TKR Possible 2nd MUA and possible referral needed

[maryo52]

Re: Question about not using knee

Sounds like you're in good hands with an exceptional PT. Reminds me of a book, "When Bad Things Happen to Good People." Never read it but the title says alot.

Is there a surgical intervention being considered . . . or is the plan to take the conservative approach? Last I remember, a nerve study was being proposed (involving injection of dye).

Were you started on coumadin pre-operatively? Or did they use enoxoparin? Just curious because I just now remember my OS saying if my PT was above a certain number (they checked it just before surgery), the anesthetist would not do a spinal and I would have a general. It didn't occur to me that such bleeding might create a hematoma that would press on nerves. Of course you don't know yet for sure where the problem occurred, but as I remember this was one theory.

Oy!

 

[skigirl]

Re: Question about not using knee

Dear Jill,

Thanks for clarifying the situation with your pt--who does sound really wonderful.

I have to admit that I also admire your positive attitude--although, I suppose that is what we all have to do--play the hand we are dealt.

I am sorry though to hear of your struggles--and of the life changing scope of this problem. We go into surgery hoping and expecting the best outcome--but sometimes, that is not the case.

I am with Jamie--I also wish I had a magic wand to change the situation--but, since I do not, I will offer you my prayers and hope for your future. So many nerve injuries do repair themselves--although often only after a frustrating length of time. I am so glad that you have the help of an expert pt while you wait. Kelly

 

[skigirl]

Re: Question about not using knee

Mary,

I have never heard of taking coumadan before tkr. I refused to take it--too many variables. So did use 10 days of heparin shots post surgery.

But, if you did take it preoperatively, of course, you would need a protime before a spinal or epidural. But, I am sure that those type of anesthesia would not be used if you were taking coumadan pre op.

I am always scared off by conservative docs!! Kelly

 

[Joy1]

Re: Question about not using knee

Sorry to hear about your complications. Hope things work out and keep the positive attitude.

 

[leenie60]

Re: Question about not using knee

Unfortunately nerve damage is one of those potential complications that we sign off on before surgery and hope we don't have to deal with. I've heard as is stated here, that depending on the extent it can regenerate and heal. I hope this is the scenario that plays out for you and wish you all the best. I was put on coumadin PREoperatively and they did the appropriate blood test just before surgery to ensure I was eligible for epidural which I was and thankfully the only thing I'm dealing with is a numb knee.

All the best to you.

 

[Josephine]

Re: Question about not using knee

Jill, nothing you don't do will harm the new knee. What it will harm, as you are finding, is the surrounding ligaments and muscles. But you have to work one step at a time. Do that and try not to worry about the 'ifs', 'ands' and 'buts' of all this. You just have to let it all happen.

 

[Jill0606]

Re: Question about not using knee

Josephine... Once again you are spot on! I asked my PT today about any potential issues to the knee itself with me not using it, and he said almost verbatim what you did. I hope you are making the "big bucks" for the wealth of information you offer us all!

I'm curious to anyone here who has had epidural anesthesia... were you awake or asleep when the needle was administered? I was supposed to be awake and have the epidural in the pre-op area, but my surgery was delayed by 3+ hours (due to OR schedules) and everyone (hospital staff) was getting anxious about the surgeries.

My OR was finally being prepped for my surgery and anesthesiology was given the go-ahead to start my epidural in the pre-op area. They were at my bedside talking to me when someone came in and said... "change of plans. She's getting her epidural in the OR now" and they started wheeling me down. I was moved from my pre-op bed to the OR table, had a second to ask if my OS was in the room and then was out cold. Next thing I remember was waking up in the post-op area. Maybe it's done different ways in different hospitals, with different doctors, etc... I'm just curious.

On happier notes... I walked for 8 minutes on the treadmill today at a rate of 1 mph. Yay!!! Okay, so my legs felt like Gumby after and even though I held onto the railings for dear life... it felt great to be moving without crutches under my arms. My PT is using a lot of "magic tape" to help hold my kneecap over which alleviates pressure. He also feels that he probably won't get me past the 50 degrees flexion, but despite that I'm becoming sturdier in the 50 degrees that I do have.

Just got a call about my upcoming CT myelogram and CT of the pelvis. They are scheduled for bright and early Thursday morning. Trying not to get nervous. The hospital will be calling in the morning to explain things and answer my questions (I have lots!). Thanks again for being here. I'll be sure to let you know how it goes Thursday.

~Jill

 

[Jamie]

Re: Question about not using knee

Thanks for the update, Jill. Your progress is wonderful and you should be proud of your accomplishments. I'll be waiting to hear the results of your tests.

 

[maryo52]

Re: Question about not using knee

Jill,

I am in awe of your ability to keep up your spirits. I hope Thursday is a +++ day for you.

 

[Josephine]

Re: Question about not using knee

There are heaps of different ways to do the anaesthetic, spinal, epidural or general. It matters not one jot if it's 'this' way or 'that' way. The end result is the same and by the second day it's all yesterday's news anyway!

 

[Jill0606]

CT myelogram... piece o' cake

I just arrived home from the test. I had myself more worked up and nervous for this than I was for my TKR. The nurses, techs, and (two) radiologists were all WONDERFUL and took extra special care with my bum leg. I explained my story no less than a half dozen times to everyone involved in my care and all were surprised or shocked as they had never met anyone with or heard of femoral nerve damage as a result of spinal anesthesia.

I had to lay on the table on my stomach, which was obviously uncomfortable for my knee, as well as my neck after my 3-level fusion. They pillowed me nicely and a really nice (male) tech took great care with my "girlie parts" and the wide open gown as I was moved and rolled from the gurney to the procedure table. What a sweetheart he was.

The radiologist explained everything in great detail ahead of time. He performed the procedure with all the needles which was uncomfortable and hurt, but it wasn't horrific.... and got to the spinal fluid to take out some of it out but for some reason couldn't get any fluid from that level, so he withdrew the needle and started again at a new level. So I kinda went through it twice. The procedure took about an hour to an hour and 15 mins. I returned to recovery in the same day surgery area and laid flat for about 2-1/2 hours.

The radiologist said his part looked good - which is what we were expecting, but I didn't hear anything about the CT scan. I have a follow up on the 9th with the spine surgeon first and then immediately after with my knee surgeon. I don't think we'll have any more answers, but we'll know more thngs that it's not.

Thank you everyone for all the moral support. I'm so thankful for this board.

 

[Jamie]

Re: CT myelogram... piece o' cake

Jill, I'm thrilled to hear things went well for your test. God bless those caring medical staff members!!! They DO make the difference.

 

[Just Judy]

Re: CT myelogram... piece o' cake

Jill I am so glad things went well at hospital. I sure hope you will soon have the answers you need so you can move forward.I am so sorry you had to go thru all of this. I wish you all the best !!!!!!!

 

[Josephine]

Re: CT myelogram... piece o' cake

Terrific! I am so pleased it went well.

 

[WaterBaby]

Re: CT myelogram... piece o' cake

So glad to hear that the myelogram was done and that it wasn't as bad as you had thought it would be. Cheers for you for being brave and having such a good attitude. You are now definitely much closer to having a firm idea of what is causing your problems, and a treatment plan to address them - and that is a VERY GOOD thing!

 

[skigirl]

Re: CT myelogram... piece o' cake

My husband had the same experience you did with a myelegram---both of us are surprised that they done't give you a bit of pain relief, since you need a ride anyway. we both think that a percoset would help with the whole thing. I think that radiologists are worse at pain relief than orthopedic surgeons. Kelly

 

[jugornot]

Re: CT myelogram... piece o' cake

Now that your done and it doesn't matter. My experience was a bit different. I was to have a procedure (I don't remember if it was ct or just an xray ) with contrast. I guess my size intimidates people so the doctor started me out with a shot of valium. Then they had me curl up into a ball to get better access to inject the die. She then tried 3 times to get the needle into my spinal canal. It didn't hurt but it felt like an immense pressure. Finally she went out and got another person. He had better success when all of a sudden my legs mule kicked out. I had no control I guess he touched a nerve. Anyway the procedure continued without mishap except I came in for an outpatient test and ended up staying the night in the hospital. There was no mention of this beforehand but with the valium I really didn't care. Everything turned out OK and I didn't have any ill effects. Glad your went so well. See why I waited til you were done; this story might have made you nervous.

Bill

 

[maryo52]

Re: CT myelogram... piece o' cake

Jill, Glad to hear it went well. It's amazing what we can go through when the people around us use a little TLC. Hoping you'll get some valuable info. I did look up one of the things you mentioned this could be, a hematoma on the spinal cord, and I think the article said the occurrence was 1 in a million. Yeah, and you get another A+ for attitude!

 

[jerseychick]

Re: CT myelogram... piece o' cake

Glad everything went well. Once you get the results you can move forward. Keep up the positive outlook!

 

[Jill0606]

The next step.... manipulation

Okay... so here is the latest. My CT myelogram from a few weeks ago was negative for spinal tumors, and the did not see any nerve or major disc damage in the lumbar spine. Yay! I've been discharged from the spine doctor with his "diagnosis" being that during placement of my spinal anesthesia (during my TKR) the femoral nerve was damaged, causing what they can really only guess was a bleed of some sort - which caused the nerve/quadricepts damage, and the bleed has since healed.

No one knows if the damage is temporary or permanent, and we are at the "only time will tell" stage. I had a long talk with my PT prior to my visit with my OS early last week. Even though he is typically against manipulations, he feels that in my case my OS should attempt it. At 3-1/2 months s/p TKR, I am still only at 50 degree flexion and I guess my 5 degrees extension is the straightest it will ever be. During my appt with my OS I discussed manipulation with him. He told me I definitely needed it but it was the "timing" that he was concerned about. If I go through it now, and my nerve damage is still such that I cannot sustain the bend after, I would be going through this for nothing. He then said that if we did decide to go through with manipulation now, that there would definitely be at least one other manipulation down the road, as well as a surgery to fix the kneecap issue, the ligaments and to remove all the scar tissue and adhesions that have formed over the last 3+ months.

Before we made the decision he explained what he was going to do, and what I should expect after. Because of the issue with the spinal epidural I will not be having spinal anesthesia this time, but will have conscious sedation. He forewarned me in every way possible that I will be in significant pain after, and because of that he has me scheduled as the first procedure of the day and I will be staying the day and night for pain managment purposes. He said because the knee hasn't moved at all in over 3 months that the ligaments and muscles will be screaming at me afterwards, as well as the knee and the joint themselves. He said I will be cursing him up and down and calling him every name in the book. He really has me expecting the worst... which is the way I prefer things.

So all that being said, I am reporting to the hospital at 6AM on Tuesday and will be discharged Wednesday morning. I'm not sure about the machine to bend it after, my OS said that would depend on how things went. I know most people here have had great results with the manipulation, which has me somewhat at east about it. Everyone on this end will be happy if I can get 10 more degrees and sustain that. I will be stopping at PT on my way home from the hospital on Wednesday... for assessment and therapy.

So any good thoughts thrown my way on Tuesday morning would be very welcomed and most appreciated. I'm praying for just a little bit more bend (I don't need to get greedy!!! :smile: ) so that I can sit in a chair or better yet, get behind the wheel of my car and drive!!!!!

Thank you again for your continued support. Keeping my fingers crossed and I will let you know how things go after!