Pain Management and OS's

[Weezy]

There are several threads running around now about pain management and sleep, so I'm not going to repeat that stuff here.

HOWEVER, I've recently had what I think is an interesting experience with my orthopedic surgeon and his idea of pain management that I want to pass on so those of you coming up to your TKRs can be more prepared than I was.

I'm six weeks out now from my LTKR and had cut down on my meds to where I was taking only 1 Darvocet a day, but was hurting a lot--both during the day and at night. Tylenol, Advil or other over-the-counter things weren't touching the pain.

Had my 6-week followup appointment with the OS this week and asked about getting another prescription and he said no! I was floored...he told me that at 6 weeks I shouldn't be hurting enough to need narcotic drugs and that something like Advil should be enough.

Fortunately, I had an appointment that afternoon with a GP to look at a deep scratch (I was worried about infection). New doc that I'd never seen before since I moved last year and never got a new GP. Anyway, she was wonderful and scoffed at the OS's idea that I didn't need pain meds at 6 weeks.

She convinced me to take them often enough to be comfortable, to NOT worry about addiction issues because if it happens, I'll taper off slowly and deal with it. I also came away with a prescription for a mild anti-depressant to try since I've been pretty blue/down/teary lately.

I'm not a fan of taking pills or drugs, but I'm beginning to understand the value of good pain management as an integral part of healing. My ideas of stoicism are NOT good for healing--pain makes one tired and interferes with sleep too.

I wish I had had a better understanding of pain management before my TKR...and I wish I had listened to the folks here better and followed the suggestions about taking enough pain meds to cope. I've been following my new med regime for 2 days now and I can already feel the difference in my energy levels--I'm not nearly as tired as I was. I'm sleeping better because when I wake up hurting, I take a pill if it is time; I take a pill in the afternoon if I'm hurting and my evenings are much more pleasant. Mornings are better because I take a pill when I get up.

Good luck to all you June kneebies....see you on "the other side" soon!

Weezy

 

[AlaskanTKR]

Weezy -

Oh - You have made me feel a bit more like "one of the crowd". My OS is extremely conservative with pain meds. After my last scope I was on a vicodin generic for 1 fill. He refilled it (and I did ask for a lower dose since I was going back to work) one time and that was that. I was an easy rehab and extremely motivated to loose weight and had started on the treadmill (he ok'd that) really early on. I would save my med till right b4 and then walk. Great. Super response. But then the meds evaporated. I was cruising. Saw him for at a 4 (???) week followup and asked for a refill for use only prior to treadmill. Nope - If it hurts then you are doing to much. Well. OK. So I sucked down a bunch of Ibuprofen for another two weeks and just used a ton of ICE. I made it through but boy was I a bit ticked off. Imade it through. I have a feeling it may go much the same way this time and am very concerned - I will be back at work in 4 weeks and doing pt I guess after a full day of work. Plus taking care of the house, kid and dogs (husband will be going hunting for a week around Labor Day so with his schedule he will be gone 5 weeks- ughhh when I am right around 6 weeks) I know I am able to do it but.... (whine whine whine.... What if it hurts!) I won't be able to just "stop" if it hurts. Thanks for the vent. I know --- I will be fine and all will be good. I am sure it will be fine but thanks for providing an arena to vent a concern.

Glad you have been able to get your pain back under control!
Take care and REST!

Marianne

 

[northman22]

I also was cut off from my OS at 8 weeks. My PT wanted me to continue to take Flexiril because I have a numb quad and she thought it was helping, but they said no. I live 200 miles from them, so it was all done over the phone without looking at me or consulting my PT. I went to see my GP and she gave me flexiril and yesterday gave me some 5/500 hydrocodone. I had stopped taking it 3 weeks ago but am now back to work and needed something for after work and sleep.

 

[1jt@atime]

Even when you are healed and hardly notice the new knee, it's best to try and keep a small stash for those random times like when the weather changes or you've had a physically hard day. I had my first kr on Oct 1st and found that I needed something every once in a while and was glad to have it on hand. I could feel that my OS is a little conservative on the drugs but my Neurosurgeon is not so between them, I was fine.

 

[JudyS]

I had my right hip replaced last week. I was also part of a research study on pain after hip/knee replacements conducted by a hospital anesthesiologist.

He was to be in charge of pain med when I left the hospital. He and I were talking as I was about to go home . His study was for 5 days with IV tylenol and we were talking about the insanity of insurance companies booting you out after 48 hours. He stated they should get their hip replaced and see if they are ready on the 2nd morning followind surgery.
After he left the nurse gave me his pain med prescription . It was for 20 percocet tablets, no refills.
Monday I get to go back to the hospital for the last of his blood work. I can't wait to talk to him about his post pain management.

Of course I called my OS and got a prescription for 75 more. I will see my OS for a 2 week check up and discuss the med situation
Judy in So Ca.

 

[ship4]

Thanks for the wish for good luck to all of us who are having our knees done this month. I am in on Wednesday. I am really feeling the loss of my Aleve in the AM and PM daily. I did not realize it was helping me as much as it has. I have been taking 2 every morning and every night for about 3 years.
I was in agony last night and realized I could take extra strength Tylenol. I took 2 and was able to go back to sleep. I am so looking forward to being on the other side of this surgery.
So, Thanks in advance to all of you who are wishing me well. I wish all of the rest of the June knee's have a good experience and heal well and thoroughly.
Best,
Crystal

 

[ship4]

Even when you are healed and hardly notice the new knee, it's best to try and keep a small stash for those random times like when the weather changes or you've had a physically hard day. I had my first kr on Oct 1st and found that I needed something every once in a while and was glad to have it on hand. I could feel that my OS is a little conservative on the drugs but my Neurosurgeon is not so between them, I was fine.

I have kept a stash of meds for years to help me with my knee over the hard times. Especially the winter storms. I have plenty of Tylenol 3 and some Darvocet to keep me going.
I agree, it is a good idea to be prepared. I just do not over use them and have them "left over".
It is a great suggestion.
Best,
Crystal

 

[Turtlelady53]

I am in on Wednesday. I am really feeling the loss of my Aleve in the AM and PM daily.

Oh, Ship, I am sooo with you! I have been taking Mobic, which is once-a-day prescription antiinflammatory, and didn't think it was working until I stopped taking it. Oh boy, that Tylenol is just NOT doing the trick. These knees have been throbbing like a toothache all night. Getting through the workday and commute this past week was an experience I'd soon like to forget.

Best of luck to you on Wednesday. I'm "going down" Monday. See you on the other side!!!
Sharon

 

[ship4]

Best of luck to you on Wednesday. I'm "going down" Monday. See you on the other side!!!
Sharon

Sharon,
Good Luck to you on Monday. I will be right behind you on Wednesday. We can keep tabs on each other!
Best,
Crystal

 

[Simon]

Hi Folks

I was switched to MS-Cotin every 12 hours as they could not match up my PT schedule with meds.

I am ok with that but the PT is making me taking a short acting one before PT so that she can work on it.

The OS needs to talk with PT as if you have pain they can't work you as hard.

The insurance company is refusing to pay for the next 3 days as according to their chart 7 days in rehab for my age and bilat is enough. The doctor is fit to be tied and is fighting them all the way. One said she was betting she was talking to a gynceologoists.

If they don't pay they don't pay I was not ready to go home on Friday.

Simon

We are still aiming for Tuesday but they want 100 ROM. The left is about 92 the left I just can't push it beyond 84. The CPM machine is going at 105 for 8 hours a day so I know it can do it.

Simon

 

[Rowdy66]

I Know I Probably Always Have Too Much To Say About Pain Meds But Then I Have Been On Them For A Great Portion Of My Life, Bad Back, Bone On Bone Lumbar Spine, Ruptured Disks Thorasic, Moderate To Severe Stenosis Cervical As Well As Bone Spurs And Degenerative Arthritis Throughout. When My Knees Went Out I Didn't Ask For More Pain Meds, Made Do With What I Was Already On For My Back. I Have Tried To Be Strong And Bear Up And Let Me Tell You It Don't Work! Pain Is Dibilitating And When It Is Constant With No Relief You Quickly Wear Down To Nothing. Thank God I Found A Pain Clinic In The Late Ninties That Pretty Much Saved My Life In The Sense That It Gave Me Back A Life I Could Live And Actually Enjoy. I Have Seen Many Doctors In My Nearly 70 Years And The Worst I Ever Encountered Was One Of The Best Spine Surgeons On The 80's, Took A Part Of Each Year To Teach Other Doctors Around The World His Techiques. He Worked A Miracle On My Back When No One Else Would Touch It. But He Was One Of Those Doctors Who Was Extremely Conservation When It Came To Pain Meds. He Suggested That I Drink A Couple Of Drinks Every Evening If I Had Pain. I Was Shocked. You See, He Never Thought To Ask If Alcoholism Ran In My Family. Both Parents Were Alcoholics, Oldest Half-brother Was An Alcoholic Who Committed Suicide While On A Bender. I Have Been So Afraid Of Inheriting That Gene I Was Always Extremely Careful Of Drinking Too Much And Would Regularly Ween Myself Off Pain Meds To Make Sure I Could Control Them As Well. Now I Am Not So Afraid Of The Pain Meds As I Have Tapered Off Of Them Enough Times To Know If I Had To I Could And As For Alcohol I Have Not Had A Drink In Many, Many Years. Although It Has Been Over 30 Years Since My Brother Killed Himself, I Never Had A Drink That I Didn't Think Of Him That Last Day Of His Life And To Be Honest It Just Isn't For Me, Not That I Think Everyone Who Takes A Drink Is An Alcoholic Or Begrudge Others Their Cocktails. I Just Hope And Pray That There Are No Longer Doctors Out There Who Recommend A Couple Of Drinks To Control Pain. Weezy I Am So Happy You Found A Doctor Who Had The Wisdom To Prescribe The Pain Relief You Need And Thanks For Your Post. You See I Am Two Weeks Behind You And Was A Bit Worried Today That I Am Having A Bit Of Pain Still At Four Weeks. Feel As Though I Should Be Doing All The Things I Did Before My Knees Went Kapoot. So Thanks Weezy For Your Post And Thanks To This Forum For Being There For Us. Rowdy

 

[JenniferG]

Simon, I hope your doc wins. Too bad it has to be that way. As far as pain meds, I know from my 8-9 week visit, my guy is done writing scripts. He gave me enough to go another few months if I just take 1 at night. And honestly I pretty much only need it then when the day catches up with me and I'm tired. I am 12 and a half weeks. Though I did notice the other day, because of weather, I took the max dose (2) earlier in the aftrenoon and physically felt pretty good. Made me wonder if I was suffering more than I wanted to acknowledge. What I feel is tolerable though and every day does get better.

 

[JenniferG]

Rowdy, those docs are still out there. We have had a few of their patients suffering here on the forum. It is pretty awful way of suggesting how to cope with pain.

 

[Josephine]

In my opinion, such surgeons or doctors should be forced to undergo such an op and see how they cope! Nothing like a "walk a mile in my shoes!" to change their minds!m

 

[JudyS]

Josephine,
I love the "walk a mile in my shoes" expression. I have always used that in regards to others I can't understand.
Tomorrow will be 5 days after leaving the hospital for me. I have to go back to have lab work done as part of the IV acetaminifin study . I can't wait to speak to the anesthesiologist in charge of the study as he discharged me with a total of 20 percocet tablets to last through recovery!!!!!
Judy in Ca

 

[Shawn]

I have found great success with a medication called Tramacet. I only take it when I feel the pain coming on but it really works - my GP will only prescribe 60 at a time though - But you may want to try them.