TKR Rex's RTKR Big Adventure<

Rex919

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I had a RTKR on 11/14
I was moving along satisfactorily. Moderate walking, limited PT, ice, elevate, plenty of rest. Today is day 8 and pain started escalating in the morning and is continuing to get worse. I am taking the pain meds at the prescribe times and at the maximum allowable doses and pain levels come down but then go back up to higher levels.
My post op appt is in 6 days. My concern is how to handle this if it keeps getting worse over the holiday.
 
Good morning, welcome to BoneSmart.

You are doing the right thing in taking your meds by the book. Perhaps you could call your doctor and (a) ask if you can take more (b) to schedule an appt to raise the dose. Sounds simple but I'd doubt you taking the maximum level of meds your body can tolerate.

Knee pain does get worse in the first couple of weeks, sometimes, as the body's reaction (What the HECK was THAT?!) starts to kick in.

A lot more reading for you:

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now; they are almost certainly temporary
2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​
4. PT or exercise can be useful BUT take note of these
5. Here is a week-by-week guide for Activity progression for TKRs


The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?

Energy drain for TKRs

Elevation is the key

Ice to control pain and swelling

Heel slides and how to do them properly

Chart representation of TKR recovery

Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 
Yes, the pain can get worse at first. In addition to Roy’s advice, make sure to elevate your legs (to reduce swelling) and ice for long periods (40 minutes to an hour), which helps with both swelling and pain. Hope you find relief soon!
 
I am taking the pain meds at the prescribe times and at the maximum allowable doses and pain levels come down but then go back up to higher levels.
Moderate walking, limited PT, ice, elevate, plenty of rest.
It could be that even the moderate walking and exercises you're doing are too much for your new knee at this early stage.

Until your pain settles, I suggest you restrict the exercising to just walking a little around the house. Spend most of your time resting, icing and elevating your knee. Re-read the articles about icing dan elevating, to make sure you're doing them properly, and make sure that you're icing for 45-60 minutes at each session. Just make sure you have some material between your knee and the icing medium, so you don't get "freezer burn."
 
Thanks for the reply. I am trying very hard to go slow. Moderate seems to be the puzzle, what feels good one day is excruciating the next. Intellectually I have done the reading and understand the program, unfortunately my knee isn't playing by any rules....lol. slow and steady is the plan and most importantly positive attitude. This forum is a tremendous help.
 
Most of the time we don't feel the over-done-it until that night or the next day. It's a real bummer. You think things are going really well, then ut oh, you find out something different later on. You will learn what you can do and can't do and let the knee be in control!
 
unfortunately my knee isn't playing by any rules....lol.
Very true. The knee has its own rules--which it doesn't disclose to us. :heehee: We gradually learn to pick up on the signals if we pay attention. :chinstroke:
It's much easier to overdo this early in the recovery than to "under-do."
 
Today is day 8 and pain started escalating in the morning and is continuing to get worse.
I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 
I don't check here every day. I am open to any conversations.
 
Well it has been an interesting weekend. On Friday I did the math and my surgeon had not given me enough pain meds to make it to my first post op appt. What should have been an easy situation to fix was complicated by the holiday weekend and US rules concerning opiates. I was able to speak to the on-call Dr but because none of their physical offices were open there was no way to pick up a hard copy script. They recommended I go to Urgent Care.

To make a long story short they really didn't what to deal with it and sent me to the ER. At the ER the Dr was concern about the swelling so they did an ultrasound to check for clots and blood work to check for infection. Everything came back negative and I left with a new pain script.

But other than going to the bathroom and moving from sofa to bed I have had my knee elevated and icing on a 45 min on/off program. And guess what the swelling has gone down considerably. So I am a smart guy and have had numerous surgeries in the past and followed instructions to the letter.

I had to do some honest thinking about what I had done wrong. It goes like this, for the holidays I am staying with my older brother, who had a TKR about 5 months ago, and his family. For some reason a competitive thing kicked in and I tried to show him how I didn't really need much help. Well that was straight up stupid, when I was sitting in the ER talking with him, he said he was really surprised how much I was moving around because it was a lot more then he did.

Anyway I may be rambling but the point is follow the program you are given and don't let anyone else stories, expectations perceived or otherwise effect how you handle your healing process. Everyone is different slow and steady is good.
 
Oh that brotherly competition!

I personally would not want an ER doctor having anything to do with my knee replacement, that is not their area of expertise. Glad you got your pain medicine though!
 
What an absolutely ridiculous thing you had to go through just to get some pain meds. But, thank God you were able to finally get them. I wonder how much worse this pain med situation can get for people that so badly need them.
 
I'm glad you got the pain medications in the end, and you had a check for blood clots as well. That's probably a good thing.

I hope you don't have to go through all that again.

Now you know what not to do as far as activity is concerned, so treat your knee to lots of TLC, with rest, ice and elevation.
 
I had a call to the Holiday on-call. I was given a dressing to replace after 7 days. In the hospital the nurse had to tease it off while keeping the mesh/glue wound skin closure on my knee. We start to remove the top dressing bandage, got it off and the mesh came up too. Oops! Call the on-call and she got back to me and said to put on the new hospital provided water proof dressing.

Holiday weekends and medical issues are trying to say the least.
 
Time for an update.
After my ER adventure I had better pain management but was not what I would consider acceptable. I got through those several days and had my first Post OP appt. with my surgeon on 11/29 . I have a very long history with him and his staff. (I tried to edit my signature to list my surgical history and I was not given access.) The main topic of conversation was getting pain management under control, followed by a discussion about swelling which is getting better but needs more work. He reiterated what I needed to do but with a clear understanding that the pain and swelling will get better in tandem

I was told when I left the hospital I was to shoot for 90 degrees. This seemed very important to my in home PT tech. Thanks to this forum I had a clearer understanding about what was important and in what order.
Now my DR..... after we had covered everything else, ROM of motion seemed very much like a cursory check, he ask my to show him how much flexion I had..... he glanced at what I could do and said "yup that looks like about 90 degrees" It was very empowering that he is on the same page as myself and that I don't have to let the PT tech drive the boat. He increased the dosage strength of my time released meds, 20 mg oxycontin, and refilled the oxycodone 10mg every 4 hours. My appt was yesterday at 11am, at 530pm today I am feeling 100% better. I just finished my PT, which I controlled the pace and I am typing this with my leg elevated, attached to ice machine and a pain level of 2.

A question for admins, Is there a way to rename my thread. I did not expect to have the feeling and connection to this community when I first started posting. I will mostly lurk but I do read a great deal of the posts and will post when I have something to say. I would like to rename it, "Rex's RTKR Big Adventure". Just saying ... humor and positive attitude are as important as just anything else when it comes life and healing.
 
Sure, we'll change your title for you.

It sounds like you have a wonderful, up to date, OS! And great that you got your meds renewed. So many are now being denied that because of all the publicity about addiction.
 
I do have considerable sympathy for those that are having issues getting the meds they need. Yes, there are addiction and abuse issues out there but the people that are truly in need of pain drugs should not be swept up in this political driven hysteria.
I have had a relationship with my surgeon dating back to an ACL reconstruction done in 1994 and covers 7 procedure he has done and another 4 performed by a foot specialist in his practice. This has put me in a situation built on decades of trust. When I say I am in pain and would like X I get it and as soon as we can tapper I tell him and we do. I am extremely aware of how fortunate I am and in this day and age how rare this relationship is. Is it perfect no, but most issues I have are more related to paperwork and his office staff. When I started seeing him it was a four Dr. practice, now it is close to 30.
 
I have a very long history with him and his staff.
We prefer signatures to be restricted to just joint replacements and relevant associated surgeries that are recent.
the pain and swelling will get better in tandem
Very, very true!
people that are truly in need of pain drugs should not be swept up in this political driven hysteria.
I SO agree. It makes my heart ache to hear of such stories.
 
Just a side note, between naps and the the pain drug induced fuzz I started to have trouble keeping track of when I had or should take meds. The solution I found was to d/l an app. Problem solved! I have an android and there were dozens, I am sure Apple store has plenty also. I picked the one with the most and best reviews.
 
An app is a good idea. A lot of people set alarms on their phones. A tracking method is important because, as you found out, it’s easy to lose track of when the last dose was taken.

Sounds like you’re having a really good recovery so far. :)
 

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