Ready for January RTKR

[Jamie]

Unfortunately arthritis pain is one of the most difficult types of pain there is to deal with. Not much has an impact on it. I'm sorry you've had such an ongoing problem with your knee. My only suggestion is to continue all the things you're doing if any of them help you and try to catch naps during the day when you can to help catch up on sleep. All this will be history once you have a knee replacement and get through the healing process.

You might want to discuss with your PCP all the options to deal with pain that might be available to you. He or she is the best person (because they know your complete history) to make recommendations for any additional things you might try. Let them know exactly what helps and what doesn't.

 

[IronGirl6]

I so understand your fear - I was so petrified I could barely speak when we checked into the hospital on surgery day! But after 16 years of pain and 10 years of frequent disabling pain, and years of doctors telling me my knee was in horrid shape but they thought I was “too young” to be fixed - I finally found the genius surgeon who knew I was overdue - and I knew I had to. Oddly, I’ve also had 2 spine surgeries, yet this scared me the most!?

I’m now 5 1/2 weeks post surgery, and like someone else said, first step I knew it was right. No more grinding / popping / sound of walking on rice cakes... in all 3 of my joint replacement surgeries (other two were artificial discs for spine), I’ve woken up with the pain instantly gone. Sure it’s replaced with new surgery pain, but the amazing thing about that is it’ll go AWAY... now we get better each day instead of worse!

Being patient is hard - we have an active life w horses and it’s hard to be on “injured reserve”, but it’s a small price to pay really.

Wishing you the best of luck!

 

[CAdesgirl]

Thank you. Getting back on a horse is high on my list of things to do. I'll get there with the help and support of all of you.

 

[kneeper]

The waiting is the hardest part. I think you're doing just about all you can pre-surgery for pain.
Luckily the pain is manageable after the surgery and diminishes as you recover.

 

[CAdesgirl]

I should get my surgery date tomorrow. That will give me some peace, I think. I've had nightmares the last two nights about the surgery. Once, they didn't put in out all the way and I could hear the noises and the other I woke up and they had amputated the leg. I actually had the conversation in my head that I could deal with either of those options. I'm not going to let my head get to me.


I keep telling myself that the pain will probably be much less within a few weeks to a month after the surgery. I'm trying to keep my activity to a minimum. Yesterday, I just did laundry and opened Amazon packages to sort for wrapping. Today, it's lunch with my youngest son and then home to ice, elevate and either nap or read a book.

 

[Babki1]

Wow. Compared to what you have been through already with various surgeries,etc. The TKR will be a walk in the park. I had both of my knees replaced 5 months apart in 2017. I had never had any major surgery in my life. I was scared and nervous but realistic at the same time. I was in so much pain that my quality of life was getting worse. Of coarse the first week is the hardest. I just kept telling myself tomorrow I'll feel a little better and so on everyday. I stayed positive. Did my physical therapy religiously. Also did it at home. I feel I had very good results. I would do it again in a heartbeat. Life is so great to not be in so much pain. Good luck! You can do this! Pump yourself up and be your own cheerleader! Stay positive!

 

[CAdesgirl]

I'm naturally a very positive person. I find the gold lining around every dark cloud in life. I think my rational side knows that this surgery can't be any more painful that the ACI w/osteotomy. I think the pain will be about the same (or less!) and I managed that just fine... Well, when I was good about taking my medication, I managed just fine. With that surgery, I was toe-touch only for 11 weeks so being about to walk the same day is definitely an improvement.

I appreciate the support and positive words. This group is AMAZING!

 

[SusieShoes]

Keep up that positive spirit. Even positive people (I'm one, too) can get overwhelmed a little by all the possible negatives, but we know most of the time our decisions will turn out to be what we hope. And sometimes better. My knees turned out better than hoped. I hope yours do too.

 

[Jeffntate]

Check into how they will manage your post op pain.

 

[CAdesgirl]

Jeffntate - I did the ACI and muscle flap surgeries with Percocet ramping down to Oxycodone. I "think" the surgical pain will be similar to that pain. I'm definitely not looking forward to the pain of the first few weeks but I am looking forward to the rest of my life living a life without being in the amount of pain I've been in for years. The way I am looking at it is that it's only going to get worse if I don't get it done. I'm not going into the surgery anticipating that I will have no pain even after it's healed. I'd be good if it cut the pain by 50% but I'm hoping it will be cut by 75%.

My bigger concern, which is based on my previous experience, is getting another MRSA infection. I know how unlikely that is but I have undiagnosed PTSD from my misadventure 5 years ago. The 5th anniversary of getting the news that I had MRSA was yesterday. I was lucky that they saved the leg. It was what caused the delay in getting this surgery but I refuse to live in fear and pain.

Hopefully, I have many more years ahead of me and I want to make them as healthy and happy as possible.

 

[Jeffntate]

You might know this already based on all your surgeries, but back when I had hip replacement in 1998 I was told that the OR is cleanest the first case of the day. If you think about it, if you are case 2 or 3 or 4 or 5 for that OR room, there is blood and pathogens that they can't eliminate. But the clean up overnight is with clorox or something really strong, and it stays that way from 6 PM to 6 AM. If I were you, I'd make sure I was case 1 even if that means getting up at 4 AM to be at the hospital for a 7 AM surgery. Ever since my hip replacement, for any serious major surgery, I make sure I am case 1 every time.

I'm talking about the acute post op pain, not the pain in your knee long term. You have very realistic goals. I don't expect to be 100% pain free either. But the concern I'm voicing is the management of that post op pain in the midst of this opioid crisis. Just make sure you know what your pain plan will be. Some doctors now are only giving Tylenol to patients. I read an article today about "opioid free knee replacement". Google it if you want to confirm that for yourself. I'm not saying that will happen to you, but it stands to reason that with all this anti-opioid hysteria going on, it is better to ask and know what you are getting into. Many have told me to see about an ON-Q block that can last several days and essentially numb you up. Some surgeons hesitate at that due to having an open portal for bacteria to enter your new knee. Try to get a 3 day block if you can, because blocks are NOT opioids so not under the same scrutiny right now.

 

[CAdesgirl]

Oh, he promised to hook me up. I am getting the 2 day pain block. He already prescribed Tramadol and said he'd up it to Vicodin if I need him to. I don't take the Tramadol very frequently because it makes me feel hungover the next day. I have a low-tolerance for opiods although I'll take them and feel sick before I suffer in pain. I'm sure he won't be an issue although the insurance company might be.

One thing I'm not afraid to do is advocate on my behalf. I had a nightmare getting approval for my muscle flap surgery. I had an open wound (where the bone was visible) and the insurance company was dragging their feet. I called the CA Department of Managed Care that is there to help with issues for people on HMOs. I had a nice chat with the lead attorney and had my approval within 4 hours after dealing with the insurance company for 3 weeks to no avail.

 

[Jaycey]

I have a low-tolerance for opiods although I'll take them and feel sick before I suffer in pain.

No need to feel nauseous. Just ask for anti-nausea medication if you have to take any of the heavy duty medication.

 

[Celle]

Many have told me to see about an ON-Q block that can last several days and essentially numb you up. Some surgeons hesitate at that due to having an open portal for bacteria to enter your new knee.

The ON-Q pain relief isn't given directly into your knee, so it's not a portal for bacteria to enter your knee. The cannula is inserted near a nerve, so it acts a bit like the femoral nerve block many people are given during surgery.

From this web site:
https://www.halyardhealth.com.au/products/pain-management/surgical-pain-solutions.aspx
ON-Q C-bloc is a continuous peripheral nerve block system that slowly infuses local anaesthetic near a nerve for effective pain relief.

 

[CAdesgirl]

@Jaycey - Of course, you're right. I will add that to my list for the doctor.

@Celle - I'm getting the nerve block. The OS said it would be good for a couple of days. Does that sound right to you? I'm starting to get confused about what he said and what I've read on here. I spend at least an hour a night on here preparing myself by reading the postop stories.

 

[Jockette]

I spend at least an hour a night on here preparing myself by reading the postop stories.

 

[Celle]

The nerve block seems to work well. How long it lasts depends partly on the person, but mainly on whether or not the local anaesthetic is topped up.

 

[Josephine]

when I had hip replacement in 1998 I was told that the OR is cleanest the first case of the day. If you think about it, if you are case 2 or 3 or 4 or 5 for that OR room, there is blood and pathogens that they can't eliminate. But the clean up overnight is with clorox or something really strong, and it stays that way from 6 PM to 6 AM.

I am amazed that you opine about something you clearly know very little about! I've been a theatre nurse for some 55 years and between every case, the theatre was always cleaned and tidied ready for the next one. Certainly when I was in charge, I was stringent about this and made sure the theatre was cleaned and ready for every case. As a professional, it was my duty to do this.

And I'll tell you something else - nearly all my career as manager, I rarely used 'strong' chemicals to clean up. The only thing I used was a simple detergent similar to washing up liquid. Why? Because that was all that was necessary. A professor of bacteriology once told me that if the surface or item looked clean, it probably was and I used that philosophy all my career. And I was repeatedly told that during my tenure as a manager, the statistics of post-op infection was the lowest it had ever been. Often surgeons would even complimented me on the cleanliness of my department, saying that it was so clean you could eat off the floor! So it doesn't follow that cases after the first case on the list will always be at risk. Well not on my shift it didn't!

But the clean up overnight is with clorox or something really strong, and it stays that way from 6 PM to 6 AM.

Where on earth did you get this information? There are very few theatres I know of that are idle 6-6. Even lists might carry on until around 9 or 10pm and that doesn't account for the emergency cases that might carry on all night after that! I often did on calls for the theatres I've worked in and it wasn't uncommon for me to work a late shift from midday to 9pm but then carry on with emergencies all through the night and then hand over to the day staff who came on at 8am! (that's UK system). So we HAD to make sure we cleaned the theatre between and even during each case regardless!

 

[CAdesgirl]

@Celle, excuse my ignorance.. What does this mean "but mainly on whether or not the local anaesthetic is topped up."? I want to know what to ask for at the bar.

 

[Celle]

@Celle, excuse my ignorance.. What does this mean "but mainly on whether or not the local anaesthetic is topped up."? I want to know what to ask for at the bar.

A dose of local anaesthetic, jut like any other medication, will wear off (be metabolised) after a certain amount of time. However, if more is added through the cannula, the anaesthetic effect will last longer - adding more is topping up.
For example, say a dose of medication lasts for 4 hours. If you're given another dose towards the end of the 4 hours, you will get an effect from that medication for about 8 hours.

I can give you an example:
About 15 years ago, my son had an accident and he had to have his right leg amputated above the knee. The trauma of the accident had caused his kidneys to stop working, so he couldn't be given any IV or oral medication for pain relief. Instead, he was given a femoral nerve block and through the cannula he was given a slow, continuous infusion of local anesthetic. That relieved his pain effectively for 5 days, until he'd had renal dialysis and his kidneys started working again.
Once it was safe for him to have oral medications again, the femoral block was removed and he was given a combination of Tramadol and Paracetamol (Tylenol).

I'm sorry, but I don't understand what you mean by "I want to know what to ask for at the bar."