PKR Let the games begin!!! (therapy/recovery)

[referee54]

We don't even use these breathing / pneumonia prevention devices here in Australia so....hmm. How important?

That seems to be SOP here in the States. It is called an Incentive Spirometer and looks like this:

It encourages the patient to perform deep breathing exercises.

 

[jeano]

I never had one for the first knee. They sent me home with one for the second knee with no instructions whatsoever. Its gathering dust in my medical equipment closet of horrors.

 

[referee54]

I had one after my BTKR---my father had one after each of his TKR's as well as during his latest surgery.

My nurses were pretty adamant about me staying on top of taking nice deep breaths.

 

[Josephine]

If you have Tramadol, then you're okay as it's all you need - that and Tylenol. This is the regimen I used for my knee (paracetamol is Tylenol). Use it and you should be okay.

 

[kneeper]

Oh, good grief. If you get a survey be sure to let them know about the terrible nursing care. I hope things are getting on a more even keel for you now that you're home.

 

[SuperSnapper]

@billingcl been looking out for posts and hoping you have been able to get your pain meds under control. Hang in there . Perhaps you are already feeling more comfortable. I really hope so.
Best wishes.
Mary x

 

[billingcl]

Good Morning everyone. I apologize for the intermittent postings/responses. I log on a few times a day and usually am dozing off while writing a post or responding to one.

I need advice regarding my Dr.'s Pain Management technique and need to know if I have any options at this stage. I really wish I had known better to inquire about his pain management philosophy since this is the first time, out of 4 prior knee surgeries (this is my 1st partial) that I've never had such a problem with acquiring stronger pain management and receiving support from the Dr./staff.

Today is 10 days post-op and I can't stop crying from being in so much pain. To quickly recap: Upon discharge from hospital, I was prescribed Hydrocodone one (1) - two (2) 7.5 -325 MG pill every 6hrs. And a nausea med. every 6hrs too. I contacted the Dr. Day2 post-op and told the nurse how much pain I was in and the Dr. to her I could take 1 Hydrocodone every 3hrs. and prescribed Ultram 1 pill every 6hrs for breakthrough pain. I had another Hydrocodone prescription called in yesterday and the bottle now says only 1 pill 7.5-325MG every 6hrs. I tried to adhere to the schedule and am in so much pain right now I am beside myself. Called the Dr. office and his nurse said this is the last refill I will receive. That the Dr. only prescribes medication the first couple weeks post op. And that tomorrow I could start adding ibuprofen since I still have 1 more dose of blood to take today.

Is this a normal Pain Management regiment for a partial knee replacement? I realize this type of surgery is painful and the medication isn't supposed to eliminate the pain entirely. But to me.... manageable pain means I shouldn't be in tears from the constant throbbing of my entire leg and the intermittent sharp pain that occurs around/on top of my knee cap when I start to relax/doze off. Every time it happens I am jerked awake in terrible pain which feel like someone just hit or dropped a bag of ice cubes on my knee. This happens almost every time I fall asleep.

Any words of advice are appreciated.. I know I started to write a similar post the other day. But I don't think I completed it before falling asleep...I apologize if I did post this question already. I hope everyone is having a good day and each day of recovery brings us closer to living life to it's fullest.

 

[dovemck]

The more I read about TKR's in the US, the happier I am having had mine done here in Australia. The (lack of) pain management over there is truly barbaric and I'll say a prayer tonight that your doctor has an especially warm accomodation in the afterlife.

It's not the norm here and that level of pain is also unacceptable here. If it were me and the surgeon wasn't forthcoming with a new 'script, I'd be seeing your regular family doctor and if that didn't work I'd head for the local emergency room.

Also don't play brave and stoic, if they ask your pain level don't hem and haw and tell them 5ish or around 6, tell 'em it's an 8 or 9, don't be afraid to show some emotion. The squeaky wheel gets oiled. You need to do two things - be an active advocate for yourself and COMPLAIN OFFICIALLY when your needs are not met. Hospitals, surgeons and doctors have to explain complaints and how they rectified them to the quality assurance groups. They hate the paperwork complaints genrate so make them do their job to avoid it. If you get stonewalled immediately ask for their official complaint procedure.

You are being put in a horrible position, don't put up with it.

 

[billingcl]

@SuperSnapper @referee54 Thank you both for the well wishes/suggestions. I'm adapting to the daily pain level and for the most part able to handle whatever is dealt. However, the biggest hurdle I face at this stage of recovery (10 days post-op) is falling into a deep sleep. My knee feels like it dislocates or has a spasm of some sort every time I drift into a deep sleep. Then the quick/sudden pain is so severe I'm jerked awake by a flash of white lightning (behind my closed eyes) and am in excruciating pain that radiates across the top of my knee cap. I am already crying/yelling out loud, grabbing my leg.....by the time I become fully awake and realize what is happening. I feel horrible that I startle my boyfriend (who is usually sleeping next to me) with such an outburst each time this happens. The pain I feel upon waking now can only be compared to how my knee would feel after it would dislocate when I was 13yrs old. I would describe the pain to my parents by stating "I thought I jogged by the janitors cart in school and assumed I had ran into a broom hanging out of the cart and broke the broom handle across my knee cap" . The pain eventually subsides about 20 minutes after the onset. Then it often occurs again a couple times during an 8hr planned stretch of attempted night time sleep. I assume whatever is happening is due to me fully relaxing my knee. Could be a spasm specifically in my knee or possibly pain in my knee that results from my body having a "sleep" spasm.

Has this happened to anyone else? Any thoughts of what causes this pain?

 

[billingcl]

@dovemck Thank you for the response about the Pain Management concerns. I appreciate you letting me know since I feel like I'm being a big baby when I've had many many surgeries before and never had some of these issues occur. I just moved to this specific area and am going to meet with a new PCP in the near future (my boyfriends family Dr.). Hopefully he can advise &/or provide help in resolving my concerns.

 

[SuperSnapper]

@billingcl what a time you are having. I have had a similar knee dislocation feeling a bit like you describe a few times with my soon to be operated knee bug only for a very few seconds. So 20 minutes! You poor soul! I think @dovemck has it about right re your surgeon and the afterlife. I hope you can get somewhere with your GP if you go back to him.@referee54 or @kneeper might have some more ideas.

 

[kneeper]

Is the spasm/jerk kind of like the ones you get sometimes (in non surgical situations) when you fall asleep? And then you get pain b/c of the jerk? I had that at first, but not as intensely as you describe. I wonder if a muscle relaxer would help?

 

[dovemck]

I wondered that too @kneeper, for weeks afterward on waking I'd have an awesome whole body yawn/stretch that would tighten my quad and kneecap. My husband would have to scrape me off the ceiling because of the jolt of pain - especially since I was half asleep and not able to 'brace for it'. Since billingcl gets it when asleep, i wondered if a muscle relaxant wouldn't help.

 

[forever39]

I had LPKR and had pretty much the same meds prescribed. Doc won't give me more either. The hydrocodone, Norco, made me nauseous and put me in a deep but not restful sleep. If I was in the bed, on back because too painful for side, I would suddenly wake with a jerk from crazy dreams and pain. I am sleeping in a recliner with pillows for about 2 hours at a time and cut back on meds to just 1 pill. This helped with the sudden waking, but still having pain. So sorry about your hospital stay. I had mine done outpatient and was in and out in 5 hours. I thought that was crazy, but I think I'm glad after hearing your story.

 

[billingcl]

@forever39 , @dovemck , @kneeper , @SuperSnapper Thank you everyone. I am tending to agree that the pain is a result of jerking awake suddenly (like when you are "falling" in a dream and jerk awake) and my leg let me know it couldn't stretch that far yet. Forces my let to go "way" beyond the PT stretches. Luckily the frequency has subsided a bit &/or my leg can now bend enough to catch the brunt of a sudden nightime leg jerk. Overall I feel 100% better today than I did a week ago. I greatly appreciate everyone who has responded to my various postings (various emotional stages) since my journey began last week...most of the postings I've had to re-read as I don't remember typing most of the verbiage to begin with.

 

[SuperSnapper]

@billingcl so pleased to see you are felling so much better and the jerkiness is easing off a little. It sounded nasty. Here's to a continuing smooth recovery!
Mary x

 

[billingcl]

I hope everyone had a great weekend. This is the 1st wknd in which I remember pretty much everything that happened each day vs. the last few weekends...lol. The painful muscle spasms have stopped. I assume as my knee regained some mobility that the knee jerk/spasm didn't induce pain any longer. Outside of what I assume is normal recovery pain in my knee, I'm also experiencing a lot of thigh pain. Is this normal? I haven't noticed "thigh" pain mentioned in postings I've read to-date. Also noticed that my thigh and calf are still pretty numb. Never had a prior knee surgery impact the thigh or calf. However, I realize that even a partial replacement is still a major surgery.

Overall...enjoyed a wonderful rainy Sunday today by just laying around in bed with my honey and 4 legged babies. Today I did as little as possible, outside of occasional PH exercises throughout the day. Spent a lot of this weekend reading as many articles as possible to help with my motivation and emotional/physical state in an attempt to stay as positive and patient as possible. However, based on the pain I'm still experiencing, I'm getting slightly worried about my recovery pace and eventual returning to work. The thought of sitting at my desk with leg bent 90% of an 8-9hr day and then driving 2hrs each way has me a little nervous wondering if I'll be recovered enough to handle these originally simple activities without pain/exhaustion by the time I return. Interested in how other members handled their return to work regiment. My return date is tentatively scheduled for 1/21st. However, my STD reimbursement % rate will start decreasing in about 2 weeks. I'm worried that financially I may have to force myself to suck it up and return to work sometime after 12/8th (1st post-surgery appointment with OS). I'm sure all will work out in the long run.

 

[RedRider]

Hi @billingcl, I'm a few weeks behind you with my partial so I appreciate reading about your experience up to this point.

Currently, my pain management consists of oxycontin and oxycodone (for baseline and breakthrough pain respectively). So far this regime has been working great for me. Icing and elevation are huge components of pain management, but you definitely need to get your drugs dialed in correctly.

If your doctor is hell bent on sticking with hydrocodone, there's always the 10/325 formulation (Norco I believe?). And if the tramadol seems to be working for you, there's also a sustained release formulation (I think it's called Ultram ER or something). These are just some other options to discuss with your doctor.

Have you had any luck with finding a comfortable icing/elevation position? I'm having the same trouble as well. It's been fun playing "forts" with all the couch cushions though. Finding a comfortable "toes above nose" position can be challenging but once you find that sweet spot, it's all good!

Keep us posted of your progress and hang in there, you're doing great!

 

[SuperSnapper]

@billingcl good to hear from you and that your spasms have stopped. That must have been a great relief to you. You seem to be doing ok for only 3 weeks . I keep thinking after reading all these posts about recovery that it seems to be a case of taking one day at a time. I hope I have patience as I'm sure it's easier said than done.
Anyway keep posting and I'm sending you lots of good wishes for your recovery.

 

[referee54]

Have you had any luck with finding a comfortable icing/elevation position? I'm having the same trouble as well. It's been fun playing "forts" with all the couch cushions though. Finding a comfortable "toes above nose" position can be challenging but once you find that sweet spot, it's all good!

:iagree: There were times that I had issues getting comfortable---but once I found the spot---I felt great---and then it was lights out for a while!