PKR Mom2Four Rebecca's TKR Recovery Journey<

[Celle]

You're doing very well and I'm glad you were pleased after your visit to PT.

Don't get too wrapped up in the ROM numbers game - There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

 

[SusieShoes]

Sounds like you're having a great recovery! At this point, your flexion is good enough you don't need to fret about it at all. More flexion will come as your swelling goes down and you continue getting back to life as normal.

 

[Mom2Four]

Hi, everyone! I think things are going pretty well overall. I wanted to ask everyone who has been through this, is it normal to have really bad pain at 2 1/2 weeks, even when you're not moving, when the pain medication has worn off? I am on hydrocodone, and I am being "encouraged" to stop taking it by it being heavily implied that they "may or may not" continue authorizing refills, as I've mentioned before. I haven't gone to my GP yet, because they haven't refused a refill YET, but I only get around 3 days of medicine at a time. I must call them for refills, at which point we must drive 2 hours roundtrip to get the physical prescription, or wait for it to arrive in the mail.

Anyway ... because of this, I'm trying to limit my pain medication, and, of course, it HURTS. I take a dose in the morning, which gives me several wonderful almost pain-free hours. Then, because I want to take a dose right before bed so the pain doesn't wake me and also want to save my medicine, I have been waiting all day to take another dose. The pain has been getting to an excruciating level by the time I take my evening dose, every single day. I'd say at least a 6 on the pain scale, where I feel shaky, a little nauseated and can't focus on anything but the awful all-consuming pain in my knee.

My big question is this - is it normal to be having pain this severe at this point when the pain medication has worn off? Does anyone have any suggestions for managing the pain in between the doses, besides icing and elevating? Should I try ibuprofen, or maybe take one hydrocodone pill to bridge that gap? I also have some hydromorphone, and Voltaren gel and even arnica gel. What about naproxen sodium? Has anyone had luck with that? I'm looking for a good overall strategy with this - and a little reassurance that something isn't wrong that my unmedicated pain is still so severe!

Thanks everyone!

Rebecca

 

[SuperSnapper]

Yes, you can still expect severe pain at this stage when your knees is still in an early stage of healing. It's not nice and can really be most unpleasant and I'm sorry you are having such problems with medication. You could ask your own GP for tramadol which taken with Tylenol I found really effective . Tramadol is not a narcotic and your doctor may be happier to prescribe that. You do have to reduce it slowly though to avoid side effects. Hope you get something sorted out.

 

[Mom2Four]

Yes, you can still expect severe pain at this stage when your knees is still in an early stage of healing. It's not nice and can really be most unpleasant and I'm sorry you are having such problems with medication. You could ask your own GP for tramadol which taken with Tylenol I found really effective . Tramadol is not a narcotic and your doctor may be happier to prescribe that. You do have to reduce it slowly though to avoid side effects. Hope you get something sorted out.

Thank you for the suggestion! I've never tried tramadol, but it is actually the thing that worked best for my brother when he had spine surgery a few months ago. That would be wonderful if it worked.

 

[SusieShoes]

Yes, you can still have severe pain at 2½ weeks. I know I did! I'm sorry your surgeon's being so ridiculously rigid with your medication. An OS should know just how painful this surgery can be, and for how long. I would guess few KR patients are off pain killers at 2½ weeks. Give your GP a call, explain the situation, and if you can't get more hydrocodone, ask about Tramadol. You need to be able to stay ahead of your pain, not saving pills by waiting too long.

Do you have Tylenol? It's a better pain killer than ibuprofen. Take 1000 mg (two 500 mg pills) every six hours. No more than 4000 mg a day is safe. It may help you bridge the gap between doses... but ideally you should not be skipping doses of your best pain meds.

I'm tagging @Josephine, our Nurse Director, to see if she has ideas for you. She knows her meds!

But know your pain is not a sign of anything wrong. Your body has been through a major surgery and if you're having pain, that's par for this course.

 

[Mom2Four]

Thank you! I do have Tylenol, but I know there's some in my hydrocodone tablets and I've been taking an extra Tylenol tab with my hydrocodone doses. My mom, a CNA, suggested this and it really seems to boost the effectiveness of the hydrocodone dose. My doctor's office claimed that 3,000 is the new "safe" dosage for Tylenol, but my mom says they're full of it : )

 

[Celle]

My doctor's office claimed that 3,000 is the new "safe" dosage for Tylenol, but my mom says they're full of it : )

The 3,000 mg per day suggested limit was set out of an excess of caution, because it was feared that people would overlook the Tylenol (Acetaminophen) in other drugs they were taking and thus unwittingly overdose on Tylenol.

However, as long as there is no Tylenol in any other of your drugs, it is safe to take 4,000 mg in 24 hours.

 

[Josephine]

My doctor's office claimed that 3,000 is the new "safe" dosage for Tylenol, but my mom says they're full of it

Both are correct. Celle gave the FDA point of view and I suspect your mother is around my age group so lived when 4,000mg Tylenol per 24hrs was okay. I am happy to report that in my country (UK) it remains thus though we call it paracetamol!

 

[Mom2Four]

Okay, I've got a big question about the hydrocodone I was prescribed.

I have been experiencing a lot of pain, which has been getting better gradually. I'm only experiencing a lot of pain first thing in the morning, after exercise or walking around, and sometimes at night. For the first week and a half or so, I was taking hydrocodone, two tabs, 10-325, three times a day because the pain was so severe. I've been cutting it down to only morning and night, with no mid-day dosage, and have been considering cutting the day and/or night dosages in half.

The problem? In the afternoon, I start feeling really, really sick - almost like I have the flu. It's miserable. In fact, I'm experiencing it right now - nauseous, headache, shaky, aches, irritable, uncoordinated, etc. I found myself looking forward to my nighttime pain medication, because then I'll stop feeling awful.

Does anyone have experience with this? I'm thinking of trying to step down, taking one three times a day, then cutting them in half? Do you think this problem is because of the hydrocodone, and what's the best way to address it in a reasonable, weaning off manner? If I can stop feeling bad like this, I'll put up with the pain from my knee!

 

[Celle]

I think you've cut down your Hydrocodone too soon and what you are experiencing is a sort of withdrawal, because you haven't taken the dose in the middle of the day.

The time to cut back is when you start to forget a dose, and don't feel any ill effects or increased pain.

At this early stage of your recovery, taking your pain medications on a regular schedule is important for your knee's healing:
The importance of managing pain after a TKR and the pain chart

 

[Mom2Four]

Thank you!

 

[LuluArchie]

Hi Rebecca,

Good to hear from you. I went to physio on Monday,and I feel that I have done too much. The Physio really pushed us hard,we are in a class and we move around the room tasking it in turn to do each excercise.
By the evening I couldn't move. The next day my knee and foot were very swollen. I know that I have done too much. I still can't move properly,and it's Wednesday.

I didn't realise I had done too much until the next day.
Sounds like you are doing well.

Take care.

Jane .

 

[Mom2Four]

Hi Rebecca,

Good to hear from you. I went to physio on Monday,and I feel that I have done too much. The Physio really pushed us hard,we are in a class and we move around the room tasking it in turn to do each excercise.
By the evening I couldn't move. The next day my knee and foot were very swollen. I know that I have done too much. I still can't move properly,and it's Wednesday.

I didn't realise I had done too much until the next day.
Sounds like you are doing well.

Take care.

Jane .

Wow, Jane! Circuit-type physio sounds like a LOT - I don't think I could do it now. Tuesday, I went to physical therapy, felt awesome, the stretches he did felt great, he put me on a modified stair stepper for ten minutes, worked on my gait without crutches (super hard to do, no limping, which I actually haven't done for years!) I, being my stubborn self, came home and did several more exercises, walked around most of the day without my crutch - and paid for it the last two days! Today, probably because I did too much Tuesday, my knee was painful, stiff and less reactive at physical therapy. So, I hear you on that.

I discovered this awesome place near my house called Feet Retreat of all things, they specialize in only feet and calf massage! It's perfect for when my leg swells up and feels tight and awful because they work below the knee, and were really careful and respectful of my recent surgery and the need to be careful and work around it. How are you managing your pain? Are you having any post-surgery blues at all? I'm off-and-on emotional - last night, I cried for half an hour because my surgery scar is crooked, which hasn't bothered me at all before I think part of my problem is, in addition to my own healing up, my 70-year-old father just had quadruple bypass open heart surgery, and is having some issues. He had a seizure afterwards, and they can't get his heart beat to regulate, so he's still in the ICU in hospital. But he's getting better slowly.

As I mentioned, I'd love to hear some of the ways you're dealing with the pain, healing process, etc. You and everyone else! What is your day like? How are you staying busy? Do you have an icing schedule, and ice pack or cryocuff?

Good luck!

Rebecca

 

[Celle]

As I mentioned, I'd love to hear some of the ways you're dealing with the pain, healing process, etc. You and everyone else! What is your day like? How are you staying busy? Do you have an icing schedule, and ice pack or cryocuff?

@Mom2Four - Rebecca, we like to encourage people to write about their progress on their own threads, so they don't sidetrack your recovery thread.

LuluArchie's thread is here:
https://bonesmart.org/forum/threads/physio-visit.43814/
so you can read about her recovery in her thread.

 

[Mom2Four]

My Incision Has Started Shedding/Spitting Out Sutures!!!!!!!!! I really need advice.

I am a little over 4 weeks out, and have taken meticulous care of my incision. Earlier this week, as we were getting ready to leave on vacation, I bent my knee and large drop of pus oozed out of the previously sealed incision at the bottom. I freaked out and called the surgeon on call, thinking infection, and my doctor had me come in the next morning to be seen between surgeries. There wasn't anymore pus or obvious inflammation, and no obvious stitches sticking out. However, there were areas of the scar that were more raised than others, and the incision had still felt super stiff.

The doctor put me on an antibiotic course, just in case, and had bloodwork done. He said he believed my body was rejecting remaining stitches that hadn't dissolved under the skin yet, and, if I saw them sticking out, to simply sterilize tweezers and pluck them out. In the last two or so days since, I had seen tiny, clear, shiny, sliver like bits sticking out, and had plucked them with no problem.

Tonight, another drop of pus popped out of the TOP of my incision. I looked carefully at the area, not really expecting to see anything, and saw something white. So, I took the tweezers and went to pluck it, and pulled, and pulled ... and pulled. What was sticking out had the thickness and consistency of dental floss. After I had pulled about 3/4 inch, it started to bleed and hurt so much it felt like I was going to throw up. At that point, the stitch fibers also broke off, and I could no longer see the stitch, but the whole area around that part of my incision swelled up and started to look bruised.

What on earth do I do? I'm still on the antibiotic, and am set to see my doctor again Monday to go over the bloodwork. My guess is my body has simply not dissolved some of the stitching inside, and is trying to form a protection around the stitching and push it out. However, after pulling that much, I'm a little worried. It seems like there maybe A LOT in there, and I'm afraid my doctor will want to cut it back open to remove them. What do all of you think? Between now and when I see the doctor, should I put moist heat on it to encourage it to do whatever it's doing? That's what I would normally do for an infection - but it's not really a normal infection. Help?

 

[Celle]

What on earth do I do? I'm still on the antibiotic, and am set to see my doctor again Monday to go over the bloodwork. My guess is my body has simply not dissolved some of the stitching inside, and is trying to form a protection around the stitching and push it out. However, after pulling that much, I'm a little worried.

We usually advise people not to pull on those sutures, but to leave them alone. If they need pulling out or cutting off, it should be done under sterile conditions, with sterile scissors, preferably at you surgeon's rooms. Until then, cover them with a sterile, dry dressing.

 

[Mom2Four]

Ah. My surgeon told me to just take tweezers and yank them out! It didn't sound like the best idea, but I figured he knew what he was talking about. Have your or others had leftover subdermal stitches that were this large? What is the usual outcome?