New Member, A.C.I soon, Medication help

[summerfun]

Hi Guys,

I would first like to thank everyone for the posts as its so nice to know you are not alone and have so much information about what to expect before going in. I am having the second stage ACI on 12th November at Stanmore so not long now and am getting nervous, one of my concerns being the pain medication, i already have to take Tramadol, Dihydrocodeine, Naproxen during the day and Amitriptyline at night for pain as i have Ehlers Danlos Syndrome and suffer with severe joint pain. I have tried limiting my intake since the first stage to Tramadol but have had to fall back on them every few days, especially the Amitriptyline as i cannot sleep, partly due to back pain and also because i have had to stop my HRT 10 weeks ago as you cannot take it 6 weeks before op and as there are only 6 weeks between the two i have not been able to start taking it again, so hot flushes and mood swings have been a nightmare lol. When i was sent home from stage 1 they gave me Paracetamol, Ibuprofen and Tramadol which was no good to me but i had given them all my medical history prior to having the op so i am concerned what they will give me this time, has anyone had or got any knowledge of what they might do in these circumstances. Also i have read about the icing that it is really good but do Stanmore supply these or do i need to purchase one?

Any other thoughts or tips would be appriciated, 

[mlashmar]

Hi

Good luck with your op.

I don't know too much about medication but have had my ACI done at Stanmore.  The pharmacists don't take too much time on their visits, so I doubt too much thought goes into the medication before prescribing.  I suggest that you speak to your GP beforehand and explain your concerns regarding pain control as you really sound like you want to be prepared and don't want to be fighting for this post-op. 

Regarding ice, I found it a massive help and most people posting on here seem to agree.  I strongly recommend a cryo-cuff, you should be able to get it for under £100 (I got mine from PhysioRoom.com but have a look around, perhaps even have a look on ebay).  The NHS do not provide cryo-cuff devices unfortunately.

Lastly, don't take no for an answer (from your GP or pharmacy staff), ask them to explain any of the decisions regarding pain control in detail (for example, ask about the drugs that your GP recommends, ask how they relate to the other drugs you are currently on, how they differ, how they work and even research them at home and call your GP back if you are uncertain - i.e. become very knowledgeable!!).

Good luck for your op

[cdubb]

I just had my patella ACI yesterday (11/3/10) along with an AMZ of my tibial tuburcle.  I was not given any of those meds, but I am here in the US, not UK.  I was given morphine waking up from anesthesia, which helped a lot because I was in a decent amount of pain at that time. I was discharged home about 2 hours after the surgery and discharged with long acting Oxycontin to take every 12 hours and Norco to take 1-2 inbetween ever 4-6 hours inbetween the Oxy.  I also am taking promethazine to help with nauseasness (although, I haven't had any, so I may stop that) and I also am taking Benedryl to help with the itching from the narcotic pain meds.  These meds have made the pain very manageable and I had the AMZ (aka Fulkerson or TTT) as well, which I was told will cause most of my pain vs. the ACI.   

It seems in the UK, narcotic pain meds are not prescribed as readily as they are here in the US.  Although, we are sent home 2 hours after the surgery and it seems that most ACI's (with or without osteotomies) are kept for 2-3 nights.  I managed perfectly fine at home though and was more comfortable than if I was kept overnight.

[CR_UK]

Hello
Hope all goes well with your op.
I am 4 weeks post MACI today. I posted last week as I have had problems with pain management. I also think its a good idea to discuss this with your GP before so that he/she understands the procedure.My GP and physio both have no prior knowledge of the procedure and I have had to inform them , but still I struggled until I posted on this site and have received invaluable help and advice. Talking to others  who have gone through the same experience and reading the posts outweighs medical input from inexperienced practitioners (I'm a doctor and that has not really helped me... probably make the worst patients!)
I also feel the icing has been a absolute blessing and appears to be more effective than the meds in my experience. I was given an aircast cryocuff and am using it constantly. At night almost hourly as I keep waking up with pain. I think if I had a system of continuous icing I would probably be able to sleep for longer. I got mine from the hospital to use for 6 weeks, but reading the posts and from my current experience it looks like I'll be needing it for longer and will purchase one. If there is one thing to get for pain relief , that would be my recommendation.
CPM machines appear to not be used in the UK, but in my case as my pain is worse on inactivity, I managed to arrange one on loan from the hospital last week after Renn's advice and it appears I have turned the corner.
On reading the posts I also discovered that NSAID's were controversial for use in ACI/MACI as possibly could inhibit cartilage cells from growing. I discussed it with my consultant, Mr Skinner, as I've been on them  and oblivious of this information. He confirmed that in vitro it is an issue but he does use them post op to reduce inflammation , with no problems. However I would have preferred to know this before and it will be the first drug I wean myself off. Still need it though unfortunately but icing has an anti inflammatory effect so that would be my preferred option if one can avoid NSAID's.
I would be interested to know what others experience re NSAID's are and importantly success stories despite their use.
All the best for your op!

[Rennschnecke]

Summerfun

You will meet your anesthestist before the procedure and can discuss your concerns for pain management then.  Make use you get everything written down for you because the Ward staff can be very nervous about giving anyone something that is out of the norm. They very nearly had apoplexy when they heard what I was taking, but it was all prescribed by a pain consultant.

It would also be useful to take in one of you repeat prescription slips with you for the Ward staff when they take down the details of your medication.

One of the things you may get is a PCA so that you can administer morphine as and when needed within safety constraints.  There may be other things they can do for your pain management as well.  FWIW I had some pretty strong meds pre-op and didn't need any more than that post-op so you may also be pleasantly surprised.

CR_UK:  I had the same issues arising.  I was given ibuprofen by default then stopped them ASAP on reading about the restrictions on the Brigham Hospital protocol.  I later did further research and found conflicting opinions. The only research I could find relating to the issue of anti-inflammatories and cartilage health indicated that in vitro anti-inflammatories have an inhibitory effect (not good for cartilage growth), but in vivo the effects are beneficial.  I also understand that the inflammatory effects are essential to promote healing ...

Although I took NSAIDs for about 1 month or so at the 3-month stage the cartilage was well integrated with the edges and looked very good – all white and shiny.  I've had some complications from the op which have hindered the outcome, but the cartilage itself is still complete at 15 months (although a bit thin in some places possibly because of limitations on the rehab).

I'd say don't worry too much about the NSAIDs now, but drop them if you can manage.

Take care!

[summerfun]

Hi Guy's,

Thanks everyone for all your advice, i have been having a bad week this week and it would seem post op nerves have been getting the better of me  
I have however seen my G.P and she is going to do a home visit as soon as i home and will adjust meds as nessecary so i have that bit sorted, i know from reading all your posts that the cyro/cuff is very much needed but unfortunatly i only work 16hrs a week and my husband is at home with the children as two of mine are special needs and as such money is extremly tight. We have been told we will get no additional help with rent etc so with all that in mind i cannot justify buying one now but if the hospital do not loan me one and it becomes a must then we will purchase one.

I did take a repeat prescription form in the first time i went and gave them a full medical history but will of course do this again and feel happier knowing my G.P is on board with me but am surprised that Stanmore do not inform our G.Ps of what we are going through and what is to be expected, i guess i am more nervous as like most i am over 2 1/2hrs away from Stanmore so if there is a problem its not like they are round the corner. I think this is my second worst part of all of this is being so far away from my family as this will be the longest i have been away from my children and hubbie, my biggest nightmare is how i will cope post op, being a mum sitting around is defianlty not something i do well, we also run a football club and being away from it all is going to be frustrating but i know its all going to be worth it in the end (i hope) .

I will of course keep a diary as best i can after my op so that a) it may help future knee geeks and b) so i can get more invalueable advice from people who know exactly where i am coming from. Once again thanks so much, it really is a god send this forum and everyone on here  

Emma x