Help! Doctor Didn't Order Physical Therapy

Status
Not open for further replies.

MidnightCry

new member
Joined
May 10, 2008
Messages
2
Location
United States
I'm actually posting this for my dad, who's 70 and just had a knee replacement 8 weeks ago. He did have mediocre in-home PT for maybe two weeks but then the doctor released him and said he didn't need further PT (just keep doing his exercises which amount to flexing his knee once a day!). He's having a very difficult time with pain, too -- on a lot of Vicodin and Ibuprofen. My mom is about going nuts not knowing what to do with him (he basically sits around all day and complains about the pain). Anyway, is it normal not to need PT after this surgery? If not, how do we get the doctor to order it?
 
Midnight, I certainly am no doctor, but your brief description does not sound at all like what most of us have done following a knee replacement. We have had lots of therapy that includes exercises to increase both bending and straightening of the new knee. Your range of motion (ROM) is measured and tracked to be sure you get to a point where you can do everyday tasks. And usually you end up riding an exercise bike to push the knee to as much ROM as possible.

If he's not icing and elevating his knee when it hurts, that might help some with the pain. And he needs to be moving around! Sitting all day is NOT good. I think most doctors will order additional therapy if the patient asks for it. If I were you, I'd call the doctor myself and talk to him/her about the situation and your concerns. One issue may be insurance coverage for therapy. Do you know what kind of Medicare plan your Dad has? On some of the supplemental plans, Medicare is not the primary insurer and whoever the insurance company is has a lot of say over what treatments are given. If he has Medicare as his primary insurance, therapy is covered for a longer time than two weeks if the doctor orders it. You might have to do outpatient therapy, but assuming you have a way to get your Dad there, it should offer some benefit if he is having trouble doing daily activities like walking, going up and down stairs, stepping in and out of the tub, etc. If your Dad goes back to his doctor, maybe you should go with him. Many times it's better to have additional ears to hear and remember all that is said.

I'm sure Josephine, our forum nurse, can speak to the medical aspects of what you describe. Hopefully she'll take a look at this thread and respond soon.
 
No PT?
[Bonesmart.org] Help!  Doctor Didn't Order Physical Therapy
No way! No wonder the poor chap is in pain and , by the sound of it, depressed. Is this another case of rampant ageism - he's old so it doesn't matter! If that were my dad I would have him along to his doctor and ask him some tough questions, like how come you've read of all the tough PT the members here are having when he is being left to just get on with it? I take it your dad was reasonable mobile and active before his op? (knee problems notwithstanding, of course!)

Don't you let that doctor get away with it!
 
Not sure about elsewhere, but in CT a doctor's prescription in strongly desired, to the point that they want you to believe that the only way to get PT is with it. But I heard the a converstaion in my PTs office, while they were teaching/working with a college kid intern, that once in a blue while someone can be seen without it. Certainly under the direction of an OS would be best, but if not..... And insurances may require the RX to be willing to pay.
 
I would bet money that an inquiring phone call from an attorney regarding the lack of care for pain management, and follow up Physical Therapy would snap his butt in gear!
 
I agree with everyone, I cant understand why no PT. If this was my dad I would be calling the doctors office and demanding to know why no PT. I did PT for 3 months after my replacement.
Debbi
 
First thing I would do were it my dad would be to show up at the surgeons office demanding to know what is going on, if I didn't get some really good excuse as to why, like a serious health condition that prevented PT I would be at an attorneys office the same day and I would be calling the director of the hospital getting the names of other ortho docs. Even if there was a reason for him not getting pt there is absolutely no excuse for him not getting pain relief. This kind of thing makes me so mad. I sure hope tomorrow finds you in the surgeons office. No one should be scrap heaped much less by the doctor who swore an oath to do no harm, etc., and who is responsible for this treatment. Shame on your dad's OS. Rowdy
 
Midnight, since I don't know you or your parents please don't take any offense with another perspective I'm going to throw out regarding your Dad's situation.

I wholeheartly agree that if your Dad is in pain and not moving around well at this point after his surgery, you should immediately take action and talk to his surgeon. After all, your father's well being and health are at stake! But I think how you begin that discussion is very important.

Unless you were present at one or more of the previous meetings with the doctor, you don't really know what was said by either the doctor or your Dad. Because of that, I would not begin the conversation on an angry or accusing note. To do so would immediately put the doctor in a defensive position and that would not serve your Dad well. A better approach might be to tell the surgeon that you have some concerns about your Dad's progress in recovery and would like to have some questions answered about the treatment following his surgery. If the doctor is a good one, he/she will talk openly with you and you will have maintained a good relationship with him/her by starting the conversation in this way. You always have the opportunity to get tougher if the doctor cops an attitude, doesn't provide adequate answers, or refuses to help your Dad. And you SHOULD get tougher if any of these things happen - up to and including legal action, in my opinion! But like I said, if you weren't there, you don't really know what your Dad might have said regarding therapy. Some people don't want it or don't understand the surgery and think they don't need it.

Be prepared before you try to discuss your Dad's case with the surgeon that today's laws regarding medical information require that your father must agree in writing for his doctor to discuss particulars of the case with you. This would be easy if you had a physical meeting with the surgeon and your Dad was present. But if you are planning to talk on the phone, your Dad will need to sign a release form and you'll have to take it or fax it to the doctor's office before you talk.

Another big factor in your discussion with the surgeon which was not mentioned in your original post is how active your Dad was prior to surgery. If he was active, up and doing things but having pain because of the need for surgery, what is going on now is a major life change and definitely not right. But if he was used to sitting in a chair most of the day before surgery, it could take some effort to change that habit. You didn't really say whether he wants to be more active or not. Therapy, including stretching and pushing to get normal range of motion for your new knee, is very difficult following this surgery and a person has to make a commitment to that effort. Plain and simple, it hurts for the first couple of weeks!

I have a 72-year-old friend who was not willing to make that commitment and didn't want to endure the pain of therapy on his first knee replacement. He refused to do what the therapist asked in terms of exercises and because of that was "released" from therapy at that point because he was not making any progress. The result is that his knee does not have normal range of motion and he has somewhat of a limp because of it. On his second knee replacement, he was a much better patient, did therapy, endured the pain and that knee works great. His doctor recommended that he go back in on the first knee and have a manipulation done to break up the scar tissue that formed during his inactivity, but he is still choosing not to do it because of the fear of more pain and therapy.

I hope what I have written is of some help to you. As I mentioned at the beginning of this post, I did not mean to offend you in any way, but only to offer some things to consider. I commend you on your caring concern for your father. He needs your support to get past this problem and begin to get an active life back. Please write more to let us know how things progress in the coming weeks. I pray that you can get some answers and get him on the road to a more active and pain-free life. He's too young to be relegated to a chair!
 
Hey Jamie, I Totally Agree And Said As Much But Part Of My Post Didn't Get Posted. I Must Have Done Something Wrong. What I Had Intended To Be The Rest Of My Post Was That Unless You Had Been At The Meetings And Heard The Doctor Say What The Dad Was Saying There Was A Possiblity That He Could Be A Bit Like My Mother-in-law Who Drinks With Diabetes.. She Insists That Her Doctor Approves. The Woman Is A Raging Alcoholic And In A Stupor By Four Every Afternoon. I Know Her Doctor Didn't Say What She Said Because When I Asked To Go To Her Next Appointment She Got Angry And Of Course Refused. Sometimes For Reasons Unknown To Us Older And Even Younger People Give Up And Don't Do What Is Best For Themselves. So I Am Really Glad You Added Your Very Valuable Two Cents. After Thinking About This Overnight It Makes Even Less Sense Than It Did When I First Read It. I Don't Know About Other Peoples Os's But Mine Has A High Precentage Of Older Patients And It Would Not Make Any Sense To Deal With Them In The Manner That Is Being Reported By Midnight. I Am Sure She Is Very Concerned And Confused By The Treatment Her Father Is Reporting But It Just Makes More Sense To Follow Your Good Advise And In Retrospect I Have To Add Dealing With Anyone In Anger Is Not Going To Get You The Best Results. Thank God Cooler Heads Like Yours Prevailed. I Am Very Curious Though As To What Happened Here. Rowdy
 
Gee, Rowdy......I can't imagine what happened to make part of your response appear and part not show up. I know a couple of times I have gotten in a hurry, written a reply, and then clicked off the thread before hitting the "Submit" button. Of course when you do that, your comments don't post and they go into cyber limbo-land. But what you're describing is something else entirely different. It sounds like a case of computer gremlins!!
 
Jamie, I have no idea what I did but I would bet money I did it not a computer gremlin. I am so quick I often push a button that looks good but isn't what it appears to be. LOL. So I have to take responsibility for anything that doesn't post. I would like to know the outcome of the gentleman's pain and lack of PT though. No one should live thier life in pain as we all know. I just hope he gets the care he needs so he can have as full a life as possible. Having spent the last 20 plus months in terrible pain I can't imagine just giving up or accepting anyone telling me I had to settle for the pain. I, actually, had a group of doctors tell me when I was 42 that I was going to live the rest of my life in pain and in a wheel chair. I got really angry that they were that willing to give up on me and that willing to allow me to give up hope in my own recovery. I went out and found another doctor who referred me to a new Physical Therapist who in six weeks of really hard work had me up and walking and believing I could have a full life again, which I did. Had I settled and listened to the first doctors I would not have lived the last 25 years of my life and ended up such a fiesty old lady. Seventy is still young and I hope he gets the help he needs to see that he has a lot of living yet to do. And I almost lost this replay by hitting a key with my wrist that made it disappear, so see I am the gremlin. LOL Rowdy
 
Rowdy, I couldn't agree more. And I am thrilled to know that you had the determination to find the right doctor to make sure you have the life you want! And it will be even better soon!!!

Midnight, please write again and let us know how things are going. We care about you and your Dad!
 
Gee, Rowdy......I can't imagine what happened to make part of your response appear and part not show up. I know a couple of times I have gotten in a hurry, written a reply, and then clicked off the thread before hitting the "Submit" button. Of course when you do that, your comments don't post and they go into cyber limbo-land. But what you're describing is something else entirely different. It sounds like a case of computer gremlins!!

Been there done that.

Yes Midnight, please let us know how your dad gets on. Please make sure he gets something for the pain or he will continue to be depressed. That is how I felt before I had the correct pain meds for myself. Sue
 
Thanks to everyone for their replies! The information (not to mention validation) was very appreciated. Today my mom called the head of the bone surgery program (something like that, anyway) and she agreed that he SHOULD have had PT post-op. So, my mom is going to call their regular doctor (it was the surgeon who didn't order PT) and ask for 1) non-narcotic pain meds and 2) PT!

I do realize that he is suffering from some degree of depression, too, and when you're in that state, it's awfully hard to "pull yourself up by your bootstraps" and get back into the game of life. But it's also hard when my mom and I (and others) try to motivate him to do just that with little success. Anyway . . .

We'll see what happens tomorrow. Thanks again!
 
Midnight, God bless your Mom for doing what needed to be done. It sounds like things should improve for your Dad and I'm so very happy for you. I feel like adequate pain management will be the first step toward a better recovery. As folks have said, when you hurt, you can't do much of anything. I hope he gets a good therapist....check on that to make sure it's someone who is pushing him, hopefully in a personable way, and that measures both his extension and flex at each visit to monitor progress. Please continue to post when you can and let us know how things are going!
 
So glad to hear your dad is going to get the PT. Maybe the actual physical exercise will help him feel more himself. Just doing something other than sitting will improve everything.

Hope you don't mind me mentioning this but, if you read back on posts in Jan and Feb constipation is a real problem sometimes with the pills we had to take, that can be helped by exercise as well as diet. Constipation can also cause you to become very low, so make sure you find out (in as subtle way as you can) if he is OK in that aspect.

Please wish him well and let us know how he is doing?
 
Just a comment on the depression. I found out that many folks experience some level of depression following this surgery. My doctor upped my anti-depressants by 2X and I felt so much better, so it may be that he needs treatment for depression if you don't see improvements. It is also quite common to need help sleeping during the first couple of months. His doctors should be able to provide meds for both these issues if needed. God bless you and your father. I pray he gets PT soon and starts seeing some huge leaps in his recovery.
 
I agree with Skeet on all counts. The depression that comes with the surgery; not sleeping = tired; many people at his age already battling depression and a feeling of 'I can't do what I used to do' definitely need add up to a need for additional help. His diet and nutrition level also need to be checked closely. Remember that my degree is in Horticulture, so there will be no charge for this service.
 
Yep - pain, lack of adequate pain control, poor appetite and therefore poor nutrition, consequent constipation, lack of profession encouragement, lack of activity - all a good recipe for depression - the good ol' post-op blues.
 
Not sure about elsewhere, but in CT a doctor's prescription in strongly desired, to the point that they want you to believe that the only way to get PT is with it. But I heard the a converstaion in my PTs office, while they were teaching/working with a college kid intern, that once in a blue while someone can be seen without it. Certainly under the direction of an OS would be best, but if not..... And insurances may require the RX to be willing to pay.

Found it! Here is what I was talking about. But it is a CT thing, so not sure about other states.
"Direct access in CT allows you to visit your physical therapist for evaluation of musculoskeletal injury without a physician's prescription. If you are ever in need of our services call our office and we can assess your injury and help guide you along the road to recovery." Quoted from the bottom of the patient survey from my PTs office. I heard them talking about it as well.
 
Status
Not open for further replies.
Back
Top Bottom