TKR Recovery as an April not very patient patient!

[Marguette]

According to a recent report, the new protocol is no narcs but start other pain meds prior to surgery and stay on it on the clock. Narcs are to be offered as a last resource. I wish I had known this prior to my surgery. I was over medicated and ended up with severe withdrawal after 3 weeks of hydromorphone.

 

[Josephine]

What report was that, @Marguette ? You can't say something like that without supplying a link to said article.

 

[lovetocookandsew]

@Larryhg3 I loved what your doctor said so much that I made it into a silly poster and will be sticking it up in my doctor's exam room when I see him before my surgery!

 

[lizziescam]

@lizziescam Tell me what you are taking, how much and at what times.

Morning meds 8am after breakfast: omeprazole 20mg x1 naproxen 250mg x2 paracetamol 500mg x 2 codeine 30mg x 2

Lunchtime meds 1pm after lunch: paracetamol 500mg x 2 codeine 30mg x 2

Evening 7.30pm after dinner: cocodamol 500mg/8mg x 2 naproxen 250mg x 2

Bedtime 11pm: paracetamol 500mg x 2

I know you will say this is not enough and I know you said try another GP but in my part of Cornwall there is obviously a real clamp down on addictive presecription drugs - no other GP in my surgery will prescribe tramadol and a close friend who is a GP locally says if I try and move surgery to get a prescription they will highlight it as a possible sign of addiction or at least, physical dependency.

For 6 months prior to the knee surgery I took tramadol x 2 and paracetamol x 8, the former was for a tmj injury totally unrelated to the knee, the latter was for the knee pain. I was given omeprazole at this time to protect my stomach (presumably from the naproxen).

I have a neice and a sister who are both nurses in Yorkshire and who have been climbing the walls at my medication (or lack of it), one is in Leeds general the other Sheffield Northern and they have both worked on orthopaedics and both agree no patient would ever be discharged with the meds I was given (3 days of codeine phosphate 30mg).

A neighbour gave me some zapaine and my best freind sent me some tramadol from Ireland, thats how desperate I got, I have 'used' 5 of the tramadol and they are like gold dust, I honestly do think the meds I am taking are a total waste of time and am concerned for both my kidneys and my liver!!!

I do respect your advice but feel lost as to what to do, at the moment I am relying on ice ice and heat alternately and today am going in search of a tens machine....there's a very good acupuncturist in Penzance too so I might try that!!!

 

[lizziescam]

if you have reflux, then be careful of the types of fruit you are eating - citrous fruit and apples can play havoc with a sensitive stomach!

I don't have reflux!! but I do tend to stick with soft fruit, raspberries, blueberries, strawberries....

 

[lizziescam]

I was sent home from hospital with an ice band knee brace. I have six reusable ice packs so I always have some in the freezer. It's really good and relieves the swelling and pain loads. I ice as often as I can simply because it feels good !

I will get organized and order one. Thanks xxx

 

[Larryhg3]

All doctors are different I am quickly learning. During the consult my OS was engaged gave me details on the surgery. Said recovery is quite painful for most and answered all my questions. Even encouraged me to watch a You Tube video of the procedure so I got an idea of how much trauma there is to all the soft tissue.

His office believes strongly in PT but only up until week 12. That being said he believes equally as strongly in managing your pain through that time period. I personally stopped pain medications except for an occasional pill after a hard PT workout @ week 10. During my 3 month follow up I thanked him for his policy on pain management because many people I talk to or read about here are not having good pain management. His response “ The opioid crisis is not my problem or yours. You are not going to become dependent in 90 days if taking pain meds as prescribed. Performing this surgery and sending you to recover without proper pain management is torture plain and simple”.

My PT had almost talked me into looking forward at a different surgeon for my second knee because my doctor doesn’t think much of follow up visits. He sees you to set up the surgery, sees you to pull the staples and X-ray at 3 weeks then sees you 10 weeks later after PT. If you have any issues of any kind call the office and they will get you in same day or next day. I asked him about follow ups at my 3 month he said “you want to drive here every 3-6 weeks so I can tak an X-ray and say keep up the good work? I figure you want that time to start feeling better”. I think I am sticking with him.

 

[hopalong61]

@lizziescam You take more or less the same meds as me but i can't take Naproxen. I'd love to but my doctor won't prescribe it for me, I have high blood pressure. I took it years ago, with Lansoprazole, before i had my arthroscopies and it really helped. I'm in Yorkshire, just outside Leeds and have no problem getting my GP to prescribe Tramadol or Codeine. I do get the third degree if i ask for more Tramadol but i tend only to take it at night now so don't need it that often. Recently though i've found i can miss an afternoon dose of meds altogether without being in too much pain so i think i'm gradually getting there ! Also, HUGE celebrations as i can actually get down the bottom half of my stairs normally, WITHOUT HOLDING ON ! I've been going up without holding on for about a week now but not coming down, but a couple of days ago thought i'd try it. Don't do it too often though as my unoperated knee isn't very strong (it needs replacing too) and definitely wouldn't try from the top step
Onwards and upwards thankfully x Hope you are too xx

 

[Mutti3]

@Larryhg3
Agree with your statement. I only saw my OS at 1 and 2 month, x ray at 1 month visit. My next appointment will be at one year. Also learned as well from this site is differences of protocol !

 

[Marguette]

What report was that, @Marguette ? You can't say something like that without supplying a link to said article.

in was on the evening news and I did find the report on line. I will try to find it again and post the link.

https://www.healio.com/orthopedics/...xplore-non-opioid-options-for-pain-management

https://eorthopod.com/news/new-pain-protocol-during-total-knee-replacement/

 

[katchmo]

@Marguette this was the protocol my os used, along with IV acetaminophen and Celebrex. Unfortunately I still needed hefty doses of narcotics by that evening and beyond. I never felt overmedicated, in fact when my oxycodone kicked in was when I felt more alert and able to function. However, I have always had an idiosyncratic effect with narcotics and Tramadol; they make me hyped up and unable to sleep. Tramadol is the worst. One tab and I am up all night, guaranteed, so I can't take it. Oxycodone and morphine have the least effect but I still take Ambien with it.

 

[Marguette]

I find pain management to be a real challenge and I don't know that there is a clear answer. I was really leery of taking narcotics. My concerns proved to be justified in my case. On the other hand, no one wants to be in severe pain. So we way the pros and cons and make the best decision possible. As I understand It, the sleep disruption is primarily due to the overall trauma of the surgery, assuming it's not pain related. I will be so happy when I start sleeping more than three hours a night. Hope things are improving and you are feeling better. Hugs!

 

[kneeper]

 

[Josephine]

I don't have reflux!

What you described here is stomach issues which is very smilar

if I take the pain meds my tummy is kicking off, reduce the pain meds and my tummy pains go but knee kicks off.

 

[lizziescam]

@Josephine I assumed reflux was excess stomach acid coming back the wrong way. I wasn't very clear in my original post but the pain I was getting was very crampy and deep similar to a twisted colon
Would increasing the amount of omeprazole help that?

 

[Josephine]

the pain I was getting was very crampy and deep similar to a twisted colon. Would increasing the amount of omeprazole help that?

It would but don't do it without your GP's agreement.

 

[lizziescam]

@Josephine thanks! Trust me to start getting these pains during a bank holiday.
Probably need to chat to GP tomorrow.

 

[lizziescam]

Well I chatted to the Dr who said to just take paracetamol and drop all other meds, they never seemed to help anyway. So I did that. Then it was our long awaited and 'booked before the operation date' silver wedding anniversary holiday treat. 6 nights away from home in a lovely hotel on Guernsey (a little island just a stone's throw away). I wondered if the following tips might help others who are going on holiday or thinking about it.......

1. My surgeon said not to fly sooner than 3 months post op - I was only 7 weeks 3 days but the flight was only 20 minutes and a ferry would have been 4 hour drive and 3 hour ferry crossing so he said okay. My advice - don't book holidays at all if you are expecting a knee replacement, at least not within 12 months of the op!!!!!!

2. Take all your meds and ice packs - I took the TENS machine too. Behave the same as though you were at home ie keep on elevating and icing the knee and ignore the funny looks of the people in the hotel lobby who don't think you should have your foot on the table!

3. If your life before TKR was an active bike riding hiking swimming lifestyle do not expect to go on holiday and do any of these things unless you have allowed the previously stated 12 months. Move from dining room to bar to garden to pool side, slowly carefully and then rest.

4. If you are lucky enough to have hubby along do not feel obliged to accompany him on his 'little walk' around the historic and interesting castle, this will only result in tears (yours and his ) as your knee tells you it doesn't give a hoot for history and what do you think you are doing?

5. Avoid bus transport unless of the high end luxury coach type, by this I mean many buses are very shake, rattle and roll and the vibrations of a round the island bus trip will, just like the castle tour, leave you with a very cross knee.

6. Don't be afraid to ask the hotel staff for as much help as you need. Any decent hotel will happily freeze and refreeze your ice packs.

7. Be sensible and ask for a ground floor room. I didn't and ended up at the end of a very long corridor and no lift.

8. If you do fly, use the wheelchairs at the airport and ask for assistance. I was told I must always inform security that my knee will set off the alarm so must also always take off my shoes. This was at teeny weeny regional airports (Exeter and Guernsey) and I also then had to have a body search.

9. Take a collapsing walking stick/cane for extra support and make sure you wear sensible shoes no flip-flops!!

10. Try really hard to enjoy yourself even though you are short of sleep, in pain and generally wishing you were in your own bed. Be grateful that someone else is cooking all your meals for you and it's okay to laze around all day and do nothing!!

HTH xxxx

 

[sistersinhim]

What wonderful and logical tips you have there! They are sure to help many travels out there!

 

[ChrissiG]

Love your holiday tips lizziescam!! My OH wants us to go away in October (my op was April 26th) which is AGES off - but I’m still worried that my knee won’t be ready! I’m 6 weeks post op now and still in lots of pain (only on paracetamol) Just looking forward to a normal life again! Hope you managed to enjoy your holiday despite everything