevated and iced . Its not like I had alot to do . Just do your PT , go to bathroom . Eat , drink , get ice , eventually do dishes and light housework. Nothing to strenuous . The first weeks are tough, lack of sleep , energy drain and overall poopy feeling due to the meds. It will get better. My surgery was on February 10th and im riding my motorcycle , watching live ballgames and going to the gym regularly. I did however overdo it at gym yesterday and OPT. Back to elevation and ice . !! I truly believe my excessive elevation and iceing very early on contributed to my recovery. There will be light at the end of the tunnel . I remember my first few weeks and in hindsight it was like the twilight zone. Its not comfortable. Best of luck . Iceman
 

kneeper

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Congratulations. Like Jamie said, it's ok if the meds make you sleep--you need the rest. Good for you for doing some heel slides. Just some gentle motion like that a few times a day is all you need besides getting up for the bathroom etc. at this point.
 
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Welcome to the other side!! As the others have said, take your meds!! Do not worry about being knocked out, that's the time your body is healing. Also, as you've said, do not allow anyone to hurt you or push you to do something that hurts. This recovery is difficult, but once you have your pain under control, it is ever so much easier to handle. Even now, I need my pain med several evenings a week - I'm perfectly OK with that!!

It's funny, I was comparing how I'm feeling now to a couple of months ago - 1000 times better! - but I literally could not recall much at all of my first couple weeks. With being so medicated, sleeping so much, and really not doing anything the hours/days/weeks just blend together. I took my prescribed doses of meds around the clock (even set alarms for the night doses), iced and elevated religiously - THAT really helps with your pain level, too. My activity early on was basically self care, some gentle bends and stretches, and that was about it. Your real job right now is to allow yourself the time needed to simply heal - rest, ice, and elevate as much as possible, your knee will love you for it.
 

Josephine

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long acting Oxycotin 10mg 3 times daily (every 8 hours)
Dilaudid 2-4 mg every 3 hours as needed for severe pain
As far as I can ascertain, neither of these contain acetaminophen (Tylenol) so you could add 1,000mg up to 4 times a day. But please do check the ingredients on the box to make sure they don't contain any of this first.

Other than that, it may be that this combo of drugs just doesn't suit you so I would suggest you ask either your surgeon (if he is amenable) or your GP if you can change to something else like Tramadol which I have found is much more effective for pain management.
Mobic (meloxicam) 7.5 mg 1 per day
I can never see the advantage of taking NSAIDs (anti-inflammatories) as part of a pain management regimen as they are useless as a pain med and largely ineffective as anti-inflammatories as this is not the kind of inflammation they are design to affect. But they do have oodles of hazards! NSAIDs, acetaminophen (Tylenol, paracetamol) differences and dangers I wouldn't take them now if you paid me!
 
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hopefaith

hopefaith

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thank you all for your perspectives. I am so glad I found this site. Yesterday my PA changed my Dilaudid to Oxycodone for breakthrough. I get up to walk short distances. I have pain almost all of the time. There are times when I am lying in bed with ice to my knee that it doesn't hurt. I ice almost constantly. I have read a lot of others experiences with the CPM. I am starting to use it several times/day. It feels good. I wake up at night with excruciating pain. I take my meds round the clock. I have PT for the first time this Friday. I feel a lot of anxiety around what the reaction will be that 1.) I haven't started PT sooner. and 2.) that my ROM is bad. I see my OS next week. I dread that for the very same reasons.
I have so many questions and I will try to restrain myself at this point. Thank you for listening.
 
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hopefaith

hopefaith

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hello all,
I have so appreciated the input of others journeys. I started PT Friday, and then again today. I like my physical therapist a LOT. I made it very clear to her that I will not go past a point of discomfort. It was hard work, but not exhausting. I would say to her "that is enough of that stretch, and she would really listen and stop. The main thing I am struggling with is the crying and crying. It is hard when no one really gets this. So I need compassion around this. I know I need to be compassionate towards myself. It is hard when I have heard messages contrary to this. Thanks for "listening."
 
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hopefaith

hopefaith

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The past few days I have had, what I would call sciatic nerve pain. It starts at the top of my thigh and radiates down my leg. This is on the operative leg. Have any of you had this? It is very uncomfortable.
 
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Jamie

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@hopefaith....I have merged your latest thread with your original recovery thread. We like to keep each member's recovery posts in a single thread. It makes it much easier for us to check back on your history and see what's gone on as well as what advice has been given. So please keep your concerns, questions and updates here in this thread. You will notice I changed your thread title slightly. At any time if you prefer a different thread title, just post what you want here and we'll get it changed for you.

That sciatic pain happens sometimes with both hip and knee patients. Remember that you only had your surgery on April 10th....you're still very early and it may be that you need to adjust your pain medications for a while to take care of this pain. Be sure you don't try to push through any pain you're feeling or do things in therapy that hurt. It would be a good idea also to ice as much as possible wherever you have pain.

Just to double check....your pain is down the back side of your leg, right? And not on the side????
 
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hopefaith

hopefaith

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So sorry about the tech. issue......still learning :umm:. Yes, the pain is down the back of my leg, not the side.
I am wondering about a med. for neuropathic pain.
 
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hopefaith

hopefaith

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I am very concerned about not being able to do even one leg lift on my operative leg. When I try, I get a very painful sharp pain behind my knee cap. And no I do not push it or force it. It seems strange that I can't even lift it off of the bed. Do any of you have resistance getting your OS or GP to refill your prescriptions? I run out of my short acting med. in 3 days and there is an implication I should be off all narcotics 1 month after my TKR. I don't see that happening, because I have intense pain if I am not right on time with my meds.
 

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Do you do a quad set (where you tighten your quad/knee) before you try to lift? I think that puts a bit less strain on the knee.
Be honest with your doc about your pain levels. It may be that they just want to make sure you're checking in with them before they issue more refills.
 
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I am amazed how much this recovery drains me. I have been very discouraged over the past few days, but I am holding on to hope and faith, thus my name here. I have struggled with those two things over my lifetime, but I hold on and look back and see how I was not alone. The sciatic pain comes and goes. My PT had some good ideas yesterday. I need to embrace the journey of this recovery and what I read over and over is this is NOT for the faint of heart. Some sail right through, a bunch of us do not. There is no good/bad to the reasons why and there are no secret reasons why. Within the journey there is a lot to learn. My rant of the day. Thank you for bearing with me.
~~Hopefaith~~
 

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Hopefaith, It's very true what you said. No one knows what a knee replacement recovery is like except those that actually go thru it. Like you say, there are some that seem to recover easier than others but I think they are the exception. This is a brutal attack on our body and we have no choice but to allow time to heal. There are things we can do to alleviate some of the pain but not all of it. The 1st 3 or 4 months are extremely difficult. You have to "embrace it" like you say. Not enjoy it of course but accept it and endure/cope with it. Pain meds, ice and elevation are the key ingredients for any comfort. You need to sleep and find a comfortable position either in bed or in a recliner and don't allow others to hurt you. Time will definitely pass and you will eventually start having easier days and a lot of what you are going thru now will become a blur and you will not remember every painful day. Sort of like childbirth I guess. You won't have a beautiful baby at the end but a beautiful working knee! I feel for you because I've just gone thru it. It's been a year now and I'm very glad I did it, but now I am facing my second replacement in June and not looking forward to going thru it again so soon but I do know that in about 6 months I'll be glad again to be rid of this present arthritic pain and my walker. Please hang in there and vent all you want on this site, you have plenty of understanding and compassion from us.
 
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hopefaith

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thank you so much. I will be thinking of you with your upcoming TKR. You are brave to do the other one. I see that you have seen, experienced the other side, so you know there is hope ahead. I will pray for you. I never understood the pain of arthritis before I had it. I was SO unaware of what others were going through. So, this has given me a whole new perspective on pain and I hope a whole lot more empathy and compassion. I think it has. I would love to keep in touch as you approach your next journey. (and yes, ice, elevation and pain meds. have been my mantras also)

~~hopefaith~~
 

Midwest knees

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I don't know if it's bravery or just not having a choice! You certainly do develop more empathy for others the more you go thru tho...Please do keep in touch, we have to keep encouraging each other. I find that prayer is a great comfort and source of peace of mind for me. Have a good day and keep repeating that mantra!
 

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