Some help/support about shoulder surgery recovery...

Oh dear! she is that, isn't she?

Generic and trade meds might look the same and even bear the same markings but the company will very likely make a different batch for the generic one. I am unaware of the specific differences in Tramadol but did have an experience with a drug many years ago. The trade name was DF118 and the generic dihydrocodeine. My sister had a back injury when she was a youngster and was prescribed DF118 for many years which managed her pain very nicely. Then our government decided that in future only generic meds should be prescribed as they were much cheaper. So my sister got dihydrocodeine but found it had no impact on her pain whatsoever. Her GP was very uncooperative about this, insisting there was no difference. So I contact the manufacturer (DuncanFlockhart - now ceased trading) and spoke with the senior pharmacist who confirmed that though there was dihydrocodeine in DF118, it also contained other ingredients which he wouldn't disclose for security reasons. But he did write sis a confirmatory letter which she took to her GP who then grudgingly agreed to prescribe her 30 tablets per month. Occasionally the pharmacist would issue her the generic form but sis would know instantly that it wasn't DF118 as they would have no effect on her pain whatsoever.

A bizarre turn of events was when the GP suddenlydecided she was addicted to DF118 and wrote on the front sis's notes in large red letters. Yet at the same time, she continued to insist that the generic was 'exactly the same' as DF118 and if sis would only accept the generic she could have as many tablets as she wanted! :shrug: Totally ridiculous!
 
Josephine,

I was struck by the similarity of your sister's story, and, in particular, by "no impact on her pain whatsoever". That's almost literally what my wife said about that one set of Tramadol pills.

I wish that I could do what you could do (call Northstar), but I think that, at this point, it's probably futile, because she's getting reactions to both sets of Tramadols (nausea/vomiting), so she's off of both.

She took the one muscle relaxer (flereril generic cyclobenzaprine) and is sleeping now, which is probably a good thing, given how much pain she was in after PT today, and we'll see how that goes. I spoke with my/her OS' assistant, and she's sent out a prescription for more (she only had a few left from after surgery), so if that works ok for her, and helps, I'm hoping she can continue to take that without any bad side-effects.

Thanks,
Jim

P.S. Your sister's lucky to have you!!
 
Jim, bless your heart!!! You have your hands full, don't you!

My heart goes out to you and your wife. I had a friend who had shoulder surgery and it was very difficult for her in recovery. So I have a feel for what your wife must be going through.

If you think her nausea was due to the flu, you might try to coax her into trying the pain medication again. Is there some reason she can't take Tylenol? It is much better for pain than ibuprofen and easier on the stomach.

You might try a test on the generic versus original medication to see if the generic is the problem. Although I haven't heard specifically of a problem with a generic from the same manufacturer as the original medication, it could happen. The companies are allowed to make some minor changes to the formula when they make the generic and it's possible that is the case here.
 
Oops....I just read in one of your posts that both the generic and the original are giving her problems. In that case, you might talk to her doctor about trying another medication such as the Percoset. Or....possibly the Tylenol in 1000mg doses (no more than 4000mg in 24 hours). When she took the cocktail before, it may have been the ibuprofen that caused her problems, not the Tylenol.
 
She said she felt a little better after that, but the cleaner had just left, so guess what? She started vacuuming the areas that she said the cleaner had "missed".
Jim

Haha...that sounds just like me! Cleaning trumps all kinds of pain!! It makes me feel so much better when everything is clean, neat, and tidy. I bet that your wife feels better when everything is in its place too! Jim, it's a woman thing. :)

Glad the Flexeral worked and that she doesn't have reactions too it. My PT lasted one and a half hours today, new exercises, and lots of stretching. I hope I can sleep tonight, I go back for another round tomorrow.

Take care,
Jeri
 
Jeri,

I'll suggest that she use only the Tylenol, and see how that goes.

We talked about the possibility that she might have the flu, but she had a flu shot this year (well, last year), plus she said that the pain doesn't feel like it.

We'll have to see how the flexeral, together with the Tylenol, works, for now.

Thanks,
Jim
 
Hi,

Second day using the Flexeral plus Tylenol, and so far, the main side-effect she has has been very dry mouth.

The other unfortunate thing is that it kind of looks like it's not helping much thus far with the pain. I'm trying to keep her taking it, since the only side-effect has been the dry mouth so far, in hopes that this is one of those meds that you have to take continuously before seeing the (good) effects.

She said that it is helping "a little", but that's not very precise, but I'm glad to get "a little", vs. "it's got horrible side-effects" any day at this point :(...

Jim
 
Jim, haven't heard from you lately, how is your wife doing? I hope her pain is getting better and that she is progressing in PT.
 
Hi,

She still seems to be tolerating the muscle relaxant, and together with Tylenol and Ibuprofen, was doing ok until today. She had PT yesterday (Thurs) and the PT had her do some new exercises (isometrics) and today she was in more pain, and even the muscle relaxant, etc. wasn't helping that much. I've been telling her to refuse to do things that hurt at the PT, but she didn't in this case... Hopefullly she'll start feeling better tomorrow.

Thanks for asking!

Jim
 
Hi Jim, my sympathies to your wife. From what I have heard here - this is not the fun part of shoulder surgery. Sending you both good ((((((((((((vibes)))))))))))))!
 
I've been telling her to refuse to do things that hurt at the PT, but she didn't in this case
Unfortunately, she is right as the 'gentle way' does not work with shoulder surgery. In knee surgery, there is a danger in doing painfully aggressive PT because of the nature of the limb in connection with swelling and they way that kind of PT impacts on the leg and obstructs the very thing one is striving to achieve which is improvement in flexion. It's different with a shoulder. For a start there is a lot of space around the shoulder which will absorb any swelling so that is not the cause of the pain.

When a shoulder is immobilised for an extended period of time, the muscles go into a kind of lock down. It's not adhesions, just a state often referred to as a 'frozen shoulder' where the muscles are just not working well - or even at all! The aim of PT here is to get those muscles to wake up and get going. There's no way round this - in shoulders, effective PT hurts like crazy so if she wants to get back her functionality, this is one case where the saying "no pain, no gain" really does apply.
 
Hi Jim, I hope your wife is comfortable tonight. I can certainly relate to your wife. Boy did my therapist stretch my shoulder on Thursday and I paid for it all day on Friday. It's not too painful when I get stretched it just feels really tight, but the day after therapy is painful. I also just started adding weights and bands so my muscles are getting a work out and are sore the next day. It all seems to be working as my arm is getting stronger.
 
Josephine and Jeri,

Thanks for that info. I guess that I was going on the advice from the THR, but the shoulder is different. FYI, she had a frozen shoulder, a couple of years ago, on the left shoulder, so both she and I are very much aware and not wanting to "go there". She had another PT session today, and talked to the PT, and the PT told her about the same thing. She also said that my wife is about 3 weeks behind "the average", because of her not being able to tolerate most of the meds.

That (the 3 weeks behind) was, I think pretty sobering news for her (and me).


Jeri,

The PT said that she's going into her 8th week, and so she's going to have to move forward, and that's why they added the new isometrics. From what I can tell, the PT is kind of pushing for her to get to the strengthening stage, and is also worried about progressing too slowly and getting a frozen shoulder that Josephine mentioned. I think that, while she's definitely not happy, that's kind of strengthened her resolve. She told me tonight that she thinks that she's just going to have to try to deal with the pain.

She has another appt coming up with the OS, and I'm kind of bugging her about possibly asking about trying some other med. Not sure what though, but she's not really excited about trying something else.

I've been thinking that maybe we should get a TENS unit. The PT place ices and puts her on a muscle stimulator for about 15 minutes after each session, and she said that does help, but it's not long-lasting. Have either of you tried one of the consumer type TENS units? Any recommendations? And, if we got one, how often (and how long) can she use it?

I'm just thinking that if the meds aren't going to work out, maybe having a TENS unit might. Right now, about the only relief she gets is when I massage her, but I can't do that 24x7 :)...

Jim
 
Hi,

During my wife's PT appointment today, I had asked her to ask her PT about a TENS unit (actuallly a combo TENS/IF unit), and her PT told her that might not be a bad idea, and gave her contact info for a medical equipment company that she was aware of that sells them. I contacted that person, and she said she'll start the process to give us info on how much our out-of-pocket cost would be.

At the same time, I've been searching for pricing on combo TENS/IF units, and found one for about $100.

When I spoke to the rep that we were referred to by the PT, I asked her what the difference was between the one that she'd be selling to us (a "Flex IT") vs. something like the one I found (a "combo select"). She didn't really give me a good answer to that question, but I'm thinking that if the costs work out about the same for either one, we'd go with the person the PT referred us to.

The main reason that I'm thinking that way is that if we did that, they would send a person to our home and show us how to use it, including placement of the pads, and they'd supposedly be available for support calls. Even if the cost is slightly higher than buying one off of the internet, the "peace of mind" factor would be important.

Both units are at least combined TENS and IF units. The select combo one also does muscle stimulation and something called "micro amp".

Has anyone gotten something like either of those? If they work, it'd be a real benefit to my wife, since she's had so many problems with meds. The PT also said that potentially, I could use it for some of the ongoing problems I've been having with my post-RTHR pain and left buttock pain.

Any thoughts/comments would be appreciated!

Thanks,
Jim
 
I'm a great fan of TENS units, now being on my fourth machine in 30 years! They are simplicity itself to use and I've never had a moment's problem with any of them. But I get them, a lot cheaper than $100. The present one I have was around $35 from Ebay with free shipping!

aflagsforworship.co.uk_jo_pic_images_tensmachin.jpg


I tend to use a 'diamond slot formation' with the pads (as below), thereby getting a double whammy of pain relief in the centre. So far I have used it on lower back, upper back, shoulders and knees (that after an arthroscopic menisectomy when it enabled me to get back to work at two weeks instead of six!)
tens pads.jpg


There are points to be careful of, such as getting the modality correct for the user (there are usually many) and the strength and then not being tempted to turn up the 'volume' when the signal becomes less noticeable. The risk here is that when the signal seems to fade, people are tempted to turn up the strength but it actually means it's working at its peak efficiency and does not need to be increased. Doing so can risk causing burns under the electrodes. In short, you get a really good instruction leaflet with the machine and you just need to read it!
 
Hi Josephine,

THANKS for all of that info! I'll post back when we get one, either from the 'net or otherwise.

I have a couple of followup questions:

- When you said "modality", did you mean like the pulse shape/speed? Or something else?
- Do you (or anyone else) have experience with IF vs. TENS? From googling, my impression is that one of the main differences is that with TENS, the pain returns as soon as the TENS is off, whereas with the IF, the pain relief lasts for some period of time after the IF is off. Also, one of the goals of using IF is to increase the amount of time that the pain relief lasts.

The latter is kind of why I'm leaning towards getting a combined TENS/IF unit that the PT referred, as I think that if we get that, we can leverage her experience together with the PT sessions.

Also, off-topic to this post, but we just got some Biofreeze cream in (we had Perform cream, the retail cream from the same company), from Amazon, and my wife tried it last night before going to bed and this morning. I've been asking her how it compares to the Perform. She said that it seems to work better than the Perform, and she thinks, but isn't sure, that the relief might last longer. She said that neither the Perform nor the Biofreeze completely eliminate the pain though :(...

Jim
 
When you said "modality", did you mean like the pulse shape/speed? Or something else?
That's right - modes vary from feeling like a trickling sensation, tapping, pulsing, surging and waves. And there is often one that combines all of the, which is the one I use. This is because after a period of time (around 30 mins or so) the nerves can get accustomed to one mode so it's best to have it ranging from one mode to another and stop them going to sleep on you!
Do you (or anyone else) have experience with IF vs. TENS? From googling, my impression is that one of the main differences is that with TENS, the pain returns as soon as the TENS is off, whereas with the IF, the pain relief lasts for some period of time after the IF is off.
Never had any experience with IF but I would totally refute the notion that the pain returns as soon as the TENS is switched off. I've never found that but in any case, I've used my TENS pretty much constantly throughout a day on occasions. Mine has a 30 minute timer on it (just to prevent it running on if one should fall asleep!) and soon as it switches off, I switch it on again! But even so, I've found that even if I only use it for an hour or so, the pain doesn't inevitably return very soon.
Also, off-topic to this post, but we just got some Biofreeze cream ... and my wife tried it last night before going to bed and this morning. I've been asking her how it compares to the Perform. She said that it seems to work better
Oh I am a great fan of Biofreeze as well! My chiro put me on to it. It's amazing stuff and no drugs! But I tend to use the roll on as it only applies small amounts which is quite sufficient and you don't end up with messy hands afterwards! I think between that and the TENS she will have a great pain management!
 
Hi Josephine,

I REALLY hope that you're right about the TENS, and that it helps her with her pain. It would be kind of fitting/ironic that with all of the problems that she's had with pain meds, that the TENS and/or IF would do a great job for her... but we shall see, soon, I hope.

Re. the gel: YES, believe me, I understand about the "messy hands". I'll tell you, that stuff is powerful, if nothing else because of the "fumes". Sometimes, when I'm applying it on her, my eyes start watering (no, I didn't touch my eyes), just from the fumes.

Also, I wash my hands liberally afterwards, with warm water and soap, but even then, that doesn't get rid of all of it. I occasionally make the mistake of bringing my hand up to my face after that, and even then, I can feel the menthol or whatever it is... Gotta be careful with that stuff!!

Jim
 
Hi,

Report on TENS unit:

The two machines, a Hybrid 5000 and a Combo Select arrived today, and, tonight, my wife tried the former. It's much, much simpler than the Combo, so we figured we'd start easy.

The 5000 comes with a 9v battery, lead wires, and 4 pads, so I connected the leads to the pads, and then applied the pads: 1 pair across her right elbow (one on upper arm, and one on lower arm), and the 2nd pair across the right front of her shoulder, kind of from the clavicle to just before her underarm.

I have no idea what "modality" to use, so we left it on "B", which I guess is "Burst", and I didn't tweak the two knobs at all (for pulse rate and width?).

There's a pair of up/down buttons for each channel, so you can control the intensity for each channel separately.

Powered the machine on, and adjusted each channel for her, and she used it for 2-30 minute periods (it has a timer also).

After she got done, I asked how it felt. She said that she almost felt no pain in those two areas (right elbow and right/front shoulder) while she was using it!

The thing is that we had an appointment with the OS this morning, and when he examined her, he kind of moved her arm in all directions, checking her ROM. My wife said it felt ok while he was doing that, but she hurt a lot afterwards. She thinks he did that on purpose, because he's worried about her shoulder freezing up. But, it looks like that little (and it IS little) machine seemed to help with that.

We'll have to try some of the other modes, and also haven't even tried the other machine and IF yet, but at least initially, this seems like it was a good investment, and it was really good to see my wife with less pain!!

At this point, we probably won't get the other machine that the PT had referred (there are reasons), and go withe the ones that we just bought.

Hopefully, it'll continue to provide relief for her (and me, in a way :)!!).

Later,
Jim
 
Great news that the TENS is working! Thanks for the report. Hope you and your wife are having a good day today.

We are having a major snow storm here is New Jersey. They are predicting around 14 inches of snow and 40 mph winds. No shoveling for me for the first time in years, I'll have to leave that to my hubby and son.
 

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