TKR Terrified

[Ziggy100]

I'm having a left TKR on May 14. I'm terrified because I saw all the stuff and pain my spouse went through when he had both of his done. I'm trying to get ready by getting all the aids needed like bath chair, toilet bars, CPM, ice machine, etc. I notified my doc that I have a nickel allergy so he changed the kind of hardware he will use.
My main concern is pain. I can't take narcotics as I get major stomach upset and depression symptoms, and I can't take nsaids or ibuprofen due to bp and stomach issues. ( I can take all but not more than I say). My tolerance is so low that after I was taken off iv pain medication, I was able to take only Tylenol after major heart surgery. Anyone got any ideas for pain management that aren't hard on the stomach?

 

[Jockette]

Hi and Welcome!

I’m sure you’ve told your doctor about what you can and can’t take for pain, so he/she should be able to come up with a workable plan for you.

I do have a suggestion. One way to need less pain relievers, is to not do things that increase the pain that is bound to happen, due to the nature of the surgery. Be very careful with PT and a list of exercises. It seems that too often, we are given too much PT which causes us a lot of extra pain. (Been there, done that, and definitely learned from it!)

Here is an article from our Recovery Guidelines, about things to avoid when doing rehab:

BoneSmart philosophy for sensible post op therapy

You will have noticed there is a significant opinion here about the potential hazards of PT. You may feel that your therapists are experts and know what you should be doing. However, over the last several years I've been here, I have observed that the more intensive the regimen of exercising...

bonesmart.org

And, here is a member whose surgeon did not send her to PT, but told her to move around as able, which is what I call “natural PT” and she did very well.
https://bonesmart.org/forum/threads/second-knee-replacement-done.74524/

Remember, people are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

 

[lrj]

I found acupuncture to be helpful. It won't magically stop all pain, but it can have a big impact. Some doctors have different opinions on how long after surgery you can start, so make sure to talk to your surgeon. I was able to go right away, but not have treatment in the operative leg for 2 weeks. Someone else I know was told to wait 6 months for any acupuncture. Acupuncture has a cumulative affect. The more you go, the more it helps. Some people feel immediate improvement, I wouldn't feel it till the next day.
Before surgery, I was taking Diclofenac (NSAID), topical lidocaine, tried cortisone shots, ice, heat, elevate, rest. I was enough pain I couldn't sleep at night and was in pain all day. Acupuncture helped me be able to sleep and tolerate being awake. After surgery, it helped with pain, range of motion, and swelling. I had post-op nausea, or maybe related to the medicine. My first post-op session, I told them that. They stuck a couple pins in the top of my ear and after 30 minutes, I suddenly felt like I could eat again. So there could be a chance it could help you tolerate meds that upset your stomach. Talk with your doctor and the acupuncture therapist.

 

[Jockette]

We usually wait until after surgery to post the Recovery Guidelines, but maybe knowing this information now, will give you more confidence heading into surgery.

Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

Knee Recovery: The Guidelines

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary

2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

​

If you want to use something to help heal the incision, ​

BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.​

3. Do what you want to do BUT

​

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​

b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

​

​

4. PT or exercise can be useful BUT take note of these

​

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity Progression for TKRs​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[Pumpkin]

@Ziggy100
Members that cannot tolerate opioids have used an ON-Q pain pump that goes home with you. It can help get you past the early days.
Another option is EXPAREL, a pain reliever placed directly into your knee during surgery.

A good ice machine can also help with pain relief.

Work with your surgeon, he should be able to come up with something for you.

 

[Ziggy100]

Should I ask the surgeon about the ON-Q and Exparel before surgery or wait until after? I did purchase an ice machine. Thanks.

 

[Pumpkin]

You need to ask about the two alternatives ahead of surgery, so he can have one of them on hand to use.

 

[Ziggy100]

Thanks. I sent a message to my surgeon through their app. Hopefully they will answer. So far I have had good luck with them responding but I feel like I'm bugging them a little. At the time surgery was decided on, I was actually sort of in a daze.

 

[Pumpkin]

Usually the surgeon or his nurse will get back to you. Hopefully sooner rather than later.

 

[Ziggy100]

Well, the surgery is going to be at a hospital instead of a surgical center, so the PA says they can't use either option because this hospital doesn't use them. She has offered to have me consult with pain management people about what to do. I said yes, but I'm thinking they are going to continue to push opioids along with anti nausea meds and I really don't want that. I just haven't had good luck with opioids as I throw up even with anti nausea meds. I'm 72 and this is not my first rodeo with major surgery.

I did ask about sleeping pills for a week or so. Haven't heard back yet.

 

[benne68]

I'm thinking they are going to continue to push opioids along with anti nausea meds and I really don't want that. I just haven't had good luck with opioids as I throw up even with anti nausea meds. I'm 72 and this is not my first rodeo with major surgery.

Don't be shy. Advocate for yourself. You clearly know how your body reacts because you've had surgery before.

I told my surgical team that I was allergic to a certain medication, which had given me bad vertigo in the past. While not a true "allergy"; it was a bad reaction and I didn't want to take a chance. When I saw my paperwork, that's how it was listed and they didn't prescribe it.

 

[InkedMarie]

For me, the only pain med that I can tolerate is Dilaudid. I have no idea why I don’t vomit when I take it (with anti nausea meds & food) but it works for me. Might be worth trying, unless you already have.
Good luck!
Marie

 

[UKFrenchie]

Firstly, we will be in surgery at the same time. I am also May 14th but here in the UK so all good wishes to you over there for the day.

I found after my first TKR the left one. that i was guided by the guys on this webpage massively....i had a physio who was trying to push me too much and that increased the pain. Little and often and lots of ice and rest in between is the answer and as everyone says if it hurts too much don't do it. I have complete movement with my left knee replacement and literally wouldn't know it isn't my own knee.....i am hoping to have the same with this one but scared it isn't going to be....

rest, listen to your body and take your time....i ended up managing on naproxen and co codomol, after the first two days post op. just keep the meds up so that you don't have to play catch up with your pain....i set alarms on my phone so that i was taking my pain meds around the clock even through the night.

you will find the right solution for you and i know it sounds crass but it is bloody painful but also temporary and will get better unlike the pain we are all feeling before we have the operation.

 

[Shea]

I had the same problem with vomiting, despite anti nausea drugs, and was very slow to figure out that the opioids were causing the vomiting. I think they made me much more befuddled than I realized at the time.

I remember telling a friend that I thought the ice machine was just as helpful as the opioids. I agree with the naproxen recommendation, although I can’t take it very often. It seems to stop the pain in its tracks. Good luck to you and your future surgery!

 

[Ziggy100]

For me, the only pain med that I can tolerate is Dilaudid. I have no idea why I don’t vomit when I take it (with anti nausea meds & food) but it works for me. Might be worth trying, unless you already have.
Good luck!
Marie

Yes I forgot that I can take Dilaudid. For my last surgery (hip) they wouldn't send it home with me though and I don't know why.

 

[Ziggy100]

I had the same problem with vomiting, despite anti nausea drugs, and was very slow to figure out that the opioids were causing the vomiting. I think they made me much more befuddled than I realized at the time.

I remember telling a friend that I thought the ice machine was just as helpful as the opioids. I agree with the naproxen recommendation, although I can’t take it very often. It seems to stop the pain in its tracks. Good luck to you and your future surgery!

Yeah I can't take naproxen as it is an nsaids and messes with my stomach (hx of ulcers) in a very short time.

 

[Ziggy100]

Firstly, we will be in surgery at the same time. I am also May 14th but here in the UK so all good wishes to you over there for the day.

I found after my first TKR the left one. that i was guided by the guys on this webpage massively....i had a physio who was trying to push me too much and that increased the pain. Little and often and lots of ice and rest in between is the answer and as everyone says if it hurts too much don't do it. I have complete movement with my left knee replacement and literally wouldn't know it isn't my own knee.....i am hoping to have the same with this one but scared it isn't going to be....

rest, listen to your body and take your time....i ended up managing on naproxen and co codomol, after the first two days post op. just keep the meds up so that you don't have to play catch up with your pain....i set alarms on my phone so that i was taking my pain meds around the clock even through the night.

you will find the right solution for you and i know it sounds crass but it is bloody painful but also temporary and will get better unlike the pain we are all feeling before we have the operation.

I'm glad I have a surgery twin. We can compare notes! I wish I did have a solution but the surgeons PA sort of blew me off. It seems like if you can't take opioids they kind of don't believe you. She did prescribe Lyrica, which is like gabapentin, starting now, and then it will be doubled after surgery. I started it last night and I slept for 14 hours!! It might be the answer to my prayers!

 

[Ziggy100]

You need to ask about the two alternatives ahead of surgery, so he can have one of them on hand to use.

Unfortunately I learned they don't have either one available because I will be at a hospital instead of a surgery center. Who knows? The PA said they don't offer either at that hospital. She said he will put extra pain medicine in the knee before closing it back up and she prescribed Lyrica both before and after the surgery.

 

[Ziggy100]

I found acupuncture to be helpful. It won't magically stop all pain, but it can have a big impact. Some doctors have different opinions on how long after surgery you can start, so make sure to talk to your surgeon. I was able to go right away, but not have treatment in the operative leg for 2 weeks. Someone else I know was told to wait 6 months for any acupuncture. Acupuncture has a cumulative affect. The more you go, the more it helps. Some people feel immediate improvement, I wouldn't feel it till the next day.
Before surgery, I was taking Diclofenac (NSAID), topical lidocaine, tried cortisone shots, ice, heat, elevate, rest. I was enough pain I couldn't sleep at night and was in pain all day. Acupuncture helped me be able to sleep and tolerate being awake. After surgery, it helped with pain, range of motion, and swelling. I had post-op nausea, or maybe related to the medicine. My first post-op session, I told them that. They stuck a couple pins in the top of my ear and after 30 minutes, I suddenly felt like I could eat again. So there could be a chance it could help you tolerate meds that upset your stomach. Talk with your doctor and the acupuncture therapist.

I would love to do acupuncture but my policy won't cover it and I can't afford it without coverage. They are right down the street from me!!!

 

[lrj]

I found acupuncture to be helpful. It won't magically stop all pain, but it can have a big impact. Some doctors have different opinions on how long after surgery you can start, so make sure to talk to your surgeon. I was able to go right away, but not have treatment in the operative leg for 2 weeks. Someone else I know was told to wait 6 months for any acupuncture. Acupuncture has a cumulative affect. The more you go, the more it helps. Some people feel immediate improvement, I wouldn't feel it till the next day.
Before surgery, I was taking Diclofenac (NSAID), topical lidocaine, tried cortisone shots, ice, heat, elevate, rest. I was enough pain I couldn't sleep at night and was in pain all day. Acupuncture helped me be able to sleep and tolerate being awake. After surgery, it helped with pain, range of motion, and swelling. I had post-op nausea, or maybe related to the medicine. My first post-op session, I told them that. They stuck a couple pins in the top of my ear and after 30 minutes, I suddenly felt like I could eat again. So there could be a chance it could help you tolerate meds that upset your stomach. Talk with your doctor and the acupuncture therapist.

I would love to do acupuncture but my policy won't cover it and I can't afford it without coverage. They are right down the street from me!!!

Fortunately, I found a place that looks at it like a community service for people who otherwise wouldn't be able to afford it. They do have some private sessions (still a reduced cost) but the also do community acupuncture. They have a room with 7 chairs, so they can have multiple all at once, which saves them money that they can pass down. For these sessions, it's pick what you pay $25-50/1-hour session. I know another place I looked at was $100/session. I would have never been able to afford that. I hope you can find something like that where you live.