THR Onward, forward for NextStep

[Eman85]

A reality check. Sorry part of the reality is we're not kids any more, no matter how fit and active we are. Then the reality is although they do this in less than an hour and all the cool kids are having it done it's a major surgery. Actually it's a major trauma like simulating a car wreck on the operating table and then using metal and plastic parts to put us together with.
3 mos is the major milestone followed by the one year mark. Most of us see significant improvements all of the way to 3 mos then slow steady for up to the 1 year or more mark. I just recently noticed a muscle improvement in my right and it's been almost 3 years.
I was fortunate and my THR's were pre-covid. Getting run down in the early months leaves us open to pick up all kinds of things and today especially Covid. I did manage to go out and pick up a good cold that led to a nasty sinus infection with my first THR. That's when I started using hand sanitizer and wipes long before Covid.

 

[NextStep]

I've debated whether to post. Here goes. Great news and some challenges.

My pain level overall, and especially with the hip, has dropped significantly for the past eight or nine days. I'd previously needed something for the pain which regularly ramped up between 8 and 10 nearly every evening--say around 6 nights a week.

Since Sunday a week ago, I've suddenly needed no pain meds. One night the pain level could have justified use but it was too close to when I needed to be out and about, clear headed. So the great news is-- so much less pain, no pain meds.

Thus comes the challenge: shifting from daily use to suddenly dropping it without even trying to, just no significant pain. It wasn't till late in the week that we figured it out: the fatigue and then the rest of Wednesday through Friday's symptoms were likely tied to that change! (I'd had pain medication for weeks after my elbow fracture in February, surgery with radial head replacement in March, followed by THR in June.)

Bottom line? The past week held totally unexpected challenges! There are times when I just try to focus on "what's my next step? Let's do the next thing, just one step, one moment at a time. "

 

[Jaycey]

@NextStep Sounds like real progress when you can drop the medication. What medication were you taking? It's possible some of your symptoms were withdrawal.

Hope this eases quickly.

 

[NextStep]

@Jaycey, that's the question I asked the phone nurse at the pain clinic. She's the one who confirmed that it's all very likely related. (I treat there for a chronic pain issue that predates the elbow and hip surgeries.) She also clarified that I'm likely dealing with a "mild" physical dependence as result of legitimate use of medication, but not addiction which would involve likely abuse or misuse of drug or medication and a psychological dependence as well as physical.
And so here I am.

 

[Jaycey]

Definitely not addiction - as you were taking medication for a purpose. Sometimes it's better to decrease the medication gradually to avoid any withdrawal symptoms. I know you are already well into this process but for other members who might be considering reducing their medication, here are some guidelines:

You can do one of two things to begin reducing the amount of drug you are taking:

1. Begin spreading out the times when you take the drug. If you are currently taking it every 4 hours, for a couple of days make it every 5 hours, then 6 for a few days and so forth until you reduce to one pill a day (usually at bedtime, because that's when we seem to need the pain relief most). Then at that point, you can start taking half a pill for a while and then no pill. At that point (no pill), you would take them only periodically when you have pain that over-the-counter medication won't take care of.

2. You can stay on the same schedule (like every 4 hours) and cut back on the amount of the medication with each dose. That can be done by asking your doctor for a lower-strength medicine or by cutting pills in half. Only reduce the amount by 1/2 pill at a time if you are staying on the same schedule - not a whole pill. Then when you get to the point that you're taking a half pill at each dose time (that's about as small a dose as you can get), start spreading out the time between doses. This approach works if you need the pain medicine during the day when you are more active - where over-the-counter meds won't work.

As you're cutting back, expect that you may have to use NSAIDS to fill in the gaps for pain.... Aleve (Naproxen), Advil (Ibuprofen), Motrin or try Tylenol (Paracetamol).

Just be sure you don't try to cut back too fast. You'll feel it if you do and will need to make adjustments accordingly to slow the taper. The whole process can take several weeks, so be patient and make sure you are stable for a day or so at each level before you make another reduction.

Or....you can contact your doctor and ask what schedule THEY prefer you do. But I believe a person will do just as well taking care of this yourself. Only YOU know how you feel at any given time. You want to cut back just enough so the over-the-counter meds work and not so much that you get those flu-like symptoms or have pain.

 

[NextStep]

Just to clarify my situation, it wasn't planned. Suddenly I realized "Hey, I've not taken ANY pain meds for 3 days, wait, I think it is 4!" By that time I thought I had a stomach bug or had eaten something off.
Only 6 days in did we figure it out with a measure of certainty. Need for meds had tapered naturally to one at bedtime with occasional second for breakthrough pain. It's still been an adjustment.

 

[myglasshalffull]

Sounds like you are moving right along in your recovery. I was very fortunate not to really need the pain meds once I came home. I did use for a few days but they make me a little nauseous, was same when I had my ankle surgery, everyone kept telling me to stay ahead of the pain, I didn't really have a lot of pain after my ankle surgery. Guess just lucky.
My hip seems to like extra strength tylenol and ice the best. After 6 months I find during day I can go go go. Once I sit I get stiff. But I was like that before my surgery so nothing new there.
We all just need to listen to our bodies. My primary told me the Ibuprofen long term isn't good for your heart. I do have 800 mg. Ibuprofen I use occasionally for my back.
All my best.

 

[NextStep]

Not that it's been a pain free stretch, but I've only had a tylenol or two in the past week and a half. I'm now able to lie on either side for several hours at a stretch. With bedroom on the main floor, I had been able to arrange life to avoid more than four stairs at a time since the doc recommended "no more than necessary" till that second follow up appointment.
Well, this week I braved a couple basement trips (fairly steep stairs). Then today I made a couple more trips down...and back up carrying a load of stuff each time. Without even thinking about it, I also found myself going up the next step with alternate legs....and I'd not done that in a while!
Tonight there's places in front of the hip, a slight place behind, and another behind that knee where soft tissues are grouchy. Seems they have opinions about being called back into action.
Oh, so what do I do? Give them the cold treatment.

 

[NextStep]

Nine weeks. Seems like last week and forever, all at once. Last week I had a very full week, and was able to do most all of what I needed, although near the end of the week I reverted to using the walker for a couple days. Not absolutely necessary perhaps, but the need to carry books and walk quite a bit while setting up displays meant I'd be putting a heavier demand on the hip. I didn't want too much of a setback, nor did I wish to use pain meds afterward.
Yesterday I took a rest day. Between the demands of last week and the impact of strong storms moving through, rest was much appreciated! Things are getting back much closer to normal, though I find some ups and downs through the week. Pacing myself is not easy, but I'm finding it is wise at least for now.

 

[Layla]

A belated Happy Two Month Anniversary! I'm catching up here.
It sounds like you're doing well and making wise decisions as you mete out activity with rest. Lots of time and healing still happening and it will keep getting better.
Thanks for the update, I hope you have a lovely week!
@NextStep

 

[Boofit]

Yesterday I took a rest day. Between the demands of last week and the impact of strong storms moving through, rest was much appreciated!

Hello @NextStep So happy to hear that you are doing well! I am almost 4 weeks ahead of you in my THR, and like you I find pacing myself not easy.... On some days I find myself walking in excess of 10,000 steps and not all entirely on flat surfaces, and I end up feeling achy in the hips (both of them, cos my un-operated side is also affected by OA and will need surgery sometime down the road). Hence I often factor in "rest days" in between where I do very little walking or exercises. AND I find these rest days help get rid of the aches and tiredness quite quickly (Until the next time I walk or stand too much that is!!!)

 

[Mojo333]

hippy pal.
Wonderful to see your progress!
This hip recovery road certainly has its twists and turns, but well worth the end result.
Happy Wednesday @NextStep

 

[NextStep]

Somehow I feel like the clock turned backwards. I've had more tenderness in the hip, sometimes pain, and I'm not sure what I've done to cause it. I've just lived life, trying not to overdo anything, to be gentle with the hip. Back to the cane. I honestly feel like using the walker today.

 

[myglasshalffull]

If that's how you feel then use the walker, no shame in that and most of all give your body a break and rest a little more. You are not even 3 months post op. Still in very much up and down stretch of recovery.
My cane is in the car, I seldom grab it but with summer activities many of our social engagements were in friends yards which are uneven lawns so sometimes I needed it.

 

[NextStep]

I've had more soft tissue pain the past few days, and have fought with trying to understand "what's going on, what I'm doing wrong. " Things had seemed to be improving and now it feels like a setback.
This afternoon I came up with a theory of sorts. It's felt like maybe I'd injured or pulled some soft tissue but couldn't recall overdoing it. Then I remembered waking up or just about to drift to sleep when a muscle would jerk or spasm, or it might even happen when sitting quietly. So...could this be the good news-bad news combo of nerves reconnecting or healing around this time in recovery...and a spasm maybe pulling at healing soft tissues causing renewed pain? It has gotten more painful to bear full weight for any extended time, yet I've avoided all strong pain meds, anything stronger than acetaminophen, since mid August.
I do have a pain clinic appointment Tuesday so will discuss best way to manage this tomorrow. Hopefully we can come up with a plan. Not sure what to even ask or how to proceed. It feels like I just wasted a day, today...accomplishing nothing. Too much pain to be active or even mentally active.

 

[Mojo333]

Hi @NextStep
Your post prompted me to go back to my recovery thread and see how I was doing at just under 3 months post-op.
Take aways:
Ongoing groin pain
Intermittent thigh pain
Nerves jumping especially at night
Struggles finding work/rest balance
Few days of extra unexplained pain

Sound familiar?

Not to be dismissive of your concerns, just to say that it does seem that I had forgotten some of the ongoing issues and that very likely these will resolve.
It was also about this time I decided to request some PT for guidance on whether any gait issues or weaknesses were attributing to my aches.
Maybe pain management could refer you or suggest some PT that could help.

Really think this is mostly a Time Thing.
Not Super helpful but hope it makes you worry a bit less.

 

[NextStep]

Well, a good appointment today, and a plan to manage the breakthrough pain...so things look a bit better even if pain levels have not yet shifted.

 

[NextStep]

The past ten days or so have been challenging. Many of the days I've used the walker again, though I have moved back to the cane at times the past three or four days.
It's frustrating to do so, to feel like I'm failing somehow when recovery had been moving forward pretty consistently. Monday and Friday ended up being mostly rest days though I worked the rest of the week. Yesterday I saw my PA for an ear infection. I'd asked if we needed to treat now vs wait and see due to this shiny new hip--and she asked me to come in. (And yes, we're treating it now, rather than chancing any complications with hip.)
It seems folks around think "hips are easy, knees take longer" and there's almost an unspoken expectation to be back to normal by now, and maybe even doing back flips or something. So how do I counter with "even my elbow is still trying to find normal, not to mention the hip"? Right now I'm finding it a wee bit hard.

 

[Layla]

Hello NextStep, I am sorry you're feeling frustrated and challenged by the speed of your recovery.

there's almost an unspoken expectation to be back to normal by now, and maybe even doing back flips or something.

We certainly don't believe that here, where we read about recoveries every day. Many of us reading threads for years now. You are not even three months into a process that can take a full year, even longer for some. Many continue to notice progress into their second and even third years post op.

If I'm understanding, you're feeling judged by others in your life in regard to the speed of your recovery. If that's so, you'll need to ignore their comments or simply tell them given your individual situation, your surgeon is fine with your progress. Case closed.

You may want to examine activity to see if you're overdoing it in any way through exercise, or activities of daily living and if not, you'll have to be more patient. I understand it's difficult though because we want to be completely healed, NOW. I hope the plan in place after the pain clinic appointment, coupled with rest, brings you relief soon. Wishing you a peaceful weekend.

 

[Boofit]

@NextStep , I had my left THR almost 4 weeks ahead of you, and my recovery is not going as quickly as I would have liked it to go, BUT so far it's been a slow but steady process, and I plan on keeping it like that. Every now I feel like I am having a set back (the aching ramps up) and I will rest and ice more. I am still using a cane when I go out, and I reckon I will ditch them eventually, hopefully sometime next month before I go visit my daughter in Sydney in November!

It seems folks around think "hips are easy, knees take longer" and there's almost an unspoken expectation to be back to normal by now, and maybe even doing back flips or something.

Everyone's recovery is different, much depends on the physical condition of the person before and after the surgery as well as the surgery itself. Just try and ignore what the "expectations" are, it is YOUR body, and YOUR surgery, so just do your recovery at your own pace!

Hugs from Hong Kong!