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TKR Sky Blue's recovery - both TKRs

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Sky blue

Sky blue

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TWO other things I'm thinking of right now that I need to tell y'all.

For my left knee TKR six weeks ago, I did NOT use a CPM machine at any time during my recovery. This time I contacted the surgeon's office several days before surgery and told them that it took 5 weeks just to be able to bend my knee to 90º, and for those 5 weeks it was torturous trying to do PT (I exaggerated a little for effect, because I actually did NOT allow myself to hurt that much during PT; but I also made very little and very slow progress). Therefore, I wanted to request a CPM for use in the hospital with the option of taking it home. Surprisingly, my doc approved the request and it was sitting in my hospital room when I got up there. Since my pain was FAR from being under control the rest of that day, I used it for the first time on the day after surgery... twice, for 2 hours each time. We started it at 35º and upped it 3-5º each session. Like I said earlier, I stayed an additional night and used it during the night and twice the next day. By the time I was discharged on Saturday afternoon, we had been able to raise the angle of flexion (with no discomfort) to 55º. Since being home, I've been in it ALMOST non-stop because it's relaxing and puts me to sleep. It's now set on almost 85º, and I promise, with NO discomfort. Of course, I cannot ACTIVELY bend it that far-- in fact, I can hardly bend it at all ACTIVELY ! When I'm ready to start that active flexion, I think it'll be a lot easier this time around. I hope someone can confirm this hope.

2nd, when I called the doctor's office about requesting the CPM, I also complained about not having enough pain medication after my first TKR to last until my first follow up appointment, and that it was real inconvenient to have to ask someone drive 20 miles across town to pick up a refill Rx in person for me, so the doctor went ahead and wrote out two prescriptions (an original and a post-dated refill Rx) which I picked up the day before surgery and dropped off at the pharmacy. I was SO HAPPY that this request was taken seriously and approved, 'cos I know it's gonna make a huge difference in HOW I take my pain meds this time around-- instead of being overly cautious, I'll be able to use what I actually need, knowing that the refill Rx is already on file at the pharmacy.

OK, I think I've told y'all everything I needed to tell you. God bless us EVERYONE tonight, even the ones here that are supporting and encouraging the rest of us!
 

pamsknees

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I appreciate you sharing your pointers! I go see my surgeon on Nov 20 & hopefully get mine scheduled.
 
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For future reference - and for other members - here it is. The first chart is for 4-hourly doses and the second is for 6-hourly doses:
I'm a little confused. The Tramadol I take here in the U.S. contains 325 mg acetaminophen, and each Tylenol contains 500 mg acetaminophen.
 

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The 1000 is if you take 2 of the 500 mg of Tylenol pills.
 
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The 1000 is if you take 2 of the 500 mg of Tylenol pills.
Yes, I realize this. But what about the 325 mg acetaminophen in each Tramadol? Doesn't it count toward the total amount of acetaminophen?

I'm having a LOT of pain right now; maybe this is keeping me from understanding this chart... I'll try again later.
 

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Yes, I realize this. But what about the 325 mg acetaminophen in each Tramadol? Doesn't it count toward the total amount of acetaminophen?
Yes, it all counts toward the daily total. You have to adjust the Tylenol so that you stay within the daily limit, which is 4000. The bottle says 3000 in case people don’t consider the other medications they are taking that contain acetaminophen.
 
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Yes, it all counts toward the daily total. You have to adjust the Tylenol so that you stay within the daily limit, which is 4000. The bottle says 3000 in case people don’t consider the other medications they are taking that contain acetaminophen.
I just figured out what the problem was. I was looking at a bottle of Tramadol which contains acetaminophen (prescribed for my arthritis, not prescribed post-surgery); but the chart above was based on Tramadol that doesn't contain acetaminophen.

Sorry for the confusion.
 

Jockette

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No problem. It’s good to make sure everything is clear.
 

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I'm a little confused. The Tramadol I take here in the U.S. contains 325 mg acetaminophen, and each Tylenol contains 500 mg acetaminophen.
Most people are prescribed Tramadol without the added Acetaminophen. In fact, I wasn't aware of any medications that have both Tramadol and Tylenol combined in the one pill.

I just figured out what the problem was. I was looking at a bottle of Tramadol which contains acetaminophen (prescribed for my arthritis, not prescribed post-surgery); but the chart above was based on Tramadol that doesn't contain acetaminophen.
Yes, You've worked it out.
You can only follow the charts I gave you if you're taking Tramadol and Tylenol as two separate pills. Then you need to buy the extra-strength Tylenol that contains 500 mg in each pill.
 

Jamie

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@Sky blue .... I'm glad you figured out the answer to your questions about Tramadol and acetaminophen. The combination drug you were prescribed for your arthritis (not post-surgery) goes under the trade name of Ultracet. It's been around in the USA since 2001. But normally surgeons will use the straight Tramadol for post-op pain. It allows a lot more flexibility since you can combine it in different ways with acetaminophen (Tylenol) for a pain control regimen that works for you.

If you want to use the Tramadol and Tylenol combination, I suggest you contact your surgeon or GP and ask for a prescription of Tramadol, 50mg and use it with the Tylenol according to one of the charts.

And....you are correct that any and all sources of acetaminophen MUST be counted toward that 4,000mg limit in any 24-hour period. Going beyond that creates a serious risk of liver damage.
 

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the doctor went ahead and wrote out two prescriptions (an original and a post-dated refill Rx) which I picked up the day before surgery and dropped off at the pharmacy. I was SO HAPPY that this request was taken seriously and approved, 'cos I know it's gonna make a huge difference in HOW I take my pain meds this time around-- instead of being overly cautious, I'll be able to use what I actually need, knowing that the refill Rx is already on file at the pharmacy.
This is a great idea! This will help out those of us that are single and have no way to drive to get another prescription for at least 4 weeks. What a relief to know that you already have another one waiting for you when you need to have it filled!
 

LindaO

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So glad your surgeon wrote the two prescriptions! I remember having to drive 150 miles round trip to get a prescription or have them mail it to me. I started requesting it about a week before needing it to ensure I received it in the mail before I ran out.
Glad you are learning how to be creative to support your needs! Great job!
 

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When I was non-weight-bearing on my left ankle/foot, I had to solve the problem of how to get out of bed to get to the toilet, and I found that having a sturdy chair with arms placed sideways alongside the bed and to my right was helpful. I could grab that chair arm and leverage myself up. You might find a variation of this method helpful. You aren't non-weight bearing, so you just need a little help and to definitely be safely stabilized so you don't fall and break something!

I notice you are in Texas. The Texas state legislature passed a law that went into effect September 1, which limits the quantities of opiate medications that can be prescribed for acute pain. Physicians are legally permitted to prescribe only one week's supply for acute pain. Another prescription can be issued after that one week but the physician is supposed to see the patient for that prescription. I'm not sure how this is going to work out for me if I have my other knee replaced; I guess we'll just have to see. I have rarely needed opiate medications beyond three weeks post op except for after my kneecap broke, but I've never been able to be completely done with them after only seven days post op. Some Medicare D drug plans also limit their members to only a seven day supply as well. I get tired of this nanny-like treatment. We are paying for the irresponsibility of abusers.
 
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Some Medicare D drug plans also limit their members to only a seven day supply as well. I get tired of this nanny-like treatment. We are paying for the irresponsibility of abusers.
It's ridiculous, isn't it, that people are legitimately suffering for the irresponsibility of others. This is pretty much the world we live in, however, at least ever since the "zero tolerance" thing took over.

Although I live in Texas, I really hadn't noticed the effects of the law you mentioned. I was supplied (prior to surgery) with two prescriptions of Hydrocodone, 40 tablets each, with (of course) one prescription being post-dated 10 days out. At any rate, it's working fine for me since I'm alternating the dose of hydrocodone with the dose of a tramadol 50 & 2-Extra strength Tylenol. And in case of emergency, I've also got some meds saved up from a dental procedure several months ago. And the pharmacist said it would be OK to take 5 mg of Ambien at night to sleep through any residual pain. These may or may not be the best practices, but when you're in pain, you've got to do SOMETHING... you can't just tough it out... Well, I guess someone could, it just depends on your pain tolerance and determination.

I'm just so glad this is almost all behind me. I can't imagine choosing to go through ANY other procedure like this... especially without a support system.
 
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I'm hurting so much right now. At 9 am I wrote down what I took for pain, but it hurts so much that I wonder if I actually took the pills or just WROTE IT DOWN.

Should I err on the side of caution, or should I take a fresh dose?
 
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I hate talking about all the pains I'm feeling; it seems to make them worse. But oh my gosh, this is so much harder pain-wise than my left knee recovery 6 weeks prior. No one is here with me most of the time, except the two dogs, and it gets so overwhelming to me that I can't hold it in-- you know, like a grown-up would-- I start whimpering, and then groaning in rhythm with my breathing, and then crying. One of my dogs (the one who is closest and most dependent on me) often (it depends on how loud I get) reacts by distancing himself. Talk about adding insult to injury... it feels like he's judging me. Which is ridiculous of course. But still, why doesn't he come closer and lick my tears away like Lassie would probably do?!

Although it feels kind of cathartic to cry I think it's lowering my defenses physically because I keep having horrible chills, especially when icing, and feeling a general malaise like you do when you're coming down with something. Is this a common problem? Is it just because of the icing? Or can crying make you feel sick?

Another source of discomfort is my bum. It feels like the bed or recliner is rubbing my skin raw and making a pressure sore.
 

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I’m so sorry you are hurting so much. Maybe you should let your doctor know how bad it is, maybe he will adjust the medication.

I think your dog is just unsure as he’s not used to seeing you upset.:console2:

You are not totally alone, we are here for you. Not the same as actually being in the same room with you, but we totally understand all you’re going through, we’ve been where you are.:console2:
 

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I was hopeless in the beginning and still am not good at remembering at what time I should take my pain meds so I used the notes app on my phone and as soon as I took a pill I wrote it down,with the date name and time (ie 22/11- paracetamol at 2pm, etc) this helps me to remember what I last took.
You should consult your doctor regarding your pain level at the beginning they didn't give me the correct pills and the dosage was too low, like you, the pain was awful, but as soon as it was altered I was then able heal and life became rosier.
I too spend most of the day alone we live in the country with no neighbours, and not being allowed to drive in the early weeks meant I hardly saw anyone other than DH when he got home from work so I also just had my dogs for company, try and keep your mind occupied, use light activities as your daily exercise ( making cups of tea/coffee, chatting on BS- there is always someone online somewhere around the world )
:dogsniff:Dogs are very sensitive and hate to feel/hear our distress he is probably alarmed and scared and is afraid he will hurt you further but he loves you just the same, you'll see in a short while he will be close to you again, mine also kept their distance for a day or two when I was in a lot of pain.
Regarding your bum place a soft cushion under it if you have sores maybe a small rubber ring (like the swimming pool ones ) the hole will protect your sores.
Once you are sorted pain wise you'll see you will feel a lot better, we have all been through it and lived to tell the tale so don't feel alone we are all here to help xxx
 

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One other thought what about using one of those pill boxes you could in the morning put in the pills for the day in each separate compartment then write the time on top and that way you would know if you have taken the pill or not :tada:
 

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Although it feels kind of cathartic to cry I think it's lowering my defenses physically because I keep having horrible chills, especially when icing, and feeling a general malaise like you do when you're coming down with something. Is this a common problem? Is it just because of the icing? Or can crying make you feel sick?

Another source of discomfort is my bum. It feels like the bed or recliner is rubbing my skin raw and making a pressure sore.
The feeling like chills/hot flashes seems to be fairly common. I had this in my first weeks. I would check my temperature and it was fine. (I assume you're not running a temp.) I think the pain meds & the icing contributes to it. It the middle of the summer I'd have my winter fleece blanket on.

Sounds like you need to change position if you seem to be developing a sore. Can you lay on your side for a while? I could about 10 minutes at a time at first. Are you able to walk around a little? Any change of position periodically would be good.
 

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