TKR New Left Knee . . . Check!!

[DeputyDawg]

Niki:
I am glad that you at least were able to get out of the house I think we all echo the feelings about pain management. As someone said, these types of operations are not easy. I know I was in for a ride, but never expected this kind of ride either :rolleyespink:

Everything that you have posted, I can say, yep...felt that too. Fortunately for me I had to have only one knee and nothing else to make it more challenging. My wife tries to be a comfort, but until one has been in our shoes, it cannot be explained about the emotional roller coasters, the pain and yep....weepy too. That's why I love this forum for we can vent a bit and support each other. I think you are doing excellent given all that has happened. Just hang in there:cat-kittyandsmiley: Keep looking for that light at the end of the tunnel whether it be 8, 12, 16, or 24 weeks. If you do your part, it will happen!

 

[editor98]

"Well, 6 weeks out today and not much new to report"--she said as she lays there still strapped into that dang CPM! I know the CPM has been good for me since I am so immobile, but man, I will be happy to see this baby go! I will keep it until at least the 17th when I go back to the doc again. If he says I can start walking then the CPM will be history. I am up to about 96 or so on there. I am no longer doing in-home PT, though, so don't know what my real flexion measurement might be. I am trying to do the exercises and stretches on my own. It's been hard to find the time between 6 hours a day on the CPM and icing and elevating A LOT. I think I will be doing outpatient PT for a week or two once I am cleared to start walking.

Yesterday I started stretching my pain meds to every 5 hours instead of 4. It seemed to go fairly well. Although I had some swelling/tightness issues yesterday, I think because my husband didn't replenish my ice machine when we got up in the morning, so as the day went on it was less and less effective for me. By evening I was pretty tight and uncomfortable. I don't think he'll be doing that again! :th_heehee:

Definitely had some rough patches this past week (a week's delay in walking, feeling depressed about that, more weepy than usual, etc.), but had some good things as well (took my first bath, broke 90 degrees on the CPM, went to church for the first time, actually went to a store). I have a couple of events coming up later this week that I am really going to try to make. I think I will just have to keep them short because I still get tired so quickly.

I am working some every day--usually about 2 or 3 hours. It does wear me out though. I'm an editor for a magazine and work from home. I think I edited my first article after surgery at about the 3-week point. My husband came into the room and asked me what happened. I told him that I just edited one article. He said I looked like a gunshot victim!! I think it was a little too soon for work, even if it was from home! :hysterical:
Niki

 

[carousel66]

Niki
you still amaze me!
you have done 6 weeks!!! 6 weeks are down!
and you are rounding 3rd heading for home base!

keep up the good work,
I am one of those people who really like PT
I enjoy the structure, and the stretching that I get at PT that is hard for me to do on my own. Everyone is different.

 

[editor98]

I have a couple of questions today that I'm thinking some of you Smarties might be able to help me with. First, I've been stretching my pain meds out to 5 hours instead of 4. And during the day I am taking only 1 hydrocodone and 1 regular strength Tylenol. I'm still taking 2 hydrocodone at night. Since I've started doing this, I've added 3 ibuprofen every 6 hours. I am also taking 7.5 mg of meloxicam (Mobic) twice a day. My question is, can I take the ibuprofen (an anti-iflammatory) while I'm also taking Mobic (also an anti-inflammatory)? Or should I not take the ibuprofen. I added it because I'd like to eventually be just taking 2 extra strength Tylenol and 3 Advil every 6 hours. That's the goal when I can get by without the hydrocodone--maybe in another couple of weeks time.

My second issue is that I've developed some sort of rash across the width of my knee right above my incision. I'm going to try to attach a couple of photos (if I can figure out how to do that). They're not great pictures, but maybe you'll be able to see what I'm talking about. The rash is slightly raised red patches that are very itchy. They started at about 3 weeks out with three of them, which stopped itching withing a few days. In the photo, the areas that look purple are the remnants of the first three patches. Then last week at 5 weeks out, more of them started showing up. I had a few when I went to the OS last week and showed them to him. He wasn't sure what they were, but told me to put cortisone cream on them. I've been doing that since Sunday and they only seem to be multiplying. Do you think this could be from icing so much? I never ice directly on my skin. I wear this thin knit sleeve thingie that I have and also have on pants or PJ bottoms. So there are always at least two layers between the icing machine and my skin. But could icing cause this kind of itchy, raised rash? Thanks for any input on both questions! Niki

 

[karmigirl]

Niki,

For question number 1, I was always told NOT to take Ibuprofen if you were taking any other anti-inflammatory. I was on Mobic also didn't think it did much so stopped it and went to Advil just not at the same time.

Question 2, sorry can't help you there, if it were me I would give a call to the OS and tell them it is getting worse then when you were seen last week. Never hurts to be on the safe side.

 

[Jamie]

I'm not too sure about the rash either so I'm going to tag Josephine so she can take a look. Thanks for the photos...that helps! @Josephine:

As for the meds, you should NOT take Mobic and an ibuprofen product ... or any other NSAID for that matter. It can react with ibuprofen and can cause a skin rash, so that may be why you have the rash on your knee. Please stop one or the other and talk with your GP about any of the meds you want to take before you start them. Your GP will have the best knowledge of all the meds you're taking and what you can add if you need to.

As for the Advil, you are exceeding the recommended doseage by taking 3 pills at a time. Were you advised by one of your doctors to take that many? Normal dosage is 1 or 2 pills. You want to take the least amount possible to get the job done because NSAIDs can be rough on your stomach, especially if taken at high dosages or for an extended period of time. Under your doctor's guidance, you could take up to 800mg with each dose for a total of no more than 3,200mg in a 24-hour period. But, I think it would be much safer to take 400mg at a time (2 pills) along with 2 Extra Strength Tylenol (500mg each pill for a total of 1000mg per dose).

With the Tylenol, a regular strength (325mg) is pretty useless. It's just not enough medicine to combat real pain. You must count the acetaminophen in your hydrocodone along with any Tylenol products you take. Each dose should not exceed 1000mg of acetaminophen and no more than 4000mg in a 24-hour period.

You are just over a month out from surgery and I don't think you should be reducing your pain meds at this point. If you have pain, stick with the hydrocodone or request a different pain medication if it is giving you problems. There are lots of choices for prescription pain meds to ensure your pain (stiffness, aches, etc.) are properly managed

Then later....when you find yourself missing a dose here and there of the prescription pain medication, you could switch to the 1000mg Tylenol along with 400mg ibuprofen taken at intervals throughout the day up to the maximums I mentioned earlier.

 

[editor98]

Thanks, Jamie! Interesting about the NSAIDs and rashes. This rash started long before I started taking the Advil though. I've had the rash since about week 3. The first bout cleared up and then it flared up again about 2 weeks after that.

I started taking the 800 mg of Advil a few days ago because that is what I was taking prior to my surgery. And my thinking was that it would help me cut back on the narcotics. I've been taking that every 6 hours--so just four times a day for a total of 3200 mg. I guess I need to decide which works better for me, the Mobic or the Advil and choose one or the other.

I've only been taking 1 regular strength Tylenol because of the 325 mg of acetaminophen in the hydrocodone. When I take two hydrocodone at night I don't take the Tylenol. I only take the one Tylenol when I take one hydrocodone instead of two during the day.

I'm not having any problems at all with my pain meds (except that they make me tired). I'm just starting to feel like at 6 weeks out, maybe I can start taking less or start slowly switching to over the counter drugs. I guess I'm trying to figure out the best way to do that. I'm the kind of person who needs a plan. I'm much too OCD to just find myself missing doses!
Niki

 

[Jamie]

Just understand that, even though YOU think 6 weeks is a good time to cut back on pain meds, your KNEE may have different ideas. If you need the meds to counter pain, you still need to take them no matter what the week is. I took my prescription pain meds for around 3 months. Some can stop them sooner; others may take them longer.

Ibuprofen (Advil) and other NSAIDs are not very effective pain relief medications. They are mainly anti-inflammants. Right now you are experiencing post-op pain and that needs to be treated with pain medication....either prescription meds or acetaminophen (Tylenol). By my math, you could take 1 hydrocodone (325mg acetaminophen) and 2 of your 325 regular Tylenol. You can take up to 1000mg per dose and that is only 975mg. By the same token, you can take 1 325mg Tylenol with 2 of the hydrocodones. Don't take any more than you need, but this is an option for you.

As for the NSAIDs....they're okay to stop inflammation, but don't try to use them for pain relief after surgery....they won't cut it.

 

[MsHeidi]

Niki, I haven't reduced mine yet, other than the oxycontin they gave me in hospital. I just never got more of that when it ran out at about two weeks. I figure when my knee stops hurting, swelling, etc., that will be the time to reduce pain meds!

 

[susanw]

DO NOT RUSH TO TAPER OFF YOUR PAIN MEDS!!! Maybe you think you "should" or maybe your doctor thinks you "should" - mine was so worried about me getting addicted. But I was in nasty pain and I just couldn't endure it - I took oxycodone for two and a half months. Then, I just somehow knew I didn't need it. I switched to ibuprofen and while it took care of the pain, I had withdrawal symptoms of restlessness and anxiety and not being able to sleep. So, this time I'm smarter (sort of a smartie) and I know that I will take pain meds as long as I need and then I will give myself a couple of weeks to taper off.

There is NO glory is hurting and it hampers your recovery, your mood, your daily life, your families life and it prevents you from looking hopefully to the future.

You have been through a lot - be kind to yourself.

All my best.
Susan

 

[Josephine]

Just checking in .... can't add anything to the excellent pain management advice given and I'm not very good with skin problems so I suggest you see your GP. It's does need looking at, I would say.

 

[editor98]

Thank you all for the advice and input. The rash is pretty much the same. I have an appointment with my OS on Thursday (more xrays and hopefully the okay to start walking :yes 4 so I'll ask him to take another look at it and see if he thinks I should see my GP. Thanks for the suggestion, Jo. I didn't even think about seeing my GP!

As far as the pain meds. I did stop taking the Advil altogether since I'm taking Mobic. Don't think it was really doing anything for me anyway. But my thoughts on my pain management are kind of like the trial and error of how much is too much to be doing physically. If you don't try something how will you know whether or not you're ready for it? My pain has been very well managed. (I don't even like to be uncomfortable.) So I figured it is time to see if I can be just as comfortable on less medication. So far it has been absolutely fine! I am now stretched to one hydrocodone and one regular strength Tylenol every 5 1/2 hours round the clock. So on average, I am taking 4 1/3 hydrocodone in 24 hours instead of 12! A huge difference in my mind! And I am not in any pain. Who knows, I may need to up the meds again next week if I'm able to start walking and using my knee for the first time--but for right now I feel good with taking so much less medication. And how would I ever know that I really only needed one-third the amount of narcotics that I was taking if I never tried lowering it? Believe me, if I find myself uncomfortable or in pain, I know where the drugs are! But I think the drug regimen is trial and error too, just as the physical activity is. Anyway, just my humble opinion and what seems to be working for me. Niki

 

[karmigirl]

Niki,

I wholeheartedly agree with you. We have to go the trial and error routine with the recovery, that is for MEDS as well as activity. When you find what works for you stick with it. Only thing I would recommend only adjust one thing or another at a time, or else you are never sure what is working.

Great to hear you are doing so well on Your schedule.

 

[Jamie]

I agree too. As long as you're doing fine and not in pain, then it's working for you.

 

[editor98]

Today I'm stretching to every 6 hours. Will see how this goes for a few days. First sign of discomfort though and I'll be changing in the other direction!
Niki

 

[tyncam]

Good luck - anxious to hear how you're doing once you're walking - which sounds like it can be as early as next week.

 

[editor98]

Thanks, Dale. I'm interested to see how that goes as well! Doc visit on Thursday, so we'll see. I don't really know what to expect if he says I can walk. A little nervous.....
Niki

 

[Diney]

Hi Niki
Thanks for your post about ice. I left a reply on my thread about us both being editors. I hope you get some joy about walking when you have your appointment next week.
Diney

 

[editor98]

Thanks, Diane. Are you working now as an editor? What kind of editing do you do? I am one of the editors for the professional journal of the United States Marine Corps. I love telling people that--it sounds so much more impressive than it really is! :hysterical: Niki

 

[Jamie]

Niki.....which Marine Corps magazine? I retired after almost 30 years from the Marine Corps Finance Center in Kansas City.