CAJUNLAWYER
Member
So when are you gonna send me the money for that gun you bought from me yesterday???
Ice Water Machine for Knee Surgery Recovery
- Thread starter Onomea
- Start date
CAJUNLAWYER
Member
Add a generous slug of Bailey's and you might have a new coctail there!!
I just about spit a pretzel nugget across the room after reading that. Nice one Caj
OP
A Prescription Fumble but a Better Day Today
Today, third day post op, less pain than yesterday. So far anyway, at 1500/3 PM.
Ice water machine is chuggin' along nicely. Feeling better. Exercises, bending that knee, hurt(s), as expected, but not unbearably so by any means.
The swelling, and the pain, ramped up yesterday,
Reviewing my hospital discharge documents, my meds list, specifically, I noted that the oxycodone dose listed in the documents was 1-3 tabs, 5-15 mgs, every three hours as needed.
Hmm.
Then checked, again, the label on the oxycodone bottle that my wife picked up, after we left the hospital Monday from Walgreens. Label says 1-2 (5 mg tabs) tabs every four to six hours as needed...
That's a pretty significant difference. An increase of a third in dosage and a decrease of 25% in the interval between administering it.
So, discovering this discrepancy mid morning yesterday, knee throbbing, I called up my surgeon's office to ask which dosage was correct for me. Sure don't want to go over the correct limits on a narcotic.
(Also, thinking ahead, wanted to be sure I did not run out of pain killer over the weekend with no access to my doc to get a new script. Their policy is make your request by noon on Friday or wait until Monday.)
Wound up leaving a message on an answering machine asking for a return call.
My surgeon's medical assistant, when she called back several hours later, around 2 PM, said Walgreens probably did not realize the usage was for immediate post surgery. Dosage of 1-3 every three hours is correct, she said. Then she helpfully added that for the refill script, upon my doc's approval of issuance, that she'd send to Walgreens, she'd add the code to tell 'em it was for immediate post surgery.
(Well duh, and thank you very much!
)
Somewhere in there, late morning, I also called my insurance company and asked why only 42 tabs were covered from the initial 50 tab prescription that my wife picked up at Walgreens. (Walgreens told my wife that my insurance company would not cover more than 42. The insurance company, after putting me on hold, came back to say it must be because the pharmacy wanted to see how I would tolerate the medication before fully filling the prescription. As far as they are concerned, they said, they will cover a month's supply...
There's a message here, I think. Nobody cares as much about you, or your loved ones, as you do. Follow up on this stuff, because if you don't, likely no one else will.
Anyway, feeling better today. Getting around pretty good on the walker.
Today, third day post op, less pain than yesterday. So far anyway, at 1500/3 PM.
Ice water machine is chuggin' along nicely. Feeling better. Exercises, bending that knee, hurt(s), as expected, but not unbearably so by any means.
The swelling, and the pain, ramped up yesterday,
Reviewing my hospital discharge documents, my meds list, specifically, I noted that the oxycodone dose listed in the documents was 1-3 tabs, 5-15 mgs, every three hours as needed.
Hmm.
Then checked, again, the label on the oxycodone bottle that my wife picked up, after we left the hospital Monday from Walgreens. Label says 1-2 (5 mg tabs) tabs every four to six hours as needed...
That's a pretty significant difference. An increase of a third in dosage and a decrease of 25% in the interval between administering it.
So, discovering this discrepancy mid morning yesterday, knee throbbing, I called up my surgeon's office to ask which dosage was correct for me. Sure don't want to go over the correct limits on a narcotic.
(Also, thinking ahead, wanted to be sure I did not run out of pain killer over the weekend with no access to my doc to get a new script. Their policy is make your request by noon on Friday or wait until Monday.)
Wound up leaving a message on an answering machine asking for a return call.
My surgeon's medical assistant, when she called back several hours later, around 2 PM, said Walgreens probably did not realize the usage was for immediate post surgery. Dosage of 1-3 every three hours is correct, she said. Then she helpfully added that for the refill script, upon my doc's approval of issuance, that she'd send to Walgreens, she'd add the code to tell 'em it was for immediate post surgery.
(Well duh, and thank you very much!
)Somewhere in there, late morning, I also called my insurance company and asked why only 42 tabs were covered from the initial 50 tab prescription that my wife picked up at Walgreens. (Walgreens told my wife that my insurance company would not cover more than 42. The insurance company, after putting me on hold, came back to say it must be because the pharmacy wanted to see how I would tolerate the medication before fully filling the prescription. As far as they are concerned, they said, they will cover a month's supply...
There's a message here, I think. Nobody cares as much about you, or your loved ones, as you do. Follow up on this stuff, because if you don't, likely no one else will.
Anyway, feeling better today. Getting around pretty good on the walker.
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AJ
US Veteran
Today, third day post op, less pain than yesterday. So far anyway, at 1500/3 PM.
Ice water machine is chuggin' along nicely. Feeling better. Exercises, bending that knee, hurt(s), as expected, but not unbearably so by any means.
The swelling, and the pain, ramped up yesterday,
Reviewing my hospital discharge documents, my meds list soecifically, I noted that the oxycodone dose listed in the documents was 1-3 tabs, 5-15 mgs, every three hours as needed.
Hmm.
Then checked, again, the label on the oxycodone bottle that my wife picked up, after we left the hospital Monday from Walgreens. Label says 1-2 (5 mg tabs) tabs every four to six hours as needed...
That's a pretty significant difference. An increase of a third in dosage and a decrease of 25% in the interval between administering it.
So, discovering this discrepancy mid morning yesterday, knee throbbing, I called up my surgeon's office to ask which dosage was correct for me. Sure don't want to go over the correct limits on a narcotic.
(Also, thinking ahead, wanted to be sure I did not run out of pain killer over the weekend with no access to my doc to get a new script. Their policy is make your request by noon on Friday or wait until Monday.)
Wound up leaving a message on an answering machine asking for a return call.
My surgeon's medical assistant, when she called back several hours later, around 2 PM, said Walgreens probably did not realize the usage was for immediate post surgery. Dosage of 1-3 every three hours is correct, she said. Then she helpfully added that for the refill script, upon my doc's approval of issuance, that she'd send to Walgreens, she'd add the code to tell 'em it was for immediate post surgery.
(Well duh, and thank you very much!
Somewhere in there, late morning, I also called my insurance company and asked why only 42 tabs were covered from the initial 50 tab prescription that my wife picked up at Walgreens. (Walgreens told my wife that my insurance company would not cover more than 42. The insurance company, after putting me on hold, came back to say it must be because the pharmacy wanted to see how I would tolerate the medication before fully filling the prescription. As far as they are concerned, they said, they will cover a month's supply...
There's a message here, I think. Nobody cares as much about you, or your loved ones, as you do. Follow up on this stuff, because if you don't, likely no one else will.
Anyway, feeling better today. Getting around pretty good on the walker.
I worked with six different Orthopedic surgeons and none of them ever ordered more than 10 mg of oxycodone every 4 hours for pain. Your guy must be pretty generous with his pain meds. We did about 600 knees and hips a year between scheduled and unscheduled. Watch you narc intake and ensure you have a BM every three days at least. Or you may be looking at a bowel blockage.
OP
AJ, thanks for the continued advice and comments.
Had difficulty with BM yesterday evening/night as I came up on two and a half days since the pre op movement. In addition to your advice, discharge papers also mention three days as a not-to-exceed limit for no BM. In addition to routine, standard approaches, tried AJ's cocktail in early mid/afternoon. No luck six hours later..
At that point, keeping this family friendly, decided heroic — if store bought — measures were called for. Once initiated, met with success late yesterday, and, with no further intervention, several times this morning.
Will continue to watch this closely. The oxycodone does freeze one up down there.
Eating a lot of fruit and drinking a lot of liquids.
Had difficulty with BM yesterday evening/night as I came up on two and a half days since the pre op movement. In addition to your advice, discharge papers also mention three days as a not-to-exceed limit for no BM. In addition to routine, standard approaches, tried AJ's cocktail in early mid/afternoon. No luck six hours later..
At that point, keeping this family friendly, decided heroic — if store bought — measures were called for. Once initiated, met with success late yesterday, and, with no further intervention, several times this morning.
Will continue to watch this closely. The oxycodone does freeze one up down there.
Eating a lot of fruit and drinking a lot of liquids.
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AJ
US Veteran
That is the problem with any of the aids/concoctions to assit your bowels. Once the flood gates open sometimes they open multiple times!!!
OP
Some Useful Ideas for Recovery
A couple of other things that have been quite useful for me, that I'd like to pass on to those of you, or your loved ones, who may have a knee replacement done:
Get a grab stick. A stick with a pincer on one end and a squeeze handle on the other to allow you to pick up stuff that you can't reach. This is handy for a number of tasks: Dressing, picking up something off the floor, or from a part of your bed that you can't reach, and (and this is surprisingly useful) arranging blankets to cover your feet (or your wife) while in bed in the middle of the night.
This next is a maneuver not a tool: To lift your bad leg (the one with the surgically replaced knee), wiggle your good leg, top of foot, under it and lift the bad leg with your good leg. This helps a lot, reduces pain, for getting in and out of bed, or moving your bad leg to a more comfortable position when lying in bed.
When you are healthy, and your knees work, the above seems hardly worth noting. When a knee is painful, and does not work, both are godsends.
Have also learned that a total of 12 water bottles for freezing, insertion, and use in the ice water machine are not enough. Need 18, if running around the clock, given the time taken to thoroughly freeze.
A couple of other things that have been quite useful for me, that I'd like to pass on to those of you, or your loved ones, who may have a knee replacement done:
Get a grab stick. A stick with a pincer on one end and a squeeze handle on the other to allow you to pick up stuff that you can't reach. This is handy for a number of tasks: Dressing, picking up something off the floor, or from a part of your bed that you can't reach, and (and this is surprisingly useful) arranging blankets to cover your feet (or your wife) while in bed in the middle of the night.
This next is a maneuver not a tool: To lift your bad leg (the one with the surgically replaced knee), wiggle your good leg, top of foot, under it and lift the bad leg with your good leg. This helps a lot, reduces pain, for getting in and out of bed, or moving your bad leg to a more comfortable position when lying in bed.
When you are healthy, and your knees work, the above seems hardly worth noting. When a knee is painful, and does not work, both are godsends.
Have also learned that a total of 12 water bottles for freezing, insertion, and use in the ice water machine are not enough. Need 18, if running around the clock, given the time taken to thoroughly freeze.
Remember: "Pain is weakness leaving your body."
AJ
US Veteran
OP
Use adequate insulation on knee for ice-water machine
Here's another tip for the ice water machine: Be sure to adequately insulate your skin from the knee wrap/bladder.
The instructions for the machine state that the pad should not be placed directly against the skin (to avoid frostbite and such). It's not an issue when first out of the hospital because one's knee is well wrapped in two wide, elastic, "stretch/pressure" bandages to help control swelling. They send you out with a well insulated knee. When you strap on the ice water machine over these, it takes time for the cold to penetrate these bandages
The hospital advises that you remove these elastic bandages in a a few days. (The wound itself has it's own, stick on, sterile bandage.) When I asked about timing for removal of the elastic wrap bandages, I was told it was up to the patient but that it was best to remove then for the sake of the skin, so that the skin could breath. I removed mine before my first post-op real shower.
After the shower, since I was wearing pajamas, I thought the cloth of the pajama leg would be sufficient for insulation. For the first 24 hours or so it was, but the machine became increasingly uncomfortable, in a nagging, unpleasant discomfort sort of way, so I started taking it off for hours at a time. I then realized that the issue was insufficient insulation.
With a bit of experimentation, I've learned that one of the wide "stretch/pressure" bandages, loosely applied under the pajama leg, is perfect.
Here's another tip for the ice water machine: Be sure to adequately insulate your skin from the knee wrap/bladder.
The instructions for the machine state that the pad should not be placed directly against the skin (to avoid frostbite and such). It's not an issue when first out of the hospital because one's knee is well wrapped in two wide, elastic, "stretch/pressure" bandages to help control swelling. They send you out with a well insulated knee. When you strap on the ice water machine over these, it takes time for the cold to penetrate these bandages
The hospital advises that you remove these elastic bandages in a a few days. (The wound itself has it's own, stick on, sterile bandage.) When I asked about timing for removal of the elastic wrap bandages, I was told it was up to the patient but that it was best to remove then for the sake of the skin, so that the skin could breath. I removed mine before my first post-op real shower.
After the shower, since I was wearing pajamas, I thought the cloth of the pajama leg would be sufficient for insulation. For the first 24 hours or so it was, but the machine became increasingly uncomfortable, in a nagging, unpleasant discomfort sort of way, so I started taking it off for hours at a time. I then realized that the issue was insufficient insulation.
With a bit of experimentation, I've learned that one of the wide "stretch/pressure" bandages, loosely applied under the pajama leg, is perfect.
I used a large hand towel for insulation. Worked great.
OP
Two weeks and four days since the operation.
Doc and PT guys say I am doing great. Hit 103° flexibility in my knee two days ago with the PT guy wrestling with it, pinning it back under the bed/counter I was sitting on, feet well off the floor.
He's saying, "Tell me if it's too much and you want me to stop..."
I'm saying, gritting my teeth, "Use your judgement," and thinking, "Ow! Sure hope he backs off soon!" That, and "Thank God for pain meds!"
For PT, it is important to time your consumption of pain meds so that they are at max effect during PT. So go longer between doses beforehand if need be to time it right. Done properly, the PT is gonna hurt, regardless, but it is gonna hurt a whole lot less if you time the meds right.
Last Sunday and Monday, before it got too hot, went for walker and cane assisted walks of 0.7 miles. Started with the cane and switched to the walker about a third of the way in.
I think I prepared for this as best I could, with the preoperative PT sessions and by not waiting until my bad knee was virtually non functional. And I am trying to do everything right in recovery. That said, there is no getting around it that it is a slog.
No easy way to do it.
Having had a partial in my left knee to compare to the full in my right, I can also say that a partial is easier in terms of time to recover and in that it hurts less. But be sure you are a good candidate for the partial. If your knee is too far gone, having a partial done may mean that the knee has to be redone later. In my case, I suspect my partial knee doc (in Japan) is too partial to partials. (After that op he said to me, "Well, the other side of your knee was farther gone than I realized, but no worries 'cause if it gets worse we can just stick in another partial for that side....") I may need it reworked sometime in the future.
I remain a big believer in this knee joint replacement surgery, and recommend anyone with bad knees consider it. If successful, as almost all are, and which is something the patient has a lot of control over through diligence with the PT , it is life changing for the better.
Doc and PT guys say I am doing great. Hit 103° flexibility in my knee two days ago with the PT guy wrestling with it, pinning it back under the bed/counter I was sitting on, feet well off the floor.
He's saying, "Tell me if it's too much and you want me to stop..."
I'm saying, gritting my teeth, "Use your judgement," and thinking, "Ow! Sure hope he backs off soon!" That, and "Thank God for pain meds!"
For PT, it is important to time your consumption of pain meds so that they are at max effect during PT. So go longer between doses beforehand if need be to time it right. Done properly, the PT is gonna hurt, regardless, but it is gonna hurt a whole lot less if you time the meds right.
Last Sunday and Monday, before it got too hot, went for walker and cane assisted walks of 0.7 miles. Started with the cane and switched to the walker about a third of the way in.
I think I prepared for this as best I could, with the preoperative PT sessions and by not waiting until my bad knee was virtually non functional. And I am trying to do everything right in recovery. That said, there is no getting around it that it is a slog.
No easy way to do it.
Having had a partial in my left knee to compare to the full in my right, I can also say that a partial is easier in terms of time to recover and in that it hurts less. But be sure you are a good candidate for the partial. If your knee is too far gone, having a partial done may mean that the knee has to be redone later. In my case, I suspect my partial knee doc (in Japan) is too partial to partials. (After that op he said to me, "Well, the other side of your knee was farther gone than I realized, but no worries 'cause if it gets worse we can just stick in another partial for that side....") I may need it reworked sometime in the future.
I remain a big believer in this knee joint replacement surgery, and recommend anyone with bad knees consider it. If successful, as almost all are, and which is something the patient has a lot of control over through diligence with the PT , it is life changing for the better.
AJ
US Veteran
hemiram
Member
Not everyone loves the ice water machine. I'm one of them. I tore my quadriceps tendon off my left kneecap. Hurt like hell. I had surgery and my leg came back alive with the ice water machine pumping away, it drove me up the wall, very uncomfortable! Almost immediately, I began asking the nurses to take it off. The only pain I had was right after the surgery from a muscle spasm due to my disconnected quadriceps drawing way up into my thigh because my surgery was delayed for 2 days. I found out that night that I'm immune to intravenous morphine, it does nothing to me. I had three ampules of it and wasn't the slightest bit drowsy and was still complaining about the ice water machine. They gave me a couple of Percocets and I went to sleep for 4 hours, and woke up without any pain, but the ice water machine was intolerable. The doctor ordered the ice taken out, but the room temp water left to circulate. When he came in the next morning, he allowed the ice water machine to go bye-bye. It was the WORST part of my recovery, by far. The 16 hours or so it had ice in it were miserable.
My mother hated the ice water machine when she had her knee replaced, so I guess hating cold packs, etc, is genetic. When I mentioned the ice water machine to her doctor later on, he said, "Let me guess, you complained about it too?". Point is, if you are one of the rare people who doesn't like the ice water machine, tell your doctor! Don't suffer because, "Most people like it a lot!". They originally wanted to have it run for 72 hours. I would have taken it off myself long before that. When I found out I paid for it, I wasn't happy at all, and tossed it into the trash before I left the hospital.
My mother hated the ice water machine when she had her knee replaced, so I guess hating cold packs, etc, is genetic. When I mentioned the ice water machine to her doctor later on, he said, "Let me guess, you complained about it too?". Point is, if you are one of the rare people who doesn't like the ice water machine, tell your doctor! Don't suffer because, "Most people like it a lot!". They originally wanted to have it run for 72 hours. I would have taken it off myself long before that. When I found out I paid for it, I wasn't happy at all, and tossed it into the trash before I left the hospital.
OP
That's interesting, Hemiram. Never occurred to me that some people would find it's presence more uncomfortable than it's absence. Just goes to show we are all different.
Advocating for yourself as a patient is definitely worth doing.
Advocating for yourself as a patient is definitely worth doing.
Good luck and hope you are back 100% soon. Amazing what they can do with knee and hip replacements these days.
OP
About elevating your leg
Another tip which I hope makes it easier for folks who decide to have this operation: The docs, nurses and PT people will tell you to elevate, raise your leg, prop it up, several times a day so that your foot is above your heart. The reason for this is to reduce the swelling in your leg, especially knee and lower leg, that results from the trauma of the surgery. Gravity helps drain the swelling.
What they don't tell you is if you just prop up your lower leg on pillows or whatever, it's very uncomfortable. You won't be able to hold the position for long. You need to build a sloping support that begins under your thigh and continues on the upslope until it is under the heel of your foot. After experimenting, I use a bed pillow, a smaller sofa cushion, a folded up blanket, and a rolled up towel to build the slope.
If your entire leg is supported, an elevated leg is comfortable.
------
It's been four weeks since the operation. The knee still hurts, but a lot less than earlier on. Inside the house I now walk, gingerly, without a cane. Outside the house, most days I walk between 2/3 of a mile and a mile, slowly, with a cane, along fairly flat terrain. Takes me about 50 minutes or so. Drove the car for the first time since the op today, and that went well. Doing my supervised PT at a local clinic twice a week, and on my own at home the other days. Sleep is still a bit of a challenge, as when I move the leg wakes me up, but this, too, is improving I think.
Now in bed, leg elevated, ice water machine strapped on, and another day is just about done...
Another tip which I hope makes it easier for folks who decide to have this operation: The docs, nurses and PT people will tell you to elevate, raise your leg, prop it up, several times a day so that your foot is above your heart. The reason for this is to reduce the swelling in your leg, especially knee and lower leg, that results from the trauma of the surgery. Gravity helps drain the swelling.
What they don't tell you is if you just prop up your lower leg on pillows or whatever, it's very uncomfortable. You won't be able to hold the position for long. You need to build a sloping support that begins under your thigh and continues on the upslope until it is under the heel of your foot. After experimenting, I use a bed pillow, a smaller sofa cushion, a folded up blanket, and a rolled up towel to build the slope.
If your entire leg is supported, an elevated leg is comfortable.
------
It's been four weeks since the operation. The knee still hurts, but a lot less than earlier on. Inside the house I now walk, gingerly, without a cane. Outside the house, most days I walk between 2/3 of a mile and a mile, slowly, with a cane, along fairly flat terrain. Takes me about 50 minutes or so. Drove the car for the first time since the op today, and that went well. Doing my supervised PT at a local clinic twice a week, and on my own at home the other days. Sleep is still a bit of a challenge, as when I move the leg wakes me up, but this, too, is improving I think.
Now in bed, leg elevated, ice water machine strapped on, and another day is just about done...
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AJ
US Veteran
Try taking either some Tylenol or oxy just as you go to bed. May give you a few hours of uninterrupted sleep.
AJ
i used an ice machine too after my right knee replacement...(may 4) worked great!!
...i plan to buy a small ice machine before my oct 5th left knee replacement so my wife does not have to go buy ice....our refridge does not put out but a quart of ice cubes before dry, we need an ice machine.
i'd love one like the hotels use but will probably find a cheaper one. the cheap one's you have to remove the ice when ready for the next batch to freeze....not super handy, but in my price range.
...i plan to buy a small ice machine before my oct 5th left knee replacement so my wife does not have to go buy ice....our refridge does not put out but a quart of ice cubes before dry, we need an ice machine.
i'd love one like the hotels use but will probably find a cheaper one. the cheap one's you have to remove the ice when ready for the next batch to freeze....not super handy, but in my price range.
