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TKR Possible 2nd MUA and possible referral needed

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Re: Pain meds - How much? How long?

That's quite a list of issues, Jill. It does seem like you might want to at least chat with someone else. Maybe the "great reputation" is just among the "golfing buddies." I think you're wise to consider your other options.
 
Re: Pain meds - How much? How long?

Jill0606 said:
and my issues with peeing (I have only been able to "trickle" since surgery - someone said the catheter can "shock" your bladder... but I'm starting to wonder at what point does the "shock" wear off??? - its been almost 7 weeks).... do I just call it a day and go with another OS and hospital altogether?
Click to expand...
Hmm - never heard of that one before! I would think the urination problem is more to do with a faulty spinal and/or nerve compression in the spine. Certainly needs looking into - preferable by a gynae/urologist.

Jill0606 said:
but the fact is that he has a great reputation.
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I agree with Jamie - I've lost count of the times I've heard surgeons I know to be mediocre being proclaimed as the "top man" or "best there is" by people who just happened to strike it lucky and get a half way decent treatment form them. The only such accolades I would give any credence to are those from his peers (not his working partners) who are in the same speciality, from people like PTs or theatre nurses who've seem him work, etc.
 
Follow up visit with OS today

Hi All,

So I had my f/u with my OS after my EMG/NCS last week. I'm going to list here what my report says. I've looked up some of the medical terms... and it is a bit terrifying. My doctor is at a loss that so many issues have surfaced since my LTKR. I have been referred to a spine specialist and have been scheduled for an "emergency" CT scan of the lumbar spine for Monday morning at 9am. He also said that due to the femoral nerve damage and the approx 50% motor loss to the vastus medialis (inner thigh muscle) he was not going to perform the MUA, as there was too much damage to the nerve and muscle to sustain any flexion that he might achieve. Also, because of the spine issues found, he said he didn't want anyone sticking anything into my spine until we found out what was going on. At no time were lesions or tumors talked about during my visit, however, as the findings below note, it couldn’t be ruled out.

I didn't think about it until after my appt when I got home and started looking up what the various findings meant... that I noted my doctor's tone was much different from my previous visits. No "fun" or chatting about things.... he was very sympathetic to everything and rather subdued. He upped my pain meds again, telling me that he wasn't at all concerned about the Oxycodone, but the amount of Tylenol and potential damage to the liver, and he also filled out paperwork for a handicapped parking pass good thru 2011. I guess I'll be sporting my crutches for quite some time!!

Okay... for anyone still with me. Here are the findings as stated on my EMG/NCS report. Most are actually related to my spine (which probably means I will have to find a different forum for that issue) I'll abbreviate where I can.

1. Abnormal Study.

2. Likely left femoral neuropathy proximal to the motor branch of the iliopsoas; with approx 50% motor axon loss to the vastus medialis, prognosis for functional recovery good if instigating lesion is removed.

There is electrophysiological evidence of a left-sided femoral mononeuropathy as shown by the abnormalities on needle EMG of the left iliopsoas, vastus medialis which is clouded by the abnormalities throughout the rest of the left lower limb and in the right as below.

3. Possible left and possibly right L5 or S1 radiculopathy, plexopathy, cannot rule out left lumbosacral panplexopathy.

There are diffuse abnormalities on needle EMG throughout the left lower limb w/ sparing of paraspinals. A panplexopathy cannot be excluded in this situation. However, there is an alternative more likely explanation for the proximal left lower limb symptoms as above. The remainder may be explained by an L5 or S1 radiculopathy or plexopathy. Abnormalities were seen in the tibialis anterior on the right side and there may be a similar but lesser process on the right.


Clinical Impression: Test shows what is likely a left femoral neuropathy with approx 50% motor axon loss to the vastus medialis. If this is related to a one-trauma the prognosis is good. Recovery usually takes place at 1 inch per month as a very rough estimate, and recovery could therefore take a year or even longer. There was no current evidence of axonal sprouting or regrowth.

There are diffuse abnormalities thruout the left lower limb and even some on the right. This may be due to a bilateral L5 or S1 radiculopathy, though a panplexopathy on the left cannot be excluded. Imaging of the lumbosacral spine and pelvis should be considered.


If anyone here can decipher any of the medical jargon and give me their thoughts in "normal people" speak, I'd appreciate it. I gather that they are looking for/ruling out a tumor on my spine (trying not to freak about that). One thing I know now is that my issue with the inability to flex my knee is not because I'm a whimp and can't handle pain. The muscle/nerve issue is playing a huge part. My PT is so incredibly positive and hopeful that he will get some bend. "It will be a dogfight the whole way" were his words, but again he remains so optimistic... and I desperately need to bend my leg so that I can get into my car (mid-size SUV) and drive! Right now I am continuing my PT three times a week. I am refusing to freak about the possible spinal problems until I know for certain what they are or are not. I am going to pry myself out of my chair and go to church on Sunday... it certainly can't hurt!!

Thanks in advance for any thoughts or advice. You all have set a huge precedence for forums. I only hope that if I have to turn to a spine/neurologic forum, that they are half as helpful and supportive as everyone here.
 
Re: Pain meds - How much? How long?

Jill, going back to the pain issue, have you tried taking any Ibuprofen (Advil)as well as the pain meds, as this is an anti inflammatory medication. That would be OK wouldn't it Jo?

Hope the appointment went OK today (((HUGS)))
 
Re: Follow up visit with OS today

Glad your OS is at least being sympathetic now Brenda. At least a recovery is expected in time. Patience will be a virtue I guess.Can't help with the report but I expect Jo will help out there.

Good luck with your recovery. (((HUGS))) Sue
 
Re: Follow up visit with OS today

Jill, I moved your post onto your original thread so all of your previous discussion would be at hand. It helps me (and others, I am sure) keep track of your situation. Hope you don't mind.

Well, the first thing to get out of your head is that they are looking for a 'tumor'! In med speak, a 'lesion' is anything that's not supposed to be there, in this case, a simple disc protrusion which could be quite mild and still be responsible for these symptoms. Even a simple mole or wart is referred to as a lesion! :wink:

Point #2
Some definitions
radiculopathy: a problem with normal nerve function
plexopathy: an injury or other damage to a complex junction of nerves, especially a nerve plexus, with neuralgia (nerve pain) due to trauma or pressure. The 'pan' prefix just means many. In this case, the complex nerve junction would be the sciatic nerve which at the spinal nerve root level is huge as you can see in this image!

[Bonesmart.org] Possible 2nd MUA and possible referral needed


So "bilateral L5 or S1 radiculopathy" is referring to the likelihood of a disc protrusion in those intravertebral joints, being low back pain. L4/L5 and L5/S1 are the most common places for a disc protrustion.


[Bonesmart.org] Possible 2nd MUA and possible referral needed


(explanation: L = Lumbar vertebra, S = Sacral vertebra so L5/S1 refers to the space or joint between those two vertebrae)

Point #3
Clinical Impression: Test shows what is likely a left femoral neuropathy with approx 50% motor axon loss to the vastus medialis. If this is related to a one-trauma the prognosis is good. Recovery usually takes place at 1 inch per month as a very rough estimate, and recovery could therefore take a year or even longer. There was no current evidence of axonal sprouting or regrowth.

There are diffuse abnormalities thruout the left lower limb and even some on the right. This may be due to a bilateral L5 or S1 radiculopathy, though a panplexopathy on the left cannot be excluded. Imaging of the lumbosacral spine and pelvis should be considered.
Click to expand...
Overall, this is good news as it indicates you can expect your limb to eventually be restored to good function. However, it remains a 'guesstimate' of what the source of the problem is. Is it from the nerve block and/or tourniquet (the "one-trauma" to which he referred) or is it from the 'lesion' in L5/S1 intervertebral joint? Or a combination of both. You probably won't know this until they do an MRI of the lower spine and even then it's a guess as to which of the combinations I've cited are responsible. If you do have a disc protrusion, my guess is that it'll be a combination of all the above.

Good news is that the radiologist (or whatever 'ist' it was produced this report!) projects that ultimately, the nerve should regenerate. But nerve growth is an extremely slow business - he says one inch per month though personally, I think he's being a tad over-cautious there. So if the damage is at the femoral block level just below the groin, this is something like 6-10 inches thus being 6-10 months.

So you have these options
1. MRI of spine - disc protrusions yes or no
2. If no, then it's damage at the femoral block site and wait for healing and nerve regeneration to take place
3. If yes, micro-discectomy (removal of the herniated bit of the disc) but you'll still have to wait for the nerve regeneration to take place. Micro surgery for this is an extremely small incision, about 1" or less, procedure done with an operating microscope (meaning no messing about!) and therefore recovery is usually very swift.

Hope this help some and has calmed you down! It's not anywhere near as bad as 'med speak' makes it seem. Could be a lot, lot worse. If I've missed anything, please say and I'll try and explain it.
 
Re: Follow up visit with OS today

Jill, Thursday was a big day, and I know if it had been me, I would've been looking forward to the part where you get "answers." But it's almost like a Sherlock Holmes story where the "answer" directs a new set of questions. Your patience is amazing.

I do know people who have had back surgery to correct impinged nerves with very good success and immediate relief. Hopefully despite these complications you'll ultimately have good results, just a longer time getting there. I'm glad you're on this forum and I look forward to seeing this sorted out!
 
Re: Follow up visit with OS today

Josephine... seriously, you rock. Without you, Jamie, the other wonderful people on this site and my PT... I wonder where my mental state would be.

I'm 45 and have a whole lot of experience with orthopedic issues and surgeries over various parts of my body - the first being bilateral major knee surgeries in middle school which was the start of all my knee issues. I was in an MVA in 2005 which resulted in two cervical spine surgeries with fusions at C4-5, C5-6 and C6-7 (ACDF), the first time with donor bone and the second from my own hip. I'm used to complications (I call them challenges) after surgery. My first ACDF (5/6, 6/7) resulted in a pseudoarthrosis at C6/7. The second surgery was C4/5 and a redo of C6/7 with my own bone graft.

After these two surgeries I ended up with severe occipital neuralgia with debilitating headaches, head pain and pressure and after a year of pain mgt w/ more steroid injections, facet blocks, rhizotomities etc to all levels of my C-spine and occipital nerves then I care to remember. The breaking point was when I would laugh and the pain was get so intense, I would actually run to the bathroom and become physically ill, I underwent a surgery to have an occipital neuromodulator (pain mgt device) implanted, which has been an amazing help in dealing with the head issues. The only drawback is the fact that I can no longer undergo MRIs, hence the CT scan as opposed to an MRI for my lumbar spine.

Many long stories short... I have a lifelong history of dealing with orthopedic issues, "challenges" and nerve issues and have always been able to deal with them, and while painful, I didn't ever have to rely on others to help me through. This time around with my "bum" leg, I need people to drive me, lift my leg for me, (I have a leg lifter to use at home), push me in a wheelchair if I have to go to the mall, etc. It's just frustrating. Hopefully, I will have more answers after the CT scan.

In the meantime, I am still so incredibly greatful for the people and the knowledge here. I know we all say it over and over.... but this forum truly is a lifesaver.

HAPPY NEW YEAR TO ALL!!! ‎2011 is now here so remember this.... Life is too short. REMEMBER, break the rules, always forgive, love truly, laugh uncontrollably, and have no regrets.
 
Re: Follow up visit with OS today

Do I take it my explanations helped then? :th_heehee:
 
Re: Follow up visit with OS today

Jill....you have been through so much. I admire your strength to deal with it all and keep fighting. That is going to see you through this "challenge" also. You're gonna be just fine....I know it!!
 
Donations?

I'm assuming there are costs associated with running this site. Is there a way for us to donate if we choose? I've found so much solace here lately, I couldn't give a lot, but would be more than willing to do what I could.

Just curious. Thanks.
 
Re: Donations?

Well I never! :th_DOH: There was always a "Donate" button on the Nav Bar but we forgot to add it at the upgrade! Thanks for bringing this to my attention, Jill.

There is a place on the website for donations
 
Re: Donations?

Jill, that is so sweet of you! Thanks for your offer to donate to the operation of BoneSmart!!

I'm with Jo, though....all of us looking at the new forum format and NO ONE noticed the donation button wasn't there!! Thanks for tuning us up.
 
Re: Donations?

I used the link that Jo provided to make my donation...it was very simple. I wish I could have donated more, but I wanted to make sure the "powers that be" knew I was appreciative of the site and the support here.

~Jill
 
Re: Donations?

The amount is not important, Jill. The idea that BoneSmart helped you is what counts. Thank you so much!!!
 
Re: Follow up visit with OS today

And the saga continues.....

I am now just shy of 9 weeks s/p LTKR. After 10 outpatient PT visits (and a month of home visits immediately following my surgery), I am still at a max of only 50 degrees flexion. The electrical stim is atleast stimulating the thigh muscles that are not affected by the femoral nerve damage. It was amazing how quickly these muscles atrophied away to nothing as well. My PT is taking a very gentle approach with me, I leave there feeling like I've "worked" things, but never in any horrible pain. Lots of stretching and stepping and he got me on the treadmill for two WHOLE minutes at 1.0 mph. I was terrified I'd fall and I don't think I breathed once during the two minutes!!

I am awaiting my appt with the spine specialist on Friday when I will finally get the results of the CT scan from last Monday. Waiting is the worst. In the meantime, however, my PT (who has never been in great favor of MUA) has told me that I should approach the subject again with my OS in early February when I see him again, as he definitely feels there is something within the joint that is contributing to my inability to bend my leg. My OS, however, told me at my last visit that he will not ever put another needle in my spine... so I will have to see what options are available - or if he will even do it. I guess alot depends on my results this Friday as well.

During PT I have had severe pain on the inside of my knee just over from my knee cap which has remained constant from the beginning. During my exercises my PT holds/glides/moves my kneecap inward. He has even tried taping it in place so that I can do my simple exercises while hooked to the elec stim. When he pushes it toward the inside the pain isn't as severe when I try to bend it. He informed me today that this is going to continue to be an issue as my knee cap is slipping or sliding off to the side and isn't staying in the "groove". He said we will continue to work on strengthening around it, but that I shouldn't be shocked if at some point someone mentions another possible surgery for this.

I told my husband about the latest and he just rolled his eyes. I think he is getting tired of hearing about "things going wrong". I can't blame him... but a "gee....that stinks" would have been nice... ya know? Anyway.....

On a positive note... I can use the muscles that are working in my thigh and FINALLY lift my leg about 1 inch off the PT table in a straight leg raise!!! This was HUUUUGE for me and my physical therapist. He really has been an incredible help to me - both physically and mentally. He's a long-time family friend and he has such a calm and soothing/sympathetic voice... he remains hopeful and optimistic even when he's talking about things a patient may not want to hear. I'm lucky to have him and these boards. Not sure what I would do at 3:15 am if I couldn't come here and at least get my thoughts out through the keyboard.

The snow is falling and it really is a beautiful night. Off to fill my water and tryyyy to get some sleep. As always... thanks for being here and for "listening".

~Jill
 
Re: Follow up visit with OS today

Jill, I am sorry to read about your knee--and cannot even imagine how frustrated you must be. A rom of 50 is not what we want when we consider this surgery.

I think you are doing the right thing by going to your surgeon and asking him what the problem is with the knee. Is it scar tissue? Is it some mechanical problem?

I wish you all the best and am very glad to hear that you have a wonderful pt---mine also was a great help to me as I recovered from this surgery. Keep us posted about your knee. Kelly
 
Re: Follow up visit with OS today

Oh Jill...how absolutely frustrating. I am so sorry...but I note that you are trying really hard to keep a positive attitude. I hope the OS has some positive words to encourage you.

Just know we are all here for you!!! :th_grouphug2:
 
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