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TKR Sky Blue's recovery - both TKRs

Sara's suggestion about a pill box or even envelopes for each 24 hour period might help you. Then you could write the date and time on the envelope when you removed the pills to take them.

It is important to take your pain medications on a set schedule. How about telling me exactly what you're taking (name of med, strength, prescribed dose and your schedule for taking them) and I can possibly offer some suggestions to talk with your surgeon about. If you are in serious pain, he needs to know it. It is counter productive for a good recovery as your body does not react well to constant inflammation and the reactions pain causes. Let's see if we can get this under better control.

As for the icing, that's important. You need to continue doing that as it helps with pain. But if you are chilled, there is nothing wrong with using extra blankets or a heating pad on the other parts of your body to stay warmer or be more comfortable.

When you respond with your medication information, please be sure and tag me so I'll see it quickly. To do that, you type the "at" sign - @ - immediately followed by my username to create the tag....like this @Jamie
 
@Jamie Thanks. I'm taking a Tramadol 50 [prescribed dose is 1 every 4 hours] + 2 Extra-Strength Tylenol every 6 hours. Midway through that 6 hours, I'm taking one Hydrocodone 10/APAP [prescribed dose is 1 every 4 hours] + Robaxin 500 mg [prescribed dose is 1 every 4 hours]. Did that make sense?... In other words, everything is prescribed to be taken every 4 hours, but because I want to take the Extra-strength Tylenol at the same time I take the Tramadol, I'm only taking the Tramadol every 6 hours.

Any insights?

The bad thing about putting on the extra blanket is that after the ice "melts," and I wake up, my pajamas are all damp from sweating from too much cover. I'd forgotten about my microwaveable heating bag; I should use that. With my other knee, my small dog was keeping me from having chills while icing; but this time around I'm having a harder time getting comfortable with her in the bed, too (because of the sore bum), so I don't even try. But I WILL get out the heating pad. It'll start cooling off about the same time the ice melts, so hopefully will not cause me to perspire.

Thanks to everyone for helping me think through this.
 
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kneeper said:
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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I'd give anything to lie on my side! For some reason, once I find a good way to position a pillow between my knees, it hurts like the devil all of a sudden. I'll keep working on it, tho'. Thank you.
 
Please confirm that this is the schedule you are using with your medications. Your times might be a little different for a 24 hour period, but this is what I got from the information you provided.

12:00 midnight - Tramadol plus 1000mg Tylenol
3:00am - Hydrocodone (contains 325mg Tylenol/acetaminophen)
6:00am - Tramadol plus 1000mf Tylenol
9:00am - Hydrocodone (contains 325mg Tylenol/acetaminophen)
12:00 noon - Tramadol plus 1000mg Tylenol
3:00pm - Hydrocodone (contains 325mg Tylenol/acetaminophen)
6:00pm - Tramadol plus 1000mg Tylenol
9:00pm - Hydrocodone (contains 325mg Tylenol/acetaminophen)

If this is the case, you are taking 5300mg of Tylenol (acetaminophen), which significantly exceeds the maximum of 4,000mg in a 24 hour period. You must stop this immediately as you are risking damage to your kidneys. The Hydrocodone is your strongest pain relief and you're only taking it every 6 hours. Since it lasts about 4 hours in your system, you're trying to manage this time with the Tramadol and Tylenol and it's obviously not enough.

If I have interpreted your schedule incorrectly, please see if you can put the times and doses together for me like I've done above and we'll go from there.

Did your doctor explain which of the pain meds he wanted you to use for your primary pain medication? Normally that would be the Hydrocodone, as it's stronger than Tramadol. But it could be that he wanted you to use the combination of Tramadol and Tylenol with the Hydrocodone strictly for breakthrough pain. It would be a good idea to clarify that with him.

Since you're having significant pain on this schedule (assuming what I have above is correct), I believe you'd be better served to make the Hydrocodone your primary pain medication right now. The 10mg is a pretty strong dosage (it also comes in 7.5mg and 5mg strengths). When you talk with your surgeon (and I do want you to call and tell them you're having problems with the meds prescribed), ask if you could take them on this schedule until you get your pain under control:

12:00 midnight - Hydrocodone
4:00am - Hydrocodone
8:00am - Hydrocodone
12:00 noon - Hydrocodone
4:00pm - Hydrocodone
8:00pm - Hydrocodone

Once the pain is managed and stays that way for a few days, you could substitute one or two of the Hydrocodone doses with 50mg of Tramadol and 500mg of Tylenol. That would keep you within the 4000mg of acetaminophen in 24 hours. Gradually, as your pain stays managed over the next couple of weeks you can try spacing out the doses to 5 and then 6 hours and substituting more of them with the Tramadol until you get to a schedule of taking the Tramadol and 1000mg Tylenol every 6 hours. As you're making any adjustments, just be sure to add up all the acetaminophen you're taking so you don't exceed the 4000mg per day.

I hope this all makes sense to you and I definitely want you to contact your surgeon for guidance as soon as possible. It sounds like he's sent you home with a lot of medications but not enough help about how to use them effectively.
 
@Jamie THANK YOU SO MUCH for breaking this down for me. Yes, you had my dosages and schedule exactly right, and my error is now obvious. You were right about not being educated very well on HOW to take the meds I was prescribed... I think the hospital staff, although very attentive and caring, were a bit in a hurry to discharge me-- I had stayed an extra day because of pain, and they were basically bringing me the hydrocodone at all different times... basically whenever I asked for it. So sometimes it was 4 hours, sometimes just two. And they threw in the Robaxin because it seemed to boost the effect of the hydrocodone the day I left. Once home, I was trying to use the Tramadol/Extra-strength Tylenol regimen recommended here because it had helped me so much with the other knee (but further into recovery). Also, being home alone most of the time, I was trying to "figure it out" while in a lot of pain. I'm so glad for the personal attention you gave me, and just wish that this were the norm for people being discharged. Today I have been icing my knee about 75% of the time, have had a 10 mg hydrocodone every 4 hours "on the dot," and haven't even needed any tramadol/Tylenol yet. I feel better than any day in the past 10 days. Thank you for your help and dedication, Jamie!!!!
 
This is FABULOUS news!! It sounds like you're on a good path now. Just remember that you are still healing (you might want to review those recovery articles posted earlier in your thread one more time as a reminder), and don't go crazy on activity or exercise because you are feeling better. Slow and steady increases are best.

What you report about the meds in the hospital is exactly how most hospitals work these days. They don't give medications on any schedule and instead wait for you to ask for them. So many people try to tough it out or think that someone will bring them meds automatically. But it doesn't work that way. We try to educate people to be pro-active with the hospital staff and stay ahead of your pain by asking for medication at the very first twinge of discomfort. These first few weeks in recovery can be tricky and even downright difficult if you don't get the pain managed properly. Everyone and every surgery is different, so you have to really listen to your body and respond accordingly when dealing with your medical team.
 
@Jamie, tell me about it! Why does the staff at our hospitals-- especially the ORTHOPEDIC-specific hospitals-- not do a better job at helping us manage post-surgical pain? I just don't understand.

I want you to know that I STILL have not had to take a Tramadol yet. Still just taking 10mg Hydrocodone every 4 hours on the dot, AND HAVE NOT CRIED BECAUSE OF PAIN (or despair :boohoo:) SINCE MONDAY MORNING!

I can't thank you enough, @Jamie.

I hope you-- and ALL-- have a blessed and happy Thanksgiving. I'll bet a number of us will be wishing for turkey! If I'm lucky, my cousin will bring me a plate of turkey dinner, BUT I don't need to eat turkey in order to be grateful!
 
Bless you, Sky Blue!!! It's the best reason for me to give thanks tomorrow to hear how well you're doing. No crying and no substantial pain. Yep! That's what we want!!! :thumb: If you lived closer, I'd send you over a plate of turkey, with all the homemade trimmings. I've been cooking all day today and I'm ready! Have a calm and peaceful day and dream of the things you'll be able to do a few months from now with those new knees.
 
@Jamie, Hi! I tried substituting a hydrocodone dose with a tramadol/tylenol dose a few days ago, but suffered for it, so I resumed the hydrocodone-only regimen. However, I HAVE finally progressed to only needing the 50 mg Hydrocodone every SIX hours instead of every four and not needing to supplement with tramadol, tylenol, or anything else.

Do you think that my being able to do well on this schedule means I can try substituting tramadol/tylenol for hydrocodone again with better success?

Thank you, Jamie.
 
I have two NEW questions!

1- I don't understand the healing process and would like to very much. Does anyone know of an article or a video that explains HOW the joint heals after surgery and the roles that inflammation, icing, elevating, and movement play in the process? Yes, this is a nerdy question, but sometimes understanding these nerdier aspects helps me. It definitely gives me a better appreciation for what my body is accomplishing and how I can "cooperate" with the healing process. In a nutshell, I'd just like to know exactly what is going on inside my leg as I lie here trying to recuperate.

2- The lateral side of my lower leg is real sensitive to touch and pressure even though there's no bruising. I read that opioids can actually cause this-- I mean, that they can actually cause you to feel more sensitive to pain. I hope that's all it is, but to be safe, my PT said to put my compressive stocking back on (I took it off a couple of weeks ago because it felt like it was cutting into the back of my knee). She said that if the top of it irritates my incision (which has healed enough to remove the dressing for good), I could just pull it down below the incision. Well, I put it on, and so far (one day) it hasn't irritated my incision although it rests right across the top of it. My question is, IS THERE ANY HARM TO WEARING THE COMPRESSION SOCK ON TOP OF MY INCISION? Does it cut off blood supply to anything?
 
I wore my full lenght compression stockings over my incision for over a month and it did it no harm whatsoever, after which I wore knee high which like you ended right in the middle of my incision- I actually through it helped as my incision is now less sensitive to fabrics (jeans/pants/leggings etc.) I was told to only wear day time and to remove at night.
Unless it is far too tight itwon't cut off blood supply - they shouldn't however dig into the back of your knee - were they measured correctly?
 
Sara61 said:
Unless it is far too tight itwon't cut off blood supply - they shouldn't however dig into the back of your knee - were they measured correctly?
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I don't think they were measured at all; or maybe I was still asleep when they did. But yes, they definitely do dig into the crease on the back of my knee. It hurts even when elevated and icing.
 
It sounds like you're still doing just fine. It's okay to experiment with your meds to see if you can begin to scale back. But you were wise to go back on the hydrocodone for now when the one dose of Tramadol/Tylenol didn't work.

Sky blue said:
I tried substituting a hydrocodone dose with a tramadol/tylenol dose a few days ago, but suffered for it, so I resumed the hydrocodone-only regimen. However, I HAVE finally progressed to only needing the 50 mg Hydrocodone every SIX hours instead of every four and not needing to supplement with tramadol, tylenol, or anything else. Do you think that my being able to do well on this schedule means I can try substituting tramadol/tylenol for hydrocodone again with better success?
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I'm assuming when you say "50mg Hydrocodone," you really mean 5mg. That's a good reduction since you started out with 10mg of Hydrocodone. So you ARE tapering. Don't get in too much of a hurry. The important thing is to keep ahead of your pain.

Sky blue said:
I don't understand the healing process and would like to very much. Does anyone know of an article or a video that explains HOW the joint heals after surgery and the roles that inflammation, icing, elevating, and movement play in the process?
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BoneSmart to the rescue! Just click on the WOUND CARE link in your dark blue toolbar at the top of the page. There is a ton of information there about healing and you'll be the smartest kid on your block once you've read it. Even your surgeon will be impressed....:heehee:. Seriously, though, we have put a lot of information there for you. Let me know if you have any questions as you go through the material.

Sky blue said:
The lateral side of my lower leg is real sensitive to touch and pressure even though there's no bruising. I read that opioids can actually cause this-- I mean, that they can actually cause you to feel more sensitive to pain. I hope that's all it is, but to be safe, my PT said to put my compressive stocking back on (I took it off a couple of weeks ago because it felt like it was cutting into the back of my knee). She said that if the top of it irritates my incision (which has healed enough to remove the dressing for good), I could just pull it down below the incision. Well, I put it on, and so far (one day) it hasn't irritated my incision although it rests right across the top of it. My question is, IS THERE ANY HARM TO WEARING THE COMPRESSION SOCK ON TOP OF MY INCISION? Does it cut off blood supply to anything?
Click to expand...
You're really new in recovery and it's very normal to have all types of pains and sensitivities for months after surgery. I don't believe it is related to any medication you're taking.....it's just part of your body's reaction to all the trauma it's been through. Actually I still sometimes get a little sensitivity on my lower legs now and then. It's nothing to worry about.

If the compression stockings make you feel better, it's fine to wear them. Just make sure nothing is constricting too much. The constriction can occur if the stockings start rolling down from the top. You don't want that! Some people actually cut that top band off.

I think it's great that you're now taking your meds on 6 hour intervals instead of 4 and you've dropped to 5mg of Hydrocodone. When you're ready to try the Tramadol again, substitute a dose where you know you'll be fairly inactive so you have the best chance of not needing the stronger meds. Be sure and use your ice frequently, especially when starting with the Tramadol/Tylenol.
 
Might be a good idea to talk to ask @Jamie whom is probably more knowledgeable than I - I would myself try and stretch them a bit ... But it might defeat the object- here in Portugal we get measured for them x

Lol Jamie beat me to it xx
 
I wouldn’t wear them if they hurt. I was less than 2 weeks post op when my surgeon told me I could take mine off. I never looked back!
 
This is kind of a funny trick that works sometimes when your skin gets ultra sensitive following a joint replacement. Try wrapping your leg where it hurts in Glad plastic wrap. This is especially good when you're sleeping at night. The heat generated by the plastic helps some people with that sensitivity and the wrap protects the area from things rubbing against sensitive skin.
 
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