TKR The Journey on the Other Side Begins

[Lusknewknees]

@madinana I spoke to the nurses at the hospital and each one of them confirmed that the weight gain is probably due to fluid retention from the IV fluids that they pump into your system to recuperate fluids lost during surgery and to prevent dehydration. I imagine it is physiologically impossible to gain that much weight in a short period of time. Especially when neither of us has been over eating. I know I haven't! My body is probably using more calories to heal the tissues around the new knee. So I will be patient and expect that those extra pounds of fluid will fall off very quickly. I just need to be patient about everything related to this total knee replacement. And when I say everything, I mean everything!

 

[Clipless]

Sorry guys, I meant that my prescription was faxed or computer submitted in, not telephoned.

 

[madinana]

@Lusknewknees that sure did make me feel better I put a note on my desk to call my OS So I will be patient Ha I will try seems like I have a short fuse and so dang emotional and I been threw this is July but sure is different from the first time.

 

[ConnieJOS]

@Clipless @Lusknewknees @madinana @lunula

I read up on the electronic submission of schedule 2 narcotics. Even a fax doesn't qualify. But many doctors now have computer programs where they write the prescription, sign it electronically, then submit it to the drugstore. This way is legal and wouldn't require a trip to the doctor. My surgeon wrote my prescription for 100 7.5/325 hydrocodones upon discharge from the hospital I can take two every four hours, but I won't take that much for long, so that will at least last until my follow up visit on Nov 6.

 

[Minnie's knees]

@Lusknewknees glad you are doing okay and hope you get your meds sorted out.I came home last night with 10 days of tramadol and 15 days of Tylenol 3. So far it's working okay. Take care of yourself.

 

[madinana]

@Lusknewknees I came home with tramadol and hydrocodone and use wisely as my OS is not crazy about giving you any more. When I get staples out next week I am hoping PA gives me tramadol, that help much better for me

 

[Lusknewknees]

Here's the rub. If they want you to dose judiciously they should write the script for dosing accordingly. I am taking meds strictly as prescribed: 2 every 4 hours. As such, they should dispense the numbers that provide legal usage for the period of time between visits. My OS office is 25 miles from home. 45 minutes in good traffic. We live in San Diego county, for context. I don't want to eat these like candy and for no purpose other than to keep pain under control. Yesterday I started on a daily dose of meloxicam (mobic) which should help with swelling, and therefore, pain.

 

[Lusknewknees]

What's the best way to taper off narcotic meds without ending up in excruciating pain? How does one introduce tylenol into the equation? Isn't tramadol a schedule II narcotic like percocet or Norco? My trial tonight is to scale back from 2 every 4 hours to 3 every 3 hours, happening my last dose of the day. 5/325 and supplement with 1/2 tylenol extra strength at 325 mg. total 3900 mg acetaminophen and not above limit. Also worked a little harder today. Heel slides with PT, walked up and down stairs, and repeated heel slide sets twice along with ankle pumps and quad sets. Took a couple short walks around interior of downstairs and down to the corner of my house and back ~.10 mile total for that outside walk. More throbbing but not a big spike in pain. Icing and elevating or CPM (drs orders) when not standing.
@Jamie, @jeano, @Josephine - any other tips?

 

[Lusknewknees]

So, I have cut back my dosage of Norco 3/325 from two tablets every four hours to one tablet every three hours which is eight tablets instead of 12 per day. Every other dosage of Norco now includes one half of a Tylenol 650 extra strength or 325 mg. I am staying under the maximum amount of recommended acetaminophen while reducing my total narcotic consumption for the day. I tried this for the first time last night and slept very well through the night, waking only four times dosage alarms. I set those on my phone. I have also set alarms for exercise, icing, and CPM machine. I am being very regimented which gives me something to work toward every day. That in and of itself has taken away some of the boredom. I am a bit of a nerd I admit. My husband just loaded five movies into the DVD player and I'm going to treat myself to a film festival, and I'm sure I will not off at some point during all of them. My pain levels have been extremely well controlled, and I'm hoping that this will continue. The pain I am most afraid of is the burning needlelike pain at the surgical site. The deep muscular pain is not as bothersome and seems to have improved significantly since the day of surgery. I am so happy about this because I had such doomsday expectations regarding nerve damage and the pain itself that I am pleasantly surprised that things have gone as well as they have, and that I am improving with small baby steps every day. I think that perspective makes me feel like my surgery is and will be a success. I don't expect to be doing big things in a short time, I am expecting to be doing little things each day and each of those little things build on one another. That is helping me psychologically in a big way.

 

[kneeper]

Generally people go from 4 hours to 5 and then to 6 etc. I'd think you'd get better pain control with 2 every 5 hours. Though it's only been a week for you so I don't know that you need to worry about reducing doses yet. But I'm glad it seems to be working for you.

 

[Lusknewknees]

Last night was a bit rougher pain wise. The back of my calf is stiff and painful, and tender to pressure. I had same symptoms and Hospitalist ordered an ultrasound in hospital just prior to discharge and they ruled out dvt, suspected bakers cyst, but did not confirm and discharged me straightaway soon after ultrasound. I've been on lovenox injections for dvt since post op day 1. I think I may be feeling a bit anxious thinking that dvt may have arrived up now while not evident in first ultrasound last Thursday. I will be seeing my primary care dr today to discuss my blood pressure, which dropped significantly post op resulting in discontinuation of maintenenace BP meds. My BP reading this morning was a bit elevated, but much better than in the hospital and without meds. Maybe my primary care dr will order another ultrasound just to be safe. The center is right in her building so they can take care of right away. Other than this, I have taken a couple gentle walks indoors, a couple longer ones outdoors, ankle slides, ankle pumps and quad sets regularly and then ice and elevate rest of the time. Nothing strenuous. So that's why calf pain worries me. Is it possible to have a latent onset of dvt even with preventive measures? @Jamie, @Josephine? Meds; 1 Norco 5/325 every 3 hours. 1 tylenol 325 every 6 hours, meloxicam 15 mg 1x per day. Pain at 2-3 everywhere else or non existent, pain at 5-6 in clad closer to med time, but eases to 3-4 after dosing.

 

[lunula]

Hi there! Hope they can rule out a blood clot and you get your pain under control soon. I know you're probably a bit miserable (and a bit scared) - but being that you're not even a week out from surgery, I think you're handling everything fabulously! I hope I'm tough enough to start gentle walks within a week - it's just sounds so scary that your bones are cut and a new joint is put in...and you're able to put weight on it right away.

Take care.

 

[Lusknewknees]

Oh happy day! I'm over the moon. Post op day 8 : Released from walker and graduated to cane. Walked my cul de sac with cane. Released from home PT. Will start outpatient PT after staples come out next Wednesday. Doing marching, leg over leg stairs. She said I could move to my own bed and lose the medical-Esque surroundings. Pain is controlled and I've tapered back from 12 to 6 Norco per day (stronger ones at night) with no incident. Icing and elevating most of the day. Nagging calf pain has been managed with icing in that spot, up until then was only using cryo cuff on top of knee Not out of the woods, but definitely well on my way!

 

[Lusknewknees]

Regarding my meds, I saw my Primary care dr on Monday and she was saying On the tylenol back up to the Norco. Too much acetaminophen even though I was keeping under 4000. She shook her head just like that emoji. So she gave me a rx for Norco 10/325. I only take one of those 2 x per night every four hours. Then I take the 5/325 every four hours during the day. Seems to have worked and pain is in control without added strain on my liver.

 

[Lusknewknees]

I've had a setback and would appreciate some help from other bs folks and experts:
Here's a case of delayed onset, and I'm wondering if anybody experienced this so many days out after surgery (today is day 10 for me).
The fact is that I have had very little what I would call significant pain since day of surgery. The last 20 or so hours have changed that. My shin pain (weight bearing only) onset suddenly and acutely when walking yesterday. i awoke about 3:30 am with pain approaching 6 -7 (maybe 8) in inside of knee...made me cry out in pain and lasted for about 5-6 minutes. Moved cryocuff over region and took pain pill one hour before scheduled interval. To wait would have been folly. Added more ice packs.

Prior to yesterday Activity was leg extensions 3 times a day x 10
Toe tap on lowest step 3 times a day x 10
Seated hamstring stretches with towel at ball of foot, bend at waist and pull on towel.
Cpm machine 4 hrs per day got to 108 but backed off to 104

Home PT came yesterday and we did the following. 3 sets of 10 each
Seated leg left
Toe raises holding chair
Hip abduction
Sit/stand with minimal arm support from chair
Hamstring curl
Walk up stairs with cane, good leg up/bad leg down (1x)
Walk up stairs with cane, bad keg up, bad leg down
Walk around cul de sac where I live one time, cane instead of walked

About 3 hours later I started another walk with my husband using cane, got down to end of street which is very short. Had deep shooting pain up shin and started to become lightheaded and knew I would be unable to walk rest of way home. He had to ask neighbor to fetch walker and bring to me, then get his truck to fetch me, I could not walk without excruciating Pain in front of Lower leg. Have been resting and icing since, rising only for bathroom breaks. Still pain in shin, showing bruising not previously seen, and above episode of knee pain at 3:30 a.m.
Is this a case of overdone or have I set myself back and/or injured?
@Jamie, @ConnieJOS , @jeano, @Minnie's knees

I have home health care nurse coming today to assess and discuss if visit to OS before scheduled 2-week follow up on next Wednesday is in order. I had virtually no pain in knee and never any pain in shin until now.
Drugs: meloxicam(mobic) 15 mg 1x/day, norco 5/325 every 4 hrs daytime, Norco 10/325 every 4 hours nighttime.
Icing and elevating most of day, daily. Using Polar cuff on top/sides of knee since day of surgery Starting today, ice gel wraps on shin and back of knee.

 

[Jamie]

You are doing way, way too much for being only 10 days out. Stop the outdoor walking around and reduce your exercises to just some gentle bends and stretches several times each day. When the therapist comes next time, at least skip the stairs. Too soon for forced stair climbing with the weight on your new knee. If you need to do stairs, use the method they taught you in the hospital with the good leg up first.

Go back and read the recovery articles again and you'll understand that you are still healing. Doing all this activity so soon when you have pain will only make things worse.

 

[Jane B.]

Lu, did you have computer assisted surgery?

 

[Lusknewknees]

Yes, I did, Jane B. I went to the ortho today because I can't place any weight on my shin. He had me do some moves and while my operated knee is In amazing shape, he diagnosed me with IT band syndrome that is referring to the shin. Then point at which the band joins the leg at the knee joint is very tender. Attributed to overuse yesterday. I will start outpatient PT Monday and they will treat me for this as well as starting rehab PT for my tka. He also prescribed some muscle relaxers which I hope help to reduce some of the tension. Off the CPM he said (yay!). Meanwhile, just rest, ice, take pain meds, do gentle exercises. There's the plan.
Why did you ask about the computer navigation? He gave me a copy of my surgery report. I can understand about 10% of it. Not sure I want to know more.

 

[Jane B.]

In the computer assisted surgery I read about on some threads here, the surgeon screwed equipment in place in the shin bone. The BoneSmartie had a lot of pain there, and later had more issues.

The more likely explanation is that we all have pain that moves around to different sites after a TKR. Tomorrow the pain will likely be somewhere else. Please remember that I although I ran a surgery center, I have no medical training of any kind except for an occasional CPR course.

And you seem to be vying for my position on the ODIC Board of Directors. Watch it!

 

[kneeper]

Each of those activities are ok--but not all in one day! The knee and surrounding tissues definitely talk to you when you overdo. You may not feel like you're doing much, but in the first couple of weeks, rest and gentle movement are the key. Plenty of time to increase activity as you progress.