Continuing Complications

[John NC]

Hi...I am new here and looking for some thoughts on my THR and complications that have followed. I will try to be brief and yet detailed.

THR (right) on Dec 10th 2009. Jan 29th had swelling, pain and numbness on both sides of incision with slight drainage. Surgeon admitted me to hospital and I was diagnosed with a "minor" infection. Dr. performed surgery to clean out bacteria. While in the hospital, I developed a DVT in my left arm and a Pumonary Embolism - left lung. Was in the hospital for 15 days.

Since then I have healed well until 6 days ago when I noticed the swelling, numbness and pain again in the exact same areas. Went to the Surgeon yesterday and he was beside himself and upset about what was happening.

He said - It could be an infection again. It could be Brusitis. X-ray showed significant heterotopic ossification or new bone formation comming out of femur. The bone formation is close to connecting with my pelvis. He thought that could be the problem. He does not want to open me back up until he is sure.

I also had an appt. with my Hematologist for DVT follow up. She was concerned about my WBC count (11,800 compared to 8,300 on Feb 27th).

I have been on Keflex for 10 weeks. Surgeon said to stop taking it. Walk with cruthces and come back on Monday.

I am frustrated. Any ideas?

John

#heterotopicossification

 

[JudyS]

John
I am so sorry, you seemed to get all the complications possible. I am a hippy and did not have any complications with my replacement. All I can do is pray that surgeon of yours figures it out soon and helps you to be on the road to healing.
Our nurse Josephine, who can help with the medical end, just returned home after having a knee replacement. hopefully she will see this and offer her advice.
It does seem like an awful long time to wait until monday. I'm not sure you have any other options though. I would probably call the doc up and ask why he wants you to wait.
WElcome to bonesmart and I'll be praying for you
judy

 

[Jamie]

John, so glad you found BoneSmart. You certainly have been through a lot already and it sounds like you still have some issues to deal with. You'll find plenty of support here if you need it.

As Judy mentioned....our forum nurse, Josephine, is at home recovering from her own knee replacement right now. She is the one we depend on for a medical viewpoint in situations like yours.

But....in my non-medical opinion, I would seek an independent second opinion (not in the same practice or a recommendation by your current surgeon). I'm sure it will not be possible to get that done by Monday when you see your surgeon again. It's important to hear what your current doctor recommends anyway, so you want to go to that appointment also.

I did a little Googling on heterotopic ossification and it appeared that surgery might not be your only option for treatment if that is what's going on. It would be worth researching yourself before you go see your doctor so you can be prepared with some written questions.

I share your hemotologist's concern about the white blood count. Although I did read that elevated WBC and swelling can accompany the ossification due to the inflammation that is usually present, it is still always good to know it's not the result of an infection or even a blood clot (although if you are active, this should be much less likely to be the case). Are you running a fever?

I wish I had a "magic" answer for you. One way or another you must find out what is going on. Waiting until Monday is a long time when you're dealing with the things you are experiencing. Just keep a watch on yourself and if things change and don't seem quite right or your symptoms worsen, don't hesitate to go to an Emergency Room.

Please post again when you can and let us know how things are going. We care about you!!

 

[John NC]

Jamie - Thank You for the reply. I am not running a fever. However I did not run a fever with the last infection either.

Today the swelling and pain have increased. I am still scheduled to see my OS on Monday. I hope all goes well but, I do not have a good feeling about it.

Again - Thanks!
John

 

[Jamie]

John, take care of yourself and please consider going on in to Emergency if the swelling and pain continue to get worse. It's hard for me to judge from your posts how bad it is at this stage, but just don't put yourself in jeopardy waiting for the appointment on Monday.

 

[Josephine]

Well, your history and WBC count all indicate an active infection and my suggestion is that you seek out a revision specialist ASAP. The ossification is irrelevant to the infection - lots of people get that but it is neither responsible for the infection nor contributing to it.

And there's no such thing as a 'minor' infection when you're dealing with joint replacements. You always have to assume the worst until it's proven otherwise. Delay is not in your best interests.

 

[John NC]

Thanks Josephine - I just called my OS and he said to come in right away. I will let you know.

 

[Judles]

Just read your post, John! Welcome & just know that
MORE positive thoughts & prayers are coming your
Way!

 

[hurtingbuthopeful]

yes, good luck John. I was thinking you should not wait till Monday and am relieved you are going now.

 

[YoungM]

John -good luck to you and keep us posted. You are in my thoughts and prayers.

 

[Jamie]

Now I feel better that you will be seen right away. Please let us know what your surgeon says!!!

 

[John NC]

Hi All - Thanks for your concern and replies. Just got back from the OS.....actually his PA. Doctor is not in office.

PA said it may be nerve damage and prescribed Neurotin.......Im confused.

Sent me to Blood Lab for CBC w/diff, CRP Sed Rate??? Results will be in on Monday.

Gave me Percocet 10/325 and said he would call on Monday. I suppose I will try to take it easy and take the pain Meds - again.

 

[Judles]

John..... So glad at least the PA saw you!
Just keep taking those pain meds, I wish
You a comfortable weekend! If you still
Have concerns, call your OS again! It's
So important to be your own advocate!

 

[UTdave]

"Sent me to Blood Lab for CBC w/diff, CRP Sed Rate??? "

CBC - checks the white blood cells - general marker for infection, but can be falsely elevated or low. Higher is worse (>10 or 11 is usually abnormal)

diff - what types of white blood cells are out there, i.e. bacteria fighting, allergy-mediating, virus fighting, etc.

CRP - C reactive protein is a pretty sensitive marker for infection. The higher the number, the worse.

SED rate - erythrocyte sedimentation rate measures, well, sedimentation of your erythrocytes (red blood cells) in a small tube. If your body has inflammation (from say an infection) the cells will take longer to move making the value of the test higher (i.e. 80 is pretty darn high, 10 is normal).

I suspect your surgeon is trying to build a case that makes it very clear to operate or not. Given that the last time he operated, you had a blood clot and are presumably on blood thinners, I can see his desire to be 100% certain before cutting again.

Personally, I would assume I had an infection unless all of the above labs were totally normal, my swelling went down, my pain got better and I had a good explanation of why it all happened (i.e. hematoma or something). If those criteria weren't present, I'd be very suspect of a surgeon who didn't think an infection was present.

Remember that your body fights off infection with it's immune system (sometimes with the help of antibiotics), but metal hardware doesn't have an immune system and cannot defend itself. When a bacteria gets hold, it's terribly difficult, if not impossible, to get rid of it without removing all the hardware.

Listen to Josephine if it looks like an infection - find a revisionist. Although, you may have some difficulty finding a surgeon willing to assume care of another's problems.

Good luck and keep us updated!

 

[Josephine]

PA said it may be nerve damage and prescribed Neurotin.......Im confused.

Sent me to Blood Lab for CBC w/diff, CRP Sed Rate??? Results will be in on Monday.

Gave me Percocet 10/325 and said he would call on Monday. I suppose I will try to take it easy and take the pain Meds - again.

I don't blame you for being confused. Those blood tests are to show infection but he's as good as said it's not the cause.

Did you seek out a revision specialist as I suggested? It's the only way you'll know for sure. These guys seem to be a tad too laid back for my liking.

 

[John NC]

There is only one Orthopeadic Group in my city. I am going to search for a revision specialist in nearby cities on Monday.

It will be difficult. Surgeons here are afraid to take on a problem caused by another surgeon. Also, my health insurance has expired (due to being out of work for so long) so that will make it next to impossible.

It's a bad situation. Im afraid I will be stuck with this surgeon. What about asking to see another Dr. in the group? Will they be afraid to contradict the original surgeon?

Anyway, Lab results on Monday will tell me what to do I suppose.

 

[Judles]

PLEASE listen to Dave & Jo!!!!! An infection is scarey
With ANY joint replacement is scarey & certainly
NOT to be ignored!

 

[Josephine]

It's not a case of them being afraid to contradict rather of them wanting to cover his back and support him. It's the buddy system. That's why seeing a surgeon in another city gets you a truly independent opinion.

 

[PRGal]

John, understand your concerns re: health insurance (assume you were not in a position to choose Cobra continuance), but this is REALLY important! Please do not opt to either settle for your original OS if it makes you uncomfortable or "see how it goes." Fight, fight, fight and uncover every possible alternative, (i.e., Medicaid, any state programs, etc.) to get your problem solved.

BTW, I'm totally a non-medical person, but Neurontin doesn't seem to be relevant at all here. I was prescribed that about 6 weeks ago, after experiencing extreme sensitivity in my outer thigh (i.e., dog's tail brushing against skin or very soft touch caused burning or electrical tingling sensation). It helped my issue, but I really can't see how it would make any difference to what you're experiencing. (Oh, and Neurontin has a much cheaper generic version called Gabapentin.)

 

[Jamie]

John, I'm in the same boat with the others here. What you describe points to an infection which is not something you should fool around with.

Are you able to get COBRA coverage??? That would help. But even if that is not an option, contact a revision doctor in another city anyway. Many, many times they understand that you don't have insurance and will work with you.

The truth is if you don't try to find another doctor (NOT in the same practice....NO GOOD), you will have no other options. Your current doctor is gonna do what he's gonna do. But if you do try to find a revision specialist you may have a chance to make things better if you do have an infection. You will have options, choices!!! You need to try!!