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TKR Two (almost) matching knees at last!

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Slept through the night, and I am paying the price. Was trying to save my Norco for Pre-PT and late night; because I wasn't awakened to take pain meds. Didn't elevate; my leg is still stiff but I was able to get out of bed and use the walker to use the loo. They gave me my Opana (oxymorphone) and Neurontin but no matter what I do that leg is driving me nuts--it aches from the hip down along the side and from the butt down in the back. The kind of ache you get when you stretch, only that ache goes away if you hold the stretch long enough. Mine doesn't go away until I fall asleep or the actual pain of bending/weight bearing and the incision takes my mind off the ache. And to make matters worse, I developed a triple blister (three small ones close to each other in a triangular pattern) from the tongue of my gym shoe from all the work I did yesterday--leaving my shoes on till bedtime. I sure hope they have those special blister bandages here, since I didn't bring any. I didn't get my sock aid delivered till after lunch, so I stupidly soldiered on without socks. D'OH! No way I can exercise in the PT room unshod, and I still can't don my slipper-socks myself (the sock aid won't work with them.

Oh, and the rehab's Internet is still down so I have to use cellular. I hate typing on an iPad--I fat-finger everything, the slightest brugh of a knuckle can delete a whole message. Grrrrr.
 
Yay! Internet is back--I can type on a computer with two hands, like a normal person, in a font I can read.....oh, wait, it's down again (or was it just a dream)? What's really bad about it is that it controls who gets which meds here.

Speaking of meds, here's a cautionary tale underlining how we must all be aggressive advocates for ourselves. My oxymorphone was doubled in order to be able to reduce my Norco 10/325s from a limit of 9/day (in hospital it was 12) to 6. The drug "day" here starts at midnight. I got 2 last night at 10:30, hit the sack at 11:30 and next I knew it was 6:30 am and it was time for vitals. Slept like a baby--dreamt I was in rural B.C. (Hadn't been there since 1977, and wasn't even thinking about it, so I have no idea why I dreamt about it. Great dream, though). Got my Neurontin and oxy but no other painkillers. Had breakfast, dressed and rang for the transporter to take me to morning PT. At the same time, asked for 2 Norco timed to kick in at PT. The nurse asked, "Are you sure? After this you have only 2 left for today." Say WHA??? Have I been cut down to 4 now? The answer was no, I could have 6/day. So I asked why I would have only 2 left after this dose? It was like I was speaking Martian and she Esperanto, even though our mutual first language was English. I wanted the stuff to kick in on time, so I figured we'd get to the bottom of it after lunch.

Made great strides (literally) in PT--walked holding on to just one parallel bar, in preparation for transitioning next week from walker to cane. Walked fluidly with walker, not hanging on to it for dear life. Had lunch, practiced my dulcimer a little, and my OT came by for me. Once again, I asked for my Norco. The nurse warned me that if I took them I'd have none left for bedtime unless I burned the midnight oil. Grudgingly accepted 2 Tramadol and a Neurontin instead. OT was tolerable, as it was all upper body strength training. But by the time PT came around, I was aching deep inside from ankle to butt and my incision felt like it was being sliced open again and Tasered. All we coul manage was lymph massage and one anemic circle around the room with the walker.

Came back upstairs in tears, asked yet another nurse, who explained, "you had two at 2am last night." I told her NOBODY had awakened me during the night. She said, "let me check the charts instead of the computer. Voila: my records were mixed up with another patient's. I was given 2 so I could lie down to ice & elevate (which is TORTURE for me) and I just got my bedtime dose. It's not kicking in-- my thigh feels like it's being squeezed inside by munchkins. (Hard to believe that's not clots). I am now way BEHIND my pain and I don't know how I can ever catch up, much less get ahead of it.

Thank you, Information Age and electronic medical records! Josephine, Orthodoc, Jamie--anything I can do? My OS is deferring all further drug questions to my attending, who visits just once a week. Help!
 
Ohhh, I'm so sorry you're having pain like this. No matter what they do, there's always room for human error..getting your pain med times mixed up with another patients is terrible. Now you will be chasing he pain..something we all know takes forever to get a decent handle on once it gets out of control.

Here's hoping you get some relief and have a much better day tomorrow. I, myself, am battling swelling and can't find a comfortable position any where. A 20mg Oxycodone should knock me out and allow me to sleep through at least a couple hours of the night.

Better days ahead, Sandy
 
Thanks, Toni. I'm where you are swelling-wise. I called the nurse after I tried to sleep, but my leg had a mind of its own. The deep muscle spasms were like nothing I ever felt before--like switches being turned on and off by a mad scientist and my muscles squeezing--as one stopped the other started. So many--especially in the thigh--that at one point I feared I was getting DVT (my last INR was 1.9, which made me sorta paranoid about that). I rang for the night nurse for the Tramadol I was still allowed, but she wouldn't give me any, fearing I might get sedated because my BP was already on the low end of normal and I'd gotten the Norco "only" 45 minutes earlier. I kept telling her about the day staff's medication screwup and that now I was afraid it would take too long to catch up to and overtake and that it would set back my progress several days. She kept responding that I should "let it go and try to relax" and that there's no such thing as falling behind the pain (totally contrary to both Bonesmart and the knee class at the hospital, not to mention my OS's staff). When I told her about "rest, elevate, ice and take your meds around the clock" she replied that I should take pain meds only when I need them. Oh, boy.
 
One unusual thing about this rehab center is that the nurses' aides are all CNAs, from different countries. Most but not all are Filipino (the nurses are all American-born), but many--plus the OTs, PTs, pianist, chef and beautician--are from Eastern Europe, from behind the former Iron Curtain. Their stories of what they and their parents had to do to get to America and freedom are fascinating--and in some cases heartbreaking. To hear firsthand the brutality of life under totalitarian dictatorships and the amazing ingenuity, courage and often sheer luck it took to escape before all of Europe became free again is to realize how much we in the US, Canada, UK, and other free countries take for granted. And to visit these former Iron Curtain countries and see the bustling cities and thriving middle classes is to have all of one's assumptions learned in high school and grade school current-events classes shaken and stirred.

Funny what you get here besides physical healing!
 
Dulcimer Diva Sandy, you can bet none of those nurses have ever had any type of major surgery! They know nothing about controlling pain. To tell someone to just let it go and try to relax is about as useful as a fish with a bicycle.

Hang in for just a while longer and focus on coming home. At home you can take better care of yourself and your medication needs than you're getting now, that's for sure. I hate seeing you go through this when it is preventable.

Sending some good thoughts your way. :)
 
Maybe you can pretend the med mix up was one of your dreams (I guess nightmare would be more like it). I had a similar situation during my hospital stay. Nurses think "1 to 2" always means 1, and "4-6 hours" always means 6. Doctors tend to be PROACTIVE. Nursing staff, REACTIVE (and not all that quickly at that). I still suggest that you have written record of everything you take--not just their computer record--and that you keep a copy of it in your room. Check it off with each dose you get. When is your discharge date? Honestly, the challenges you have faced have taken such a toll on you both physically and mentally, you'll be much better off once you get home. In the mean time, hang in there.
 
So sorry you got behind on your pain-meds and are now playing catch-up - I really know how bad that can be when I went without pain-meds for ½ a day . I suffered an unusual intolerance to Oxycontin (gave me the runs) so it was decided that I shouldn't take the 8am dose as doctors rounds were scheduled for 8.30-9.00am. The OS agreed and recommended a change to another med - we all heard it - but then he forgot to sign-off on it before he went off to carry out surgery and the staff of course could not dispense it (even though we had all heard it) until the OS signed off on it. It was first lunchtime that he wrote it up. That morning I suffered the worst pain (9s and 10s) and it took 24 hours to get it back under control.

Pain-med catch-up is really tough
 
Don't have a firm discharge date yet; my plan's website says they'll cover 10 days for a single and 14 for a bilateral joint replacement sans complications. The way it works is that on day 7 (today) the insurer wants the hospital to report on my progress and recommend a discharge date. When I checked in the administrator said she was going to ask for 2 weeks; they'll probably split the difference at 12 days. But I'm planning on being here for another week.

Did 3 laps around the lower level with the walker (w/o hanging on for dear life), 3 stair climbs, and even a short jaunt with the cane (though the therapist was holding on to me gently for my balance). She says she doesn't trust my quads enough yet to handle walking alone with the cane--we're also working the right leg to strengthen it. (Her opinion is that though the right leg is fully functional, I have at least a couple of months yet before I can say I'm completely healed from my RTKR).
 
Sounds like you have everything worked out. As good as you're doing, you'll probably be bored before the week is up and ready to go.
 
Finally figured out how to remove the armrests from my wheelchair so I can effectively play guitar & dulcimer. Pres. of the Dulcimer Society's coming over this week to rehearse for our group concert at the Fox Valley Folk Festival on Labor Day. Am a tad nervous about playing the Old Orchard farmer's market in a couple of weeks, as it's in the parking lot, we'd be plugging in.....and said parking lot is currently a pond after today's storms.

Was treated to a piano concert tonight by a semi-autistic savant visiting his grandma--he had an impressively large repertoire of Scott Joplin tunes. I defy anyone to feel sorry for him or herself while listening to "Maple Leaf Rag." Early shower and PT day tomorrow, so I got my bedtime Norco a tad early. When my typing turns to gibberish (or at least more gibberish than usual) I'll sign off.
 
Hello diva,
I hope your doing well in your recovery. Looks like we have a great hockey game to watch tonight. I,d wish you luck
But you know how it is. What a great match. Up both teams are giving their all and it makes for a great series.
Take care,
Diana
 
Hawks win! Hawks win! It was so crowded in the TV room around the big screen that I had to go back to my room to watch the final minute. Spent a couple of hours talking in the lounge after dinner with a new friend who's being discharged tomorrow. So many interesting stories--she emigrated from Czechoslovakia three days before the Soviets marched in. Discovered that despite our age differences we shared tastes in shoes, clothing, food, etc. Turned her (and a lot of others) on to Bonesmart. Most folks here are amazed by the UK model of post-op rehab---no PT for the first month, just basic gentle exercises and lots of elevation. Nearly everyone here finds elevation more painful than motion.

Today we walked with the cane again and I was allowed half a lap solo. Nonetheless, for tomorrow (a non-PT day) my therapist warned me not to use the cane without someone holding my free hand or arm. I system to be making more progress every day; the swelling isn't getting any worse and seems to be aggravated by keeping my foot down too much. Was advised that when in my wheelchair I should try to keep my foot on the floor and try to gently increase flexion in order to combat stiffness. Have found that if I lift my leg in the air while I lie on my back, I can more effectively do a lymph self-massage. Have gotten accustomed to the pain, at least most types of it. The incision and knee pain is the easiest to deal with, regardless of intensity; the muscle cramps and squeezing sciatic pain is tougher. Unfortunately, the latter is what elevating aggravates. And I'm noticing some tender nodules in the cellulite on my inner thigh (way TMI, I know).Also the Opana is making my skin muscles twitchy ( but in the other leg). The nurse says that's what the Neurontin is for. I wonder when I will be inured sufficiently to the pain or it will ease off enough to start weaning off the Opana. It's oxymorphone, and I've never been fond of morphine and its derivatives. Mobility-wise, I've been declared ready to drive--but not while this' stuff is in my system and addling both my brain and my neuromuscular system. Once I can get off the Neurontin and Opana, I can begin weaning off the Norco when the pain abates.

Oh, and the Internet is down again--time for my bedtime Norco and I hope the pharma-bot will release it to the nurse.
 
Dulcimer Diva. Hi Sandy..it sounds,Ike you are coming along very well,and quite quickly. Funny you should mention that elevation is more uncomfortable than not..I find that is true with this leg. My problem is the tourniquet pain to my thigh is aggrevated when I elevate..my thigh is still tender to the touch. My calf is also sore..lots of bruising with this one. When I elevate the weight of my leg through the back of my thigh is painful.

My last knee, the nurse was amazed thwt I had no swelling. This leg is making up for it in spades! My ROM right now is 100/0. I can feel the internal swelling intensify the moment I stand up and walk, but walk I must, and certainly do. At least 5 times a day I get up and walk to the kitchen, the bathroom, and dining room focusing on standing straight and proper gait.

I'm not thrilled with my PT. Monday I will be asking for my PT from last year. The one I have now is trying to work too fast. I won't be rushed to reach goals on his schedule. He seems to recommend the exact opposite of what my old PT did. He doesn't believe in lymphatic
massage, says it not used for knees. He also wants me off the walker ASAP. I, frankly, will stop using my walker when I feel ready.
I found that the Oxy I was prescribed is perfect for my pain management.

Believe it or not, I'm SLEEPING!! Last time I didn't sleep for more than 15 minutes at a time for months! This time I am sleeping for hours at a time. I think the difference is the pain meds.
This time I even avoided the dreaded constipation..no problem at all. (TMI)

Good for you that you are coming along so well!! I'm sure you will be glad to get home though. There's no place like home to recouperate no matter how good our treatment in rehab is.

Take care my blond Doppleganger!!
 
Toni, 100 degrees flex and 0 extension already? Wow--even more impressive given the swelling. I would love to get to the point where the oxymorphone BID (hopefully the 5mg. dose) is the only prescription pain relief I need--but that would still make me an unsafe driver (and I'm not so sure how trustworthy I'd be with knives and fire in the kitchen). But this is my first experience with long-acting opiates; from my experience defending DUI cases, a chronic long-term late-mid-stage alcoholic can function normally with a BAC above the statutory definition of "under the influence" and could go into life-threatening withdrawal at levels below that. (I definitely disapprove of chemically-impaired driving; but the legal and legislative system and medical substance abuse community aren't on the same page or even the same chapter when it comes to the physiology and neurobiology of intoxicants and the variables of their effects based on these factors: age, gender, body mass and composition, magnitude of underlying pain vs. psychological need for euphoria or fear of withdrawal symptoms, even the stage of an individual's progression of addiction).

But I digress. I too had very little swelling on my "maiden voyage" RTKR. And while I was lucky to catch sleep in little snippets of naps last year (even the first couple of weeks at home), this time I have been sleeping soundly between routine awakenings for vitals, pee breaks & meds, even in the hospital; here in rehab I have been able to sleep through the night on my bedtime dose of Norco). Last year I had no social life till I got home (the only chance to interact with fellow patients was in the gym and the two times I sang, with half the audience suffering with dementia); here at Alden I am actually making friends; it feels like we're aging coeds in a college dorm.

Internet came back up briefly late in the wee (wee-wee, it turns out) hours after I was a bit too wakeful after a trip to the loo; it was a delight to be able to type on the physical keyboard of my laptop (MacBook Air, a great compromise between large iPad and full-size laptop). I'm a bit apprehensive, as I needed to have the walker brought to me because both it and the wheelchair were too far from the bed to be grabbed by my reacher. When I got back to bed and the aide reconnected the ice machine, she began to cough. Allergy? Smoker's cough? Nuh-uh. "My son gave this to me and I can't get rid of it." Uh-really-oh (to the max). We are all so paranoid about infection here (even the prospect of a zit) that I couldn't have my son visit till it was confirmed that the "cold" he thought he'd caught at Bonnaroo was his allergies. Here, the moment a resident comes down with something they're in isolation, quarantined to their room for meals and even PT/OT. Socializing is on of the major advantages of this facility!

Today, being a non-therapy "day off," we're experimenting with timing of my 6 allotted Norco. Normally it's two each before morning and afternoon PT and at bedtime, which can leave irregular intervals. At first, had to use a Tramadol for breakthrough pain. Tramadol seems to work for me only if I'm not really doing anything physically demanding: it sure doesn't cut it for PT. Last night I had my 2 Norco after midnight (the hockey game pushed back the news and SNL). When I awoke for the day at 7:45am, I'd gone 7 hrs. Since my last dose of painkiller except for the oxymorphone I got at 6am (and will get again at dinner) was 7 hrs before, I was in moderate pain even with icing. So we're trying a single Norco every 6 hrs. With the thrice-daily Neurontin, that should get me through till my 2-tab bedtime dose. Right now I'm fairly loopy again, so I'm hoping this means that I can start weaning soon.

Meanwhile, the 'net is down again so it's back to typing with thumb and forefinger on the screen of my iPad Mini.
 
Sandy, I think the Norco every 6 hours might be a better way to go along with your Oxymorph. My Oxy is not continuous release, but it is 20mg per pill.a pretty good doseage. I was told to take it every 3 hours, but I take it every 6.

I too, sleep through the night, but sometimes I wake up because of pain. I sleep with my legs elevated and when I wake up because of pain, I remove my wedge and pillows and sleep on my side for a while..it usually helps.

I try to go to bed with two alcohol ice packs ace bandaged to my knee..one underneath and one on top, then wrapped up with the ace bandage. I usually wake up in discomfort once the ice bags have lost their cold.most of the time they last about 5 hours before I need to
change them.

We'll get better every day..I had forgotten how intensee the first month of recovery can be, but we're on our way.
 
Yup, I'm with you, Toni. I think I'd like to try q. 6 h. with the Norco but my PT is at 10-10:30 and 2-2:30 or so, necessitating a 4 hr. interval between the first two doses so the Norco kicks in before I start the torture sessions. The other day we tried waiting the 6 hrs, with two Tramadol before afternoon PT, but it was a disaster--I was hurting so badly I couldn't do anything actively, just my therapist stretching and moving my leg for me and then massaging it before one pathetic lap around the basement with my walker. Then got the Norco and was too loopy for dinner.

Today turned out to be screwed-up analgesia-wise. Yesterday I took 4 single pills of Norco at 4-5 hr intervals, with two at bedtime. Trouble was, bedtime was 12:23 and they (the computerized pill robot) reset the pill clock at midnight. Yup, I actually forfeited my a third of today's dose, since the computer recorded only 4 pills yesterday and counted my bedtime dose as today's first one! My OS' PA told me that now that I'm in rehab to direct all medication matters to my attending.....who actually sided with the nurse and the dang robot! So I had one early morning and a late lunchtime pill and when I wanted one at dinner, they made me take 2 Tramadol instead. Therefore, I will have gone from 1:15 to bedtime on a single Norco! And in order to get my bedtime dose (which has to be two pills, since one doesn't work) as part of "today," I have to get it early (for me 10:30 is a very early bedtime) in order to make tomorrow's 3-dose schedule work. It is against the rules to bring it at 10:30 and let me take it later--they have to watch me take it. So I am very likely to be awakened by pain (and pray they'll give me Tramadol--they refused a couple of nights ago because they said I'd become sedated). I asked how about just some good old fashioned Tylenol (which would keep me well below the 3 gm max), and the nurse answered there was no order in my chart.

How am I supposed to stay ahead of my pain and keep a constant blood level of Norco unless I go to bed way before I'm ready in order to keep from "turning into a pumpkin" at midnight? This is one definite downside to being in rehab--at least a modern computerized facility. At home I'll keep the time clock, and 24 hrs. will mean 24 hrs.

There has been a fly in my room, mostly on the windowpane, since I arrived. I don't want to swat it--something about it staying on the window and not bugging me gives me a vibe that it was meant to live. I know it sounds crazy (I'm a monotheist who doesn't believe in reincarnation), but...
 
Today another one of us "graduated" to home. My pal Libby, who had her RTKR a week and an half before mine (same surgeon) came into my room pushing her wheelchair, and then DANCED over to my bedside! We hugged and vowed to go shopping and to tea on State St. once I've been sprung. Her son came to pick her up--he is in his early 50s and we reminisced about our wild youth rock & roll days. I mentioned I now have a big sister, and she replied, "no, a new mother." She's 86! God bless her and long may she run.

Gordy came over tonight, on the bus. He said it wasn't too bad except for the last few blocks because construction has temporarily closed the nearest stop. And he (and we) seem to have missed the storms. Bob'll be in later.
 
You, know, Sandy, in a way I'm glad I came home in such a short time! I cannot believe the way they are messing around with your pain meds. They seem to be more interested in schedule time than patient needs. Your friend Libby sounds like quite a gal!

Will they let you go home sooner? If you can do all the required activities, I see no reason for you to stay there and never get ahead of your pain. PT must be difficult without proper med levels in your system..and sleeping..well that's not too easily accomplished when you hurt like crazy and can't relax. Not too compassionate there about patient comfort. Here's wishing each and every one of the 'can't give you a pain pill' nurses a few days of TRK recovery pain!
 
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