Revision TKR Relief...Not what I expected<

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[2014knees]

Josephine,

1. Daytime: 2 Nighttime: 8

2. No prescription drugs. I am taking Ibuprofen and Tylenol. At night I will take 2 extra strength Tylenol and 800 mm Ibuprofen. Most days I don't take anything because it doesn't hurt bad during the day.

3. Slight swelling

4. ROM is very good, more than 135. Extension is not quite there yet but very close.

5. Sometimes at night I will ice it before bed. I ice for about an hour.

6. No more than just sitting in a recliner for about and hour or so once or twice a day.

7. I am doing normal housework and working 2 days a week.

8. Approx. 15 minutes once a day: 20 stretches: 12 bends: Up and down 8 steps two to four times a day.
Walk a half mile or more everyday.
No more PT. Insurance maxed out.

I have an appointment to see the doctor in the morning. Gotta do something to get rid of this nighttime pain.
It's the same pain I was having before surgery only worse.

Thanks for your help.

 

[SusieB]

I was put on Gabapentin it’s nerve pain medicine... that’s what it sounds like nerve pain .... he gave me two different strength. Am 300 mg night 600 mg !! I have NO pain!!!

 

[2014knees]

Josephine, here are the doctor notes from today's visit. He seems to be on the same page with you!
He put me on Gabapentin 100mg 3 x day and take two at bedtime.

The following list includes any diagnoses that were discussed at your visit.
1. Knee pain
• knee pain or injury: care instructions
• XR, knee, 3 view
• Neurontin 100 mg capsule
2. Lumbar radiculopathy
• MRI, lumbar spine, w/o contrast
3. Mechanical complication of internal joint prosthesis
Based on my evaluation, I do not think that the replacement is the issue. The xrays show stable hardware without complication. I would recommend evaluating her lumbar spine to make sure this is not a radiculopathy at play. I have no concern for infection or failure of the prosthesis.
RTC after MRI>

 

[Josephine]

Can you change this answer to comply with this question please?

8. Approx. 15 minutes once a day: 20 stretches: 12 bends: Up and down 8 steps two to four times a day.
Walk a half mile or more everyday.

This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Thank you

 

[2014knees]

Straight leg raise: 10 raises 2 x a day.
Toe touching bends from standing position: 12 bends 2 x a day.
Using a stretch band: 15 stretches 2 x a day.
Walking: half a mile or more 1 x a day.

May I ask you how long you were on the Gabapentin?

Thank you

 

[Josephine]

1. Daytime: 2 Night time: 8

Oh that's neuropathy for sure!

2. No prescription drugs. At night I will take 2 extra strength Tylenol and 800 mm Ibuprofen. Most days I don't take anything because it doesn't hurt bad during the day.

I'm not sure that ordinary pain killers will help much. Why don't you stop taking them for one or two days to see if they really are making any difference?

3. Slight swelling

Okay

4. ROM is very good, more than 135. Extension is not quite there yet but very close.

Good

5. Sometimes at night I will ice it before bed. I ice for about an hour.

Good

6. No more than just sitting in a recliner for about and hour or so once or twice a day.

Okay

7. I am doing normal housework and working 2 days a week.

Okay

Straight leg raise: 10 raises 2 x a day.
Toe touching bends from standing position: 12 bends 2 x a day.
Using a stretch band: 15 stretches 2 x a day.
Walking: half a mile or more 1 x a day.

I think youdon't need to do the ones I've crossed out, mainly because you have excellent ROM anyway so what's the point? An certainly you should never be using stretch bands at all.

May I ask you how long you were on the Gabapentin?

I was only on it for about 8 weeks but it was a very tiny area of cellulitis, caused, I believe, by the skin tear at the bottom of the incision. I asked him about this and at first he just shrugged his shoulders but then realised WHO he was talking to and that I knew perfectly well that it was a tear! But those things happen sometimes!

 

[2014knees]

Josephine,
Thanks so much for answering a lot of my questions and offering advice. I will wait and see if the pain goes away by May. If so, I will have right knee revision done.

Thanks again!