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

oh my goodness...what rotten luck you've had. i know what you mean about the eating. i could only eat a few things for the first 3 to 5 weeks: peanut butter on celery, 2 or 3 tbsp. apple sauce no sugar, 10 plain shreddies (no milk on top), a few carrot sticks, salty crackers ~ that sort of thing and lost 12 lbs. in the first 2 weeks. i didn't even brush my teeth for the first 10 days or so unless i had to go out to surgeon or having company; even that made me nauseous. you would think this is the time to eat healthy but you can't force yourself if it makes you want to throw up. good that you like those protein drinks (i couldn't even stand them). you're right, respect has to be a 2-way street between patient and medical staff. those 2 nurses have a lot of nerve, one questioning whether your driveway will be plowed (for her) and the other burning rubber on your driveway and being messy in your house. i understand they are busy with more patients to visit but it's better to slow down and be accurate than make a mistake and have to undo it another time (same for the driveway and driving so fast ~ accident waiting to happen). wishing you a more comfortable and less pain recovery and very sorry you're going through this.:friends:
 
Bob, I understand totally where you’re coming from. My fuse was short, but I was usually able to hold it together with nurses or visitors. However, a few times my family had to deal with my frustrations and I’m still apologizing today (I felt that badly).

Chances are you won’t be able to plow for quite a while. Is there someone nearby you trust to do this chore? I had nearby nephews who came to shovel, but couldn’t always do it first thing in the morning. My TKR/infection occurred in 2013/2014 during the Polar Vortex and I didn’t want nurses coming into my house through the front door with snowy shoes, nor did I want them to have to climb steps outside in the cold/snow. I worked out a signal (usually a honk of the horn) and I used the remote garage door opener to let them in through the garage. That way they were climbing basement steps in the warmth of the house and leaving snowy footprints in the basement instead of my living area.

My OS suggested a high protein diet to promote healing. Luckily, I am used to eating a high protein diet and had eggs with sausage for breakfast, Greek yogurt and nuts for lunch and something else meaty for dinner. I wasn’t always able to eat a lot, but I did try to consume protein. I am a picky eater.
 
Thanks for all the encouragement and kind words. It does help knowing its not just me experiencing these symptoms and annoyances. As much as I'd like to address each of your meaningful replies, its not in me right now. I hate to say what I'm thinking right now more so because I don't want to jinx myself, but...

I strongly suspect the nurses unintentional error of pulling on one of the stitches caused my knee to become inflamed again. The pain and inflammation is just about constant now and the pain level has averaged a solid 6 since yesterday afternoon. I'm wide awake right now at 3 AM because of the constant pain, doubtful it's due to the disruption of sleep cycle I've been experiencing. Yesterday evening we changed the bandage...OS order for daily change now...and the area where the infection is was very red. Even my wife commented. The incision itself where the stitch was tugged on appears to be open as well. Wish I thought to take a pic but was anxious to cover it up again. Pretty sure someone lost their job after the last catastrophe with the home visiting nurse company, and if my hunch is correct it might happen again with this new company. Hope I'm wrong, but I'm not overly optimistic that I'm not. As I've mentioned many times, my OS and his PA don't play games and run a very strict regime. I've experienced first hand what they are capable of if you cross the line.

On a brighter note: the visit last week with my OS was encouraging. They got rid of the wound vac because it served its purpose and was no longer needed. The overall condition of my knee was well above their expectations, so now its just a waiting game for the healing....or so I thought.

Also my ID Dr called me last Thur and said they had more results regarding the infection. Something else has started to grow (from the blood tests or culture?? not sure) but the infection was caused by normal skin bacteria that entered the wound through the stapled area. She then decided to switch the AB to Vancomycin(sp?) which instead of using a syringe through the picc line, I now have a pressurized ball that takes 90 mins to dispense. Not a big deal other than the feeling of being tethered once again. Thought those days were behind me after being discharged from the hospital.

Thinking back about my recent posts in this thread...I've messed up the timeline of events, felt very scattered brained at times trying my best to be coherent, likely repeated myself numerous times and feel like I'm using a lot of words to say very little. Or maybe its just me being overly conscience(<<not the correct word and cant come up with the correct spelling for the word I want). Either way, I'll blame all the trauma I've been through so please excuse me for the errors.

I've exhausted all the prescribed meds I've been given other than 2 Hydromorphone every 4 hrs for pain and Rifampin twice a day for the infection. And since yesterday afternoon, neither has had any effect on the pain. I'll mention it to the OS when see him in a few hrs, but not to confident he'll prescribe any more pain meds unless the condition of my knee currently dictates otherwise. Might be time to pay my original ortho Dr a visit or maybe my PCP to see if either will write me a script for pain meds. I still have Tramadol tucked away from earlier this year, but would prefer to save that as a last resort. And I'm not sure I should be mixing that with the current dose of what they're giving. I do know I was instructed not to take any Tylenol at all, post op from the emergency surgery for the infection.

Once again I typed waaay more than intended and likely used too many words to say very little.
 
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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
 
Bob, fret not about the length of your posts. I've written a novel or two on here in my day. :snork: You are free to express yourself within the board rules.

I sure hope your OS understands why you might need more pain meds. You've had complications and aren't the usual 5 weeks out.
 
Thanks again for the well wishes!!! I'm at the OS office right now so I'll update when im through. Most likely not until I get back home though.
 
Bob, Rifampin is an antibiotic. It won’t help with pain, but is for your infection. I took it orally along with the
IV antibiotic.
 
KarriB said:
Bob, Rifampin is an antibiotic. It won’t help with pain, but is for your infection. I took it orally along with the
IV antibiotic.
Click to expand...
I knew it was an AB, just didn't know if it had any effect on pain.
 
Wednesday was a day of reckoning, a day where the proverbial something hit the fan.

My intuition was a dead ringer...spot on the money for 2 counts:

1st- No sooner than when the PA removed the bandage he fired a shot that was a direct hit to my central nervous system...."what did you do to it now?" and I immediately fired back with a strong emphasis of sarcasm..."what do you mean what did >I< do to it?" and before he could even reply I unloaded a verbal fury that was long overdue. I finally reached the end of the line with their insinuations and let him have it. Majority of what I said would be difficult to translate into a language suitable for this forum, so instead I'll just mention what I ended my tirade with. "I'm done being a lab rat and allowing you to treat me like a piece of meat. Either we get on the same page and work together to get through this, or you can wrap my leg back up and I'm out of here never to be seen again by you clowns." I also attempted to explain what the visiting nurse did on Monday, but not sure if he heard/understood it through my rage. Right or wrong, what I said was intentional and very much deserved, with no regrets. Surprisingly, he didn't say anything and left the room. A few mins later he returned with the OS. He asked what happened and I explained what happened while the nurse was cleaning it on Monday. He then told me that even if she ripped the stitch out, it wouldn't cause any further damage other than the pain it caused. He then instructed the PA to remove the upper half of the incision stitches and for me to return Friday(tomorrow) so he himself could remove the rest.

2nd-While the PA was removing the stitches, I asked if they were going to numb the area where the remaining stitches were...this was where the infection was and was still inflamed from Mondays mishap. He said no and suggested that I be sure to take my pain meds prior to the visit. "Excuse me...what pain meds? The only meds I have left are the Hydromorphone and Rifampin and that I may as well eat a bag of M&M's for pain relief because the 2 meds I'm still taking are worthless for pain relief." He then told me due to federal law, he couldn't prescribe any more oxy. OK fine, can you give me something else or can the area at least be numbed prior to removing the remaining stitches. He said all he could was write another script for more Hydromorphone, in which I replied "you already did that last week" Sheesh!!! What is with these clowns?!!? And that was the end of it. He wrapped my knee back up with specific instructions to leave it alone until Friday when the OS removes the rest of the stiches. For one thing, I'm kinda glad he brought up the oxy instead of me as I didn't want to come across as some drug phene. I also am not the least bit surprised with his refusal for any more oxy, because early on when I realized how strict they were, something told me they were on the same train as the fed gov or whoever is behind the push to end ophioids. As I left and making my way through the halls back to the waiting room area, I passed several members of his staff. Each one of them looked at me in a way that if eyes could talk, I would have gotten an earful. Not sure if thats a good thing or bad, but no doubt they heard my tirade with the PA. I can only imagine what the conversation was between the PA and the OS after I left.

And then just when you think it couldn't get any worse...the night before this appt, my wife and I were discussing the pain and my hope that they would give me some more oxy or something. Well her position was in line with the way the 2 bafoons think and that I shouldn't ask for anything else. Her concern was over me becoming addicted to oxy. Given the circumstances, I about exploded..."addicted?? They only gave me a weeks supply post op from the emergency surgery. How could I become addicted in such a short time. In fact early this year my ortho Dr refilled the script several times over a 3 or 4 month period and I never got addicted to them. At that point it was becoming a full blown argument that I didn't want to deal with. And I;m sure the stress wasn't healthy for me either. So I told her I'm done with this conversation and to leave me alone. I'll deal with this nightmare by myself from now on and I didn't want any help from her...PERIOD! END OF DISCUSSION!!

Yeah I'll admit to being a hot head and when there is just cause, I refuse to back down. And to further prove my point of being bullheaded and sticking to my guns, I drove myself to the Dr appt the next day. Left bright and early and didn't give her a chance to interfere. Even though it was an hour away one way, with no pain meds in my system, I knew I could do it safely. Made the trip without any problems and then spent the rest of the day at a buddies place. Actually felt good to get out in the world again after being cooped up for the last month. But I will admit to paying the price for that foolishness because I was totally exhausted by the time i finally did get home. No doubt I pushed myself too far, but mind over matter is a powerful thing, esp when fueled by anger.

It'll be interesting when I go see the OS in a few hrs. Not sure what to expect...will he numb my knee before he removes the rest of the stitches or will I have to endure another round of excruciating pain? If I'm left to suffer, I have a half of mind to tell him I'll eat a half bottle of Tylenol after he's done to counter the pain.

It's probably best I end this here as I feel my blood press rising just thinking about what I'll be facing soon...
 
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If I do contact my Ortho Dr or my PCP for pain meds, I have a concern...

Not sure about my records from my Ortho Dr but I do know my medical records from my PCP are somehow linked to my medical records at the hospital. They call it 'MyCare'. I know this for fact as I have access to this site and I've seen them. The hospital hosts a site that connects all my medical records from my pre op Dr, OS and his PA, ID Dr, blood work from both the hospital lab and Quest, and my PCP.

If I contact my PCP and he prescribes me pain meds even though the PA refused to write any, will I suffer any consequences? I do know all the scripts I've been given are listed on that site, so I won't be surprised if my PCP writes a script and it shows up. Or would the PCP be willing to keep this off the record?

I've seen it mentioned here several times about seeking help from your PCP, so what was your experience if you went that route?

Thanks!
 
If your PCP prescribes your pain med and the other doctors see it... they’ll sigh with relief that someone else did it and they didn’t have to. That’s it. They aren’t going to care because they won’t have to defend the decision. That falls on your PCP.

It’s not that your OS doesn’t want you to have pain relief, or that he thinks you’ll become addicted... it’s that he doesn’t want to have to justify to some governing agency why he’s prescribing these meds in amounts above what the agency thinks sufficient. Doctors are as frustrated by these new rules as patients are.

So ask your PCP, and crossing my fingers he/she comes through for you. PCPs often step forward for their patients, especially long term ones.
 
Thanx @SusieShoes...that's reassuring to hear!!! Now I just need to find the strength to get thru the removal of the rest of the stitches. Not sure what to expect other than my insides are trembling something fierce because of the expected pain.

Right now my opinion based on limited experience of surgeons in general is they are a bunch of cruel masochists...

Edit: not even sure that is the correct word to use but I'm sure the intention is understood.
 
Bob, did the first lot of stitches hurt? If so, couldn't they give you a numbing shot of some sort?

I'm glad you read all those 'professionals' the riot act, but do you really want to be at war with your wife? She is on your side, you know, in spite of the misinformation out there...
 
Give your pcp a try. For me the pain diminished about 2-3 weeks after the infection surgery. Can you tell us when your infection surgery occurred? We’ll add it to your signature.
 
@BionicBob, I think doctors are reticent to prescribe opiates for long periods because there is a database where pharmacists must report every opioid Rx. I know the database is at least statewide - not sure if it crosses state lines, but I wouldn't be surprised. @SusieShoes is right: the doctors just hope someone else will prescribe it for you so they will not be seen as overprescribing. The docs don't want to see you suffer, but do want to make sure they don't lose their licenses to practice. My brother-in-law has been on opiates for many years and must go to a pain clinic 40 miles away once a month for blood testing to make sure he is using what is given, not exceeding his dose, and not selling (which would be indicated by low levels in his blood). He has never taken more than prescribed but has some miserable side effects and questions daily whether he should have followed doctors advice to take these meds at such a high dose for so long. He is definitely addicted, has OIBD, and has lost about 1/3 of his body weight. His pain comes from an eye disease he contracted after sinus surgery and it's left him in constant pain. The docs tell him they could remove his eyes (he still has limited vision and doesn't want them to do that) but even then, they can't guarantee that it will stop the nerve pain. Insurance won't pay for him to try marijuana and no local doctor in this town of 380,000 is willing to prescribe. It's a mess. I know the last half of this isn't about knees - but it is about the opiate issue which pops up here fairly often. TKR is inherently painful - my doctor told me I had to take opiates, which I did for 3 weeks. For those of us who take them for a few weeks or months, I think it is true that if you need them for pain relief, they are not addictive. If your pain persists for months that turns into years, they are - and it kind of angers me that the companies that developed these drugs are not coming up with alternatives a little faster.
 
rubyyarn said:
Bob, did the first lot of stitches hurt? If so, couldn't they give you a numbing shot of some sort?
Click to expand...
Yeah it was somewhat painful, but tolerable. No numbing shot as the OS does not want any needles in the knee. I never pushed the reason as to why.
 
KarriB said:
Give your pcp a try. For me the pain diminished about 2-3 weeks after the infection surgery. Can you tell us when your infection surgery occurred? We’ll add it to your signature.
Click to expand...
I called my PCP on Friday and he's out til Tues. But the nurse didn't think there would be any problem for him to prescribe something.

Surgery for the infection was Oct 28th
 
Friday AM in the OS office...

Needless to say I was a bundle of nerves waiting for the OS. He knocked and entered the room and I'm positive my heart stopped. But I had also resigned to the fact that this needs to be done, so lets do it and get it over with. After a bit of small talk, he unwrapped my knee. His first question was who wrapped it and how long ago. I replied "your son did it on Wednesday and he specifically told me to not touch it until today" ...remember my 'like father like son comment while in the hospital? I didn't and wasn't the least bit hesitant to say it to his face... At first I wasn't sure what to expect as his expression was emotionless, but then he cracked a smile and chuckled. Wow...this guy is actually human!! In fact from that point on he was a complete 180* from what I ever seen of him. Either my little hissy fit a couple days ago left an impression or he actually had sympathy for me and my current condition.

He then asked if I was ready and I quickly replied no, but understood it needs to be done, so do it already! His reply "suck it up" and me "excuse me...really? I mean just like that, suck it up?" And then out of the blue he said "I'll tell you what, we can wait until next week, but on Wednesday the remaining stitches have to come out" I was like sure no problem and could have kissed him...well not really but my excitement overpowered any rational thinking. He the went on to say the wound didn't look any better or worse, and minimal leakage was encouraging. But he also went on to say I'm still not out of the woods as to whether of not a complete revision would be needed. He also asked when I was going to see the ID Dr again, which is scheduled for the 29th. And that was pretty much it. He wrapped my knee up with a fresh bandage and said see you next week, have a nice day.

I was waaaay to elated to even think about questioning him further about what he meant about not being out of the woods. Instead all I could think of was I had 5 more days to enjoy and enjoy I intended to do!! Granted it only delayed the inevitable, but I wasn't going to argue. If anything 5 more days of healing and hopefully less pain. It was all I could do to not skip through the halls as I made my way back to the waiting room....seriously, I couldn't feel any pain at that time if I wanted to. And now after discovering my new found freedom of being able to be out on my own, under my own power, I wasn't about to waste any of it. Spent the rest of the day out gallivanting the streets paying visit to friends and enjoying the fresh air from a beautiful fall day here in New England. Got home, ate and lights went out almost immediately with no regrets.

Saturday I was asked if I wanted to watch my twin grandsons while my wife and daughter went shopping. Their father had to work, so I said sure and spent the day at my daughters house. Loved every bit of it, even the constant 'why' from the boys after I answered a bazillion questions from each of them. Seemed all they knew how to say was why why why! Lol

Last night another storm was heading our way with high winds and power outages to be expected. So, when I got home, got the genny ready. Sure enough about 3 am power went out. I wasn't about to bother firing it up just yet as the temps were quite warm...close to 60* so i fell back asleep. Daylight came and I went out to the garage and fired it up...ahhh, we have power again!! Today was a day for a fresh makeover and it was warmly received. Its times like this where you don't realize how much we take for granted with just doing the basic things of life...or more like not being able to do them. Bless my wife for tolerating me because I'd be in a whole other world of hurt without her!!

and here I sit, wide awake at 11:40 on a sunday night, paying homage to newly found friends who share similar stories:happydance:yeah, I guess you could say my attitude is finally on the positive side...not sure how long it'll last though
 
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@phrog I agree with everything you said, only I wish my wife would understand what its like from our side.

Sorry to hear about what your BIL is going through, that has to be tough to deal with.
 
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