Pain Meds don't touch the pain 4 wks out

[TVGOOFY]

OK, I will try to keep this short and sweet. RTKR on 1-12-10. LTKR on 3-10-10. I have a lot of scar tissue pain issues in the right knee. The doc says I have scar built up between the lateral condyle and the patella. PT says that the knee cap is sitting and riding on the outside of where it should be in the groove, thus causing me A LOT of pain every time I kick out to walk or to kick out doing exercises and when I keep the knee bent. The left knee is only 4 weeks out but it is 20 degrees valgus. I have pain when I stand because it puts more pressure on the inside of my knee that didn't have that weight before (it doesn't help that I am over weight either) the surgery. I also have a lot of pain just below the knee cap on both knees whenever I am up or when I sit with my legs dangling.

OK, that's the most recent surgeries.

Now, my real problem. I have had 16 surgeries in the last 8 years and was on pain medicine for quite a while. I also have chronic pain from degenerative disc disease. Because I didn't want to get dependent on Opioids, I went on a new drug that is mainly used for people who are addicts. I was not abusing the opioids, but was in a lot of pain and I didn't want to become dependent on them. This same drug that is used to help addicts, is also used for chronic pain patients. The medicine DOES NOT help ACUTE PAIN only chronic pain. The medicine is called SUBOXONE.

I have been on this medicine for almost 2 yrs and it is a narcotic that blocks the pain receptors in the brain. Since this medicine blocks the receptors, any patient that is on this medication and has a surgery must stop the medicine. Since I have been on this medication and other pain medicines for so long, It takes a butt load to take the pain away. My problem is that I did not tell my Ortho doc that I took this medicine because I didn't want him to think I was an addict. My OS has been prescribing me #30 vicodin 5mg with the directions of 1-2 every 4-6 hours. 2 pills doesn't touch the pain and if I took 2 every 4 hours, I would run out in 2 1/2 days. I have been only taking 1 pill every 4 hours so that it would last almost a week. Needless to say, I have been in constant pain.

Now that I am in outpatient PT 3 X a week, I am in tears after and my both legs ACHE the rest of the day and night which inhibits me from doing any more exercises at home. Plus I am scared to do my exercises at home because I don't want to aggravate the situation more. I only see the doctor that writes for the Suboxone for that reason only. My family practice doctor knows that I am on Suboxone, but also knows that I had two total knee surgeries in the last 12 weeks. She has given me the impression that she will not write any pain meds. I just called the Suboxone doc to see if he could help me since he understands the mechanism of the drug. Guess what? He is out of town for the week. Even if I call my OS tomorrow to ask for more, all he will call in would be for #30 and that will run out before the weekend. I have no clue what to do.

I am so so sorry that this is so long, but I wanted to be honest. WHICH I GUESS I SHOULD HAVE BEEN in the first place with the Ortho doc.

 

[Josephine]

Goofy, firstly, it's not a long post at all but, secondly, I have split it up into paragraphs as one big block of text is awfully difficult to read (for me to read, anyway!)

Now about this pain med issue you have - I really cannot understand why you opted out of opioids for fear of getting dependant. It doesn't make sense to me. You're in that classic 'between the devil and the deep blue sea' situation. You also have two doctors prescribing strong meds for you which is much more dangerous. I think you have to make a decision as to whether to quite the suboxone and get something better for your knees or tough it out. Either way, you cannot do it without consulting with one or other of your prescribing doctors.

As for not telling your ortho surgeon, I think that was a very unwise thing to do. I think previously we all advised you not to do this because, apart from putting him in a potentially compromising position, you're now also taking the suboxone and the vicodin which is also dangerous. And I completely concur with your own doctor in refusing to prescribe you anything else. Your OS would have done so as well, had he known.

Is the doctor that prescribes the suboxone a pain specialist? If so, I recommend that you go to him, tell all and get him to help manage your pain. For one thing is certain - you cannot subdivide the pain from your back and the pain from your knees. They have to be treated by the same doctor.

In addition, you should take meds as they are prescribed and not cut down to make the prescription last. Half a dose of something gives you half the pain relief for half the time. So it's a pointless exercise.

I agree with you not doing your exercises right now. It would make a bad situation a lot worse. But are you using ice and elevation? They are your only salvation right now. Use it all the time except don't put fresh ice packs straight onto your bare skin.

I'm truly sorry you are in this fix but it was partly of your own making. Never ever hide meds or conditions from a surgeon. He needs to know everything or he could inadvertantly put your life (and his career) in jeopardy.

 

[TVGOOFY]

Jo, I may not I have said that I did stop taking the suboxone. The surgery in January I stopped taking the suboxone a week before and then I only stayed on opioids for that surgery for 1 month because I knew that I would be taking more opioids after the surgery in March. I then stopped taking the suboxone a week before this last surgery. I am taking the medication exactly as it is prescribed. I would never take moth together as the suboxone is an opioid antagonist much like methadone. I would never have two doctors prescribing pain meds at the same time. That is illegal and you are right...very dangerous.


My problem is that since I have been taking such a high dose of pain meds before the surgery; the 1 vicodin every 4 hours is not helping. You are right, I should have told my Ortho about the suboxone, but I did not want to be labeled as an addict and then him not give me anything for the pain. Hindsight is 20/20...ya know. I just got a call from the Suboxone dr and he is out of town. He was very very very compassionate to my problem. He said he can help me when he gets back on Monday, but until then I need to try to explain to the Ortho doc that since I have had so many surgeries I have built up such a tolerance to the pain meds and could he please raise the dosage and also the frequency.

You are right as far as controlling my chronic pain and my acute pain with the same medication from only one doctor. That is exactly what I have tried to do, but doing so has cost me a lot more pain and anxiety because what I have been prescribed doesn't help either of the pain.

Thanks so much for all you do. I guess I will just have to get the guts to call the Ortho in the morning and ask him for more medication. Pain management can be such a "PAIN" for people who are really in pain because you feel so guilty asking for more pain medicine from doctors.

 

[Jamie]

I'm sorry you are in this position, but you are absolutely right. It won't get any better until you take action and call your surgeon. As Jo says (and you now recognize) you need to be completely honest with him and the two of you figure out where to go from here. Take whatever he recommends. You are not going to become addicted. Remember HE is the doctor and he knows what works and what doesn't for pain.

How are you doing on getting the second opinion? You know you still do need to deal with the valgus....that is not right and no doubt accounts for at least some of your discomfort. Plus...is it getting worse? You mentioned on March 23 that your PT measured it at 12 degrees and today in your first post you say it is 20 degrees. That would be quite a change....

 

[Josephine]

Plus...is it getting worse? You mentioned on March 23 that your PT measured it at 12 degrees and today in your first post you say it is 20 degrees. That would be quite a change....

Jimminy, I missed that!

 

[calling_all_angels]

Awww Goofy,
I think that you need to talk to your OS or if possible have your Pain Mtg Doctor explain it in a letter that you can share with your OS. And since you stopped taking it before both surgery's I think he will understand about you having a fear about what he would think. You are only human and pain is pain!! He should be able to figure out with your pain Doctor a plan of pain meds that will help you with your recovery and problems you are having at this time with the pain of it all. Goofy I am so sorry that you have had to go through all of this. I will pray that the Doctors can get you on some good pain meds.

 

[TVGOOFY]

As far as the Valgus issue. The 1st time that I noticed it was when the home health nurse measured it. I went to the OS on monday and got a full leg x-ray and took it to my PT and we measured the "exact" degree. My husband is an Oral Surgeon and the other day he talked with another Ortho doc that is supposed to be the best in my city. This doctor said that he has never seen or heard of any studies that state that a valgus knee after total knee replacement is harmful. He also said that we could e-mail the film to him and he would be glad to take a look at it or even see me. He also said that he has only done one redo for cosmetic reasons only and that it is a very difficult surgery. They have to go in and break the bone and dig out the implant and then plate the bone. I need to see if I can get this pain under control and get the knee stronger to see if that helps with the pain in that knee.

When I was in a lot of pain in the hospital on my last day, they had already taken my IV out and then some error occurred and I didn't get to leave until the next day. I asked the nurse to please call my doc to see if I could have something more for pain management. The doctor told the nurse that I didn't need anything stronger, so I am a little worried that he will not help me. If I can just last until MOnday, I will be able to see the pain management doc.

 

[skigirl]

Wait a minute here---a knee that is 20 degrees valgus is not a COSMETIC problem--who is that doc kidding??? My knee was10 degrees valgus and that was the major reason that led me to consider a tkr---the valgus knee was making me walk "funnY" and it was unstable. So---now it is a cosmetic issue!!!!

You sure do not want that doc looking at your films!! I would contact the manufacturer of your implant and ask them who is the best doc in your area---I bet they will be horrified to hear that your implant was put in in such a shoddy fashion. and I bet they will not consider a valgus leg a cosmetic issue either.

something is very wrong here---why are you getting such bad medical care? Are you in a small town? I live in a small ski town so I have access to a really good surgeon---recommended by Stryker. But, you are not getting good care---there is some bigger problem here.

First, you will have to get the pain issue under control. Then, I suggest you consider someplace like the Clevland Clinic or the Mayo clinic---both of them do consults by mail and computer---you send the info to them for an initial consult. Your problem is huge and you will need to solve it before you have full knee function.

Please do not led the incompetent dunderhead touch your knee again. Kelly

 

[Ginnibug]

Hey girlie, if you wish I can provide you with all the information you need to consult with my surgeons, they are EXCELLENT and can provide another opinion, very close to you as well.

(((HUGGS)))

Ginger

 

[Josephine]

I'm with Kelly here. No way is this 'cosmetic'. That surgeon is feeding you a load of .... you know what!

I spoke with an OS who's a friend and described your leg and asked him what he thought. His first reaction was that 'someone made a mess of the surgery'!

This is true, Goofy. And of course your patella is riding on the edge of the femoral condyle - because the quads/patellar tendon doesn't go round corners! It'll take a direct path from A to B. It may be painful but it's a result of the angulation not a cause of it.

Please get a proper second opinion from someone who does revisions and has no connection with this surgeon.

All that about breaking the bone to get the implant out - also garbage. Sure they'll need to replace the implants and they'll need to build up the bone where it's been over cut but this can be done by using a special knee with an assembly of wedge implants. They are designed for just such cases as these where the bone has been eroded by disease, tumour, trauma or other such failures. I've scrubbed for such procedures many times and seen legs that were in much greater valgus than yours fully corrected. It's very doable and needs doing soon, before all the ligaments and muscles start adjusting to this abnormal positioning.

 

[Jamie]

TV, please take Jo's advice and talk to a new surgeon (a revision specialist) as soon as possible. If you need help finding someone in your area, PM me with your city and zip code and I can help you locate doctors to contact for appointments. I feel like you really are risking your body's health the longer you wait and walk around on that knee.

 

[skigirl]

TV,

I am also urging you to see someone else--ASAP---this can be fixed and needs to be fixed!! I would never see that surgeon again---unless it is in a court of law. Good luck to you---this is the kind of stuff that no one wants to deal with. I am sorry that you are having to go through with this. Keep us appraised of your case. We care. Kelly