KNEEtalk

The REHAB DEPARTMENT => Soft Tissue Healing Problems - Arthrofibrosis => Topic started by: Stasha83 on August 26, 2011, 09:47:22 AM

Title: LOA & MUA round 2
Post by: Stasha83 on August 26, 2011, 09:47:22 AM
Hi everyone

Last Friday I had my second surgery for AF. Pre-op my ROM was flexion of 110-115, lacking 15-20 degrees of extension and a fixed flexion deformity.

The surgeon said that the scar tissue was worse this time than my last LOA in February this year. My patella was totally scarred down and the front of my knee was full of scar tissue. This was all released. He also released some scar tissue from the posterior but not a true posterior release. My posterior compartment has also contracted. The remainder of my fat pad (some was taken out in my original surgery in June 2010) was fibrotic and has now been totally removed so I no longer have a fat pad.

Interestingly, my scar tissue had developed its own blood supply (I cannot remember the medical term for this). My surgeon said he had never seen anything like it. I think that explains why we knee was purple and why my veins had become very prominent, I guess they were feeding that area.

Post op my ROM was 0 extension and with help from the physio, 140 degrees of flexion. I had a femoral nerve block put in while I was asleep but when I came round I could still feel the pain so it was decided to give me an epidural. My blood pressure and heart rate were a bit up and down so I spent the first 24 hours in the high dependency unit which was a little scary.

On Saturday afternoon I was moved down to my room but the epidural remained in place until Monday. I also had a fentanyl PCA which I found I needed despite the epidural.

I had physio 3/4 times a day and we worked purely on ROM. My extension began to slip after a few days and my leg no longer lies straight without force. It seems determined to spring up and have a deficit of about 10 degrees. I am obviously disappointed but the fact that it can still go straight with some force gives me some hope. Perhaps it has just sprung back because the compartment has contracted and needs a lot of stretching out? My flexion is still going well but my surgeon has said that the extension is what is more important right now.

I came home on Wednesday and have continued my routine with the CPM and extension and flexion exercises. I see my own physio today so will see what he thinks. My medication at home is pretty much the same as pre-op, Gabapentin, Celebrex, Fentanyl patches and Paracetamol. We have also added some local anaesthetic patches would are applied directly to the knee.

I think that is about it from me at the moment, I hope all of your knees are doing ok.

Stasha
Title: Re: LOA & MUA round 2
Post by: Decruz on August 26, 2011, 04:34:04 PM
Dear Stasha,
if I may ask, who's your surgeon of your previous and just done LOA & MUA?
By the way how did he explained the situation was even worse that the last time he went in? I mean, if the past LOA & MUA in February aggravated the situation why he think a new one should end up better and not aggravate again the situation? Obviously hope the best for you, just to understand this point as I always wondered about this specific situation...
Bye
 
Title: Re: LOA & MUA round 2
Post by: Decruz on August 26, 2011, 04:38:30 PM
Dear Stasha,
if I may ask, who's your surgeon of your previous and just done LOA & MUA?

I realized just after posting you already answered this question in you previuos thread about your February's procedure, sorry for double-asking..
Title: Re: LOA & MUA round 2
Post by: Stasha83 on August 26, 2011, 05:01:50 PM
Hi Decruz

It was Mr Rahul Patel who has performed both of my AF surgeries. Both were at The Wellington hospital in London.

In terms of the situation being worse than last time, I meant the amount of scar tissue that I had. I am not totally sure that the op in Feb caused this, I did very well for a few months after that surgery and then things began to go wrong. I think this was a combination of things, maybe I pushed it too hard, didn't do the correct rehab- I just dont know why the scar tissue returned and nor does my OS or Physio.

My OS had made no promises that this will fix me but he thinks that by removing the remainder of the fat pad it may help to stop the knee being so irritated and inflamed. To be honest I couldn't have carried on as I was and am willing to take a chance no matter how small it is.

At the moment I am feeling positive, I have minimal heat and swelling and my knee seems to have tolerated this op pretty well. It's very early days though, as we all now AF can return much further along the line but I am certainly going to give it my all in the hope that I can beat AF. Fingers crossed anyway!
Title: Re: LOA & MUA round 2
Post by: missmyknee on August 26, 2011, 06:53:49 PM
Hi Stasha

Glad you are doing well after surgery.  ;D  Extension is more important to work on right after surgery. Are you propping your ankle up on a towel , about 4 inches?  Stretch out those hamstrings several times a day and doing patella mobes with tissue massage several times a day. A freely moving patella is crucial.

Positive thoughts for a successful recovery !

Decruz

AF surgery is not a guaranteed success. Using an AF doc gives you the best chance of a successful surgery and recovery, however , there is still a chance it will not work. There are other factors that enter the recovery including patient compliance to rehab and how the patient's body reacts to the surgery.  Some people have one surgery for AF and have complete success and go back to an active life and others have to have several surgeries to recover back to an active life, and some don't recover to an active life at all.

Thar's the chance you take on this rare condition.

Pam
Title: Re: LOA & MUA round 2
Post by: Lottiefox on August 26, 2011, 07:36:44 PM
HI Stasha

So good to see you posting. I was thinking about you this week. It sounds like you had a tough recovery with the HDU and stuff. You were in good hands though down there. I bet it was great to come home!

I can only echo the positive thoughts of the others. Pam has personal experience of AF and her suggestions sound sensible. I have all fingers and non fused toes crossed for the AF staying under control this time. As you say, you couldn't have carried on as you were so making the decision is the right thing, even without the guarantees. Nothing is ever guaranteed when you have surgery. I hope that extension starts to behave - I know you'll work hard on it (within the right constraints!).

Good luck and keep us posted,

Sending hugs from rainy Warwickshire to probably rainy by you!

Lottie xxx
Title: Re: LOA & MUA round 2
Post by: Stasha83 on August 26, 2011, 08:49:07 PM
Hi Lottie and Pam

Thank you for the well wishes. It's good to be back!  ;D

I am working hard on my extension. I do an hour on the CPM and then an hour working on various exercises for extension. My physio has shown my mum all the exercises that she can help me with at home which is a real help.

The current schedule includes heel slides, hanging my leg (propping my ankle up on a towel), patella mobes (sideways and up and down), raising the leg with a towel under the knee, lying on my stomach on the bed with my legs hanging from the knee down (this is an interesting one!) and my mum lifting the ankle to encourage those last few degrees of extension. Rehab is pretty much a full time job for the next 6 weeks!

My walking is still awful even with crutches, I just can't get away from walking with a bent leg but to be honest I am not too worried about this right now, I think we can work on that further down the line once I am a bit stronger. Obviously I will keep trying to get it right but the lack of quads and VMO doesn't help.

It is raining here too which makes being stuck indoors a little bit easier although it is still pretty tedious. I feel like I have gone back in time by 6 months and am right back to square one. Hopefully it will be worth it in the end.

Hope you both have great weekends and your toes and knees behave  ;)

Stasha
Title: Re: LOA & MUA round 2
Post by: mouk786 on August 27, 2011, 02:29:43 AM
2 exercises I found good for getting my leg straight as recommended by the surgeon (I see you are doing both anyway to an extent).

- lie on the bed with stomache down, leg hanging off and have some ankle weights on your ankle - this will get your leg straight. I find a firmer surface works better - I sometimes use a piece of wood on the mattres and put the duvet over it, so its a hard surface underneath but soft enough to lie on.

- the other way is the opposite - get somesort of box and put your heel up on it - then get some weights (start at maybe 2-3kg and work up) and put on your thigh - this will force your knee straght - I found this REALLY helped me - I was using upto 15 kg at one point.

I found doing the first one takes the pressure off your leg and allows you to relax but doing the second one really forces a good leg straightening.

Also my surgeon said my leg always wanted to bend a little because of the knee capsule - apaprently it was so used to being in the bent position - hence you need to work on making it go back to straight and it doesnt happen overnight - perhaps the same for you?

You are having a lot of meds - all i got was some paracaetamol and codeine and got sent home the same day! I spose that is the NHS for you, lol.

0-140 is pretty much perfection isnt it? So annoying that it has gotten slightly worse. What did you have immediatley post op last time?
Title: Re: LOA & MUA round 2
Post by: Lottiefox on August 29, 2011, 09:54:10 PM
Hi Stasha

How are things going? Hope the long weekend hasn't been completely full of physio and rehab work....although I suspect a fair chunk of it was taken up....hope you got to relax and rest up a little as well.

Keep us posted, sending positive thoughts,

Lottie xx
Title: Re: LOA & MUA round 2
Post by: Stasha83 on August 30, 2011, 09:31:27 AM
Hi Mouk786 and Lottie

Thanks for the tips, I had thought about adding weights to these hanging exercises but the physio said to hold out at the moment but we will be introducing the weights in the future. Not sure I would manage 15kg though?!

My OS said something similar about my capsule too, he said it, along with my posterior compartment, has contracted due to being in the wrong position for so long. I think its going to take a long time to stretch these out/correct them.

I think if I could maintain 0 to 140 I would be very happy but I am not at 0 anymore. Think the deficit is about 10-15 degrees although it can still be pushed straight so I think this is a good sign. Just got to keep working on it and trying to force home the idea that the leg does want to be straight rather than bent! Last time he got me to the same in theatre, but realistically (ie when awake!) it was -5 and about 130.

I have had all 3 of my op's privately (I've got BUPA), but I didn't get any decent meds after the original op either, just the same as what you were given. I have been on most of these meds since February now but slightly increased after this op. I do find this condition pretty painful, Im still in pain even with all these meds so I don't know how you managed? The other side is that my OS wants me to be as pain free as possible so that I can tolerate the rehab too.

It's not long until your next op is it? Do you know exactly what is planned for you? As you're NHS i'm quite interested to hear who your OS is if you don't mind sharing? It's just that there aren't many OS's in the UK that seem to know how to deal with AF successfully.

Lottie - my weekend was indeed full of rehab  :( I am learning to bake though when I'm not on the CPM or doing home physio, I've made 2 batches of cupcakes so that was a good escape for me. This week I'm going to try chocolate chip muffins and some lemon cupcakes. I honestly can't cook to save my life so this is quite an achievement for me! I hope your weekend was good and your toe is getting better?

Stasha
Title: Re: LOA & MUA round 2
Post by: Lottiefox on August 30, 2011, 10:14:17 PM
Hi Stasha

Choc chip muffins???? I need to hit that A41!!!  8)  Baking is an excellent distraction therapy - I am addicted to the Great British Bake OFF on BBC as like you, I am not a very accomplished cook. I can do decent roasts, pastas, chilli, casserole type things but cakes or pastry - not a clue!

Good to see you posting. Sorry the pain is still hitting hard. There are so many facets to pain. I find it hard still to know what is RSD pain and what might be normal for having had my foot sawn in half and pinned together at the pin toe. I do know I get sick of my pill container rattling.But as you say, you need to have pain controlled enough to cope with the exercises. It is good that the leg goes flat with work. I guess the compartment is really contracted after all this time and its a long process of balance to stretch it but not inflame things. How are you doing in terms of swelling, heat etc?

Thanks for asking about my toe. It is OK. I worked today and drove to Surrey and back and battled the M25 which was hideous both ways round. Sitting with my foot on the accelerator pedal all that time makes it throb. (is that RSD or normal?! Who knows!). I have made myself a little sock that is filled with Epsom salts. I wet my foot, stick it into the sock, and then make the sock slightly damp. It is so soothing and also brings swelling right down. I sit and read with my soggy salt packed sock on for 20 minutes!  ;D I am also going for my first reflexology session this week. She is going to work on my other foot and the hand of my right side, rather than directly on my RSD foot. I find self massage on it soothing but am wary of someone else manipulating it about, and also worried that the foot may see it as a trauma and react badly with more spread. I have got it really contained at the moment - I don't want it any bigger!!

Keep us posted,

Hugs xxxxxxx
Title: Re: LOA & MUA round 2
Post by: Decruz on August 31, 2011, 12:03:08 AM
Hi Decruz
It was Mr Rahul Patel who has performed both of my AF surgeries.
In terms of the situation being worse than last time, I meant the amount of scar tissue that I had. I am not totally sure that the op in Feb caused this, I did very well for a few months after that surgery and then things began to go wrong. I think this was a combination of things, maybe I pushed it too hard, didn't do the correct rehab- I just dont know why the scar tissue returned and nor does my OS or Physio.

Hope the best for you.
So Dr.Patel didn't have a real answer why, even after the 1st surgery in which he removed some, the amount of scar tissues when he came in the 2nd time was even more.
I'm trying to understand, only thing I can figure is your body hyper-reacts reproducing even more scar tissues if a procedure is performed in order to get them out (like you had "10" in terms of amount of scar tissues prior 1st surgery then your OS came back in with the recent 2nd procedure and found "12"), so did you asked your OS, following this logical thought, why this 2nd surgery should end up differently than having even more scar tissues again (like that "12" becoming a "14")?
I'm just trying to understand myself what is the OS' view in this specific situation..
Best wishes
Title: Re: LOA & MUA round 2
Post by: Lottiefox on August 31, 2011, 08:39:13 AM
I'm not sure any OS could answer specifically "why" the scar tissue may have increased/started in the first place. There are many theories underpinning AF but I think Stasha was faced with the choice of live with what she had or else take a chance that another surgery (with all its associated and well explained risks) to free the joint and to try and put in place a program that works to minimise the reformation of AF this time could bring her better function. I think even with the risks and no guarantee I would do the same. I got RSD in my forefoot after a standard foot surgery this year. No one can tell me why - or how it will pan out. Evidence/anecdote indicates it never goes away. I'm certainly reducing my symptoms and level of the condition. What if I need surgery on that foot again or somewhere else? I am at a higher risk of RSD happening again in that foot, but apparently not in the rest of the body - according to the surgeons. But not according to anecdotes!

I guess what I'm saying is that we never think serious complications will happen to us. When they do, it sucks. And very often there is no definitive answer as to why or how to improve them. We just have to take the route that brings us the best hope and do what we can to make it work. Underneath that involves all of the research and analysis that we all do - but we can never bring a guarantee.

Stasha I hope the baking went well....my smilies went wrong, I meant to put choc chip muffins  :D :P 

Lottie xx
Title: Re: LOA & MUA round 2
Post by: mouk786 on September 01, 2011, 01:12:34 AM
I'll PM you the name of my as I don't wanna put his name up as I am still a current patient. I am on NHS as mentioned - the main frustrating thing is waiting for Ops and appointments. On my follow ups I don't always see the main consltant surgeon and I have had a falling out with one of his deputies who wouldn't take my scar tissue issues seriously (in my opinion).

He is an experienced knee surgeon and he didnt really make a big fuss of the scar tissue, both times just said he would go in there and cut it off - our sessions are not massivley long because it is the NHS but there you go. I think maybe he didnt go too technical to save time but also because I indicated I have done my own research anyway.

To be fair I didnt need much in the way of meds and my post op periods were relativley pain free,

This time I will be having an LOA and MUA again but staying in hospital overnight on a CPM and 'aggresive physio'. I have decided this time I won't walk on the knee to maybe prevent irritation - see how that pans out. Hopefully the hospital physio wont force me to try and walk on it.

Are you sleeping in the CPM?

Presumably the CPM doesn't put pressure on getting ROM it just does what comes naturally? Or if you put in 135 will it keep trying to push you knee back to 135 or will it just go as far as the knee goes and stop?
Title: Re: LOA & MUA round 2
Post by: Decruz on September 01, 2011, 01:34:42 AM
Are you sleeping in the CPM?
Presumably the CPM doesn't put pressure on getting ROM it just does what comes naturally? Or if you put in 135 will it keep trying to push you knee back to 135 or will it just go as far as the knee goes and stop?

I used to sleep in the CPM, a bit uncomfortable but not too bad.
CPM just make Continue Passive Motion of your knee, your set it when you start as directed by your OS or as much as you can tolerate; usually is set to full extension to the max flexion you can get with no pain/too much resistance.
If you put 135 and you can bend 90 the CPM will keep bending but you'll stop it using the remote and restarting the opposite extension movement.
Basically, otherwise directed, you set 0°-70° (just an example) and try, if you see you get 70° with no problem then you move up to 71°-72°-etc. until you figure out what's the flexion limit (let's say at 111° you feel stiffness, resistance and pain then you set it 110° and use it for 30 min, then re-try 111° as it should be better, if yes you keep 111° and go ahead increasing day by day, always following the flexion limit your knee tells you and trying to play around that limit increasing it).
You can increase by 1 degree at the time, so it's very easy.
Title: Re: LOA & MUA round 2
Post by: mouk786 on September 01, 2011, 01:50:14 AM
Is it advised to 'go for the kill' straight after surgery - or i nthe first coupel of days - to push as hard for most ROM as you can or do they suggest slowly building it up over time?

I would have though straight after surgery was the best time to try and max out ROM because your knee will be most clear - but at the same time clogged up from swelling.

Title: Re: LOA & MUA round 2
Post by: Decruz on September 01, 2011, 02:50:16 AM
Your OS has to advise how to use it following surgery.
In my case my OS always with 0°-70° in the bed post-op (I woke up in the CPM already) and from the 2nd day at home I was told to increase as tolerated, without forcing but feeling in the last 3°-4° flexion degrees some resistance.
PT told me to go as far as the knee went as well, time was not a concern (if few days post-op I was already able to bend until 100° then work on that limit without forcing, if I was able to bend like 120° then the CPM limit became 120°) so in my case as I quickly regained a max flexion that overpassed the CPM max flexion limit (mine CPM reached 120°, if I remember well) PTs said once I was over 120° CPM was no longer actually necessary, only thing was that using it I kept the knee mobile (it should help to avoid adhesions) so I kept using it for the 1st post-op month no matter what flexion I regained (obviously wit a 0°-120° setting).
Defintely don't force, never, but reach the knee limit feeling some resistance (not too much, but the feeling it's stretching tissues a bit to get flexion) in the very last degrees - if after 30-60 min the last degrees resistance is mostly or completely gone than increase of 1° and see.
Never force on pain
Title: Re: LOA & MUA round 2
Post by: Stasha83 on September 01, 2011, 09:51:17 AM
Hi All

Lottie - no muffins i'm afraid, the pain was just too bad to do any baking. Hopefully be able to do some over the weekend to keep myself amused. The boredom is relentless at the moment! I like the idea of your soggy sock! It'll be interesting to see how you get on with Reflexology, it would be great if it helps. I'll keep my fingers crossed.

My swelling is still pretty controlled, the main areas are directly above and below the patella. It''ll be interesting to see what the knee looks like once the swelling at the bottom of the knee has gone down as this is where I think it will look noticeably different without the fat pad. I'm still getting quite a lot of bruising coming out but i'm not surprised, my poor old knee must feel pretty traumatised!

I'm seeing my OS for a review and to have my stitches removed this afternoon so looking forward to getting his opinion.

Decruz - I'm not sure if anyone really knows why AF comes back? Obviously if there is a specific trigger, say you have an accident or you know you have continually pushed it too hard and ignored the warning signs then that could be a cause.

I haven't got an obvious reason as to why my scar tissue returned, we did everything right as far as I know. Do you know why your scar tissue returned?

The reason my OS is hopeful that this time round may be different is that we have removed the remainder of the fat pad which is a known cause of some of my inflammation. I'm hoping that now the fat pad has been removed my knee wont be in a constant state of inflammation and therefore reproduce scar tissue. Well, fingers crossed anyway!

Mouk786 - Thank you for the note of your OS. It's always good to get more names of UK based surgeons who are dealing with AF, we seem a bit short of them here! Perhaps if you are pleased with him you could eventually name him on here too?

My CPM was set based on what my OS and hospital physio decided. The physio wprked with me and then they decided that -3 (as far as the machine will go to for extension) and 90 flexion would be a good place to start. I'm now up to 110 and hope to go up to 120 next week. My machine goes to 130 and like Decruz, once I have reached this I will continue with the machine for the movement to try and stop those adhesions forming. I have it booked for a month at the moment but last time I kept it for 6 weeks. I'm not sleeping on it (although I can as it's pretty quiet and gentle) and just use it throughout the day, an hour on and then an hour working on extension, back on the machine for another hour etc. Your OS should advise you what schedule is best for you.

Will you be able to get enough physio on the NHS? When I tried the NHS after my original op they wouldn't offer me more than 1 session a week which wouldn't be enough for me. I have a private physio which is expensive (£45 per session) but to me it's worth it. When I approached my NHS physio about AF they hadn't even heard of it let alone know how to rehab someone with the condition!

I think crutches are a good idea, the rehab protocol on here for AF says not to load the knee for the first week or 2. I'm on crutches and think I'll need them for a good while yet.

One other thing worth mentioning to your OS this time round is pain control, it might be worth having a plan in place incase you find that you do need more meds this time round, especially after the op as you'll be doing physio and CPM pretty soon after the surgery. In February I had a femoral nerve block and this time round I had an epidural, mainly so that I could cope with rehab so soon after surgery.

Right, I'm off for a stint on the machine now!

Stasha
Title: Re: LOA & MUA round 2
Post by: missmyknee on September 01, 2011, 09:45:41 PM
Hi Stasha

This is in reference to Decruz's question as to why scar tissue came back.  I've had scar tissue come back many times even though everything has been done. Here is a link to my thread before my current thread was started. The title says it all........I DID EVERYTHING RIGHT AND STILL GOT SCAR TISSUE

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=38179.0

PAM
Title: Re: LOA & MUA round 2
Post by: mouk786 on September 01, 2011, 11:07:35 PM
regarding NHS physio - found it is both inconvenient and poor quality. I had 3 NHS Physios who didnt notice the scar tissue the first tiem and my surgeon was a little critical of them after I went to see him like 6 months post Op and my knee was terrible (it was also not picked up by 2 registrar surgeons).

My hospital of choice is quite a bit away from where I live so I also have a private physio near me who I use. To be honest I know all the drills. The physio is good for mobilisation work though - which I wil utiilise.

NHS physio of 1 session per week sounds about right and then it gets less over tiem - it is very 'hands off' due to time contraints.
Title: Re: LOA & MUA round 2
Post by: Stasha83 on September 02, 2011, 11:46:38 AM
Thank you for posting the link to your thread Pam. I knew I wasn't alone with this!  :)

My NHS physio (after original op last June) failed to recognise all the classic signs that I had scar tissue forming too. Frustrating because if they had I would have had a much better chance of recovery than I am faced with now. I moved to my private physio about a year ago, to be honest I would never go back even if I had a problem totally different to my knee.

After the AF surgery in February I saw my physio 5 times a week for the first 2 weeks. I know this sounds a lot but it was because I wasn't confident to go it alone at that stage. This time round I am much more confident and am happy to rehab at home so I'm seeing my physio once a week at present but I may increase this to twice a week in a few weeks time when the knee has calmed down a bit more.

I saw my OS yesterday. My stitches have been removed and he is pleased with my progress. My knee is pretty angry though so I need to be extra careful with it. It is a fetching shade of purple, red and green! He was happy with my ROM and advised that we will stick with the basic rehab and CPM for a further 4 weeks with a view to adding more strengthening etc after this period. He reiterated that I need to work really hard on the extension as it would be all to easy for this to slip away. I am determined not to let this happen though!

So all in all I think things are going ok at the moment. I really wish some of this pain would go away though, if anything the pain seems to be creeping up rather than decreasing.

Stasha
Title: Re: LOA & MUA round 2
Post by: Lottiefox on September 02, 2011, 03:15:18 PM
Hi Stasha

I get so frustrated that our NHS Physios do not seem to be able to recognise complications. That has nothing to do with staff levels, funding etc - it is a basic lack of training and understanding and evaluation of the patient. I honestly think I could go and rehab someone with a knee or foot problem and spot the signs of scar tissue or CRPS earlier than so called experts!

Good to hear that your OS is pleased with your ROM. I am impressed by the rainbow effect you seem to be cultivating! Not so good that the pain isn't abating. You have some nerve pain issues don't you? I know they can come and go and mine were probably at their peak some 2-3 weeks after surgery then gradually they've abated. Constant pain wears you down. Does anything help? Can you get the leg wet now? I keep sticking my foot into Epsom salts either in a warm bath or in a damp sock wrapped round my toes. Really seems to help the puffy feeling I get when my foot is tired. Not sure how suitable that would be for you.

I reckon you deserve a treat. Something pretty and sparkly often cheers me up.  :P ;D  Have you checked out Fabulous the jewellery shop - they have an online shop. Some lovely things, leave the page open for other half to spot.. :P

Take care and I hope the weekend is bit easier for you, I know how hard you're working on this knee and you deserve a break. I've just had a proper Indian Head massage - I am thinking of reflexology but this is a new therapist and I kind of wanted to meet her and judge her and show her my foot before I let her loose! She was lovely, very thorough so I think my foot will get some TLC soon, as will the matching non chopped one. She has hypermobile toes and can lift her big toe off the ground and bend it nearly right back to her foot without moving her other toes! Weirdsville!

Hugs,

Lottie xxx
Title: Re: LOA & MUA round 2
Post by: mouk786 on September 02, 2011, 05:16:17 PM
I agree that it is due to staff training but that always goes back to funding one way or the other.

My private physio told me that the training is poor on the NHS - i.e as a private physio he often spends a lot of his own money going on training seminars - whereas training on the NHS is fewer and far between.

He also said there is an element of being able to hide behind a big corporation o the NHS

Finally, and I think it is a good point, I think NHS physios are less likely to criticise surgeons. If the registrar surgeon says you knee is getting better (like mine did) then the physio is very unlikely to disagree IMO even though I was telling them it didnt feel right big time - because the surgeon is above them in the NHS. A private physio on the other hand has much more freedom and was always pushing me to ask the surgeon quetsions and offered to write a letter for me highlighting his concerns.
Title: Re: LOA & MUA round 2
Post by: missmyknee on September 02, 2011, 06:27:14 PM
Hi Stasha

Sounds like you had a good OS appointment. ROM will be a long process and the earlier you can establish it, while tissues are still soft and pliable, the better. Keep doing patella mobes several times a day to keep the patella moving freely. For extension try doing hanging weights. Do this at least 6 times a day for 10 min. This works by causing a gradual consistent stretch to tight tissues. I did this for 6 weeks to get to 0 extension. It does work. Here is a link from Dr Noyes AF tutorial, on doing over pressure for extension and flexion. Complete with pictures. Page down to this info

http://www.kneeguru.co.uk/KNEEnotes/node/2064

Pam
Title: Re: LOA & MUA round 2
Post by: captainruss on September 02, 2011, 07:17:19 PM
Stasha,

I am fortunate as my wife works at a Veterans Association Hospital taking care of our brave veterans and we have excellent medical insurance.  My problem is I am at 60 degrees flexion after 2 hours of intensive PT only to have my knee tighten up after ice.  I started with a MUA three weeks ago and the OS could only get it to 30 degrees as he was afraid he would break my leg.  I am new to this blog and trying to get answers.  I had a TKR 15 months ago, I have had probably 25 cultures/tests and all cultures come back negative, yet all 3 OS and all 3 infectious disease doc's tell me my knee is infected.  They rely on my c reactive protein and ced rates as indicators of infection.  I just found out about AF and now think these levels show inflamation, not infection.

I actually had my knee joint removed last October by OS #2 and I now believe it was not infected, I just had AF.  I had scar tissue, knee was hot, purple...and until I was able to see my spinal/shoulder OS who put my joint back in....I was considering amputation. 

I have tried nerve blocks during surgery and it has worked only once in the last five operations.  I had actually told the anesthesiologist to not put me under until I confirmed the nerve block worked.  The last two surgeries, the block did not work and he put me out.  The nerve block really makes recovery easier to me as less pain medication is necessary.  I have such a tolerance to high amounts of oxycontin, that I take more medication at home than they give you when leaving the hospital. 

My big question is i have had three MUA's, one with each OS and if they don't take out the scar tissue first, it is a waste of time.  My current OS is wonderful, but he admits he has never seen scar tissue as thick and pervasive as mine.  My OS is going to take out the scar tissue in 3 weeks and I am trying to find as much info for him as possible.  I am at a "catastrophic rate" with my insurance which means I pay no copays/deductibles until the first of the year.  I have to get this fixed this year as I have been out of work for 15 months for the first time in my life.  My wife is working overtime and we are in trouble. 

My OS 1-2-3 did not know to keep my knee moving after surgery.  I am now trying to be on a CPM as much as possible,  but my hip and back spasm after a couple of hours.  It also slides across the bed and the velcro pulls apart because the scar tissue squeezes my knee.  My knee is different because i shattered my knee cap at 17 and I am not sure if I even have a fat pad.  I am actually pretty tolerant of pain after having multiple spinal fusions, rotator cuff repairs, etc.  I am unfortunately very tolerant to high amounts of opiates as one of my first doctors increased my dosage to 3 times the maximum recommended amount of oxycontin for years.  I am now at 1/3 to 1/2 of what I used to take....but it is less effective.  I had not heard of Lidocaine Plasters or lidoderm patches.  Has anyone had results from these? 

Thanks all........Russ
Title: Re: LOA & MUA round 2
Post by: Lottiefox on September 05, 2011, 06:25:05 PM
Hey Stasha

How are things going? Been thinking of you and hoping the extension is maintaining and improving.....how is the pain feeling? A quick question about your Lidoderm patches if you don't mind. Are they prescribed through your GP? Do they do anything for you? I am thinking I might ask to try them on my toe and try and wean down on my tramadol as it makes me feel so weird some of the time. I hate it. I'd rather try and patch on my foot and maintain the Lyrica and Epsom Salt sock wraps!

Let us know how you're doing,

Hugs,

Lottie xx
Title: Re: LOA & MUA round 2
Post by: Stasha83 on September 06, 2011, 10:23:56 AM
Hi Lottie

Things are pretty much the same with me except for Sunday night the knee became hot and red which frightened the life out of me. I don't understand why it got angry, I didn't leave the house on Saturday or Sunday, just did my usual rehab plan. I really hope it doesn't do that again any time soon, I don't think my nerves could take it! The pain is pretty much the same but the knee is going a bit more purple which is nice.

The patches aren't available on the NHS here, nothing that I need is! I do have a private prescription for them but it's over £100 for a months supply. My statutory sick pay can't quite stretch to that sadly.

I think it would be worth you giving them a try if you can get them, you can cut the patch into smaller bits so it would be able to go on your foot or even your toe. I cut each patch into 3 or 4 strips so that I can surround the knee with them.

I'm so used to drugs now that the Tramadol does nothing for me. I've swapped to Fentanyl patches instead but these don't seem to do anything either?! I must be immune to all of these strong drugs!

Title: Re: LOA & MUA round 2
Post by: Stasha83 on September 09, 2011, 05:47:35 PM
Hi all

My patella is beginning to get tight again despite doing plenty of mobes every day. I've also had an increase in pain levels since my physio session on Weds.

Does anyone have any ideas as to what I can try to loosen the patella? I feel that I can't push it much harder, especially as I've had this increase in pain but not sure what else I can do?

Any advice appreciated.

Stasha
Title: Re: LOA & MUA round 2
Post by: kcknee on September 09, 2011, 06:12:43 PM
Stasha-

This suction cup device is what I have my PT use to keep my patella moving. He can then lift it slighly up and then mobilize it. I got the set, I think throuigh Amazon.com, because I wasn't sure of the size cup I needed, but I only use the yellow cup.

http://www.bannertherapy.com/ProductInfo.aspx?patella-mobilizer-set&number=95-550

When my patella was getting really stuck my PT remembered something like this in his PT training programs. It took a while to find it on-line. For me, it works great.

Good luck and I hope you can keep progressing forward.

Kristin
Title: Re: LOA & MUA round 2
Post by: Lottiefox on September 09, 2011, 07:59:37 PM
Hi Stasha

I can't offer anything practical but I hope the patella can be kept free. That looks like an interesting device that Kristin recommends, I can see the logic. I hope your pain levels settle down. I know so little about AF but I really hope this surgery brings you some relief and function. Been thinking about how you're getting on this week. Any progress on the baking at all?!  :P  It is exhausting dealing with pain every day. I am trying to get in to see my pain doc as I've had a few rough flare ups with my toes and I am not sure quite what is going on. I have this big red hard lump on my toe joint - not the fused one, the little one by the end. Its so strange, and painful at times. Can bend it all OK, but its totally numb, I could saw it open and wouldn't feel it. I don't see RSD as being described like that but who knows, it seems to be as unpredictable a beast as AF. We're so special!

Have a good weekend, I hope you get some pain free time to relax.

Lottie xx
Title: Re: LOA & MUA round 2
Post by: Juneau on September 10, 2011, 10:29:43 PM
Hi Stasha,
I am so sorry to hear that you are struggling with your rehab.  :( Having to deal with AF setback is such a strain on our emotions.

Maybe your patella getting tight is your knee's reaction to doing too aggressive rehab that it can't handle. Having increased pain after physio may be a sign that your PT is trying to work you too hard. You went through quite a bit of surgery pretty recently and your knee is trying to heal from that and then just can't handle the added activities.

I was doing fine with rehab until 3 weeks ago (which was 6 weeks post surgery) when I did a leg press like device in one PT session and then a bit too much wall slides a couple of days later and I started to get into swelling cycles - knee got much more swollen, hot and had more weightbearing issues again.

I cut way back in my rehab and have been doing only the bare minimum to keep the current mobility.
Careful stationary bike a few times a day (I am not on a CPM anymore, so bike for flexion),
hamstring stretch in sitting position, quad set, and patella mobes every 1 - 2 hours during the day

The first two weeks, I basically stayed all day on top of the bed so I could elevate my legs really high all day. Only got up to do my exercises and when necessity called. Used two crutches if I had any pain while walking. My knee would just balloon up and get hot whenever I got up even to go to the next room - but I still did those very limited exercises without pushing too hard. It was also hard for me to have to ask my husband to cook all of my meals again and serve me since he is so busy with his work, but I just had to really cut back in my activities of daily life as well.

My patella mobes felt squishy and a little tight at times, so I had to start carefully and do them a bit longer.

My knee was heating up uneven, my portals were often way more hot. It helped to use an ice cube on them and do a little ice massage before I did my regular icing. Otherwise I would have a very icy knee on one side and still warm knee in those sensitive areas.

It really helped me to try to relax as much as I could. The three day weekend last week really helped. I did not turn the computer on. Got a massage, read a gripping book, watched some fun movies - tried to get away from it all.

This week I started to do much better and felt that I could add more activities again. I could go to the office again to work instead of having to work on top of the bed lying down. I still swell up after exercise and if I do too much but it goes down again and my knee is looking normal again and I don't have to ice it anymore at night, only during the day. I also felt that I could add again straight leg raises and straightening and locking my knees standing up.

I think that we have to listen really hard to our knees and adjust all our activities as needed. Our PT's think that we need to follow a schedule to see this and that improvement per week and our AF knees just can't handle it. A normal knee may take a couple of days to deal with a setback but an AF knee may take a few weeks.

Hope you can relax this weekend and take it really easy! I wish you all the best to get back into your groove  :)
Title: Re: LOA & MUA round 2
Post by: Decruz on September 11, 2011, 12:23:42 AM
This suction cup device is what I have my PT use to keep my patella moving. He can then lift it slighly up and then mobilize it. I got the set, I think throuigh Amazon.com, because I wasn't sure of the size cup I needed, but I only use the yellow cup.

http://www.bannertherapy.com/ProductInfo.aspx?patella-mobilizer-set&number=95-550

Kristin

Hi Kristin,
when you buy this patella mobilizer set (http://www.bannertherapy.com/ProductInfo.aspx?patella-mobilizer-set&number=95-550) it includes 1 bulb and all the suction cups available? If I got it right the suction cups are different in size so once you get the set you pick the one that better fit to your knee, right?
Thank you
Title: Re: LOA & MUA round 2
Post by: kcknee on September 11, 2011, 02:25:57 AM
You get the set of one bulb and the three cups. They used to sell the cups separately, but it looks like they must have sold out of the individual cups. My PT tried working with each of  them and the yellow works best for me. He wets the cup first so the suction is better. The scar tissue coming back over my knee had stopped me from doing stairs normally for months before my PT tried this and now as long as I get him to do it a few times a week I can do stairs normally most of the time. My PT can get a better angle on this than I can and uses more strength, but it does work when I do it too.  My insurance lets me see him 2-3 times a week so I usually let him handle the major stretching out of my knee.

If you live in the States, compare the price + shipping with what it is on Amazon; at the time I got it Amazon was slightly cheaper. Search for "patella mobilizer".

Kristin
Title: Re: LOA & MUA round 2
Post by: Lottiefox on September 11, 2011, 08:45:54 PM
Hey Stasha

How has the weekend been? Have you had gales?! It has been pretty windy up here - cats blowing sideways....

I hope that your pain and patella have settled down. You've got some really good advice from folks here. I know I don't have AF but RSD seems to have the same "mind of its own" mentality with the key to being pain free (relatively) and having good function being able to identify what is enough but not too much activity. I am nowhere near that. It is hard work, draining on the soul and the emotions as well as the physical side.

We do get it on here so feel free to vent and also to let us know you're OK,

Hugs xxxx
Title: Re: LOA & MUA round 2
Post by: Decruz on September 12, 2011, 03:23:34 AM
Yes, it costs less on Amazon: http://www.amazon.com/Therapy-Best-Buys-Patella-Mobilizer/dp/B0008EJFWW/ref=sr_1_1?ie=UTF8&qid=1315794174&sr=8-1

Thanks
Title: Re: LOA & MUA round 2
Post by: Stasha83 on September 12, 2011, 12:56:16 PM
Hi everyone

Thank you for all the replies, I really do appreciate all the help and advice. I am trying to keep my weekends 'knee free' for the sanity of my family and friends (I fail miserably though!) so haven't been on here over the weekend.

There hasn't been any improvement with my pain levels and if anything, my knee is feeling stiffer. I agree that perhaps we are doing too much in physio. My OS said he wanted me to just do basic ROM work and quad activation exercises for the first 6 weeks but my physio is really keen to push forward. I can understand this, but like Juneau said, AF knees can't handle it. I am seeing a different physio today as my usual one is off. I think it will be good to get a fresh opinion on things.

This time round is so much harder than the LOA in February. I guess it is because I had more done? Everything hurts more and my recovery is much much slower. I read my surgery notes recently and I found out that my patella tendon also had to have scar tissue 'dissected' (my OS used this word). If my patella and patella tendon were both effected does this put me at a higher risk of patella baja?

This morning I found a small lump in my calf which is also bruised. It is painful to touch and painful when I lift my toes towards my knee. I am slightly paranoid that this could be a blood clot. I am probably worrying over nothing but will check with my physio when I go this afternoon.

Kristin, thank you for the link to the patella mobilizer, I have never heard of this before and will speak to my physio about this. Anything is worth a try!

Lottie, it is very windy here today! I'm not sure how me and my crutches will manage going to physio! Your numbness sounds worrying, could it be something to do with a nerve? I hope you get an appointment with your pain doc soon. Did you find out about the Lidoderm patches? I am going to ask my GP for a referral to the NHS pain clinic, I'm not sure that there would be much they could do for me but I think it's worth a try.

Juneau, thank you for the advice. I try to not think about my knee at weekends, but it's a little tricky when I'm in pain and on a CPM! Managed to go to the pub for a few hours this weekend which was a great distraction. When you had your CPM did you still use the bike? I have a CPM at home, but when I go to physio (3 times a week) I also go on the bike for 10mins with no resistance. Last week we also did the leg press machine with very little weight (2kg) to work on my lack of terminal extension. I'm wondering if this is too much at this stage?

Stasha

Title: Re: LOA & MUA round 2
Post by: Stasha83 on September 13, 2011, 04:13:09 PM
So it turns out that I was right to be paranoid about a blood clot as I do have one! I have what the Doctor called thrombophlebitis which is basically a small clot and an inflammed vein. I just need to keep an eye on it as there is a small risk that the vein could get worse but hopefully not a DVT! Stupid leg!  >:(
Title: Re: LOA & MUA round 2
Post by: Lottiefox on September 13, 2011, 04:57:50 PM
Boo! Stupid leg! Why are our lower limbs so determined to misbehave??? Good work on getting checked out. Do you have to try and do more ankle punp type actions and stuff? Can you massage it or does that raise the risk of it getting more upset? Boo. Not what you needed!

How is the knee feeling today? I think Physio perhaps needs to back off a little, although I am no expert in AF. Balancing acts are very hard to achieve....

Hugs,

Lottie xxx
Title: Re: LOA & MUA round 2
Post by: Juneau on September 13, 2011, 06:57:33 PM
Hi Stasha,
It's very healthy to get a way from the computer over the weekends and to try to relax. It was also very good for me, when I took it completely easy with no computer over the long labor day weekend.

Doing the leg press at Physio 3 weeks ago (which was 6 weeks after surgery) is what caused my setback that I now have to deal with. I talked to my OS after it started and he said - absolutely no leg press!  My knee can't handle the extra pressure at this point in the rehab. I am only to do exercises for ROM and isokinetic squad. That's pretty similar to what your doctor said. I have read in many places that for AF knees, you have to first work on ROM and that the knees can't handle being loaded early. I also have terminal extension lag and I need to get stronger to get over this - but I can't get it through machines or aggressive rehab. I am planning to start going to the pool later this week or next and start walking there to strengthen in a safe manner for me. That's what helped getting my strength after my last surgery.

I either used the CPM or the bike, because as long as I used the CPM, I could not go around on a bike (except at the Physio in Palo Alto where they had a special bike that allowed my full rotations even I had not achieved enough flexion yet). If you do the bike at the Physio, don't force the rotations either - if you use it to warm up and you can't go around at first, then just do some half circles until you can go around easily.

You might have to reduce even further what you are doing since you have a flare up. I even eliminated my straight leg raises and I can just now start doing them again 3 weeks after my flare up started. Don't let the PT bully you into doing more because it's what they expect you can do. I have discussed with them that I need to follow a schedule that my knee can handle. Maybe your PT can just work on hands on massaging and stretching you to help with your extension for the time being. I had to reduce dramatically the exercises that I am currently doing at Physio and even reduced the visits for now - my knee needs to get over the setback and then I can be more aggressive again.

Sorry to hear about your blood clot. I guess your knee just wants to be treated very carefully now.
Take good care of it.
Title: Re: LOA & MUA round 2
Post by: Stasha83 on September 13, 2011, 07:05:19 PM
I'm certainly not willing to be friends with this leg now!

The Dr just said to elevate it as much as I can (difficult on a CPM and AF rehab plan!) and keep an eye on it. Its  really sore so I'm not very keen on touching it. Sure it will be fine. Hoping it won't leave an ugly lump in my leg though, the multiple scars are enough!

The pain in the knee is still high, I'm seeing the physio tomorrow but I agree that we need to back off a bit. I'm sure this amount of pain is not right. I haven't had much heat or swelling so that's something to be pleased about.
Title: Re: LOA & MUA round 2
Post by: Stasha83 on September 13, 2011, 07:24:48 PM
Sorry Juneau, I posted my reply before seeing yours.

I was worried about the leg press machine, but with very little weight I hoped it couldn't do any harm. This was last week, so 3 weeks post op for me. Way too soon. I won't be going near that machine again for a while!

I am going to firmly stick with just ROM and quad activating exercises, no loading and no irritation (I hope!). I just hope my physio doesn't take offense when I see him tomorrow. My OS did speak to him about this and so have I, but for some reason he is just so keen to push forward. I guess this is what you would do for a normal knee but it just doesn't work for an AF knee.

I have got my CPM for another 3 weeks. It does take me a while to be able to manage a full rotation on the bike and I have to have the seat pretty high but I get there eventually!

I'm impressed that you can do a straight leg raise! I haven't managed this for over a year now and still can't even get close. I can lift my leg but the knee has to bend before it will lift. I guess I'm just not strong enough.

It's interesting that you mention going to the pool, I was thinking about that this morning. I think walking in the pool would be great, I don't think I'm quite at this stage yet though.

Thanks again for your advice, I'm off back to bed for my next stint on the CPM - lucky me!
Title: Re: LOA & MUA round 2
Post by: Juneau on September 13, 2011, 10:08:12 PM
Stasha,
Don't worry about your physio taking offense. It's your knee that has AF and you have to live with it. Some physio's and OS that are not experienced with AF think that the patient is not working hard enough but we can only do as much as our knee allows. A normal knee might take a couple of days to recuperate from a setback but an AF knee may take a few weeks.

If you have not done so yet, print out the Rehab protocol that Mr Dirk Kokmeyer, physiotherapist at the Steadman Hawkins Clinic posted on this site. I have given this to my physio therapists.
http://www.kneeguru.co.uk/KNEEnotes/node/263

Under the principles he explains clearly:
"Decreasing swelling and preventing inflammation is essential to maintaining and increasing motion. Weight bearing is also another important variable. When the knee is loaded by early weight bearing activities or aggressive strengthening, recovery from an inflammatory process will only be delayed or exacerbated."

Another good article that I have found that was written by Dr. Millet a few years ago that also explains the rehabilitation process is:
http://drmillett.com/attachments/article/87/Rehabilitation%20of%20the%20arthrofibrotic%20knee.pdf

I can do up to 15 straight leg raise on the bed (not on the floor) if my knee is not irritated. If it is irritated, I can't do it either. On the things that has helped me tremendously with getting strength is Kinesio taping. I am planning to post some of that but have not had time to do it yet. I have been so busy with work the past week.

It's probably a little too early for you to go to the pool. Your incisions have to be all healed up again. I want to go this week but one of the things I have not done it at our public pool yet is that I am a bit concerned about mastering the wet floor in the locker room and pool area. I wished there was a person I could go with the first  time.

Good luck with your appointment tomorrow!!!

Title: Re: LOA & MUA round 2
Post by: Lottiefox on September 20, 2011, 07:23:35 PM
Hey Stasha,

How are things going? Has the leg settled down now? I hope the Physio took on board your concerns...after all this is YOUR leg and knee and you know it well! Hope you had a weekend where the knee didn't dominate things too much....let us know how you're getting on...

Sending positive thoughts!

Lottie xx
Title: Re: LOA & MUA round 2
Post by: Stasha83 on September 21, 2011, 11:02:13 AM
Hi Lottie

Thank you for asking after me, not much has changed really. I had a really positive discussion with my Physio and feel that we are now thinking along the same lines. We have backed off a bit and spent the past few sessions just working on the patella and surrounding tissues to try and keep everything free. I think my knee has dropped a level in pain but I am still in pain all the time so it's hard to tell.

Im seeing my OS next Monday so I'm hoping he'll be pleased with my progress. Im planning on going back to work in 3 or 4 weeks so fingers crossed!

How are you getting on? Any improvement? I hope things are getting better for you.

Stasha

P.S Apologies for any typos, I'm typing this on my iPhone and can't fully see what I'm writing!
Title: Re: LOA & MUA round 2
Post by: jigs on September 25, 2011, 01:14:14 PM
Hey Hey Hey Stashaaaa...........

Calling out to u. Quickly read thru all u have gone thru and feel for u. Hope u remember me. I sued to post in ur earlier post and last couple of months I got really tied up so couldn't  post and also couldn't do much with the knee either. All i am gonna tell u is that just HANG IN THERE.....

Well today is my knee anniversary and exactly a year ago on 25th sept i busted my knee and my ACL.... though i had my surgery in oct and then an MUA in feb......

I have been doing quite well..... though my extension still lags by a 2 to 3 degrees and my bending lacks by a couple of inches and when forced my ankle touches my butt...... the pain comes and goes but it is nothing severe........ i can run or jog for 3 to 5 mins and then the knee acts up..... i have not been doing physio for the last two months or so and also no workout for the last month...... and as i see it my knee has been doing reasonably well........ though i dont wanna jinx it by saying so...... i do get worried suddenly coz i have not been doing much for it in the last cpl of months due to my crazy busy schedule........

One thing i have discovered and studied over a period of time is that the lesser scopes and surgeries u do the better it is....... i am glad that i just did an MUA in feb and it seems it have almost sorted my knee..... All i can tell u is just hang in there and give it ur best shot this time round and trust me u will be sorted.....

Was thinking about u so specially came to check on u and discovered that u have got another scope done.

Will keep checking on u for sure :)

KEEP SMILING.....

Cheers.....

JIGS....
Title: Re: LOA & MUA round 2
Post by: Rennschnecke on September 26, 2011, 02:16:25 PM
Hi Stasha

Hope you are currently well and that the pain has gone down a bit.  Sorry I haven't been in touch earlier.  I haven't been on visiting KG because I became overwhelmed by work and now have no Internet at home so just picking it up wherever I can.

It's good to hear that you're managing to get a break through baking – and then you're treated to the finished products! ;)

I just wanted to say that I think you ought to have more frequent physio in your early days.  They should be concentrating on mobilising the patella, helping you to achieve full extension and checking you are working on ROM appropriately.  There are things they can do to help you get the swelling down, e.g. pulsed shortwave therapy.  Focus more on icing to relieve not only swelling but also pain (doesn't apply to Lottie with RSD).  Ensure you elevate frequently enough and for long enough – must be above hip and heart levels.  My OS and PTs have always said that people often don't elevate high enough; don't know if it applies to you after all the expertise you've picked up.

I think the basics are quad sets with your leg straight and also turned in and out to get to medial and lateral muscles.  Until you can get your leg straight with quads set and can hold for a count of 5 or so, it's not worth try for a straight leg raise.  I didn't bother with straight leg raises for months because I was working hard enough with quad sets.  Now (1 y on) quad sets are not enough so I do SLRs.  Just think quality not quantity so that you can save time and have a bit of a life.

FYI Lidocaine plasters are available on the NHS – I've been using them since December 2009, although now it is only every now and then.  I like the cooling effect they have.  It is helpful for some situations, but I'm sure there will be some pain situations for which the plasters aren't suitable.

Don't know what dosage of fentanyl patches you're using, Stasha, but if you're not getting sufficient relief then they need to be reviewed.  I'm quite small so I'm on 25 mcg, which is fine as long as I don't overdo things and I don't set off my neuromas.  I have morphine sulphate (Oramorph) for breakthrough pain.  You'll need to experiment with your medications and activity levels to find out when you are pain-free.  If you can't be pain-free under any circumstances then you must talk to a pain relief specialist in case there is some underlying condition to your pain that hasn't been diagnosed.

I'm now going to put in a good word on behalf of the NHS.  I would have had physio three times a week had I been local to my OS's hospital.  As it was, he negotiated twice a week with my physio (she couldn't do three times a week because of her various clinics and she wasn't available on Wednesdays so we could have a Monday, Wednesday, Friday routine.  I had two sessions a week for maybe 8 weeks or so and when my condition was stable I was reduced to once a week but it increased to twice a week again when my condition was not improving.  I was finally just going once a week at around 3 months post-op.  I was going maybe once every two weeks from 5 months post-op and was discharged at around 9 months post-op (possibly because my physio was going on maternity leave).

I think that 'AF' isn't always a term they use in the hospital.  However, they will all know about a 'stiff knee syndrome' and will be aware of 'cyclops lesions'.  The lower limb specialists will be more experienced with knee and ankle issues.  I have to say my best treatment has been by these specialists (but there are not many of them).

I have also been subjected to the 'hands off' sessions and objected to be 'talked at' by someone who knew I already knew more than she did.  However, I have been treated by those who like the 'hands on approach' as well.  I had an in-depth discussion with my OS and his mates on one occasion and it seems that 'hands on/off' is a personal style and not necessarily an NHS approach.  However, that won't help you as an individual going through the NHS.

To get the appropriate hands on mobilisation therapy you need on the NHS you may find it useful to ask your OS to direct therapy more closely.

Mouk:  the main objective of the CPM is to mobilise to knee to reduce the likelihood of it stiffening.  It's not necessary to go through the full range of movement (see HeatherM for her experiences with Steadman Hawkins).  Besides, it gets really uncomfortable beyond 100 degrees as the leg gets pushed into your chest and some CPMs don't go above 105 degrees.  In summary, don't fret too much about the angles on the CPM.  Just follow your OS's instructions.

Must go now.  Hope everyone stays well and I'll check in again later!

R  :)
Title: Re: LOA & MUA round 2
Post by: Stasha83 on September 27, 2011, 03:40:23 PM
Hey Jigs

Welcome back!  ;) I'm glad to hear that things are going well for you, lets hope that they stay that way and you'll keep making improvements. As you'll have read that's not quite the case for me but I hope that I'll get there eventually. Third time lucky maybe?!

Hi Renn

It's great to hear from you, I was wondering where you had gone. I think in a way its good that you have been busy and not on here so much, it shows that you are able to get on with your life and not have to think about knees all the time which is great.

I am having physio 3 times a week at the moment, going once a week only lasted for about a week or 2 and I soon realised that it wasn't enough. My mum has also been trained by my physio to do some basic work with me at home, she's getting very good at mobes! I am happy staying with my private physio. Although it is costly, I feel that I have a better chance of recovery as they have worked with me for a year now and know me and my knee pretty well. My physio also sees my OS in London twice a week when he is lecturing so they are able to keep a close eye on my progress as such.

We are going to start hydrotherapy soon too hopefully (if it can all be arranged at the local gym etc), I think this could be really helpful for my walking and weight bearing.

I have been told that I can't have the Lidocaine plasters on an NHS prescription by my GP. I guess this is down to the local PCT? I am also not able to have Pregabalin for the same reasons. The PCT round here seem to be a bit rubbish for some reason.

At the moment I have the 25 mcg patches too. I am always in some pain, although the levels do increase throughout the day and depend on what I have done. Sometimes icing seems to make the pain worse which I don't quite understand? I have asked my GP for a referral to the NHS pain clinic, I just can't afford to see my private pain specialist anymore, my SSP doesn't quite cover it!

My CPM is going back at the end of this week so it'll be interesting to see how the knee copes without it. I am also hoping to go back to work on the 17th of October so fingers crossed it will all be ok.

How is your knee now? Are you able to do the activities that you want to do or are you still restricted? Fingers crossed for good news!  :)
Title: Re: LOA & MUA round 2
Post by: Juneau on September 28, 2011, 03:46:49 AM
Hi Stasha,
I hope that you will be able to start hydrotherapy soon. I have started to go to the pool last week and have been 3 times so far. My PT wants me to go there every 3rd day and then later every 2nd day and really hopes that it will help me with strengthening. The first time I went, I was very worried about slipping but the pool shoes that I have really help with getting through the locker room and also walking in the pool. Last time I went, I was already much more confident and felt comfortable to increase my exercise program a little.

When you have to give up your CPM, maybe you could try a stationary bike at home. If you can't make it around yet, you can do half circles until you can. That will still help with bringing motion into the knee. I have a regular street bike but I got a stand for it so I can use it as a stationary bike with no or very little resistance and use it a few times a day for 5 - 15 minutes.

Good luck!
Title: Re: LOA & MUA round 2
Post by: Stasha83 on September 28, 2011, 11:11:10 AM
Hi Juneau

I'm glad to hear that your experiences with hydro have been ok so far. I think the first time will be daunting but it seems to be a pretty safe way of taking the next steps with my knee.

I don't have a bike at home but my Physio will let me use the one in his gym everyday so I'm planning on doing that. I can manage to cycle almost normally now as long as the seat is extra high.

How would you say your knee is now? Do you still have much pain?
Title: Re: LOA & MUA round 2
Post by: Rennschnecke on September 28, 2011, 02:38:42 PM
Hi Stasha

There's no need to change physio if you're getting the treatment you need.  I just wanted to highlight that the appropriate treatment is available through the NHS.  However, like any huge service organisation, opinions on their service is shaped by the individuals you meet and like any profession, there is a variety of abilities.  And yes, you may have to go through a large number of individuals to get to the person you need.  I know I've been working my way up the hierarchy. ;)

Hydro can be very good for you, but monitor how much you do because it's easy to overdo things.  I found that it was easier to avoid irritating my scar tissue on dry land, so ended up stopping the hydro.  Besides, it seemed that the effort of having 5 minutes in the pool wasn't worthwhile (i.e. showering, drying off and drying my hair).  Others have found hydro an invaluable therapy to return them to full function.

It sounds to me as though your GP is fobbing you off to preserve their budget.  I'm using fentanyl with pregabalin and my OS's pain specialist explained why gabapentin was useless for me.  At least it wasn't my imagination that stopping the gabapentin made no difference.

If icing hurts you then it's worthwhile be rechecked for RSD, or perhaps it's worth going through the treatment to check.  My research seemed to indicate that tests for RSD are not reliable and they tend to go on the classic symptoms and pain with icing is one of these – it's almost definitive.  If you have RSD and the current meds don't provide relief then it may be worth having a nerve-block type treatment from the pain clinic.  As far as I could work out, it's a bit like having your pain system reset. ???

Good luck with your return to work.  Will you have a chat with someone about making suitable adustments for you?  I would advise getting something to elevate your leg whilst sitting.  I have something like th item shown on this page:
http://www.online-ergonomics.co.uk/shop/shop-infopage.php?longref=1242~0
It was provided for me by my Disability Students Allowance and it's absolutely fantastic.  It isn't easy getting it to everywhere I need it, but if you could get this set up at your workplace you'll find working much more comfortable.

I'm progressing slowly.  My knee still has breakthrough pain, but I am doing more now as well.  I can do some tidying up and cleaning around the home as long as I do it in short bursts and sit down as much as possible (little things  ::)).  I have full range of movement, but I'm wary of steps still.  This is because I have had a MACI op (kissing lesions) so I want to test things carefully to avoid messing that up.  I ought to be OK now, but prefer to do things gradually.

I can't do everything I want to as I was an elite skier and have a role as a tutor to return to when fit, which involves skiing.  I can walk on level ground for around 5 minutes or so.  I have to go slowly on inclines and I have to go down stairs one at a time.  I'm now approaching the point where I might manage going up normally but will take it gradually to avoid setting off another pain reaction.  However, I am better than I was this time last year.  I have maintained my ROM but my fat pad is getting irritated with trying to get full extension when walking.

Did I tell you about the terminal knee extension exercise?  When your fat pad area is no longer painful or irritable then talk to your physio about extension when walking.  There is an exercise to do to help regain extension with walking – or maybe you've already tried it.

Anyway, must go.  I'm popping into the gym to do the bike and then I'll be working.  Still have no Internet at home and got a letter telling me to see my email about connecting to the broadband! ::)

'bye, take care!

R  :-*
Title: Re: LOA & MUA round 2
Post by: Juneau on September 29, 2011, 03:58:00 AM
Stasha,
I don't have a lot of pain but I think that I have also quite a high pain tolerance because I had some other pain issues and learned to do visualizations that  provide pain relief and the Kinesio tape that I am using also helps. On some days, I am sometimes more stiff than other days and then it hurts more. Also there is an area on the medial side of my knee that hurts a lot if I am not careful with my exercises and that also prevents me from pushing my re-hab more. Nobody knows what the cause of that is - either my meniscus that is very thin from 3 surgeries, or scar tissue.

I feel like I am finally getting close to where I was 6 weeks ago when I had that swelling episode that set me back.

Renn,
It's so nice to hear about your progress. It's great that you have your full range of motion.  ;D And it's also so nice that you can do things around the house as well. It's so trying to have to be patient, but better safe than sorry. I am so glad that you are still making progress. That's wonderful!

I agree that if you can spend only 5 minutes in the pool it's not worth while. I am very careful not to add too much at once. Today I made sure to look at the clock, so I didn't stay for longer than 20 minutes even though I felt that I could have done more but I want to be able to go back again on Friday. 

I would be very interested to hear about the terminal knee extension exercise. I have almost full extension when standing and when I put my leg flat but I am lacking quite a bit when I am walking. My PT thinks that's because of my lack of quad strength.
Title: Re: LOA & MUA round 2
Post by: Rennschnecke on September 29, 2011, 10:49:05 AM
IMHO the terminal knee extension (TKE) exercise is only worth doing when you can get your knee straight and maybe even do an SLR.  At that point, all you will be doing is re-educating your muscles to get your leg to full extension when walking.  The details are thus.

Stand with your hands resting on a table edge or some other item which you can use for balance and/or to put some of your body weight through.  Have your good foot in front of the 'bad' one with the heel of the rear foot raised and your legs slightly bent – not a squat, more of a relaxed position or as you might be when walking.  You can start with all your body weight going through your good leg and your arms (i.e. virtually no weight through the good foot).  Once you're in position, extend your leg by pushing the rear heel down towards the floor.  I find it useful to hold for a count of 2-3 seconds; aim for 3 sets of 10 reps.  The exercise may be progressed by adding a resistance band which is tied around your knee and the leg of the table.

The alternative is to ensure you extend as fully as you can when walking, but it will be fully weight-bearing and it really slows down the walking.  However, as you're doing pool work, this exercise could probably be attached to one of your existing aqua ones.

HTH  :)
Title: Re: LOA & MUA round 2
Post by: Stasha83 on September 29, 2011, 10:58:28 AM
Hi Renn and Juneau

Thank you both for the advice, I will keep a close eye on how much hydro I do and how the knee reacts.

I agree that my GP is fobbing me off. She did say that she  referred it to the PCT but both those drugs are apparently 'blacklisted' in my area. I just heard that I can't see the pain clinic until 18 weeks time. What a joke. I am fuming, I feel like I ask so little of the NHS - I have not used their resources for any of my surgeries or their physio teams and now that I do need a little bit of help I have to wait a ridiculous amount of time. I'm not quite sure how I am meant to cope for that long with the pain that I am in?! I will ring and ask to be put on the cancellation list but other than that I don't what else I can do. I am seeing a friend later who is a nurse so I will also ask her advice. It really does make me so angry.

Thank you for the link to the leg support, I think this could be really helpful for me. I have an extra high foot rest at work but at this stage that wouldn't be much use to me so I will ask if I can have one of these too. Fingers crossed they agree!

I am glad to hear that you are both progressing, slowly but surely seems to be the key. I do wonder with AF knees if we will ever return to where we were before the AF nightmare begun but for me, any improvement would be gratefully received!

I too would be very interested to hear about the terminal extension exercises. I really struggle to straighten my leg whilst walking. As I have no fat pad I think it could take a while for this area to settle, it seems to get irritated very easily. I am also no where near being able to do a SLR so I guess it's probably to soon for me to try?
Title: Re: LOA & MUA round 2
Post by: Rennschnecke on September 29, 2011, 11:46:22 PM
Hi Stasha

The 18 week wait is the standard that all NHS trusts (& equivalent) work to for a patient to get their first appointment following joining the waiting list.

I appreciate that you're in a lot of pain, but you'll be competing with all the other chronic pain patients for an appointment.  The pain clinic is very popular.  The pain relief consultants are also anaesthetists so have OR duties which limits their clinic times.  They will see all patients requiring pain relief including cancer patients as well as orthopedic patients.

As you said, other than request you be notified of a cancellation there isn't much else they can do.  It's difficult for them to prioritise you over the other pain patients who will probably also be in severe pain.

In the meantime, I think it is worthwhile you cutting back on your activities to see if that helps you.  I know, it's scarey.  However, I had some episodes when I was just too sick to do anything for a few days.  During that time I just slept so didn't take much medication and yet was pain-free.  That confirmed that my pain was activity-related and means that I know when my pain levels rise that I've done something wrong, either too much activity or the wrong activity.  I hope you can get some rest and that it helps you work out what you can/cannot do.

I think TKEs are too much for you whilst you are still in pain with what you do.  If you can't manage an SLR don't worry.  I took Dirk Kokmeyer's advice to heart and didn't try an SLR until I could hold form.  That meant I didn't even try until I could reliably do a quad set, hold for 5s and maintain hyperextension (would be straight if hyperextension is not a goal/possible).  I only introduced SLRs once the quad sets weren't helping.  I work on dynamic quad strength on the bike.

HTH – must go now!

R. ;)
Title: Re: LOA & MUA round 2
Post by: Stasha83 on October 31, 2011, 10:39:20 AM
Hi everyone

I hope you are all well and your knees are behaving!

I haven't posted for about a month so thought it was time for a quick update. I am really struggling to move forwards this time round, after my op in February I had progressed a lot more at this stage. For some reason my knee is very very reactive still which is preventing me from progressing. I am still in constant pain which I just cannot get under control. The pain gets worse throughout the day and night time is horrible. My knee is also going red again at night and becoming warm. During the day I don't have any heat but the knee is a purple/red colour and generally just looks wrong.

I have pretty much retained my ROM, flexion is about 120 and lacking about 5 degress of extension. I am still missing terminal extension and having to walk with a bent knee. I am getting the horrible 'tight' feeling again though which I don't like.

Last Monday I had my usual physio session and my knee reacted very quickly and severly afterwards. I have not been able to calm it down since, and the pain seems to be getting worse rather than easing. I am seeing my physio again tonight so will discuss what to do. I spoke to him on the phone on Friday and I think he may suggest going back to my OS.

I really am beginning to feel that this is as good as it will ever be for me. I just don't know what my physio or OS will be able to do for me. I have a feeling that they will suggest injecting the knee but this has never worked previously. Of course I would be willing to try though.

I wonder if having no fat pad is impacting on my pain levels? I don't know how well a knee can cope without a fat pad? Has anyone else had experience of having no fat pad other than TKR's?

Stasha
Title: Re: LOA & MUA round 2
Post by: Rennschnecke on October 31, 2011, 10:59:43 AM
Hi Stasha,

I'm so sorry that you're really suffering – I'd been hoping so much that you would be improving this time round.  What has your physio been doing with you and what have you been advised to do to manage it yourself?

I had a search of the literature on fat pad removal as mine is fibrosed (if there is such a word!).  As far as I can make out the outcomes of fatpad removal are mixed.  My personal take on the situation is that it is akin to removing a meniscus but from the patellar tendon region.  The ideal is to keep it as far as possible.  However, in some instances this is not a viable option (e.g. the fat pad is no longer pliable enough to do its job of cushioning).

As you are still in the early stages of your last op, I wouldn't imagine you doing anything that would require a fat pad.  The benefit of removing the fat pad for you is that it cuts off the blood supply to the scar tissue in your knee allowing time for your body to break it down.

It really does sound like you ought to be in touch with your OS about your problems. :'(
Title: Re: LOA & MUA round 2
Post by: Stasha83 on October 31, 2011, 01:48:56 PM
Hi Renn

I was hoping for the same too! I feel a bit like we have lost direction again, my physio said we are clutching at straws as to what to do with me. He did suggest taking a 4-6 week break from rehab and then try again but I'm not sure about doing this, To be honest I don't know what to do anymore, everything just seems to make it worse.

I do worry that the removal of what was left of my fat pad has made my knee worse. My OS did tell me that this op could make me worse but it was a risk I had to take.

I need to remember that it is still early days, it's just frustrating as I know I should be progressing better than this.

We shall see what the physio says tonight. My normal physio is away this week so I'm seeing someone else (who does know my knee well) so perhaps a fresh perspective could be helpful.

Title: Re: LOA & MUA round 2
Post by: Rennschnecke on October 31, 2011, 06:36:25 PM
Oh Stasha, you stopped being normal with your first complication!  :( :(

Your knee has shown that it doesn't respond well to 'normal' rehab and it hasn't ever shown a 'normal' progression.  It's unlikely to do so now.  :(

You need to talk to your surgeon about what you need.

I had mobilisations and stretching from my physio for 3 months along with ultrasound and shortwave therapy.  I did most of the other stuff on my own, at my own pace, listening to my knee to decide what I should do.  I wasn't progressing quickly, but at 13 months on, my sports massage therapist (PT as well) has said that I'm further along than he ever expected me to be so couldn't suggest anything more for me to do than I have been.

You may find it better to stop fretting about how behind you are in the rehab and focus on your current day to day needs.  You too may find you can see changes only on the scale of months rather than weeks.  Although there are mixed findings for the removal of the fat pad, I would imagine that applies to FWB.  If you are in pain even without FWB then there may be something else that is causing you problems.

Contact your OS urgently to discuss this.  Prime his secretary about this so that he can maybe discuss this with the Prof beforehand and explore all the options to consider.

Take care!  :-*
Title: Re: LOA & MUA round 2
Post by: Lottiefox on October 31, 2011, 07:25:49 PM
Hi Stasha.

Oh boo. I was SO hoping that the lack of an update meant things had improved. I am SO sorry you're still in such a lot of pain and feel stuck. It is simply vile being the one with the complications. I agree with Renn that you need to see your surgeon and prime the Prof too. I know a few posts back you mentioned about the ice, and Renn commented on being checked for RSD. Did that ever happen? I know I probably bang on a bit too much about it and see it when it isn't there but having dealt with arising in my foot I am probably hyper vigilant. Is ice still making the pain worse or have you stopped icing? Along with the colour changes and heat do you get periods of cold at all? Any weird sweaty events? I know before my meds were stabilised my pain would get worse through the day and by night time it was enough to make me cry. Of course, many other things can be causing the pain but it is just a thought. I know you're on Neurontin but I was reading somewhere that Pregabelin has a much better success rate with RSD type pain. Might be time to start fighting the PCT/pain clinic. It might also be worth trying to see if a nerve block could be scheduled to see if the pain responds. It isn't likely to remove the RSD with one shot, but if the pain abates then your treating team will have a better idea of what to do next and how your rehab should proceed. It is unfortunate that rehab for RSD is quite aggressive but of course with AF that is the worst thing you can do.

It sucks being in pain. I wish you could get some relief and at least start to feel like some gains are being made. I think it is definitely wise advice to consider things in terms of months not weeks and not tell yourself you should be better than you are. You are where you are, and you need some more advice to move you onwards. I now think in months, and even years. I hope that by 12 months my RSD will have continued to reduce (it is gradually slipping out of my toes and side of the foot!) and I can come off my meds. Time will tell. But until your pain is improved you just start to feel so hopeless.

Good luck and keep us posted,

Big hugs xxxxx

Title: Re: LOA & MUA round 2
Post by: Stasha83 on November 01, 2011, 11:36:16 AM
Hi Lottie and Renn

I saw the physio last night and she does not know what to do with me either. She tried to call my OS there and then but didn't have any luck. I have emailed his secretary this morning and asked for him to call either the physio or me. I really do feel that no-one knows what to do with me anymore, I feel like I am stuck with a wrecked knee that no-one really knows how to help.

I have an appointment with the NHS pain clinic at the end of November. I was checked for RSD previously and the verdict then was that I didn't have it. I am not icing at the moment, I think that ice makes my nerve pain worse. I don't get any cold periods or sweaty problems. I was meant to be prescribed Pregabalin instead of the Gabapentin but the NHS here won't let me have it and I can't afford a private prescription for it.

I like the sound of nerve blocks  :) I would quite like a permanent one! I will be asking about this when I go to the pain clinic. I am slightly worried that they won't know what to do with me there either.

I think I just need a plan of some sort to give me some focus rather than the feeling of clutching at straws. I just feel like the vicious circle has started again and once again no-one really knows how to stop it.

On a positive note I am managing to work again and earn some money which is great!  :)
Title: Re: LOA & MUA round 2
Post by: Rennschnecke on November 01, 2011, 12:10:23 PM
It's good that you've got back to work, Stasha – it gives you something else to focus on.

What type of activities are you doing at the moment?  Are you fully weight-bearing or still on crutches?  Have you been assessed by Occupational Therapy services for you home and general mobility needs?

I have had good experiences with each of my pain consultants.  My only complaint is that they don't seem to stay around me for very long. :-\  I am sure that they will be able to help you.  They may also refer you to a pain physio who can advise on some of your needs.

I am on pregabalin and I felt so much better on this, much more so than gabapentin which seemed to do nothing.  Perhaps the pain clinic will prescribe this.  Unfortunately, this doesn't mean your GP will and they may be having an eye on their budget at this time.  My scanty research seems to indicate that pregabalin is a great pain relief agent and more effective than gabapentin.  It's benefits go beyond the classic nerve pain conditions.

Hope you get relief and direction soon!
Title: Re: LOA & MUA round 2
Post by: Stasha83 on November 01, 2011, 12:30:05 PM
It is good to be back at work, it's nice to have other things to think about rather than just my knee. I'm off the crutches at the moment, I found that the pain seemed the same wether I used them or not so I've decided to stop at present. I just have to walk very slowly and carefully.

Activities are pretty minimal, I just go to work and then rest in the evenings with physio twice a week. I am in need of an assesment for my desk area etc but have a feeling this will never happen here!

I'm pleased to hear that you have had good experiences with your pain consultants. I've just got so used to the private route I'm not sure what to expect.

It's so frustrating that they wont let me have Pregabalin! I have asked 3 times now and get the same response everytime so have pretty much given up. If the pain clinic do prescribe it will the NHS allow me it? My GP said it's 'blacklisted' here so I presume that will be the case across the board? I guess I will find out at the end of the month.
Title: Re: LOA & MUA round 2
Post by: Rennschnecke on November 01, 2011, 12:52:00 PM
Stasha,

Sorry that you're feeling lost with no real support from the medical system. :(

I know that it seems stupid to use crutches when it does relieve the pain.  However, if (like me) you have delayed pain responses then it may be worthwhile using crutches all the time.  I was using crutches for a long time and I still need one crutch or a cane at times – although it is getting better and I can see that my walking spans are extending.

It's just that if your pain is affected by the accumulation of activity then using crutches will help.

Can you remember a time post-op when you didn't feel so much pain?  Can you recall a point at which things changed?
Title: Re: LOA & MUA round 2
Post by: Stasha83 on November 01, 2011, 03:18:46 PM
That's a good point - perhaps an element of my night pain is a delayed reponse. Maybe I'll try the crutches again for a week to see if it helps or not.

The pain began creeping up about 2 weeks ago, and then last Monday I had a physio session which flared it up and it hasn't reduced since. We did minimal activity at physio yesterday, 5 mins on the bike and then just on the Cybex machine (it's like a CPM) and even that caused a pain increase.

I seem to have a very sensitive knee!  :-\

Title: Re: LOA & MUA round 2
Post by: Rennschnecke on November 01, 2011, 04:07:22 PM
I hate to say this, but it's possible you've simply tried to push it too far too fast for your knee.  The best thing you could do now is try to rest it as much as you did before the flare up and see what that does for you.  I know it's frustrating, but your knee is in control for the moment.  It needs time to repair.  :'(
Title: Re: LOA & MUA round 2
Post by: Stasha83 on November 01, 2011, 04:15:37 PM
I have wondered about this too. In some ways I think this is possible, but then on the other side I'm not so sure as we have gone at a snails pace this time round. We didn't introduce any basic strengthening work until about 3 weeks ago and even that was minimal and was approved by my OS.

I think i am leaning towards the option of putting the rehab on hold. My OS's secretary has emailed me back to say that he would like to see me in clinic so I will arrange an appointment asap and the hopefully I will know what to do.
Title: Re: LOA & MUA round 2
Post by: Rennschnecke on November 01, 2011, 04:58:49 PM
TBH at your stage I had not yet begun any strengthening work.  I kept doing the basics as my knee was still symptomatic – pain, heat and swelling.  It has only been relatively recently on the bike that it has become clear I could push it further.  This is because the bike feels too comfortable just spinning it over and the speed has naturally crept up without trying till it is on the edge of CV work.

You might like to re-read the postings made by HeatherM, Laurie and JakeM as well as myself to remind yourself of how long this recovery can take.  Heather is particularly good at reinforcing the framework for progressing with exercises as is Laurie.

Putting your physio on hold may be a reasonable thing to do.  However, you should try to maintain your mobility exercises in the interim, e.g. patella mobes, quad sets, ham sets, heel slides, ham & calf stretches.  My current minimum is patella mobes and stretches but my knee has settled to an equilibrium that allows me to maintain full mobility with a day or 2 off.  Any more than that and I notice it.  That said, the therapist I saw on Saturday said my knee is as good if not better than he's ever seen it since my troubles (he's know me from before then).  BUT before you despair about your own situation, remember how far out I am post-op ...
Title: Re: LOA & MUA round 2
Post by: Stasha83 on November 03, 2011, 01:50:28 PM
Thanks es ever for the advice, I will look up those pasts. I haven't read them for a while, not since I was first diagnosed.

I have an appointment with my OS next Thursday so I hope to know more then, fingers crossed anyway!
Title: Re: LOA & MUA round 2
Post by: captainruss on February 16, 2012, 09:15:13 PM
I can't imagine the path Pam has taken......I am pulling my slightly graying hair out on a daily basis after 2 years.  In 1989 the telephone pole I was on broke and I woke up in the helicopter.  I only missed less than 2 months of work after that deal with multiple back surgeries, knee surgeries, and both shoulders along with a skull fracture.  AF has taken 2 years out of my life and I am going absolutely nuts....hearing voices...the voices won't stop...you guys are my witnesses if something terrible happens to my mother in law....don't print this post!

I hope you keep improving.  I am so jealous that you are back at work.  My teenagers are growing up and I have refused to make them suffer because their fat dad is a physical wreck.  But, saying yes has burned through the 401k fund, the retirement fund, my gun collection...and anything not nailed down.

If you hear of a crippled guy doing bank robberies in Florida...you don't know me!!

If you don't have humor....all you have is pain!

Russ