First test after knee replacement

[Viperdoc]

Re read some other posts. First, Percocet is a combination of Tylenol and oxycodone. You need to be careful about taking too much Tylenol, but probably not more than a total of four grams a day, including that found in the Percocets.

In my opinion, someone beyond six weeks still requiring Percocets for pain should have a close look for infection. If this can pretty much be eliminated by the tests I described, instability would be second on the list.

Beyond three months, there might be an occasional twinge, but it should not hurt on a daily basis without a discreet cause.

Good luck.

 

[JohnO]

Viperdoc,
Thanks for the informative comments. I appreciate them and I will take heed. I saw the physical therapist yesterday and he measured 133 degrees with trousers on. When I shot sitting - for 60 seconds, I was allowed to use a pillow under the right knee to cushion it and I felt no discomfort. Again, I did not push it. The pain I might experience is not necessarily in the titanium joint itself, but the muscles and tendons close to it and the surgeon said that was fairly normal at this time. I don't take oxycodon all the time but once in a while in the evening I might take one to take the edge off the ache which on a scale of 0 to 10 might be a 3 or a 4. I have resumed my trips to the local gym to use the bike and other machine to keep the knee from disuse. The therapist said the knee looks normal.

I used to work in corrections and I have seen what extreme drug use can do to you and your brain. (not YOU, of course) I joked with the surgeon that I could take all those drugs to the street and pay his bill. He was not amused. Then again, when I told him I had the cat lick the wound every night was not laughing, either.

 

[fm1947]

Way to go

 

[jonbearman]

Everyone including doctors always get upset when they learn of pain medicine used on a daily basis.In the 1990's I herniated a disc.I went through physical therapy several times and cortizone injections(lumbar punctures) about 20 times,facet joint cortizone injections and trigger point injections and after 4 years of extreme pain I had a mri which showed that the disc was bulging badly but not to warrant surgery as surgery is the last resort.More cortizone and a weight gain of 60 pounds which made everything worse and finally in may of 2003 now 7 years and counting,both legs were paralyzed momentarily and down on my face on concrete at work.I never missed a day at eastman Kodak for the 7 years of extreme pain I was in.I called the neurologist and told his office that something changed and had another mri.He looked at it and said this is a no brainer.I wept,for the simple fact that someone was actually going to take me seriously.I was operated on less than a week later.I was out of work for 3 months to the day.I went back to work and got laid off just 3 months after returning.They got rid of me for my back period.Now things are going bad and the pain management team put me on vicodin 4 times a day along with neurontin 2700 miligrams a day and 30 mg's of morphine a day to control the unbelievable pain I am in.At least I could take a new job and work or so I thought.You see there is a stigma attached to anyone on painkillers.My pain management team wrote a paper on how well I handled the pain medicine and my attitude towards getting back to work.I was almost unhirable due to the stigma of legal drug use.Alot of people have surgery thinking that is it and go back to work.Not true,they can deny employment to anyone for any reason.The same goes for shooting,if you are on pain killers then you are an instant danger to everyone.It is bullshit .I have been unhappily on pain killers however I am able to do things I couldnt in the 90's and can do it today.My pain medicine is a closely managed and I tolerate it well. To those of you fortunate enough to not need the medicine,you are lucky.To those of us that need it to function on a daily basis ,it is a gift of life. I get really mad when I read comments out of ignorance of managed pain medicine's that give a patient the right to a semi normal life back rather than languish on a couch waiting to die,so let it go.There are those like John O that need it and dont see the walls melting like a bad trip.At best a little tired may be the only side affect.My liver gets checked every 6 months along with other bloodwork.I never abuse my medicine and never will as the levels get checked as well.Do you know what it is like to have extreme nerve pain,no drug will touch it,they just dull it a little. I am facing another surgery now at 53 and the thought of becoming pain free makes me cry.yea cry.I hate not being able to sleep and shovel snow or wrestle with my grandkids anymore.So keep your thoughts to your self and quit criticizing people with disabilitys.I know I will get blasted for this but I dont care.I am a human and I have a right to a semi normal life just like you should too. John You keep getting better.

 

[JohnO]

Jon, I almost cried when I read your post. Like we were related, or something. I suffered for 35 years before somebody finally listened to me and sent me to the Salem, Oregon pain clinic and I got injections in my vertebrae and neck and with a new therapist I can now sleep without extreme back pain for the first time in THIRTY FIVE years. I taken Oxycodon only occasionally in the early evening to take off the edge and according to the surgeon and the therapist, the pain - or ache - will disappear in 5 or 6 months on it's own.

Believe me, I worked at the county jail for 10 years and I know what drug addiction can do to you if you cannot control it because they lack the gene to do it. I saw beautiful young girls with fried brains from drugs and that would never happen to me. Of course, no doctor is going to sanction use of narcotics to control pain for the long term due to the threat of being sued (just my opinion).

I will be 66 in June and I truly enjoy target shooting and the high I get when I can shoot a clean. THAT is a narcotic for me. Too bad Walt Berger isn't a relative who liked me.

I too get blood work done to check functions fairly regularly. If I took the OTC drugs to kill the pain, I'd damage my liver & kidneys if the dose got high enough to work.

Jon, I can truly "feel your pain."

 

[Viperdoc]

There is a big difference between the management of chronic pain compared to pain from an acute event, like surgery. The problem with the chronic use of narcotics for pain management is that the body builds more receptors over time, and ends up requiring more and more to get the same pain relief. Although effective, their use is far from ideal.

On the other hand, persistent pain in a knee replacement can be a sign of other underlying problems, like infection. Most patients do not require prescription meds for more than a month or two, so if the pain persists or worsens, it warrants a close look. Pain can be an important symptom, and it can be easier to write out a prescription and send someone away rather than take the time or effort to look into a problem. It is the wrong approach.

I see at least four patients every week that were told there was nothing wrong with their joint replacement by their original surgeon, only to find their chronic infection, obvious instability, or other problem that had caused suffering for a long period of time.

Chronic pain management is an entirely different issue from acute pain management.

Related to shooting, I built a Krieger barreled 7.7 twist AR, and worked some loads with SMK 77's that consistently shot under .5. Would this accuracy be good enough to use this rifle as a match rifle? Around here it's mostly reduced course, so usually 200 yds.

I also built up a SR with the same twist and Geissele trigger, but still can't hit anything with it. Shooting more than forty rounds prone, or worse, sitting, pretty much is all I can take with either rifle. My left hand goes numb, and it's hard to breathe and my back hurts hunched over sitting.

Are these rifles competitive, and are there any training regimens that would make it more comfortable to practice? I like the shooting, but find that prone and sitting just are painful.

 

[infantrytrophy]

...
Related to shooting, I built a Krieger barreled 7.7 twist AR, and worked some loads with SMK 77's that consistently shot under .5. Would this accuracy be good enough to use this rifle as a match rifle? Around here it's mostly reduced course, so usually 200 yds.

Viperdoc,

Yes, plenty accurate. At 200 yards, you may not even need the SMK 77's, although they are fine. You could use SMK 69's, or even some inexpensive varmint or spire point bullets in the 60 to 77 grain weight class. You need only about 3/4 MOA to hold the X ring on the 200 yd reduced version of the 600 yard slow prone target.

Related example: I am working on fireforming brass for a 6RAT AR-based match rifle. I shoot the fireforming loads in matches at 200 yards with inexpensive 6mm Sierra 85 grain SP (spire point) bullets. They are excellent at 200 yards - I was able to shoot a 100/10X in a practice recently (200 yards) with these inexpensive bullets. I know you are speaking of bullets for a .223 rifle, but the point is that you don't need super-premium components for XTC shooting at 200 yards.

...
I also built up a SR with the same twist and Geissele trigger, but still can't hit anything with it. Shooting more than forty rounds prone, or worse, sitting, pretty much is all I can take with either rifle. My left hand goes numb, and it's hard to breathe and my back hurts hunched over sitting.

Are these rifles competitive, and are there any training regimens that would make it more comfortable to practice? I like the shooting, but find that prone and sitting just are painful.

Yes, the rifles should be competitive. First, make sure that your vision is good (proper eyeglass lenses) to see the post front sight clearly. Very important.

Regarding the numbness and discomfort, I experienced the same things when I started shooting again just over 3 years ago after a 40-year absence from shooting (I'm 63 now and a retired radiologist, BTW). This is completely resolved now, and I'm shooting well. The abduction/external rotation at the shoulder and the C-spine hyperextension may be the cause of much of your problem in the prone position. My issues with this disappeared with more practice and more staying in position to increase my ROM gradually. I actually shot some 80- and 120-shot prone smallbore matches - a brute force way to develop the range of motion and positional comfort required. If this doesn't work for you, then there may be a structural problem - DJD or degen. disk disease with extensive osteophytes, markedly reduced ROM in the shoulder, a cervical rib, and so on. If there are no structural issues, the simple exercises designed to increase ROM are needed. That resolved the issues for me.

For sitting, this requires good ROM at the hips (external rotation) and knees (flexion). Same deal here - devise some exercises or gradual approaches to getting into and staying in position to develop the ROM required. Also, excessive abdominal fat is not conducive to a comfortable sitting position. Wear loose trousers and unbutton your trousers and unbuckle your belt for sitting. For prone position, if there is excessive abdominal fat you can try partly rolling up on your left side by flexing your right knee (for a RH shooter). This reduces intra-abdominal pressure and improves depth of respiration.

My initial problems 3 1/2 years ago disappeared completely. All it took was just forcing myself (gradually but repeatedly) into the positions required, plus a little common sense.

Start with the prone position first - it's the most important in terms of points in the matches, plus you need total comfort for the longer slow fire prone stage. You may find, as I did, that you need a relatively "high" prone position. Bring your sling swivel and left hand back (RH shooter), shorten the sling, and raise the rifle and your head a little higher than some others do. This will reduce the neck hyperextension required, compared to a lower prone position. It will also reduce the extreme degree of upward gaze required of the shooting eye due to the more upright head position, reducing eye fatigue.

The comment above about the sling swivel adjustment applies only to match rifles, of course. For the service rifle, you just slide your left hand back. You may need a "stickier" glove, or a glove with more friction so that your left hand will stay back several inches from the fixed sling swivel of the service rifle.

David Tubb describes this slightly "higher" prone position in his book, "The Rifle Shooter," pp 123 - 126. He attributes the change in his prone position over the years to changes in the rifles, but I'd bet that a significant part of this is due to age-related factors. Just my opinion.

Hope this helps,

Randy

 

[jonbearman]

Viperdoc,if I had another way to end my chronic pain I would,but you are like alot of docs that know the risks but still dont know what chronic nerve and muscular pain feel like everyday of your life.It is a nightmare lived out in every day and minute of your life.Try broken sleep for 17 years,numbness in places I cant describe,legs shutting off,2 neurologists that as usual , look at the 1000.00 mri and say they cant see anything wrong.If I didnt pushm it,I never would have gone to the rochester pain management center.Again alot of docs dont like narcotics.I realize my pain receptors are ruined,but the pain out weighs the risk.If I have to go to something stroger I will but I dont see that right now.I want them to open me up and find out visually what the heck is wrong with me. Imaging sometimes doesnt show all.I think all docs should have to take a course or two on pain management to understand what drives a person for some relief. If I could get off all the garbage I am on and be normal I owuld in a heartbeat.I HATE the meds more than anything.I just want the neurologist to do his job a hundred and ten percent. By the way what is an SR and the other gun should do just fine in comp.

 

[JohnO]

I can now shoot sitting with little or no ache in my right knee. I see no sign of infection and the professionals don't either. What I am experiencing now is exactly what the surgeon had predicted and I trust his judgement. If the knee or leg looked seriously wrong I would obviously do something about it but everyday it gets better.

As for pain management, over the counter drugs do nothing for me unless I take too much of that and that can lead to real problems. I have been there and done that already with Motrin. I am not an addict regarding oxycodone, I don't take it all the time and I don't experience severe pain, only an ache which I believe is normal. I just know it works when I need it. I know exactly what Jon is talking about. I suffered for 35 years with severe back pain because doctors weren't interested in doing anything other than to tell me to take 3200 mg of ibuprofen a day which is insane. Only when I went to a pain clinic and had back injections after extensive testing did I get relief. That, plus a physical therapist who took an interest in me and my brand of target shooting and actually helped me. Do you know what it is like to hate the thought of going to bed at night because you already know you are going to be in pain?

 

[Viperdoc]

People seem to have difficulty making a distinction between pain as a symptom and the use of pain medications for chronic pain. At least to me, there is no emotional connection between the two.

In the first case, a range of motion of 140 degrees, aching at night, and prolonged pain following surgery are consistent with excessive laxity: the knee is loose and the native ligaments are not providing enough stability. Some of these symptoms can also be a sign of a low grade infection. The knee can look normal, as will the xrays, and only lab tests can rule out infection.

If the knee were trending better, then my approach (and that of most surgeons) would be to try weaning off the narcotics, which seems to be the case here. If the pain persisted to the point of still requiring narcotics at three months, iwould be taking a long hard look for other treatable causes of the pain.

On the other hand, back surgery, in the absence of objective findings on plain films, CT, or MRI is not associated with good outcomes. Back surgery is associated with higher risks, including nerve injury, infection, and impotence, and the outcomes are not as predictable as for knee replacement. Clearly, therapy, anti inflammatory medications, and occasionally injections are always more preferable than surgery. As you said, you need to find the right people, and unfortunately sometimes family practice docs or even general orthopaedic surgeons are not the best choice.


I am only trying to provide my perspectives to you as an
academic orthopedic surgeon and university professor. However, my opinion is worth no more, nor should it generate any more of an emotional reaction than anything else you read on the Internet.

 

[JohnO]

Viperdoc, I am not at all ignoring your informative posts nor am I dismissing them. Perhaps I am not being informative enough or I am misstating the symptoms. I can only go by what my wife went through with her knees wich were both replaced as well as observations by the physician and the physical therapist. I wish there were other methods to control ache but they all have their own issues. I am referring to over the counter drugs which do not help and they have their own baggage. With narcotics, it is certainly easy to become addictive. As I stated, I worked in corrections for ten years and I saw my fair share of weak people who over used drugs and would sell their grandmother to get them. I am not at all in that case and I also am aware that some of these perscription drugs have their share of ugly side effects which no doctor wants to see. They also don't want to get sued for telling patients that taking narcotics is OK. My symptoms are waning and I suspect that by July or August, my situation will be different and this conversation will be gone. My first knee surgery on my left knee in 1997 - an arthroscopic surgery - was sore for six months and then one day, the ache and pain were gone as if nothing ever happened.

My surgeon knew that target shooting was all I had left in life that I enjoyed and I asked him prior to cutting on me was that if I could never shoot rapid fire sitting again, then there was no deal, but he saw no reason why I couldn't so I guess the rest is history. It didn't help my case by being a stubborn Swede who wasn't going to quit and stake out a seat on the couch.

At almost 66, bowling, tennis, golf and maybe even sex are out of the question so gun shooting will have to do....

 

[Viperdoc]

I do not feel the need to be "right" or proven correct, it is simply my input based upon the medical literature, my training, and experience. I have no emotional stake in these cases, and was not involved in the surgeries.

Over the weekend I was on call: the first night we operated on a gunshot victim all night. He is only 20, has been in prison, and had warrants for murder. Then, Saturday night we operated on a guy who was drunk and driving the wrong way on the interstate. Sunday we did a hip fracture on an elderly woman, which has a mortality of nearly 20%, and Monday morning at 0330 we operated on a guy who had been hit by a car while crossing the street.

Point is that we work all day and all night to save these patients' life and limbs. Who they are or what they did does not alter our efforts to do our best. From my perspective it is pointless to engage in bargaining or anything else that might compromise getting a good result. So, I can only offer my best advice, but no longer get upset trying to prove a point. I try to do my best, and then move on. I cannot afford to make personal judgements on people or their practices, there is more than enough to do just taking care of my own patients.

Shooting my SR, I am glad to keep everything in the nine ring (we only have 200). I have a223 AR match/varmint gun and am having fun working up loads for our PD trip this summer. Would like to see 0.5 groups with light varmint bullets, but stlll having trouble getting there.


It is so much easier with my 6.5 cm bolt gun compared to the AR.