Things not so good and due to return to work on 4/1

[btilelli]

I'm about 9wks. out from a TKR and still feeling miserable because of pain and swelling with walking. It is so frustrating as I really thought I would be so much better by now. P.T. has gone O.K. with 115 degrees flexion and about 8 degrees extension. I absolutely have to wear a heavy compression stocking on my leg or pain and swelling get the best of me. I'm planning to return to work April 1st (that would be 3 months since surgery). I'm hoping I'll improve a lot over the next few weeks.
Discouraged,
Bridget

 

[Josephine]

Re: 10 weeks out from TKR, and miserable!!!

Well, that's not at all uncommon, Bridget. Some people do have significant swelling this late. Are you elevating your leg, by which I mean with the calf and foot above your hip, even on a level with your heart if you can? And icing? And being good about pain management? It's all connected.

 

[btilelli]

Re: 10 weeks out from TKR, and miserable!!!

Hi Josephine,
I don't believe I have good pain management at all. Darvocet 1-2tabs daily and Celebrex once daily. I have a pain level about 8-9 most of the time. The swelling and stiffness continue. I am able to walk some but have to sit and rest after about 5 minutes. I also have severe degenerative spine disease which became worse after my knee surgery when I limped significantly to one side. I've since had two epidural injections and now will be seen at the spine clinic at the Mayo Clinic on Tuesday 3/17. I am supposed to go back to work on April 1st which is when my 90day leave will be over. Since I work as an ICU nurse, I really am concerned that I will not be able to make this deadline. I'm praying for a miracle anyway. I am finished with my P.T. now and I wear heavy compression hose on that leg all day (20-30mmHg). I elevate, ice and soak in the jucuzzi tub often. What else can I do to move things along and maybe in a more effective direction?
Help!
Bridget

 

[Josephine]

Bridget, I put your posts in a thread of their own because they were getting lost in and derailing Kevin's thread.

Now about your pain levels
- is that 8-9 from your knee or your spine or a combination?
- do you have Occupational Health Departments in the hospitals in the US? And don't you need to get Health and Safety clearance from them before you return to work?
- what does your PCP have to say about your pain levels and the problems with your knee?
- why are you taking so few pain meds when your pain score is so high? Would you do this to a patient?

Seems to me that your recovery is just being slow, that you need better pain control (pain causes swelling, you know) and that your return to work is just not on the cards yet. No one should be at work who has to rest after only 5 minutes activity, specially not a nurse and specially not in ICU! Suppose your patient arrested or something?

No, you simply have to get your bosses in on this, your PCP and/or your OS and maybe even your union rep to advocate for you. April 1st is not going to be doable in the (not so humble!) opinion of this ex-nurse manager.

 

[ship4]

Bridget,
Being a nurse you need to remember to take the time to take care of YOU! Only you can be proactive towards your pain management. Also remember for every hour your body was under anesthesia your body (not just the knee) requires 2 weeks to recover from the anesthesia only...... So, if you were under for 2 hours, your body required a month to recover just from being under never mind the stress caused by the surgery. This contributes to your fatigue and if your pain is not under control (mine would not be with that little bit of drugs) it is going to take a toll on your whole body.
Call your PCP as Jo suggested and ask for better pain management even this far out from surgery. I was on pain pills for a full 3.5 months cutting down gradually from what i started with and then weened off them for the following 2 weeks. Then I continued on Celebrex for an additional month. I sure hope you get some pain relief.
My other question is how often are you in the jacuzzi? With all that swelling you are talking about, I would cut back on hot baths........ as this can contribute to your swelling issue. There is a difference between soaking in a hot bath and PT in warm water in a pool. JMO
Best,
Crystal

 

[Josephine]

Good point about the jacuzzi, Crystal. I missed that!

 

[Jamie]

Bridget, I'll echo what Ship and Jo said....you need more pain relief and time to heal. I know you made an agreement to go back to work after 3 months, but you need to discuss your situation and make other plans with your supervisor. You are going to need more time. If you have no paid leave alternatives, there is always the Family Leave Act to fall back on. The hospital cannot fire you because you have a medical problem....the Family Leave Act protects you from that. You probably need some written statement from your OS and/or your primary care physician to back up what you tell your supervisor.

Jo, in the US there is no central authority that evaluates and pronounces you fit or unfit for work. That is the job of the doctor who is treating the patient. It is quite common for a doctor to need to prepare written documentation stating when a person can return to work and what tasks can be performed at each stage of recovery, so Bridget should be able to obtain this without any problem.

Post again, Bridget.....and let us know how things are going. And tackle this now...before your time is at an end. Best to deal with it in a "less-crisis" mode than a couple of days before your supervisor expects you back at work.

 

[btilelli]

Thanks for the helpful info, what about swimming in a pool? I know I need much more effective pain management. We will bring that subject up on Tuesday when we're at the Mayo Clinic. In the meanwhile I'll need to contact my hospital and let them know that I am just not ready to return to work yet. I do still take Celebrex but I will request better pain management on Tuesday. Thanks so much for the responses from Ship, Jo, and Jamie. I'll write again after I get back from Mayo Tueday. Thanks so much for you support. I felt like crying tonight so this website was extremely helpful in redirecting my thoughts. I appreciate your help and suggestions.
Thanks,
Bridget

 

[Nursepair]

Hope you feel better soon Bridget. Post whenever you need to, I remember feeling very low at your stage in recovery. What this site is all about, information and encouragement as well as friendship. (((((HUGS))))) Sue

 

[Jamie]

We'll be waiting to hear from you again, hon....hugs to you!!!

 

[btilelli]

Hi Jo,
Thanks for asking all the right questions. My pain, between 8-9, varies between my spine and my knee. Even with heavy compression hose on my R leg, my knee has obvious swelling. I am taking Celebrex which isn't enough nor is extra strength Tylenol. We are planning to address this issue when we are at Mayo on Tuesday. Since I still fall under the 90-day "leave of absence" umbrella, all I need to have to return to work is a signature from my nurse manager. I will call her tomorrow and explain the issues and my inability to return to work at this time. I need more time to heal and we need to see what the physicians at Mayo will recommend for my spine. My primary care doc gave me Darvoset for pain which hasn't been adequate at all. We will ask Mayo's suggestion for pain control. Meanwhile, I will be icing and elevating. I'm glad I came on the website tonight to chat because I was really feeling down. Thanks for all your help and support. I'll keep you all posted.
Bridget

 

[btilelli]

Thanks Sue and you are so right about having people you can identify with who sincerely want to help. It gives me and my swollen knee alot of hope when I read some of you experiences and suggestions. I'll update again soon. Thanks for listening.
Bridget

 

[Josephine]

Thanks so much for you support. I felt like crying tonight so this website was extremely helpful in redirecting my thoughts. I appreciate your help and suggestions.
Thanks,
Bridget

Cry anyway! Tears are good because they relieve stress and that's very healing.
Never dam back the tears!

 

[TCHarp]

I'm thinking that getting that extension out to 0 (or almost 0) will help with the spinal problems more than you can imagine.

Just a thought.

TC Harp

 

[btilelli]

Thanks for giving me the suggestion of trying to improve my extension to 0 to help with the spine problems. It makes sense to me and I pray your suggestion will help. It´s the most promising I´ve heard yet. Thanks again.
Bridget

 

[Hope810]

I found taking one Tylenol Arthritis extended release 650mg every 4 hours to work better for me than Tylenol Extra Strength (500 mg). DO NOT TAKE MORE THAN 6 PER DAY, 3900 MG max. I think the 650 mg extended release kept the pain down over a longer time. Check with your doctor but mine said it was okay for me. Good luck on your big day!

Hope

 

[TCHarp]

Thanks for giving me the suggestion of trying to improve my extension to 0 to help with the spine problems. It makes sense to me and I pray your suggestion will help. It´s the most promising I´ve heard yet. Thanks again.
Bridget

What I was told is that when we are not getting full or pretty nearly full extension our leg is effectively shorter. This can put your spine in a real bind and cause much pain. As your extension and you gait improves, so should your back pain.

On my latest TKR I'm getting pretty good extension and trying to keep it that way.

Good Luck,
-TC