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[THR] On The Healing Path

Discussion in 'Hip Replacement Recovery Area' started by Rbc, Jul 1, 2019.

  1. Rbc

    Rbc junior member
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    I had anterior right hip replacement on June 20. I was unprepared for the challenge of the recovery symptoms and the range of pain. This forum has been a big help in explaining and reassuring me as what to expect! My current challenges are my jumpy surgical leg pulsing with pains, sore knee, sore ankle, pain off and on in my buttock, and shin pain. I have slight incontinence, and my skin is very sensitive to the touch below the knee (but improving there).

    I’m in PT 3x a week (started strengthening at PT before surgery. I’m on a cane now unless I really need the walker. I’m icing, resting, taking Hydrocodone/Acetaminophen 5-325 every six hrs and Acetaminophen 500 mg every six hrs. Sleep is difficult with jumpy legs, and the sore knee and ankle. I have wound up massaging them with lotion in the night to ease the pain and help me fall asleep. It’s hard to reach that ankle! Has anyone experienced this?! I’m sure I’m getting better but it’s not always easy to be convinced. Thank you for listening!
     
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  2. Layla

    Layla FORUM ADVISOR Forum Advisor

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    Hi, :hi:
    Welcome to BoneSmart! :welome:Thanks for joining us.
    The post surgery pain you describe is common especially given you're only 11 days post op.
    Ice any / all areas of pain for 40-60 mins, no less, several times per day. Elevate per instructions in the Recovery Guidelines below. I don't know many who can reach their ankle this early out. You may have to wait awhile longer to accomplish that.

    Consider Magnesium for the restless legs, it has helped many -
    Magnesium Glycinate supports the following:
    Bone health
    Healthy blood sugar
    Cardiovascular health
    Muscle relaxation and nerves
    Promotes healthy sleep (falling asleep and staying asleep)

    An article on Magnesium -
    https://bonesmart.org/forum/threads/magnesium-is-a-star.20301/

    Stop back often. We'd love to follow your progress offering support and encouragement along the way.
    A great week to you! :)


    Hip 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
    elevate
    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

    Pain management and the pain chart
    Healing: how long does it take?
    Chart representation of THR recovery

    Dislocation risk and 90 degree rule
    Energy drain for THRs
    Pain and swelling control: elevation is the key

    Post op blues is a reality - be prepared for it

    Myth busting: on getting addicted to pain meds
    Sleep deprivation is pretty much inevitable - but what causes it?

    BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

    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 a majority of BoneSmart's forums, we ask the at each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice. @Rbc
     
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  3. Debru4

    Debru4 graduate

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    My first reaction to my hip replacement was also that I was unprepared for the level of pain and various aches and pains that I had. I expected hip and incision pain, but was surprised by the fact that I had so much thigh and knee pain. I also had the twitching.

    With that said, I quickly learned that the pain I had was perfectly normal, and much of it was the result of the extreme things they have to do during the actual surgery. Just knowing that gave me the peace of mind and patience to ride the waves until relief came and the pain lessened, and eventually left.

    It really is a complex process and being on the forum is incredibly helpful. Feel free to ask about anything you are wondering, or worried about. Someone will have had a similar experience and be able to advise and support you!

    Like many on the forum, I was advised by my surgeon not to do PT---that it wasn't necessary and could even be harmful. If you have increased pain that doesn't seem to be improving with ice, meds, rest, etc., you might consider taking a break from your PT and just letting your body heal through daily life activities. :flwrysmile:
     
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  4. ceezee

    ceezee senior

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    This is my experience...My surgeon initially advised against any PT, just walking and daily activities as I became able without pain. At my 6 week check up yesterday he said I was now healed past the point where PT could harm me and it would help to go once or twice a week for ROM ,strengthening, and gait training.
     
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  5. Rbc

    Rbc junior member
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    Thank you for your replies. It helps!

    As others have posted, we hear the stories about fast recoveries and no pain. People want to encourage you so you don’t get the flip side. I had no idea where pain would be, so far it hasn’t been where I expected! My Mom had open heart surgery years ago and claimed it didn’t hurt her. She was always trying to be stoic. The psychological journey is really interesting. And complex!

    One strange thing I’m curious about is an anesthesia reaction (I think). Because my clotting factor (some element in blood work right before surgery) was borderline, they switched the plan from epidural to general anesthesia.

    When I was coming to after the procedure I was sobbing and sobbing. Through my fog the nurse was telling me “breathe”, my mind was racing to thoughts of family members. The pain was intense. I could sense them moving me, and the buzz of quick activity. A voice said we’ll give you something for the pain very soon. I managed to get out “I’m just so sad!” The relieved voice said, ohhh, I thought it was the pain... Well it was BOTH.

    It was tough coming out of the fog. After moving from recovery to my room, they sent someone in to start PT. I said you’ve got to be kidding! I can’t keep my eyes open! It seemed like a scrolling film reel before my eyes. Dizzy and loopy. The young PT went through a few requests and gave up. They brought me a giant meal of hard baked chicken, mac and cheese and nice fresh fruit salad, other dishes too. What an odd meal post surgery, if I could cut the chicken, I couldn’t eat it.

    All the techs and staff were so kind. Almost all the nurses as well. The first night was agonizing and I was sobbing in pain again. The nurse told me I wasn’t on schedule for more meds but she’d try to find something. Another came in to give me morphine, I was in such agony. She didn’t even make eye contact, just with her computer screen. I wonder if that’s a survival technique for dealing with so many patients in pain? I think when I felt my most vulnerable and anguished, the nurse’s response was detachment.

    The morphine eventually kicked in and I slept, but I still feel sad about that. We had PT in a group the next morning. I was the only one in tears, it was excruciating. Second PT session a couple hours later, I did manage most moves including stairs.

    My blood pressure was low until discharge time and finally stabilized. Somehow the Dr missed me on morning rounds. The resident gave me instructions to change the bloody PICC drain bandage at home rather than change it before discharging me. What a mess!

    Sorry for the vent, it’s a process absorbing it all, and who wants to hear it? Very fortunate to have a supportive, tireless husband who does anything at all! He was with me at the hospital and took two more days off. He comes home at lunch and is back in the afternoon. I don’t know how anyone manages solo. I am also grateful my upper body is fine!
     
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  6. Layla

    Layla FORUM ADVISOR Forum Advisor

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    Hi, :hi:
    I'm sorry you had such a rough and emotional start.
    Each persons experience is different and should you experience surgery again, that experience may differ also. Thankfully those early hours / days are behind you, you're feeling better and on your way. :yes!:

    Beyond getting in a 15-30 minute walk, or two, a day, in addition to some very light household activity, easy meal prep, load of laundry... all you need to do is ice / elevate and rest as often as you feel the need. It's early days but if you look back each weekend, to the weekend before, you'll see the progress.
    Wishing you a nice Tuesday and a happy 4th of July!
    @Rbc
     
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  7. HipsterKat

    HipsterKat member

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    Exactly. I have been all over that map dealing with the emotions. Feeling vulnerable and dependent on other people is eye-opening.

    Hope you are feeling a little better each day. It really does get better (though maybe not as quickly as some people would have you believe).

    :welome:
     
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  8. Mojo333

    Mojo333 FORUM ADVISOR Forum Advisor

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    :hi: and welcome to the forum.
    It is definitely a physical and mental struggle these early weeks, but I can tell you I emerged stronger on both fronts:yes:
    Layla's advice is spot on..
    Just do what is necessary right now.:ice: is our bestest friend right now.
    All Temporary...:tada:
     
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  9. Rbc

    Rbc junior member
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    It’s encouraging to know my experience is familiar. My husband gets concerned with my symptoms and I’m glad to tell him it all sounds normal.

    Today I dreaded PT (I’ve been having more pain that interferes with sleep), the therapist was good at listening and not pushing. He was befuddled with my shin and leg pains, and wondered if my back is involved. He thinks my pain is more than average. The Senior PT who worked with me prior to surgery was back from vacation, and asked me a lot of questions. It was hard to remember what pain I had before surgery! She adamantly wants me to return to side glides for my back and knee pain. I’ll see if that helps!

    I was feeling sorry for myself after another difficult night's sleep, and feeling isolated. But how can I complain when it’s gorgeous outside and I have a comfy home to recuperate in? Sweet dogs and husband looking out for me! I’m thinking of manageable ways to cheer up. (Besides ice cream.)
     
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  10. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    That'll be prothrombin
    Why besides? It's great comfort food.

    I'd also like to remind you this that was in among the recovery articles Layla left you in the second post of this thread

    BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

    If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?
     
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  11. Rbc

    Rbc junior member
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    Thanks for that information @Josephine!
    I have a sitting question to all. I’m 2 weeks out, and we had July 4 dinner at our favorite cafe overlooking the river. I was eager to get out amongst people and enjoy the summer scenery. We took a pillow (but forgot the better foam one). The chair was really hurting me, they kindly brought me another that felt a bit better. But as we waited I seriously thought we might need to take our meal to go. I decided to fight the discomfort in trade for being in our favorite place on a gorgeous evening, feeling normal and social. I made it through my duck breast with raspberry maple sauce, garlic mashed potatoes, fresh summer veggies (and Saratoga Water!). Even endured key lime pie! :loveshwr:

    I was about crawling when we got home and this morning my butt hurts the whole way across. Like I’d sat on rocks. Before surgery it sometimes hurt like that in straight chairs. This is similar discomfort- straight through my body as I sit. A couch or padded chair, even the woven plastic deck chairs are more forgiving.

    It seems life has been reduced to looking forward to meals and this much discomfort was a shock. It’s hard to declutter my house to look tidy for guests so I haven’t had visitors. My kids and family live far away.

    I am terribly lucky to have a dedicated helper in my husband and the company of my 2 dogs and 2 cats. But as we know, it’s lonely. Going out to eat helps!

    Restaurant seating aids advice or tips? Thanks in advance.
     
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  12. Eman85

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    Best advice..Find a comfortable chair at home. Sit in it and ice and don't do PT or anything else that hurts. All of the pain free recovery stories and being back to normal in 2 weeks are fantasies. The one truth is your hip won't hurt, mainly because you don't have it anymore. What most fail to tell you is everything else will hurt and in ways you never imagined it could. Then you get to pushing because you want that miraculous recovery you've heard about and guess what happens? You get more pain and delay recovery further. Then of course it never fails that you run into someone with the tales of someone they knew that had the miraculous recovery so now you get depressed. This is the reality not the fictional one that is spread around by people that ave never had a THR and physical therapists.
     
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  13. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    My tip would be wait a bit! I know you want to get back to normal but this was major surgery. You need to allow time to heal. It won't be long before you can get out and socialise. But it is still very early days.
     
  14. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    I'm with Jamie. You shouldn't be going out to restaurants yet. It's only been 2 weeks! You need to read this again Activity progression for THRs. In fact, go back to the second post of this thread and read ALL the articles - again, if you already have. It's essential reading.
     
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  15. Rbc

    Rbc junior member
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    I’d like to get advice on my meds. I’m going to run out today, before I can get a refill, because it’s Sunday and they never called it in to my pharmacy. I phoned my OS for a refill Wednesday July 3, assuming they would call it in Friday July 5 (after the July 4 holiday) so I’d have my refill by today (Sunday) when I’d be running out. We went to the pharmacy yesterday and nothing was called in.

    So, I’ve been extending my hours from 6 to 8 to stretch it out until the office opens tomorrow.

    I had trouble with my first refill (Oxy) I hadn’t realized initially that if I took the upper level of recommended dosage, I’d run out before the refill period. So I was headed for a weekend and asked for a refill via the OS patient portal. Got a call that my OS was away for a week, and my message was forwarded to his medical secretary, someone would be calling me back. No one called, -Next day I sent a second portal message, received a portal reply that my message would be forwarded to my OS medical secretary. No call back. I left a voice mail with the medical secretary. She finally called me to say they had to clear with my insurance because of the time frame from surgery date, they would call back. No one called back. I left another message which she returned, sounding a bit annoyed, telling me the portal messages may not reach her for two days, next time call her. Also, she’d have to find another Dr to write my script (ok). No one called back to say that was done, but we discovered the pharmacy had my script.

    So this time I did phone, in what I thought was sufficient time (unless the holiday closed the office, in which case, their voice mail would have said, right?). But no script! I don’t have my first post op check up for another week- 25 days post op. With all the great, informative sessions and literature and discharge materials they provide, shouldn’t they address pain meds more directly? All it says is wean off pain meds per OS instructions.

    (They switched me from Oxy to Hydrocodone.) Running out of meds throws off pain control and kicks in withdrawal issues. More patient education needed since these scripts are written “no refill”. Very vague...
     
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  16. ceezee

    ceezee senior

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    I had the exact same problem.

    If I followed the dosage instructions I had basically 3 days worth of coverage of the oxy. When I tried to get the OS area to call in a new prescription I didn’t realize the pharmacy would not take a new prescription (they don’t do refills for opioids) over the phone unless it was between 8-4, not on a holiday nor a weekend. This was around Memorial Day. I ended up waiting 3 days. It was agony. I probably should have gone to urgent care or the emergency room to get a written prescription but who knows if they would have done it for an opioid. With my next surgery coming up I’m using my primary care doctor to address my ongoing pain medication. The OS here don’t like to handle it and don’t view it as part of their job....I think.

    Edit: also, my insurance company would only cover 3 prescriptions in a month. I ended up paying out of pocket for one. I have no idea if the pharmacy would also stop filling them at some point. This opioid crisis has greatly affected the ability of people who really need it to get adequate coverage.
     
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  17. Rbc

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    @ceezee I appreciate your comments. There were so many things I felt the care providers did a super job with (steps to prevent infection was one, and the pre-op hospital class), that this seems like a glaring gap in patient care and education. I’m sure their silence on pain meds is effected by shifting rules of compliance and the opioid crisis. I think I can juggle my schedule to get me through to Monday afternoon. Phew
     
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  18. ceezee

    ceezee senior

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    It really is a huge gap. Like you I was impressed with super job that the care providers did except for this.

    I’m really glad you’re going to make it until Monday afternoon. Phew, is right!

    I had Tramadol on hand from dealing with the pain before the surgery and used that until I was able to get the oxy. It didn’t work nearly as well but it helped a little.
     
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  19. Rbc

    Rbc junior member
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    I finally received a new prescription, this time Tramadol. The OS nurse finally returned my messages and said are you really in that much pain?! I said, I am. Is that unusual? She said no, but she assumed I was taking 2 hydrocodone every 4 hours, I had been taking 1 every six and stretched it to 8hrs. She decided to move up my post op checkup to tomorrow. I’m sure I’m progressing normally, with decreased pain, but pain. I just don’t get how patients are expected to deal with ten day prescriptions between surgery and a 3-4 week checkup. And no clear instructions outlining how to most efficiently obtain refills. Or taper off. I used the patient portal, and eventually was advised to phone instead. Next time, I phoned Wednesday and left a voicemail for a refill by the weekend. but the office did not have an outgoing message alerting that they would be closed for the holiday July 4 & 5. I didn’t get it straightened out until Monday night after much confusion.

    Wonder what schedule I should use for taking acetaminophen and tramadol, at six hr intervals. (Pain is worse at bedtime). I’m taking one of each, same time, but wonder if this is inefficient.

    I am curious if anyone received clear instruction before discharge on obtaining pain meds when (before) a prescription runs out?

    Can anyone tell me what I might expect at my post op checkup? Besides removing my bandage and whatever they closed my incision with? I know these aren’t pressing issues, compared to many others!
    Thanks
     
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  20. ceezee

    ceezee senior

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    Nope not me either. I got caught with the Memorial Day holiday. It was no picnic. My prescriptions lasted not even 3 days with 2 pills every 4 hours. It was really the only issue I had with my OS and staff.
     
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