My journey

[BionicBob]

@Josephine
I still can't help but to think of the discomfort the hardware would cause...the bits taped down part gives me the willies lol. I'm sure you'd get used to it like I'll have to with a TKR

 

[BionicBob]

@SusieShoes
re: the pre op class
You were indeed correct when you said others may ask questions that I would find helpful.

 

[BionicBob]

As I already mentioned, I'm so glad I went to the class. If anything it opened my eyes to even more of the procedure I am facing. However, I have a bit of uncertainty growing. As you recall, I expressed a concern over my OS stating I could expect to return to work in 6-8 weeks while knowing what I do for a living. Combined with the chest thumping attitude of his PA and a few other minor instances, I detect a strong overpowering power trip brewing. Hope I'm wrong because my thickheaded stubbornness is likely going to clash with them.

In class they had several speakers and one of them was head of their PT dept. A question asked by one of the attendees prompted me to ask: "How soon can I expect to climb a full set of stairs?" I asked because while I do have a half bath downstairs, the shower is upstairs. His reply was I can fully expect to be able to go up & down the stairs the day I get home. I was shocked to say the least. Unless I misread here, there is no way I'll be able to do that on the first day. And if I do manage to do it, I'll suffer the consequences.

Since this class was sponsored by the surgical team that will be treating me, I suspect they share a common theme. Should I be concerned?

I know I had a few other comments and questions to post, but forgot what they were since I have a busy day of errands and such to do today. Most importantly I need to call the nurse for my OS and relay what info I have regarding the denial for surgery. Sad that I have to get involved in the administrative part of this surgery, but I need to get this dispute settled ASAP or request a hearing with WC.

Thanks for following and any advice offered is welcome

 

[2happy]

Bob I would love to hear about your experience with WC. I started with torn meniscus, had scope with repair in 2013, recovered. Then reinjured in 2014 at work, another scope and repair that led to neuroma/ surgery then PKR in nov 2016. Now WC doc said I am MMI, medical care stopped along with disability pay. Waiting for WC hearing. Advice or suggestions? I have lawyer


Sent from my iPhone

 

[BionicBob]

@2happy
I'll be more than happy to offer up a few pointers in regards to WC but it'll have to wait until later today/tonight. Busy day and I need to get off this laptop. Sit tight...I'll return, promise!

 

[SusieShoes]

I can address your concern about climbing stairs. I had the same concern. Consider I was having BOTH knees replaced! I thought no way could I climb stairs right away. I have the same home situation as you, with a half bath downstairs and the only full bath is upstairs. My OS and PT assured me I would be able to climb stairs, though not several times a day.

They were right. On my third day after surgery, in rehab, PT had me climb five steps up and come down five steps. No trouble at all. A little awkward, a little discomfort--remember, both knees had been replaced--but pretty darn easy. And two days later, five days after surgery, I climbed a full flight up and down. Again, minimal difficulty. I could have climbed the full flight on the second or third day.

Stair climbing is absolutely something you should be able to do. :smile2:

 

[2happy]

Okay

 

[Josephine]

I still can't help but to think of the discomfort the hardware would cause...the bits taped down part gives me the willies

You mean the wires and pins? Honey, you will be as aware of that as you would a new tooth filling! So far as you are concerned, they just won't exist!

His reply was I can fully expect to be able to go up & down the stairs the day I get home. I was shocked to say the least. Unless I misread here, there is no way I'll be able to do that on the first day.

Well, maybe not the same day or the day after but I came home on day 2 and was going upstairs to to the bathroom and to change into my 'shlumpies' for sitting about. It's not a problem, your discharge protocol should include PTs teaching you how to manage stairs. Just follow the instructions and take it very slow and easy. Here an article Stairs: how to cope with stairs after surgery

Most importantly I need to call the nurse for my OS and relay what info I have regarding the denial for surgery. Sad that I have to get involved in the administrative part of this surgery, but I need to get this dispute settled ASAP or request a hearing with WC.

Maybe it's because I'm British but I really don't understand this post, Bob. Can you or someone please interpret for me?

 

[BionicBob]

@2happy
sorry I didn't respond last night

Both of my knee injury experiences with WC were uncontested so I didn't see a need to hire an atty. What I did do was get a copy of the WC manual and studied it front to back so I better understood the process. You can also find this manual online as I did this time around. I almost hired an atty for the current injury after I was notified that the insur carrier requested an informal hearing to discontinue benefits. But after a little research I was able to determine that their claim was baseless since they were using previous case law to classify my injury as pre existing. There's a little more to that matter that I'll discuss in another post when I reply to Josephine's question.

I'm a little surprised to see you've been given a MMI rating already. Here in CT, a MMI isn't issued until a minimum of one year has passed since your last treatment/surgery. Your PKR was Nov 16, so I wouldn't have expected a rating no sooner than Nov 17. Maybe it's different where you live? You mentioned a WC Dr issued the MMI, was he your OS or a DR retained by the insur carrier? I ask because your treating physician is who issues the rating, not a 3rd party. However your insur carrier does have the right to have you examined by a 3rd party DR in case they dispute the rating # itself. I assume your atty has explained most of the MMI process, but in case he didn't...

Maximum Medical Improvement is when you've reached a point in time(one year post op) when no further improvements are expected. The rating is given as a percentage that is used to calculate an award/compensation for permanent impairment. I won't get into the specifics of the calculations unless you need me to. But I do want to make of a point and I emphasize this...DO NOT CLOSE THE MEDICAL PORTION OF YOUR CLAIM. I only say this from personal experience. Since you state you had a PKR, my research as well as what 2 DR's have told me, a PKR can eventually result in the need for a TKR. But every case is different, and not saying you will eventually need a TKR, so just be aware. I was fortunate in that my first injury of the torn meniscus in 1997, I was compensated for the injury and the medical wasn't closed...not that I was given a choice. WC made that decision for me. Unbeknown to me at the time, most knee injuries of this nature usually result in a TKR, which mine did. So even though it's been 20 yrs since the first tear, there are no grounds for my current injury to be disputed and this has been expressed in writing by several DR's. Including a 3rd party Dr hired by my insur carrier...they requested an IME (independent medical exam) and wasn't in their favor.

I'm far from an authority on WC, but my research and reading of the manual gave me a great deal of insight of the process. Over the last several decades, the rules have changed due to the abuse by many. What I can tell you is if your injury is legitimate(not saying yours isn't) and the medical records support the injury, WC will side with you and do what is needed for you to expedite treatment, recovery and able to return to work. There are an untold number of imaginary injuries as well as non work related injuries being claimed and those are the ones that create the problems and the need for constant revisions for WC rules. Sad to say but insur carriers are known to drag their feet and run you into the ground hoping you get tired of the process and go away. My current carrier has done just that numerous times, but I have no intention of going away...and I sure as heck don't have any choice if I want to return to a normal life.

Not sure if what I mentioned helped or if you have any other Q's, so ask away or comment. If the forum Admin prefers that you ask/discuss your situation in your own thread, use the @BionocBob to notify me. Otherwise I have no issues with discussing it here.

Good luck and hopefully I wasn't too long winded with this reply

 

[BionicBob]

@SusieShoes
Thanks for the reply. I can only imagine what it was like with both knees having a TKR. Were you able to climb the stairs the same day when you first got home? There's no doubt I'll be looking forward to a shower when I first get home, but I thought it was said somewhere that don't expect to be able to do that for at least a day or so.

 

[SusieShoes]

I could climb stairs the same day I got home. Make no mistake, it was a bit painful, and I was slow, going up the steps using a cane and two feet on a step. Same with going down. But I always felt stable. The new knees were awesome and strong. I learned that hours after surgery when I stood up and walked. But there's swelling and pain, so even though the knees work perfectly well, you have to tough out the discomfort for a bit. It gets easier as you get used to it.

Whether you can shower or not, and how soon, will depend on the kind of closure you have for your incision. My OS used glue and a waterproof bandage, so I could shower right away. I didn't in the hospital because I was too zonked to care. I needed a bath bench at first, because with both knees done getting into and out of my tub shower was impossible without it. If you have a walk-in shower, just be sure you can stand for as long as you need. A shower chair is really helpful at first.

If you have staples, you would need to cover the incision and should ask your OS how best to take showers.

 

[BionicBob]

Well, maybe not the same day or the day after but I came home on day 2 and was going upstairs

OK, looks like I misunderstood. It appears when you did finally get released and return home, even though it was 2 days later...you were able to climb the stairs. I thought it would still be another day or 2 after I got home before I could climb a full set of stairs. I'll be sure to read the link you put up.

Most importantly I need to call the nurse for my OS and relay what info I have regarding the denial for surgery. Sad that I have to get involved in the administrative part of this surgery, but I need to get this dispute settled ASAP or request a hearing with WC.

Maybe it's because I'm British but I really don't understand this post, Bob. Can you or someone please interpret for me?

Sorry for the confusion...and I doubt it has anything to do with being British. More a case of being in a hurry and not proof reading. I'll do my best to explain what I meant and hopefully not get too long winded, but since you asked...

My employers insur carrier for WC (Workers Compensation--which covers work related injuries) uses a 3rd party to review each and every treatment to determine if it's "deemed medically necessary". This 3rd party has been involved in this matter since day one for the current injury of March 2016. They already have all the necessary documents and have approved everything so far...the cortisone shots, Synvisc injection, PT, knee brace, referral from my original ortho DR to the OS for the TKR. So it's not like they didn't know anything about the TKR. Yet now they're claiming they don't have the MRI or Xrays. In addition they are also claiming my symptoms do not match the Dr's report. Hence, they are denying the need for the requested sugery for TKR. Makes me wonder and I even asked if the report they had was for some youngster who stubbed his toe...lol...they didn't answer me.

It also appears the 3rd party review board has a '3 strikes your out' rule. Meaning: the first 2 times they contacted my OS and left a voicemail. After their 3rd attempt, they found it was the wrong number. So the last attempt...with the correct phone #, they also had to leave a voicemail. Which evidently stated my OS office had 24 hrs to respond with the requested info or the surgery would be denied. Guess what...denied!. Given all the shenanigans that this insur carrier has played so far, I'm not surprised. From what I understand, it's just an administrative matter right now and my OS office will resubmit the file. However, since the insur carrier themselves are the ones who initiated the need for the 3rd party review and also supplied all the necessary files, IMO they are the responsible party for the wrong/missing files. And you wonder why the wheels of justice move so slow and waste so much $$$. Worst case if my OS can't get this resolved, I'll request a hearing with the WC commissioner for review. He has the final say and authority to rule on the matter. The last hearing I attended, he told me that there was no need for me to attend any more hearings regarding the initial dispute(I'll explain next paragraph)...there have been 3 so far and all were requested by the insur carrier in an attempt to terminate liability. It was my understanding that the last hearing a decision would be made over which insur carrier would be responsible for the claim...it wasn't due to the insur carriers dragging their feet and asking for more time. The commissioner did assure me the surgery and all related matters regarding it would be covered and to contact him personally if I had any more delays. He gave a good lashing to my insur carrier in a previous hearing, so I expect they'll get another if the denial for surgery is not settled. Sound complicated? It's really not...but wait for the rest and then you'll have reason to have a headache lol

The real issue that's behind all the hassles from my employers insur carrier is they claim my current injury is pre existing and originates from the torn meniscus from 1997. My ortho Dr who repaired that tear agrees but only to the point that the injury could possibly lead to the need for the TKR, not that it caused it. His position is that the physical demands of my job are what caused the current injury. In case I didn't mention it, both injuries occurred while employed by the same employer, but different insur carriers. The first insur carrier that covered the torn meniscus claims that since 19 yrs had passed without any complications or need for treatment, they are not liable. The current insur carrier still feels otherwise and that's where we are today. I'm fortunate that the WC commissioner understands all the details and is ruling in my favor for the surgery being necessary since I intend to return to work 100%.

I did my best explaining:smile2:, but if unclear ask away.

note...I edited this post a few times after proof reading.

 

[BionicBob]

Great info Susie, thanks!
note to self...i need to learn to use the like buttons where applicable as I recently became aware of them

I was told my bandage will be water proof and that internal stitches would be used. Sometimes the OS uses a staple on each end of the incision if he feels the need for them. I can't tolerate skipping a day without a shower, so that will be first and foremost on my mind when I get home. All things considered though, I could probably skip it the first day home if I'm a zombie from the post op meds. But if I can manage, I'll do it. My wife will be here and can supervise.

I only have the tub/shower combo, not walk in. Up until yesterdays class, I was thinking I could get by without the shower seat as I have a strong upper body and RT leg. Now I'm reconsidering that thought based on a few recent posts I read here, including yours as well as what was discussed in class. Still not convinced I need anything for the toilet though. Wouldn't the walker be sufficient for assisting getting up?

 

[SusieShoes]

Others may come along with the single TKR experience. I needed the higher toilet (I have comfort height toilets at home, a true blessing!) and rails. Most TKR patients appreciate a higher toilet or use of a riser, a plastic unit placed atop the toilet, usually with attached side rails. A low toilet, and some are very low, can be difficult to get up from because it puts such strain on the new knee joint just to sit on it (painful) and get up from it (more pain). Upper body strength helps. A lot. But it doesn't prevent the pain of sitting down!

Walkers aren't really all that useful for getting up. They're lightweight and inconveniently place in front, where there's no leverage for pulling (because they will move toward you when you do). You will be doing more pushing up on chair arms and table/counter tops.

 

[BionicBob]

Thanks Susie, I didn't look at it that way and thought for sure a walker would be sufficient.

J ust the regular toilets so I'll heed your advice and get the riser. Sometimes I'm a little slow getting through my thick headed stubborn way of thinking, but the explanation of 'why' eventually finds its way through:smile2:

 

[kneeper]

I have a tub/shower combo. I used a bath bench. Very helpful for getting in and out and also initially for resting as at first even a short shower takes a lot of energy.

 

[Josephine]

Okay thanks - I uderstand now (I think!)

but only to the point that the injury could possibly lead to the need for the TKR, not that it caused it.

I would suggest that this is at best, splitting hairs!

 

[2happy]

@BionicBob. I sent you private message

 

[BionicBob]

(I think!)

I tried lol. In person I speak better than I type trying to explain something.

RE: splitting hairs
My understanding is that since a portion of the torn cartilage was removed, it precedes an eventual empty medial compartment

 

[Josephine]

since a portion of the torn cartilage was removed, it precedes an eventual empty medial compartment

The correct interpretation is that removing a portion of the cartilage precedes arthritis!