Revision TKR Third times the charm- hopefully

[FCBayern]

@jboles Have you contacted your GP? Sometimes a doctor that knows you better is more willing to give you pain meds. Before surgery I asked my GP for some pain meds for the days that were really bad due to bone on bone and he looked at my records and said no problem, you obviously aren't abusing them.

 

[jboles]

@FCBayern no I haven’t. I still have some for nights and really bad days if needed. Tylenol helps most of the time. I have a pretty high pain tolerance, I’ve dealt with pain for years now between back pain before my back surgery and knee pain. So at least now I have hopes that there’s an end in sight.

 

[Josephine]

jboles, I am so sorry to be so long answering your answers! I'm afraid I forgot to 'watch' your thread! Sorry!

1- actual knee pain 2 aching in calf and thigh add 2 more - so probably a 4. It’s usually just stiff in the morning, gets more pain in the evening. Left knee usually no pain- but last 2 weeks it feels tight and I’d say pain of a 1

3- between slight to moderate- probably closer to slight.

Moderate swelling adds at least 4 points to your pain score which makes it about 8!

2-5 mg oxycodone 1-2 every 4-6 hours
I’m only taking 1 before bed and I take 2 500mg Tylenol every 6 hours during the day.
Usually 3 doses of Tylenol in a day.

I would suggest you start taking the oxycodone as prescribed and not as necessary.

4- it hasn’t been measured in 2 weeks but 2 weeks ago it was 110/0 right knee.

That's excellent!

5- probably 3 times during the day.
6- elevate whenever I ice.

Though you haven't actually told me how long you're icing for, I suspect it's only 20 minutes at a time. You accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day. And elevate when you ice.

7- most of the cooking- just simple meals though. Husband usually cleans up after if I cook. Sometimes I load dishwasher and he will unload it. Wash clothes, make bed, put away groceries, I went to grocery store one time, that was too much though. Haven’t vacuumed yet- worried about balance

You're doing a tad too much, my dear. Do read this again (assuming you read it when it was posted in the third post of this thread (!) Activity progression for TKRs


Try to walk outside each day for about 10 minutes - is that per day or more than that?
Inside walk for 10 minutes - same here - is this once per day?
Quad sets 10 x 2-3 times a day - give these a miss, you don't need them if you're walking about
Glute squeezes, not sure if that’s correct name 10x - 2-3 times a day - same here

Go to PT 2 times a week- 1 hour session - give your most excellent ROM, you don't need any of this so I suggest you quit it all
10 minutes on Nu-step level 1
Straight leg raise- 2 sets x10
Heel slides -laying down and sitting-2 sets x 10
Laying down with wedge under knees-lift knee- 2 different sizes of wedges- 2 sets x 10
Sitting- straight leg raises -2 sets x 10
After exercises- 2 laps walking track to work on gait
all far too much so stop them. It's responsible for all your aches and pains and stiffness.

In summary:
1. adjust your pain meds as suggested
2. quit ALL your exercising and PT. You don't need it and it's causing the aches, pain and stiffness you've complained of.

 

[winemama]

My doc cut me off pain meds at FIVE DAYS. Thankfully I had a pain management doc nearby who could take the reins. That's whats happening now - you might want to find such a physician to help you. The 'no need after 6 weeks' routine is a load of... It always seems to be people who've never gone through this saying stuff like that. I used mine very sparingly - but if you have constant pain, staying ahead of it so you can walk and move in order to heal properly is of paramount importance.

I could not imagine being off pain meds it five days I have to start hitting the streets looking for something, I think it’s absolutely ridiculous that your doctor would say that, I have to find myself another doctor I was off the Oxy at 4 weeks but then I had Tylenol with codeine whenever I needed it I was off most pain meds by eight weeks I can’t imagine five days I am so sorry for you

 

[jboles]

@Josephine thank you for your suggestions.

I am icing for at least 40 minutes, usually an hour each time. It does help tremendously.

After my 6 week OS appointment last week, I canceled my last 2 PT appointments. He said that I only needed help with my gait and he still wants me to use my walker to try and get my leg stronger. I may try another PT place for gait help, the one I’ve been using doesn’t give me much help with this.

What is an exercise you would recommend to build strength in my leg? I have stopped all exercises now, just ADL’s. I know I probably need more medication during the day, but my OS won’t write another script for any. So I’ve been taking Tylenol and a pain pill only at night.

 

[Josephine]

What is an exercise you would recommend to build strength in my leg?

What I already said in the "BIG TIP"
Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

I know I probably need more medication during the day, but my OS won’t write another script for any. So I’ve been taking Tylenol and a pain pill only at night.

You should take 1,000mg Tylenol 4 times a day, assuming you don't have any acetaminophen in the oxycodone.

I know the FDA has ruled that 3,000mg acetaminophen is a safe maximum but that would be assuming that the patient is taking another medication that also contained it and thereby inadvertently take an overdose. Assuming that this is not the case, the maximum safe dosage per 24hrs 4,000mgs.

 

[jboles]

8 weeks today. I’m improving, slowly but I do see improvements. Energy levels are coming back. I walk around the house at times unassisted, some of my steps almost look normal, but my leg is weak and I start to limp.

I drag my walker out and use it when I start limping. I do have a pain that I’ve not read about on here. I assumed it was hamstring pain. It runs down the back of my thigh but it goes all the way up to my butt cheek?? Sitting really aggravates it. If I sit very long it goes from the top of the back of my thigh down past my knee into my shin.

I really don’t have a lot of knee pain, it’s leg pain now. @Josephine do you have any ideas?? Or anyone else have anything similar??

 

[Josephine]

I'll say. What you have described is a fairly classic, text-book description of Piriformis syndrome.
Had it myself so my sympathies!

 

[jboles]

@Josephine thank you so much for the reading material. It sure does seem like what I have. I know it sure is painful. The only time I’m not in pain is first thing in the morning. It takes hours to ease off at night before I can get to sleep. I’m going to try the exercises and see if I can get some relief.

 

[Josephine]

Yep, that's what it's like. Terrible, isn't it?

 

[jboles]

I read the article about Piriformis syndrome and the exercises. I can do the stretches on my left leg but I’m not able to get much of a stretch on my right leg. My inner quads are still sore from the last surgery. After an hour of driving I’m literally in tears. I’m so done with all of this.

 

[jboles]

Having some new pains. After sitting for 30 minutes or so, anywhere, I start having sharp pain that runs down my leg. It starts in the back of my thigh- most of the time- sometimes it starts on the inside of my thigh then goes down my leg to the shin. When I walk, it hurts all the way up my leg every time I take a step. I saw a new PT group yesterday that specializes in gait therapy. They have isolated some hip weakness and I have some exercises to do. She was impressed with my knee ROM, almost 125 flex and 0 extension. My left knee measured 135/0, so not much different. If it just didn’t hurt and ache like a gigantic toothache, I would be so much happier. When it constantly hurts, it zaps the happiness right out of you. Now the hip exercises are really making my hips sore. Oh and one other thing. Last week I developed what I thought was a bug bite on my incision, but now I wonder if it’s a stitch trying to come out. The skin on top of the bump peeled off and when I pushed on it some whitish liquid oozed out. I poured some peroxide on it and it bubbled a little bit. Hopefully it’s okay.

 

[Celle]

I'm sorry you're still having pain. I hope it starts to ease off before too much longer.

Go gently with those new exercises, wont you?

 

[sistersinhim]

I bet the new exercises are angering your knee.

 

[Irish471]

@jboles , sorry to hear about the new pains I have been having new ones, too, mostly around the kneecap and in the area I used to have the worst arthritis pain. My soft tissues seem to remember! But I have spent a lot of time in the ODIC, too, so I am not totally surprised. I broke down twice in the past two weeks and took some of the precious few oxycodones I have left.

 

[jboles]

ODIC club, I wish I could give up my membership! It’s been an extremely tiring weekend. Worked all day Thursday, brought granddaughter home with me, then on Friday morning, she and I trekked out to grocery shop for my daughter-in-law baby shower. We cooked all day Friday until midnight then I was back up and at it on Saturday morning. I got home from the shower at 7 last night, ate a few crackers, took a pain pill and went to bed. I don’t plan on doing anything today!! But I will say my watermelon baby carriage turned out okay.

 

[Jockette]

That watermelon baby carriage is adorable!

Rest, rest, rest now!

 

[Irish471]

@jboles, what a trooper you are! That would have done me in I hope you rested today with your feet up!

 

[Lindylee]

I love the watermelon carriage, not seen anything like that before. What a brilliant idea!
Sorry you're having a lot of pain issues, but boy you're doing a lot. I hope you do have a day of doing nothing, just relaxing and letting your body recover. I know what you mean about that constant wearing ache - that's just how my back is at present and it just wears me out. I've slept a lot the past couple of days after a busy week.

 

[liam2015]

i'm sorry to read about the pains you had been suffering. how are you doing now? i am in awe of your energy helping out with the baby shower and your watermelon carriage is spectacular. hope you've had some improvement.