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TKR Now post-op, surgery on Feb 25, 2020 USA

TrixieRuby

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Dear Kneebies--I am new as of today, and I am now 11 days post op. I have found this very rough going, with lots of pain and discomfort. From reading here, I suspect I have done too much and need to take it easy. I have been pushing the flexion and extension thing too much.

My major concern right now is pain management. Maybe it is because I am in the USA, but my docs are really anti-pain prescription pain meds, especially after two weeks. Right now I am taking acetaminophen (4000 mgs a day) and naproxen sodium, 2 tablets 2 x day, and oxycondon, 5 mg tablets, 6-8 a day. And I am still feeling a lot of pain! I think I need to rest more, and ice even more than I already do.

I suspect my doctor's office will want me to taper off of the oxy quickly in the next week or so. Any advice on how much oxy or similar is typical? The anxiety I have over this is not great for my recovery. Thanks!
 

Jockette

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Hi and Welcome!

I’ll tag @Jamie to come discuss your medications with you.
I have found this very rough going, with lots of pain and discomfort. From reading here, I suspect I have done too much and need to take it easy. I have been pushing the flexion and extension thing too much.
Cutting back your activities and exercises can also be a pain management strategy, the more we do in the early weeks, the more pain we have. You do need movement, but gentle bends and shorts walks will suffice for now.


I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​


4. PT or exercise can be useful BUT take note of these

5. At week 4 and after you should follow this

6. Access to these pages on the website

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 

sistersinhim

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During this early recovery you need to do very little except manage your pain. Ice, elevation, pain meds, and rest are your main order for the next few weeks. Walking around the house doing your daily activities is enough for your knee at this point in your recovery. Your ROM will come back naturally. There's no need to push to try and get it.

Which knee did you have replaced?
 

Julia1911

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I too am in the US and rationed my Oxy the first 2 weeks -- now wish I had not because it made me miserable and depressed. I was in constant pain 24/7 for the first 3 1/2 weeks. It really wore me down. Now I have some Oxy left, but will save them for the next knee coming up within 6 -12 months.

I think we have to be assertive with the docs, remind them we are responsible patients and in great pain. Our suffering is not going to "atone" or help the addicts and irresponsible people (and irresponsible docs and drug companies). We are just trying to get well and will transition as soon as possible. Making us suffer will only increase time to heal and recovery (plus, make us choose more empathetic doc next time and give them bad online ratings!). Most of the illegal opiates and ODs are now illegal fentanyl and heroin, not RX meds for surgery patients.

I asked what the pain protocol was for my doc after reading opinion piece in local/national paper from someone who had knee surgery (not even replacement!) and did not have adequate pain meds and claimed what a problem this now was in US. Will also revisit this again with doc for second knee replacement and remind him how responsible I have been. And I have had 5 other joint surgeries, and a hysterectomy, and never abused the meds given freely back then.

For me, I only took one Oxy at night to help me sleep and one before PT 2 x a week during week 3 and early week 4. Then I transitioned to only 1 before PT second half of week 4 (that was only 1 day) and then went off as it was not really helping me sleep (unfortunately, nothing is). And these were lowest dose Oxys.

Have only been taking 2 Naproxen or 2 Alleve 2x a day and 2 X-strength Tylenol 2x day all of week 5. Pain is no longer 24/7; mostly stiffness (except for heel slides). Still ice/elevate about 3x a day and usually discomfort is now due to me trying to do too much as I am getting antsy.
 
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TrixieRuby

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Thank you for your replies, people. I had my left knee done, and that is helpful in that I will be able to drive sooner rather than later. (in the USA). Julia, you have not used many pain meds! I would love to read the article you mention in your post, as maybe that will help me in advocating for myself with my doc. Can you post a link? or give a few details, like which newspaper and rough date? I plan to take it easy and not push myself--I think I am aggravating my knee.
 

Jamie

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Can you tell me the schedule for each of those meds you're taking for pain? When you take what matters.

As you've guessed, your activity level also matters, especially in these early days when your body is healing. So, please let me know what your average daily activity is. If you do exercises, tell me what exercise, how often, and the number of reps and sets with each exercise session.

You didn't mention icing and elevating your leg. You should be doing that a majority of the day and even at night if it's comfortable for you. Ice is great help with pain.

Please read the articles that were linked for you. And also take a look at the tab at the top of the page on Pain Management.
 
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I was only given 5M of Oxy. Low dose tablets I think? I only used it the early weeks and sparingly then. I would have used more had I needed too. And I ordered a refill just in case. My doctor was never hesitant about my refill. I didn't have stomach issues with it or the Tylenol regimen I was on.

It's well known that some are using Oxy to get high and the like. But as I was oriented about healing, and pain management I tended to forget the misuse which is so rampant and top of mind re. dose and refills. Thankfully, I now only need to take an occasional Tylenol or Aleve at this point.
 
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TrixieRuby

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Hi all, thanks for listening, it is so nice to be heard and to have a community. @Jamie, I am taking 2, 500 mgs tylenol at 10 pm with 5 mgs oxy, then 2 500 mgs tylenol at 7 am with 5 mgs oxy, and 2 500 mgs tylenol at 3:30 pm with one 5 mgs oxy. I just today swapped out the Aleve (naproxen) for ibuprofen, and I am taking 400 mgs 5 x a day for a total of 2000, 9 am, 12 noon, 3 pm, 6 pm, and 9 pm.

I am only doing flexion and extension exercises, 3 x a day, only up to a level of "discomfort" (per this website--was doing more). I do about 10 reps, one set, and less reps if it seems too hard. I do standing calf stretches (leaning on the kitchen counter), heel slides, sit flat on the floor and press legs down quad tighteners, ankle pumps, and I think that is it. I ice constantly--maybe 5 times a day for 15-20 minutes with a cryocuff cooler and wrap. Ice and elevation are very helpful.

As far as the oxy--I just got a refill today from my primary care doc. I switched out from the surgeons office, and I feel a lot of relief. I do want to taper off of it, but now I won't run out, and once at 3:30 pm was not enough coverage to do the exercises. My doc said to add one in during the day time, and work toward extending the time between doses. I am to try to wean off organically rather than on a schedule.

I also had been setting an alarm for 3 am, and taking an oxy in the middle of the night. She said to not set an alarm, to have one handy, but to try to sleep through the night until morning.

I realize this is long, and I guess I have a low pain threshold, but I have felt the pain makes me preoccupied and unable to read, watch tv, or relax, or exercise. I feel better now after talking to the doctor, and getting more meds. I don't think of myself as a cry baby, and my husband has commented that I am not at all, but I think I just feel a lot of pain!

One more thing: my left knee was replaced, but as it was a bit vagus (angled inward) the doc loosened some adhesions and so forth. maybe this added to the discomfort.

I am grateful for this forum and for all of you!
 

Jamie

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It's normal to have pain with this major surgery. You are just barely out from the big day and it's way too soon to worry about cutting back on your pain meds if you're experiencing pain. Your schedule for the meds and level of exercise sounds fine. The only thing I would suggest is that you ice longer than 15-20 minutes. That is what you do when you have an injury. It's not the same when you have joint replacement surgery. You should ice any time you are resting. Elevate at the same time. Each icing session should be at least 45 minutes, but can certainly be longer. The ice will help with your pain. Just be sure you keep a towel between the ice source and your skin to prevent damage from the cold.

I'm not sure what you mean by "try to wean off organically rather than on a schedule." Maybe you could explain that for me. But....remember.....now is not quite the time yet for weaning.
 
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TrixieRuby

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@Jamie--thanks so much for your reply. I will ice longer, but I might need more tea towels as it is hard to get to 45 minutes! so cold. Um, "Organic Decrease" in pain meds. This means that rather than stick to a schedule with meds, to try to wait (during the day time) until I experience some pain, and take it at that time. I will keep the tylenol and ibuprofen on a schedule, and see how it goes with the oxy, trying to reduce over the next week of two. What do you think of that? I feel so much better emotionally after finding this website--the whole "no pain, no gain thing, the no oxy, etc." was very demoralizing to me. I have shifted my point of view to go forward gently, to work at this at my own pace, to listen to my body, and to look for progess. My swelling is going down, and my body in general feels better. Little steps forward!
 

Jamie

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It's possible that you can reduce your pain meds this way, but usually a schedule works better. You're only two weeks out of surgery and it's probably much too soon to try and reduce your pain meds. You'll know if you try that organic approach and it doesn't work. If that happens, don't get shook....just go back on your regular schedule for a while longer.

The thing is, if you try to wean off the opioid and you get pain, you still need the pain relief it is giving when you take it on a schedule. If you were ready to be off it, you wouldn't get pain. You might feel some of the side effects of stopping a prescription opioid such as malaise, nausea, flu-like symptoms...these are the symptoms one gets when your body becomes dependent on pain meds. It's not addiction....just dependence. The scheduled weaning process we recommend usually avoids those uncomfortable symptoms by allowing your body to transition off the drug slowly.

With my first knee, I opted to quit taking my hydrocodone cold turkey. I was sick like I had the flu for three days and pretty miserable. That process works too, but it's so much easier on you to do it gradually with a step-down schedule.

It also is possible to step down to a "lessor" prescription pain medication like Tramadol too. This medication works very well when combined with Tylenol for pain. Then you gradually phase it out when you're ready. So that's an option for you too if you still are having pain and want to stop taking the oxycodone.
 

sistersinhim

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@Donm, I will start your very own recovery thread titled, "Donm's Recovery Thread". Posting on your very own thread is like keeping your own journal of your recovery journey.
 
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TrixieRuby

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@Jamie Thanks so much for your reply. I am under such pressure from doctors to get off of the oxycodone. I have no history of addictions, almost no experience with any narcotics except for 1or 2 after a dental procedure, and no history of addiction in my family. It is the medical establishment in Boston that is paranoid about this. I am glad to hear your reassurance that it is still ok to be on meds after 2 weeks out. Many people say they are off of them, or the docs say that many people are off of them. I will stay on a schedule, which I prefer anyway, and stick with my meds for now. I like that you say that when I don't experience I won't need them! Of course that is true!

I had PT yesterday, I have 5 degrees in extension, and 108 in flexion. I discussed a gentle approach with my PT, and that went well. She used massage to help reduce swelling, and that was a great relief. I am bored at home, trying to come up with little projects and have people over, and enjoy the quiet time. The only way out is through.
 

Rubyroo

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Take those meds as long as you need to! I'd get as many refills as they'll allow you to get because in my opinion- it is better to have the medicine and not need it than to NEED IT and not have it. Those doctors aren't the ones being kept up at night from pain and they aren't the ones crying because they are in pain. I get the addiction crisis out there- but good gracious- let them get their leg sawed and drilled on and then let's talk!
 

Jamie

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I think you may find you can transition to using Tramadol and Tylenol together on a schedule if you still need prescription pain relief as your Oxycodone is starting to run low. I suggest you talk with your surgeon about that option as soon as you can so you both have a plan in place in case you need something stronger than just Tylenol for a bit longer. With some knee replacements, it's not unusual for someone to need something for as long as 6 weeks. I know surgeons don't like that, but the alternative of leaving you in serious pain will impact your recovery.

The ice will help too. Some people have been known to use a heating pad or electric throw along with the ice if chilling occurs. Just don't put any heat directly on your knee itself. Stay with the gentle therapy for a while too. As long as you're bending and stretching along with some walking during the day, you'll be fine.
 
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TrixieRuby

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Hi folks--I just thought I would write a post to count my blessings, whichstarts with this group. Finding this forum has made this recovery so much easier. I have felt very alone with this. I am grateful for many things right now: 1. I am fit, in good shape, flexible, and decently coordinated. All of these things make the recovery a bit easier. 2. I am retired, and I do not need to think about going back to work. This is a great blessing! 3. My husband is a wonderul "nurse" and has organized my meds, brought cups of tea and ice packs, done the laundry, etc. He works part time, and has been working from home, so that is so fortunate. 4. My friends! A dear friend organized some people to bring meals, and that has made life so much easier and more delicious. Shephards pie, stuffed shells, salads, fruit salad, chili, and more. 5. My dog--she still makes me laugh, and while puzzled by the changes in our routine, she loves to keep me company and bring me toys. How about you? Any blessings to count?
 

Jamie

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What a great post! We should all take time to count the good things in our lives. I'm thankful that we are able to keep BoneSmart up and running to be able to help our members and guests. This is such rewarding work.
 

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Oh so many, many blessings!
  1. 6 + months and still recovering, but so much progress!
  2. I can walk so well that I tend to over do it, but with each little flare up I learn my limits, (another blessing)
  3. This forum has truly kept me sane and engaged and distracted...(A blessing!)
  4. I could whine without worrying if I offended anyone (another blessing)
  5. I always had someone to turn to when it was 3 AM somewhere on Bone Smart!!! (A huge Blessing!)
  6. A different philosophy has developed for me too....slowing down and being patient is a really good thing! (What a blessing)
  7. I could really go on and on ....... :yes!:
Thanks @TrixieRuby for the reminder!!
 
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TrixieRuby

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A Post a Day--that's my thought, to keep my thoughts organized and to record this journey. I am happy to report that last night I slept well, I took 2 50mgs Tramadol, a new med for me, and this helped me sleep longer as I was in less pain, but also it has a longer half life. My mood is good--there is something about getting out of the first two weeks that feels great, as it felt like I had been in a car wreck or something that was out of conrol, painful, scary, and dangerous. My days are beginning to feel more balanced, and I think I have accepted that this is going to be a long haul. I am wondering when I will be able to walk perhaps one mile without a crutch or a limp, but now I think it doesn't matter--it will happen when it does. And, I think about people form 100 years ago, before TKR surgery--I guess people were confined to a life time of pain? Or perhaps immobility, and isolation. I would take this post-op journey anyday! Be well to everyone, and thanks for your support.
 
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TrixieRuby

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I have a new prescription medication, Tramadol. I am to take 50 mgs at bedtime, as it has a longer half life than oxycodone. However, it does not seem as strong. @Jamie do you have any thoughts?
 

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