A friend has just undergone her second knee replacement surgery and was in excruciating pain. Prior to now she was using heavy duty narcotic pain meds and was tired of being doped out but also had this severe pain throughout her leg. The first replacement knee surgery did not take, therefore this second procedure which was much more painful.
This has been an interesting week. I’ve had the opportunity to show her how to use the Infrex Plus unit.
It has been literally decades since I’ve gone to a patient’s home to help so new experience, but also very enlightening to me since once you see a patient it helps you keep focused on what your real mission is, helping others not have pain and heal. Here were my observations:
1. The first day one major complication was the muscle cramping which occurred during any movement ( cpm being used as well as ice machine ). Our first mission was to stop the cramping and our remedy was multiple IFT treatments on, an as needed basis, to calm the muscles trying to move them away from tenseness to relaxation. By second day with approximately 8 or 9, 30 minute interferential treatments the cramping was gone.
2. The patient described the first day that the one place she was hurting most was the popliteal space ( directly behind knee in crease ) and wanted an electrode put there. Well the normal electrodes we provided were lacking sufficient “tackiness” and would not stick well enough to go over popliteal area. On day two I returned with a superior silver electrode which is much tackier and stuck well even allowing some movement. Going forth we need to look at a larger, better adhering electrode for the patient. It’ s on our “to do” list as I write.
3. First day ( this is not first day after surgery, but first day when patient had actually called us, since she could not take it anymore – hopefully later I’ll find out how long we were post surgery with her ), I saw our patient literally crying and agonizing over her pain so, in addition to use of interferential, I left her:
a. one bergamot oil scented patch which is labeled to relieve “stress” and this was put on her chest so essential oils could be inhaled.
b. put on lateral inside of knee one Tiger Balm patch
c. on outside, lateral on affected knee, rubbed Sombra lotion on.
All of above was done so we could immediately address her most pressing needs first – pain, much of it due to cramping of leg muscles. We attacked it with all we had as many of the above products are what are most effective over time for most of our chronic pain patients.
4. Second day back I showed her and her husband, daughter, and sister how to use the Tens aspect of the unit. Width was set at 350 microseconds as we wanted greatest penetration. Tens was not introduced nor explained on the first day, only on second, and reason for that was wanted to get new electrodes so could put on popliteal space and also patient in so much pain first day doubt she and her sister would have remembered too much information. She had used only IFT first day and after that first day she was wanting to see if ok for her to get up and walk around house some so showed her tens as as assist modality so she could be more mobile and yet still use tens part as needed. She had been told our preference was to use the IFT mode with the AC adaptor when possible. The patient seemed to still prefer the interferential, IFT mode but did like the Tens and was going to use that.
5. Also on first day had left her one lavender patch to place on her chest to help her sleep as she was in a sleep deprivation situation due to the pain which only made things worse. By second day she was sleeping longer and more often.
What was learned:
* Better electrodes needed especially for acute situations – electrode tackiness should not dictate placement.
* Use topical pain relieving products when possible and if sleep cycle disrupted then do not fear using essential oils for inhalation.
* Try to intervene as early as possible with IFT post surgery – there’s no reason for the patient to suffer through this when if can start prior to the pain cycle starting then should be better results. It’s harder to intervene and stop pain once it has been present for long time periods and already into the drug program.
* Cramping is extremely excruciating pain in the affected leg so use interferential to relax the muscles so that does not happen.
* Let the patient decide how often and for how long they want to use Ift mode when in pain. On this patient she used multiple times during the first 24 hours depending on when was hurting. I’m not sure one can “overtreat” but this patient was bedridden the first day of treatment with the unit.
* It’s well documented and known that electrostim will make happen ( 80% of non-union fracture cases ) the healing of bone tissue so seems like e-stim could have helped in first surgery to heal, rather than redo ( do not know what the complicating factors were such as infection, diabetes etc. so only can guess ). Would estim have prevented the first surgery from failing to mend? Do not know but would have been cheap and easy to use the unit. No telling what the second surgery costs and for sure there was a lot of patient discomfort due to pain and missed work. This lady has a very active physical job.
* Estim, such as PGS or Tens, has been shown to help decubitus ulcers heal and accelerate soft tissue heal time in surgical situations so why not use anytime post surgery to facilitate faster heal rates, and less pain through the process.
* Interferential is a very desirable muscle relaxing form of estim and if had been used earlier maybe the patient would not have had to endure the pain from cramping she did.
* EDUCATE the patient and family (caregivers) well so they understand and also can either help the patient or the patient can self help. Better understanding then better results will happen.
Will drop by patient’s home tonight to leave some essential oil patches and couple of topical pain patches but from first day of usage of IFT, to second day of explanation of how to use the tens mode, she had improved dramatically as far as pain goes and could now sleep and cramps gone. Made me feel good that we might have something going here that can help lots of folks not go through this.
Also very appreciative of the orthopedic doctor who was willing to do whatever he could to help his patient. One phone call and prescription was here.