THR I have a cold, my mother has her THR today<

[Cynthia777]

I would be quite firm in telling the OS that your mother needs to STAY AHEAD OF THE PAIN! This means (as Josephine mentioned), every four hours (or less if OS okays) around the clock. It seems what's happening is she's constantly trying to catch up with the pain, instead of avoiding it in the first place (BEFORE she's in pain). It's quite normal for her to experience discomfort, but no excuse for her to be in so much pain that she hasn't gotten out of bed for 18 hours! If she's not mobile, not only will her recovery be hindered, but she risks a blood clot. You must be your mother's advocate and speak your mind to the staff (example..."No, I do not want to wait until the OS comes in tomorrow! You need to call him NOW!"). Don't be shy!

 

[nevillek]

I already asked him multiple times today for the pain meds, because of which they gave all those painkillers in the afternoon, but it never helped.

I don't know but maybe he doesn't have a system to give very strong drugs like narcotics that they usually prescribe in the US. Also, all the drips and tablets given in the afternoon as I mentioned above didn't help her pain until now (8pm) and now they're only giving her 2 pain killers at 8 and 10 pm, one of which is a lousy Lanol. So I'm sure it's not going to help with the pain either. My OS just checked the xray and says it's only a muscular pain and shall go, and that he'll make her sit tomorrow. But I know she's going to be in pain during any movement. Maybe he'll assign her stronger drugs tomorrow.

As far as being in bed, it's going to be 48 hours by the time he visits her tomorrow, but the PT said as far as she keeps doing the ankle, knee and buttock exercises, she'll be okay. I even asked them about the leg pressure belts but they said its not required she'll be okay.

I'm just confused why exactly would they not give her more meds if they know it's paining? I think it's because of the side effects.

P.S. Is it OKAY to put the ICEPACKS in cloth on the dressing? I just checked and the dressing looked wet. Any danger with that?

 

[Cynthia777]

Boy, that's too bad that her OS isn't going to control her pain better, but maybe he has his reasons. Always make sure you wrap something around the ice packs. While I was in the hospital they had very large ice filled baggies, which they then put the Baggie inside a pillow case. It worked out great. I'll be sending up prayers for you and your mom. This must be very difficult for you too! Hugs!

 

[Jamie]

The bandages should not be wet from the ice packs. Make sure they change out any wet dressings. And as Cynthia says, ice packs should be wrapped in plastic bags if they are at all leaky or sweaty on the outside.

 

[Jamie]

I can tell you that the Dynapar (an NSAID) and Paracip (acetamenophin) will do very little to address your mother's pain. I'm glad to see they have finally offered a Morphine patch. It is a narcotic and should help her. But they have to keep using it on a schedule. If it's time release for 72 hours, then be sure you are after them for another one immediately at the 72-hour point. It took a long time for pain relief from the Morphine patch because your mother was trying to catch up to her pain. If she has steady medication in her system, that won't happen. She needs at least 4 or 5 days on good pain medication (narcotics such as the Morphine, percocet, hydrocodone, oxycodone, or tramadol. I'm not sure what the equivalents in India might be, but it's up to you to ensure that she gets the needed meds on time.

 

[Jamie]

I see that Tramadol is a pain medication used in India. If you are having difficulty with the Morphine patch, see if her surgeon will prescribe 1-2 Tramadol ever 4 hours for her pain for at least a week. And if he will, make sure she gets the medications right on time. As you so wisely observe, she's not going to be able to get up and move around (which needs to be done) until her pain is properly managed.

 

[nevillek]

The ice packs are in plastic and then put in a pillow cover, maybe the dressing just gets a little moist but not exactly wet. I'll ask the OS today if she should avoid keeping the ice pack on the dressing?

 

[nevillek]

Would Tramadol be more effective than morphine?

I'll ask him about it. Does she have to stop the morphine if he prescribes her Tramadol? Could there be any side effects?

She's so sore even when they come to sponge her in the morning and try moving her on the good side with the op leg over the pillow. She literally yells.

Thank you so much @Jamie

 

[nevillek]

That part is still paining badly when moving @Jamie .. This means she has to wait more time to do Physio or do the Physio in pain

 

[nevillek]

So the OS just came and made her get up from the bed.. He's like it must be the stretched muscles and tissues because of the surgery and lengthening by 2.5 cms.. She was in so much pain while getting up, but he made her stand, walk 10 steps, sit in a chair, and the toilet seat. She became super dizzy and felt low pressure in the chair and wanted to go back to bed. OS said this will go away, not to worry, and I'm getting paranoid and making her more paranoid. But mom feels so awful, it's making me sick.

I asked him about Tramadol and he said what he's giving her is stronger than that.

 

[nevillek]

I'm so devastated.. I don't know what to do now.. She doesn't even want to do the evening Physio after what she experienced in the morning session today.. They're only giving her Lanol for the pain killer now along with the Morphine patch...

 

[froggymom]

Good morning nevillek. I'm very sorry your mothers having so much pain and the hospital is not up to par. You're mom needs to move so she can strengthened her muscles and its going to be painful but the more she moves the better it will get. Slow and steady wins the race. I pray she gets what she needs from her is. Maybe at home it will be more comfortable and she'll feel more comfortable doing things to get better. Take care and better days ahead sending good vibes and big hugs keeping you and your mom in my prayers m

 

[nevillek]

Thanks froggy, she's a little better now and was okay doing the second Physio today.. Not taking her home though until she's pain free

 

[Jamie]

The morphine is stronger than Tramadol and it is the better choice for her pain as long as the doctor will prescribe it for her to use constantly. With the patch, it sometimes is possible to "top" it off with additional pain medication (not the acetaminophen or NSAIDs). Ask the doctor if there is something strong she could have in addition to the morphine for breakthrough pain.

For your mother's sake, please try to remain calm and don't panic. Gentle encouragement to move about a bit will help her.

Is there any way you can get a disc copy of your mother's post-op xrays and post them for @Josephine to view? It might help to have a second set of eyes on the joint replacement itself to see if there are any issues going on there.

 

[nevillek]

Thanks @Jamie ill try getting it tomorrow

 

[Josephine]

I'll ask the nurses about what meds are being given to her in a while. They're snoring in the duty room right now (530am).

That's outrageous! They are getting paid to be on duty, not sleep. in my experience, that could be a case for instant dismissal!

As for the drugs on the lists you posted for me:
None of these drugs are to do with pain management:
levofloxacin is an antibiotic
duphalac syrup is for constipation
Lonol is a PPI for gastric reflux

These are:
lanol er is paracetamol - very few side effects
dynapa or dynapar is diclofenac - this is an NSAID and since it seems your mother has reflux, she shouldn't be taking it. But this is IV so it's probably okay.
ultracet is Tramadol and paracetamol - so your mother is getting Tramadol already! Tramadol has a list of side effects most of which are not common. But it does cause constipation and drowsiness.

I'm also worried that her op leg has remained inactive for the last 15 hours without the blood circulation bands.

The circulation pumps are only supposed to be used for about 8-10 hours post-op.

I'm making her do the ankle, knee and bum exercises though but not the up/down left/right movement as it pains her.

I suggest you don't make her do the bum exercises as that is where her incision is, or the knee exercises! But the foot pumps and ankle rotations are a good and easy thing to do

I'll ask the OS today if she should avoid keeping the ice pack on the dressing?

Of course you can keep it on the wound. That's the bit that hurts the most!

Could there be any side effects?

There are always side effects with any medication.

This means she has to wait more time to do Physio

She actually doesn't need any physio! I think I mentioned that before.

He's like it must be the stretched muscles and tissues because of the surgery and lengthening by 2.5 cms.

If she had a lengthening of one inch, that could well explain some of her pain but that will ease eventually.

OS said this will go away, not to worry, and I'm getting paranoid and making her more paranoid. But mom feels so awful, it's making me sick.

Your surgeon is correct on both counts. You just feel helpless at the moment. I know how that feels as I've been through it myself. The best way to deal with it is to take some time out and leave her to the care of the staff. Sometimes when a patient has a relative in hospital like that, they are sometimes more likely to be a problem. Your worrying can make her feel more anxious.

They're only giving her Lanol for the pain killer now along with the Morphine patch...

If she's having Lanol and a morphine patch, that should be sufficient. Though how often are they giving her the Lanol and how many tablets? They should be giving her two at a time every 6hrs.

Not taking her home though until she's pain free

That's an unattainable target, my friend. Her pain is likely to last 4-6 weeks. I think she would probably feel a lot better when she is home. THRs don't usually stay in hospital this long. Mostly they are discharged on day 2 or 3 at the most. At least once she's at home, she (or you) can manage her pain.

 

[nevillek]

@Josephine Thanks for your reply dear. I'm scared to take her home in this state. She can't even get out of bed for passing urine/stools. If she's uneasy at night at home, I'll be totally helpless. Atleast here, they can give her immediate meds. You said once she's home she (or me) can manage her pain. How?!

Physio is the only time she's out of bed. Otherwise she's lying on her back all the time and I see a few red blister type things on her back when she gets up for Physio. I'm worried , could it be bedsores starting?

Even right now it's paining her (1.5 days after the morphine patch). Do you think the morphine will subside the pain further for sure or will it remain like this? The chart says one Lanol is given at 8-1-8. I'll ask the OS if she can get two.

Please pray for her.

 

[Josephine]

I must say, with great respect to your country, I have observed Indian doctors invariably are pretty stingy with pain meds and expect patients to just get on with it. I even had one that tried to do a circumcision on a 30yr old man using just local anaesthetic! And the fact that he had two extremely pretty nurses watching never crossed his mind as an issue! I got an anaesthetist in to put the poor man to sleep and had a word with the doctor afterwards. He told me they always do circumcision under local and couldn't think what I (and the patient) was making so much fuss about! I think perhaps you have had the misfortune to come across this mentality. I so wish there was something more I could do or suggest to help you and your poor mother.

 

[nevillek]

That's what I feel too. But I don't understand why. Are they afraid of the side effects that stronger doses may create? Like even here, he didn't give her the patch until we complained about the pain twice. The only answer they give is "bear the pain for a bit, it will go away".

Today, when he came to check on mom and make her get up (after 2 days), he asked me to go out and not come back in until he said, saying I'm just making both of us more paranoid. Then he made her walk in pain and nausea/vomiting and said don't worry, it will go away.

 

[nevillek]

@Josephine hun, I'm sorry to keep bothering you but I had a little doubt about ice packs if you don't mind..

1) Is it better to put two ICEPACKS, one below the wound and one on the side if all of it is paining or should I just keep one? The doc said she can put it 15-20 mins on the wound, and otherwise on the side.

2) Also, should she take breaks between ice packs or is it okay to have it 24/7? Like even during sleep?

3) It's 4:15 am and I just put an icepack below her wound and she was finally able to sleep. Not sure if I should leave it there or move it on the side after sometime. And put a new one after an hour even if she's asleep?

4) They have two types of packs here.. Hard rectangular one and a soft one in a plastic cover.. Is any one better than the other?