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Surgeon first appt this Week... pain management

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Steelmanpa

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I had my hip start crashing late April. Saw Ortho doc, xray and 3+ weeks of PT which I feel injured my knee. Stopped PT, had leg buckle due to referred pain.

I am getting an MRI tomorrow on the affected leg knee due to this pain which was ignored by the first doc who I basically fired after 2 visits for the knee pain. Had an ultrasound guided hip cortisone injection from an arthritis doctor friend who was started guiding my care. Totally ineffective. Started on Meloxicam which was basically useless.

At this point I am 3 months in and in much worse shape with knee and referred pain in the shin, my life has shrunk 70%. Seeing a highly rated surgeon for anterior replacement this Wed, initial consult- he did my doc friend's hip. Protocols indicate a 3 month wait post injection for surgery to reduce infection risk.

This doc is pretty popular and I am presuming it will be 8 weeks to operation following the protocol and his schedule. I am in a cycle of constant hip/rear lower back, knee pain and don't sleep much, except when I am exhausted to the point of pain, not front and center in my brain, toss and turn, difficulty sitting.

So I guess I am going to need serious meds to sleep to get through the next 2 months, with care to use the least possible.

Love to hear from other folks about suggestions. And should this be on the surgeon or me going to my primary? We are all different, the human body is dynamic as well.

Thanks in advance
 

Jaycey

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@Steelmanpa Welcome to BoneSmart! Sorry to say no one has been able to come up with a medication that addresses pre-op pain. It's basically a matter of trying to stay off that bad hip. A crutch or cane can ease things for some. Icing or if that doesn't work try heat.

In the first days of my left hip pain I took Diclofenac (unfortunately my pain was incorrectly diagnosed as back issues). But I would not recommend any NSAIDs as they do have some nasty side effects.

Visit your primary doc and have a discussion. I hope you get a surgery date as soon as possible.
 

leejaa

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There is no magic pill for pre op pain or lack of sleep. At the moment I am waiting for Nov surgery and am taking Celebrex which I was already on for my thumbs and Tylenol Arthritis 1300mg 3x/day. It does not make it go away but helps a tich. I have to wait till Nov for surgery because my OS has a protocol of 6m wait post hip injection. I knew the hip injection would not cure me but per OS PA I needed some proof of conservative treatment so that the insurance company would not disapprove the surgery. My x-rays are not ugly but they were not ugly with the last hip either but the pain and lack of movement was. My OS did my other 3 joints so I trust him and the office and the outcome I am hoping for again - return to life and mobility without constant pain and limitations. My OS is very good and busy so I would have had to wait 4+m anyways and I find it worth waiting for him.

I hope you find your surgeon to be a good fit for you and can have your surgery as soon as protocols allow. There is nothing like getting back to normal. By the way with my first hip it took a year and much painful PT and spine injections before my PC said it was my hip and ordered a MRI. This time the minute the symptoms appeared I followed up immediately with my PC and the OS office - in the same week just to get moving with whatever would be necessary.
 

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As has been said before there is nothing that touches that horrible pain...paracetamol is as useful (and less side effects) as anything else.
The best thing you can do is use ice fir the inflammation & rest when the pain is too bad.

Hoping you get a date as soon as is possible after the 3 months ...
stay on Bonesmart and you will find some very useful advice & a lot of support from those who have already ‘ been there... done that...’

Take care xx


Sent from my iPhone using Tapatalk
 
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Steelmanpa

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I have had a spinal lumbar MRI which showed some issues L4-L5 and an EMG of affected leg as well which didnt show anything. X rays of hip and knees- the hip at issue moderate to severe narrowing ( Didnt need an x ray for that LOL) , and tomorrow paying 100% out of pocket to get the knee MRI since that pain is worse than the hip, but no one wants to own it...Sold a couple guitars to pay for it.....Protocol seems to require stable knee joint.. if the knee is not right, this whole thing will get extended and I shudder to think about how many more months dealing with that first while the hip degrades more...But we shall see as the week progresses and will report with updates. And thanks to all for sharing information...
 

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So sorry to hear that you’ve joined the chronic pain and chronic insomnia club here, in the online waiting room for joint replacement surgery. PT, injections, and medications appease insurance companies, but if they relieved hip pain, I imagine there would be a lot fewer hip replacements.

I recommend you consult your primary for pain management and insomnia. Mine told me to start taking Tylenol around the clock, and limit Aleve to 2-3 times a week to manage pain flare ups. I get better sleep on the 8-hour extended release formulation, personally - your mileage may vary. He hasn’t wanted to prescribe narcotics heading into surgery, to keep me from developing tolerance and preserve that pain management tool for the post-op window. Other doctors have different approaches.

Other pain management strategies that have worked for me to minimize pain: an anti inflammatory diet, icing, elevating, TENS, and a PT modality called Muscle Activation Technique, which allowed me to work on those areas of referred pain, staying off my hip, adapting sitting and sleeping positions with pillows and stools.

Other insomnia strategies that have worked for me: moving my bed to the guest room so I have a quiet place to sleep and nap, reviewing and implementing good sleep hygiene habits, icing before bed, breathing/mindfulness, cutting out caffeine.

I, too, have knee pain on my operative side. It’s been sorted in PT, but nothing is going to permanently resolve until the hip is fixed. The adductors flake out, which apparently stresses the sartorial. My PT calls this compensation. I have also heard it called referred pain. I wouldn’t worry too much about whether your knee will delay your hip surgery, but I do understand why you want to rule it out.

I recommend you explore this website at length. The hardest thing for me to grasp was that the hip chapter of my life was going to take months/ years, not weeks/months and that coping would demand adaptation, not just endurance. Once I realized this idea was consistent here - even while it remains an unspoken secret in the surgeon’s office - I started to make the changes that have made my life far more enjoyable than it was even two months ago. I still have pain and insomnia, but I adapted. You will too.
 
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Eman85

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I guess because I've had my hip pain for over 50 years now I'm used to it. I never took anything more than aspirin,Ibuprofen,Aleve or Tylenol and in moderation. I have figured out recently that pillow between my legs helps.
 

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Hi Steelmanpa,
So sorry both your knee and hip have pain. Your primary doctor may know a good pain management doctor.
For sleep, tizanadine muscle relaxer, which only works for 6 hours, can be helpful to me, some nights. I also wear a sleep mask to block out all light. I use a dense pillow between my legs to be able to lay on any side. Sometimes an over the counter Salonpas Camphor, Menthol, salicylate patch, which can be cut into strips or smaller rectangle and medical taped to what hurts, helps me. This is usually good for 8 hours. Sometimes I spray lavender spray on my sheets and try a little aromatherapy. Whatever works, that night.
It also helps me to rest during the day, with some ice, so things do not get super inflamed.
There are 5% Lidoderm patches, by prescription, but a pain doctor would have to write an appeal to Medicare to get them to cover the cost, if your are in Medicare. Salonpas also makes an over the counter 4% lidoderm patch, which you might try first to see if it takes the edge off the pain, if your primary thinks it’s a good idea. More expensive route, but you will know if it does anything for you. I pay $5 for 60 through Medicare for the 5% lidoderm patches. I am limited to not more than two lidoderm patches in one day, according to my doctor. These, too can be cut into strips or smaller rectangles.they only last 12 hours.
Can you tell I have been in pain a long time?
Also, I try to distract my mind, “night blinders” mask on, and listen to a movie, or a calm voiced, public news broadcast on PBS, on my I Pad so it shuts down in a matter of time, during the evening.
I am a little younger than you, and my doctor still allows me to occasionally take 15 mg of meloxicam. The older you get the less doctors want you on this.
When not on Meloxicam, I can also use a pain gel, that is a topical NSAID, Diclofenac Sodium Topical Gel 1%, which was originally for my bone marrow edema in my wrist. I find I can use the measured amount on some painful areas. It only works for 4 hours at a time. These are both topical NSAIDs, so they are not as bad as oral NSAIDs, according to my doctor, however, you may not take any other NSAIDs when you use them.
You may need a pain doctor to assess you, and you may want to read about these things because they all have risks.
Those are all the options I use, and none of them takes all the pain away.
Oh, and last but not least, I find, an epsom salt bath for 20 minutes at night can help my painful muscles feel a little better.
Good luck!
 

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I'm almost done waiting
Tylenol
1000 mg 2x day and 1 Aleve at the same time works for me
But I have only been doing that for two weeks
I have known since 2014 I needed a THR but the knee came first
Sleep is ok mostly
Surprised that I was able to climb on and off a lobster boat today and climb some 150 stairs alternating legs
Today is a good day. We are staying on the top floor of an inn. of course. No elevator and liw toilets I guess its good practice for my confidence that I cam still do this

As you can see what one might need is not what another might need
 
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Steelmanpa

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Thanks to all for contributing Such varied responses... like I said before the human body is dynamic and things are not the same for all, or even for the same person at different times..Right now the knee pain is constant and driving everything else position wise.Even a pillow between the legs wont help since it triggers the knee as does sometimes laying on my back which generates pressure on the back of the calves. I tried the Icy Hot Lidocaine patches and ordered a couple boxes which just arrived...MRI on the knee was this morning and they wont give me the read till the doc has had it 24 hours..So we are still in a learning/gathering information mode . I am hoping this is just some horrid referred pain and the doc will give me an October slot..Going to study all your experiences THANK YOU!
 

Mojo333

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:wave: and welcome to Bonesmart.

I am in a cycle of constant hip/rear lower back, knee pain and don't sleep much, except when I am exhausted to the point of pain, not front and center in my brain, toss and turn, difficulty sitting.
Been there, done that...:sigh:
Lots of sympathy here.
Chronic pain and sleep deprivation was driving me to a desperate depressed state and I think I tried Every Possible Remedy to just take the edge off. To no avail.
I'm a very active positive person so this was definitely not a nice place to be.
Thankfully:shrug: I finally got a diagnosis of end stage OA in both hips and my surgery was set up fairly quickly after 2 years of increased suffering.
A heating pad seemed to soothe things some and I stayed on one until my surgery date.
I do hope you get all sorted so you can get your life back.
 

InkedMarie

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So sorry you’re dealing with this. I just want to point out to make sure you have a complete list of all meds you’re taking or going to take because there will be many that you will have to stop using for a period prior to surgery.

Keep us Posted!
 
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Thanks to all...I can say the surgical consult went very well and now I have a close by date and can focus on that.
Scheduled for right anterior THR on Thursday Oct 3rd with the surgeon I wanted. Was looking forward to sleeping last night after a very restless night with early rise around 430 AM and 8 AM surgery consult...then we lost power last night after heavy summer storms..and after finally sleeping for about 90 minutes the power came back, all the lights went on and the TV was blaring...that ended my good sleep for the night. The organization doing my surgery is a very prominent regional ortho network and they have everything down, from the minute we went into the patient exam room to driving away with the packet was less than 90 minutes-they handle the preop exam/testing, first post op is scheduled and I am amazed at the minimal suggestions and restrictions for this surgery. This same group did my achilles reconstruct (FHL tendon transfer) back in 2012 and that went fantastic. So I am still bleary eyed a bit, hoping for better sleep and appreciate everyones advice... One question, for this surgery do you use knee high or thigh high compression socks..and just moderate compression-in your experience. I will check with the nurse, but again everyones experience is valued.. I still have my compression socks from the achilles work...
 

Eman85

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I didn't have compression socks. Took 1 aspirin a day and did a lot of ankle pumps to keep the blood moving.
 

Layla

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Hi, Welcome to BoneSmart. Thanks for joining us.
Good to see you have a surgery date and are going through the pre-op motions. Hopefully as you move through the process any anxiety you have will lessen as questions and concerns are addressed. You don't have long to wait now and you'll soon be moving forward without pain. I look forward to following your journey.
I hope you have a nice weekend!
@Steelmanpa
 

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@Steelmanpa welcome! I had compression knee-hughs both times, I suspect provided by the hospital. I found them quite painful, as they cut off the circulation behind my knee and gave me serious leg cramps. I secretly took them off at night. For the second hip, the pair I was given were Even Tighter, and came not even above the swell of the calf. VERY painful. Op leg upper half swole up hugely. I finally said some serious cuss words and took them off at about the 4th night home. Instant 200% (not exaggerating) reduction in pain. Leg went back to normal size, I felt safer, and the next morning I put on the old ones for show. I am pretty sure I took them right off again, although they were much much looser. I was ankle pumping like crazy and walking the equivalent of a few blocks a day and didn't get a clot. I shouldn't be admitting all this in front of people who faithfully wore theirs for Six Weeks (!)!! My OS PA released me from them at the two-week followup both times when I pleaded, but I suspect I beat him to the punch and he would have anyway.

My 91-yr-old mother otoh was not given any!
 

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Ask your surgeon. Mine told me up front that no compression stocking would be issued. I had them post TKR and managed to lose them by day 3. They went to live with the errant dryer socks..
 
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Steelmanpa

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Thanks again to all for your thoughts and information.. I have been trying some of the Icy Hot lidocaine strips with varying success, but some of the pain is referred in the knee and doesnt care what I do ( so they tell me ...) and calf. My OA doc did prescribe a low level controlled RX pain killer but it was not effective so its basically hot baths, meloxicam in the AM, some of the strips now and then and just grit it out....Its a mixed bag of sleep/sleep deprivation/amounts of sleep from night to night. Usually about 2 hours then I am up for a little while then if I am lucky another 2 hours and then the pinwheel starts trying to find a comfortable spot but not deep sleep. Sometimes I use a bodymate waist/hip-thigh brace when I have to go somewhere. Have had that since about the start of this in late April.. its effective for a few hours...Picked up a couple of 2 wheeled walkers at the thrift store for each floor of the house- sometimes I really need them. We had my mother/father inlaws cane and I use that sometimes. At 46 days and counting now..its time to read other peoples stories and hopefully see a lot of success there to encourage me...The one good thing that comes out of me not sleeping is going out on the deck with our cat just before 6 AM and having a cup of coffee, listening to the cicada's and birds and watching it get light. As all cat people know, we are merely 24/7 staff LOL
 

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So sorry you have such a long and painful wait. You are doing the right thing using walking aids. Anything you can do to baby that hip will help. Hang in there, you day will come!
As all cat people know, we are merely 24/7 staff
Oh man - this is SO true! :rotfl:
 
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