My Patellar Realignment Surgery Nov 4, 2010

[kasia_ny]

As far as CPM goes, I probably did not do 6 hours on the days I worked.  I also do not have a desk job - I am in a doctoral program and take classes and also teach college.  I am lucky I have to be physically in the school building only 3 days a week - on the other hand teaching is hard in my condition because I have to walk around the room and write on the whiteboard - we do a lot of calculations in class and it is hard to teach while just sitting.  

So I had the CPM for 3 weeks after the MUA: in the first week I did not work at all, second week I went to work twice only and the third week I went three times.  I would wake up at around 5.30 on those days and try to squeeze in one or two hours in the morning strying to snooze while on the CPM (however hard to do) and then I would go to go to PT and then to work.  At night I would do as much as I could, but not much because I would not be home by 8pm.  I also did some bending in my office at school during the day - for my PT, the most important was that I do the bending not the time on the CPM.  

I do not understand - they would charge you $200 for PT and they would not touch you?  That does not sound right.  My PT said he would charge around $100 for a regular visit if I run out of appointments.  I am still doing twice a week of PT now, but I am planning on scaling down to once a week soon.  I do the whole PT routine I have every day at the gym now.  

The knee replacement question also came up for me.  And also "you are so young, how come you needed all this surgery?"  
We should start selling T-shirts here on kneeguru that say:
"Not a skiing accident,
Not an ACL,
and definitely not meniscus!"

Hang in there!

Kasia

[kasia_ny]

Hi Countess,

I was just thinking about you.  I was wondering how did your MUA go?  How do you feel? 

Hugs,
Kasia

[Countess]

Sorry Kasia and everyone for the delay. I have been resting after the MUA as I haven't gotten much sleep these past couple of days.

The MUA went well...as well as to be expected. The femoral block did help with the pain however today is a challenge. I didn't realize how much my thigh would hurt afterwards. It makes it difficult to walk. Also I was pretty sick last night from everything.

All I remember is the anesthesiologist giving me my femoral block...which I felt this time. I made my OS promise he wouldn't break my leg and he said he has never had that happen and that he will be really gentle because I will not be his first. When I woke up I asked the nurse when it would be over and she told me they already did it. I asked her how far he got me and she said she didn't know. My OS was already in another surgery but he talked to my husband. Apparently I was 2 degrees off straight again due to some scar tissue so he broke that up then bent my knee 3 times...which got me to 120 degrees. The back of my knee hurts worse than the front. I do notice that when I walk now it pops a lot.

I was in the CPM for a total of 7 hours after the MUA yesterday and am on my 2nd two hour session as I am typing this. Yesterday I was able to push the CPM to 110 and today it's at 105 so far. I also have been using my cryocuff off and on. Last night I was so tired that after my last CPM session I just took an ice pack and went to bed instead of taking my pillows with me so I could elevate. I am really trying to keep the swelling down. My knee was really hot yesterday but it isn't today...just a bit swollen.

My OS said I could use my crutches until the femoral block wore off...then no crutches. It really is painful. I am trying so hard to walk without grabbing onto things but I am limping so badly! 

I have PT in about 3 hours which I am not looking forward to. I know it is necessary but still...it's more pain and torture. If it was up to me I'd stay in the CPM. I also have to get the details on the self pay situation. Kim (my therapist) bills my inurance $200 per session. With self pay she told me I could use all the equipment but she couldn't touch me...and I am pretty sure it would be about $100 per session. Even with that I am looking at $400 a month or more. It would be cheaper to join a gym at this point. I have spent so much money on this knee due to deductibles and copays it's rediculous. Plus all of the equipment I have bought as well. I have had a recumbent bike in my living room for 4 months and my coffee table is littered with EStim, straps, meds and a goniometer. My couch has become a triage station for the last 5 months.

I really do hope this is it. I am so tired of fighting. I was not happy at all to be back in the OR and the nurse didn't use a lidocaine wheel this time so I got jabbed with a 16 gague needle to start my IV. The whole experience pretty much sucked. 

I hope everyone is doing ok...I will check back in with everyone after PT.

[kasia_ny]

Oh Countess, this all sounds so familiar to me... I am so sorry you have to go through this. 

So you got around 25 degrees back in the OR!  That is good news.   

I forgot about it, but the back of my knee hurt initally the most as well.  This should go away pretty soon.

Tip about the CPM - you can set it up so that it stops at the highest flexion for a designated amount of time - I was doing 20 seconds each time.  My PT was encouraging me to do it this way.  It is unpleasant but helps practice the bend. 

Please do not get discouraged with the initial loss of flexion - for me it all came back eventually and I was really obsessing over it.  My surgery report said 135 and I am on 138 as of this Tuesday.  The other guy that I know from PT that had the MUA had the same thing happened to him. 

Paying so much for PT while they would not touch you sounds unreasonable.  My gym has all the equipment that I need at this point... Maybe you can go once in a few weeks to PT so that she will tell you where you stand and show you what you can do on your own at the gym? 

Let us know how yout PT went!
Kasia

[Countess]

I am sorry you had to go through this too Kasia. It is definitely no fun...no fun at all. But it helped you and I am really hoping all this suffering is just a temporary setback for me as well.

I am hoping this pain in the back of my knee goes away quickly. It really sucks.

PT was good. I had to fill out more paperwork because I am a re-admit...due to the MUA. Kim and I had a really good chat about everything. She had to do another consult with me and more measuring. She asked me what I want out of therapy and "don't tell me that you want to be normal." I told her I just want to walk my dog again. That's all...just walk my big boy Jake. I miss walking him...and really enjoyed our bonding time. Now I can hardly do anything with him and he has suffered. He knows I'm hurt but doesn't understand why mommy can't play with him. I feel so bad about it. 

Kim is going to call my insurance to ask for more PT visits because I have 4 left. I told her that would only get me to Monday! She said when the gal in billing called them she was really hopeful that the insurance would ok more visits for me. I asked Kim if she had ever gotten any approved before for other patients and she said no but in my case it's different. She is going to tell my insurance company that I need more visits because of the MUA so they can either approve more visits or they will have to pay for more surgery next year. If I don't get these visits my joint will get stiff again and my OS will hafta go back in. Plus I told her to let them know that PT is super important to me, that I have NEVER missed an appointment and that I have done everything that has been asked of me including following all of my at home protocol faithfully. She is going to ask them for 10 more visits tomorrow. I am really hoping they will give it to me. I need it. I won't be able to be done in 4 visits. I don't know if I will be done in another 10 visits. I told Kim I didn't want to have to give her up and that I was so glad I chose her to help me get better.

The first time I saw her I cried in the appointment. She said she didn't think I would be back. We were curious how far I had actually come so we looked back in my chart. I was only at 25 extension and 32 flexion!! I fought...through all of that to get to 0 extension and 90 flexion. Kim did tell me she has never had a case like mine and that she knew I would need an MUA way back when she first met with me. I told her it took my OS 3 times to get my knee to 120. She laughed then said "Oh I'm not laughing at you it's just good to hear he had that much trouble breaking up the scar tissue. It makes me feel like I'm not such a failure." I told her she didn't fail...it's no one's fault...it's just this damn stubborn knee and stupid scar tissue.

I asked her about the self pay option. She told me that it's $80 per visit and they don't bill my insurance. The last time she explained it to me she said she couldn't touch me and I brought up that concern. She said that she would still stretch me, measure, etc which is what I need anyway. I guess because they are independent therapists the clinic doesn't like them to touch patients if they are self pay. It's more of a stupid rule than anything. Kim said she didn't care about it and would break the rule for me. Even with the $80...if I go once a week that's still really expensive.

So Kim has me doing 2 hours in the CPM at 120 degrees, then 20 minutes ice/elevate and 20 minutes on the recumbent bike 3 times a day. Then at 8pm I am to crank the CPM down to 100 degrees for 4 hours and stay in it till midnight. Then after that I can just go to bed. I can fall asleep in the CPM as long as I am comfortable but my couch isn't quite long enough. I was so exhausted last night I fell asleep halfway sitting up.

These two weeks in PT are focused on flexion. She said that's all that matters and it's not going to hurt me to not work on strength or extension.

I measured 113 flexion and 3 extension. Let's hope I can keep it up. PT again tomorrow. I was also debating going back to work tomorrow but I don't think that is possible. I will text my boss later and tell him I am taking the rest of the week off. I can't work and focus on this knee at the same time right now. It's just not possible.

Kasia thanks for the tip on the CPM. I will definitely see if I can tolerate staying at 120 for 20 seconds. 120 is uncomfortable now...but no matter how uncomfortable it is I just suck it up.

Kim did tell me that no CPM is ever calibrated correctly so I may be doing 120 but in actuality it's only 110. She has had so many patients who get so excited to be pushing 120 and she only measures them at 110. She said that is her only gripe with the machine. I found it quite interesting.

More to follow....

[Countess]

2nd Day of PT...and I cried.  It hurt so damn bad I thought I was going to pass out. I was able to get to 115 on my own but Kim, my therapist, went for the gusto. She got me to 120. I yelled at the top of my lungs and burst into tears. Everyone in the gym stopped what they were doing and looked right at me. She then said "Do you even want to know what it said? You got to 120! Now wasn't that worth it." Between sobs I told her that indeed...yes it was even though it hurt like hell. Her and her assistant gave me big hugs.

Tomorrow will be more crying and more pain. Now that she got me to 120 she will be out for blood and accept no less. I am thinking I will take 2 percocets instead of 1 before I go.

More to follow...

[kasia_ny]

Congratulations on the 120!  This is great news.  I am very happy for you!  You came such a long way...

I know it hurts, I was crying in PT too... many times.  It really sucks but if it works, it is all worth it.  It will get better, I promise.  I was taking two percocets (5/325) before therapy in the first week after my MUA.

As far as CPM goes, my PT also said that the degrees on it do not exactly correspond with what he measures.  It seems to be a little less.

Take care,
Kasia

[cdubb]

Man, I've been out of the loop for a while. I don't log in in a couple weeks and a lot happens!  Sorry to hear you had to go through a MUA and are still struggling with so much pain. I am really so grateful that my ROM came back okay and my recovery has been relatively uneventful...and even with that, I am still dreading when I need to do my right knee...and based on recent issues with it, I may end up doing sooner than anticipated.  Still going to discuss options to push it off until winter though.

I do hear you on getting frustrated with people though.  People always ask at PT when they see my scar if I had my knee replaced...really...at at 31??  Then people say, "Oh, I was back at work in a week or 2 after my ACL."  Okay...you can fully weight bear after an ACL.  Or, people who say that they were back a week after their menisectomy....okay, really people.  A week is a bit excessive to take after a menisectomy, you should have been back in 2 days! I just start to throw out a bunch of technical terms and then they get all confused and just stop asking questions.   

Good luck at PT and I hope you get it figured out to try and extend your visits.  Another reason I have to be grateful that I have 75 per calendar year.  It's $20 a visit, but still worth it.  It's starting to get cumbersome going twice per week though, so I'm going to stop after 2 more visits and then continue on my own.  I'm independant enought at this stage, but it's ensuring the motivation is there to get my butt to the gym!

[Countess]

Hi Everyone,

I hope you all are well. As for me I have been very busy with PT and the holiday as Easter dinner was at my house this year. It went well and everything tasted great however it was really difficult to prepare. I had to keep sitting down and taking breaks which was frustrating.

I also started back to work yesterday. I wish I had more time I can take but I don't. I used every bit of vacation and PTO time on this damn knee. My knee is swollen...and pretty much I am hating life right about now. I am trying to keep the knee moving but it's hard when I am the only one working around here. My boss just expects me to jump right back into things...and seeing as I am his only employee it makes it next to impossible to find time to get my bending in. I still have an extremely busy week this week. PT was yesterday, today and Thursday and then I meet with my OS on Weds. I will really be glad when Friday gets here. I need a break.

I am still in a lot of pain. The back of my knee still hurts and where the reefing was done is screaming today. Last Friday my therapist didn't even measure me because I was so exhausted and still hurting from Thursday when she got me to 120. As of last night I am at 119 on my own and 125 with assistance. I cry every single time I go to PT now. I figure if I don't push myself to the point where I feel like I am going to pass out from the pain then I am not doing myself any good. Now is the time I need to find my inner strength and dig deep to heal....because I need to heal...and it needs to happen now. Every time I reach another 5 degrees it encourages me to keep going. It just kills me though. I have never felt pain like this in my entire life.

I am so sorry to hear about your other knee cdubb. I was hoping you would be able to put it off a little longer.  Let me know what's up with it and if/when you hafta go back in for another surgery. The number one question I get in therapy is the same too...Did you have a knee replacement? Ummm...I am not old enough yet to have a TKR ok!?! People also get sarcastic and tell me "Oh I can't believe you are having so much trouble. I healed up just fine. It only took me x number of weeks and I was better." Well fu#king good for you then. 

I have come a very long way Kasia. I look back at where I was and where I am now and it helps to keep me grounded. I have to keep reminding myself that my knee has been messed up for a long time so what is another year or so as long as it gets better. I am hopeful that the MUA has worked. The real test is maintaining ROM these next few weeks. We shall see. Glad to hear though that you are doing so much better. It has been a hard fight for you as well.

My insurance is still not figured out. I called them yesterday to see what the hold up is and they can't tell me. They also can't tell me when a decision will be made. "It's still in process." So I have no more visits left. I told my therapist last night hopefully they will approve more visits for me and to bill my insurance even though technically I don't have any more. At this point I am over worrying about it and hopefully my insurance will cover the extra 2 visits. I just hope it doesn't turn around to bite me in the ass. I need something to go right for once.

I am crabby because I have to sit here in pain and work. Then PT which I am not looking forward to...meh. I hope the pain stops soon.

More to follow...

[Countess]

OS Update -

So I went to my post op follow up today. My OS walked into the room. I looked up and said "Can we just cut it off now?" He laughed. I told him about my severe cramping issues. It was so bad last night I couldn't get through my PT protocol. My hamstring was done. My therapist massaged me and got one more measurement. On my own I am at 121 flexion. Still at 125 with assistance. We just couldn't push any more even though Kim told me the joint itself has more give in it.

My OS explained that my muscles haven't been used in so long that they are just not used to it so he was not surprised I was having muscle issues. I asked him what was up with the pain on the medial side of the knee. Every time I walk it radiates sheer agony. I told him I didn't expect this much pain and that I haven't been sleeping at night. I almost cried. He told me that when he did the MUA the scar tissue was deep inside the knee. The pop was the loudest he had ever heard. It scared him so badly that he immediately checked to see if he had damaged anything. He then told me that's where the scar tissue was...on the medial side.

I told him I decided to take all of last week off and was in the CPM machine for 10 hours a day...even after therapy. He said that was the best thing I could have done for my knee. He then said that he was worried about flexion when I was describing all the problems I am having. He would have been happy with 100 degrees. Once he read the progress report he was very surprised at how well I was doing and excited with the results. I told him if I am not crying in therapy I am not doing it right. He laughed again. I told him I am pushing it...hard. I am over this and just want it better. I am tired of the pain and this is it. It has to be. He gave me a perscription for muscle relaxers and more percocet. He said "You are almost there. We will get through this together. You will be better I promise." He asked me how far I can bend while just sitting there. I showed him and his eyes lit up. He said even though I am really swollen the range looks so great.

What happened next I wasn't expecting. He gave me the biggest bear hug and said "Hang in there. Keep working hard. I am so proud of you." That moment...made all the difference in the world. That moment meant more to me than words can say.

My OS is awesome.

Then more good news. I called my insurance company after I got back from the office. They approved 24 more PT visits for me. Kim will be thrilled. I see her tomorrow so we will formulate a comeback plan for my knee. Now I can just get better and not have to worry how I am going to pay. I need her. I need therapy.

Even though today I was in agony...I feel like I can concentrate on getting well...for once...things worked out as I have been hoping for.

[kasia_ny]

Great news!  I am so happy things are working out for you!  Great ROM improvement and you got those PT visits approved!  I hope your pain levels will subside soon, for me, the first couple of weeks after the MUA was the worst.  Keep up the good work!
Hugs,
Kasia

[Countess]

**HUGS** Thanks Kasia!! I am hoping the pain will subside very soon as well. I hate being in constant pain all the time. 

Last night in PT was about the same. My hammie decided to cramp up again twice after Kim worked on it as we tried to go for the glory. We got 120...and I got 115 on my own. Not too worried about it as I am able to maintain the 120 my OS got in the OR. This weekend is supposed to be crappy weather so I am planning on just hanging out in my CPM machine for most of the weekend. Hopefully I will catch up on some much needed sleep as well. I still haven't been sleeping and this past week has left me exhausted.

Kim did tell me that in all her years as a therapist I am the first she has seen that has gained back their strength so quickly in such a minimal amount of time. She also said that I am the first patient who hasn't lost ROM after a MUA. I guess there is a first for everything. Secretly thought I am worried about the scar tissue re-forming and I am trying to do everything I can to prevent it. I just wonder if I am doing enough. It sucks that I have had to go back to work and I only get 5 hours max in the CPM machine. I still bend while at work when I can.

I hope I take off from here and keep getting better. I know I shouldn't second guess things and just be thankful I can move my leg at this point instead of it being stuck at 90 like it was. Even though it hurts a hell of a lot so far I am happy with my decision to go ahead with the MUA.

That's all for now...

[Countess]

PT Update-

I went to PT last night and got to 124 easily on my own. My gait is coming back and I am limping less. The pain has also subsided a bit. It still hurts but not as badly. I am cramping less but it's the worst when I really try to push the bend past my comfort zone. I am still in the CPM machine. I asked Kim when I could stop using it and she said that if I achieve 124 as easliy on Monday as I did last night then I won't have to use it anymore. I am really hoping that this is it. I am so close.

I did receive some bad news. Turns out that when my therapist's billing department called my insurance they told them that my visits weren't approved. I was told 3 times....3 TIMES by the insurance company that 24 more visits were approved and I had to use them before May 24th. Now they are asking for my OS to write a letter of medical necessity, how many visits I need, what the diagnosis is, when my tentative discharge date is and a new perscription. My therapist's billing department made me sign an affidavit that I am responsible for the bills if my insurance doesn't pay....which is $212 a visit....and I am out of visits.    So I called my OS's MA yet again. She never returned my call from the last time. I was also looking at my medical bills online and the insurance company denied my OS's charges because they say an MUA is not scientifically proven to be a proper treatment for my specific condition. This makes no sense to me because they paid the hospital fee so....   My insurance company left a message for my OS's MA and she has yet to return their call...so when I called her today I told her that I wasn't paying the bill and that she should have gotten pre-authorization to perform the procedure. See...things are never that simple for me....ever. Nothing ever works out smoothly. I always have to fight some big huge battle all the time. That's why my profile pic is Charlie Brown...

**SIGH**

[kasia_ny]

Countess,
I am very happy to hear that your ROM is good and hope you can ditch the CPM machine soon - it is going to feel good not to have to be stuck in it for so many hours a day...

My insurance rejected the OS charge for an MUA too.  My diagnosis was "stiffness of joint" and the insurance found it scientifically unproven and wants more information from the OS - in my case the kicker is that because my OS is out of network, I am responsible for contacting the OS and the insurance company about everything, because the insurance company does not talk to the doctors out of network and does not send them anything.  My hospital and anesthesia bills were covered and paid in full - makes no sense. My OS's office says that it is common practice to initially reject the bills for an MUA, so I am hoping that they'll finally approve and pay it.

I am sorry about your PT being not approved - call them 10 times a day and record them if you have to.  I won one of my appeals based on a recording...  If you bother them enough, it is more likely they will pay.   

 

[Countess]

Thanks Kasia. It's good to know I am not the only one fighting the insurance companies!! I heard from my OS's billing department. They instructed me to let them handle it. They received the declination letter too and have resubmitted the bill. She told me she doesn't know why they always deny an MUA on the first go around because it is medically necessary and proven scientifically to work. I am still waiting on a letter from my OS for the PT visits so I can submit that to the insurance company. Kim has already written hers and has instructed me to go pick up the letter from my OS. We have had problems in the past with things not getting done.

Kim also told me to call and get my CPM machine picked up today. Hooray!! This past Friday I was able to get 125 easily so she says I don't need it anymore. It will feel good to not have to be in that thing anymore.

I freaked out yesterday. I spilled some water on the bathroom floor and grabbed a towel. I was mopping it up with my bad leg when all of a sudden it felt like my patella went too far to the lateral side. It felt like it was going to dislocate. Immediately alarm bells went off in my mind. I stopped what I was doing and looked at my knee. Everything was where it should be. It hurt a little bit and today it still hurts on the medial side as well as the patellar tendon. I am chalking it up to normal patellar movement. My brain doesn't know the difference yet so it still thinks my patella wants to dislocate. I would be seriously pissed if all this was for nothing.

Yesterday I think I may have overdone things. The knee felt better than it has been feeling so I ran a bunch of errands before the bathroom incident. I was able to stand in line at the grocery store for 20 minutes!! But fatigue probably played a part in the whole thing. It is sore and a little stiff today but when I did my exercises at lunch everything felt fine in there...like it should.

The pain is still there although it is intermittant instead of constant. I am still taking 2 percocets a day but I am cutting them in half now. The muscles are still cramping especially while bending so I am still taking muscle relaxers as well.

I called my mom yesterday to wish her a happy mom's day and all that. She told me that my sister went home and cried after Easter dinner at my place. She said it was really hard on my sister to see me so crippled. I told her that most people don't understand how handicapped I really am until they see me. 

Tonight is more PT....

MEH....