Negative doctor or just realistic?

[hnkford]

My husband had LTKR today and I am so upset that I can't think straight. I can't tell if is doctor is being realistic with a terrible bedside manner or just plain negative. Some quick background: DS is 42 and started having problems with his knee when he injured it at 27. He has had 4 scopes since then and after the last one in 2007 the doctor said the only thinkg left was TKR but that OS didn't do TKR so he was referred to another OS who referred him to a rheumatologist.

He spent one more year w/ the rheumatologist but the pain just got to be too much. The rheumatologist sent him to a third OS for a second opinion. Well he ended up liking the new OS even though he was never very positive about the prospects of TKR for DS. He felt that the 4 scopes would reduce the chance that DS would get pain relief from TKR. And he didn't seem to think that the damage he could see w/ x-rays & MRIs was that bad. But he also didn't have another answer for pain relief.

But DS still decided he wanted this third OS to do the surgery. So we did. But the OS was so negative when he talked to me after surgery. He still believes the scopes will mean chances are slim for pain relief. He also said that DS still had a lot of healthy cartildge in the joint (on one side) even though it was bone on bone on one side and under part of the knee cap. I stuipdly asked him if the damage warranted the surgery and he replied that he had seen many people with similar damage use the joint for years before replacement. It almost seem like he was implying that DS had too low of a pain tolerance.

I was already having doubts before surgery even though DS has been using a cane for months now and spends most of his waking moments icing the knee. Not to mention that while pain was the initial problem in the past few months has fallen several times due to instability. Now after talking to the OS I am so worried we made a mistake. And tomorrow morning when the OS talks to DS I'm sure he will tell him what he has already told me. He doesn't even seem to think PT will be helpful. As in yes it will help but no matter how much DS dedicates to PT he will still probably always be in pain.

Is the OS being realistic with a terrible bedside manner or he just being negative? And how do I keep DS motivated when his own doctor isn't positive about his outcome? I just don't get it. This OS has a great reputation in our area. He does hundreds of surgeries a year with great results. If he really didn't think he could help DS why didn't he turn him away?

 

[Texas]

I dont know about the Dr. but I had 6 scopes and they were not helpful. If your husband was at his point and couldnt do it anymore, and you said he was falling that is sad then he made the right decision. I would do PT. Dont let anyone tell you it cant work because it can. Let him try. If he was bone on bone seems to me replacing it all would help. Tell your husband he is in charge of his life and you can be there to back him up. So sorry I think your husband will be fine. please let us know how it goes. your in my prayers...Dont let someone like that bring you all down now is his time to pick himself up and start all over .Really makes me mad..I am 41 and am fine.....Kim

 

[Linda2]

My knee was only bone on bone on the medial side, and both my rheumatologist and my surgeon thought it was time for my first TKR, and it is now much better and I have every confidence that things will continue to improve. I am having the 2nd one done in July and it is mostly because of the kneecap--the cartilage is shot on one side of it making it track incorrectly and rub the femur. I hope the OS is better at surgery than he is with tact or optimism!

 

[JudyS]

From reading your post it seems like this surgeon did not feel it would help your husband but went ahead and did the replacement. That sounds crazy by itself.
From your husband's standpoint, why did he pick this guy??? I did not know a surgeon would operate if he did not see a good chance of a positive outcome.
Lets hope and pray that your hubby meets a wonderful physical therapist tomorrow am at the hospital who is very positive.
judy

 

[Surfsister]

All of the negativity emanating from the doctor is not going to help your husband. You, hnkford, will have to be the opposite, the person who brings some positivity to the situation. It sounds like your husband knew what he wanted. And, truthfully, he is the one who can best judge whether or not the surgery was a success (given his previous surgeries). I get the impression that your husband wants this to work. You're on his team, not the doctor's. You be the positive one. You help your husband through this. Then, a year from now when it's all behind you and your man is walking without a cane, tell your husband all that was going on with regard to the doctor's attitude and how it affected you.

The doctor is being a jerk. Period. As you said, why would he assent to performing the operation if he thought it unnecessary. That's medical malpractice—doing an unnecessary procedure. I think the doctor is trying to cover his butt(ets). Don't let him say PT is not helpful. Regardless of the pain issue, your husband will need PT to regain full use of that joint. If the doctor won't sign off on that, it's time to make some veiled threats about lawsuits. You cannot do surgery and then not follow through with what's best for the patient's recovery.

Don't let the doctor bully you two around. Set him straight. Make him understand that the deed is done, his negativity is unnecessary and you expect a prescription for physical therapy whether he agrees with it or not.

 

[Texas]

You go sister, well said !!!!!!!!!

 

[Jamie]

Hnkford, from the situation you describe in your husband's knee, it does sound like the knee replacement will help him regain stability and mobility. But something about what you say the doctor is telling you just doesn't seem right. The arthroscopic surgeries didn't help. The rheumatologist didn't help. Your husband still had LOTS of knee pain. And now the offending knee joint has been replaced. So what is the doctor saying is going to cause "constant pain" after recovery? I think you need to have another discussion with the doctor before you go any further. You need to understand exactly what he feels will cause pain in his knee now. And you need to ask why he feels therapy will not be a benefit following the surgery. (I doubt that!) It just isn't making a lot of sense and you need some clarification as to what the problem was and seems to be now that the joint has been replaced. Please try not to worry in the meantime. Your husband will heal from this surgery and he needs your support. Post again soon, okay?

 

[Texas]

Jamie whats up with these Dr's.....lately. It' so so sad. Kim

 

[Jamie]

In this case, I need more information about what is going on. It's difficult to tell right now. I know Hnkford is upset and it is a very emotional thing to watch someone you love go through major surgery and be hurting. Hopefully she will have a discussion with the doctor and find out some additional particulars.

 

[Texas]

I agree I hope he doesnt wake tomorrow and the Dr tells him that negative stuff, I know that would have bothered me...........Maybe she will ck on here first......

 

[hollie9]

I agree with Jamie, you need to aggressively make that doc explain why he would have continuing pain in the knee after recovery. Does he have rheumatoid arthritis or something similar?

I had a scope which ripped out all my meniscis leaving me "broken". But when they take out the entire joint and put in a new one, why would previous scopes matter at all? The bad joint is gone.

As soon as your husband is three weeks, I'd get my XRays together and go get a second opinion. The way this doc sounds, he may not have done a very good job. Better to find out earlier than later.

Talk to the doc and beat him up like I do.

Hollie

 

[hnkford]

I really can not explain why DH chose this surgeon other than that he is good and DH said he really knows his stuff.

The only thing I can think of as to why the OS thinks there will always be pain is that there will always be scar tissue AND the OS seems to think DH has a low pain tolerance. Maybe, but DH didn't just decide "oh, let's get TKR today". He has been debating this for years.

The OS isn't going to stop PT. The PT came up from me when he said the pain relief wouldn't be total (he did not go as far as to say it wouldn't be better either). I said something about PT helping get past that (meaning more PT more chance of success) and he just shook his head and said the next couple of days would be tough.

Thank you all for your replies. I've pulled myself together and am off to the hospital. I fully intend to be the best cheerleader I can be and get him through this. I'll post again later.

 

[Judles]

Yikes, hnkford......as if you weren't on an emotional roller coaster as it was, right? First and foremost, how is hubby feeling and doing this morning? Jamie, as usual, offers the best advice! Your doctor's surgeon definitely owes you some explanations! Why would ANY surgeon be so discouraging so early out? And don't fool yourself....PT and OT are a MUST! Don't let the OS bully you! Stand firm! And be positive! Our prayers are with BOTH you and your hubby! :

 

[Judles]

Whoops! I obviously meant your husbands surgeon! Hope to hear good news today!

 

[Jamie]

Hnkford, as your husband's advocate, make sure he is getting adequate pain management especially during these first few weeks of recovery. He should NOT be in significant pain at this time. It will impede his recovery.

 

[Josephine]

I got rather a different interpretation of the OS's attitude. He said at one point that your husband had "too low a pain threshold" inferring that it's psychosomatic or pain with no physical foundation. I've met doctors like that and have so wanted to say "In whose opinion? Your opinion? Your opinion doesn't count. Only the patient's opinion counts. Pain it exactly what the patient says it is - not one wit less and not one wit more!"

Tis true that some people can report pain that seems to be far in excess of the appearances of their condition but as carers we have to remember that we may not be seeing all the story through our clever little cameras and scans. We have also to recognise that whilst we will be more than ready to accept someone with a high pain threshold - standing in awe of "how can this chap keep walking - his knees are a mess"! - yet our patience is quickly worn out by someone who keeps complaining of pain when we can see no valid reason for it. We can then so easily dismiss them by saying "It's psychological" in other words, imaginary.

I think he's decided that your husband is in this category and that nothing he does will stop your husband's psychological state of 'being in pain'. As one other member put it, he's covering his you-know-what!

Ok, he might be the bestest knee surgeon ever but he has a rubbish bed-side manner and the sooner you get out of his sphere of influence the better. Find some good, positive and pro-active PTs and be guided by them. If you have any problems or need medications (which you will) then see you own doctor. Hopefully, in 6 months you'll have proved him wrong with a vengeance and can give him the cabbie's infamous two fingered salute! And if, perchance, he does have any serious problems, go see another surgeon (if you can get him there!)

All the best!

 

[Surfsister]

We don't use two fingers here in the States, but I know exactly which salute you mean. Josephine, you're a crack up! It's too bad we can't all have a BoneSmart KR group meeting at Gringo's house in BWI and finally get to see one another face-to-face.

 

[Judles]

In Manhattan, those cabbies drop a finger, Jo! Tee Hee!

 

[Texas]

Haha Surf you are correct. I sure hope he is doing well this morning and pushes on no matter what the Dr says thats horrible...............Get Better soon.............Kim

 

[hnkford]

You all are such great support. I am in much better condition tonight. Hubby was doing better today but I'll need to have a little chat w/ the OS tomorrow about pain management. The OS has DH on a strick 4 hour vicodin/tylenol (as well as other stuff but this is the one that really helps) pain pill regimine and it isn't working as well as it should. The pain starts getting bad at 3 hours or so after the pill rather than 4 and by the time he gets it "on time" he is over the top in pain. I missed the OS today (he does hospital rounds REALLY early) but plan to be there super early to address this. Though tomorrow 4 hours may be just fine for the pill cycle it would be nice to have a "or 3 hours as needed option". According to the nurse the strick cycle is due to the tylenol and potential liver (or kidney I forget which) damage. She suggested I ask for something without it.

Thank you so much for your support. At least I know I don't have to just take the negative attitude. Oh, and the PT staff are so very positive. With them it is "the pain causing joint is gone once the muscle and bone around it heal you will be all better". That is the type of attitude he needs right now.

He did end up asking at the end of the day if this was a mistake. I told him it is too soon to even think of asking that. I know I'll have to field that question a few more times but one day he won't have to ask because he will know he made the right decision.