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Knee Infection* So Much Pain (WhyMePlease)

Raithtaxi said:
I haven’t researched Tramadol, it does help with pain, without knocking off your feet - so to speak. I wonder if you could take antacids so you can take Celebrex or another type of NSAID. For me ibuprofen has always helped me. My surgeons office told me to alternate oxy and tramadol every 4 hours starting the 3rd day after surgery. It helped tremendously. This far out, I normally take a tramadol in the morning, Tylenol or Advil later in the day and a 5mg cylobenazprine muscle relaxer to sleep. I take only take an oxy if I have done too much- PT day for sure.
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@Raithtaxi
I know you meant well, but please don't suggest medication regimens to members who already say they have an intolerance or allergy.

For those of us who don't tolerate NSAIDs due to immediate gastritis symptoms it's simply not feasible to be on the very high dose proton pump inhibitors required long term as they carry their own side effects.

Administrative note: Actually, BoneSmart’s forum rules prohibit members from giving any medical advice to other members. We have trained staff to address these issues when the need arises. What we DO encourage members to do when they want to offer help to someone is to talk about what has worked (or not worked) for them in their joint journey. Please make sure your posts on the forum adhere to this requirement and only talk about your own personal experiences without making suggestions for someone else.
 
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Tramadol is a good option for pain control. It is something many doctors use as a step down medication from hydrocodone or OxyCodone. I’m not sure what article you read on the internet about this medication, but it was incorrect. This is one reason we caution folks about doing internet searches. You really have to check out the sources. If you haven’t tried it, I suggest you contact your GP and see if it’s an option for you. It works best when taken on a set schedule throughout the day and night so that medication is always in your system. Then, as things get better, you can begin extending the time between doses or even alternating it with doses of 1000mg of Tylenol. It is best to wean off of Tramadol so that you don’t go through any discomfort.

It is possible since you’ve had such extreme and constant pain since your surgery, that you may have soft tissue problems that are contributing to your pain and swelling. When muscles are over stressed and tense, they don’t function as well as when they are loose and supple. Muscle relaxants work on this, but I have found from my own personal experience that a specific type of therapy - pressure point massage - can do wonders. You may have to look around a bit to find a therapist who is skilled in this type of treatment, but it will be worth it. Muscle imbalance can result from the pain and from not walking properly over time. It is my feeling that this pressure therapy is the best way to address the problem and get it resolved.

I do encourage you to not try and work through this on your own. These problems can become chronic if not addressed early on and we don’t want that to happen. Unfortunately even great surgeons are sometimes woefully untrained in some of the issues that can arise with pain management for patients. Often it’s better to work with a good therapist and your GP to get the job done.

Let us know if you want more information about any of this. We’ll be here to help you find the right resources.
 
Raithtaxi said:
I haven’t researched Tramadol, it does help with pain, without knocking off your feet - so to speak. I wonder if you could take antacids so you can take Celebrex or another type of NSAID. For me ibuprofen has always helped me. My surgeons office told me to alternate oxy and tramadol every 4 hours starting the 3rd day after surgery. It helped tremendously. This far out, I normally take a tramadol in the morning, Tylenol or Advil later in the day and a 5mg cylobenazprine muscle relaxer to sleep. I take only take an oxy if I have done too much- PT day for sure.

Please see administrative note in post #22….
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Thanks for trying to help. I do stay away from NSAIDs quite strictly per doctor’s orders. But, in a way , I think having to do that is at the root if much of my problems. It is so important and helpful to find the right type and frequency of pain killers, but your body is still forced to try to reduce the inflammation all by itself. I have plenty of that not just in my new knee, but also hips, shoulders and back. And the other knee, of course. I am trying to find out whether muscle relaxers have to wait until they cut off my pain pills or no. Thanks again for your concern.
 
Jamie said:
Tramadol is a good option for pain control. It is something many doctors use as a step down medication from hydrocodone or OxyCodone. I’m not sure what article you read on the internet about this medication, but it was incorrect. This is one reason we caution folks about doing internet searches. You really have to check out the sources. If you haven’t tried it, I suggest you contact your GP and see if it’s an option for you. It works best when taken on a set schedule throughout the day and night so that medication is always in your system. Then, as things get better, you can begin extending the time between doses or even alternating it with doses of 1000mg of Tylenol. It is best to wean off of Tramadol so that you don’t go through any discomfort.

It is possible since you’ve had such extreme and constant pain since your surgery, that you may have soft tissue problems that are contributing to your pain and swelling. When muscles are over stressed and tense, they don’t function as well as when they are loose and supple. Muscle relaxants work on this, but I have found from my own personal experience that a specific type of therapy - pressure point massage - can do wonders. You may have to look around a bit to find a therapist who is skilled in this type of treatment, but it will be worth it. Muscle imbalance can result from the pain and from not walking properly over time. It is my feeling that this pressure therapy is the best way to address the problem and get it resolved.

I do encourage you to not try and work through this on your own. These problems can become chronic if not addressed early on and we don’t want that to happen. Unfortunately even great surgeons are sometimes woefully untrained in some of the issues that can arise with pain management for patients. Often it’s better to work with a good therapist and your GP to get the job done.

Let us know if you want more information about any of this. We’ll be here to help you find the right resources.
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Thanks for the tips and info. I will probably wait until the doc starts to hold out on the oxy before I mention tramadol. I just finished the 8th week and I really haven’t seen much improvement in pain. I am trying hard to limit and even taper off a little on the oxy. Maybe some of these other suggestions like massage or muscle relaxants will help. Thanks to all. When you are really feeling low and sorry for yourself, it is very welcome to receive messages of help and concern.
 
@WhyMePlease sorry you're still in so much pain. As someone who can't take NSAIDs either due to kidney disease (CKD) it is really tricky finding the right mix.

If your doc is already trying to stop your oxy it might be in your best interest to bring up the subject of tramadol before he stops it. Having been in your shoes its much easier to drop down to tramadol for pain management. And you definitely don't want to be left with absolutely nothing.

My neurologist used to prescribe me a low dose muscle relaxer while taking the tramadol. I usually did the muscle relaxer at night before bed as most make me quite sleepy. The addition of the muscle relaxer was quite beneficial. Unfortunately we had to stop the muscle relaxers as my nephrologist said it affects my kidneys. Since we have the CKD under control we want to keep it that way.
 
I am sorry you're still struggling on your two month anniversary. I hope you're able to find relief soon.
We're here for you whenever you need support. :console2: I hope today is a good day!
@WhyMePlease
 
Layla, thanks for your encouragement. Unfortunately, I still have more bad days (and nights) pain wise than good. I even think my knee is swelling back up a bit.

I talked to the PA assigned to me Friday and sent him a picture. I thought there might be a localized infection, because the knee is always warm and often red, even though I don’t have a temperature overall. He said that isn’t at all likely, and also emphasized the need to cut back on the oxy. I asked him about muscle relaxers, and he came around to prescribing me some Flexeril generic, but only in a low 5 mg dose for 30 days. I am to take it once a night to help with sleep. So far I’ve taken it once and it might have helped a little. He did opine that my 3 round trips a day on 2 flights of stairs, together with too many bathroom trips day and night than I would care to admit to here, might be taking a toll. My wife and I have decided to spring for a stairlift as an investment in our future plan to stay in this house until we can’t survive here. But that will take about 7-8 weeks.

Do you think there comes a point where the icing, which I do very regularly, is counterproductive? It leaves my leg very cold and very red, although it does seem to reduce the pain a little, but I wonder if it could somehow create more swelling? I have tried self massage a couple of times (per people’s suggestion here), and I think it does do some good. I’ll keep that up.

Coincidentally, when I logged into ancestry.com yesterday it fed me some typical attributes for people with some of my DNA characteristics. The first thing on the list was “low tolerance for pain“. Hah! Maybe that is my problem. (Probably has as much validity as a fortune cookie).

So I don’t have much choice but to carry on, but I’ll tell you, some mornings it just doesn’t seem worth it. I don’t know what to expect for a new “normal” after all this.

Thanks again.
 
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Layla said:
I am sorry you're still struggling on your two month anniversary. I hope you're able to find relief soon.
We're here for you whenever you need support. :console2: I hope today is a good day!
@WhyMePlease
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I replied several hours ago to your encouraging post, and made some more comments about my progress, but that post is “awaiting moderator approval”. I don’t know what I did wrong, but I wanted to make sure you know I appreciate your concern.
 
WhyMePlease said:
My wife and I have decided to spring for a stairlift as an investment in our future plan to stay in this house until we can’t survive here. But that will take about 7-8 weeks
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I think that is a good idea. I bought some rails for the front steps of our house during my recovery. I just wish I had had them for getting up on that first journey back from hospital and the first few weeks getting out...... I am sure your PA is right that having so many stairs doesn't help. I too have a three storey house and I used a commode for the first few weeks.
 
For some of us, TKR recovery goes amiss. I have chronic pain (from neuropathy) and had a very painful initial TKR due to arthrofibrosis, so I identify! Out of control pain is so difficult to sort out and treat.

Medication wise, too much of any drug has its issues. But following the label and also good fluid intake will most likely avoid those kinds of complications.

For me NSAIDs has been an important part of my pain management and made all the difference when my TKR was redone. I have to be careful, once again, to drink plenty of water with NSAIDs to minimize impact on kidneys, but there might be an NSAID regimen that would work for you which you can find out from your PCP. Perhaps Voltaren, which is topical, and I follow my PCP's suggestion to keep the Voltaren in the bathroom so I remember to apply it three times a day. Voltaren used to be by prescription only but is not over the counter. There are also NSAID transdermal patches.

The other thing that I find essential in pain management is staying active, and there's a fine line for me between too little and too much. And yes when you're debilitated with pain it's very hard to remain active. Biking -- mostly on flat ground, so I walk up hills -- has been a great way. My strategy is a limited time of gentle exercise followed by rest and water, and repeat. I do that half a dozen times a day (not due to TKA pain but due to painful peripheral neuropathy).

Another thought about your story is all the bruising. Doesn't sound normal.

Psychologically, that amount of pain over an extended time must be very hard. My chronic pain has no definitive treatment so I have it for life, and although most days I manage, I have days when I feel beaten down and I have to let myself collapse, make sure to get a good night's sleep, baby myself, and hopefully re-set. It's some verson of giving up and giving in. But I always come back around and resume problem-solving, refining my routine. I use the computer to research my issues and maybe come up with things to try.

I'm really glad you've gotten on this forum and bared your heart because you'll find plenty of good information and caring people.
 
WhyMePlease said:
I don’t know what I did wrong,
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Please no worries, you did nothing wrong, occasionally a post will get hung up in the Mod Queue over one word.

I'm really sorry you're struggling as you are. I'm hoping that since this recovery lasts a full year for most, and even longer for others, that some of this will ease with more time. In regard to icing, maybe ice for shorter periods of time, or use a thicker barrier between bare skin and the ice source and see if it makes a difference. Please stay in touch and know that we're here for support always and we do care.
 
Progress Report (Probable Infection):

Closing in on the end of my 9th week post TKR surgery. I’m still in about the same quandary, where the pain is severe and quite consistent, especially at a couple times a day.

This past week, I wrote a note to the PA handling my case explaining my ongoing incessant pain, redness, and some lingering swelling. He prescribed some low dose Flexeril to help the pain at night and to help me sleep. Maybe that has helped a little.

So, a couple of days ago, I wrote my Doctor’s Office:
———-
“Dr., I am in the ninth week following total knee replacement surgery. My knee is still very painful a lot of the time, and often quite red with some swelling, even though I do ice it frequently during the day. Lately, I also have been sometimes having a very slight temperature just under 100, and have skin sensitivity all over my limbs. I have been wondering if there’s a possibility there is some kind of local infection and whether there are some tests you could do to rule that out.”
———-
Finally, I got a reaction - start an antibiotic and go get several blood tests.
[
For only those with an interest in such things, the out of ordinary results were:
Erythrocyte Sedimentation Rate (ESR): 54 (0 to 20 being normal)
C-Reactive Protein: 77.3 (normal being <7.4) - Not a mistake, 10 times higher than normal according to the provider’s website.
Also incidentally lower than normal readings for RBC, HGB, AND HCT
]
I have an appt. In 2 days to discuss the results, but since Dr. Google seems to say the results point to an infection of some kind, I am glad to have started the antibiotic course.
 
I am sorry as this news must feel a bit unnerving and I'm guessing the uncertainty is exhausting.
If an infection is confirmed, you will find many detailed accounts here from those that shared their journey through infection back to good health, so don't lose heart and know that we're here for support whenever you're in need. Please keep us posted. We do care. Wishing you comfort, peace and perfect healing :console2:
@WhyMePlease
 
The lower blood results consistent with anemia aren't that unusual post op; we have blood loss and trauma and often take time to recover.

May I ask if your doctor means your ortho surgeon or your primary care physician? Was there any question about trying to aspirate some fluid from the swollen tisssue?

At any rate, I'm glad your labs were done, clearly point towards a direction, and especially that you have an appointment Monday!!!! Please keep us posted!
 
mendogal said:
The lower blood results consistent with anemia aren't that unusual post op; we have blood loss and trauma and often take time to recover.

May I ask if your doctor means your ortho surgeon or your primary care physician? Was there any question about trying to aspirate some fluid from the swollen tisssue?

At any rate, I'm glad your labs were done, clearly point towards a direction, and especially that you have an appointment Monday!!!! Please keep us posted!
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The Doctor is the ortho Doc and/or his physician Assistant. I have been reluctant to bring my PCP into it, because he is frightfully busy, but I surely will at some time later. I’m not sure the ortho Doc is that focussed on post-op.

Of course, the ESR and C-Reactive protein readings really do suggest a further look at possible infection.

I did ask the doctor’s assistant about aspirating liquid for testing, and she basically said not yet, because it could add infection.

Thanks to all!
 
Good, glad it's your ortho because if there might be an infection he's often the lead on it, referring to infectious disease specialist as a consultant.
 
I am so sorry you have this worry. Thinking of you and good luck for your appointment in two days.
 
I saw the PA on Monday. He thought my knee looked better in person than it had in a photo a few days ago. Not as red and may be a little less swollen. He wasn’t too concerned about the high numbers, indicating inflammation, because he said they go a lot higher when things are really bad. He suggested I see him again on Friday after continuing with the antibiotic course that I am on. He wants me to taper off oxy to about one per eight hours pretty soon. But he won’t cut me off right now. I also mentioned tramadol and he said that was a possibility as an alternative to oxy.

So yesterday and today my knee feels overall just a little bit better, perhaps because of the antibiotic, but it still hurt like the dickens last night and first thing this morning. I’ll just have to wait and see how it is on Friday and see how he wants to proceed from there.

As always, thanks to all for your suggestions and concern.
 
Happy Wednesday!
Hopefully you continue to notice improvement over the next few days. Good to read that the swelling and redness is dissipating and the PA didn't seem too concerned. Best Wishes for good news on Friday.
Have a safe 4th and enjoy! :)
@WhyMePlease
 
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