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Author Topic: Scope Nightmare  (Read 3522 times)

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Offline 256ted

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Scope Nightmare
« on: February 06, 2006, 02:12:23 AM »
Hello; This is my first post after reading your site. I had arthrscopy on the right knee 12-21-05 and the surgeon did a lateral retinacular release, and chondroplasty.   He stated that I had a significant lateral tilt of the patella and a lesion of the  medial femoral condyle which he trimmed. In his notes he states that my lateral meniscus is hypermobile yet not torn?
Now,  I am in as much and often More pain than I was prior to surgery. I can tell no difference in my symptoms and I have numbness and often quite alot of pain on the outside of the leg from the knee down to my calf. In talking to the surgeon he says this will go away as I heal and as I stated to him I dont seem to be healing. He has cleared me to return to work and I work at a job which requires me to stand 8 to 10 hours per day with lots of moving around and twisting and turning. I told him that I cannot drive a car due to the pain in the knee and the leg and also the fact that if I sit in such a position for over 10 minutes or so my leg feels like it is asleep. Last week I got up from the toilet and my knee went to rubber and I fell. The surgeon did not put me into physical therapy and now wants to which is fine but, is the damage done or can I now so late after surgery be helped.  I am upset at the surgeon as he seems to have his mind made up that I am ok to work but, I am not. I stand of loosing my job if I cant go, but, risking my life if I get behind the wheel and my knee locks or leg wont work to control the car and hurt someone or myself. 
I feel helpless in this situation and wishing I had never had the surgery. The surgeon said I would have a quick recovery and apparentely he intends for me to have that as he basically is ignoring me and my pain.
I am 39 years old and diagnoised with patellofemorall syndrome, and femoral condyle chondral defect. The surgeon said that my scope shows mild osteoarthritis.
So my question is why am I not healing and is this standard care for the surgeon and HMO to dismiss a patient as though the doctor is always right after surgery saying in effect that once he did his surgery that I should be doing well enough to go to work and drive at this time?????

Offline shade

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Re: Scope Nightmare
« Reply #1 on: February 06, 2006, 12:01:08 PM »
Hi

Welcome to the site......

Sorry that you are having these problems after your surgery.  It's a surgery that can take awhile to heal from though.  I had mine back at the end of July and still having problems, so try to hang in there.   
Are you taking anti-inflammatories for the OA?  They can sometimes help.  Some people swear by glucosamine tablets also.

Here is an article that might help (check out the tabs at the top of the article)

http://www.steadman-hawkins.com/knee_chondral/overview.asp

Your doctor does not seem very sympathetic to your needs.  Heck, I can't imagine having to stand for 8 to 10 hrs and I'm 6 months post-op.  Lateral release surgery takes from 6 months to a full year to recover from. 
Maybe you should see if your GP will give you another referral to see another OS.  It certainly would not hurt to have another opinion.  Your GP could also help you with delaying going back to work, I'd think.......
Let us know how everything goes.  ~Shade
July '05 (RK) - LR/debridement
Mar '06 (RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
 Feb '07 (LK) - LR + Fulkerson TTT

Offline mtnbk1113

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Re: Scope Nightmare
« Reply #2 on: February 08, 2006, 12:30:42 AM »
Hi there,

Sorry to hear about all your trouble. I just wanted to buzz in and let you know that it will get better and there is light at the end of the tunnel. I had a lateral release and plica removal on 12-21-05 (ironic, no?) only it was my left knee. I am a cyclist and runner, and was very strong before surgery, so this has helped undoubtedly. As for me, I was off crutches and walking around by the second week, and I am now at 135 degrees flexion, able to use all the leg machines at the gym again, back on my bike doing easy rides and starting light jogging. It still looks a bit puffy and not quite normal at the incision sites, but that's about it. The numbness and strange shooting pains have lessened considerably, and are almost non-existant.

Can you tell me- was your primary problem patellar tilt? A LR will not correct malalignment, only tilt. For this reason it is an often over-prescribed and not useful surgery. If you already had some OA, the release of course won't help that, but may prevent further breakdown. Stay on the anti-inflammatants. Wouldn't hurt a thing to start taking some Glucosamine as well. You have to have the anti-inflammatants in your system for 14 days consistently to see therapeudic benefits, or so they've told me.

Hang in there. It will get better. I would say your doctor is negligent at best and pathologically unethical at worst for not putting you in PT immediately. It is absolutely crucial for recovery. You'll have to reeducate your quadricep muscles, and you need structure and guidance from a talented therapist to help you with this. Get into PT immediately and do it religiously. I believe you will quickly see improvement. I began mine two days after surgery and am being dismissed to continue building up on my own next week.

I don't know much about the chondral defect, or the meniscus problem, but I do know that therapy is absolutely critical. Good luck- let us know how it goes!!!

Anne

Offline 256ted

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Re: Scope Nightmare
« Reply #3 on: February 08, 2006, 01:00:47 AM »
Hi and thanks for your response thus far. I had a lateral retinacular release for the patella tilt.  The orthopedist had diagnoised the osteoarthritis prior to surgery from the x-rays and MRI but, also confirmed this after the scope.
I have ask the surgeon to get me to physical therapy and I have a appt. with the surgeon on Thursday 2-9-06 to further discuss my condition.
Basically I feel the surgeon is saying to me that his "textbook" standard of care says I should be well and driving and working by now, yet, my symptoms say otherwise.  I only know that I am depressed and now wishing I had not had the surgery done.  I as stated before was told prior to surgery that this was a surgery with a quick recovery and minimal pain and problems. Yet after having the surgery I find a S-L-O-W recovery and as much pain and discomfort along with instability in the knee as before.  My pain is as bad as prior to surgery and seems to be in the same area other than the numbness in the leg which occured after surgery and again the surgeon said was not uncommon yet, as he stated it, "most patients dont complain" thus making me feel that he simply does not care about my future health.
Thanks to all who have responded.

Offline Heather M.

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Re: Scope Nightmare
« Reply #4 on: February 08, 2006, 04:32:09 AM »
Definitely find a new surgeon.  Yours doesn't seem to care about treating you, and is either blind or completely ignorant to the fact that those with PFS (which you seem to have) and signs of early OA sometimes DON'T respond positively to LR surgery...so giving you the crap about how you should be better by now is less than helpful.  The fact is that you are not.  Frankly, at six or so weeks post op I wouldn't expect you to be better yet...this is a tough surgery, lots of soft tissue insult.  It takes awhile to recover for most patients, and you have the complicating factors of a) no PT (crazy) and b) signs of chondral defects/early OA.  These can jeopardize the success of the procedure, to say nothing of slowing your recovery.

Anyway, it sounds like you have a 'cut and run' surgeon.  Unfortunately, it's not uncommon--or there wouldn't be a name for this type of doctor.  Is the current OS a knee specialist--does he do some of the 'bigger' open patellar realignment procedures like the Fulkerson and such?  If he doesn't, then maybe he recommended and did the LR because he didn't know anything else to do.  That does not bode well for the future with this doctor!!  Heck, even if he did all of the big open procedures, I personally wouldnt' go back for more of this mistreatment.  Who doesn't do any kind of PT after a lateral release??  This surgery changed the mechanics of your knee--the whole way the leg functions.  I can't imagine not doing formal PT after this....it just seems crazy.  Like a cost-cutting measure that has the insurance company's bottom line in mind, not the patient's best interests.  It would be one thing if the OS felt that PT would be risky because the therapists could mess things up by being inexperienced or too aggressive (I've actually heard this before from a very good surgeon), but it just sounds like your OS thought you wouldn't need it or didn't prescribe PT for...whatever reason.  Since you're having problems, it seems very reasonable to try PT and see if things improve.

If you want to post the general region where you live, someone may be able to recommend a good knee surgeon for a second opinion, one who could examine you and prescribe an adequate PT regimen, and make sure you don't have complications like scar tissue setting in.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
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Offline TinaRich

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Re: Scope Nightmare
« Reply #5 on: February 08, 2006, 03:04:46 PM »
Hi there,
 
I agreee 100 % with Heather. I too had a OS that did my first surgery and after did not have the time or made me believe all the pain i was having after the surgery was all in my head. I have since said see u around doc and got another OS annd he is wonderful, did my second surgery and now is helping me fight my insurance company cause they are dening me ACI surgery and my only other option is a TKR but my OS does not want to do that cause I am still to young for a TKR. So the best thing i can tell is go and find another OS that will listen and talk to you about all your opions avaialbe to you.  Make sure request all you rmedical records from the OS you have now and all xrays Mri etc. And do lots of research. I hope you find a better doctor and get some relief from your pain.

Tina
10/04 L knee, LR
09/05 L knee, partial medial lateral menisectomy, Chondroplastyof the trochlea and medial femoral condyle the posterior surface of the patella, Microfracture Technique of the lateral femoral condyle, Carticel biopsy
ACI?
2/28/06 Microfracture surgery

Offline 256ted

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Re: Scope Nightmare
« Reply #6 on: February 09, 2006, 05:42:44 PM »
Hello everyone and Thanks for your help thus far.  I today 2-9 went to see my OS to discuss my problems and from here I will quote his remarks.  " You are now 6 weeks post op with what was a MINOR procedure in which I normally see patients return to NORMAL activities within 4 weeks. I DID NOT do anything inside the knee that would warrant your continued PAIN and complaints"
He then agreeded to place me on a limited of 4 hours per day on my feet at work, as opposed to standing 8 to 10 hours. This is only for 2 weeks and see how it goes.
He prescribed PT for 2x per week for 4 weeks to build the quads and work on ROM which he wrote to be 0 to 110 ???
He stated that he could do nothing for me except to schedule a bone scan to check nerve function? but could not do this for 6 more weeks as it was to SOON after surgery.  Now it is too soon to get a firmative test reading but, NOT too soon for me to live in pain working on my feet all day in a fast food resturaunt, for which I have worked 21 years at the same job.
At this point I ask him if he in respect was saying nothing was wrong with me and he answered, "not that I can help you with", I did your surgery and corrected the patafemorral pain and shaved the cartlidge and there is no reason for you to have any other problems. I ask then, Are you saying that your surgery was a complete cure, to which he responded, I feel comfortable to release you from my care today, saying that I believe you are fine, with NO permant problems.
He totally ignored my questions of the numbness in the leg saying He didnt do anything in that area, and I needed to get my muscles moving more...... He said also that I have no osteoarthritis that would cause such pain. to which I ask what about your original diagnosis, he stated It is not enough to warrant your complaints and I would rate your OA as being extremely MILD.
At this point I think both he and I were getting feed up with each other, and he said, If you have no more questions then I have other patients to attend today, to which I just gave up.
Upon checking out I was ask by the receptionist if I was to return and I said he didnt tell me to, she ask him and came back saying unless you have any New problems, he will see you on a as needed basis, and further explained that means, IF I call him........
SO..... what am I to do?
I am in pain, and he has his mind made up that my surgery was successful and that a lateral retinacular release and chondroplasty is a MINOR surgery with a RAPID healing time with NO long term disability lasting over 4 weeks and God forbid you hurt beyond the 6 weeks as I have you are labeled as fabricating your symptoms.

Offline shade

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Re: Scope Nightmare
« Reply #7 on: February 10, 2006, 03:07:36 AM »
Hi,

Unbelievable......

Sounds like we have the same surgeon, but mine waited six months.  How could he say you should be okay after four weeks, it takes up from 6 - 12 months to heal from a lateral release.  Absurd!!  Just cause it's a simple surgical procedure for the doctor, it's not for most patients.
You need to find a surgeon that is going to have time for you, obviously this is not the guy.....
Good luck.  ~Shade
July '05 (RK) - LR/debridement
Mar '06 (RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
 Feb '07 (LK) - LR + Fulkerson TTT

Offline 256ted

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Re: Scope Nightmare
« Reply #8 on: February 10, 2006, 03:30:21 AM »
Shade;   Thanks for your support and knowledge.  I wanted to add that I sometimes question the staff at his office. Today the nurse called for Scotty and no one responded, she went back to the receptionist and I watched as the girl pointed to me, then she came back into the waiting area and said again, Scotty come back with me. I looked at her like she was crazy and said My name isnt Scotty, and told her my name, She had the WRONG chart a guy with the same last name and as I found out to be a 3rd couisin of mine, who was there for some type of foot or ankle problem, but, his appt was later in the day and when they pulled the charts for today, she gave the nurse his file for me, although he wasnt even there and I had signed in using MY name.  They found it funny and I guess I did at first but now seems not so funny.
Secondly I cant fully understand what a bone scan is to do in reference to my pain, if as everyone says a lateral release and chrondroplasty takes such time to heal.  I am puzzled and now wonder if my numbness, could be a medical error? if anyone could help here with this?
Again I went into this surgery blinded and trusing the surgeon, I have now found that he is at least one who if he says you will have a quick recovery he means it.......... Regardless of how much you hurt you are expected to work a job standing, walking and twisting your knee all day in pain and soreness while he says  "my textbook says....."
Again I wish I had never had surgery the mental frustration I face in trying to function and with the pain... for which I get nothing but Tylenol.....is getting to me and affecting my outlook at life.... Thanks again for everyone and all of the help and support.

Offline ClimbingGirl

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Re: Scope Nightmare
« Reply #9 on: February 10, 2006, 10:22:24 AM »
Your OS's attidude stinks!
The level of pain any individual gets from OA is very very variable - some will experience alot of pain from small lesions and some will have no pain. Likewise, large lesions don't necessarily cause people pain at all. What causes this is still very much a misunderstood area of research. This is similar to when people have disc problems in their back - generally in the UK one of the primary reasons for removal of degenerative discs is pain not the extent of degeneration.

I'm not sure that 6 weeks post op is really that long in the scheme of things - I had a scope done 3 weeks ago and am still very much recovering from it even though 'all' I had was a washout. Spending less time on your feet has got to help so maybe over the next 2 weeks you may see some improvement - if not get a second opinion!
Good luck!
Climbing Girl
Several L kneecap subluxations
R kneecap dislocation '00
Diagnostic scope Jan '06
R MPFL reconstruction & lateral release Mar '06
L MPFL reconstruction Dec '07

Offline TinaRich

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Re: Scope Nightmare
« Reply #10 on: February 10, 2006, 02:03:58 PM »
Sounds like your OS does not want to be bothered so why bother with him any more,,, run far and fast from him and find one that wants to help and listen to you!!! And for the Office staff to get you confused with another patient is bonkers too. That would show me that none of them take the time to really care about their patients. Beleieve me been there done that and got away from it and found me a wonderful OS.

Hope everything gets better for you!!!!!!

Tina
10/04 L knee, LR
09/05 L knee, partial medial lateral menisectomy, Chondroplastyof the trochlea and medial femoral condyle the posterior surface of the patella, Microfracture Technique of the lateral femoral condyle, Carticel biopsy
ACI?
2/28/06 Microfracture surgery

Offline twobabyprincess

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Re: Scope Nightmare
« Reply #11 on: February 10, 2006, 10:32:36 PM »
Hi...

Sorry to hear about the pain you are dealing with post-op. I can definately relate. Although my osteoarthritis is in my ankle and not my knee I've dealt with a similiar situation with my original OS. I also had osteochondral defects on my Talus (ankle). Shade's post to you had an amazing website that pretty much summed up the same ordeal for both the knee and ankle. The procedure I most recently had on 1/17/06 was the cartilage transplant from my knee to ankle.

Before that...last year my Orthopedic Dr sent me to an OS. My MRI showed the space between the tibia/fibula and talus to be small...which as Shade's site mentions of the deterioration of cartilage. In your case I can understand how you feel when you say you have pain...then surgery and expect to feel relief after surgery but come to find out you feel worse. Well...just like me...I had my surgery because of pain I developed 6 months prior. He did a arthroscopy with debridement and drilling to help formate hyaline cartilage which failed...obviously...because I still had pain.

So...I thought I'd do all I could for myself and joined the gym to stay active and thought...okay...maybe rehab was gonna take longer then I thought. I would end up seeing my OS complaining of pain...had repeat MRI/CT and he ended up giving my 5 cortizone injections over a 5 month period...which didn't do a thing for me. I would end up taking Vicodin as needed for pain.

I knew this was no normal way to live. And like you...how can you continue with a job you've had for so long...be the best you can be...when you are in pain. HOW frustrating is it?...you know....VERY. I was expected to be on my feet for long periods of time...like 8 hrs on a clinical day...it was a nightmare.

Basically...my OS gave me the run around...not sure what the hell to do about it...which wasn't helping me any. He gave me this line of "Oh I'll talk to my mentors about your situation"...talking and doing are 2 different things. Right? So...I took it upon myself...knowing something wasn't right. You and I both know...when you feel pain or something is not right...it's a sign...don't ignore it.

I heard of Rothman Institute in Philadelphia and how they were ranked #1 in the area and well known as caring for professional athletes. So...I made an appt with their ankle surgeon. He had me do weight bearing x-rays...which made sense to me...not sure why no one ever did that before. He took one look and my MRI/CT and x-ray and stated the facts right before me and said what needed to be done and here I am recovering. Yes I ask myself...when I asked my other OS about some kind of cushioning...he just looked at me and never responded. Well...let me just tell you...I'm glad I made the change. My current OS is world known and very brilliant.

So...in reading your posts...I can feel for you. My advice as others have stated...it's time to get another opinion. The more you research and talk to others the better your outcome will be. Trust yourself and your judgement. I still had pain a YEAR after my first surgery. Please don't let it be that long for you. Good luck and keep me posted on how you are doing. If you live in the Delaware Valley area NJ, PA or DE...I'd be glad to help. I'm not sure of other areas...although I'm sure someone would recommend an OS that would help you. Take care

~Amy~

-1989 R ankle talus FX age 14
-Dec 2004 Arthroscopy w/ drilling R ankle
 Cooper Surgical Center Voorhees NJ Dr. Michael Castro
-Jan 2006 OATS R Medial Malleolar Osteo R Ankle
 Osteochondral Auto Transfer harvest from knee
 Rothman Institute at Jefferson Philadelphia, PA
 Dr. Steven Raikin















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