OA meds

[smillie]

I am currently dealing with several problems in my knee.  I'm working in PT on the mechanical issues, but I also have some OA in there, so my OS put me on Voltaren twice a day to help with that pain and inflamation.  After being on it for nearly a week, I was having good results with the pain and inflamation, but it made me very very depressed.  So I quit taking it and called my OS.  Next, they called in Mobic.  Same situation, I took it for nearly a week and had good relief, but ended up with depression again, so I had to stop taking it.  Each time, coming off of the medication was really painful and when I'm not taking it, I have a lot of achiness and ugly puffy type swelling, especially in the afternoon/evening.  I'm trying to do my PT and work on my other issues which is enough for me to deal with without having this OA pain as well.  So I'm a bit miserable at this point.  I'm going to call the OS back again and ask what I should do now, but I also wanted to check in here and see if anyone had ideas.  Am I just not going to be able to take any NSAIDS?  I've taken Advil (ibuprofin) for years without any problem, so I'm surprised these other NSAIDS are giving me so much trouble...

[dm]

try the topical voltaren gel and see if you get the same effect... the blood plasma levels are much lower with the topical versions than the pills. the topical doesn't get anywhere near the amount into your system that the pills do, since its topically applied to a small skin area, and not digested and absorbed through the whole bloodstream. thus, a very small percentage gets into the system via skin absorption, versus the larger quantity via intestinal absorption.

Worth a shot, since the pills helped so much?

[smillie]

I'll ask about the gel if I can decide on another OS to see. As it ends up I can't even take Ibuprofin or Aleve now.  I am completely miserable and I can't get the inflamation under control without the meds. But if I take them, there is no telling what I might do. The depression was really scary and it came on fast.  I don't know what to do to get this under control! The OS says there is nothing he can do--I just need to strengthen my quads to pull my patella over. He basically released me and washed his hands. There is substantial cartilage damage behind the patella and it is sitting against the lateral side of the groove. I can't strengthen my VMO because it is completely shutting down from the inflamation. It's anybody's guess if I can even lift my leg from day to day. I can't walk on it without terrible pain and the swelling and heat get fired up again. I'm sick of being told to strengthen my VMO and/or there's nothing wrong. And I'm sick of the pain and swelling and heat--sometimes I can't even feel the cold of the ice packs at all. My muscles are disappearing and I can't figure out what to do.  I'm scared. 

[TwoBadKneesUSA]

Keep looking for an OS to start.  Ask your GP about the gel, he or she may be able to prescribe it for you.  While waiting for my partial I used a Breg PTO brace that helped center the kneecap and help that lateral drift.  It also helped me do some of the PT stuff without really ticking off the knee and having the quads take a vacation.  Do as much of the strengthing as you can manage to try and keep the muscles going.  See if there are any docs in the area that is familiar with a patella femoral joint replacement.  As long as your damage is behind the kneecap this could help you.  Good luck to you.

[smillie]

I had wondered about using the PTO brace but my patella is stuck pretty hard to that lateral side and tilted down. I'm not sure if the brace could pull it over?? I haven't found anyone nearby who does a pfjr. We're behind the times down here. I would love to be evaluated for one, though, to see if it is even something I should be thinking about.

[KW]

Where is "down here"?  Sorry, you might have posted in the past and I've missed it.

Someone might be able to come up with a suggestion! 

The other place to look is a larger teaching hospital...That's where I had great luck.

Karen

[smillie]

Sorry...Louisiana...a lovely place but not known for cutting edge medical care.

[KW]

Have you checked the Larger teaching hospitals? (you can get lists on the internet) That was where I had luck.  They other option is starting to check the different manufactures web sites (Zimmer, Stryker, Smith and Nephew to name a few) for OS lists.  Stryker (Avon PFJR) has a list of 40 OS's who do Partial Knee Resurfacing.  Not the most scientific method but at least they are names to start researching.  It's not a procedure that get's advertised alot...you need to do some research to find the right OS...maybe a little more where you are located.

[smillie]

That's a good idea to check the manufacturer sites. I had been wondering about that this afternoon, but I didn't know which companies to check. Thanks!

I did do some searching around and found a semi-local OS (within an hour) with some interesting credentials and I've decided to go see him and see what he says. It's just a $25 co-pay and I'll be able to tell pretty quickly if he is someone I might be able to work with. He does some teaching at the local med school, research, and only does knees.  Some things on his page made him look interesting, so I'm going to give him a try.

[dm]

If you're having problems with getting vmo engagement because you just can't make it "fire", you can use a tens unit in conjunction with the exercises targeting the vmo to reactivate it. Your therapist ought to be doing this already. If you're familiar at all with a tens unit, you know it causes muscle contractions when placed over the muscle and the electrical stimulus is applied with enough intensity. Not comfortable, but it makes the muscle contract from an external source.

If you work to contract the muscle at the same time that the tens does, essentially "double tightening" on it, it helps retrain the muscle to fire when you tell it to, since you're also trying to tighten the muscle at the same time the electrical current is doing it for you. You get a ton of muscle fatigue and some soreness, but it also helps build muscle too.

There's no guarantees this'll work, but it's worth a try if it'll help strengthen the muscle and shift the kneecap.

If you're not doing patella mobilization massage to loosen up the patella so it doesn't sit so hard to the one side, that's something else you can do too, manually working on the patella's movement, encouraging it to loosen up on the lateral side so it'll move medially easier. Again, not comfortable, but could help.

I use a tens unit for painblock, it's easy enough for me to use mine for muscle stim if I need to. You can get a script for one from your doctor, they cost around 50 bucks for an inexpensive one on the internet, but you gotta have the script for it. Insurance may pay, they're classified as durable medical equipment, if they do, great, if not, figured I'd tell you that there's inexpensive models to be had online.

Hope you feel better, I know it stinks to be feeling crappy and not have any good answers. I'm 3 weeks postop from a big mess... partial acl tear, grade 4 chondromalacia to my kneecap, osteochondral defect to my femur (articular cartilage chunk got knocked off the bone), and both meniscus got torn. It was a lot of work for my OS to patch this mess up. I'm still not allowed to walk yet.....

[smillie]

I used a tens unit when I was building back up after my TTT etc. surgery, so I'm familiar. At the moment, though, I don't know that it would help. I'm in a bit of a vicious cycle. I work to get my knee calmed down so my quads will fire. Then I start doing some exercises to build them back up and the heat and swelling come on with a vengance and shut them down again.  So I'm kind of listening to them at the moment and seeing what I can do to coax them along.  When I was in PT earlier this year, my therapist did all sorts of things to try to get my patella freed up to no avail. I do some mobes, but not with great results. It's stubborn.

You've been through it!  I hope your recovery moves along well. These knees surely try our patience.

[dm]

Maybe you ought to gang up on your poor knee and use the tens unit with ice packs at the same time? I use this technique for painblock, but you could do it to keep the reaction you're getting under control, perhaps?? If you keep the time you work on the muscles to short increments, like 5-10 min chunks a bunch of times a day, maybe you'd make some progress like that? If the session is too short for things to get the reaction going, but enough to get some engagement started off, then perhaps you could make some progress, but in smaller increments. It'd take you longer to get anywhere like that, but if you can avoid the muscle heating by working with it for a shorter time, and with the ice, but more often, maybe that's what it would take, since you seem to have this reactionary issue going on.

I dunno, it's just a thought running through my head, when I read your post. Have no idea if it'd make a difference, but thought I'd throw it out there to you and see if you'd contemplated the concept.

wish me luck, I start with my own PT tomorrow... officially anyway. Been doing exercises since surgery on my own, trying to make recovery easier, even if I'm not doing a ton of stuff, just keeping things working and working on ROM.

[smillie]

Saw the new OS today. I hear that he does partial replacements, but I don't know if PFJR is included or if he just does the other. He is involved in a lot of research/trials/etc. with OA meds, treatments, surgeries. So I felt like if anyone in this town might know what to do it would be him. He didn't spend as much time as i had hoped listening to me. He reviewed my history, x-rays, and mri before coming in and I know he took his time there. But not so much time with what my day to day life is like at the moment. I feel like my pain isn't necessarily in proportion to what you might expect by looking at me on paper. As a matter of fact, they gave me this long sheet to rate my "discomfort" in doing all of these various daily activities. I couldn't figure out what to put on there and got so upset I cried. So I don't know if he had any picture of my pain at all.  Anyway, he ended up putting me on Voltaren gel and giving me Darvocet when I need more. He wants to see me in a month. I'm hoping that it will help with my pain and function some and I will be sure I'm ready with a few questions when I see him next time. I hate that I got so flustered!

So far, it seems like the gel has taken away the pain that is near the surface and my knee is more comfortable when just sitting. But it still hurts to walk on it. I'm hoping the Darvocet-induced sleep is good and long. I definitely need to catch up!

[dm]

New drs can be frustrating when you don't know what to expect. With the forms, take a deep breath, slow down, and do one line at a time, and take it literally. If you can't get it all filled out before they get in to you, then you don't... you finish before you leave, no big deal, done that before. More important to be right than fast.

Have some patience, hopefully next visit you'll be better prepared and will make some progress.

[smillie]

I think the tears were a combination of (1) I haven't been able to do so many of those things on the sheet for some time because my knee has gotten so bad and (2) the rest had finally started helping, so giving numbers for the past 48 hours weren't indicative at all of what I've been going through. And I was in a fair amount of pain at the time and hormonal, so I just lost it.  I hate putting numbers on my pain anyway. I just really find it hard to do. I don't know if it is because I've been in pain so long that I don't always recognize it? One day last week I was sitting and watching a TV show. My daughter came into the room and started talking to someone else. I totally snapped at her for talking while I was watching TV. That is TOTALLY not me--I don't snap at people like that. I heard myself and wondered what had gotten into me. At that point I looked at my knee which was bright red, swollen and radiating heat and I realized "Oh my gosh, my knee is killing me!" I had totally tuned out the pain. So I find it really hard to fill out those forms because I just don't know what to write down. Stairs don't hurt because I don't do them. Getting in and out of the car doesn't hurt because I compensate. Bending down doesn't hurt. I compensate. Putting my socks on doesn't hurt because I compensate.  and on and on and on... So on paper, I don't have pain. But I'm not functioning--I'm compensating.

As for the new meds--the gel definitely helps with the pain. The Darvocet helped me go right to sleep. But I woke up when it wore off about 5:00am.  I didn't want to take another one, so I just tried to sleep and ignore it.  By the time we got up this morning, my knee was killing me. I got the gel on there and it's feeling a bit better now--just a dull ache. But I worry about whether using the gel is going to make my knee feel better so I do too much and cause more damage. I can tell I over-did it yesterday.