Revision TKR Never give up, keep trying, don't settle - that's me, Bonnie

[RunA42K]

turtle68, Celle, Oldie since my last posting I've emailed back and forth with the physicians assistant. She said I could have a hematoma from my knee following the fascia to my ankle/foot (what ever that is, Orthodoc) She said that during surgery that the foot/ankle is braced so it can't get whipped around. I do know that they'll take your foot out of the brace to check your fit, alignment and flexion before sewing you up so there was some movement. Or perhaps she suggested from walking funny on it in the beginning at the hospital. She called me in a muscle relaxer, told me I could take ibuprofen in addition to my pain pills. I said I have Aleve and was that ok, and she said yes.

And now the stinginess on the pain pills...first RX was 50 of 10 mg hydocodone/325 mg acetaminophen. Today they approved 40 of the same drug same strength. I guess next they'll drop it down to 30 maybe even lower the strength. The surgery instructions for before and after surgery state no narcotic pain killers after one month. That the patient would be referred to a pain management doctor if pain control was still needed. So I'll take what I need and eventually if I only need one, I'll still get them refilled for the one month, whether I've used mine up or not. The first TKR I needed Norco for 6 weeks. Then at 8 weeks I had a little set back from doing too much, had to use them again, especially to sleep. So if I can refill up to a month then I am getting them!

 

[Pumpkin]

Bonnie,
I hope your ankle starts to feel better soon! Frustrating to have these extra challenges.
Pain pills, Ugh! Maybe your GP can help you with with your pain medications after 30 days.
Follow the Mantra,
:santa:

 

[turtle68]

Bonnnie, Hope you had a decent night and are having a better morning, and that you were able to get your prescription. Your dr. is the 1st one I've heard of where you can only get narcotic pain pills for one month. I can see it with oxycodone, but NORCO? I took it off and on for 7 months with all the problems I had. When do you you see the OS?

Dorothy

 

[Orthodoc]

Bonnie,

Can you provide a little more clinical info about the question...

Orthodoc

 

[Oldie]

Bonnie, hope you had a good nite. I was thinking I told you about using heat on your foot,ankle but only use heat if there is no swelling.
Sorry I didn't think of thst before.
Have a good day!

 

[RunA42K]

Orthodoc, I've been complaining about ankle pain and the top of my foot. I also have a pain in the right side putter side of my calf. The calve pain feels like a muscle cramp that does not go away. When my ankle and foot started hurting it was a few days after surgery. I thought it was from bruising with my leg being man handled during surgery but the PA says the foot/ankle is braced is it should not be from that. She suggested that if my foot/ ankle/calf was swollen I should get evaluated for a blood clot. I told her my foot and ankle were not swollen and no obvious swelling in my calf.to me just the usual leg swelling that a TKR would have. She suggested that if it was just weight bearing in the ankle/foot that possibly I had a "hematoma" from my knee that traveled down the fascia to the ankle...I don't know what that means. I set a note to my primary care doctor just a bit ago about the calf pain.

 

[RunA42K]

Ok, this is the problem…My doctor said I CAN cancel home PT I just have to do all the exercises myself which is no problem because they are so easy. The doctor says NO outpatient PT until I see in him his office when my staples come out. That is about 10 days from today. The woman Marilyn who came out for PT today was very nice, and I did like her, I know I don't need them. So I discover this afternoon she left accidentally a piece of her equipment here. Something that takes your pulse and oxygen level that they put on your finger. So she did call and told me she'd get it on Friday at our next PT appointment. So now I feel like I have to let her come Friday since she's needs to come and cause she was so nice. Then…a bit later the same home healthcare service calls me (I didn't answer) and it's an occupational therapist who wants to come over and do an evaluation on me! NO WAY! What do they think I am. Sunday Dec. 1, I was driving the car, cleaning the house, getting a pedicure, going out to dinner. Then I have a knee surgery (albeit major surgery) on Dec. 2, and they are asking me if I can dress, and bathe myself? Really?? I walk all over the house, crutches or walker close by. I shower, get dressed, take care of feeding the dogs, fix myself coffee and breakfast, fix up my ice packs and talk care of myself all day while Dave is at work. They told me they are used to working with Medi Care patients, older and less active. So they sent out an RN on Monday, along with a PT evaluator who was the jerk, the one today was actually a PTA, now they want to send Occupational therapy?? I guess they are used to gouging the government for the Medi Care Patients. I'm not letting them do that to my insurance company. They take my blood pressure every time they are here and guess what?? It's high! I give you one guess why?? Because they are in my house!! My blood pressure has never been high a day in my life. So what do I do about Friday? btw, I've not taken a pain pill since 7:30 a.m. today. I am truly believing that Revision hurts less.

 

[turtle68]

Bonnie, I think it's probably more like providers trying to gouge people on private insurance because they get paid more. Being on Medicare, I had none of that and was more than fine on my own. Medicare will only provide those kind of services if you are alone, and then it's usually in the form of a "nursing home" where you get PT once a day if you are lucky. It's all about profit for insurance companies and providers. Isn't it great we have BS to vent on? If it were me, I'd let Marilyn, even though she was so nice, pick up her equipment and say thank you very much for your kindness, but I'm fine and appreciate your help.

Take care, relax, and wished I still lived close to you - I would be happy to pop in if you needed anything at all.

Sending you big hugs. XOXO Dorothy

 

[RunA42K]

Just got to look at my staples. I don't get them out till December 20

 

[Orthodoc]

I had a "hematoma" from my knee that traveled down the fascia to the ankle

Blood will pool in dependent (lower) areas. If the blood is not contained in a specific location it will travel through the soft tissues and around facial planes (think of these as strips of tissue that run the length of muscles and groups of muscles). It is very common for knee bleeding to extend down the leg and can even get all the way to the toes.

Orthodoc

 

[RunA42K]

Blood will pool in dependent (lower) areas. If the blood is not contained in a specific location it will travel through the soft tissues and around facial planes (think of these as strips of tissue that run the length of muscles and groups of muscles). It is very common for knee bleeding to extend down the leg and can even get all the way to the toes.

Orthodoc

Well this certainly does make some sense to me Orthodoc because my ankle sure is sore. Got an ice pack on it right now. Would it have any bruising at all, because there is none.

Also, how long does this usually last? If indeed this is what you described. The more I walk on it, the more sore it gets. Sometimes that bothers me more than my knee. Who ever would have imagined!

Thank you for your reply

 

[Celle]

Hi Bonnie,
As long as it's not a blood clot (DVT), which it doesn't seem to be, I think you just have to ride it out. Don't forget that the pain medication will help the pain in your ankle and foot as well, so take the pills if you're sore.

Rest, ice, elevation will help those pains as well as your knee. Maybe a little heat on your foot and ankle (not your knee), but don't overdo it. I know it's not the same thing, but when I had tendonitis, the physio told me to alternate heat and cold, and it did seem to help.

I know you don't want Marilyn to do anything with you as far as exercise goes, bu maybe she could suggest something to help decrease the ankle-foot aches? It wouldn't hurt to let her take a look. Just a suggestion! (May as well use her, since she's there!)

 

[skigirl]

Bonnie, I used Percoset 5/325 mg every four to six hours---try cutting your pills in half and see if that is enough for your pain. I got nausea when I was taking too much pain meds--when I cut them in half, the nausea went away and so did the pain--eureka! I agree with you that you should get whatever refills they will give you of the pain meds---you will need them for a while. I found that at three weeks, I switched to Tramadol which is a milder narcotic. It was easier to get a script--my Internist gave me a script for 50 with two refills. i still have some of the original 50!

 

[skigirl]

Oh and to what to do here are some suggestions: I learned to knit---got some yarn and a YOu Tube video!! I watched all of Downton Abbey. then I watched all of Doc Martin---finally figured out what was going on!! I got a ton of books from the library. I reread all of Jane Austen and then watched the DVD's too.

I found You Tube to be a fun entertainment--it was like looking through an enclyopedia---I kept finding new things to look at. I discovered Jonathan and charlotte for instance!

It is a good time to arrange photos and I did make some doll clothes for my granddaughter--sewing them by hand.

You can find lots of runner's websites---look at all the new bikes and dream away. Mostly, I allowed myself to be idle some of the time--which is unusual for me.

 

[RunA42K]

Guess I'll really be able to vouch for rest and no formal Physical Therapy after TKR for at least 3 weeks. First TKR, I was in out patient Physical Therapy at 6 days post op. That was after 4 nights and 5 days in the hospital. I had a lot of bad days and nights after that TKR, and looking back now, just like we learn here on Bone Smart that when it comes to Physical Therapy that less is more.

This revision has gone so much smoother, less pain, better mobility than my first TKR. Yesterday I had one pain pill at 7:30 am, then not again till 4:30 pm at only 9 days post op I am amazed. Had it not been for my doctor saying "no out patient PT, but home Physical Therapy for 3 weeks until office visit check up" (of course now he says I can cancel home PT), I more than likely would have taken myself to out patient PT and not be doing as well as I am right now.

I showed my husband all the exercises that I got from the home PT, along with those I brought home from the hospital. I got right down on the floor (that was unheard of with my first TKR) and showed him each exercise. It was almost laughable how easy they all were. He was convinced just like me that I didn't need someone coming to the house to do this. So I'll do my exercises because I told the doctor that I would, and in the meantime I get LOTS of time to rest, ice and elevate and yes, yes, yes, I can see so clearly the difference now the recovery with this revision and first TKR. I am a believer, especially because I've done it both ways for the same knee. First TKR I describe as most horrific pain in my life horrid recovering from it. This revision is like a vacation comparatively.

Rest people, don't make you knee mad!

 

[maryo52]

Wow. Fantastic. Is it the same surgeon for your TKRs?

 

[RunA42K]

Wow. Fantastic. Is it the same surgeon for your TKRs?

maryo52 Absolutely NOT the same doctor Mary! My first doctor kept blowing me off for almost 2 years, every time I went to him he'd just say "Highly Unlikely" when I would suggest scar tissue. He always to me tell me to go do more physical therapy. After having the scar tissue removed by a different OS and I still was not better, he referred me to 3 different names of OS who do TKR. One OS them was Dr. Stephen Incavo. Dr. Incavo knew something was wrong with my TKR, finding sloppiness in the metal parts having to much play, moving side to side, and ligaments that were not even/unstable. He did my revision and I think he is a great doctor! He knows his stuff. Chief of Adult reconstructive surgery here for the Texas Methodist Health care System in the highly respected Texas Medical Center. He took out my Smith and Nephew Legion knee that Sonja has now that she is so happy with. I got a Stryker Triathlon revision system knee that I am very happy with. Different knees for different folks!

 

[maryo52]

I wondered because a friend had her revision with one of those super orthos in Boston and when I saw her three weeks later, I was astounded at the lack of swelling and the appearance of her leg. She had a great recovery although slow ROM which she was wise to be patient with. So I think, all in all, luck plays a bigger factor with many orthos, but then there are those who regularly produce excellent results. Glad you found one!

 

[RunA42K]

Thanks maryo52, I think I found a good one this time. If you read my post above the recovery which I expected to be worse than TKR has actually been amazingly good. I can go hours without taking pain pills (after the first week). No where near the pain and swelling as with the TKR and my knee bends much better already. I am just 10 days post op today and I am just not believing how much better I am doing. The doctor was not the least bit concerned about scar tissue coming back this time. I think that is because what he saw when he opened up my knee. Misalignment and unstable loose ligaments. I basically had been inflaming it with every move for as long as I had it. Imflaming causing scar tissue to grow continually to want to heal.

 

[maryo52]

So his name is Incavo? Well this confirms my suspicions that my laxity is part of my problem, which is why I wear a brace. Are you describing this as you understand it, or did Dr. Inova also say this? Because some day, who knows, I might brave a revision but only if I had good confidence in the doctor's understanding of my knee's problems.