TKR Where is this "Other Side" of which you speak?

[rjrober23]

Hello all (an update and a rant),

I haven't posted for a bit. I have had the worst 48 hours since I came home from the hospital! Pain, pain and more pain. Friday at PT, she wanted me to move to a 6" step for 2 sets of 20 step-ups. I had only been on the 4" step once, and that did hurt, but not too bad. I said it was too tall, she said, try it, I did and said again, it's too tall. She said 2 sets of 20. Stupid me trying to be a "good girl" and do what I'm told, I go ahead with the 20. By the time I finished I could feel my knee swelling tighter and tighter. I said that to the PTs and they said now do side step ups. Again with the negotiating about the height. I did one and said, NO, since my knee was now hollering at me. So we go to the 4, which by this time is too much and again with the 2/20 business. By this time I'm resigned to my fate. Needless to say, by the end of the session I was hurting (and I had taken pain meds an hr before the appointment). So the rest of the day was shot while I elevated iced and took my Norco.

I wasn't paying close attention to my quantity of pain meds either and my doc closes at noon on Fridays. We had a wedding to go to Saturday. My niece, which I was really looking forward to. (I'll spare you the details of trying to struggle into a pair of tights which must have been the wrong size as they were very long and the waistband was up to my bra!) anyway, the wedding was beautiful and I enjoyed chatting with siblings and great aunts and cousins, but it was a long event. We got home after 9 and I was beat. I ended up taking the last of my pain meds when I woke up during the night. It was a downhill spiral from there.

The "they" that follows is my ortho's office. They took me off the Percocet after just 2 weeks at home and gave me Norco instead at a lower dosage and longer interval. At 3 weeks! Anyway, I ramble.

The past two days have been awful to put it bluntly. Doc's answering service and on-call doc won't do prescriptions after hours. I tried just about every OTC analgesic in our medicine cabinet with middling results. No sleep, lying on the sofa for two days in a blur of pain and tears. All I could do was moan and rock and pray for relief.

Finally this morning got the refill request called in. It took about all day for them to order it from the pharmacy. They have been giving me Norco 7.5-325. The script reads 1-2 every 8-12 hours. A couple weeks ago I called the Dr and said I have break-through pain (level of about 5-6) after just 4 hours. So they said take the hydrocodone every 6 hours. That still meant I am chasing my pain and never really able to be comfortable in PT or sleeping. They won't change the prescription to read 6 hours and have been doling out the pills 1 week at a time. Today they said that the next prescription would be scaled back?! I feel like I'm being judged as a drug seeking addict. It's like they all know something and I'm not in on the secret.

I am so frustrated and angry at this point. I'm in pain, being pushed into very aggressive PT and being treated like I'm at fault or doing something shady. I am just 5 weeks from surgery tomorrow. I think I have made a lot of progress in ROM and strength. I walk without cane or walker most of the time. Yes, I am becoming depressed and feel like I've just come out of a battle.

It wasn't so difficult managing pain with my right knee back in May. I don't know what has happened. Do people not believe me when I say no or I'm hurting? I have a usually calm demeanor and bear up as much as I can, but I am tired of fighting to be listened to and heard.

 

[rjrober23]

PS- I am printing out some of the articles on myths in recovering from TKR to give to Doctor, nurses and therapists.

 

[rjrober23]

Finally! It took 18 hours, but I slept through most of the night. My knee only hurt a bit (about a 3 on pain scale). I did try to elevate, but I'm a side sleeper, so I put a pillow between my knees. This also helps my sciatica, which has calmed down a little. I feel sooooo much better today. Maybe I'll even brush my hair; I think it's felted in the back.

So my husband came home with my prescriptions, potato chips (like I need the salt!), ice cream and minions. I hadn't eaten for a day and a half, so I went for yogurt instead and shared the chips all around later. Thank you for this forum, it helps so much to find that you're not alone on your boat, but in the company of many on a very large ship.

 

[Josephine]

I feel like I'm being judged as a drug seeking addict. It's like they all know something and I'm not in on the secret. I don't know what has happened. Do people not believe me when I say no or I'm hurting?

What's changed is not you but them. I do believe that the law enforcement is tightening up on doctors in regard to handing out too many scripts for narcotics and they can get fined or worse if found to be transgressing in the eyes of the officials. Some get more jumpy about this than others and as a result, it's the patients that suffer when their doctor's go into defence mode.

I'm in pain, being pushed into very aggressive PT and being treated like I'm at fault or doing something shady. I am just 5 weeks from surgery tomorrow. I think I have made a lot of progress in ROM and strength. I walk without cane or walker most of the time. Yes, I am becoming depressed and feel like I've just come out of a battle.

If you are having your pain meds withheld, it's even more crucial that you put your foot down with a firm hand about all this aggressive PT. You can do without it. You can do it on your own like a lot of other people do. It's not necessary and it's also your choice. As a final salvo, what she is doing will also only stall your recovery. Do you have the strength to do that? To be firm and assertive and say "No more"?

 

[rjrober23]

Update- I ended up going to the OS practice Friday so the PA could check my incision. I have 2 areas, near the upper end of the incision, that have not completely healed. They both have what appears to be suture thread poking through. That in itself didn't seem to be a problem. However when I took my shower Thursday and was drying my leg, I noticed that there was a hole around those threads. One was 2-3mm deep and about 2mm x 4mm long. The other was smaller and not so deep. I think when the skin was soft from showering or during the shower, I brushed away the scabby material surrounding the threads. (It's not like I scrubbed the knee or anything! I am very careful.) Husband said call doc. They said come in for a look. She cleaned the area and put 3 steri-strips across and said not to touch it. Last night (Saturday) I noticed there was some oozing from under the strips. This morning I uncovered the area and it was looking red, with a small amount of fluid in the areas. Not good. I cleaned with a sterile wound cleanser and put some silver sulfadiazine cream and covered with band aids. (I've always had good results with that cream on small wounds that appear to be getting infected. They are usuall much better in 24 hours.)

So tomorrow I'll call the Dr office. I'm scheduled for x-rays and visit on Wednesday. I DO NOT want any infection!

I told the PA that I was having issues with pain management and after a brief conversation she ordered more pain meds and gave me some suggestions for reducing the amount I'm taking. She did emphasize not to try and stretch the meds if it results in an increase in pain. So I have decided that it is far easier to talk about the pain and medication issues in person than over the phone. I felt no judgement or push back from her.

I have been taking 2 hydrocodone (Norco 7.5/325) every 6 hours. It's only been the past 5 days that dosage and frequency have worked well. For reducing the amount of narcotic pain med, She suggested to take 1 Aleve liquid gel first thing in the morning, wait 3 hours and take 1 Norco, wait 3 hours and take another Norco if needed. If not wait 6 hours and so on, taking 1 Aleve 8-12 hours apart. I haven't tried this yet. The cold weather has everything hurting. It sounds like a viable approach.

That's my story so far. I haven't been to PT all week, just stretchy bendy stuff at home. I'm going to go back on Tuesday. We'll see how it goes after I have a talk with the therapist.

 

[Josephine]

They both have what appears to be suture thread poking through. They said come in for a look. She cleaned the area and put 3 steri-strips across and said not to touch it. Last night (Saturday) I noticed there was some oozing from under the strips. This morning I uncovered the area and it was looking red, with a small amount of fluid in the areas.

It will be until they trim the sutures. Until then, they are holding open the wound. Go back and see the PA again before it gets infected.

I'm glad she's been more helpful in regard to the pain meds but you never responded to my suggestion that you reduce that crazy amount of PT you are being asked to do. It's in your hands - refuse to do it.

 

[rjrober23]

Well so far I'm passively resisting the excessive PT. In other words I haven't scheduled any more sessions. I will be talking to her, or them as the case may be, when I go back. She needs to understand that at 54 years I know my body well and if I'm to put trust in her expertise, I need to know she will listen to me and BELIEVE me when I say "No". Further conversation with my OS about PT and pain management will happen at my Wednesday appointment.

It's so bitter cold here I wouldn't be going to PT anyway. My husband is back to work after the holidays and I'd have to drive myself. I won't go to PT without pain meds and can't drive while on them. I haven't tried getting in my car or driving since I'm just at 6 weeks. My car is a compact, low to the ground and a manual, so clutch operating w/my left foot.

 

[rjrober23]

Fester. Sutures. So antibiotics have helped reduce inflammation with the migrating suture material. Yesterday, I saw that I could grab the threads with tweezers. Clean of course the area, the tweezers, my hands. A week ago, there was resistance so I left them alone. Yesterday two pulled out easily. A centimeter long and corkscrewing at the top where it they were exiting. Today another piece that was getting all wadded into a knot. I think there might be another piece, but those areas already look like they are calming. I'm going to call tomorrow about maybe extending the antibiotic course. It hurts, but like splinters and surface cuts, a little stinging. No longer hot, hard and oozing. Thank you.

I've decide to wait on continuing physical therapy at a later date. I want to get in the pool when the incision areas are closed. Meantime, a friend and I are going to meet for walks, which will be good for fresh air and change of scenery. My classes got canceled, so I'm able to heal at my own pace. Whew!

 

[Josephine]

A centimeter long and corkscrewing at the top where it they were exiting.

Where you instructed to do this? Because it's not a very good idea (for which read 'a very bad idea'!). The exposed ends are contaminated and when you grab one end and pull it out, it' means the other dirty end is pulled through internal tissues and could set up infection. They should be trimmed as I suggested previously.

The corkscrewing is where the thread was knotted!

 

[rjrober23]

Yes, ma'am. I have been properly admonished. (Although the PA at my OS office said she did the same thing.) I didn't pull exposed ends through, these pieces were clean and unattached. So everyone else don't do what I did! Fortunately, everything in the area is finally settled, scabbed and healing.

I have confirmed that I am not ready for prime time. I went with my Dad last week when he had a procedure. It was all afternoon, that was the longest I had been out on my own. Knee was pretty swollen and hurting when I got home. I was wiped out the next couple days. Glad I'm not teaching. If I were, I'd need more frequent pain meds when I got home and the next day. My pain is primarily of the achey variety, feels like its in the bone. Swelling mostly decreases range of motion, but elevating and ice still help any pain.

One of my primary pain problems has nothing to do with surgery. (At least I don't think so.) I have peripheral neuropathy that is really affecting my feet. It's worse on the left leg. That's my sciatica flaring side and my most recent surgery. I also have type II diabetes, but sugar levels tend to stay below 200. I have good sensitivity to touch on my soles, it's the fiery redness and sensations that are the worst. I take Neurontin 2100mg per day, which helps. I'm going to ask my doctor about going back on Lyrica too. Of course the Norco does help that too, so I need to keep that in mind when talking to my doctors about pain management.

DH is home today MLK Day, so I think an afternoon excursion is in the offing.

 

[Josephine]

Oh you poor thing! That sounds horrible. Is it as a result of your diabetes? (I'm unfamiliar with US measurements)

 

[rjrober23]

Some of it must be Diabetes. My toes and soles of my feet get bright red when the neuropathy is really zinging. Since it's worse on the left foot, I'm thinking a good bit is due to nerve compression. The surgery with the increase of deep inflammation has aggravated this mightily! I started Lyrica (Pregabalin) yesterday. I think it will help.

Good news is my little sores where sutures were exposed have healed over. Now that skin is closed, I'd like to get in the pool. Not tomorrow! Wind chills at -15°F to -28°F.

 

[rjrober23]

Weird nerve pain this evening. I have pain that feels like stabbing located around where the post surgery drain exited and deep in toward the knee. It hurts, but doesn't respond to rubbing. Must be nerves getting regrown.

 

[Josephine]

Maybe - you can never tell with nerves. They have minds of their own sometimes!

 

[rjrober23]

So back to my former TKR- right knee, 8 months out at this point.

Pain is localized to rows C and D, columns R3 and R4. Pain ranges from a tearing feeling at 6 to an aching feeling at 4.​

I have pain when standing up from a sitting position and going up or down stairs. Weight bearing through range of motion. Earlier in this thread, Josephine suggested it could be tendon or ligament issue. Do these types of issues show up on MRI or other imaging? Should I ask my surgeon or GP to send me. Actually, with our insurance I don't need a referral. Is there a Kinesio taping meth

It's been impossible to give the right knee time off since I had the left TKR. So increase in pain. Sigh!

 

[Josephine]

... tendon or ligament issue. Do these types of issues show up on MRI or other imaging?

Only if it is accompanied by significant swelling/oedema.

 

[rjrober23]

Been up and down the stairs a lot in the last week. I am figuring out that part of the pain in my right knee is an issue of mechanics on the stairs. If I get myself in proper form, the stress is less on the tissues of the knee. This means paying close attention to my form until it becomes habit.

 

[Josephine]

Your 'form'? Do you mean your gait?

 

[rjrober23]

I don't know if 'gait' applies on stairs, but yes in a way. I've figured out that I use my knees more than my glutes and quads when I go up stairs. It might be a consequence of old house with narrow treads and carpet. It is hard to have my whole foot on the stair. If I get it right, I push through my heel with a deeper squat and use my gluteus very maximus to lift myself up to the next stair. In PT they tell you to stick your butt out, almost like sitting down. Since it's not habit, I have to exaggerate the motion. Of course this is all in the privacy of my home.

 

[rjrober23]

I've been flat on my back the past couple days. Major back attack, spasms so standing, walking, sitting, etc. very difficult. I couldn't even go up the stairs to bed. Stayed on the couch and took my meds. I still don't know why, but it's getting better. If it's not one thing...