Knee Infection Whew!! it's finally done: the Good, the Bad and the Ugly

[BionicBob]

It amazes me the fight you all have in USA to get pain relief over here one is on repeat and I just order when getting low and the other I request
I think your writing is good you have a great diary of events for future use if needed
Take care

its funny you say this as earlier I was reading some of my older posts and it put me back in time when I was still in the hospital. Don't miss any of it...especially where my desperation was so obvious. How I got through those moments I'll never know

 

[BionicBob]

Seems like I still have a bunch of Q's to ask, just need to organize my thoughts so I can do it rationally. So bear with me while I transition back to sanity.

What exactly determines when I'm 'out of the woods' for a revision? I'll be sure to ask the OS next week when I see him again, but I have all the faith in the world in you folks, so I'll ask here first. I do know that the blood tests play a role but does the visual of the wound itself have any bearing? I'll attach a couple pics of what my knee incision currently looks like as of today if that helps. Be forewarned...they're a little graphic if not disgusting IMO, but then again I'm sure most here are accustomed to this already.

Might need @Josephine to use her photo editing skills again as mine are still lacking. A number of years ago I used a program called Irfanview(sp?) that worked wonders for photo editing, but I never installed it on this LT. Its now on my list of things to do and learn
how to use it again.

 

[BionicBob]

Back to my OS and his denial of pain meds...

I knew he had a military background from his bio when I first started looking for info pre op. However I glazed over this as it didn't mean much to me at the time. Now that the possibility exists that I may be facing a revision, I wanted to see where he stood. So I dug up his bio again and I'm pleased to say his revision history rates up there among the best...at least based on his bio which I have no reason to doubt.

As for the military background...it all makes sense now. He has an impressive record of achievments and recognition, including CO for a surgical team during the times of war. I can just see it now...he's tending a wounded solder on the front lines who has a leg blown apart while screaming in agony. He tells the solder "suck it up solder, that's an order" and believe me, that's a reality that many do not understand. Growing up a military brat, I know first hand what those guys go through. When we were stationed in Sidi Yahia Morocco and Rota Spain during the mid/late 60's, I used to hang out in the barracks with these guys. Yeah I was young, but not much else to do when confined to a military base in the middle of nowhere. And since a couple guys were willing to sneak me into the barracks, I was all for it. Learned a boat load at a young age and still grateful for that experience.

So knowing what I know now...it all makes sense and why this OS treats his patience like they are his solders. The military tends to brainwash those that become lifers in the military...my father was one, so I speak from experience.

 

[Homeport]

Hi @BionicBob so glad to see an update and feel your more positive mood doing normal family things like looking after your twin grandsons it’s a huge step forward really happy for you

 

[BionicBob]

@newlybionic IIRC you mentioned in another thread that you took Vancomycin for an infection. I have a couple questions if you don't mind...

But first and foremost:
I was told I had a staph infection and understood it to be caused by a skin bacteria. It was made to be the lesser evil of infections. Is this true? Anything else you can tell me about it would be greatly appreciated. I have an appt on the 29th with my ID Dr and hope to be as informed as I can be and prepared to ask questions as well.

Next...the Vancomycin. I have been in contact with those involved in overseeing my infection treatment, so they are aware of a couple symptoms like...after 20-30 mins while the Vancomycin is dispensing, I get very light headed. In addition, after its finished, I feel totally out of it and fall into a deep sleep. Nothing was said when I mentioned it and curious if you felt anything similar?

Next...it seems after the bandage was changed last week(might just be coincidence), my elbow becomes painful while the Vancomycin is dispensing. I don't know the correct name but its the inner point of the elbow joint. I think its called the radial head part based on what I can find, but I'm not certain. In addition, the area where the picc line enters my arm gives a slight burning feeling. After the Vancomycin is done, both areas are no longer painful. Are these 2 symptoms something to be concerned about?

Thank you!!

 

[BionicBob]

Thought of another Q...

Its been said here many times that 4K mg of Tylenol per day is acceptable. Now I'm told its been lowered to 3Kmg. Any comments from those in the know?

 

[rubyyarn]

Hiya, Bob!

I'm glad you're feeling more upbeat about it all. It sounds like some healing has taken place. That scar has a pretty good scab on it, yes? I couldn't see any wet, oozing spots.

Sounds like you and your doc have reached some sort of rapport, and that is good. When the time comes to get those stitches out, you might ask him for a bullet to bite to pay him back for the "suck it up" remark

The new rules for Tylenol are a reflection of the fact that other medications can contain Tylenol. Percocet is one of them. You shouldn't take more than 4000mg Tylenol from any source, including what is in your Percocet. You can either do the math or go with the 3000mg rule.

 

[sistersinhim]

5 more days of healing before facing the stitch removals again is a good thing!

Your photos looked better than I thought they would! They do look nice and dry. This has to be a good sign!

I'm so glad you're able to do some normal things now. How uplifting that is! You are still in my prayers!

 

[KarriB]

My OS used that terminology (out of the woods) for the first 4-6 weeks after infection surgery. I believe that was mostly due to the fact that my incision (which had seeped like a small creek before infection surgery) began to seep again when the staples taken out. So one week half of the 50+ were taken out and the other half the next week. It took almost a whole month after surgery before the incision was completely healed and done seeping, even then my OS said to keep praying because I wasn’t out of the woods. In fact the day I went to see him (saw him 2x a week for a month) when the seeping had stopped we were going to decide if a 3rd surgery would mean another washout or a full revision.

Let me say, (not for a weak stomach) at 2 weeks my incision was seeping pus badly. I was changing dressings 3-4 times in a 24 hour period. In the last 2 weeks of the month I went from a fully soaked dressing to a quarter size spot to a dime size spot and finally to a clear dressing almost a month to the day after infection surgery. I spent a lot of time resting/elevating to help my body manage the energy drain that comes from healing an infection on top of 2 surgeries within a month. So clearly I wasn’t out of the woods for at least 6 weeks.

 

[Celle]

Its been said here many times that 4K mg of Tylenol per day is acceptable. Now I'm told its been lowered to 3Kmg. Any comments from those in the know?

The safe daily total of Tylenol (Acetaminophen) is 4,000 mg from all sources. That is the total recommended in many countries.

The US authorities decided that people might not be clued up enough to consider the Tylenol that is included in many medications (such as cold cures, Percocet, and several others) when calculating their daily dosage. So, to avoid accidental overdose, the recommended daily dose was reduced to 3,000 mg.

That's all. 4,000 mg is safe, but you do need to include the Tylenol in any other medications you are taking, when calculating your daily total.

 

[Josephine]

I was told I had a staph infection and understood it to be caused by a skin bacteria. It was made to be the lesser evil of infections. Is this true?

It's contrary to what I have learned. I suggest you browse in the Library for a lot of these things. There are hundreds of articles in there but these would be appropriate to this question
Acne pathogen implicated in peri-prosthetic infections
Peri-prosthetic infection - also known as late onset infection
Periprosthetic infection

Next...the Vancomycin - after its finished, I feel totally out of it and fall into a deep sleep

That's not entirely uncommon. a sudden bolus (large IV shot) of almost anything can have that effect.

my elbow becomes painful while the Vancomycin is dispensing. I don't know the correct name but its the inner point of the elbow joint.

It's called the antecubital fossa.

In addition, the area where the picc line enters my arm gives a slight burning feeling. After the Vancomycin is done, both areas are no longer painful.

Seems like you are developing a sensitivity to the drug which is not unusual when you're in this chemotherapy treatment. It's quite tough on the veins.

 

[BionicBob]

Hiya, Bob!

I'm glad you're feeling more upbeat about it all. It sounds like some healing has taken place. That scar has a pretty good scab on it, yes? I couldn't see any wet, oozing spots.

Sounds like you and your doc have reached some sort of rapport, and that is good. When the time comes to get those stitches out, you might ask him for a bullet to bite to pay him back for the "suck it up" remark

The new rules for Tylenol are a reflection of the fact that other medications can contain Tylenol. Percocet is one of them. You shouldn't take more than 4000mg Tylenol from any source, including what is in your Percocet. You can either do the math or go with the 3000mg rule.

Yes some healing/drying as occurred which has mostly been over the last day or 2, not sure I'd call it a scab yet though. It is dry now and I think that's mostly due to the OS discontinuing the use of those moist sterile strips under the bandage so it wouldn't stick. Seems counter productive for removing the rest of the stitches though as I'd think the moist skin would aid removal. Then again, they won't feel any pain when they remove the stitches :(

It is encouraging to see the OS and I are on the same page now...hope it lasts. I never once gave either of them reason to challenge me or berate me like they did. Maybe they were having a bad day? But even if they were it did not justify the way they treated me. Hoping to put all that misery behind me now and move forward with recovery.

Since the Hydromorphone did absolutely nothing, the OS suggested I stop taking it which I did last Friday with no noticeable change in pain. All I'm taking right now other than 3K of Tylenol is the 2 AB's...Vancomycin and Rifampin. Today I'll talk with my PCP and hopefully he'll prescribe something...even if its only enough to get through removing the remaining stitches.

 

[BionicBob]

5 more days of healing before facing the stitch removals again is a good thing!

Your photos looked better than I thought they would! They do look nice and dry. This has to be a good sign!

I'm so glad you're able to do some normal things now. How uplifting that is! You are still in my prayers!

Thanks again for the encouraging words sistersinhim!! I'm glad you think the incision looks so good. For me it looks pretty gruesome, but that may be due to knowing what it looked like prior to the infection. Sad part though is the OS said I will have a pretty nasty scar, which isn't what I wanted to hear. I wear shorts almost year long excluding the winter months, so I'm sure I'll be very self conscious of its appearance.

 

[BionicBob]

WOW!! @KarriB 50+ staples? I can't even imagine...just the thought of that gives me the chills! And here the I thought the 8 I had were tough enough. No doubt your description proves you had it far worse than I did. You're a tough gal for sure!! It makes me think I'm a wimp in comparison....lol at myself!

Not sure if I mentioned this before, but a number of years ago I took a nasty 25' fall and spent 4+hrs in agony with a dislocated shoulder and multiple fractured ribs before I made it to the ER. Worst pain I ever experienced and yet that pain paled compared to the pain I experienced from this infection. In fact I don't think the post op pain for the TKR was as bad as what I went through with for the infection.

Thanks for the comments about "out of the woods" because it does put me at ease now knowing its not an uncommon term the surgeons use. My OS has mentioned it a couple times now and even though I somewhat ignored it last Friday, it did register in the back of my mind.

Now that you're 4 yrs out from the infection, have you had any more issues or re-occurrences with infection?

 

[BionicBob]

Thanks @Celle for the explanation. I do recall it being mentioned here about the total Acetaminophen, but honestly forgot. I've hadway too much dumped in my lap over the last 6 weeks and its hard keeping track. In fact I have a hard time keeping up with who's who with all the nurses that come to my home.

I'm currently only taking the 2 antibiotics plus 3K of Tylenol(have been since last Friday), so I may bump it up to 4K today. But that'll also depend on what my PCP prescribes me today if he is willing to do so

 

[BionicBob]

Thanks again @Josephine for the links you supplied in the library. I took a quick glance and to be honest, some of the language is above my paygrade lol. After I fully wake up and have a few cups of coffee, I'll go back and spend the time to understand it better. I do indeed want to know more about the causes and prevention's of the infection and no doubt that info is here for me to learn from. You and your team have done a remarkable job with this forum. The more I proceed through this TKR, the more questions arise. Every last one of you here, members included have been a godsend for me!! I am forever grateful!

I must confess to a blunder. Sorry for the confusion...I obviously didn't think my description of the elbow pain location through enough, because it left some confusion. I always thought of my elbow as the back side of the arm, and remember the days when my mother would yell at us kids to get your elbows off the table while eating.

As they say...a picture is worth a thousand words. I placed a pieced of tape at the exact location of the pain I was referring to. It's a bony point that has a flexible joint. The tip of the bony point is where the pain was located.

 

[sistersinhim]

the OS said I will have a pretty nasty scar, which isn't what I wanted to hear.

The way I look at it is that our scars show how much strength we've had to get through what we have! Between my two knees, I've had 11 knee surgeries, so you can imagine what my knees look like! But, when it get warm, those shorts come on! I am what each one those scars have help to make me!

 

[BionicBob]

@sistersinhim That's an interesting way to look at it and I'll just have to change my way of thinking. Thanks!

 

[BionicBob]

Well that's a disappointment...just got off the phone with my PCP. He can't prescribe any pain meds unless he is treating me for the condition. He could in the past, but the new regulations have tightened up so much he won't risk his license...which I fully understand.

While I think this whole deal of how they're dealing with the ophioid crisis in general is ridiculous in that it affects those who truly need it, it is what it is and not much I can do about it. What upsets me the most is that even though the intention is to keep it out of the wrong hands, those very people that abuse the drug will still get it

 

[BionicBob]

Not really. I do have my original ortho Dr that I could ask, but I'm not going to bother him. If there are newer regs out now, I'm sure he'll abide by them too.