THR what is wrong with my progress?

[Josephine]

I only take 50 mg Tramadol at night, next to 3 x 50mg Diclofenac, does this mean the Tramadol I'm taking is essentially useless? It's what they gave me in hospital and what my GP prescribed once home.

It depends upon your pain level. If your pain is about 3-4/10 then it should be okay. But if it's in the 6-8 region then 100mg with 1,000mg Tylenol is necessary for good effect.

My problem is with people who say a drug is no good, has no effect on their pain and then tell me they are only taking something like one tramadol (50mgs) or one Tylenol (325mg). Take half a dose and you get half the effect.

As for your medications, if they are working then they work!

 

[Sooty]

As for your medications, if they are working then they work!

They're working brilliantly! I've started tapering off the paracetamol ever so slightly but am being very careful...

 

[CMH]

Yes to the longer leg - 2.5 cm or an inch.... unexpected but necessary apparently. My balance has been affected a bit. i work out in a hydrotherapy pool which gradually ets deeper - I make sure I stand with my longer leg in the slightly deeper water for the hour of stretches so that both legs get the same amount of work and my back isn't affected - I am finding that helps.
Pain wise I sleep with a soft bolster under my knee when on my back or between my legs on my side - It has made a really big difference to my comfort.
Best wishes

 

[thanson1964]

Thank you everyone for your advice and compassion. I am headed back to work on Monday. Feeling pretty apprehensive about it. I found out that my surgery had some complications, I read the doctor's transcription. I am still taking 1 Percocet to sleep through the night and 2 vicoden twice a day. But it is better than it was and I have started Physical Therapy. My left hip is larger than my right hip and my femur is longer on the left side. This may be contributing to my pain. I find that if I take more Tylenol or ibuprofen with my pain meds, they are very effective. My goal is to be completely off of the pain meds and only using OTC medicine within 2 weeks. This has been a slow recovery process for me, but I am coming along.

 

[Poppet]

thanson1964

I had my RTHR Nov 11 and went back to work on a phased return 31 Jan 12.. is there a chance you could go back on a phased approach?

Energy drain is what you will most likely experience, you might like to read this article Energy Drain for THRs

You haven't mentioned what type of work you do, is it office based or physically challenging?

 

[thanson1964]

Well, I am a production scheduler. I am a desk jockey; however, I am up and moving quite a bit. I did try to return to work and found that it was too difficult. In fact, my boss and my boss's boss sent me home to work from home again. I am frustrated. My swelling returned and my leg was throbbing within the first 2 hours. I am returning to the doctor on Thursday with hopes that he will have something new to tell me. I just want my life back. I don't think I should be progressing this slowly after an Anterior approach THR, do you? anyone? My doctor is insistent that I shouldn't have this much pain. But I do. I am not completely off pain meds yet and still get woken up at night because of pain at least a couple times a week. I am trying. I cannot walk as far now as I could a month ago...weird. I feel a lot of pressure and pain in my hip, deep in my hip when I walk. I can make it about 1/2 a city block without my cane. I just find this all very frustrating. Not too sure what to expect anymore. I was hoping for better than this though as I am 11 weeks post op. I have started some physical therapy, I had to request that I be referred for it though as my doctor doesn't think I need it. ????

I have a very important question for anyone out there that might be able to point me in the right direction. MY LEFT Leg was shaking, I mean convulsing shaking, right out of surgery. I am not sure what the nurse was giving me in recovery but she was pumping something into my IV to get the shaking under control. JUST MY LEG WAS SHAKING, nothing else. And it took at least 15 - 20 minutes to get it under control and that was after I woke up.

did anyone else experience this? I am wondering because I still have a lot of pain - it hurts to the touch and pain meds don't take it away- all the way down my outer thigh on my op leg.
is that normal?

 

[bottomshollow]

thanson, I so sorry that you are having so much trouble, and since I have no medical expertise, I'm going to tag Josephine to address your issues with you.

Please take care of yourself and keep us posted. We care.

 

[puddle fish]

A big hug from across the pond fingers crossed the medics get it sorted so you get back on track.

 

[Josephine]

I am still taking 1 Percocet to sleep through the night and 2 vicoden twice a day. I find that if I take more Tylenol or ibuprofen with my pain meds, they are very effective.

Then you found the golden combo! Additional Tylenol does enhance most prescription pain meds. BUT you do realise, I am sure, that both Percocet and Vicoden have Tylenol in them. You must add these to the extra you take. The safe max per 24hrs is 4,000mgs so make sure you don't exceed that.

As for the shaking/painful leg, it sounds like you have nerve damage. Which approach did you have? THR approaches or incisions.

 

[thanson1964]

Josephine, HI. Thanks for attaching the link to the video, I watched it all. I had the anterior approach. And i have suspected nerve damage this entire time because my thigh is tender to the touch, regardless of meds, it is very uncomfortable to the touch. I forgot about my leg shaking so violently in the recovery room but i will be asking my surgeon about it tomorrow.

While i found a med combination that works for me and brings me relief and I get good sleep, my surgeon is insistent that i should not need any meds at this point. Or at least not strong narcotic meds. I'm going to see him tomorrow and insist that he help me get some quality of life back. I was unsuccessful at returning to work and now when i go for my walks, i seem to encounter the discomfort and pain from the walks much quicker and cannot make it as far. My physical therapist has recommended that i start using my cane full time again. I am just frustrated as my xrays look normal and he seems to think everything is fine, but i am telling you IT IS NOT. I am hoping that my PT will get his attention. I also don't know if i mentioned this, but i was what they refer to as a tweener so they went with the large prosthesis. Could it just be too darn big? I also read my report from my surgery and my bone was very dense and they had to try 3 different types of blades to get through it. He also said he had to deviate from his normal procedure because my hip was very hard to remove. He also told me that i have very fibrous tissue and that made it difficult to get into my hip to start with.

I wish I just knew how much longer I am going to have this pain level.

Also, pre-op i was concerned about him doing the anterior approach because of my protusio, he insisted it was fine. Then i read the reports from my pre-op visists and he put in there that he brought up the risks involved with performing my THR using the anterior approach due to my protusio. That is not the way it went down.

i guess i am just frustrated. I just want to know what to expect so i can at least change my mind set. Instead, he insists that i should be all better by now.

thanks for your support and for hearing me out.

 

[Josephine]

thanson1964 I found it!

Somehow I missed that you'd had a protrusio treated via an anterior approach. Considering that and all the extra messing about he did, there is every possibility you may have some kid of nerve damage or soft tissue damage. I think a second opinion may be on the cards.

 

[Poppet]

thanson, how frustrating for you.. hopefully a second opinion as our knowledgeable Jo suggested will throw some further light on your points of concern. Make sure you write them all down, so that you go very well prepared with your questions and don't forget a key question... easy to do in the emotion of these appointments - take care.

 

[thanson1964]

Thanks you so much Josephine.
I will then find out about getting a second opinion. I may just go see my GP and ask her to refer me. I also don't know how soft tissue or nerve damage is treated. I may be putting the cart before the horse, but knowledge is power. Can you tell me if there is nerve and or soft tissue damage, is is permanent?

 

[thanson1964]

That is a great idea Poppet, i will be sure to do just that. I know my orthopedic surgeon cringes when he sees me coming. I always have a notebook and pen with me and a LONG list of questions. I'll be sure to review them all as well.
Thank you kindly for your words of encouragement.

 

[Poppet]

Dont' worry... I took three typed pages of questions to my first surgeon.. they are obliged under their 'duty of care' to answer all patient questions... funny story... my first appointment, the OS was running late and by running late I mean one and half hours.. so I figured, no way was he going to brush me off.. I had completed the second page of questions and he was wonderful with his answers, he then stood up and I promptly said... 'oh, I have a couple more questions...' It was so hilarious, he sat down just like a student in a classroom....

I was just thinking a little more about your PT's suggestion about undertaking more walking with a cane... what about thinking about getting Nordic Walking Poles... this way you look like you are exercising rather than having that feeling of being disabled with a cane.. and you get the support of both poles which takes the pressure off the hip, knees and back.. it provides you with stability and actually does wonders for one emotionally when we are frustrated that our progress is not happening.. the emotional side of this type of nerve pain is real...

check out my article on Nordic Walking here is the link https://bonesmart.org/forum/threads/nordic-walking-poppet-walks-the-talk.16606/

Don't get caught up in the advanced techniques you could just modify it to your walking pace, distance etc...and like I said, it appears to everyone else that you are an athlete .... very good for the moral

 

[thanson1964]

thanks for sharing the great story Poppet. I will look into the Nordic walking poles - they sound like a good investment regardless of my hip concerns. I was able to research somewhat while waiting in the doc's office tonight. I think I like the idea of appealing to my psychological side of recovery. thanks for the great suggestion. I am going to call my GP and request a 2nd opinion tomorrow. Maybe even ask her to give me whatever tests are available to determine if i have sustained nerve and/or soft tissue damage. My surgeon pretty much dismissed my concerns. I am not happy. It's like he isn't hearing me no matter how prepared I am when i get to my appointment, how knowledgeable i am about the subject manner, none of it seems to matter to him. When i asked him about JUST MY LEG shaking in the recovery room (not my entire body) he fell back on how common it is to shake and shiver and be cold after surgery. I WAS NOT COLD. I reiterated that to him and said again to him that it was just my left leg and it was shaking violently, but he just dismissed it. I am tired, frustrated and running out of positive. I am not just going to continue to "stay the course" and take pain meds as he concluded today - i want ansers When I inquired about the pressure/pain and discomfort when i walk, and how it seems to be getting worse, not better; he insisted that since the pain is radiating into my buttock, it is my BACK not my hip. I disagree. I tried to explain to him that it starts deep, deep in my hip joint and then moves back into my buttock. He is insistent that since he did the anterior approach, the pain is not related to the surgery. He also told me to discontinue my PT. I will take his advice for now, but I am definitely going to seek a second opinion, and as quickly as i can. Thanks for supporting me. I have found this forum to be so helpful. It gives me hope! I have ready many stories and see that several others have gone through ups and downs. Even setbacks very similar to the same time frame as mine. It's encouraging to know that this is all temporary! Thank you for bearing with me.

Cheerio (i am sure i am using this word completely out of context.)

 

[thanson1964]

I am kind of a basket case right now and I have been in the hospital for 1 week receiving strong narcotic pain relievers. I have been complaining of pain since my THR was done back in November 2012. Doc wouldn't listen, I finally went for a second opinion end of Feb. By March 19th I was back in the OR with my new surgeon so he could decompress my nerve. Lateral Cutaneous Femoral nerve entrapment was my official diagnosis.

When the new surgeon got into my incision (mind you layer by layer) he discovered that the Nerve was completely enmeshed into the entire length of my incision.....not just a little bit. Also that the protective film between the thigh muscle and the nerve was gone gone gone. I was wrenching on the nerve every time I moved. He did his best to fix it. 2 weeks post op, I still have the deep in pain that I was also seeking help for. Doctor did a series of xrays and decided that he was concerned because it looked like I had a broken screw. So he did more xrays and they looked normal. He was still very concerned that my prosthesis may be loosening. He pointed out an area right around the cup part of the prosthesis that looked a little odd to him on the xray.

He said to come back in 4 weeks and we will assess my pain then. 5 days later I was in the ER room with an elbow where my hip is (yes it was that swollen), it happened so quickly. Initially swabbed my incision to culture but admitted me for observation as I had a fever and the chills. The next morning surgeon #2 came in and aspirated fluid from my swollen incision site - 102cc's on day 1. On day 2, the nursing staff aspirated another 80 cc's, still nothing growing on the cultures. Day #3, staph reared it's ugly head and they aspirated yet another 70 ccs of fluid. Surgeon #2 made the comment that this was far too much fluid for this infection to be just subcutaneous. Signed me up for a 3 day bone scan.

Today, the 3rd and final day of the scan, I received the horrible news, MY HIP IS SEPTIC. The ID doctor and the doctor filling in for Surgeon #2, were as deaf as surgeon #1. I can imagine their surprise when the Bone Scan revealed that I was septic, my hip. I have a very high tolerance for pain, but still required pain meds....this is why the doctors were convinced that I was faking my pain, because I wasn't crawling into their office crying.

I am scared to death. Can anyone tell me what to expect next? As I am in the hospital still and it has been 4 hours since my doctor has received the news and still, here I sit with a 100 questions and no one to answer them.

 

[alexthecat]

What a situation! I'm sorry you are going through all this. I don't have the expertise to answer your questions. Josephine does, of course. She's in the UK and it's late at night there now. I'm sure she'll reply to your thread as soon as she can though. Hang in there, okay? I'm going to tag Poppet too, since you were chatting with her before and she'll want to see your update.

 

[BarbaraR]

thanson1964, I have no expertise or answers for you; I just want you to know that I read your thread, and I am so sorry for what you are going through. I hope you get the answers and the treatment that you need very soon. Alexthecat tagged Josephine for you, but it's after midnight in the UK, so you probably won't hear from her till tomorrow.

 

[designergirl]

@thanson1964 I am so sad you are going through this horrible experience. Your medical team have let you down so badly. As I have no medical experience, I will send prayers and good wishes your way.